Phaco Time Research Articles

Efficiency of phacoemulsification handpieces with high and low intraocular pressure settings

Purpose: To compare the efficiencies of the Active Sentry handpiece at low IOP (20 mmHg) to the Ozil handpiece at high IOP (50 mmHg). Setting: Private practice (Medford, OR, USA). Design: Single site, prospective, double-arm, randomized, contralateral eye study. Methods: The first operated eye was randomized to receive phacoemulsification with either the Active Sentry handpiece at 20 mmHg (Active Sentry group) or the Ozil handpiece at 50 mmHg (Ozil group). The second operated eye was assigned to the other group. Outcome measures included phaco time, total aspiration time, aspiration time during phaco, fluid use, cumulative dissipated energy, total torsional time, total longitudinal time, and central corneal thickness. Results: A total of 36 subjects (72 eyes) completed the study. Mean total aspiration time was 90.1 ± 16.4 s in the Active Sentry group and 85.1 ± 17.0 s in the Ozil group (p > 0.05). Mean aspiration time during phaco was 40.9 ± 8.5 s in the Active Sentry group and 40.4 ± 8.8 s in the Ozil group (p > 0.05).Mean total phaco time was 29.5 ± 7.3 s in the Active Sentry group and 31.0 ± 7.4 s in the Ozil group (p > 0.05). Mean total fluid volume was 32.8 ± 4.6 mL in the Active Sentry group and 33.8 ± 6.0 mL in the Ozil group (p > 0.05). Conclusions: The results of this study suggest that the efficiencies of the Active Sentry handpiece at low IOP settings and the Ozil handpiece at high IOP are similar.

A comparative study on the phaco time and corneal endothelial count in phacoemulsification using the stop & chop and divide & conquer techniques in Indian eyes

Cataract, a leading cause of curable blindness requires surgical management. Endothelium which is crucial for corneal transparency gets injured during intraocular surgeries like phacoemulsification. Various studies have compared the impact of different techniques of phacoemulsification on endothelium. But few studies conclude that Phaco time & endothelial loss is lesser in Stop & Chop than Divide & Conquer technique. An Interventional study involving 30 eyes in Group A (Stop & Chop) and 30 in Group B (Divide & Conquer) with Nuclear sclerosis grade II and III, excluding any pre-existing corneal diseases and Glaucoma was conducted in a tertiary care teaching hospital. All pre-operative parameters were similar in both groups. Post-operative values of best corrected visual acuity (BCVA), intra ocular pressure (IOP), endothelial cell count, central corneal thickness (CCT), Absolute Phaco time were recorded. Data entered in Excel sheets and analysed with SPSS. Paired, Unpaired t tests were used. P value <0.05 was statistically significant. Mean Absolute Phaco time for Group A was shorter (25.10±10.54 s) than that for Group B (44.20± 6.94 s) with statistical significance (p<0.05). Mean cell loss & changes in endothelium were higher in Group B than Group A (p<0.05). Absolute Phaco time was shorter in Stop & Chop than Divide & conquer as well as the corneal endothelial damage and changes were lesser in Group A. Hence Stop & Chop technique of phacoemulsification is recommended for less corneal morbidity.

Examination of phacoemulsification tips after different numbers of cataract surgeries

To compare unused phacoemulsification tips and those used different times with different techniques of cataract surgery (divide and conquer and chop), in vivo phacoemulsifications were performed with tips of different numbers of operation. These were compared with the same number of sterilized-only and unused tips with the help of an atomic force microscope. Comparison of roughness values (Sa, Sq), geometric and measurable flange length and surface was also performed (profile length %, area %). The differences between the parameters that can be measured during surgery (average ultrasound percentage, US ave %, Average Phaco Time, APT) were also analyzed. We found significant correlations between age and lens hardness (p = 0.0045), area % and APT (p = 0.03), between area % and US ave% (p = 0.03) and also between the two surgical techniques in terms of area% (p = 0.04) and US ave % (p < 0.01). Roughness increased with the number of uses. An increase in profile length% can be observed up to the twentieth operation. This can result from scratches and microscopic damages and also from abrasion and possible material additions on the surface of the needles. The divide and conquer technique causes less microscopic damage to the surface, and smaller average US energy is required during surgery.

Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research.

Identifying pre/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre/perioperative variables to predict ECL. PERCEPOLIS was conducted in 2015-2016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature. Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL. Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL via cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.

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.

Evaluation of Endothelial Cell Density after Torsional Phaco-Emulsification in Patients with Pseudo-Exfoliation

Background The corneal endothelium is a single layer of hexagonal cells that do not have the ability to regenerate. The normal density of corneal endothelial cells in adults is approximately 2500 cells/mm² and it is reduced by about 0.6% a year. The endothelium performs an essential function of maintaining the hydration of the cornea. When the endothelial cells density is reduced to approximately 800cells/mm², it may lead to corneal decompensation causing corneal edema and loss of corneal transparency which disrupts vision. Aim of the Work The aim of this study is to compare pre-operative corneal thickness between normal subjects and subjects with pseudo-exfoliation and to determine the effects of phaco-emulsification surgery on corneal endothelial cell density in cataract patients with pseudo-exfoliation syndrome. Patients and Methods The type of study was case controlled study, at department of Ophthalmology at Ain Shams University hospitals. This study included 66 patients divided to two equal groups (33 each): study group: 33 patients with pseudo-exfoliation, control group: 33 patients with senile cataract without pseudo-exfoliation. Results We found that ECD loss was 11.42% in the study group and 8.11% in the Control group 4 weeks after surgery. Phaco time and used BSS values were significantly higher in patients with PXS but had no significant influence on endothelial cell loss. They also suggested that the corneal endothelium in PXS be vulnerable to cataract surgery. Conclusion Torsional mode phacoemulsification and IOL implantation provided a safe and favorable surgical outcome in patients with/without PXS. Torsional phacoemulsification led to significantly higher ECD loss in the PXS than that in the control group during the whole follow up period.

Phacoemulsification Tip Elongation Under Standardized Resistance: An Objective Measure of Human Crystalline Lens Hardness.

To establish a correlation between phacoemulsification tip normalized driving voltage (NDV) and crystalline lens hardness and use it as an objective measure of lens hardness. The study used a phaco tip equipped with previously validated elongation control adjusting the driving voltage (DV) to produce invariant elongation regardless of resistance. The laboratory study measured the mean and maximum DV of the phaco tip immersed in glycerol-balanced salt solution and correlated the DV with the kinematic viscosity at 25, 50, and 75 µm tip elongation. The NDV were obtained by dividing the DV in glycerol by the DV in the balanced salt solution. The clinical arm of the study recorded DV of 20 consecutive cataract surgeries. The correlation of mean and maximum NDV to Lens Opacities Classification System (LOCS) III classification, patient's age and effective phaco time were evaluated. The mean and maximum NDV correlated with the kinematic viscosity of the glycerol solution (P < 0.001 in all cases). Mean and maximum NDV during cataract surgery correlated with patients' age, effective phaco time, LOCS III nuclear color, and nuclear opalescence (P < 0.001 in all cases). When a feedback algorithm is running, DV variation strictly correlates with encountered resistance in glycerol solutions and real-life surgery. NDV significantly correlates with the LOCS classification. Future developments might include sensing tips that react to lens hardness in real time. The study correlates for the first time phaco tip DV and crystalline lens mechanical properties, establishing an objective and reliable measure of lens hardness. This may lead to smart phaco tips reacting to cataract hardness change in real time and sparing ultrasound dispersion.

Efficacy and safety of the eight-chop technique in phacoemulsification for patients with cataract.

The aim of this study was to estimate the efficacy of the 8-chop technique in phacoemulsification surgeries of patients with cataract. Sato Eye Clinic, Chiba-ken, Japan. Prospective study. Patients were classified into 3 groups (Grade II, Grade III, and Grade IV; n = 50 each) according to the firmness of their lens nuclei. The Eight-chopper I was used for Grade II, Eight-chopper II for Grade III, and Lance-chopper for Grade IV. The best-corrected visual acuity, intraocular pressure (IOP), and endothelial cell density were evaluated at 7 and 19 weeks postoperatively. The primary outcome measures were the mean operative time, mean phaco time, cumulative dissipated energy (CDE), and volume of fluid used. 150 cataract surgeries were performed. The operative time (minutes), phaco time (seconds), CDE, and volume of fluid used (milliliters) differed significantly among the 3 groups, increasing in the following order: Grade II, Grade III, and Grade IV ( P < .01). The corneal endothelial cell density did not decrease significantly in the 3 groups at 19 weeks postoperatively ( P = .09). The rate of endothelial cell loss was 0.9% ± 5.9%, 1.0% ± 10.3%, and 5.3% ± 11.1% in the Grade II, III, and IV groups at 19 weeks postoperatively, respectively. There were significant reductions in the IOP at 7 and 19 weeks postoperatively compared with the preoperative IOP in the 3 groups ( P < .01). The 8-chop technique was effective and safe in phacoemulsification for patients with cataracts with lens nuclei of varying hardness.

Comparison of ultrasound phacoemulsification and FemtoMatrix® PhotoEmulsification® cataract surgery.

To introduce a novel technology currently under final development before regulatory approvals for the furtherment of cataract surgery, using the FemtoMatrix® laser system, and to demonstrate its safety and efficacy as compared to standard ultrasound phacoemulsification. Thirty-three patients with bilateral cataracts were operated on with one eye undergoing PhotoEmulsification® treatment on the FemtoMatrix® device and the contralateral eye receiving the control procedure, i.e., standard ultrasound phacoemulsification treatment. The number of "zero-phaco" procedures (denoting that I/A alone was sufficient to aspirate the lens fragments and that no ultrasound energy was needed) was recorded and Effective Phaco Time (EPT) values were compared. The patient follow-up was 3 months. Thirty-three eyes from a population with a mean cataract grade of 2.6 were treated on the FemtoMatrix®, of which 29 were "zero-phaco" (88%). All patients were operated on by a single surgeon who was a relative novice to the technology (63 patients treated prior to this study). Conversely, of the 33 fellow eyes who underwent standard ultrasound phacoemulsification, none were zero-phaco (0%) - all required varying degrees of ultrasound energy to make lens aspiration possible. The mean EPT was significantly lower in the PhotoEmulsification® laser group (0.2 ± 0.8 s) than in the phaco group (1.3 ± 1.2 s) (p < 0.0001). The safety profiles of the two procedures were comparable, with no device-related adverse events noted. FemtoMatrix® is a promising femtosecond laser platform that, when compared to phacoemulsification, significantly decreases or eliminates EPT altogether. The system is used to perform PhotoEmulsification®, making zero-phaco cataract procedures feasible including in high-grade cataracts (>3). It enables personalized treatment by automatically measuring and adapting the laser energy required to obtain the most efficient cutting of the crystalline lens. This new technology appears to be safe and effective in cataract surgery.

Effect of Pulse Mode Phacoemulsification on Corneal Endothelium Using Different Frequencies

Purpose: To determine a safer mode using two different frequencies (10 and 60 pulses per second) in pulse mode phacoemulsification in moderate to severe cataract. Study Design: Quasi experimental study. Place and Duration of Study: Khatam-Al-Anbia Hospital, Mashhad, Iran, from 2017 to 2018. Methods: We enrolled 145 patients with moderate and severe cataracts according to lens opacities classification system III (LOCS III). They were allocated to two different groups with different frequencies of pulse mode (10 PPS and 60 PPS) phacoemulsification. Post-operative parameters, including best-corrected visual acuity, corneal edema, endothelial cell density, central corneal thickness, and effective phaco time, were compared between the groups. Results: Patients who had undergone surgery using 10 PPS pulse mode had better vision than those in the 60 PPS pulse mode group. Pulse mode with 10 PPS caused 0.112 reductions in log MAR in best-corrected visual acuity compared with the 60 PPS pulse mode group (p value = 0.001). The difference in corneal edema was significant between 10 and 60 PPS groups on the first and seventh days post-operatively (p-value &lt; 0.0001). One month after surgery, corneal thickness increased in both groups and statistically more in 60 PPS group (p-value&lt; 0.0001). Conclusion: Pulse mode with lower frequency in moderate and hard cataracts preserves endothelial cells from damage. The mean effective phaco time is less with ten pulses per second pulse mode.

Drill-and-prechop technique: modification of the drill-and-crack technique for mature cataracts

BackgroundThere are some techniques for disassembly of hard nuclear. It is challenging in hard cataract surgery through microincision. The classic chop or prechop techniques often do not succeed,resulting in incomplete nuclear segmentation. The authors describe a new chop technique for removing hard nucleus cataracts in coaxial microincisional cataract surgery.MethodsWe create a deep hole (drill) in the central nucleus with the phaco tip and divide the nucleus (prechop) with the Nagahara chopper and the modified capsulorhexis forceps inside the hole. The chopper and the modified capsulorhexis forceps are spread apart laterally after they approach at the center of the nucleus, to create a complete fracture across the entire nucleus. Since January 2022, we have completed 27 eyes of 25 patients with hard nucleus cataract using this technique.ResultsComplete segmentation of the hard nuclear into two hemispheres was implemented with this drill and prechop technique in all cases. The effective phaco time and ultrasound energy decreased. No intraoperative complication such as iris injury, anterior capsule tears, zonulysis, or posterior capsule rupture with vitreous loss occurred during surgery.ConclusionsThis technique simplifies the previous prechop techniques especially for hard nucleus in microincisional cataract surgery. The technique is efficient, safe and simple.

Effect of uncontrolled glycemic on cataract surgery outcome in patient with diabetic retinopathy

Objective: This study aims to report a case of catarct surgey outcome in cataract diabetic patient with uncontrolled glycemic. Case Presentation: A 54-year-old woman has catarct on both eye and history of diabetes mellitus for 15 years. The patients was planned for cataract surgery when blood sugar below 200mg/dL in left eye,blood sugar patients from 248 mg/dL become 168 mg/dL. One week post operation evaluation revealed corneal edema, due to phaco time intra surgery in this patient increased. Visual acuity was 6/120 BCVA on the right eye and 6/18 BCVA on the left eye. Visual acuity has decreased in 2 months after surgery, 1/60 BCVA on the right eye and 6/18 BCVA on the left eye, as well as funduscopy presence of dot blot, flame-shaped, and traction on both eyes. This outcome was contributed by an uncontrolled blood glucose of the patient. Conclusion: Preoperative preparations in diabetic cataract patients are mandatory, including blood sugar and HbA1C control, to achieve a better outcome of ocular surgery in patients with diabetes mellitus.

Correlations of Immediate Corneal Tomography Changes with Preoperative and the Elapsed Phaco Parameters.

PurposeThe ability to predict corneal edema and understand its relationship with imaging parameters enables optimization of decision-making in terms of cataract surgery. Therefore, we aimed to elucidate the immediate tomographic alterations after phacoemulsification.Patients and MethodsIn this prospective study, we evaluated clinical and corneal tomographic data of 30 patients with cataracts, obtained using a rotating Scheimpflug tomographic system before and after cataract surgery with a phacoemulsification system. Corneal thickness and volume were measured, and Pentacam Nucleus Staging, keratometry, and specular microscopy were performed preoperatively and immediately postoperatively. The Wilcoxon signed-rank test was used to compare pre-and postoperative values. We calculated the correlations between the changes in these values and multiple parameters related to phacodynamics, including “ultrasound (US) elapsed” (phaco time), “US average” (average power used), and “US absolute” (energy effectively dissipated, a product of the other two parameters).ResultsThere were increases in corneal volume (p<0.0001) and pachymetry (p<0.0001), and a decrease in endothelial cell count (p<0.0001) after surgery. The mean differences in pre- and postoperative specular microscopy, corneal volume, and pachymetry were −335.13±236.21 cells/mm3, 1.33±0.56 mm3, and 61.33±23.73 microns, respectively. The difference in pre-and postoperative corneal volume in patients with US elapsed ≥40 s was 0.75 mm3 greater than that in patients with US elapsed <40 s (95% confidence interval [CI]: 0.24–1.25; p=0.005); that of pachymetry in patients with US elapsed ≥40 s was 31.76 microns greater than that in patients with US elapsed <40 s (95% CI: 9.55–53.97; p=0.007). Spearman correlation revealed that, for every 1% increase in cataract density, the US average value increased by 0.31% (coef.: 0.3110; 95% CI: 0.0741–0.5490; p=0.012).ConclusionKnowledge of Pentacam Nucleus Staging and the effect of US elapsed on differences in corneal volume and pachymetry before and after cataract surgery should be of particular value for surgeons who routinely encounter patients with hard 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 &amp;lt; .001), patient’s age (p &amp;lt; .05) and NO (p &amp;lt; .001) on postoperative day 1, while on postoperative day 7, it depended on UST (p = .011) EFX (p = .012) and NO (p &amp;lt; .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.

Application of prechop technique in phacoemulsification for cataract patients with highly liquefied vitreous: a retrospective study

BackgroundPhacoemulsification using phaco-chop technique has many challenging features in cataract patients with highly liquefied vitreous. This study aimed to compare the intraoperative parameters and safety between prechop technique and traditional phaco-chop in phacoemulsification for these patients.MethodsA total of 54 eyes of 54 patients with high myopia-related or post-vitrectomy cataract that underwent phacoemulsification combined with intraocular lens implantation were included in this retrospective study. Of them, 25 eyes that received manual prechop were included in the prechop group, and 29 eyes with best match of age, axial length and nuclear opalescence (NO) that received standardized phaco-chop were included as the control group. The intraoperative complications and surgery parameters were compared between groups.ResultsNo surgical complications were observed in the prechop group, while 2 eyes with posterior capsular rupture and 1 eye with a broken ciliary zonule (10.3%) were found in the control group. There was no significant difference in phaco time, average energy, and cumulative dissipated energy (CDE) between groups (all P > 0.05), but for hard nuclear cataracts with NO grading ≥ 5, prechop group required less phaco time (P = 0.008) and CDE (P = 0.029). There were significant correlations between phaco time vs. NO (r = 0.762 vs. 0.581, both P < 0.005) and CDE vs. NO (r = 0.717 vs. 0.668, both P < 0.001) in the prechop group and control group, respectively.ConclusionsThe prechop technique which seemed to have less intraoperative complications, reduced phaco time and CDE compared to standardized phaco-chop might be a good alternative for cataract patients with highly liquefied or vitrectomized vitreous, especially those with hard nuclear cataracts.

Illuminated Chop Using an Illuminated Chopper in Cataract Surgery: on the Way to Minimal-energy Phacoemulsification

Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery.Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop &amp; Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated.Results: EFX of the Stop &amp; Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (&lt;i&gt;p&lt;/i&gt; = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (&lt;i&gt;p&lt;/i&gt; = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, &lt;i&gt;p&lt;/i&gt; = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX &gt;1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; &lt;i&gt;p&lt;/i&gt; = 0.001).Conclusions: The I-Chop group had lower EFX and shorter surgical phaco time than the Stop &amp; Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

Corneal Effect of Air Bubble After Phacoemulsification.

The aim of the study was to investigate the effect of air bubble on the cornea at the end of the cataract surgery with phacoemulsification. This prospective and case-control study included 71 patients with air bubble injected into the anterior chamber at the end of the operation and 63 age-sex-matched control patients without air bubble. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality rate (HEX), and central corneal thickness (CCT) measurements were taken using non-contact specular microscopy preoperatively and at 1-day, 1-week, and 1-month postoperatively. No significant difference was determined between the groups preoperatively in respect of mean visual acuity, anterior chamber depth, ECD, CV, HEX, and CCT values (p>0.05). The intraoperative average ultrasound power, effective phaco time, and ultrasound time values were similar (p>0.05). The CCT value was lower in the study group than in the control group on post-operative day 1 (p=0.012), but similar at 1 week and 1 month (p=0.102, p=0.330, respectively). No significant difference was determined between the groups in mean visual acuity, anterior chamber reaction, ECD, CV, and HEX values at 1-day, 1-week, and 1-month postoperatively (p>0.05). Air bubble may be used as an alternative method to reduce corneal edema on the 1st post-operative day. According to the results, although air bubble has no detrimental effect, there is also seen to be no protective effect on the corneal endothelium.

Do Consecutive Phacoemulsification Surgeries Under Topical Anesthesia Differ in Terms of Pain Perception and Cooperation?

BackgroundAlthough intraoperative ocular pain has been investigated extensively in the literature, few studies have evaluated the pain perception between consecutive surgeries. Determining the facts about pain perception during phacoemulsification will allow surgeons to decide the type of anesthesia that best fits the patient when planning the contralateral cataract surgery. The aim of this study was to determine the level of pain perception, factors affecting pain perception, level of patient cooperation, and perception of operation time during consecutive phacoemulsification surgeries.MethodologyThis study included 314 eyes of 157 patients with bilateral senile cataracts who underwent phacoemulsification surgery under topical anesthesia with an interval of no more than six months. All patients underwent complete ophthalmic examination. Operation time, phaco time, surgeon’s comfort, and patient’s cooperation were recorded. Immediately after the operation, the patients graded the pain they experienced via the Visual Analogue Scale (VAS) from 0 to 10 and estimated the operation time.ResultsThe mean VAS score was 0.88 ± 0.97 for the first eye and 1.50 ± 1.27 for the second eye (p < 0.011) surgery. The perception of the mean operation time was significantly lower in the first eye surgery (p < 0.001), even though the real objective operation time and phaco time were lower in the second eye surgery. The surgeon reported significantly more comfort during the first eye surgery. VAS was found to be positively correlated with nonsteroidal anti-inflammatory drug use, intraocular pressure, axial length, anterior chamber depth, central corneal thickness, phaco time, and operation time perception, and inversely correlated with best-corrected visual acuity and mature cataract morphology.ConclusionsConsecutive phacoemulsification surgeries appear to differ not only in terms of pain perception but also operation time perception, patient cooperation, and surgeons’ comfort. Determining and controlling the factors that can influence patients’ pain perception and comfort will increase the safety of the contralateral surgery.

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial.

Subluxation techniques are superior to divide-and-conquer in procedure duration, pain, and ultrasound quantity, but their safety in endothelial cell loss (ECL) is unclear. This randomized single-blind noninferiority clinical trial aimed to determine whether subluxation supracapsular phacoemulsification techniques are inferior to a reference endocapsular technique (divide-and-conquer) regarding postoperative corneal ECL. Patients (aged18 years or older) with greater than +0.2 logarithm of the minimum angle of resolution best spectacle-corrected visual acuity and normal to severe density cataract were randomized to subluxation or divide-and-conquer phacoemulsification in 2015 to 2016. Follow-up with ophthalmic tests was conducted on day 4 and months 1, 3, and 12. The primary study outcome was ECL at all time points. Secondary study end points were operative variables, including effective phaco time and procedure duration. A clinically relevant noninferiority ECL limit was established on the basis of the literature. In total, 292 patients (mean age, 73 yrs; 59% female) were randomized and underwent subluxation (n = 148) or divide-and-conquer (n = 144). Day 4 and month 1, 3, and 12 data were available for 243, 270, 275, and 198 patients, respectively. The unexpectedly high dropout at 12 months meant that the 12-month ECL data could only be assessed qualitatively. Surgery was successful in all patients. Subluxation was noninferior to divide-and-conquer in ECL. Effective phaco times were similar, but subluxation associated with shorter procedure duration. The subluxation technique was noninferior to divide-and-conquer regarding postoperative ECL, at least in the first 3 months, and associated with reduced intervention time. Subluxation techniques may be suitable alternatives to endocapsular techniques.Clinical Trial Registration-URL: ClinicalTrials.gov. Unique identifier: NCT02535819.

COMPARISON OF INTRAOCULAR LENS IMPLANTATION WITH AND WITHOUT VISCOELASTIC SUBSTANCES IN PHACOEMULSIFICATION

Background: Life expectancy of the population may increase and cataract development may affect all the people with aging. Intraocular lens implantation surgery, a worldwide performed procedure, evolves and progresses. However, different techniques exist, which could be selected for different cases. Any ideal technique should be safe, simple, fast, and easy to learn with good clinical outcome. Objective: The aim of this work was to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification as well as surgery duration and post-operative intraocular pressure and central corneal thickness. Patients and methods: This was a prospective, randomized controlled trial conducted on 40 eyes with cataract; to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification of the lens as regard to surgery duration, post-operative intraocular pressure and central corneal thickness. Patients were evaluated 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups after the completion of lens cortex removal: Group A (n=20, hydro-implantation): One-piece acrylic intraocular lens implantation was performed with normal saline solution (0.9 solution) irrigation. Group B (n=20, visco-implantation): using Hydroxy-propyl-methyl-cellulose 2% implantation. Results: Highly significant increase in phaco operative time in visco-implantation group; compared to hydro-implantation group (p 0.05 respectively). Non-significant difference as regards post-operative Central corneal thickness (CCT) (p > 0.05). Non-significant increase in post-operative CCT measurements in visco-implantation group (p > 0.05). Non-significant difference in post-operative IOP measurements in visco-implantation group (p > 0.05). Non-significant decrease in post-operative IOP and CCT measurements in hydro-implantation group (p > 0.05). Non-significant decrease in post-operative IOP in hydro-implantation group; compared to visco-implantation group; during the serial 1st and 2nd measurements. Non-significant increase in post-operative CCT in Visco-implantation group; compared to hydro-implantation group; during the serial 1st and 2nd measurements. Conclusion: The hydro-implantation had similar clinical outcome to visco-implantation with advantage of reduced surgical time and cost, and no ophthalmic viscosurgical devices (OVD) induced intraocular pressure elevation postoperatively.