Microcoaxial Phacoemulsification Research Articles

Let's talk about incisions

Let's talk about incisions

PHACOEMULSIFICATION OF BROWN CATARACTS ON AVITREAL EYES

Analysis of the features of surgical treatment of brown cataracts in the eyes with previously performed posterior vitrectomy. The study included 25 patients (25 eyes) with nuclear cataracts 6+ density according to LOCS III classification. All patients underwent microinvasive posterior vitrectomy more than 6 months ago. Microcoaxial (2.2 mm) phacoemulsification of cataract with implantation of flexible intraocular lens was planned for all patients. In 15 patients (60 %), a system of capsule hooks was used in order to support the capsule bag 4 in 16 % of cases and 6 in 44 % of cases. Results and discussion. Sutureless surgery were performed in 24 patients (96 %). In one case with nigra cataract despite the use of capsule hooks, due to the high risk of dislocation of the lens into the vitreous cavity, the surgery was converted into a large incision. Microcoaxial phacoemulsification is the surgery of choice in the case of a combination of dense lens and lack of vitreous support. The use of capsular hooks greatly simplifies surgery and increases the chances of sutureless surgery.

Comparison of corneal pachymetry changes and surgically induced astigmatism of microcoaxial phacoemulsification surgery and coaxial phacoemulsification surgery

DOI : 10.26650/IUITFD.396179 Amac: 2,2 mm’lik kesi ile yapilan mikrokoaksiyal fakoemulsifikasyon cerrahisini, 2,75 ve 3,2 mm’lik kesi ile yapilan standart koaksiyal fakoemulsifikasyon cerrahisi ile cerrahiye bagli astigmatizma (CBA) ve pakimetrik degisimler acisindan karsilastirmak. Gerec ve Yontem: Katarakt operasyonu yapilan 39 olgunun kayitlari retrospektif olarak incelendi. Olgularin hangi buyuklukte kesi ile opere edilecekleri rastgele belirlendi. Mikrokoaksiyal grupta 15 goz, standart koaksiyal grupta ise 24 goz bulunmaktaydi, Olgulara preoperatif ve postoperatif 1. ayda Pentacam Scheimpflug kamera (OCULUS Inc., Almanya) ile kornea topografisi analizi yapildi. Pentacam’in iki topografi arasindaki degisikligi hesaplayan fark haritasindaki astigmatizma ve pakimetri degerleri karsilastirildi. Vektoryel analiz programi kullanarak cerrahiye bagli astigmatizma degerleri hesaplandi. Bulgular: Postoperatif 1. aydaki vektoryel analiz programi ile hesaplanan CBA degerleri mikrokoaksiyal cerrahi grubunda 0,55±0,37 D, koaksiyal cerrahi grubundaki 0,53±0,24 D olarak olculdu ve aralarinda anlamli bir fark yoktu (p=0,743). Pentacam fark haritasinda olcumlerde mikrokoaksiyal cerrrahi grubunda astigmatizma degisimi 0,41±0,62 D saptanirken koaksiyal cerrahi grubunda 0,44 ± 0,40 D saptandi. Gruplar arasinda anlamli farklilik yoktu (p=0,578 ). Postoperatif 1. haftadaki gorme keskinligi anlamli bir sekilde mikrokoaksiyal grupta daha yuksek duzeydeydi. (p=0,004).Mikrokoaksial kesi ile opere edilen grupta kornea kalinliginda postoperatif 1. ayda ortalama 6,47 ± 21,16 mikron azalma saptanirken diger grupta ortalama 12,62 ±30,01 mikron artis saptandi. Aralarindaki fark anlamli bulundu (p=0,004). Sonuc: Postoperatif 1. aydaki CBA degerleri, literaturdeki CBA degerleri ile benzer sonuclar vermis ancak iki grup arasinda anlamli bir farklilik saptanmamistir. Mikrokoaksiyal cerrahi grubunda postoperatif gorsel rehabilitasyon daha erken saglanmaktadir.

Correlation Between Postoperative Central Corneal Thickness and Endothelial Damage After Cataract Surgery by Phacoemulsification.

To study the correlation between postoperative corneal edema and endothelial cell loss after cataract surgery by microcoaxial phacoemulsification. Eighty-five eyes of 85 consecutive patients with mild cataract (up to C5, N4, and P5: per LOCS III classification) were included in a prospective study from September 2014 to November 2014. Eighty-five eyes were necessary to obtain a precision of 0.15 for computation of the Pearson correlation coefficient. Pachymetry and endothelial cell density measurements were taken preoperatively, 2 hours after surgery, and 4 days, 15 days, and 1 month after surgery using CEM-530 noncontact specular microscopy (Nidek CO Ltd, Japan). Every surgery was performed using the Stellaris device (Bausch & Lomb, Bridgewater, NJ) in a microcoaxial mode with 2.2-mm incisions. Mean age was 73 ± 2.1 years, with 41 women (48%) and 44 men (52%). The mean surgical time was 8 ± 5.5 minutes, and the mean effective phacoemulsification time was 7 ± 3.7 seconds. Mean central corneal thickness augmentation was 46.68 ± 10 μm (8.39%) 2 hours after surgery, 10 ± 18 μm (1.8%) 4 days after surgery, and only 0.76 ± 11.4 μm (0.1%) 15 days after surgery. Mean endothelial cell loss was 3.0 ± 1.5% at 2 hours, 9.0 ± 3.3% at D4, 10 ± 4.6% at D15, and 11 ± 4.7% at 1 month. At D4, significant endothelial loss (>15%) was mostly related to significant immediate corneal edema (>15%), whereas low postoperative edema (<5%) did not lead to significant endothelial loss (loss <5%). At D15 and D30, endothelial cell loss seemed to be closely correlated with immediate postoperative edema (Pearson correlation coefficient between central corneal edema at H2 and endothelial cells loss at 1 month: r = 0.4, P < 0.0001). Postoperative corneal thickness measurement may therefore become a marker of endothelial damage after phacoemulsification.

Сравнительная оценка попадания в рефракцию цели у трех монофокальных гибких интраокулярных линз

Purpose. The purpose of this study was to estimate a stability of hit at a target refraction using three types of monofocal IOL: AcrySof IQ (SN60WF), CT Aspira-aAy and Asphina 409M. Material and methods. This retrospective randomized study included 208 patients (208 eyes), which underwent micro-coaxial phacoemulsification. The algorithm in the calculation of IOL optical power was based on 4 formulas: Holladay 1, Haigis, Hoffer Q, SRK/T. Depending on the type of the implanted IOL the patients were divided into 3 groups: AcrySof IQ (SN60WF) – 42, Aspira-aAy – 98, Asphina 409M – 68. Three predicting errors were assessed 1-3 months after each surgery: the mean numerical prediction error (ME), the mean absolute prediction error (MAE), the median absolute prediction error (MedAE). Results. ME, MAE and MedAE were the following: -0.29, +0.01, -0.13; ±0.244, ±0.159, ±0.169 and 0.75, 0.5, 0.5 in IOLs IQ, Aspira and Asphina, respectively. There were detected no statistically significant differences between IOLs (p>0.05). The deviation of ±0.25 diopter in percentage of eyes with prediction errors was obtained in 76%, 77.5%, 77.9% of cases, a ±0.5 diopter deviation – in 85.7%, 92.8%, 89.7%, ±1.0 diopter – in 92.8%, 97.9%, 98.5%, and 2.0 diopter – in 97.6%, 100%, 100% after implantation of IOLs IQ, Aspira and Asphina respectively. Conclusion. All three types of monofocal IOLs have shown a high precision of hit in the target refraction.

Comment on "Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification".

Comment on "Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification".

Comparison of effect of nepafenac and diclofenac ophthalmic solutions on cornea, tear film, and ocular surface after cataract surgery: the results of a randomized trial.

BackgroundThe aim of this study was to compare the effects of nepafenac ophthalmic suspension 0.1% (Nevanac) and diclofenac sodium ophthalmic solution 0.1% (Diclod) on the cornea, tear film, and ocular surface after cataract surgery.MethodsA total of 60 eyes (60 patients) were selected for this study, with no ocular diseases other than cataract (scheduled for cataract surgery by one surgeon). Patients were randomly enrolled to receive nepafenac or diclofenac in the perioperative period, and cataract surgery was performed using torsional microcoaxial phacoemulsification and aspiration with intraocular lens implantation via a transconjunctival single-plane sclerocorneal incision at the 12 o’clock position. We compared intra- and intergroup differences preoperatively and postoperatively in conjunctival and corneal fluorescein staining scores, tear film breakup times, Schirmer’s tests, the Dry Eye Related Quality of Life Scores, and tear meniscus areas using anterior segment optical coherence tomography.ResultsThe diclofenac group had significantly higher conjunctival and corneal fluorescein staining scores at 4 weeks postoperatively compared with the nepafenac group (P<0.001). Within the diclofenac group, significantly higher conjunctival and corneal fluorescein staining scores were noted at 4 weeks postoperatively than those seen preoperatively (P<0.001) and at 1 week postoperatively (P<0.001). No statistically significant differences were found in any other items.ConclusionsNepafenac ophthalmic suspension 0.1% is considered safe for the corneal epithelium after cataract surgery.

Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification.

To compare the intraoperative performance and postoperative outcome after microcoaxial torsional phacoemulsification using either a Kelman or balanced phaco tip. Cataracts were treated using 2.2 mm microcoaxial torsional phacoemulsification using either a 45-degree mini-flared Kelman(®) or a 45-degree Intrepid(®) Balanced phaco tip. Intraoperative measurements included total ultrasound (US) time, cumulative dissipated energy (CDE), torsional US time, and balanced salt solution (BSS) use. The central endothelial cell density (ECD) and central corneal thickness (CCT) were evaluated preoperatively and postoperatively 1, 7, and 30d after surgery using noncontact specular microscopy. The 116 enrolled eyes (116 patients) were divided equally between the Kelman and balanced tip groups. Intraoperative measurements showed significantly less total US time, torsional US time, CDE, and BSS use in the balanced group than in Kelman group (P<0.05). The total US time, torsional US time, CDE, and BSS use were 17.45±14.53s, 16.63±13.97s, 6.38±5.26, and 48.21±17.21 mL in the Kelman group and 11.39 ± 9.60s, 10.90 ± 9.25s, 4.04 ± 3.42, and 41.36 ± 12.70 mL in the balanced group, respectively. Torsional phacoemulsification performed with a balanced tip provided more effective lens removal with less total US time, torsional time, CDE, and BSS use, as well as similar changes in ECD with a Kelman tip in all cataract grades. This special designed phaco tip for torsional phacoemulsification provides an alternative phaco tip for many surgeons' preference with straight phaco tip.

Comparison of Two Different Ultrasound Methods of Phacoemulsification

To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the OZil Intelligent Phaco torsional mode (Alcon Laboratories, Inc., Fort Worth, USA) and combined torsional/longitudinal ultrasound mode using 45 degree aperture angled tips. Prospective randomized clinical trial. setting: Maltepe University, Istanbul. patient population: Eighty eyes of 80 cataract patients were randomly assigned to 2.2 mm microcoaxial phacoemulsification using the OZil Intelligent Phaco torsional mode (Group 1) or combined torsional/longitudinal ultrasound mode (Group 2). observation procedure: Intraoperative fluid and energy usage and postoperative examinations were evaluated. main outcome measures: Ultrasound time, cumulative dissipated energy, longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of fluid used, and surgical complications. Both groups included 40 eyes. Mean ultrasound time, cumulative dissipated energy, and longitudinal and torsional ultrasound amplitudes in Group 1 were 58.21±33.81 seconds, 7.74±6.23, 0.45±0.30, and 26.30±12.60%, respectively, and these parameters in Group 2 were 64.75±30.23 seconds, 12.61±6.21, 26.32±5.85, and 40.98±8.33%, respectively. Cumulative dissipated energy and longitudinal and torsional amplitudes were found to be significantly lower in Group 1 (P=.001, P<.001, P<.001). Mean volumes of fluid used in Groups 1 and 2 were 73.30±19.87 cc and 107.07±21.82 cc, respectively (P<.001). With the aid of a 45 degree aperture angled tip, the OZil Intelligent Phaco torsional mode provided more effective lens removal than the combined torsional/longitudinal ultrasound mode, with a lower cumulative dissipated energy and volume of fluid used.

Microcoaxial Phacoemulsification Combined With Viscogoniosynechialysis for Patients With Refractory Acute Angle-closure Glaucoma

To evaluate the safety and efficacy of microcoaxial phacoemulsification combined with viscogoniosynechialysis in managing refractory acute angle-closure glaucoma (AACG) unresponsive to conventional therapy. Seventeen consecutive eyes of patients with AACG>270 degrees peripheral anterior synechiae were treated with microcoaxial phacoemulsification combined with viscogoniosynechialysis. After intraocular lens implantation, a heavy viscoelastic agent was used to deepen the anterior chamber, and then injected near the angle for 360 degrees without touching any ocular structure, to release the peripheral anterior synechiae under gonioscopy. The viscoelastic agent was then removed. Intraocular pressure was reduced from a median of 45.0 mm Hg initially to 15.0 mm Hg after the combined procedures at the final follow-up visit (P<0.001). All angles showed exposure of the trabecular meshwork over 360 degrees postoperatively without residual synechiae. The mean best corrected visual acuity improved from 0.7 to 0.18 logMAR at 6-month follow-up (P<0.001). Surgically induced astigmatism was 0.29 at 6-month follow-up. There was a 6.4% reduction in the mean corneal endothelial cell count. No severe complications were observed in any patient. Microcoaxial phacoemulsification combined with viscogoniosynechialysis is an effective and safe treatment for managing refractory AACG. Using a 2.2-mm incision caused less surgically induced astigmatism and also improved visual quality.

Outcomes of torsional microcoaxial phacoemulsification using tips with 30-degree and 45-degree aperture angles

To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed using 30-degree and 45-degree aperture angled tips. Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Comparative case series. Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 45-degree (Group 1) or 30-degree (Group 2) aperture angled tip. A quick-chop surgical technique was used. The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean balanced salt solution volume used, and mean central corneal thickness (CCT) changes. The mean UST, CDE, and longitudinal and torsional US amplitudes were 58.21 seconds ± 33.81 (SD), 7.74 ± 6.23, 0.45 ± 0.30, and 26.30 ± 12.60 in Group 1 and 63.83 ± 23.42 seconds, 12.36 ± 6.75, 0.23 ± 0.26, and 44.65 ± 14.38 in Group 2, respectively. The mean CDE and torsional amplitudes were significantly lower in Group 1 (P=.002 and P=.001, respectively). The mean balanced salt solution volume was 73.30 ± 19.87 cc in Group 1 and 74.30 ± 19.44 cc in Group 2 (P=.821). The mean CCT change was 52.40 ± 38.08 μm and 99.35 ± 47.14 μm, respectively (P<.001). Torsional phacoemulsification performed with a 45-degree aperture angled tip provided more effective lens removal with a lower CDE and less CCT change than a 30-degree aperture angled tip.

Faco microcoaxial con ultrasonido longitudinal

ObjectiveTo evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification with 2.2mm incision using longitudinal ultrasound. MethodsA prospective, observational case series, 17 eyes having microcoaxial phacoemulsification through a 2.2mm clear corneal incisión using longitudinal ultrasound (Legacy 20000® with Everest, Alcon Laboratories). Observations included cumulative dissipated energy (CDE), intraoperative complications, and corneal thickness preoperative and postoperative at one day, one week and one month, best corrected visual acuity (BCVA) at one month. ResultsSeventeen eyes from 17 patients, preoperative corneal thickness (microns) mean of 523.11 (+/-33.18), at one day a mean of 573.52 (+/-44.06), at one week a 536.35 (+/-30.55) and one month the mean was 522.29 (+/-31.66).We had a mean CDE (cumulative dissipated energy) of 7.38. The BCVA without patients with macular pathologies was 0.915. No wound burns or other intraoperative complications occurred. ConclusionIt is safe and effective to perform microcoaxial phacoemulsification through 2.2mm incision using longitudinal ultrasound.

Analyses of surgically induced astigmatism and axis deviation in microcoaxial phacoemulsification

To evaluate surgically induced astigmatism (SIA) and axis deviation after coaxial microincision superotemporal clear corneal phacoemulsification incision in eyes with differently located steep axis. This prospective, comparative study included four groups of 45 eyes with age-related cataracts; each group underwent 2.2-mm superotemporal clear corneal incision (CCI) cataract surgery. The four groups of patients were divided by location of the steep axis. Groups were matched according to symmetry of the steep axis for both right and left eyes as follows--0°-45° of steep axis for right eyes, and 136°-180° for left eyes (group 1); 46°-90° for right eyes and 91°-135° for left eyes (group 2); 91°-135° for right eyes and 46°-90° for left eyes (group 3); and 136°-180° for right eyes and 0°-45° for left eyes (group 4). Outcome measures included changes in mean total astigmatism, SIA, and axis deviation. Astigmatism was measured by manual keratometry readings before surgery and week 1, week 4, week 8, and week 12 postoperatively. SIA was calculated by the vector analysis (Holladay-Cravy-Koch method). The magnitude of mean total astigmatism was lowest in group 3 and highest in group 1 at week 12. SIA was 0.39 diopters (D), 0.22 D, 0.17 D, and 0.28 D in group 1, group 2, group 3, and group 4, respectively. The change in astigmatic axis deviation was highest in group 3 (23.6 ± 16.6) (P < 0.05). Axis deviation and SIA were stable after week 4. Planning of CCI on or near the steep axis can help decrease corneal astigmatism.

Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips

To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12-degree and 22-degree bent tips using the Infiniti Vision System. Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Comparative case series. Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22-degree bent tip (Group 1) or a 12-degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds ± 27.23 (SD), 11.53 ± 6.99, 0.22 ± 0.26, and 42.86 ± 15.64, respectively, in Group 1 and 84 ± 45.04 seconds, 16.68 ± 10.66, 0.48 ± 0.68, and 46.27 ± 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 ± 28.58 cc in Group 1 and 82.08 ± 26.21 cc in Group 2 (P=.134). Torsional phacoemulsification performed with 22-degree bent tips provided more effective lens removal than 12-degree bent tips, with a lower UST and CDE.

Histomorphological and immunofluorescence evaluation of clear corneal incisions after microcoaxial phacoemulsification with 2.2 mm and 1.8 mm systems

To compare changes in the incision's histomorphology and denaturation of collagen I in rabbit eyes having microcoaxial phacoemulsification through 2.2 mm and 1.8 mm incision-compatible systems. Randomized experimental trial. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Thirty rabbit eyes were randomized into Group 1 (microcoaxial phacoemulsification through 2.2 mm incisions using Infiniti system [torsional ultrasound]) and Group 2 (microcoaxial phacoemulsification through 1.8 mm incisions using Stellaris system [longitudinal ultrasound]). Each group was then divided into 3 subgroups of 5 eyes each based on 1 of the 3 intervention options: phacoemulsification only, intraocular lens (IOL) insertion only, and phacoemulsification with IOL insertion. Left eyes were randomized for microcoaxial phacoemulsification, and right eyes were treated as controls. After phacoemulsification, eyes in Group 1 showed loss of epithelium at the roof of the incisions and Descemet membrane detachment at the floor of the incisions. These findings did not change after IOL insertion. After phacoemulsification, eyes in Group 2 showed loss of epithelium, but Descemet membrane remained attached. There was a longitudinal split in the incision's stroma in the direction of internal entry. The stromal damage increased after IOL implantation. Immunofluorescence studies showed no obvious irregularities in the arrangement of collagen I in either group. A dot blot analysis showed significant denaturation of collagen I in Group 2. The histomorphology of the 2.2 mm system incision showed localized Descemet membrane detachment and endothelial cell loss. The 1.8 mm system incision showed exaggerated stromal damage after IOL insertion.

To Compare Incisional Fluid Loss During Different Stages of Phacoemulsification and its effect on Anterior Chamber Stability in Micro Coaxial and Bimanual Phacoemulsification

Purpose: To compare incisional fluid loss during different stages of phacoemulsification and its effect on anterior chamber stability in microcoaxial and bimanual phacoemulsification. Materials & Methods: This prospective randomized study comprised of 80 consecutive patients, 40 patients in each group having routine uneventful cataract surgery. All patients were operated on the same phaco machine by the same surgeon. Intra-operative parameters were constant for all patients in each group. Volume of incisional fluid leak was measured during different stages of phacoemulsification. Along with volume of fluid aspirated in cassette, total volume of balance salt solution used, frequency of visually significant surges during different stages of phacoemulsification and post-operative best corrected visual acuity & central corneal thickness were measured in microcoaxial and bimanual phacoemulsification Results: The mean percentage of incisional fluid leak during nucleus removal in microcoaxial phacoemulsification was 21.22±6.07% and was 24.73±5.06% in bimanual phacoemulsification (P value: 0.006).The mean percentage of incisional fluid leak during irrigation/aspiration/polishing in microcoaxial phacoemulsification was 38.60±7.22% and was 57.70±6.59% in bimanual phacoemulsification (p value: < 0.0001). Average frequency of visually significant anterior chamber surges in microcoaxial phacoemulsification was 6 and was 36 in bimanual phacoemulsification. Postoperative mean increase in central corneal thickness (CCT) in microcoaxial phacoemulsification was 4.93±3.11 on Day 1 and was 0.70±1.11 on Day 7 and in bimanual phacoemulsification it was 9.55±4.77 on Day 1 and 1.55±1.72 on Day 7 (P value, Day 1: <0.0001 & Day 7: 0.01). Conclusion: Significant increase in incisional fluid loss was observed in bimanual phacoemulsification. This led to more surges during surgery along with increase in central corneal thickness in immediate postoperative period. This suggests that microcoaxial phacoemulsification has better fluidics and anterior chamber stability.

Incision integrity and postoperative outcomes after microcoaxial phacoemulsification performed using 2 incision-dependent systems

To compare incision integrity and clinical outcomes of 2 microcoaxial phacoemulsification systems. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized clinical trial. Eyes were randomized to have phacoemulsification using a 1.8 mm clear corneal incision (CCI) system (Group 1, Stellaris system) or a 2.2 mm CCI system (Group 2, Intrepid Infiniti system). Incision enlargement at end of surgery was measured. At the conclusion of surgery, trypan blue was applied over the conjunctival surface, anterior chamber aspirate withdrawn, and ingress into anterior chamber measured. Postoperative observations included evaluation of the CCI using anterior segment optical coherence tomography (AS-OCT), change in central corneal thickness (CCT), and anterior segment inflammation at 1 day, 1 week, and 1 month and endothelial cell loss and surgically induced astigmatism (SIA) at 3 months. Incision enlargement (P<.001) and trypan blue ingress in the anterior chamber (mean 1.7 log units ± 0.6 [SD] versus 3.8 ± 0.6 log units, P<.001) was significantly greater in Group 1 (n = 50) than in Group 2 (n = 50). On AS-OCT, endothelial misalignment and gaping were more frequent in Group 1 at 1 day (P=.001) and 1 week (P=.018). There were no significant differences in SIA, change in CCT, endothelial cell loss, or anterior segment inflammation (P>.05). At the end of surgery, it is not the initial incision size alone but also the distortion of the incision during subsequent stages of surgery that determine the integrity of the CCI.

Surgically Induced AStigmatism of Microcoaxial Phacoemulsification Using 2.2mm Incision Compared with Conventional Phacoemulsification Using 3.2mm Incision

Medicine Today 2011 Volume 23 Number 01 Page 27-29 DOI: http://dx.doi.org/10.3329/medtoday.v23i1.11941

Comparison of the effect of torsional and microburst longitudinal ultrasound on clear corneal incisions during phacoemulsification

To compare incision integrity after clear corneal microcoaxial phacoemulsification using longitudinal and torsional ultrasound (US). Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized experimental clinical trial. Part 1 comprised an experimental study of rabbit eyes. Group 1 received longitudinal US. Group 2 received torsional US. The right eye of each rabbit served as a control. Samples were processed for histomorphology and collagen I denaturation by immunofluorescence. Part 2comprised a clinical trial of patients. Group 1 received torsional US. Group 2 received longitudinal US. At the end of surgery, trypan blue 0.0125% was instilled. After 2 minutes, 0.1 mL of aqueous was aspirated and its optical density measured. In part 1, incision histomorphology was comparable in both modalities. Collagen denaturation tests (immunofluorescence, dot blot analysis) showed no irregularity in collagen arrangement in either group. In Group 2, Descemet membrane was detached and endothelial cells were minimal at the roof of the incision. In part 2, trypan blue ingress into the anterior chamber wassignificantly greater in Group 1 than in Group 2 (mean 3.40 + 0.6 log units versus and 3.77 + 0.82 log units) (P<.007). Incision histomorphology in the torsional group showed minimal Descemet membrane detachment and minimal endothelial cell loss at the roof of the incision. Minimal ingress of trypan blue into the anterior chamber was observed with torsional US, indicating better wound integrity than with longitudinal US. No author has a financial or proprietary interest in any material or method mentioned.

Ozil IP torsional mode versus combined torsional/longitudinal microcoaxial phacoemulsification

To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using the Infiniti Vision System (Alcon Laboratories). In this prospective randomized comparative study, 60 eyes were assigned to 2.2-mm microcoaxial phacoemulsification using the Ozil IP torsional mode (group 1) or combined torsional/longitudinal US mode (group 2). The primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of balanced salt solution (BSS) used, and surgical complications. Both groups included 30 eyes. Mean UST, CDE, and longitudinal and torsional ultrasound amplitudes in group 1 were 1 minute 15±34.33 seconds, 8.74±5.64, 0.43±0.74, and 25.56±8.56, respectively, and these parameters in group 2 were 1 minute 40±51.44 seconds, 9.28±5.99, 3.64±1.55, and 3.71±1.34, respectively. UST and longitudinal amplitudes were found to be significantly low in group 1 (p<0.001, p<0.001), whereas torsional amplitude was found to be significantly high in this group (p=0.001). Mean volumes of BSS used in groups 1 and 2 were 63.30±18.00 cc and 84.50±28.65 cc, respectively (p=0.001). The Ozil IP torsional mode may provide more effective lens removal than the combined torsional/longitudinal US mode with a lower UST and volume of BSS used.