Lens Fragments Research Articles

Outcomes in eyes with retained lens fragments undergoing pars plana lensectomy and scleral-fixated intraocular lens insertion.

To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL). Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery. 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion. In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

Efficacy and safety of the OZil phacoemulsification handpiece in dropped lens fragment surgery: a randomized controlled trial.

Phacoemulsification is the predominant method for cataract surgery, but complications like lens nuclei dislodgment into the vitreous cavity pose significant risks, including inflammation, glaucoma, retinal tears, and vision loss. Traditional management involves pars plana vitrectomy with phacofragmentation, which can increase the risk of retinal damage due to repulsive forces. This study tests whether the OZil phacoemulsification handpiece, employing torsional movement, offers a safer alternative by minimizing repulsive forces and reducing surgical duration compared to the traditional phacofragmatome. This prospective study, conducted in a tertiary care hospital in eastern India from January to June 2023, enrolled 40 patients with nucleus dislocation during cataract surgery. Patients were randomized into Group 1 (traditional phacofragmatome) and Group 2 (OZil handpiece). Primary objectives included comparing the duration of surgery and intraoperative complications. Secondary objectives assessed postoperative best-corrected visual acuity (BCVA), surgical site safety, and cystoid macular edema (CME) incidence. Group 2 demonstrated significantly shorter surgical durations (110±2.54 seconds) compared to Group 1 (152±2.23 seconds, p < 0.001). The frequency of nucleus falls was considerably lower in Group 2 (p < 0.001). Postoperative BCVA and CME incidence showed no significant differences between groups. Multiple regression analysis confirmed the OZil handpiece significantly reduced surgical duration (β = -0.40, p < 0.001) without compromising safety. The OZil handpiece's rotational cutting mechanism offers a significant advantage in reducing surgical time while improving the followability of lens fragments, as compared to the traditional phacofragmatome. It addresses one of the key limitations of phacofragmentation by minimizing fragment displacement, where repulsive forces can complicate the procedure. Although both techniques showed similar safety profiles, the OZil handpiece's operational efficiency makes it a promising alternative for managing posteriorly displaced lens fragments in complex cases. The OZil phacoemulsification handpiece significantly enhances surgical efficiency and safety in nucleus drop surgeries. Its integration into existing phacofragmatome systems can lead to major advancement in the ophthalmic surgical armamentarium, ensuring improved patient care.

Surface Topography Analysis of BK7 with Different Roughness Nozzles Using an Abrasive Water Jet.

This study investigated the effect of abrasive water jet (AWJ) kinematic parameters, such as jet traverse speed and water pressure, abrasive mass flow rate, and standoff distance on the surface of BK7. Nozzle A reinforced with a 100 nm particle-sized coating of titanium alloy has more wear resistance compared to Nozzle B coated with nothing. Through analysis of variance and measurement of BK7 surface quality, it is concluded that the grooving and plowing caused by abrasive particles and irregularities in the abrasive water jet machined surface with respect to traverse speed (3, 7.2, 7.8, and 9 mm/min), abrasive flow rate (7 L/min and 10 L/min, 80 mesh) and water pressure (2 and 3 MPa) were investigated using surface topography measurements. The surface roughness (15.734 nm) of BK7 results show that a nozzle coated with titanium alloy has more hardness, which protects BK7 undamaged and super-smooth. The values of selected surface roughness profile parameters-average roughness (Ra) and maximum height of PV (maximum depth of peak and valleys)-reveal a comparatively smooth BK7 surface in composites reinforced with 2% titanium alloy in the nozzle weight at a traverse speed of 7.8 mm/min. Moreover, abrasive water jet machining at high water pressure (3 MPa) produced better surface quality due to material removal and effective cleaning of lens fragmentation and abrasive particles from the polishing zone compared to a lower water pressure (2 MPa), low traverse speed (5 mm/min), and low abrasive mass flow rate (200 g/min).

Hydrodissection and femtosecond laser assisted surgery in posterior polar cataract

PurposeTo present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract.MethodsMedical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule.ResultsThere were 3 males and 3 females, ages 39–73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes.ConclusionsHydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.

Time to pars plana vitrectomy in adults with retained lens fragments: a systematic review and meta-analysis

ObjectiveTo compare visual outcomes and complication risk based on the timing of pars plana vitrectomy (PPV) following cataract surgery with retained lens fragments. MethodsMEDLINE (Ovid), EMBASE, and Cochrane Library were searched between 2000 to February 2022 for studies comparing visual outcomes and complications based on time to PPV. Discrete outcomes were analyzed using a random-effects meta-analysis model on Review Manager (RevMan 5.4). The certainty of evidence of outcomes was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. ResultsTen studies and 1,693 eyes were included. The incidence of patients achieving a final best-corrected visual acuity (BCVA) of >6/12 Snellen may be similar among patients receiving PPV within 1 week or after 1 week of cataract surgery (RR = 1.06, 95% CI = [0.96, 1.17], p = 0.25), and patients receiving PPV within 1 month or after 1 month of cataract surgery (RR = 1.12, 95% CI = [0.95, 1.32]; p = 0.18). Incidence of glaucoma or elevated intraocular pressure for patients may be similar among patients receiving PPV within 1 week or after 1 week of cataract surgery (RR = 1.08, 95% CI = [0.62, 1.87]; p = 0.79), and patients receiving PPV within 1 month or after 1 month of cataract surgery (RR = 0.33, 95% CI = [0.09, 1.23]; p = 0.10). ConclusionIncidence of patients achieving a final BCVA of >6/12 Snellen or postoperative adverse effects was similar between patients who underwent early and late PPV following cataract surgery. However, all studies had an overall serious risk of bias, primarily because of confounding and reporting bias.

Lens Fragmentation with Picosecond Laser Pulses After Artificial Cataract Induction with Microwaves.

Objectives: In this work we demonstrate the first laboratory study results of lens fragmentation with low-energy picosecond ultrashort laser pulses after artificial induction of cataract with microwave radiation on an ex vivo animal model. Background: This method will be evaluated with regard to the further development of lens fragmentation with novel ultrashort picosecond laser systems instead of ultrasonic phacoemulsification or the significantly more complex femtosecond laser fragmentation. Methods: As samples we used postmortem porcine eyes. The lenses were dissected and then irradiated in a microwave oven for artificial cataract induction. Subsequent computer-driven lens fragmentation was performed with a 12 ps, 1064 nm pulsed laser source with 100 µJ pulse energy, and 10 kHz pulse repetition rate. Results: Both the artificial cataract induction and the lens fragmentation were demonstrated. When inducing cataract, different degrees/stages of opaqueness and hardness could be achieved with different irradiation times and methods. The fragmentation with 12 ps pulses led to good results with regard to ablation depth and rate, especially for the softer lenses. Conclusions: As could be shown, low-energy picosecond ultrashort laser pulses are feasible for cataractous lens fragmentation on an ex vivo animal model with artificial cataract induction. Thus, this technique may influence future cataract surgeries by possibly being an alternative or extension to state-of-the-art methods. This will be evaluated with further tests and studies.

Phacofragmentation of Posteriorly Dislocated Lens Fragments: Limbal versus Pars Plana Approach

ABSTRACT Purpose To assess intra-operative complications and feasibility of removing crystalline lens fragments from the vitreous cavity through a limbal incision compared to a pars plana approach. Design Retrospective cohort study. Subjects 16 eyes underwent phacofragmentation via a limbal approach (Group A) and 9 eyes through a pars plana approach (Group B) at an academic center over a 10-year period. Methods We collected pre-operative, intra-operative, and post-operative data. We compared rates of intraoperative complications, including corneal wound burn, iris or capsular damage, retinal tears, and hemorrhage, and recorded post-operative BCVA and IOP measurements at the one-month post-operative appointment. We also compared rates of post-operative complications, including corneal edema, choroidal detachment, or retinal detachment. Main Outcome Measures Primary outcomes of the study were the rates of intraoperative complications and the feasibility of crystalline lens removal with the limbal approach. We defined the latter outcome as the ability to complete lens removal without switching to the pars plana route. Results Mean BCVA for group A was 1.6, and for group B was 2.0 (p = .19). There was no significant difference between the two groups in the incidence of intraoperative complications, including corneal wound burn, iris damage, anterior capsular tear, iatrogenic retinal tear, or suprachoroidal hemorrhage (p > .99). There was no significant difference in the incidence of intra-operative vitreous hemorrhage (p = .36). Additionally, there was no significant difference in post-operative corneal edema (p = .27), choroidal detachment (p = .52), or retinal detachment (p > .99). The mean post-operative BCVA was 1.0 in group A and 1.0 in group B (p = .75). We completed all cases in group A using the limbal approach without switching to the pars plana route. Conclusion Phacofragmentation through a limbal incision provides a feasible option for dropped nuclear fragment removal and is not associated with a higher risk of complications than the pars plana route.

Comparison of complications and visual outcomes of combined phacovitrectomy vs stand-alone phacoemulsification: multicenter database study.

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification. A multicenter database study across 8 ophthalmology departments in the United Kingdom. Retrospective, nonrandomized, multicenter comparative study. We extracted data for patients who underwent Phaco-PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively. The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) ( P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs 20/100) in the stand-alone phacoemulsification group ( P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ∼20/100 vs 20/32), P < .001). Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery.

GIANT INTRAOPERATIVE CORNEAL BULLA MANAGED WITH BANDAGE LENS TECHNIQUE DURING VITRECTOMY SURGERY.

To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively. Retrospective case report with anterior segment optical coherence tomography. A 77-year-old woman with a history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy and scleral-fixated intraocular lens placement. During pars plana vitrectomy, a large corneal bulla formed at the site of the main corneal incision, confirmed with anterior segment optical coherence tomography. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery. This is the first report of corneal bullae formation during pars plana vitrectomy that is confirmed by anterior segment optical coherence tomography and successfully managed with a bandage contact lens intraoperatively.

Intraocular pressure changes before and after a femtosecond laser procedure for cataract surgery

This study aimed to evaluate the changes in intraocular pressure (IOP) before and after femtosecond laser capsulorhexis and lens fragmentation for cataract surgery. We measured the IOP before, immediately, 30 min, and 1 h after the laser procedure in 47 eyes of 47 patients who underwent the femtosecond laser procedure. The mean IOP was 17.51 ± 3.28 mmHg, 30.23 ± 6.70 mmHg, 17.96 ± 3.75 mmHg, and 21.77 ± 5.88 mmHg before, immediately after, 30 min after, and 1 h after the laser procedure, respectively. The mean IOP significantly increased immediately (adjusted P < 0.001) and 1 h (adjusted P = 0.001) after the laser procedure compared with the pre-laser IOP. The mean IOP at 30 min after the laser procedure was significantly lower than that immediately after the procedure (adjusted P < 0.001). However, the IOP 1 h after the laser procedure became higher than that 30 min after the laser procedure. Additionally, the IOP 1 h after the laser procedure was positively correlated with the baseline IOP and negatively correlated with the axial length. In conclusion, this study demonstrated that cataract surgery should be commenced within 30 min after the femtosecond laser procedure to ensure a safe cataract surgery that reduces the risk of increased intraocular pressure.

Vitreous hyper-reflective dots and the macular thickness after cataract surgery.

To assess the association between vitreous hyper-reflective dots (VHD) and the macular thickness changes following uneventful phacoemulsification. In this prospective cohort study optical coherence tomography (OCT) examinations were performed preoperatively and 1 week, 1 month and 3 months postoperatively in patients undergoing cataract surgery. OCT images were analyzed for retinal central subfield thickness (CST) and preretinal VHDs. Surgeries were recorded for the assessment of lens fragments in the space of Berger. 111 eyes of 97 patient were enrolled of whom 69 (62.2%) were female. VHDs were seen in 25 eyes (22.5%) at week 1; in 21 eyes (18.9%) at month 1 and in 3 eyes (2.7%) at month 3. In all eyes with VHDs retro-capsular lens fragments were visible immediately after phacoemulsification. The number of VHDs significantly decreased over the postoperative period. There was a moderate correlation between the number of VHDs and CST at 1 month (r = 0.426, p<0.001). In eyes with VHD the CST averaged 238.8±17.6 μm (214-266) at 1 week; 276.1±63.5 μm (231-481) at 1 month and 285.1±122.3 μm (227-785) at 3 months. In eyes with no detectable VHDs CST averaged 235.9±23.3 μm (192-311) at 1 week; 240.1±21.6 μm (200-288) at 1 month and 242.2±21.3 μm (205-289) at 3 months. Although the differences among the assessment points were relatively low, there was a significant difference in general (p<0.001, Friedman test). In conclusion, VHDs seem to cause macular thickening throughout the postoperative course. The origin of VHDs is still unknown; however, they presumably represent lens fragments that provoke subclinical inflammation.

First in-human clinical performance of a new non-cavitating handheld lensectomy system in 665 consecutive cataract surgeries.

To investigate the intraoperative performance and lens fragmentation efficacy of a non-cavitating handheld lensectomy system in mild, moderate, and severe cataract. Ambulatory surgical centers. Retrospective consecutive case series. 665 consecutive eyes underwent cataract surgery by 12 surgeons using a new handheld non-cavitating lensectomy system for nuclear fragmentations and extraction. Intraoperative measurements included surgical time, miLOOP pretreatment, and irrigation fluid use. Of the 665 eyes, 38 (6%), 468 (70%), 126 (19%), and 33 (5%) were of grade 1, 2, 3, and 4 nuclear densities, respectively, as graded by the surgeon intraoperatively. Successful nuclear fragmentation, lens extraction, and cortical removal were achieved in all eyes. Total nucleus fragmentation and extraction times were 70.1 seconds, 100.3 seconds, 132.6 seconds, and 287.9 seconds for grades 1, 2, 3, and 4, respectively ( P < .001). In addition, irrigation and aspiration cortical removal times were 64.1 seconds, 51.1 seconds, 48.5 seconds, and 59.0 seconds, respectively ( P = .14). There was a low rate of capsular tear (3 cases in 665 surgeries, 0.45%) and no other emergent adverse events. The miCOR handheld non-cavitating lensectomy system demonstrated nuclear fragmentation and extraction in the absence of intraocular cavitation across all grades of nuclear densities.

Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully.&#x0D; Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15.&#x0D; Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon.&#x0D; Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review.

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.

Phacophragmatomes and Integrated Phacoemulsification Features in Vitrectomy Devices

Posterior dislocation of lens fragments into the vitreous cavity is a rare complication of cataract surgery. As a result of this complication, vision-threatening sequelae such as permanent intraocular inflammation, secondary glaucoma, corneal edema, cystoid macular edema, and retinal detachment may occur. Therefore, judicious intraoperative and postoperative management should be used to reduce the risk of complications in the removal of dislocated lens fragments. Release of vitreous adhesions from the dislocated nucleus with pars plana vitrectomy (PPV), followed by removal of dislocated lens fragments using a phacophragmatome or vitrectomy probe is the most effective solution. This usually requires the cooperation of anterior and posterior segment surgeons

Effect of Modified Peristaltic Phacoemulsification Device on Efficiency and Post-Occlusion Pressure Surge.

To evaluate efficiency of grooving, nuclear fragment removal, and changes in pressure control in the Oertli Faros using traditional peristaltic and Speed and Precision (SPEEP) features. The SPEEP mode uses novel peristaltic technology permitting independent control of flow and vacuum. A porcine lens model was used with an enclosed chamber simulating the anterior segment. Grooving efficiency is evaluated with flow rates of 10, 30, and 50 mL/min using whole lenses. Lens cubes were emulsified at 20, 40, 60, 80, and 100% power with both SPEEP and non-SPEEP modes. Surge was evaluated with pressure gauges placed on the irrigation tubing and aspiration tubing. Pressure readings were recorded per the following: fluid and vacuum were initiated for 15 seconds, vacuum tubing was occluded for 5 seconds, tubing patency was then re-introduced for 15 seconds. Differences between sensors were recorded. No significant increase in efficiency was seen with increasing flow rate from 30 to 50 mL/min using SPEEP. No significant differences were shown in lens fragment removal in SPEEP and non-SPEEP modes at any power tested. Pressure difference measurements were not significantly different with SPEEP and non-SPEEP modes. We showed that lower flow rates show comparable efficiency of grooving when using the SPEEP mode. The SPEEP function did not show increased efficiency in nuclear fragment removal when compared to traditional mode. Surge control was also comparable with both SPEEP and non-SPEEP modes. We suggest that the SPEEP function included in the Oertli Faros may have some advantages.

Anterior vitreous detachment and retrolental material during cataract surgery: incidence and risk factors, with pathological evidence.

To determine the incidence of anterior vitreous detachment (AVD) and retrolental material occurrence in cataract surgery, determine the influence of surgical factors on it, and confirm the source of the material. Affiliated Hospital of Nantong University, Jiangsu Province, China. Prospective single-center study. Age, sex, ocular complication, nuclear sclerosis grade, ultrasonic time, mean longitudinal power, cumulative dissipated energy (CDE), total aspiration time, and estimated fluid usage were recorded for each patient. Retrolental anatomy was observed before and during surgery using real-time optical coherence tomography integrated into a microscope. The eyes with AVD were carefully observed and recorded during illumination with an optical fiber. Retrolental material was stained using immunohistochemistry. 205 eyes from 205 patients were included in this study. Spontaneous AVD was found in 5 cases. Intraoperatively, AVD was identified in 115 eyes (56.1%). Retrolental material presence was observed in 75 eyes (36.6%). A logistic regression model showed that CDE and aspiration time had a statistically significant effect on AVD ( P < .05, 95% CI, 1.011-1.558; P < .05, 95% CI, 1.026-1.051), and CDE was positively correlated with retrolental material occurrence ( P < .05, 95% CI, 1.052-1.534). Samples from 5 cases expressed large amounts of αA- and βA-crystallins. Spontaneous AVD is rare in phakic eyes. There was a marked increase in AVD during surgery, with retrolental material occurring in more than a third of cases. Higher CDE and longer total aspiration time were risk factors for AVD. Immunohistochemistry revealed that most of the retrolental materials were lens fragments.

Posterior capsule dynamics during femtosecond laser lens fragmentation

PurposeThe dynamics of the posterior capsule during femtosecond laser lens fragmentation has received little attention in the literature. We analysed the movements of the posterior capsule to identify the rupture risk factors, if any, and to suggest possible modification of the laser spot energy pattern during fragmentation.Materials and methodsPosterior capsule ruptures during fragmentation were identified over a 10-year period of femtosecond laser use. In addition, the dynamics of the posterior capsule were identified through the real-time swept-source OCT lateral view available during the surgeries.ResultsOut of the 1465 laser cataract procedures performed, we recorded 1 case of posterior capsule rupture during lens fragmentation, which was caused by eye movement that was detected but ignored by the surgeon. Three types of posterior capsule dynamics were identified, all related to a gas bubble formation during the first part of the lens fragmentation. In eyes with a hard nucleus, the concussion of the posterior capsule was evident, however, with no capsule rupture.DiscussionMaintaining good docking throughout the whole procedure seems important in avoiding a posterior capsule cut by the femtosecond laser. In addition, a Gaussian pattern of spot energy is suggested when fragmenting hard cataracts.

Visual Outcomes and Postoperative Complications of Eyes with Dropped Lens Fragments During Cataract Surgery: A Multicenter Database Study.

To analyze the visual outcomes and postoperative complications of phacoemulsification cataract surgery in eyes with posterior capsule rupture (PCR) and dropped lens fragments (DLF) in comparison to a reference group with uneventful surgery. Eight United Kingdom National Health Service departments. Retrospective comparative non-randomized study. Demographic, medical history, and ocular examination data were automatically extracted from the electronic records. The main outcome variables were postoperative visual acuity (VA), and the development of postoperative cystoid macular edema (CME) as well as rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) requiring surgery. The analysis included 175,589 eyes in the reference group, 2,751 eyes in the PCR group, and 519 eyes in the DLF group. During all postoperative intervals, the mean VA in the DLF and PCR groups was significantly worse than the reference group (p<0.001). On multivariate analysis, the odds of having a VA ≤ 0.3 logMAR at 4-12 weeks postoperatively among eyes with DLF and PCR were 88% and 73% lower than the reference group (p<0.001). More eyes developed CME in the DLF and PCR groups (p<0.001). The odds of requiring RRD and ERM surgery were 3.6 and 2.1 times higher in the DLF group, and 1.8 and 1.3 times higher in the PCR group, respectively, as compared to the reference group. Eyes undergoing phacoemulsification complicated by PCR, and more so with DLF, have worse visual outcomes and higher chances of CME, ERM, and RRD when compared to uneventful surgery.

Femtosecond laser-assisted cataract surgery: Update and perspectives.

Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.