Removal Of Lens Cortex Research Articles

Safety and efficiency of lens cortex removal assisted by fluid jet

BackgroundThis retrospective study investigated the safety and efficiency of lens cortex removal assisted by a fluid-based capsular polishing technique called a fluid jet. MethodsThis was a retrospective case study. A total of 300 patients were included in this study. All patients underwent phacoemulsification using two different surgical sequences: a fluid jet before irrigation/aspiration (I/A) and an I/A before the fluid jet. They were divided into two groups: the fluid jet before I/A group (group 1, 150 eyes) and the I/A before the fluid jet group (group 2, 150 eyes). The frequencies of posterior capsule rupture (PCR) and posterior capsule being sucked into the I/A tip were recorded. The times of the fluid jet, I/A cortex, and entire procedure were noted. ResultsPCR occurred only in group 2. Compared with group 1, the posterior capsule being sucked into the I/A tip was more frequent in group 2 (P = 0.003). The fluid jet time was longer in group 1 than that in group 2 (P < 0.001). The I/A cortex time was shorter in group 1, and total time for fluid jet and I/A cortex together was shorter in group 2 (P = 0.014 and P = 0.007, respectively). However, the time of the entire procedure was shorter in group 1 (P < 0.001). ConclusionsFluid jet-assisted lens cortex removal is safe, time-saving, and simple to perform.

COMPARISON OF INTRAOCULAR LENS IMPLANTATION WITH AND WITHOUT VISCOELASTIC SUBSTANCES IN PHACOEMULSIFICATION

Background: Life expectancy of the population may increase and cataract development may affect all the people with aging. Intraocular lens implantation surgery, a worldwide performed procedure, evolves and progresses. However, different techniques exist, which could be selected for different cases. Any ideal technique should be safe, simple, fast, and easy to learn with good clinical outcome. Objective: The aim of this work was to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification as well as surgery duration and post-operative intraocular pressure and central corneal thickness. Patients and methods: This was a prospective, randomized controlled trial conducted on 40 eyes with cataract; to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification of the lens as regard to surgery duration, post-operative intraocular pressure and central corneal thickness. Patients were evaluated 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups after the completion of lens cortex removal: Group A (n=20, hydro-implantation): One-piece acrylic intraocular lens implantation was performed with normal saline solution (0.9 solution) irrigation. Group B (n=20, visco-implantation): using Hydroxy-propyl-methyl-cellulose 2% implantation. Results: Highly significant increase in phaco operative time in visco-implantation group; compared to hydro-implantation group (p 0.05 respectively). Non-significant difference as regards post-operative Central corneal thickness (CCT) (p > 0.05). Non-significant increase in post-operative CCT measurements in visco-implantation group (p > 0.05). Non-significant difference in post-operative IOP measurements in visco-implantation group (p > 0.05). Non-significant decrease in post-operative IOP and CCT measurements in hydro-implantation group (p > 0.05). Non-significant decrease in post-operative IOP in hydro-implantation group; compared to visco-implantation group; during the serial 1st and 2nd measurements. Non-significant increase in post-operative CCT in Visco-implantation group; compared to hydro-implantation group; during the serial 1st and 2nd measurements. Conclusion: The hydro-implantation had similar clinical outcome to visco-implantation with advantage of reduced surgical time and cost, and no ophthalmic viscosurgical devices (OVD) induced intraocular pressure elevation postoperatively.

Hydroimplantation versus viscoimplantation: comparison of intraocular lens implantation with and without ophthalmic viscoelastic device in phacoemulsification

Purpose: To compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device in phacoemulsification. Methods: A randomized prospective study was conducted on 84 eyes of 84 patients who underwent uneventful phacoemulsification by the same surgeon. Patients were divided into two groups after the completion of lens cortex removal. Intraocular lens implantation was performed with balanced salt solution irrigation in group H (n=42, hydroimplantation) and with ophthalmic viscoelastic device in group V (n=42, viscoimplantation). The main outcomes measured were postoperative changes of intraocular pressure (IOP), central corneal thickness (CCT), mean absolute refractive error, time of surgery, and the frequency of complications. Patients were evaluated 1 day, 1 week, and 1 month postoperatively. Results: There was no significant difference in mean age, gender, preoperative IOP and preoperative CCT between the two groups. IOP and CCT were not significantly different 1 day, 1 week, and 1 month postoperatively between the two groups. Mean absolute refractive error was also not significantly different between the two groups. Time of surgery was significantly lower in group H than in group V (953.81 ± 88.33 seconds, 1072.33 ± 172.16 seconds, respectively, p<0.001). No other complications were observed during the intraocular lens implantation in the two groups. Conclusions: Hydroimplantation technique is safe and effective in phacoemulsification. Furthermore, reduced time of surgery and reduced cost of ophthalmic viscoelastic devices are the advantages of this technique. Abbreviations: OVDs = ophthalmic viscosurgical devices; IOP = intraocular pressure; MARE = mean absolute refractive error; CCT = central corneal thickness; CDE = cumulative dissipated energy; AL = axial length; ACD = anterior chamber depth; ACM = anterior chamber maintainer; ECCE = extracapsular cataract extraction.

Residual lens cortex material: Potential risk factor for endophthalmitis after phacoemulsification cataract surgery

To evaluate the bacterial growth potential of residual lens cortex after phacoemulsification with the development of endophthalmitis. University medical center. Experimental study. Staphylococcus aureus and Staphylococcus epidermidis were dispensed into aqueous humor or serial dilutions of lens cortex that were obtained from cataract patients during phacoemulsification. After a 24-hour incubation, the colony-forming unit (CFU) was quantified. Eighty rabbits had phacoemulsification. Complete lens cortex removal was performed in 40 rabbits, while a quarter of lens cortex was retained in 40 rabbits. Staphylococcus aureus, with an inoculum size of 32 CFU, 56.3 CFU, and 108.6 CFU, was injected intracamerally at the conclusion of surgery and the production of endophthalmitis was measured 72 h later. The aqueous and vitreous humor samples were collected for microbiological diagnosis. The increase in bacterial growth of S aureus and S epidermidis was statistically significantly greater in each dilution of lens cortex than in aqueous humor (P < .001, Student t test). With inoculum of 32.0 CFU or 56.3 CFU of S aureus, there was a statistically higher incidence of bacterial culture-proven endophthalmitis in the residual lens cortex eye group than in the normal aphakic eye group (P < .05, Fisher exact test). Lens cortex was associated with a significant increase in bacterial growth compared with aqueous humor. Therefore, eyes with residual lens cortex seem more prone to develop endophthalmitis if anterior chamber bacterial contamination occurs during phacoemulsification. No author has a financial or proprietary interest in any material or method mentioned.

Double Aspiration/Single Irrigation System for Bimanual Lens Cortex Removal in Cataract Surgery

The authors describe a bimanual double aspiration/single irrigation system (DASIS) for cataract surgery that efficiently and safely performs aspiration of the entire cortex, including subincisional space. DASIS uses standard and common instruments such as an irrigation/aspiration handpiece in one hand and a single-aspiration handpiece in the other, joined with a short silicone tube using a three-way stopcock. DASIS allows access to 360° of the cortex without a hand exchange, reducing wound leakage and maintaining chamber stability.

Transparent irrigation cannula for bimanual lens cortex removal

A transparent irrigation cannula was developed to facilitate bimanual removal of subincisional lens cortex after phacoemulsification. The cannula allows visualization of the proximal cortex and provides ample inflow to maintain an inflated anterior chamber even at a high aspiration pressure.

Phacoemulsification for Cataract Following Pars Plana Vitrectomy

To determine if the technical aspects of phacoemulsification for removal of cataract following pars plana vitrectomy differ from those of phacoemulsification for removal of cataract in nonvitrectomized eyes. Twenty-two eyes that had undergone prior vitrectomy were identified through a retrospective review of chart notes and operative records of 1039 consecutive cataract extractions performed by one surgeon. Complications of proliferative diabetic retinopathy was the most common indication for prior vitrectomy. The predominant lens change was nuclear sclerosis. Deep anterior chambers with large anterior to posterior excursions of the iris lens diaphragm with simultaneous fluctuation in pupil size occurred during phacoemulsification. The posterior capsule was flaccid and mobile during lens cortex removal. No posterior capsules ruptured. Postoperative visual acuity improved in 91% of the patients. Prior vitrectomy was associated with diabetes and nuclear sclerotic cataract. Phacoemulsification in this patient population was associated with inadequate pupillary mydriasis, superior conjunctival scarring, intraoperative anterior chamber depth, pupil size, and iris lens excursions that hindered phacoemulsification tip placement. Posterior capsules were excessively flaccid, prone to rapid anterior and posterior excursions, and may have plaques that are resistant to intraoperative removal.

Cataract Surgery and Intraocular Lens Implantation in Patients with Uveitis

The authors reviewed the outcome of extracapsular cataract extraction (ECCE) in 44 eyes of 38 patients with uveitis. Thirty-two of the 44 eyes received a posterior chamber lens implant; 87% of these achieved a stable visual acuity of 20/40 or better. Sixty-seven percent (8 of the 12 eyes) not receiving an implant achieved this level. The authors' results and current literature suggest that absolute control, preoperatively and postoperatively, of all uveitis inflammation and careful selection of patients as lens implant candidates are crucial for successful cataract surgery in uveitis patients. Complete removal of lens cortex and placement of an all-PMMA posterior chamber lens within the capsular bag are also believed to be important.

Maintenance of Mydriasis with Epinephrine During Cataract Surgery

The pupillary response to various doses of intraocular epinephrine (0.1 ml of 1:16,000, 1:32,000, 1:64,000, 1:80,000, or 1:96,000) was studied in 55 consecutive patients during extracapsular cataract surgery. The 1:16,000 epinephrine concentration provided a mean 0.74 mm increase in pupil diameter (range 0.0 to 1.7 mm) when administered to re-dilate the pupil after nucleus expression. The mean increase in pupil area with 1:16,000 epinephrine was 27% which greatly facilitated removal of lens cortex in most cases. However, 25% of all pupils failed to dilate with epinephrine 1:16,000. The other concentrations provided essentially the same mydriasis as the 1:16,000 concentration. Pupils smaller than 6 mm dilated more easily than pupils larger than 6 mm. Iris color, age, or sex had no significant effect on the mydriatic response. It is concluded that an extremely dilute concentration of epinephrine (i.e., 1:96,000 or less) may be effective in maintaining mydriasis during cataract surgery.

Cataract Aspiration with the O'Gawa Double-Bore Cannula

Sixty-eight soft cataracts were removed utilizing the O'Gawa double-bore aspirating-irrigating cannula. The postoperative visual acuity was found to be 20/100 or better in 83% and 20/40 or better in 59% of the 64 cases in which visual acuity was obtainable. In congenital cataracts, associated ocular defects such as strabismus or nystagmus reduced the visual prognosis. All cases of traumatic cataract had associated defects, usually a corneal laceration, however, visual improvement was noted in 81% of the cases. Significant postoperative corneal edema was not seen. Complications attributable to the operation included: rupture of the posterior capsule, insufficient removal of lens cortex, and pupullary block glaucoma. Discission of the posterior capsule was necessary in 26% of the eyes with an intact capsule. Retinal detachment followed the operation in three instances. The O'Gawa double-bore cannula is recommended for the removal of soft cataracts.