Phacoemulsification Cataract Extraction Research Articles

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M & J Western Regional Institute of Ophthalmology (M&J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M & J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value <0.05 was taken as significant.: MSICS & phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS & phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).
 Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.
 Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.
 Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction.

To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.

Cataract Surgery Outcomes in Patients with Non-ocular Autoimmune Disease.

While phacoemulsification cataract extraction is generally highly effective and safe, patients with a history of uveitis are at higher risk for postoperative complications and often require a modified perioperative medication regimen. No data exists on risks of postoperative complications and persistent anterior uveitis (PAU) in patients with non-ocular autoimmune disease. Medical records were reviewed of patients who underwent phacoemulsification cataract surgery with intraocular lens implantation between January1, 2014 and December31, 2019 at the University of Colorado Hospital (UCH) as part of a retrospective cohort study. Exclusion criteria included patient history of ocular inflammation and cataract surgery combined with another intraocular surgery. Patients were only included as having autoimmune disease if the diagnosis was confirmed by a relevant specialist at UCH. Patients with autoimmune disease were then stratified into systemic versus organ-specific autoimmune disease, and patients with systemic autoimmune disease were further stratified into immunosuppressed and not immunosuppressed at the time of cataract surgery. Patients with PAU were identified according to the Standardization of Uveitis Nomenclature Working Group. Data including sex, race/ethnicity, intraoperative cumulative dissipated energy (CDE), and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained. A total of 422 eyes from 248 patients had confirmed autoimmune disease, compared to a control group of 10,201 eyes. The autoimmune and systemic autoimmune disease groups were not more likely to have postoperative complications or PAU compared to the control group. Immunosuppression status among the systemic autoimmune disease group was also not associated with postoperative complications or PAU. Patients with non-ocular autoimmune disease do not appear to be at higher risk for postoperative complications, including worse BCVA or increased rates of IOP elevation and PAU, following phacoemulsification cataract surgery. These patients do not appear to require modification of the typical perioperative medication regimen.

Safety and effectiveness comparison of a new cohesive ophthalmic viscosurgical device.

Evaluation of the safety and effectiveness of a new cohesive OVD (StableVisc) compared to a marketed cohesive OVD (ProVisc) in patients undergoing cataract surgery. 22 sites in the United States. Prospective, multicenter, controlled, double-masked, and randomized 1:1 (StableVisc:ProVisc; stratified by site, age group, and cataract severity). Adults (≥45 years) with age-related non-complicated cataract considered amenable to treatment with standard phacoemulsification cataract extraction and IOL implantation were included. Patients were randomized to receive either StableVisc or ProVisc during standard cataract surgery. Postoperative visits occurred at 6 hours, 24 hours, 7 days, 1 month, and 3 months. The primary effectiveness outcome was the change in endothelial cell density (ECD) from baseline to 3 months. The primary safety endpoint was the proportion of patients who experienced at least one IOP measurement ≥30 mmHg at any follow-up visit. Noninferiority between the devices was tested. Inflammation and adverse events were evaluated. 390 patients were randomized; 187 patients with StableVisc and 193 patients with ProVisc completed the study. StableVisc was noninferior to ProVisc in mean ECD loss from baseline to 3 months (17.5% and 16.9%, respectively). StableVisc was noninferior to ProVisc in the proportion of patients with postoperative IOP ≥30 mmHg at any follow-up visit (5.2% and 8.2%, respectively). StableVisc cohesive OVD, which provides both mechanical and chemical protection, is safe and effective when used in cataract surgery and provides surgeons with a new cohesive OVD.

Retracted: 23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage.

[This retracts the article DOI: 10.1155/2022/7393661.].

Clinical Evaluation of a Modified Light Transmission Short-Wavelength Filtering Intraocular Lens Compared to a Colorless Control.

The aim of this study was to evaluate the safety and efficacy of a violet-light filtering intraocular lens (IOL) compared to a colorless IOL control. This was a prospective, bilateral, randomized, comparative, patient/evaluator-masked multi-center clinical trial at 12 sites in the USA. Patients underwent standard small-incision phacoemulsification cataract extraction. Visual acuity, contrast sensitivity, and color vision were tested 12months postoperatively. Patient satisfaction and vision-related quality of life were evaluated based on directed patient responses obtained from a binocular subjective questionnaire. A total of 250 subjects were bilaterally implanted with the violet-light filtering TECNIS monofocal ZV9003 (n = 126) and colorless TECNIS monofocal ZA9003 (n = 124). Mean uncorrected distance visual acuity (UDVA) was 0.123 LogMAR for ZV9003 and 0.116 LogMAR for the ZA9003 group. Mean corrected distance visual acuity (CDVA) was 0.00 LogMAR for both groups. No significant difference was found between the groups for 22/25 questionnaire categories, including color perception. A significant difference was found in favor of the ZV9003 group for day driving, night driving, and frustration with vision. Contrast sensitivity mean difference was < 0.05 log units across all lighting conditions and spatial frequencies. No difference was found between groups for visual acuity, contrast sensitivity, color testing, and adverse events as well as with the majority of optical/visual symptoms. A statistical difference was noted in driving and frustration with eyesight that may be related to benefits of using a violet-light filtering chromophore. Overall, the violet-light filtering ZV9003 showed excellent visual acuity and contrast sensitivity results with a low incidence of optical/visual symptoms.

Outcomes of Partial vs Complete Goniotomy With or Without Phacoemulsification For Primary Open-angle Glaucoma: A Multi-Center Study.

120° goniotomy with or without phacoemulsification was sufficient to lower the intraocular pressure and reduce hyphema for primary open-angle glaucoma. To compare the surgical outcomes and safety profiles of 120° and 360° goniotomy (GT) with or without phacoemulsification cataract extraction and intraocular lens implantation (PEI) for primary open-angle glaucoma (POAG). This multicenter retrospective study consisted of 139 eyes and were divided into four groups: (1) 120° GT, (2) 360° GT, (3) PEI+120° GT, and (4) PEI+360° GT. Intraocular pressure (IOP), number of topical hypotensive medications, and complications were recorded and evaluated at baseline and at the final visit. The complete and qualified success rate and their potential associated factors were also investigated. The effectiveness and safety profile of the surgery were compared between different subgroups. After a mean follow-up of 8.6 months, the IOP reduction was 13.2±8.3 (38.8±28.8%), 12.4±8.3 (41.6±18.2%), 12.8±9.9 (39.4±34.5%), and 13.8±7.2 (46.0±17.1%) mmHg in 120°, 360°, PEI+120°, and PEI+360° GT, respectively. No significant difference was found in IOP, decline of IOP from baseline, topical hypotensive medication, and complete or qualified success between either standalone 120° vs 360° GT, or PEI+120° vs PEI+360° GT (all Ps>0.05). The PEI+120° group had a lower final IOP than the 120° GT group (P=0.0002) whereas there was no difference between PEI+360°GT and 360° GT group (P=0.893). Both 360° GT and PEI+360° groups had a significantly higher incidence of hyphema than the 120° GT and PEI+120° GT groups (all Ps<0.0001). Goniotomy of 120 or 360 degrees lowered IOP equally with or without cataract surgery, and hyphema was most commonly noted following complete goniotomy. Partial goniotomy alone or in combination with cataract surgery was an effective and safe approach to manage patients with open angle glaucoma.

The prevalence of pseudoexfoliation syndrome in King Hamad University Hospital.

The aim of this study is to determine the prevalence of pseudoexfoliation syndrome in patients with cataracts in King Hamad University Hospital (KHUH) and rates of complication in pseudoexfoliation (PXF) patients postoperatively and 2-year follow-up. A retrospective analysis was conducted on medical records of PXF patients who underwent phacoemulsification and extracapsular cataract extraction in KHUH, Bahrain, between August 31, 2016, and December 30, 2018. From the 458 cases analyzed, there were 17 patients with PXF (3.71%). One patient per-operatively experienced posterior capsular repture (5.88%). Zero patients experienced complication in 2 years of follow-up. This is the first study investigating the prevalence rate of PXF in Bahrain and rates of complication for PXF patients undergoing cataract surgery. This study contributes to further understanding the epidemiology of this disease and its racial variation, for PXF patients to better understand the rate of risks involved in cataract surgery, and for surgeons to create appropriate surgical plans that help reduce the risk of complications commonly seen in these patients.

An economic evaluation of phacoemulsification and extracapsular cataract extraction in cataract surgery

Background/Aim. Cataract surgery is one of the most often performed surgical interventions. The predominant method in Western countries is phacoemulsification, while in developing countries, the extracapsular cataract extraction (ECCE) method remains popular. The aim of the study was to evaluate the cost-effectiveness of these two cataract surgery techniques from the provider?s perspective if operation complications were the outcome of the interest. Methods. The data were obtained from the Department of Ophthalmology of the General Hospital Krusevac during a one-year period. A total of 1,179 surgeries by five surgeons were performed. The cost-effectiveness was evaluated using the decision tree. All probabilities were calculated based on the likelihood of the occurrence during the study period. Only direct costs were considered, and values were taken from the documentation at the hospital and the official price list of health services. One- and two-way sensitivity analyses were performed. Results. The total cost per patient in the phacoemulsification group was 71,008.70 Serbian dinars (RSD), while the total cost in the ECCE group was 74,340.36 RSD. At the same time, phacoemulsification shows higher effectiveness than the ECCE method, with 87% and 57% of patients without complications, respectively. With these results, phacoemulsification was the dominant strategy compared to ECCE. The sensitivity analysis revealed that the results are sensitive to the number of performed operations per year. Conclusion. The phacoemulsification technique seems to be the preferred technique for cataract surgery. All the investment in phacoemulsification equipment and consumables is justified if the number of surgeries per year exceeds 350.

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage.

Objective To evaluate the clinical efficacy of the combined application of 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction in the treatment of neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) combined with vitreous hemorrhage (VH). Methods Eighty-three patients (91 eyes) with PDR diagnosed as NVG phase III complicated with VH from June 2018 to May 2020 were selected as the study subjects. The subjects were randomly divided into 3 groups: group A was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation; group B was given 23G minimally invasive vitrectomy combined with phacoemulsification cataract extraction; and group C was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation and phacoemulsification cataract extraction. The uncorrected visual acuity (UCVA), intraocular pressure (IOP), and iris neovascularization (INV) scores were recorded and compared among the 3 groups before and after operation, and then the postoperative pain relief and complications were observed. Results Through observation, there was no significant difference in the UCVA, IOP, and INV scores in the 3 groups before operation. After the operation, the UCVA, IOP, and INV scores of the 3 groups were significantly lower than those before operation. After operation, the UCVA of the 3 groups increased first and then decreased, and it improved most significantly in the 3rd month after operation and decreased in the 4th month after operation. There were significant differences in UCVA among the 3 groups at each time point after operation. From the 1st day to the 6th month after operation, the IOP of the 3 groups showed an upward trend, and there was no significant difference among the 3 groups in IOP at each time point after operation. At the 1st, 3rd, and 6th months after operation, the INV score of group A and group B was higher than that of group C. There was no significant difference in the INV score between group A and group B. The incidence of complications was not significantly different among the 3 groups. Conclusion 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction can effectively improve the UCVA, IOP, and INV scores of NVG secondary to PDR with VH, and the combined application of the 3 methods has better security.

Changes in chorioretinal flow index after cataract surgery: an optical coherence tomography angiography study.

Pseudophakic cystoid macular edema (CME) occurs in up to 2% of uneventful cataract surgeries. This study evaluates changes in macular blood flow succeeding uneventful phacoemulsification cataract extraction among otherwise visually healthy subjects. This prospective study included 18 eyes of 18 patients undergoing routine phacoemulsification. Optical coherence tomography angiography (OCT-A) was performed using the Angio-Retina 6 × 6mm protocol with the XR Avanti Angio-Vue system (Optovue Inc., Fremont, California) prior to the surgery and 4-8weeks thereafter. Exclusion criteria included motion artifacts, segmentation errors and signal strength index (SSI) < 40. The main outcome measure was change in flow index (FI) measured in all 4 retinal segmentation layers within an area of 1mm diameter around the foveal center. Following surgery, a significant increase in SSI (46.65 ± 8.62 versus 53.12 ± 8.07, p = 0.01), superficial plexus FI (0.98 ± 0.23 versus 1.16 ± 0.16, p = 0.02) and deep plexus FI (0.54 ± 0.46 versus 0.93 ± 0.39, p = 0.01) was found. No significant changes were noted in the outer retina or the choriocapillaris. The study demonstrates a significant increase in FI in the superficial and deep retinal plexus following uneventful cataract surgery, with the greatest changes occurring in the latter. These findings corroborate evidence from structural imaging and support the vascular etiology of pseudophakic CME.

Outcome of Phacoemulsification and Extracapsular Cataract Extraction

Objective: Aim was to compare the visual results of patients who received ECCE and phacoemulsification for the treatment of age-related cataracts. Study Design: Prospective study Place and Duration: Conducted at Jinnah International Hospital during from Jan, 2021 to Dec, 2021. Methods:There were 130 patients of both genders presented for cataract surgery. Patients were aged between 35-75 years.When patients signed an informed permission form, demographic information such as age and sex were recorded. Patients were equally divided in two groups. Group I received phacoemulsification (phaco) cataract surgery and group II received conventional extracapsular cataract extraction. Intraoperative and post-operative complication among cases was assessed. At last follow up best corrected visual acuity was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results:Among 130 cases, majority of the cases 85 (65.4%) were males and 45 (34.6%) were females. 15 (11.5%) patients were aged between 35-45 years, 45 (34.6%) patients were aged between 46-55 years, 38 (29.2%) were aged between 56-6 years and 32 (24.6%) had age &gt; 65years. Post-operative we found significantly good vision among patients of phaco group in 54 (83.1%) cases as compare to group II in 31 (47.7%) cases. Frequency of intraoperative complications was higher in group II 9 (13.8%) as compared to group I 3 (4.6%) cases. Post-operative complications in group I was corneal decompensation, high astigmatism and posterior capsule opacity but in group II high astigmatism and corneal decompensation were the complications. Conclusion:We came to the conclusion that the visual outcome was considerably better in the Phaco operation compared to the ECCE technique (p = 0.003). As a result, we advocate for the provision of Phaco equipment in hospitals that have sufficient capabilities for the performance of intraocular surgery. Keywords:PhacoemulsificationSurgery, Extracapsular cataract extraction, Complications, Vision Acuity

Interim Analysis of STREAMLINE® Surgical System Clinical Outcomes in Eyes with Glaucoma.

PurposeTo characterize the clinical outcomes of a novel ab interno minimally invasive procedure with the STREAMLINE® Surgical System for creation of incisional goniotomies and canal of Schlemm viscodilation in eyes with mild to severe primary open-angle glaucoma (POAG).MethodsIn a prospective, single-arm, first-in-human case series, 20 eyes of 20 subjects with mild to severe POAG underwent creation of incisional goniotomies and canal of Schlemm viscodilation following phacoemulsification cataract extraction after washout of all intraocular pressure (IOP)-lowering medications. The angle surgery portion was performed with a single-use handpiece tipped with a microcannula that creates precise goniotomies through the trabecular meshwork into the canal of Schlemm and delivers a small volume of ophthalmic viscosurgical device directly into the canal via precise catheterization. Outcomes in this interim analysis included mean reduction in IOP and medications through 6 months of follow-up, as well as the proportion of eyes achieving IOP reduction ≥20% from baseline.ResultsAt month 6, mean IOP reduction of ≥20% from baseline was achieved in 89.5% of eyes (17/19). Mean (standard deviation) medicated IOP at screening was 16.3 (3.6) mmHg and unmedicated baseline IOP (after washout) was 23.5 (2.5) mmHg. Mean IOP was significantly reduced from baseline through 6 months of follow-up to 14.7 (2.4) mmHg (p<0.001), representing an IOP reduction of 8.8 mmHg (36.9%). Overall, 57.9% (11/19) of eyes decreased dependence on IOP-lowering medications by at least one medication, and 42.1% (8/19) were medication free. Mean medication use was reduced from 2.0 (0.8) at screening to 1.1 (1.1) at 6 months (p<0.001). Three eyes had transient IOP spikes treated with topical medications.ConclusionThe creation of incisional goniotomies and canal of Schlemm viscodilation safely and effectively reduced IOP and the need for IOP-lowering medications by both clinically and statistically significant magnitudes in eyes with mild to severe POAG undergoing concomitant phacoemulsification cataract extraction through the first 6 months of follow-up.

Application of Scleral Fixed Capsular Tension Ring in Surgery for Moderate and Severe Lens Dislocation

Objective — To investigate the effect of phacoemulsification cataract extraction in patients with moderate or severe lens subluxation with scleral fixed capsular tension ring implantation. Methods — A total of 43 patients (47 eyes) with lens subluxation (scope of dislocation exceeds 120 degrees) underwent phacoemulsification cataract aspiration in our hospital from November 2018 to May 2019. During intraoperative injection/aspiration of the lens cortex, the scleral fixed capsular tension ring was put into the lens capsule, and then the capsular tension ring was fixed on the sclera with sutures to summarize the surgical methods and observe the preoperative and postoperative visual acuity. Pentacam anterior segment analysis system and UBM were used to observe the capsular center and record the related complications. Results — There were statistically significant differences in the distribution of corrected visual acuity before and after operation (P&lt;0.01). The fixations stability of MCTR and intraocular lens proved to be in good condition. There was no IOL displacement and no serious complications after 6 months of observation. Conclusion — The scleral fixed pocket tension ring is a safe and effective method for the treatment of moderate and severe lens dislocation, which can improve the surgical safety, prevent intraocular lens deviation and reduce surgical complications.

Safety and effectiveness of a new ophthalmic viscosurgical device: randomized, controlled study.

To evaluate the safety and effectiveness of a new dispersive ophthalmic viscosurgical device (OVD) (ClearVisc) compared with an approved dispersive OVD (Viscoat) when used in cataract surgery. 16 clinics in the United States. Prospective multicenter controlled randomized 1:1 (ClearVisc:Viscoat; stratified by site, age group, and cataract severity). Patients and examiners masked. Patients aged 45 years or older with age-related noncomplicated cataract considered amenable to treatment with standard phacoemulsification cataract extraction and intraocular lens (IOL) implantation were included. Patients were randomized to receive either ClearVisc or Viscoat using standard techniques. 5 postoperative visits occurred at 6 hours, 24 hours, 7 days, 1 month, and 3 months. The primary effectiveness outcome was the change in endothelial cell density (ECD) from baseline to 3 months. The primary safety end point was the proportion of patients who experienced at least 1 intraocular pressure (IOP) measurement ≥30 mm Hg at any follow-up visit. Noninferiority was tested. Inflammation and adverse events were evaluated. 372 patients were randomized: 184 patients in the ClearVisc group and 188 patients in the Viscoat group. ClearVisc was noninferior to Viscoat in mean percentage of ECD loss from baseline to 3 months (8.4% and 6.8%, respectively). ClearVisc was significantly noninferior to Viscoat in the proportion of patients with postoperative IOP ≥30 mm Hg at any follow-up visit (17.4% and 20.3%, respectively, P = .0002). ClearVisc dispersive OVD provides surgeons with a new option in the continuum of approved dispersive OVDs with beneficial properties as a surgical aid in cataract extraction and IOL implantation.

Selective laser trabeculoplasty following failed combined phacoemulsification cataract extraction and excimer laser trabeculotomy can control intraocular pressure for a limited time

PurposeTo assess the efficacy of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with excimer laser trabeculotomy (phaco-ELT).MethodsRetrospectively, the medical records of patients with primary or secondary open-angle glaucoma or ocular hypertension who underwent SLT between January 2001 and February 2015 by one surgeon at a single center after a failed phaco-ELT were evaluated. Exclusion criteria were: angle-closure glaucoma, optic nerve atrophy due to disease other than glaucoma, and additional glaucoma procedures between phaco-ELT and SLT. The main outcome measures were time to failure and Kaplan–Meier survival. Complete success was defined as a reduction of intraocular pressure (IOP) of > 3 mmHg and > 20% compared to baseline, and the number of AGM ≤ baseline.ResultsA total of 23 eyes of 21 subjects were included. Baseline IOP was 19.7 (range, 19.1–22.7) mmHg, and the number of AGM at baseline was 2.5 (range, 1.9–2.9). Median time to failure after SLT was 7.2 (range, 6.6–7.8) months. The number of antiglaucoma medications did not change during that time.ConclusionsIn eyes in which the IOP is no longer controlled following phaco-ELT, SLT could be an option to slow disease progression or prolong time until incisional filtration surgery. However, time to failure after SLT is limited. Thus, close follow-up visits are necessary in order to not delay an incisional surgery.

Comparison of visual acuity between phacoemulsification and extracapsular cataract extraction: a systematic review and meta-analysis.

Surgical treatment is the primary intervention for cataracts. Extracapsular cataract extraction (ECCE) is a routine surgery for cataracts, phacoemulsification (PE) is another procedure with a small incision and injury area. This study investigated the comparison of the effects of these two procedures on the patient's visual acuity. Embase, PubMed, Cochrane Library, and SpringerLink databases were searched from January 2000 to August 2021 to obtain randomized controlled trial (RCT) studies of PE and ECCE procedures for cataract in English. After the initial screening, Revman 5.4 software was used for the meta-analysis. This meta-analysis included a total of eight articles with 1,015 affected eyes. The results showed that the rate of good final visual acuity in the PE group was higher than that in the ECCE group [odds ratio (OR) =2.94, 95% confidence interval (CI): 2.17-3.99, P<0.00001], the incidence of vitreous Loss during PE surgery was lower than that in ECCE surgery (OR =0.16, 95% CI: 0.04-0.64, P=0.01), as was the incidence of capsular tear (OR =0.29, 95% CI: 0.10-0.85, P=0.02), the incidence of capsule opacification after surgery (OR =0.20, 95% CI: 0.08-0.53, P=0.001), and the incidence of cystoid macular edema after surgery (OR =0.16, 95% CI: 0.04-0.74, P=0.02). Compared with ECCE, PE demonstrates an improvement in postoperative visual acuity and has fewer complications for cataract patients.

Corneal endothelial cell loss after phacoemulsification versus extracapsular cataract extraction in management of senile cataract

Corneal endothelial cell loss after phacoemulsification versus extracapsular cataract extraction in management of senile cataract

Visual outcome after manual small-incision cataract surgery by viscoexpression technique.

Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9-12 million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.