Phaco Surgery Research Articles

Efficacy of Laryngeal Mask Airway Impregnation with Diltiazem Gel on Hemodynamic Changes in Patients with Hypertension Undergoing Phacoemulsification Surgery: A Randomized Clinical Trial

Background: Airway control problems are among the most prevalent causes of anesthesia-related mortality and morbidity. Some devices provide patients with adequate oxygen supply and ventilation during surgery by creating a safe airway in anesthetized patients. One of these devices is the laryngeal mask airway (LMA). The compression and painful stimuli following the LMA cuff inflation can lead to hemodynamic changes. Diltiazem gel is used in the control and treatment of hypertension (HTN) and heart arrhythmia and is absorbed through the tracheal mucosa. Objectives: By assuming that diltiazem gel is superior to other drugs used to prevent arrhythmias and hemodynamic changes during surgery, this study aimed to evaluate the effect of LMA impregnation with diltiazem gel, compared to lubricant gel. Methods: This study was conducted as a double-blind, randomized clinical trial on 80 participants with HTN who were candidates for phacoemulsification (phaco) surgery in Imam Khomeini Hospital, Kermanshah, Iran. The participants were assigned to an intervention (LMA impregnated with diltiazem gel) and a control group (LMA impregnated with lubricant gel) through the block random method in the form of 40 blocks of 2 using a random-numbers table. Hemodynamic changes (systolic and diastolic blood pressure and heart rate) were measured before, immediately after, 5 min, and 15 min after intubation, during surgery every 15 min, upon entering the recovery unit, and 15 and 30 min after entering the recovery unit. Results: The mean systolic and diastolic blood pressure in the intervention group showed a significant decrease, compared to that in the control group. A significant difference was also observed in the mean heart rate difference between the two study groups, but only at the beginning of the study (P<0.05). Additionally, according to the results of repeated measures analysis of variance, the mean of the measured variables showed a significant difference at different measurement times in the intervention group (P<0.05). Conclusion: The findings supported the effectiveness of diltiazem gel in reducing blood pressure, especially in the final stages of surgery, decreasing the number of premature ventricular contractions, and controlling normal breathing. Therefore, specialists and surgeons can use diltiazem gel to control the hemodynamic status of patients.

Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review.

Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial.

Phaco surgery in disorders of the capsular-zonular apparatus of the lens

The article presents authors' original methods of phaco surgery that can be used in disorders of the capsular-zonular apparatus of the lens. The cataract surgery techniques for lens subluxation developed and introduced into clinical practice allow using the most physiologically correct intracapsular intraocular lens (IOL) fixation in the vast majority of cases. The introduction of femtosecond laser at key stages of phacoemulsification in complicated clinical situations reduces the dependence of the results on the human factor and allows performing removal of complicated cataracts at a qualitatively new level.

Hybrid (femtolaser) phacoemulsification: technical aspects and functional results

This article summarizes scientific and practical results of hybrid femtosecond laser-assisted phacoemulsification (HFE) including study of clinical and technical aspects of the intervention and evaluation of post-surgical functional state of the eye on the basis of clinical, morphological and biomechanical data. The HFE technology should be considered the method of choice for microinvasive phaco surgery, its main advantage being the possibility of controlled handling of such important surgical stages as anterior circular continuous capsulorhexis and nucleus fragmentation on a closed eyeball, which significantly reduces the risk of complications and decreases of effective ultrasound time.

Histopathological findings of anterior lens capsule in paediatric cataract patients

AbstractPurpose: To investigate the histopathological findings of the anterior lens capsule in patients with paediatric cataracts.Methods: This study is a prospective interventional study. Anterior capsule tissue samples which were obtained by anterior capsulotomy method during phaco surgery were fixed in 0.1 M phosphate buffered 2.5% glutaraldehyde at +4°C for 2–4 h and after passing through other stages, thin sections were taken and stained. It was then examined and visualized under HITACHI HT7800 transmission electron microscope.Results: Twenty‐three eyes of 19 patients were included. Three patients had unilateral cataract and remaining 16 had bilateral cataract. Four patients had concomitant systemic disease including hydrocephalus, cerebral palsy, juvenile myelomonocytic leukaemia and Down syndrome. Except for one patient, common findings were single‐layered epithelium under the capsule, degenerated organelles with round‐oval and prismatic‐oval nuclei in some regions, enlarged mitochondria and heterochromatin cells. In the case with cerebral palsy, unlike the normal lens structure, collagen fibrils of the connective tissue and fibroblast‐like cells were observed in the epithelial area that should be located under the capsule, in both eyes. Disorganized distribution of collagen fibrils and vacuole structures in the cytoplasm of fibroblast‐like cells were observed.Conclusions: Similar histopathological findings were found in paediatric cataracts with or without systemic disease. Due to the presence of increased inflammation and gliosis in cerebral palsy, the absence of lens epithelium may have developed as a result of degeneration in this patient. The absence of lens epithelium and inflammation are thought to play a role in the development of dense subcapsular fibrosis.

Once in a blue moon: Unexpected complication of phaco surgery

Each year, about 6 million cataract surgeries with Intraocular Lens (IOL) implantation are accomplished [1]; IOL implantation into the human eye during this surgery has been an enormously successful procedure [2].

The eye wash technique: A simple and effective technique for intraoperative ocular surface lavage

Objectives: The author proposes an extremely effective and practical method of ocular surface hydrating and cleaning during anterior segment surgery, the Eye Wash Technique (EWT), in substitution for the traditional methods employing a syringe and cannula for ocular irrigation. Materials and Methods: The EWT utilizes the intraocular irrigating solution (IS) used in the surgery. It is performed by employing the irrigating line of the phacoemulsification (phaco) machine or the irrigating fluid IV drip in case of manual cataract surgery. The eye irrigation is performed directly from the Luer end attachment of these irrigating lines, which is positioned above the inner cantus pointing to the globe’s nasal limbal region. With the phaco machine pedal in position 1 (irrigation only) or in panel continuous irrigation mode in case of phaco surgery, or by opening the roller clamp of the IV drip line in case of manual surgery, IS flow ensues and is directed to the eye from a nasal direction to provide a steady flow to wash the exposed eye surface as well as the lid margins and lid speculum. The irrigation is maintained for two to five seconds with side-to-side jiggling if needed, to ensure complete ocular surface coverage. Cornea hydration is achieved and any unwanted material on the ocular surface is washed out. Results: The EWT was easily incorporated into the surgical routine with no difficulty in adaptation to the technique or in its employment. The surgical time was not prolonged when employing the technique. The EWT effectively provided both corneal hydration and ocular surface cleaning every time it was used, with no need to resort to the traditional syringe and cannula irrigation method at any time. Conclusion: The EWT should be incorporated into the anterior segment surgical routine and performed at the beginning of surgery, before inserting the intraocular lens, and at the end of the surgery; also, at any time during surgery should the need arise, enhancing anterior segment surgical visualization and safety.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary.

To compare the incidence of intraoperative complications during primary phacoemulsification (phaco) surgery between resident surgeons (residents) and staff surgeons (specialists) and to objectively determine the difficulty of stages in phaco surgery. This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists. A total of 3272 cases were included; 7.4% (n=241) of cases were performed by residents. The overall complication rate was 5.4% (n=177). The intraoperative complication rate was significantly higher (P<0.001) in residents (n=33, 13.7%) than in specialists (n=144, 4.8%). The most frequent complications were posterior capsule tear (n=85, 2.6%), anterior capsule tear (n=50, 1.53%), zonular fiber loss (n=45, 1.38%), and dropped nucleus (n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66 (60.0%), capsulorhexis in 21 (19.1%), irrigation/aspiration in 13 (11.8%), hydrodissection in 9 (8.2%), and intraocular lens (IOL) implantation in 1 (0.9%) case. Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

LASIK Surgery for Treatment of Residual Errors of Refraction after Phaco Surgery

LASIK Surgery for Treatment of Residual Errors of Refraction after Phaco Surgery

Outcomes of surgical treatment of rhegmatogenous retinal detachment after phaco surgery and implantation of a trifocal intraocular lens in patients with myopia (clinical observations)

To analyze visual functions in moderate and high myopic patients with retinal detachment that developed after implantation of a trifocal intraocular lens (IOL). The study analyzed the functional outcomes achieved in 3 patients (4 eyes) with retinal detachment developed after implantation of AcrySof IQ PanOptix («Alcon», USA) and AT LISA tri 839 MP («Carl Zeiss Meditec», Germany) during the follow-up period of 24 months. Patient examination included measurements of visual acuity at far (4 and 5 m), near (40 cm) and intermediate distances (60 cm, 80 cm), spatial contrast sensitivity, spherical equivalent of refraction, and a survey of patients for subjective satisfaction of the obtained vision. In four eyes of three patients with moderate and high myopia, rhegmatogenous retinal detachment was diagnosed during the follow-up period at 4 to 12 months after phacoemulsification of cataract with trifocal IOL implantation. The best visual indicators were found in patient N. as a result of surgical treatment of bilateral rhegmatogenous retinal detachment due to high myopia: visual acuity (VA) at far distance was 1.0 for each eye (with 100 points on the VF-14 questionnaire). In patients P. and M., after the development of unilateral rhegmatogenous retinal detachment, complete retinal reattachment was achieved after surgery with VA at far distance 0.55 (OS) in patient P. and 0.4 (OD) in patient M. (95 and 86 points on VF-14, respectively). Good visual functions were achieved in three patients with trifocal IOL after surgical treatment of the rhegmatogenous retinal detachment that developed due to myopia. The implanted trifocal IOL did not affect the effectiveness of vitrectomy. After the treatment patients retained the ability to see at different distances.

Anti VEGF for post op CME- Boon or Bane!

Cataract surgery has advanced in techniques and instrumentation over the years, but complications such as cystoid macular edema (CME) do occur even after uneventful surgery. The incidence of pseudophakic CME (detected by optical coherence tomography) is 30%–40% after uncomplicated phaco cataract surgeries. Risk factors for the development of CME include prolonged duration of surgery, iris handling and diabetes. Corticosteroids are the mainstay of treatment of postoperative inflammation and CME. In certain situations where steroids are contraindicated anti-vascular endothelial growth factor (VEGF) agents are used as the second line agents for the treatment of CME. Here, we describe a case of postoperative uveitis with CME which showed good response with single dose intravitreal anti-VEGF injection-Bevacizumab.

Historical development of energetic cataract surgery

This article reviews scientific literature analyzing the history of ultrasound and laser phaco surgery of combined or isolated designs: erbium YAG laser, 1.064 μm Nd:YAG laser for dissection of the lens capsule and nucleus, exclusively-laser technique of lens destruction with 1.44 µm Nd:YAG laser without manual, vacuum or ultrasonic action, femtosecond laser assistance with automated transcorneal delivery of radiation into the eye cavity.

A Clinical Study of Visual Outcome after Nd YAG Laser Capsulotomy

Introduction: Posterior capsular opacification is caused by migration and proliferation of cuboidal epithelium from remnant of anterior capsule and equatorial part of the lens capsule. Posterior capsular opacification also called after cataract is a nagging post surgical complication following phacoemulsification or non phaco cataract surgery (small incision cataract surgery or conventional cataract surgery) ECCE with posterior chamber intraocular lens implantation. Posterior capsular opacification is actually misnomer. Though there are many factors suggested to reduced posterior capsular opacification. The incidence of PCO still exists considerably. Aims and Objective are to find out the visual improvement after Nd yag laser posterior capsulotomy. Materials and Methods: The prospective study was conducted in the department of ophthalmology of Ad-din Women Medical College Hospital, Dhaka, Bangladesh from June 2014 to June 2018. 175 patients of 189 eyes with significant PCO. Before laser capsulotomy all patients were assess by routine slit lamp examination, IOP measurement and posterior segment examination done for every patient for exclusion of Gross posterior segment pathology. Results: The study had female preponderance (58.86%). Most of the patients 165 were 40 to 80 years old (87.31%). The patients had pre laser visual acuity 6/9 to 6/18 (31.75%) 6/24 to &lt;6/60 (68.25%). After laser capsulotomy functional visual acuity upto 6/8 were 169 (89.42%) and 6/24 to &lt;6/60 were 20 (10.58%). The mean pre and post laser capsulotomy visual functional score were 54.45±36.44 and 94.16±50.36 respectively. Conclusion: Nd YAG laser capsulotomy is safe, non-invasive and effective procedure. Medicine Today 2021 Vol.33(2): 98-101

Visual assessment between phacoemulsification and small incision with 5.2mm non-foldable intraocular lens implant.

Objective: To compare visual assessment between phacoemulsification and small incision with 5.2mm non-foldable intraocular lens implant. Study Design: Experiential Study. Setting: Institute of Ophthalmology, Liaquat University Hospital Jamshoro, Period: September 2019 to August 2020. Material &amp; Methods: We performed cataract surgeries using the non-foldable intraocular lens in 100 patients. Two techniques were performed, dividing patients equally into Phaco (Group-A) and SI (Group-B) cataract surgery. The outcomes of both were analyzed uncorrected visual acuity and complications. Results: Of the total 50 patients who underwent phacoemulsification, 55% were male and 45% females in Group-A while Group B (SI surgery) were 45% were male and 35% were female. The intra-operative success rate was 90% in Phaco group and 74% in SI group. In comparison, small Incision group had 10% of patients had difficulty in capsulorhexis, 8% in posterior capsular rupture, 6% in zonular dialysis, 2% iridodialysis, and 0% showing nucleus drip with all complications being higher than in Phaco Group except for nucleus drip (2% vs. 0%). Although, post-operatively, individually groups have similar complications with no notable difference seen, yet astigmatism was lesser in Group A than in Group B. Conclusion: Both techniques showed similar outcomes in the uncorrected visual acuity; however, astigmatism and complication rates were lesser in the phacoemulsification study group.

Correlation between keratometry and corneal incision before and after phaco surgery.

Cataract is a common cause of vision loss and blindness in humans. After surgical management of cataract, all efforts should be focused on reducing postoperative astigmatism thus providing an excellent vision to patients. To determine the relationship between corneal incision and refraction changes before and after phacoemulsification surgery in 300 patients undergoing cataract surgery in Khatam hospital in Mashhad, Iran from January 2017 to April 2018. Three hundred patients (144 women and 156 men) with cataract undergoing phacoemulsification surgery were recruited in this cross-sectional study. Refraction, keratometry and visual acuity measurement were performed before surgery. Then, a steep-based incision in the cornea was made without stitches. A 3.2 mm corneal incision was made at two supratemporal and temporal sites. The patients were followed-up for one and six months, and one year after surgery monitoring their vision and refraction, and performing keratometric measurements. The mean age of the patients was 65.7±9.54 years (age range, 42-84 years). No major complications were observed. The greatest mean of changes in corneal power was in the supratemporal incision (1.28±0.6). Keratometry had a significant relation with the incision (p.

A Comparative Study between Air Bubble Tamponade Alone versus Air Bubble Tamponade with Internal Fluid Aspiration for Nonplanar Descemet's Membrane Detachment after Phacoemulsification.

Purpose To compare the efficacy of air bubble tamponade alone versus air bubble tamponade with internal fluid aspiration for nonplanar Descemet's membrane detachment after clear corneal incision phacoemulsification. Methods This study is a prospective, intervention, comparative randomised clinical trial, conducted at a private eye centre, Ismailia, Egypt, from March 2019 to March 2020. It contained 30 eyes of 24 patients who had postphacoemulsification nonplanar Descemet's membrane detachment involving the periphery and the central area of the cornea (>50% of the cornea) with corneal oedema. The patients were divided into two groups: group A: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade only and group B: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade augmented by internal fluid aspiration. Trial Registration: This trial was registered at www.pactr.org and the identification number for the registry is PACTR202006612296119. Results During the 12-month study period, this study included 30 eyes (24 patients) out of 1356 phaco surgeries with postphacoemulsification nonplanar Descemet's membrane detachment. Six patients had DMD in both eyes, eight patients had DMD in the right eye, and ten patients had DMD in the left eye. All patients have successful surgeries without complications. The calculated incidence rate for visually significant DMD was 2.2% per year. The mean ± SD time interval from cataract surgery to the primary intervention was 4.2 ± 1.1 days. Descemet's membrane was attached in 56.25% of patients in group A (9 out of 16 eyes) and 92.6% of patients in group B (13 out of 14 eyes) with a minimum of one-month follow-up. Conclusion Air descemetopexy combined with the internal fluid aspiration demonstrated to be more efficient than air descemetopexy only to treat Descemet's membrane detachment following phacoemulsification. It should be tried before planning other major surgeries in patients with severe Descemet's membrane detachment.

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs' endothelial dystrophy patients: a randomized pilot study with 6mo follow up.

To compare the corneal outcome in Fuchs' endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS). This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope), and corrected distance visual acuity (CDVA) were assessed preoperatively and at day 1, 40, and 180 postoperatively. Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32% in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6, 6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 grayscale units (GSU; 95%CI: -2.66 to -0.19, P=0.02). In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95%CI: 1.89 to 13.50, P=0.009), 3.97 (95%CI: 0.23 to 7.71, P=0.03), 4.73 GSU (95%CI: 0.71 to 8.75, P=0.02), respectively. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation. There is no significant difference in corneal outcome between FLACS and CPS. Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

The Effect of Educational Video on Anxiety Before Surgery of Patient's Candidates for Eye Surgery by Fico Method

Objective: Phacoemulsification (Phaco) surgery is one of the most common and modern methods for treatment of cataracts. Educational video can be used to educate patients in a short time in various surgeries. This study aims to assess the effect of educational videos on preoperative anxiety in patients candidates for phaco surgery Methods: This is a clinical trial conducted on 160 patients candidates for phaco surgery who were selected using a simple random sampling method. They were divided into two groups of intervention and control after signing a written consent form. The intervention was a short educational video (10 minutes) about the nature of cataract disease, how to perform phaco surgery and pre- and post-operative care. Data collection tools were a demographic form and Spielberger’s State-Trait Anxiety Inventory. Collected data were analyzed in SPSS v. 23 software using descriptive statistics and independent t-test and paired t-test. Significance level was set at 0.05. Results: The mean age of patients in the intervention and control groups was 58.63±7.68 and 62.32±9.15, years respectively. The mean scores of overt and covert anxiety at baseline were 48.92±4.86 and 50.97±6.27 in the intervention group and 48.88±8.35 and 46.31±7.80 in the control group, respectively. After intervention, these scores were 37.95±7.04 and 44.20±6.79 in the intervention group and 48.72±7.46 and 44.10±8.23 in the control group, respectively. There was a statistically significant difference in overt and covert anxiety before and after the intervention in the intervention group (P=0.0001). Moreover, there was a statistically significant difference in overt and covert anxiety after the intervention between the two study groups (P=0.0001). Conclusion: he use of short educational videos seems to reduce overt and covert anxiety in candidates for phaco surgery. Nursing staff are recommended to teach patients by educational videos, and necessary facilities should be provided for nurses to interact with patients and educate them.

Nepafenac vs bromfenac: A comparative study to determine their role in maintaining mydriasis during cataract surgery

To assess and compare the role of topical nepafenac (0.1%) v/s bromfenac (0.09%) in sustaining intra-operative mydriasis while doing cataract extraction.: Prospective, randomized study. Regional Institute of Ophthalmology, Rajendra Institute of Medical Sciences (RIMS), Ranchi (Jharkhand). The duration of study was from June 2019 to February 2020. Topical NSAIDs (nepafenac and bromfenac) and carboxymethylcellulose (control) were administered to the cataract patients before Phaco surgery. Pupillary diameters were assessed first at starting of surgery and then after completing the surgery; average values were calculated for the three groups. Study was done on 90 patients having age 40-80 years, planned for cataract surgery with PCIOL implantation. : in group A (i.e. control) reduction in pupillary diameter came out to be more statistically significant unlike in group B (nepafenac) and in group C (bromfenac) (p &amp;#60;0.003). But on comparing group B and group C(p &amp;#60; 0.80) reduction in pupillary diameter was not that much statistically different. Mydriasis sustaining effect was more pronounced in groups B and C than in group A. : Both nepafenac (0.1%) and bromfenac (0.09%) administered a day before operation are helpful in sustaining pupil size intra-operatively but bromfenac comparatively seemed to be better than nepafenac in sustaining mydriasis during SICS/Phaco.

Assessment of age-related changes in lens capsule biomechanics using atomic force microscopy

To assess age-related changes in lens capsule biomechanics based on atomic force microscopy (AFM). The study included 50 central fragments of the anterior capsule of the human lens obtained intraoperatively during ultrasonic phacoemulsification by continuous circular capsulorhexis. The measurements were carried out in the Fast Force Volume (FFV) mode. The force curves were processed in the Nanoscope Analysis software (Bruker, USA) using the Hertz model that allows calculating the Young's modulus of the capsule sample based on the dependence of the force on the puncture depth. There was no statistically significant difference in the «stiffness» of the inner and outer surfaces before and after removal of the subcapsular epithelium (p=0.25). In all cases, the inner surface of the capsule turned out to be «harder» than the outer one. In this case, the ratio of Young's modulus of the inner and outer surfaces has a significant dependence on age (p<0.001). With an increase in age from 50 to 90 years, this ratio decreased from ~7 to ~1.5. This was due to a simultaneous change in Young's modulus of the opposite nature: an increase in the stiffness of the outer surface and its decrease in the inner one. It is possible to assess lens capsule biomechanics using AFM if the subcapsular epithelium is present. In this case, the objects of study are the areas of the capsule free of epithelium, and the epithelial cells themselves can be used to identify the inner surface of the capsule. Regardless of age, the stiffness of the inner surface of the anterior lens capsule significantly exceeds that of the outer surface.