Moderate Cataract Research Articles

Liquefaction for cataract extraction.

A systematic review of the recent literature regarding the implementation of the liquefaction in cataract surgery and its short-term and long-term outcomes in various parameters that affect the quality of patients' life, including visual rehabilitation and possible complications was performed based on the PubMed, Medline, Nature and the American Academy of Ophthalmology databases in November 2013 and data from 14 comparative studies were included in this narrative review. Liquefaction is an innovative technology for cataract extraction that uses micropulses of balanced salt solution to liquefy the lens nucleus. Most studies reported that liquefaction is a reliable technology for mild to moderate cataracts, while fragmentation difficulties may be encountered with harder nuclei.

Change in Axial Length Pre and Post Cataract Surgery Measured with IOL Master

Objective: Cataract surgery with intraocular lens (IOL) implantation tries to get a refractive result nearby to the optic emmetropia. So an accurate IOL power calculation is mandatory, and axial length (AL) measurement is one of the most influential parameter in this calculation. IOL Master is one of the most popular devices to measure AL, which uses the same group refractive index of the lens for all patients, independently of the cataract grade. But lens refractive index is higher as cataract grade increases. Nowadays cataract tends to be operated earlier, so moderate cataracts are the most extracted in clinical practice. Therefore, it is important to study the influence of moderate lens opacity in AL measurements. The objective of this study was to compare the AL value measures with IOL Master, before and after uncomplicated cataract surgery in patients with moderate cataracts. Material and methods: This study included 153 eyes of 105 patients (67.51 ± 13.56 years old) undergoing uncomplicated cataract surgery. Lens opacity was determined with the LOCSIII scale and AL was measured using optical biometry (IOL Master; Carl Zeiss Meditec) before and one month after intervention. Intraoperative measurements (ultrasound time and fluid volume) were also registered. Results: Mean preoperative AL of 25.10 ± 3.19 mm (range 20.54 to 36.06; IC95% 24.59 to 25.60 mm) and postoperative of 24.88 ± 3.16 mm (IC 95% 24.37 to 25.39; range 20.43 to 35.79 mm). The mean AL difference before and after surgery was 0.19 ± 0.05 mm (p=0.549 ANOVA) with agreement limits from 0.09 to 0.29 mm. It was observed more difference in eyes with larger AL (r2=0.14 p<0.01). The average cataract grade in each category was: nuclear opacity 2.25 ± 1.00 (range 1 to 5) (p=0.564 ANCOVA), cortical opacity 2.04 ± 0.73 (range 0 to 4) (p=0.543 ANCOVA), posterior subcapsular opacity 0.44 ± 0.90 (range 0 to 4) (p=0.563 ANCOVA), and nuclear color 2.40 ± 1.05 (range 0 to 5) (p=0.558 ANCOVA), without statistical significant effect in the AL difference pre and after cataract surgery. The ultrasound time used during the surgery was 43 ± 29 seconds (p=0.525 ANCOVA) and the fluid volume was 4.73 ± 1.31 (p=0.560 ANCOVA) cubic centimeters without statistically significant relationship between these parameters and the difference in the AL measurement. Conclusions: The difference in AL measurement with IOL Master before and after cataract surgery in eyes with low grade of cataract should be related with IOL Master reproducibility especially in extreme-long eyes. Moderate cataract showed non-statistically effect on AL measurement with IOL Master biometry.

Screening Patients With Cataract for Premium IOL Candidacy Using Microperimetry.

To explore the use of microperimetry in the evaluation of macular dysfunction in patients with cataract, to aid in proper intraocular lens selection (multifocal vs monofocal), and to set expectations for postoperative visual function. One randomly chosen eye of 10 patients diagnosed as having mild (1+) to moderate (3+) cataract was evaluated before and 1 week after cataract surgery with the MAIA microperimeter (Centervue S.p.A, Padova, Italy). Corrected distance visual acuity, dilated and undilated biomicroscopy and indirect fundus examinations, intraocular pressure measurement, and a MAIA microperimeter test to measure macular sensitivity and fixation pattern were also performed. Two patients showed macular abnormalities before and after surgery that were noted on MAIA testing: one patient showed reduced average threshold sensitivity and abnormal percent reduced threshold, whereas the other patient showed fixation drift demonstrating eccentric fixation. Both eyes had reduced postoperative visual performance after uneventful cataract surgeries. Because not every macular lesion noted on fundus examination or optical coherence tomography may be clinically significant, microperimetry can be useful to detect clinically significant retinal dysfunction prior to cataract surgery. The outcome may aid in the selection of intraocular lens type and may yield a better documented surgical prognosis. Further studies are necessary to confirm these findings.

The pattern of early corneal endothelial cell recovery following cataract surgery: cellular migration or enlargement?

To evaluate whether cellular migration or enlargement is the main mechanism of initial endothelial cell recovery following cataract surgery. A prospective observational study, of 24 patients aged 50-80years who were diagnosed with moderate cataract and received uncomplicated cataract surgery with a 2.75mm temporal clear corneal incision, was performed in Seoul National University Bundang Hospital. Endothelial cell density (ECD) and area (ECA) were obtained in central and four paracentral (superior, inferior, nasal, and temporal) areas using non-contact specular microscopy. ECD, ECA, ECD% (ECD% = ECD in each area/the sum total of ECD in five areas), and the coefficient of variation of ECA (CV) in each location were investigated pre- and 1day, 1week, and 4weeks postoperatively. ECD significantly decreased 1day, 1week, and 4weeks postoperatively (p = 0.010, 0.015, and 0.003 respectively), and ECA increased (p = 0.008, 0.013, and 0.002 respectively) in only the temporal area. Postoperative ECD% decreased, and CV increased in only the temporal area significantly, when compared to preoperative values. There were no significant postoperative changes of ECD, ECA, ECD%, and CV in other areas. Postoperative changes of ECD, ECA, ECD%, and CV were limited to the temporal area adjacent to the primary corneal incision. Cellular enlargement, rather than migration, may have the major effect on early endothelial cell recovery after cataract surgery.

The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37

To evaluate whether dietary intake of luteiin/zeaxanthin and B vitamins is associated with cataract prevalence and incidence.Clinic-based, baseline cross-sectional and prospective cohort study designs.Three thousand one hundred fifteen patients (6129 eyes) enrolled in the Age-Related Eye Disease Study 55 to 80 years of age followed up for mean of 9.6 years.Participants completed baseline food frequency questionnaires. Baseline and annual lens photographs were graded centrally. Multivariate models controlling for previously identified risk factors for cataracts tested for the association of cataracts with reported dietary intake, using the lowest quintile as reference.Cataract surgery, cataract status (type and severity) at baseline, and development of cataracts.At baseline, increased dietary riboflavin and B12 were associated inversely with nuclear and cortical lens opacities. In comparisons of persons with and without cataract, persons with the highest riboflavin intake versus those with the lowest intake had the following associations: mild nuclear cataract: odds ratio (OR), 0.78; 95% confidence interval (CI), 0.63-0.97; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.90; and mild cortical cataract: OR, 0.80; 95% CI, 0.65-0.99. For B12, the results were: mild nuclear cataract: OR, 0.78; 95% CI, 0.63-0.96; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.88; and mild cortical cataract: OR, 0.77; 95% CI, 0.63-0.95. Highest dietary B6 intake was associated with a decreased risk of moderate nuclear lens opacity developing compared with the lowest quintile (OR, 0.67; 95% CI, 0.45-0.99). Highest dietary intake levels of niacin and B12 were associated with a decreased risk of development of mild nuclear or mild cortical cataracts in participants not taking Centrum (Pfizer, New York, NY) multivitamins. For participants taking multivitamins during the study, the highest intake of dietary folate was associated with an increased risk of mild posterior subcapsular lens opacity development. No statistically significant associations were found between lutein plus zeaxanthin intake and presence at baseline or development of nuclear or cortical lens opacity outcomes.These findings are consistent with earlier studies suggesting that dietary intake of B vitamins may affect the occurrence of age-related lens opacities. Further investigations are warranted.

Do pattern deviation values accurately estimate glaucomatous visual field damage in eyes with glaucoma and cataract?

To study the efficacy of pattern deviation (PD) values in the estimation of visual field compensating the influence of cataract in eyes with glaucoma. The study subjects comprised of 48 eyes of 37 glaucoma patients. Mean total deviation value (mTDs) on Humphrey Field Analyzer after cataract surgery was compared with mean PD (mPD) before the surgery. Visual field measurements were carried out ≤6 months before (VF(pre)) and following (VF(post)) successful cataract surgery. The difference between the mPD or mTD values in the VF(pre) and mTD values in the VF(post) (denoted as εmPD/ΔmTD) was calculated, and the influence of the extent of 'true' glaucomatous visual field damage or cataract (as represented by εmPD and ΔmTD, respectively) on this difference was also investigated. There was a significant difference between mTD in the VF(pre) and mTD in the VF(post) (p<0.001, repeated measures analysis of variance). There was not a significant difference between mPD in the VF(pre) and mTD in the VF(post) (p=0.06); however, εmPD was significantly correlated with the mTD in VF(post) and also ΔmTD (R(2)=0.56 and 0.27, p<0.001, Pearson's correlation). The accurate prediction of the mTD in the VF(post) can be achieved using the pattern standard deviation (PSD), mTD and also visual acuity before surgery. Clinicians should be very careful when reviewing the VF of a patient with glaucoma and cataract since PD values may underestimate glaucomatous VF damage in patients with advanced disease and also overestimate glaucomatous VF damage in patients with early to moderate cataract.

A computer-aided healthcare system for cataract classification and grading based on fundus image analysis

This paper presents a fundus image analysis based computer aided system for automatic classification and grading of cataract, which provides great potentials to reduce the burden of well-experienced ophthalmologists (the scarce resources) and help cataract patients in under-developed areas to know timely their cataract conditions and obtain treatment suggestions from doctors. The system is composed of fundus image pre-processing, image feature extraction, and automatic cataract classification and grading. The wavelet transform and the sketch based methods are investigated to extract from fundus image the features suitable for cataract classification and grading. After feature extraction, a multiclass discriminant analysis algorithm is used for cataract classification, including two-class (cataract or non-cataract) classification and cataract grading in mild, moderate, and severe. A real-world dataset, including fundus image samples with mild, moderate, and severe cataract, is used for training and testing. The preliminary results show that, for the wavelet transform based method, the correct classification rates of two-class classification and cataract grading are 90.9% and 77.1%, respectively. The correct classification rates of two-class classification and cataract grading are 86.1% and 74.0% for the sketch based method, which is comparable to the wavelet transform based method. The pilot study demonstrates that our research on fundus image analysis for cataract classification and grading is very helpful for improving the efficiency of fundus image review and ophthalmic healthcare quality. We believe that this work can serve as an important reference for the development of similar health information system to solve other medical diagnosis problems.

Alcohol intake and the risk of age-related cataracts: a meta-analysis of prospective cohort studies.

PurposeEpidemiologic studies assessing the relationship between alcohol consumption and the risk of age-related cataracts (ARCs) led to inconsistent results. This meta-analysis was performed to fill this gap.MethodsEligible studies were identified via computer searches and reviewing the reference lists of these obtained articles. Pooled estimates of the relative risks (RR) and the corresponding 95% confidence Intervals (CI) were calculated using random effects models.ResultsSeven prospective cohort studies involving a total of 119,706 participants were ultimately included in this meta-analysis. Pooled results showed that there is no substantial overall increased risk of ARC due to heavy alcohol consumption. The estimated RRs comparing heavy drinkers versus non-drinkers were 1.25 (95% CI: 1.00, 1.56) for cataract sugery, 1.06 (95% CI: 0.63, 1.81) for cortical cataracts, 1.26 (95% CI: 0.93, 1.73) for nuclear cataracts, and 0.91 (95% CI: 0.32, 2.61) for posterior subcapsular cataracts (PSCs), respectively. No significant associations between moderate alcohol consumption and cataracts were observed. The pooled RRs comparing moderate drinkers versus non-drinkers were 0.90 (95% CI: 0.64, 1.26) for cataract surgery, 0.97 (95% CI: 0.75, 1.25) for cortical cataracts, 0.91 (95% CI: 0.76, 1.08) for nuclear cataracts, and 0.97 (95% CI: 0.49, 1.91) for PSCs, respectively.ConclusionsThis meta-analysis suggests that there is no substantial overall increased risk of ARC due to alcohol intake. Because of the limited number of studies, the findings from our study must be confirmed in future research via well-designed cohort or intervention studies.

Uveal effusion associated with an IgM lambda subtype monoclonal gammopathy

Case reportA 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome. ConclusionThis association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

The effect of cataract surgery on blue-yellow and standard-pattern visual-evoked potentials.

Blue-yellow visual-evoked potentials (BY-VEPs) may be used for diagnostics of functional ganglion cell damage in glaucoma and other ocular diseases. In this study we investigated the impact of lenticular opacities on BY- and standard pattern reversal VEPs by examining patients before and after cataract surgery. Eighteen patients with moderate cataract were included in a prospective study. Transient on/off isoluminant blue-yellow 2° checks were used for short-wavelength stimulation (BY-VEP), transient large 1° (M1) and small 0.25° (M2) black-white checks for standard pattern reversal VEPs. VEPs were acquired before (24 ± 30 days) and after cataract surgery (14 ± 16 days). The contralateral eye was used as a control. Amplitude and latency of M1 and M2 peaks did not change significantly from before to after surgery. The amplitude of the BY-VEPs did not change significantly after cataract surgery (pre-surgery, -7.42 ± 3.43 μV, post-surgery, -7.93 ± 3.65 μV, p = 0.42), yet the latency of the main negative peak showed a significant decrease (pre-surgery, 143.9 ± 12.9 ms, post-surgery, 133.2 ± 7.7 ms, p = 0.0006). The BCVA improvement was significant from before to after cataract surgery (pre-surgery, 0.344 ± 0.125 LogMAR, post-surgery, 0.224 ± 0.179 LogMAR, p = 0.013) yet not correlated to the absolute decrease in latency of the BY-VEP after surgery (r = 0.309, p = 0.22). No significant changes were found in the contralateral eye. The BY-VEP is sensitive to lenticular opacities of the human lens, presumably due to the increased short-wavelength absorption in the aging eye. This fact should be considered when applying BY-VEPs for diagnostics.

Treatment of Congenital Aniridia Associated with Subluxated Infantile Cataract

A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0,08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109° in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of Δ6º, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.

Efusión uveal asociada a gammapatía monoclonal de significado indeterminado tipo IgM lambda

Case reportA 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome. ConclusionThis association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery

To compare the outcomes of coaxial microincision cataract surgery (MICS) performed with 3 phacoemulsification techniques (phaco-chop, divide-and-conquer, and stop-and-chop) according to cataract density. Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. Prospective randomized clinical trial. Eyes with nuclear density from grade 2 to 4 were randomly subdivided into 3 groups (phaco-chop, divide-and-conquer, and stop-and-chop). Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated energy (CDE), and balanced salt solution use. Clinical measurements included preoperative and 1 day, 1 month, and 2 month postoperative corrected distance visual acuity, central corneal thickness, and endothelial cell count. Intraoperative measurements showed significantly less UST, CDE, and balanced salt solution use with the phaco-chop technique than with the divide-and-conquer and stop-and-chop techniques in the grade 4 cataract density group (P<.05). The percentage of endothelial cell loss was significantly lower in the phaco-chop group than in the divide-and-conquer and stop-and-chop groups in the grade 4 cataract density group 2 months after cataract surgery (P<.05). All 3 techniques may be effective for coaxial MICS in mild and moderate cataracts. However, in eyes with hard cataract having coaxial MICS, the phaco-chop technique can be more effective for lens removal, with less corneal endothelial damage, than the divide-and-conquer and stop-and-chop techniques. No author has a financial or proprietary interest in any material or method mentioned.

Visual Impairment among Weaving Communities in Prakasam District in South India

PurposeTo assess the prevalence and causes of visual impairment in weaving communities in Prakasam district in South India state of Andhra Pradesh.MethodsUsing Rapid Assessment of Visual Impairment (RAVI) methodology, a population based cross-sectional study was conducted. A two-stage sampling strategy was used to select 3000 participants aged ≥40 years. Visual Acuity (VA) was assessed using a tumbling E chart and ocular examinations were performed by trained Para medical ophthalmic personnel. A questionnaire was used to collect personal and demographic information. Blindness and moderate Visual Impairment (VI) was defined as presenting VA <6/60 and <6/18 to 6/60 respectively. VI included blindness and moderate VI.Results2848 of 3000 enumerated subjects (94.0%) participated. 39% were in 40–49 years age group and 11.8% were aged ≥70 years, 55% were women and nearly half of them had no formal education. 400 (14%; 95% CI: 12.8–15.3) subjects had VI, including blindness in 131 (4.6%; 95% CI: 3.8–5.4) and moderate VI in 269 (9.4%; 95% CI: 8.3–10.5) individuals. On applying multiple logistic regression, VI was significantly associated with older age and no formal education. Though the odds of having VI were higher in females, it was of borderline statistical significance (p = 0.06). Refractive error was the leading cause of all VI followed by cataract (56%). However, refractive errors were the leading cause of moderate VI (73.2%) and cataract was the leading cause of blindness (62.6%). ‘Cannot afford the cost of services’ was the leading barrier for utilization of eye care services (47%).ConclusionsThere is a significant burden of VI in weaving communities in Andhra Pradesh, India most of which is avoidable. With this information as baseline, services need to be streamlined to address this burden.

Efficacy and Intraoperative Characteristics of DisCoVisc for Cataract Surgery

Purpose: To compare the efficacy and intraoperative characteristics of DisCoVisc with those of Hyal 2000 (sodium hyalur- onate 1.0%) in cataract surgery. Methods: Cataract surgery was performed on 60 eyes in 49 patients who were diagnosed with moderate cataracts. 30 eyes were performed with DisCoVisc and a control group with 30 eyes using Hyal 2000 (sodium hyaluronate 1.0%). Phacodynamics was evaluated including ultrasound (US) time, mean US intensity, cumulative dissipated energy (CDE), and amount of used balanced salt solution. Corneal endothelium and corneal thickness were measured preoperatively and 1 day and 1 month and 2 months postoperatively. Results: There were no statistically significant differences in phacodynamic parameters in the two groups. The central cor- neal thickness change from preoperatively to postoperatively in the DisCoVisc group was +0.07 ± 2.44 μm and Hyal 2000 group +0.84 ± 2.93 μm (p = 0.032) at 2 months. Corneal endothelial cell loss (ECL)(%) at 2 months was 7.67 ± 8.01% in DisCoVisc group and 13.23 ± 15.5% in the Hyal 2000 group (p = 0.005). Conclusions: There was signicant difference between DisCoVisc and Hyal 2000 in the changes of CCT, ECD (Endothelial cell density). (DisCoVisc is effective and provides advantages both cohesive OVDs and dispersive OVDs). J Korean Ophthalmol Soc 2013;54(3):432-436

Combined Depth Imaging Technique on Spectral-Domain Optical Coherence Tomography

To describe a technique to obtain combined images of vitreoretinal and choroidal structures using spectral-domain (SD) optical coherence tomography (OCT) and to evaluate applicability in normal eyes and limitations in eyes with cataract. Prospective, observational case series. Three different foveal scans, including conventional SD OCT, enhanced depth imaging OCT and the novel method called combined depth imaging (CDI) OCT, were obtained in 42 eyes of healthy volunteers and in 26 eyes with cataract using the Heidelberg Spectralis HRA (Heidelberg Engineering). The CDI OCT images were obtained manually using an image modification process that enhances the vitreoretinal interface first and then the choroid, while averaging 100 separate OCT scans. The visualization of the inner border of the preretinal pocket and the outer border ofthe choroid was graded by independent masked observers for each OCT scan method. The CDI technique was able to create a good-quality combined image of the posterior structures in all the eyes, including eyes with cataract. The agreement between the grading performed by the independent observers was high for both the inner border of the vitreal pocket (κ, 0.86; P < .001) and the outer choroidal border (κ, 0.90; P < .001). CDI OCT was equivalent to conventional SD OCT in visualizing the vitreal pocket (P= .445 for normal eyes, P= .162 for eyes with cataract) and was equivalent to enhanced depth imaging OCT in visualizing the outer choroidal border (P= .660 for normal eyes, P= .329 for eyes with cataract). CDI OCT was superior to conventional SD OCT and enhanced depth imaging OCT in visualizing both of the structures (P < .001). The manual technique of CDI OCT is highly sensitive to visualize posterior vitreoretinal and choroidal structures into a single full-depth image and is not affected by mild to moderate cataract.

Outcomes of Pseudophakic Toric Intraocular Lens Implantation in Keratoconic Eyes With Cataract

To evaluate the outcomes of pseudophakic toric intraocular lens (IOL) implantation in eyes with stable keratoconus and cataract. Retrospective, noncomparative, case series of 12 eyes from 9 patients (mean age: 63.4±3.5 years) with stable mild to moderate keratoconus and cataract who underwent pseudophakic toric IOL implantation (AT TORBI 709M, AcriTec). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, keratometric findings, adverse events, and postoperative complications were recorded for all eyes. Mean postoperative follow-up was 9.0+8.8 months. At last postoperative follow-up, UDVA was 20/40 or better in 75% and CDVA was 20/40 or better in 83.3% of eyes. Postoperative mean refractive sphere (pre- vs postoperative: -4.80±5.60 vs 0.30±0.50 diopters [D]) and cylinder (pre- vs postoperative: 3.00+1.00 D vs 0.70+0.80 D) were significantly better (P<.01 for both). No intra- or postoperative complications occurred. No eyes had progression of keratoconus or significant IOL rotation at postoperative follow-up. Pseudophakic toric IOLs are an effective option and provide good vision in eyes with stable mild to moderate keratoconus and cataract.

Trench, lollipop, lift and chop technique for mild to moderate cataracts

No abstract available.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6561 Nepal J Ophthalmol 2012; 4 (2): 344-345

Comparison of bimanual and micro‐coaxial phacoemulsification with torsional ultrasound

To evaluate the efficacy and postoperative outcomes of bimanual and micro-coaxial phacoemulsification with torsional ultrasound. In this prospective randomized series, eyes with age-related cataract were randomly divided into bimanual phacoemulsification and micro-coaxial phacoemulsification groups. Data included preoperative and postoperative corrected distance visual acuity (CDVA), central/temporal corneal thickness, endothelial cell density and intraoperative ultrasound time, cumulative dissipated energy and balanced salt solution volume. The study evaluated 89 patients (89 eyes). When compared between micro-coaxial and bimanual phaco groups, ultrasound time (57 ± 24 second versus 85 ± 40 second, p < 0.01), cumulative dissipated energy (10 ± 7 versus 14 ± 7, p = 0.01) and balanced salt solution volume (55 ± 19 ml l versus 75 ± 20 ml, p < 0.01) were significantly lower in micro-coaxial phaco group. At 1 day, there were no statistically significant differences in CDVA (p = 0.68) or central corneal thickness (p = 0.48) between two groups; temporal corneal thickness was statistically significantly thicker in bimanual phaco group (1247 ± 123 μm) than that in micro-coaxial phaco group (1108 ± 131 μm, p = 0.01). There were no statistically significant differences in CDVA, central/temporal corneal thickness, or endothelial cell density between two groups 30 days postoperatively (all p values >0.05). With rapid visual rehabilitation and comparable endothelial cell loss, both bimanual and micro-coaxial phacoemulsification procedures with torsional ultrasound are efficient for moderate nuclear cataract extraction.

Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study

AimsTo evaluate the long-term efficacy and safety of combined cataract surgery and Glaukos iStent implantation for coexistent open-angle glaucoma and cataract.MethodsProspective, non-comparative, uncontrolled, non-randomised, interventional case series study. Subjects older...