Extracapsular Cataract Extraction Surgery Research Articles

Capsular Tension Ring and Iris Hook Use in The Management of Cataract with Phacoemulsification Method in Dogs

The purpose of this study is to evaluate the surgical outcome of capsular tension ring and iris hook use during phacoemulsification in dogs with zonular weakness and miotic pupils. This study includes nineteen dogs (29 eyes) that underwent phacoemulsification (15 dogs/25 eyes) and extracapsular cataract extraction surgery (4 dogs/4 eyes) between February 2014 and February 2015. Patients with any ophthalmic problem other than cataracts were not included in the study. Some dogs did not achieve pharmacologic pupil dilation. These dogs required the use of iris hooks or the insertion of capsular tension rings. The capsular tension ring insertion was used in dogs with zonular rupture in more than half of the zonules. Capsular tension rings were inserted in cases of zonular dialysis and iris hooks were placed to widen the pupil. Fifteen dogs (25 eyes) underwent phacoemulsification, while 4 (4 eyes) received extracapsular cataract extraction (ECCE) surgery due to the difficulty of phacoemulsification in hypermature cataracts. Iris hooks were used in four dogs (8 eyes) for drug-resistant miotic pupils. Capsular tension rings were inserted to stabilize the lens capsule during phacoemulsification and to centralize the intraocular lens (IOL) in the bag. Capsular tension rings in cases of zonular dialysis and iris hooks in drug-resistant miotic pupils improved the success of cataract operations with phacoemulsification. Both are safe and useful for zonular weakness and for maintaining mydriasis during surgery.

Eyelid and scleral thermal injury following phacoemulsification in silicone oil: a case report

BackgroundPhacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil.Case PresentationWe present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC.ConclusionsThe temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil.

A comparative study of divide and conquer, stop and chop and phaco chop techniques of nucleotomy in phacoemulsification

Phacoemulsification is a variant of extracapsular cataract extraction surgery which is the gold standard treatment modality for cataract surgery nowadays. The common nucleotomy techniques of phacoemulsification are divide and conquer, stop and chop and phaco chop.Aim of this studyto compare different techniques of nucleotomy during phacoemulsification with respect to corneal endothelial cell loss, central corneal thickness (CCT) and comment on their merits and demerits. 60 patients undergoing cataract surgery by phacoemulsification were randomly divided into three groups of 20 each (Group A, B and C) who underwent nucleotomy by divide and conquer, stop and chop and phaco chop technique respectively. The preoperative endothelial cell density and central corneal thickness were recorded using Topcon SP3000P non-contrast specular microscope. All patients were followed up at 1, 4 and 12week after surgery and evaluated for vision, slit lamp examination, endothelial cell count and central corneal thickness.The age group of patients studied was 50-80 years, where maximum number of patients were in 51-60 years age group. Out of 60 patients, most common morphological type of cataract was nuclear (40%) cataract followed by cortico-nuclear (36.67%) cataract. After 1 week of surgery, drop in endothelial cell density was 7.06% in Group A, 6.49% in Group B and 6.84% in Group C patients. A further slight decrease in endothelial cell count was recorded during 4week and on final follow up visit at 12 weeks after cataract surgery, there was an endothelial cell loss of 9.51%, 10.9% and 11% in Group A, B and C respectively. The central corneal thickness at 1postoperative week increased by 2.75%, 2.35% and 2.20% in group A, B and C respectively. Further evaluation of CCT at 4and 12 week after surgery showed the values to be almost same as preoperative values. The rate of complications, which mainly included postoperative keratitis, mild anterior uveitis and cystoid macular edema, were found to be almost the same in all the three study groups.All the three nucleotomy techniques of phacoemulsification i.e divide and conquer, stop and chop and phaco chop are equally efficacious in terms of CCT changes, endothelial cell loss and complications rate in the hands of an experienced surgeon.

Timing of corneal stitches removal after extra capsular cataract extraction for control of postoperative astigmatism

ABSTRACT Background: There are challenges in cataract surgery to predict the postoperative results and correct them. The source of variability is the change in the corneal shape which leads to surgically induced astigmatism. Objective: To determine the most appropriate time for removal of corneal stitches after extracapsular cataract extraction surgery (ECCE) as regards the stability of refractive status of the eye. Methodology: An interventional, randomized controlled clinical trial was conducted on 20 eyes of 20 patients who had ECCE surgery and sutures removal 8 weeks after surgery (group I) and 20 eyes of 20 patients who had ECCE surgery and sutures removal 12 weeks after surgery (group II). Visual outcome was assessed before and after suture removal by refraction and keratometry. Results: Mean surgically induced astigmatism (SIA) in group (I) was -5.09±1.46 diopter (D) postoperative and -2.14±0.86D after 1st suture removal and -1.786±0.66D after all suture removal, there is a statistically significant change of power among group (I). Mean SIA in group (II) was -5.26±1.43D postoperative and -3.82±1.78D after 1st suture removal and -2.818±0.73D after all suture removal, there is a statistically significant change of power among group (II). There is statistically significant higher median power among group II than group I (P=0.001) after 1st suture removal and after full suture removal. Conclusion: When interrupted 10/0 nylon corneal suture causes a high degree of astigmatism, it is better to be removed at 8 weeks after surgery, not just being as effective in alleviating astigmatism, but safer and more stable in refraction.

Clinical-ophthalmological profile of patients undergoing cataract surgery following their identification in screening eye camps

Background: Senile cataract constitutes about 50–70% of preventable blindness in the year 2000 in India. >3/4th of Indian populations live in rural areas which are away from medical facilities. Conducting of outreach camps forms an integral part in decreasing the visual morbidity due to cataract, etc., in rural areas, thus the unrecognized rural and poor population is benefited. Objective: The objective of this study was to see demographic and clinical-ophthalmological profile of patients undergoing cataract surgery. Materials and Methods: The present cross-sectional observational study which was conducted in a tertiary care hospital involved 72 cataract patients who were assigned to undergo extra capsular cataract extraction surgery (SICS with PC-IOL) following their identification in various screening eye camps of Jammu province. Results: The maximum prevalence was seen in the age group of >60 years, i.e., 76.39%. Males outnumbered females, i.e., 63.89%. Housewives comprised 36.11% followed by farmers who were 34.72%. About 37.5% among studied subjects were smokers and 38.89% were hypertensives while 19.44% had blood sugar level above normal value. Mature cataract was the most common seen in 72.22%. Majority of the patients, i.e., 59.72% had visual acuity of

Complications of Phacoemulsification and Extracapsular Cataract Extraction Surgery in Eyes with Pseudoexfoliation Syndrome

Complications of Phacoemulsification and Extracapsular Cataract Extraction Surgery in Eyes with Pseudoexfoliation Syndrome

COMPARISON OF POST OPERATIVE CORNEAL ASTIGMATISM BETWEEN SMALL INCISION CATARACT SURGERY (SICS) AND EXTRA CAPSULAR CATARACT EXTRACTION (ECCE)

Background
 Cataract surgery is the most common type of surgery done by ophthalmologists. There are many methods of performing cataract surgery. Each of them has its own advantages and complications. Here we want to find the outcome of both the manual small incision cataract surgery and the conventional extracapsular cataract extraction surgery. 
 Objectives 
 To find the degree of postoperative corneal astigmatism in both manual small incision cataract surgery and the extracapsular cataract extraction surgery and compare these outcomes in both techniques.
 Patients and Methods
 We performed an experimental study conducted from January 2016 to June 2016 in Shahid Dr.Aso hospital ophthalmology department and Best Vision private hospital, Sulemani Province/Kurdistan Region of Iraq. One hundred cases were enrolled in the study, 50 cases underwent manual small incision cataract surgery and the other 50 underwent extracapsular cataract extraction surgery. All patients had their history taken, preoperative evaluation by (Slit-lamp examination, intraocular pressure measurement, indirect ophthalmoscopy for fundus examination, intraocular lens measurement, B-scan). Postoperatively; after 2 months, all cases in both groups were re-evaluated by the same measures of the preoperative examination.
 Results
 The mean postoperative uncorrected visual acuity in the manual small incision cataract surgery and extracapsular cataract extraction group was 6/9 and 6/12, respectively. The mean postoperative corneal astigmatism was 1.27+0.94 in manual small incision cataract surgery compared to 2.59+1.65 in the extracapsular cataract extraction surgery.
 Conclusion
 Both manual small incision and extracapsular cataract extraction techniques are safe and effective for visual rehabilitation of cataract patients. However, manual small incision cataract surgery gives better uncorrected visual acuity and less induced corneal astigmatism at 8 weeks postoperatively.

Evaluation of antioxidants and argpyrimidine in normal and cataractous lenses in north Indian population.

To assess the level of glutathione, thioltransferase, and argpyrimidine in nuclear and cortical cataractous lenses as well as in the clear lenses in the north Indian population. Human cataractous lenses were collected from the patients who underwent extracapsular cataract extraction surgery; clear lenses were collected from the freshly donated eye bank eyes. Antioxidant molecules such as glutathione and thioltransferase enzyme activity were measured; simultaneously in these lenses a blue fluorophore argpyrimidine, an advanced glycation end (AGE) product level was assessed using high performance liquid chromatography (HPLC). The protein concentration was found to be present at higher levels in the control lenses compared to cataract lenses. A significant decrease in the glutathione level was observed in the nuclear cataractous lenses compared to cortical cataractous (P=0.004) and clear lenses (P≤0.005), but no significant change in the level of antioxidant enzyme thioltransferase was observed. Further, argpyrimidine a blue fluorophore (AGE) was found to be significantly higher in the nuclear cataract (P=0.013) compared to cortical cataract lenses. Antioxidants such as glutathione significantly decrease in age-related nuclear and cortical cataract and an AGE, argpyrimidine are present at significantly higher levels in nuclear cataract.

Comparison of small incision cataract surgery with conventional extra capsular cataract surgery: an evaluation from resource poor setting in India

Background: Cataract is the chief cause of avoidable blindness in the developing countries of the world including India. These patients can regain normal sight with the help of cataract surgery, which has undergone many advances and Small Incision Cataract Surgery (SICS) has gained wide acceptance world over as the surgical method requires minimal infrastructure. The present study compares it’s safety profile for the patients as well as acceptability amongst the doctors performing conventional Extra Capsular Cataract Extraction (ECCE) surgery in peripheral resource poor settings. Methods: All patients having cataract were examined prior to surgery and were randomized in two groups: group I - small incision cataract surgery and group II - conventional extra capsular cataract extraction surgery with posterior capsular intra ocular lens implantation. The various intra and post-operative complications were evaluated. Results: 252 eyes of 252 patients were enrolled with 121 patients in group I and 131 patients in group II and intra-operative and post-operative complications compared. Intra-operatively difficulty in nucleus delivery was higher in group I (12.3%) whereas repeated iris protrusion (12.5%) and posterior capsular rent (8.3%) was higher in group II. Postoperatively, on day 1 striate keratopathy was commoner in group I (20.6%) whereas uveitis was seen more commonly (26.7%) in group II. At 6 weeks, surgically induced astigmatism was higher (61%) in group II as compared to group I (35%). Conclusion: SICS is a safe and acceptable alternative to conventional ECCE in a peripheral teaching setup.

Comparison between remifentanil, propofol or both for sedation during retrobulbar nerve block

Objectives: To compare between the efficacy of remifentanil and propofol and combination of both for analgesia during retrobulbar nerve block in cataract surgery. Materials and Methods: A prospective randomised double blind study conducted in King Hussein Medical Center in Royal Medical Services during the period between September 2004 and August 2005. 160 patients undergoing extra capsular cataract extraction surgery under retrobulbar anaesthesia were enrolled in the study. Patients were randomly divided into four groups (40 patients in each group) and received different drug combinations by the same anaesthetist as follows: remifentanil 0.3 microgram/kg (group 1), propofol 0.5 mg/kg (group 2), remifentanil 0.3 microgram/kg and propofol 0.5 mg/kg (group 3) and saline 0.1 ml/kg as a placebo (group 4). Patient’s movement and pain were observed during the injection. Heart rate, respiratory rate and haemoglobin oxygen saturation were observed every minute for 10 minutes after the block. Results: No significant movement occurred in group 3 during the placement of the block compared to half of the patients in the control group. The mean visual analogue score was 2.3 in group 3 compared to 6.7 in group 4. There was no significant change in mean heart and respiratory rates and haemoglobin oxygen saturation among the three study groups. Conclusion: Patients undergoing cataract surgery under retrobulbar anaesthesia, a combination of remifentanil 0.3 microgram/kg and propofol 0.5 mg/kg is considered to provide excellent relief of pain with least patient movement and minimal respiratory and cardiac side effects.

Risk Factors of Massive Suprachoroidal Hemorrhage during Extracapsular Cataract Extraction Surgery

To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery. The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test. The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction. Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.

Small-incision manual extracapsular cataract surgery in Ghana, West Africa

Purpose To evaluate the results of small-incision manual extracapsular cataract extraction surgery (ECCE) in a district hospital in West Africa. Setting Margret Marquart Catholic Hospital, Ghana, West Africa. Methods This prospective study consisted of 200 eyes of 193 patients who had small-incision manual ECCE between January 1999 and May 2000. For comparison, the charts of 32 patients (32 eyes) operated on between July and December 1998 using a limbal incision (control group) were retrospectively analyzed. Outcome measures included intraoperative and postoperative complications, postoperative visual acuity, and refractive astigmatism. Results In the small-incision ECCE group, self-sealing wounds were achieved in 129 eyes (64.5%). Vitreous loss occurred in approximately 3% of eyes in both the small-incision and control groups. The final visual acuities were similar between the 2 groups, with more than 90% of eyes in both groups achieving a final best corrected visual acuity of at least 20/60. Eyes in the small-incision group had faster visual recovery ( P < .001), a lower incidence of fibrinous iritis ( P = .02), and were more likely to have round pupils ( P < .001) than eyes in the control group. The main complication of small-incision surgery was moderate corneal edema, which persisted until at least the 1-week visit in 14 eyes (7%). At the most recent visit, 1 eye in the small-incision group (0.5%) had bullous keratopathy. Conclusion In a district hospital in West Africa, small-incision manual ECCE surgery yielded faster visual rehabilitation and had a lower incidence of fibrinous iritis than standard ECCE surgery.

Phacoemulsification versus extracapsular cataract extraction: a comparative study of cell survival and growth on the human capsular bag in vitro

AIMS/BACKGROUNDPhacoemulsification is rapidly replacing conventional extracapsular cataract extraction (ECCE) as the method of choice for cataract surgery in the Western world. However, posterior capsule opacification (PCO) still remains the major...