Phaco Power Research Articles

Particularities of Cataract Surgery in Elderly Patients: Corneal Structure and Endothelial Morphological Changes after Phacoemulsification.

The aim of this study was to evaluate the influence of ultrasounds used in phacoemulsification during cataract surgery on the corneal structure and morphology in patients over 65 years. We compared the outcomes of phacoemulsification techniques in terms of corneal cell morphology in 77 patients over 65 years old and 43 patients under 65 years old. Corneal cell density, central corneal thickness and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of gender, axial length and anterior chamber depth on the parameters of corneal endothelium were evaluated. In both groups, a progressive decrease in endothelial cells was observed, starting from the first week post-surgery until the fourth postoperative week. The central corneal thickness increased in both groups with maximum values at the first week postoperatively, while their initial values were restored in the fourth week post-surgery, with no statistical difference between groups. Statistically significant differences were noticed in terms of cell hexagonality in the group over 65, showing smaller hexagonality at all preoperative and postoperative time points compared to group under 65. Our result highlights the importance of routine specular microscopy performed before surgery, regardless the age of the patients, with caution and careful attention to the phaco power intensity, ultrasound energy consumption and intraoperative manipulation of instruments, as well as proper use of viscoelastic substances to reduce corneal endothelium damage, especially in elderly patients.

CHOPPING METHODS IN APPROACHING HARD CATARACT: OPTIONS AND RECOMMENDATION

Abstract
 Introduction & Objectives : Mature cataracts with hard-nuclear and soft-nuclear cataracts were different in their anatomical features and their management approach. Degeneration of zonules, loss of capsule and cortical liquefaction are often found in hard cataracts. Therefore, different approaches are required in this condition. Chopping methods have several advantages in managing the nucleus which plays a major part in cataract surgery. It lessened phaco power which minimized endothelial damage. The risk of intraoperative zonular dehiscence may also be lowered with chopping methods. Several chopping methods are widely accepted in approaching hard cataracts such as vertical chop, horizontal chop, crater and chop, drill and chop, stop and chop, and multilevel chop. Burst mode which requires high vacuum and power to chop and flow rates must be adequately comprehended by the surgeon in achieving the optimal result. This review discussed chopping methods in cataract surgery.
 Methods : Several chopping methods are widely accepted in approaching hard cataracts such as vertical chop, horizontal chop, crater and chop, drill and chop, stop and chop, and multilevel chop.
 Results : Burst mode which requires high vacuum and power to chop and flow rates must be adequately comprehended by the surgeon in achieving the optimal result.
 Conclusion : This review discussed chopping methods in cataract surgery.

Comparison between Early Clinical Results of Dual-Linear and Conventional Foot-Pedal Control in Phacoemulsification

Background: The aim of this study was to compare early clinical results regarding the safety and efficacy of dual-linear vs. conventional foot-pedal control in cataract surgery. Methods: This was a paired-eye contralateral, retrospective, observational study. Each patient underwent cataract surgery in both eyes: one eye with dual-linear foot-pedal control (study group) and the other eye with conventional foot-pedal control (control group). Absolute phaco time (APT), average phaco power, effective phaco time (EPT), and surgical complications were analyzed and compared. Corneal endothelial cell count, corneal thickness, corneal volume, and best-corrected distance visual acuity (BCDVA) were measured preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results: A total of 94 patients (188 eyes) were enrolled. The respective APT, average phaco power, and EPT values were 7.05 ± 5.31 s, 28.4 ± 1.00, and 2.05 ± 1.56 s in the study group and 6.82 ± 6.48 s, 18.9 ± 1.74, and 1.35 ± 1.35 s in the control group. Conclusions: The average phaco power and EPT values were significantly higher in the study group. The safety of the dual-linear foot pedal was comparable to that of a conventional pedal in terms of endothelial cell loss, central corneal thickness, and surgical complications.

Comparison of dominant- and non-dominant-hand cateract surgery outcomes by a single surgeon

PurposeTo compare dominant and non-dominant hand phacoemulsification surgery outcomes. MethodsThis retrospective, single-center study included 300 patients who underwent phacoemulsification surgery by a single, right-handed surgeon. The patients were divided into two groups according to whether the surgeon used his dominant or non-dominant hand during surgery. Right eye operations were performed with the right hand, and left eye operations were performed with the left hand. Detailed ophthalmological examinations were performed on all patients preoperatively and postoperatively. Intraoperative phacoemulsification parameters, the presence of intraoperative and postoperative complications, postoperative refractive errors, visual acuity, and surgically induced astigmatism values were compared between the groups. ResultsThere were 171 patients in the dominant hand phacoemulsification group and 129 patients in the non-dominant hand phacoemulsification group. The distributions of age, gender, systemic diseases, and lens opacification were similar between the groups (p>0.05, for all). No statistically significant difference was observed between the two groups in terms of total operation time, phaco power, ellips fx, or ultrasonic time (p>0.05, for all). There was also no significant difference in relation to intraoperative and postoperative complication distributions, postoperative third-month refractive errors, visual acuity, or surgically induced astigmatism values (p>0.05, for all). ConclusionThis study demonstrated that cataract surgery performed by a single surgeon can be effectively and safely performed using both hands on patients in a real operating theater environment. More objective results can be obtained with surgeries performed by a larger number of experienced surgeons.

Simulation of fluid dynamics and turbulence during phacoemulsification using the new propeller turbo tip

PurposeTo investigate the fluid dynamics and turbulence in the anterior chamber during phacoemulsification with a new propeller turbo tip using computational fluid dynamics methods.MethodsA theoretical study, three-dimensional model with the...

Preferred practice of cataract surgery in brown cataract: A questionnaire-based survey among Indian ophthalmic surgeons.

To determine the most preferred method of operating brown cataracts among ophthalmologists in India. A cross-sectional, questionnaire-based study was conducted among ophthalmologists all over India through electronic and social media from May 1 to June 15, 2022. All single, voluntary entries within the stipulated time period were accepted for analysis. A total of 230 ophthalmologists participated in the study among which 198 (86%) preferred Manual small-incision cataract surgery (mSICS) as the first option. This was preferred due to the high risk of complications associated (40, 33.6%) as well as endothelial damage due to increased Phaco power (53, 47.9%). The majority of the surgeons (162, 70.4%) preferred a superior tunnel for SICS, and 51.7% (119) performed continuous curvilinear capsulorhexis in 100% of their cases. The most common complication encountered was posterior capsular rupture (PCR) (66%), followed by zonular dialysis (ZD) (18.7%), whole bag removal (8.3%), and Descemet's membrane detachment (7%). Despite diverse recent new modalities of Femto Laser assisted cataract surgery (FLACS). Phakonit, and Smart Intraocular Lens (IOLs), the majority of ophthalmologists still find the manual small-incision cataract surgery (mSICS) procedure a safe surgery for mature brown cataracts.

Postoperative Corneal Edema After Phacoemulsification

Aim: To determine the effect of nuclear opalescence (NO) on intraoperative parameters during phacoemulsification using the WhiteStar Signature® PRO and to show the impact of preoperative and intraoperative parameters on postoperative corneal edema.Methods: This prospective study included 267 patients selected to undergo phacoemulsification using the WhiteStar Signature® PRO system at the Department of Ophthalmology of the General Hospital “Dr Josip Benčević”, Slavonski Brod, Croatia. NO was graded using the Lens Opacities Classification System III. Preoperative parameters were age, sex, NO and preoperative central corneal thickness. Intraoperative parameters of phacoemulsification included in the study were ultrasound time (UST), phaco time using Ellips FX technology (EFX) and average phaco power (AVG). Patients were followed up on postoperative days 1 and 7 and after two months. The state of the cornea was noted in each follow-up.Results: There was a statistically significant increase of intraoperative parameters with NO. Postoperative corneal edema depended on all measured intraoperative parameters (UST, EFX and AVG, all p < .001), patient’s age (p < .05) and NO (p < .001) on postoperative day 1, while on postoperative day 7, it depended on UST (p = .011) EFX (p = .012) and NO (p < .05).Conclusion: Older patients, higher grade of NO and amount of energy consumed during phacoemulsification using the WhiteStar Signature® PRO are predictive factors for severity of transient corneal edema. We found this information important for better preoperative planning of phacoemulsification, as well as for better postoperative results.

Efficacy of Balanced Torsional Phacoemulsification Tip for Cataract Surgery.

Purpose:To compare the efficacy of the Intrepid® Balanced torsional phacoemulsification tip to that of the 30° Ozil® and 45° Kelman® tips using Centurion Vision System.Methods:This study included 150 eyes that underwent torsional phacoemulsification surgery using 30° Ozil® tip (Group 1, 48 eyes), Intrepid® Balanced tip (Group 2, 52 eyes), or 45° Kelman® tip (Group 3, 50 eyes). Ultrasound time (UST), cumulative dissipated energy (CDE), average phaco power, average torsional amplitude, balanced salt solution volume, aspiration and operation time, and preoperative, postoperative corrected distance visual acuity, central corneal thickness were recorded.Results:The mean UST, CDE, average phaco power, average torsional amplitude were 49.9 ± 15.7 s, 10.8 ± 4.5%-s, 23.9 ± 4.6%, and 51.4 ± 5.7% in the Ozil® group and 47.5 ± 10.6 s, 5.3 ± 2.2%-s, 12.5 ± 5.3%, and 28.9 ± 7.2% in the Intrepid® Balanced group, and 48.1 ± 12.7 s, 6.9 ± 3.3%-s, 18.9 ± 5.9%, and 39.2 ± 7.9% in the Kelman® group, respectively. The CDE, average phaco power, and average torsional amplitude of the Intrepid® Balanced group were significantly lower than other groups (P < 0.05). There was no statistically significant difference between the three groups in terms of UST and operation time (P > 0.05).Conclusion:Intrepid® Balanced tip, by means of its distinctive “double bent” design and balanced energy distribution, offers more effective phacoemulsification compared to conventional 30° Ozil® and 45° Kelman® tips.

Assessment of subfoveal choroidal thickness after uneventful phacoemulsification in diabetic patients

Background Phacoemulsification is an intraocular surgery that may worsen preexisting retinal diseases by inducing inflammation in the posterior segment of the eye. It is related to interleukin-1β expression and genes’ upregulation in both retina and choroid. Choroid imaging with enhanced depth imaging (EDI) facilitated choroidal thickness measurement. Aim The aim was to assess the changes in subfoveal choroidal thickness following uncomplicated phacoemulsification in diabetic patients − without retinopathy − using EDI of spectral-domain optical coherence tomography. Patients and methods This prospective observational study included 60 eyes of 60 patients who underwent cataract extraction by phacoemulsification, subdivided into two groups, the first group was 30 eyes of patients had diabetes with no retinopathy, the second one was 30 eyes of nondiabetic healthy patients as a control. Using EDI-spectral-domain optical coherence tomography, subfoveal choroidal thickness (SFCT) was evaluated 1 week preoperatively and 1 month postoperatively. Results The mean age of both groups was 59.033±9.072 and 58.200±8.235, respectively. In group I, mean preoperative SFCT was 194.600±27.523 µm and 1 month postoperatively was 207.100±27.530 µm. In group II, mean preoperative SFCT was 191.233±17.520 µm and 1 month postoperatively was 193.133±17.085 µm. Regarding operative time and phaco power, in group I, mean time was 12.583±2.051 min and mean power was 28.900±12.645%, whereas in group II, mean time was 11.667±1.845 min and mean power was 22.333±7.849%. Conclusion Phacoemulsification induces nonsignificant nonpathological increase in SFCT with the presence of diabetes as a systemic disease but without local diabetic changes in the eye; however, a significant difference was observed between patients with and without diabetes as regards SFCT.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma.

To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. The mean ages and male-to-female ratios of the groups were similar (p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups (p > 0.05, for all). Some surgical manipulations, including pupillary stretching (p = 0.004), pupillary membrane peeling (p = 0.021), iris hook using (p = 0.041), and capsular tension ring implantation (p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar (p > 0.05, for both), the mean APP value was significantly lower in Group 2 (p = 0.011). The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

One-Handed Rotational Phacoemulsification Technique

IntroductionWe described a one-handed rotational phacoemulsification technique to decrease phaco time and power, and surgical stress on the cornea in eyes with different types of cataract.MethodsIn this technique a single sutureless corneal incision was made without any side-port incision. After hydrodissection and hydrodelamination were performed, a phaco tip was positioned in contact with the nucleus beside the capsulorhexis edge. By using a peristaltic pump, phacoemulsification was started with high levels of vacuum to keep the probe tip on the edge of the lens and to ensure the rotation of the nucleus, and with low ultrasound energy. The torsional mode used required less occlusion time and volume of fluid. The inclination of the tip was modified to 45-degree, directing it toward the lens center. So the nucleus was aspirated from the periphery toward the center by a rotational movement.ResultsThe eye in the technical video had a NC4-NO4 cataract. The preoperative vision in this eye was 20/100 with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/20. We recorded low intraoperative parameters including ultrasound time (21.4 sec), phacoemulsification power (73%), balanced salt solution used (31 mL) and cumulative dissipated energy (7.27) at the conclusion of the case. After 1 month, Central Corneal Thickness changed from 504 µm to 516 µm, and Endothelial Cell Loss was 1.15%.ConclusionThis technique uses a single clear corneal incision, high vacuum and low ultrasound power to reduce the exposition to excessive surgical maneuvers, fluid turbulence and ultrasound energy.

EFFECT OF VARIABLE PHACO TIMES OF CONSTANT PHACO POWER ON MACULAR THICKNESS

Background: Various factors involved in phaco can influence the tissue structures of the eyeball Ultrasonic energy should be taken into consideration as a risk factor that may affect the structure of the tissue in the eyeball. Objective: To evaluate changes on macular thickness before and after phacoemulsification surgery with variable Phaco Times and constant phaco ‎power by Optical Coherence Tomography (OCT). Patients and methods: A prospective observational clinical study on 40 eyes with Nuclear cataract grade II-III. All patients under went full medical and ophthalmic history, history of ocular surgeries, complete ophthalmic examination include ingvisual acuity: Uncorrected VA (UCVA) and best corrected VA (BCVA),Anterior segment examination using Slit-lamp bio microscopy, Intraocular pressure (IOP) measurement by applanation tonometry, Fundus examination, OCT was done preoperatively and then 4-6 weeks postoperatively. Results: In patients with Nuclear cataract, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time. Conclusion: After phacoemulsification surgery with variable phaco times and constant phaco power, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time.

EFFECT OF VARIABLE PHACO TIMES OF CONSTANT PHACO ‎POWER ON MACULAR THICKNESS

Background: Various factors involved in phaco can influence the tissue structures of the eyeball Ultrasonic energy should be taken into consideration as a risk factor that may affect the structure of the tissue in the eyeball. Objective: To evaluate changes on macular thickness before and after phacoemulsification surgery with variable Phaco Times and constant phaco ‎power by Optical Coherence Tomography (OCT). Patients and methods: A prospective observational clinical study on 40 eyes with Nuclear cataract grade II-III. All patients under went full medical and ophthalmic history, history of ocular surgeries, complete ophthalmic examination include ingvisual acuity: Uncorrected VA (UCVA) and best corrected VA (BCVA),Anterior segment examination using Slit-lamp bio microscopy, Intraocular pressure (IOP) measurement by applanation tonometry, Fundus examination, OCT was done preoperatively and then 4-6 weeks postoperatively. Results: In patients with Nuclear cataract, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time. Conclusion: After phacoemulsification surgery with variable phaco times and constant phaco power, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time.

Phaco chop versus stop and chop nucleotomy techniques: A comparative evaluation

To perform a comparative evaluation of phaco chop versus stop and chop nucleotomy techniques in phacoemulsification. Materials and Methods: 60 patients with uncomplicated senile cataract were included in this study which were randomly divided into phaco chop group (group 1) and stop and chop group. (group 2) with 30 patients each and each group had 10 patients each of nuclear sclerosis grade II, III and IV. The main parameters were effective phaco time, total balanced salt solution used, total phacoemulsification power, intraoperative complications and postoperative visual acuity on day 1, 1st week and 3rd week. Results: The mean effective phacoemulsification time was 30.33±3.77 seconds in group 1 and 31.63 ± 4.22 seconds in group 2. The mean total phacoemulsification power in group 1 was 38.97 ± 4.33% whereas 41.93 ± 7.09 % in group 2. The mean total BSSV used in group 1 was 111.67 ± 13.86 ml whereas 113.17 ± 19.94 ml in group 2. The difference between the two groups was not significant. All patients received BCVA of 6/6 in both the groups after 3 weeks. Conclusion: The stop and chop technique and phaco chop technique are equally efficacious for nuclear cracking in patients in terms of visual acuity but if we compare according to nuclear grading, stop and chop technique requires more phaco power, phaco time and balanced salt solution which can lead to higher endothelial cell loss in grade IV nuclear cataract. Keywords: Cataract, Nucleotomy, Phacoemulsification, Phaco chop, Stop and Chop.

Impact of different clear corneal incision sizes on anterior corneal aberration for cataract surgery.

To investigate the impact of different sizes of steep meridian clear corneal incisions for phacoemul sification on anterior corneal higher-order aberrations. Medical records of patients who underwent 2.2-mm coaxial micro-incision cataract surgery or 2.75-mm coaxial small-incision cataract surgery were retrospectively reviewed. Only patients with preexisting anterior corneal astigmatism <2.00 diopters (D) and ≥0.50 D who underwent a steep meridian clear corneal incision were included. Primary outcomes were 3rd- to 6th-order anterior corneal higher-order aberrations with an 8-mm pupil. Anterior corneal astigmatism and effective phaco time were evaluated as secondary outcomes. Preoperative and 3-month postoperative outcomes were evaluated. Anterior corneal astigmatism significantly decreased after both procedures; however, there was no significant difference found in surgically induced anterior corneal astigmatism between the two procedures (p=0.146). Although the total higher-order aberrations did not significantly change after both procedures, the group comparison showed a significant difference in surgically induced total higher-order aberrations (a decrease of 0.337 ± 1.156 mm in 2.2-mm coaxial micro-incision cataract surgery and an increase of 0.106 ± 0.521 mm in 2.75-mm coaxial small-incision cataract surgery, p=0.046). Spherical aberrations significantly decreased after 2.2-mm coaxial micro-incision cataract surgery (p=0.001), whereas they did not change significantly after 2.75-mm coaxial small-incision cataract surgery (p=0.564). Coma did not significantly change after either of the procedures. Trefoil did not significantly change after 2.2-mm coaxial micro-incision cataract surgery (p=0.361), whereas it significantly increased after 2.75-mm coaxial small-incision cataract surgery (p<0.001). There was no significant difference shown in effective phaco time between the procedures. A significantly positive correlation was shown between surgically induced anterior corneal astigmatism and coma in 2.75-mm coaxial small-incision cataract surgery (r=0.387, p=0.006). There was no significant correlation found between any surgically induced higher-order aberration changes and effective phaco time. The results showed that 2.2-mm coaxial micro-incision cataract surgery and 2.75-mm coaxial small-incision cataract surgery did not significantly degrade the total higher-order aberrations of the anterior cornea. However, the surgically induced changes in total higher-order aberration showed a significant difference between the two procedures, with a slight reduction after 2.2-mm coaxial micro-incision cataract surgery and a slight increase after 2.75-mm coaxial small-incision cataract surgery. Phaco time and power used during surgery had no impact on corneal aberrations.

Preoperative Assessment of Crystalline Lens by A-Scan Quantitative Echography and Its Correlation with Phacoemulsification Parameters

Purpose: To evaluate the correlations between the total ultrasound energy consumed during phacoemulsification with various preoperative parameters, including the best- corrected distant visual acuity (BCDVA) and quantified metrics taken from A-scan ultrasound biometry. Patients and methods: A prospective observational interventional study included 40 eyes of 40 consecutive patients scheduled for cataract surgery. We assessed the lens internal reflectivity in the A-scan echograms within a range of 0% to 100%, and calculated the mean of all spikes. All eyes with cataract underwent clear corneal phacoemulsification. At the end of the operation we recorded the phacoemulsification time and mean percent power. The correlations of echographic and phacoemulsification data were assessed. Results: Quantitative echography in the 40 studied eyes with different types of cataract revealed acoustic reflections having various configurations according to the biomicroscopic type of cataract, i.e. cortical, nuclear and posterior subcapsular cataract. The mean spikes were 31.027% ± 25.5908, the mean lens thickness was 4.291 ± 0.6166, the mean best corrected distant visual acuity in decimal was 0.205±0.1435, the mean phaco power% was 6.400 ± 3.0701 and the mean phaco time is 84.225. There was statistically insignificant correlation between spikes% and phaco power% in the study group (p>0.05). There was statistically insignificant correlation between mean spikes% and lens thickness in the study group (p>0.05).There was statistically insignificant correlation between spikes% and phaco time (in seconds) in the study group (p>0.05). Conclusion: With regards to the predictive value of lens hardness changes in the acoustic properties identified by our method, it is not correlated with the ultrasound energy required intraoperatively. The A-scan is helpful for the clinical prediction of lens opacity location, but not predictive of lens hardness quantification.

Comparison of Phaco-chop and Divide and Conquer Methods in Grade 3-4 Cataract Patients

Purpose: To compare the outcomes of Grade3-4 cataract surgery performed with 2 phacoemulsification techniques (phaco-chop and divide-and-conquer).&#x0D; Setting: Ministry of Health Tuzla State Hospital, Istanbul, Turkey.&#x0D; Design: Prospective randomized clinical trial.&#x0D; Methods: This is prospective and randomized(double blind) study cataract surgery using two different techniques of nuclear fragmentation performed at the Tuzla State Hospital.100 patients eye with nuclear density from grade 3 to 4 were randomly subdivided into 2 groups (phaco-chop and divide-and-conquer). Intraoperative measurements included Phaco time (PT), effective phaco time(EPT), mean phaco power(MPP). Clinical measurements included preoperative and postoperative 1.day , 7. day, 30. day, and 60.day corrected distance visual acuity(BCVA), time to achieve BCVA, corneal edema rate and time to disappear corneal edema.&#x0D; Results: Intraoperative measurements showed significantly less PT, EPT, and corneal edema with the phaco-chop technique than divide-and-conquer techniques in the grade 3-4 cataract density group (P&lt;0.05).&#x0D; Conclusions: 2 techniques may be effective for cataract surgery in mild and moderate cataracts. However, in eyes with hard cataract the phaco-chop technique can be more effective for lens removal, with less Phaco time and corneal edema, then the divide-and-conquer technique.&#x0D; Financial Disclosure: No author has a financial or proprietary interest in any material, method or device mentioned.

Corneal Endothelial Changes Following Refractive Lens Exchange

Background: clear lens extraction (CLE) by phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in a series of highly myopic and hyperopic eyes was effective and had an acceptable predictability and a low rate of complications especially on corneal endothelium. Aim of the work: to study corneal endothelium changes (number and morphology) following phaco-aspiration in refractive lens exchange procedure (1 month and 6 months postoperatively) Subjects and methods: a non-randomized prospective study was carried out from October 2018 to May 2019 on twenty five eyes of 14 subjects with age (38-48) years old with high myope> 8 D and high hyperopia > 6 D; these patients were not candidate for corneal refractive surgery or phakic IOL procedure. They were selected from outpatient Ophthalmology Clinics of Al-Azhar University Hospitals in Cairo. The patients were examined by specular microscopy before and after refractive lens exchange procedure (1 month and 6 months postoperatively) Results: Log MAR BCVA improved from (0.47) preoperatively to (0.5904) at the end of the 6 th month with P-value 0.35. Changes in endothelial cell count from (2.650) cells/mm2 before surgery to (2.372) cells/mm2 1 month after surgery to (2.358) cells/mm2 6 months after surgery with P-value <0.001. Error of refraction improved from (-14.94) in myope and (7.98) in hyperope preoperatively to (-1.42) in both groups at the end of the 6th month after surgery with p-value <0.001. Conclusion: CLE surgery by phaco-aspiration technique is less harmful to the corneal endothelium because it uses no phaco power.

Corneal Endothelial Changes Following Refractive Lens Exchange

Background: clear lens extraction (CLE) by phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in a series of highly myopic and hyperopic eyes was effective and had an acceptable predictability and a low rate of complications especially on corneal endothelium. Aim of the work: to study corneal endothelium changes (number and morphology) following phaco-aspiration in refractive lens exchange procedure (1 month and 6 months postoperatively) Subjects and methods: a non-randomized prospective study was carried out from October 2018 to May 2019 on twenty five eyes of 14 subjects with age (38-48) years old with high myope> 8 D and high hyperopia > 6 D; these patients were not candidate for corneal refractive surgery or phakic IOL procedure. They were selected from outpatient Ophthalmology Clinics of Al-Azhar University Hospitals in Cairo. The patients were examined by specular microscopy before and after refractive lens exchange procedure (1 month and 6 months postoperatively) Results: Log MAR BCVA improved from (0.47) preoperatively to (0.5904) at the end of the 6 th month with P-value 0.35. Changes in endothelial cell count from (2.650) cells/mm2 before surgery to (2.372) cells/mm2 1 month after surgery to (2.358) cells/mm2 6 months after surgery with P-value <0.001. Error of refraction improved from (-14.94) in myope and (7.98) in hyperope preoperatively to (-1.42) in both groups at the end of the 6th month after surgery with p-value <0.001. Conclusion: CLE surgery by phaco-aspiration technique is less harmful to the corneal endothelium because it uses no phaco power.

Contralateral eye comparison of the phacoemulsification metrics, patient experience and clinical outcomes in patients undergoing bilateral cataract surgery with two commonly used femtosecond laser systems.

PurposeThe purpose of the study was to compare phacometrics, patient experience factors and clinical outcomes in patients undergoing bilateral laser-assisted cataract surgery using two common femtosecond laser platforms.SettingThis study was conducted in Beverly Hills Institute of Ophthalmology, Beverly Hills, California, USA.Study designThis was a prospective, comparative, contralateral eye study.MethodsFemtosecond laser-assisted cataract surgery was performed in the first eye of 50 patients with bilateral cataract (mean age 69.9 ± 8.61 years) using either the Catalys (Johnson & Johnson Vision) or the LenSx (Alcon Laboratories, Inc.) laser system. The fellow eye was treated with the laser not used in the first eye. The primary outcome measures included overall procedural times, and the secondary outcome measures included patient experience with the two laser systems.ResultsThere were no statistical differences between the two groups in terms of patient interface preparation time and number of docking attempts as well as effective phaco time, average phaco power, total ultrasound time and nucleus removal time. However, the LenSx group demonstrated a significantly longer cortex removal time and higher perception of pressure and vision loss (p < 0.001) compared to the Catalys group. A significantly higher number of Catalys eyes achieved complete capsulotomy (p < 0.001). The ease of cortex removal was also better in the Catalys group. Postoperative visual acuity, keratometry, endothelial cell count and intraocular pressure were comparable in the two groups.ConclusionWith similar phacometric and clinical outcomes, both laser platforms were efficient, safe and effective during cataract surgery; however, the Catalys group demonstrated superior outcomes in terms of the patient experience, completeness of capsulotomy and ease of cortex removal.