Ophthalmic Viscoelastic Device Research Articles

SMARTQCAn Easy Way to Prevent Velocity-Related Complications During Dexamethasone Implant Injection in Vitrectomized Eyes.

To assess the impact of inserting an ophthalmic viscoelastic device (OVD) into the dexamethasone (DEX) implant needle on pellet velocity in simulated vitrectomized eyes. DEX implants were injected into a calibrated ex vivo test chamber filled with balanced salt solution (BSS). All DEX implants were administered by the same physician and aiming for the same button depression time. In Group 1, three DEX implant injections were performed without an OVD, while in Group 2, the OVD was safely inserted into the DEX implant needle using a 27-gauge cannula just prior to injection. The slow-motion video mode of the IPhone 14 was utilized to record the procedures and calculate time and distance measurements. Group 1 exhibited a mean velocity of 450 mm/sec for the DEX pellet in BSS, compared to 54.57 mm/sec in Group 2. Furthermore, DEX pellets in Group 1 had horizontal displacements of 24, 29, and 31 mm, while those in Group 2 had displacements of 17, 16, and 15 mm. Injecting OVD into the DEX implant needle significantly decreases the velocity of the free pellet in BSS by 87.87%. This modification may help prevent potential velocity-related complications linked to DEX implantation in vitrectomized eyes.

The impact of temperature on Ophthalmic Viscoelastic Devices and clinical implications - a pilot study: Temperature effect on Ophthalmic Viscoelastic Devices.

To evaluate how temperature impacts the rheology of common Ophthalmic Viscoelastic Devices (OVDs) and clinical implications. Tennent Institute of Ophthalmology, Glasgow, with Department of Mechanical and Aerospace Engineering, and Advanced Materials Research Laboratory, University of Strathclyde, Glasgow, UK. Laboratory pilot study. The viscous and elastic responses of three OVDs (Eyefill-SC/Eyefill-C/Eyefill-HD; Bausch & Lomb) were measured using rotational and extensional rheometers at clinically relevant temperatures (5°C, 25°C, 37°C). Thermal properties were evaluated using differential scanning calorimetry and laser-flash analysis. The OVDs tested exhibited viscoelastic properties and shear-thinning behaviour. Apparent viscosities and relaxation time were higher at lower temperatures. The Eyefill-C and Eyefill-SC exhibited predominantly viscous character at low frequencies with a transition to predominantly elastic behaviour at high frequencies. An increase in temperature led to a decrease in relaxation time under shear and extension. At low frequencies, Eyefill-C and Eyefill-SC moduli increase with decreasing temperatures. Eyefill-HD at 25°C and 37°C displays two cross-over points, with the storage modulus dominating at low and high frequencies indicating a predominantly elastic behaviour. Thermal property analysis revealed Eyefill-C had the lowest thermal conductivity. This pilot study confirms our clinical experience that OVD properties are affected by low temperatures, with increased viscosities at low shear rates and higher relaxation times.Cold OVD can cause greater resistance to initiation of IOL injection system forces (compared to warmer OVD). Excessively forced injection using cold OVD could contribute to inadvertent cannula detachment if incorrectly assembled, or uncontrolled IOL release leading to avoidable injury.

Automated Capsular Decompression to Avoid Argentinian Flag Sign in Intumescent Cataract.

We describe an alternative automated technique that consists of simultaneous anterior capsule puncture and decompression of the capsular bag by using an insulin needle attached to the aspiration tubing of the phacoemulsification device to prevent the occurrence of the "Argentinian Flag sign" during capsulorhexis in intumescent cataract. Instituto de Olhos de Assis and Center of Specialties Hoftalmed, located in the state of São Paulo, Brazil. Prospective interventional study. Eighty-eight eyes of 88 patients with white or intumescent cataracts were included in this study. Routine clear cornea incision, capsule staining with trypan blue, intracameral anesthesia, and ophthalmic viscoelastic device were used before the procedure. A 26-gauge needle was connected to the phacoemulsification aspiration tubing using a double male Luer connector for irrigation, and aspiration was inserted into the anterior chamber through a new paracentesis incision with the bevel facing down. Immediately after insertion, automated aspiration of the liquefied cortex was performed to remove anterior intralenticular material and achieve capsular decompression. Compression of the nucleus with the needle tip was performed to remove any liquefied material trapped between the posterior surface of the nucleus and the posterior capsule. All surgeries were performed using the same phacoemulsification and parameters. The rate of complete continuous capsulorhexis was observed and noted. No complications were observed in any of the cases. A single-stage, continuous, and well-centered capsulorhexis was achieved in 100% of cases. We conclude that a simultaneous puncture and decompression of the capsular bag using an insulin needle attached to the aspiration tubing of the phacoemulsification machine effectively avoided the "Argentinian Flag sign" in intumescent cataract surgery.

Intraocular pressure before and after capsulorhexis using two viscoelastic substances and two surgical approaches in enucleated porcine eyes.

To investigate the influence of ophthalmic viscoelastic devices (OVDs) and different surgical approaches on the intraocular pressure (IOP) before and after creation of the curvilinear circular capsulorhexis (CCC) as a measure for anterior chamber stability during this maneuver. Prospective experimental WetLab study carried out on enucleated porcine eyes. IOP was measured before and after CCC with the iCare Rebound tonometer (iCare ic200; iCare Finland Oy, Vantaa, Finland). The OVDs used were a cohesive one [Z-Hyalin, Carl Zeiss Meditec AG, Germany; hyaluronic acid (HA)] and a dispersive [Z-Celcoat, Carl Zeiss Meditec AG, Germany; hydroxy propylmethylcellulosis (HPMC)]. The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs. Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC. The use of different OVDs made no difference. Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg. The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used. Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes. The use of different OVD has no significant influence on IOP drop.

Phacoemulsification Cataract Surgery without Ophthalmic Viscoelastic Devices: A Randomized Controlled Trial

Phacoemulsification Cataract Surgery without Ophthalmic Viscoelastic Devices: A Randomized Controlled Trial

Retrospective Analysis of a New Intrastromal Dissection Technique Using the Retinal Reflex for Deep Anterior Lamellar Keratoplasty.

The purpose of this study was to describe a new surgical technique for deep anterior lamellar keratoplasty. All pupils in the recipient eyes were dilated preoperatively. Vertical grooving was performed using a crescent blade with a width of 5 mm and a depth of one-third to half corneal thickness on the temporal side of the limbus. Stromal dissection was performed as close as possible to Descemet membrane by observing the gap between the gold line by retinal reflex and the front edge of the crescent blade. Lamellar dissection was performed along the lamellar plane using corneal dissectors. The ophthalmic viscoelastic device was injected into the intrastromal pocket to separate the anterior and posterior stroma and an anterior corneal lamella was excised. A donor cornea was sutured into the recipient bed. In 18 eyes, none of the patients had Descemet membrane rupture during surgery. The mean postoperative residual stromal thickness was 80 ± 31 μm. The mean central corneal thickness after surgery was 660 ± 69 μm. At the last follow-up, the cornea was cleared in all 18 eyes on slit-lamp examination. We estimated the residual stromal thickness based on the gap between the gold line by the retinal reflex and crescent blade, and intrastromal lamellar dissection was performed using a smooth corneal dissector. Consequently, the surface of stromal dissection was smooth, and the residual stromal thickness was even.

Comparisons of the clinical outcomes of Centurion® active fluidics system with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density

BackgroundDuring cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than the gravity fluidics system. In this randomized controlled trial, we compared these two systems’ damage to the cornea under different IOP settings.MethodsSeventy-eight eyes of 53 patients with corneal endothelial cell density (ECD) of 500∼1500/mm2 were enrolled and randomly divided into the active fluidics system (AFS) group using an Active Sentry handpiece with 30 mmHg IOP setting (40 eyes) and the gravity fluidics system (GFS) group using an Ozil handpiece with 80 cmH2O IOP setting (38 eyes). Intraoperative parameters, visual acuity, corneal edema ratio, central corneal thickness (CCT) changes as well as loss rate of ECD were analyzed.ResultsWe observed no significant differences in best corrected visual acuity (BCVA), cumulative dissipated energy (CDE), total case time, estimated fluidics usage (EFU) and ophthalmic viscoelastic devices (OVDs) usage between the two groups. The enrolled eyes were further divided into soft nucleus (27 eyes) and hard nucleus (51 eyes) subgroups. And we found less pain complaint during surgeries, lower corneal edema ratio at 1-day and 1-week visit, smaller CCT changes at 1-day visit and lower ECD loss rate at 1-month visit (p < 0.05) in both subgroups of the AFS group than in the GFS group, implying higher intraoperative comfort levels and less corneal damage of the AFS group with a low IOP setting.ConclusionOwing to a lower IOP setting, Centurion® Vision System with Active Sentry handpiece causes less corneal damage and pain perception during phacoemulsification for patients with low pre-operative ECD.Clinical Trial Registrationhttps://www.chictr.org.cn, identifier ChiCTR2300077865.

Physical Characteristics, Clinical Application, and Side Effects of Viscoelastics in Ophthalmology.

To explain the physical properties of ophthalmic viscoelastic devices (OVDs), covering their structural units, optimal features, existing viscoelastic materials, clinical applications, and potential side effects. This is a narrative review on the OVDs. A literature review was conducted in PubMed, Google Scholar, and Scopus databases. Studies that investigated physical characteristics, clinical applications, OVD commercial products, and their complications were included. We included 42 articles from 2010 and discussed physical characteristics, properties of a desirable OVD, structural units of common OVDs, OVD commercial products, clinical applications, and also complications of OVDs. Today, viscoelastics hold a distinct and crucial role in intraocular surgery due to their remarkable properties. These materials safeguard the endothelium and epithelium, uphold anterior chamber depth, manage intraocular bleeding, ease tissue handling, and aid intraocular lens placement. Currently, the American market features 12 prevalent viscoelastic types, including 7 sodium hyaluronate derivatives (Healon, Healon-Greater Viscosity, Healon-5, Amvisc, Amvisc Plus, Advanced Medical Optics Vitrax, and Provisc), 2 hydroxypropyl methylcellulose 2% derivatives (OcuCoat and Cellugel), and 3 combinations of sodium hyaluronate and chondroitin sulfate (Viscoat, DisCoVisc, and DuoVisc). Despite the introduction of new viscoelastic materials annually, no single material encompasses all desired properties. Surgeons must select and employ suitable viscoelastics based on surgical conditions and patient requirements. Advancements in material development and understanding of physical properties and clinical applications continue to refine viscoelastic selection.

Internal limiting membrane flap with viscoelastic device for lamellar hole surgery with no postoperative positioning.

To propose a novel technique of an internal limiting membrane (ILM) flap using ophthalmic viscoelastic device (OVD) with no requirement for postoperative head posture for the treatment of lamellar macular hole (LMH) repair. A retrospective analysis of 16 consecutive eyes of LMH patients who underwent vitrectomy with ILM flap with OVD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), simultaneous cataract extraction, and ellipsoid zone disruption preoperatively and at the final follow-up were compared. The mean age was 73.19 ± 7.26 years, and ten patients (62%) were females. The mean follow-up was 5.06±1.43 months (range 3-6). For all patients, BCVA was significantly improved at the final visit, from 0.65±0.36 logMAR units to 0.42±0.29 (p < 0.001). None of the patients had visual loss. Six patients had epiretinal membrane (ERM) foveoschisis, and the rest had LMH with epiretinal proliferation. Both subgroups presented a significant improvement in their BCVA with a trend for better improvement in the latter (p=0.09). Ellipsoid zone disruption was seen in 7 patients including one patient with a macular scar. There was no significant effect of ellipsoid zone disruption on the final BCVA (p=0.33). Twelve eyes (75%) underwent simultaneous cataract extraction. Mean BCVA at the final postoperative visit improved regardless of whether the eyes underwent simultaneous cataract surgery (p=0.39). CMT was also significantly improved at the final visit, from 200.06±46.8 μm preoperatively to 305.00±85.5 μm (p<0.001). No full-thickness macular holes were developed postoperatively. No intraoperative or postoperative complications were observed. Treatment of LMH with ILM flap with OVD showed promising anatomical and functional results with no postoperative head position requirements.

Intraocular Lens Unfurling Time Exponentially Decays with Increased Solution Temperature.

Intraocular lens (IOL) unfurling can be a rate-limiting step in cataract surgery, limiting operative efficiency. Furthermore, inefficient unfurling has important implications for clinical outcomes. We examine the effects of solution temperature on IOL unfurling time using three in vitro models of the ocular environment. IOLs were injected into a 6-well plate filled with balanced salt solution (BSS), dispersive ophthalmic viscoelastic device (OVD), or cohesive OVD. Experiments were also performed in a plastic eye filled with dispersive or cohesive OVD. IOL unfurling time was recorded against the temperature of the respective solution. IOL unfurling time decayed exponentially as solution temperature increased in all experiments, including the BSS-filled 6-well plate, the OVD-filled 6-well plate, and the OVD-filled plastic eye. IOLs failed to unfurl within 10 min at 10°C, below the glass transition temperature of the tested IOLs. Increasing solution temperature from 20°C to 30°C decreases IOL unfurling by greater than 2 min. Further heating to 40°C did not significantly decrease IOL unfurling time. Increased solution temperature rapidly decreases IOL unfurling time in vitro. IOLs do not unfurl within a clinically acceptable timeframe at or below their glass transition temperature. Increased BSS and/or OVD temperature may be a potential method to decrease IOL unfurling time in cataract surgery. However, future research is needed to elucidate potential consequences of warmed BSS and/or OVD on post-operative outcomes. This study demonstrates the potential for temperature regulation to decrease cataract surgery operative time and provides preliminary evidence to justify future clinical validation of this relationship.

Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery.

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.

Surgical Tips for Improving Success Rate of Deep Anterior Lamellar Keratoplasty in Keratoconus

This article aims to provide some personal surgical tips to increase the success rate of deep anterior lamellar keratoplasty (DALK), a very advantageous yet complex procedure for treating keratoconus. The most troublesome surgical step is obtaining a successful pneumatic dissection of the deep stromal tissue, allowing the exposure of a deep cleavage plane. The following tips may aid the trainee surgeon in mastering this step, among others: performing a deep trephination, using intraoperative anterior segment optical coherence tomography and/or femtosecond laser, exploiting the red reflex after pupil dilation, using the ophthalmic viscoelastic device in case of bubble formation failure. Approaches for reducing postoperative astigmatism are employing large-diameter grafts and using intraoperative keratoscopy with digital ring analysis. In conclusion, different tips can shorten the DALK learning curve and help to obtain better results from this surgery. Standardizing this surgical technique is paramount to reduce "human errors" and broaden its range of applicability.

Different strokes for anterior capsulorhexis in pediatric cataract.

A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue-rhexis), or by coaxial illumination (4. Coaxial-rhexis) or by just the sheen of capsule (5. Sheen-rhexis). The anterior chamber can be maintained using ophthalmic visco-elastic device (Visco-rhexis) or by irrigation fluid (6. Hydro-rhexis). A speed-breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque-rhexis) or by a vitrector (vitrectorhexis) or a pair of micro-scissors (8. Scissor rhexis). Above all, the technology of femto-second-laser-assisted (9. Femto-rhexis) and zepto-pulse-precision capsulotomy (10. Zepto-rhexis) is also illustrated. This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery. https://youtu.be/TgDrk5RYdbI.

OPHTHALMIC VISCOSURGICAL DEVICES

Ophthalmic viscoelastic devices (OVDs) are recently used in cataract surgery and have expressivelyupgraded the safety and effectiveness of this surgical procedure. OVDs create and maintain anterior chamber depth and visibility, protecting the corneal endothelium and other intraocular tissues during surgery. The selection of the most adequate OVD is especially relevant when performing cataract surgery in challenging cases, such as in hard, mature cataracts, flat anterior chamber, pseudoexfoliation syndrome, intraoperative floppy iris syndrome, or glaucoma surgery. In such cases, OVD is crucial for facilitating the surgical procedure and the associated minimal complication rate. The use of a combination of OVDs (soft-shell technique and modifications), the use of blue-colored. OVDs, and the combination of sodium hyaluronate with lidocaine have also been described as useful tools in some of these challenging cases.

Inadvertent Viscoelastic Separation of the Pre-Descemet (Dua) Layer in Deep Anterior Lamellar Keratoplasty With Structural Features Revealed by Polarization Microscopy.

Deep anterior lamellar keratoplasty (DALK) is a corneal transplant technique that removes the host stroma down to either the pre-Descemet (Dua) layer or Descemet membrane. It is most common for the big bubble technique to create a cleavage plane between the posterior stroma and the pre-Descemet layer. This is advantageous because the pre-Descemet layer has been found to be much stronger than Descemet membrane, and makes the procedure easier to perform. In this report, we present an uncommon viscoelastic-related complication of DALK that resulted in excising the pre-Descemet layer and allowing it to be studied using polarization microscopy. DALK was performed using a standard big bubble technique. Postoperatively, a double anterior chamber was found to have been created by the inadvertent passage of an ophthalmic viscoelastic device (OVD) through the pre-Descemet layer. This resulted in the OVD being trapped between the pre-Descemet layer and Descemet membrane. The pre-Descemet layer was then resected in a subsequent operation. The pre-Descemet layer and posterior stroma were studied by polarization microscopy using Sirius Red histochemical staining to elucidate the orientation of the collagen fibers. The pre-Descemet layer is composed of lamellar arrays of collagen that have consistent polarization properties within each layer but show variable polarization of the strands, indicative of anisotropic strand orientation. The degree of variable polarization of the pre-Descemet layer is distinct from the overlying posterior stroma. Injecting an OVD into a big bubble in DALK may result in it being trapped between the pre-Descemet layer and Descemet membrane. The pre-Descemet layer shows alternating layers of varying polarization of collagen. This anisotropic structure helps explain the basis for the additional strength that the pre-Descemet layer is known to have.

Evaluation of the Rheological Properties, Preclinical Safety, and Clinical Effectiveness of a New Dispersive Ophthalmic Viscoelastic Device for Cataract Surgery.

PurposeTo evaluate the rheological properties of the ophthalmic viscoelastic device (OVD) PRO-149, its preclinical safety, and its effectiveness when used during cataract surgery in patients with age-related cataract.Material and MethodsControl (HEC) and test (PRO-149) OVDs were compared through rheological measures, by two preclinical safety studies in rabbits, and under normal-use conditions during cataract removal and lens implantation in a parallel randomized clinical trial.ResultsRheological properties were determined. Preclinical studies did not find any evidence of safety issues or toxicity. In the clinical trial, 36 subjects were included. After 29 days, there were no statistically significant differences in mean percentage of endothelial cell count change or in the postoperative intraocular pressure between groups. There were no significant differences between OVDs for any safety parameter studied. Finally, PRO-149 showed a statistically significant improvement in surgeon rating for ease of use during extraction (p < 0.05).ConclusionPRO-149 is a dispersive OVD. The rabbit models did not find evidence of clinical alterations or toxicity. The results of the clinical study support that the two studied OVDs were clinically similar in terms of safety and effectiveness for cataract surgery.Trial RegistrationThe trial is registered at Clinical Trials.gov at NCT04702802 (21–01-11).

A Novel Tube Insertion Technique for Glaucoma Drainage Device Implantation.

Early hypotony after non-valved glaucoma drainage device (GDD) implantation for complex glaucomatous eyes with labile aqueous production can lead to significant visual morbidity. We therefore sought to report the early postoperative outcomes of a novel surgical technique that allows atraumatic insertion of non-valved GDDs through a much smaller 25-gauge scleral track, to minimize entry site leakage and improve safety. Retrospective case series of 15 consecutive cases undergoing non-valved GDD insertion into the anterior chamber using a previously unreported technique. All eyes underwent successful GDD insertion using our novel technique, with no intraoperative complications. The mean preoperative intraocular pressures (IOP), at day 1, week 1 and week 3 were 31.4, 22.4, 23.7, and 25.6 mm Hg, respectively. A statistically significant IOP reduction was achieved at day 1, week 1 and week 3 postoperatively ( P <0.05) without any observed leakage at the scleral entry site. One eye (6.7%) with complex panuveitic glaucoma developed early hypotony (5mm Hg) with shallow choroidal detachments on day 1. This was successfully managed with 1 intracameral ophthalmic viscoelastic device injection given at the slit-lamp and no further intervention. This novel single needle-docking intraocular insertion manoeuvre is an easily adoptable technique to make GDD insertion through a smaller 25-gauge water-tight scleral track more efficient and less traumatic. The technique reduces scleral distortion and therefore improves surgical safety particularly in eyes with complex secondary glaucoma.

Silicone oil migration into the anterior chamber in a phakic eye

We describe a novel technique to manage silicone oil (SO) migration into the anterior chamber (AC) in a phakic eye. A 57-year-old female patient underwent right lens-sparing pars plana vitrectomy for diabetic tractional retinal detachment with SO tamponade. Postoperatively, a large bubble of SO was detected in the AC. The case was managed with the intraoperative displacement of the SO bubble using an ophthalmic viscoelastic device, phacoemulsification, and insertion of a capsular tension ring with an opening directed toward 6 o'clock position. The insertion of the capsular tension ring in this particular position prevented further migration of SO into the AC.

Impact of Phacoemulsification Cataract Surgery to Number of Corneal Endothelial Cells: A Descriptive Study

The main optical structure of the eyes is the lens and corneal because lens with the cornea, focuses image of the visual world onto the retina. Both of the main optical structure is affected by age, it affects the corneal endothelial cells and transparency of the lens. By aging the corneal endothelial cells decrease and the lens loses its transparency then the cataract appears [1,2]. it is known that cataract surgery effecting the corneal endothelial cells number. The surgery will be decreasing the corneal endothelial cells number. The severity to which endothelium is affected depends on many factors, such as phacoemulsification time and energy, surgical technique, anterior chamber depth, and use of ophthalmic viscoelastic devices (OVDs) [3]. A total of 52 people with cataracts were enrolled in this descriptive investigation. The study is included 52 eyes. Ages ranged from 43-77 years, with a mean age of 57,7 years. From this study 59,6% were men and the rest are women, which 79% were diagnosed with immature cataract, and 21% were diagnosed with mature cataract. It was found that 86,5% of eyes experienced a decrease in the number of corneal endothelial cells after cataract phacoemulsification surgery. The mean of corneal endothelial density pre surgery is 3126 cells/mm2 ± 246,1 and the mean of corneal endothelial density post-surgery is 3029 cells/mm2. The range of surgery time is 6-30 minutes. With the mean time of surgery 13,7 ± 5,8 minutes. From 52 eyes there are 45 eyes with corneal endothelial cells loss 7 days after surgery, with the mean of corneal endothelial cells loss after cataract phacoemulsification surgery are 152,3 ± 68 cells/mm2, the percentage mean was 6%, and we found decreasing in central corneal thickness, corneal endothelium density, hexagonality and increasing coefficient of variety.

Severe Intraocular Pressure Fluctuation following Hemodialysis after Cataract Surgery in a Patient with Chronic Renal Failure

Purpose: To report a case of severe intraocular pressure fluctuation following hemodialysis after cataract surgery in a patient with chronic renal failure.Case summary: A 51-year-old female patient on hemodialysis for chronic renal failure, who was seen regularly by our retina clinic for proliferative diabetic retinopathy and right eye cataract, presented with decreased visual acuity in her right eye. During phacoemulsification under the diagnosis of right eye cataract, zonular dialysis and posterior capsule rupture occurred and intraocular lens ciliary sulcus insertion was performed. Following hemodialysis 3 days after the surgery, the patient complained of headache and right eye pain. The intraocular pressure of the right eye had increased to 44 mmHg. Mild inflammation in the anterior chamber was found with remnant lens material present at the inferior anterior angle. The use of glaucoma eye drops, anterior chamber paracentesis, and anterior chamber irrigation reduced the intraocular pressure and improved the patient’s symptoms. However, a severe increase in intraocular pressure recurred with the above symptoms, again following hemodialysis. Intraocular pressure fluctuation was repetitively present after serial hemodialysis treatments for 1 month, at which point cataract and glaucoma surgeries were considered. However, the intraocular pressure stabilized afterwards; thus, the patient remained under observation and was treated with glaucoma eye drops.Conclusions: Inflammation and a decrease in the aqueous outflow facility due to remnant lens material and the use of an ophthalmic viscoelastic device in cataract surgery may cause severe intraocular pressure fluctuations in patients undergoing hemodialysis for chronic renal failure.