Phacoemulsification Cataract Research Articles

Outcomes and complications of cataract surgery using phacoemulsification in eyes with and without pseudo exfoliation syndrome

Cataract remains a significant cause of visual impairment globally, with pseudo exfoliation syndrome (PEX) posing additional challenges for cataract surgery. This study aimed to compare outcomes and complications in patients with and without PEX undergoing phacoemulsification for senile cataract. A total of 70 patients were divided into two groups: PEX (Group 1) and non-PEX (Group 2). Surgical procedures were performed, and outcomes were evaluated. Group 1 exhibited smaller pupil diameter and higher rates of advanced cataracts and intraoperative complications. Despite similar postoperative parameters, Group 1 showed increased inflammatory response and poorer initial visual recovery. Tailored management strategies for PEX patients undergoing cataract surgery are warranted.

CATARACT SURGERY RESULTS IN BRAIN TUMOR DIAGNOSIS: A CASE REPORT

The article outlines a diagnostic investigation following phacoemulsification of early age-related cataract in patients who exhibited no improvement in best-corrected visual acuity and reported “floating spots” in the postoperative period. Optical coherence tomography of the optic disc showed a lesion in the peripapillary nerve fiber layer, symmetrically located on the temporal side of both eyes. Computer perimetry revealed bitemporal hemianopsia. Neuroimaging (MRI with intravenous contrast) confirmed the presence of a lesion in the chiasmatic-sellar region. In this article, we present a variant of postoperative management and additional examination of a patient as an example of differential diagnostic search for a possible non-ophthalmological cause of decreased visual acuity. It demonstrates the importance of an interdisciplinary approach as a key to early diagnosis of brain tumors.

Comparison of two formulas for calculating intraocular lens in patients with angle-closure glaucoma.

This study compares the accuracy of SRK/T and Barrett Universal II intraocular lens (IOL) measurement formulas for cataract phacoemulsification combined with intraocular lens implantation in angle-closure glaucoma (ACG) patients. Prospective serial case studies were conducted. A total of 146 patients (146 eyes) with ACG complicated with cataract who underwent cataract surgery with atrial angle closure ≤180° were observed. All the patients were divided into 2 groups according to different intraocular lens calculation formula, with 73 cases in each group (73 eyes). SRK/T intraocular lens calculation formula was used in group A, and Barrett intraocular lens calculation formula was used in group B. The visual acuity, the best corrected visual acuity, intraocular pressure and central anterior chamber depth were significantly improved in 146 eyes 3 months after operation, and the differences were statistically significant. There was statistically significant difference in postoperative spherical equivalent (SE) between the 2 groups (t = 2.147, P = .033), and there was statistically significant difference in preoperative expected refraction between group A and postoperative SE (t = 4.221, P < .001). There was no significant difference between preoperative expected diopter and postoperative SE in group B (t = 1.857, P = .065). The difference in absolute predicted error between the 2 groups was statistically significant (t = 4.929, P < .001). Axis length was negatively correlated with SRK/T formula and Barrett Universal II formula absolute refractive error value (ME) (group A: r = -0.740, P < .001; group B: r = -0.532, P < .001), there was A significant negative correlation between absolute refractive error value and anterior chamber depth in both groups (group A: r = -0.382, P = .001; group B: r = -0.358, P = .002). The cataract phacoemulsification combined with intraocular lens implantation is safe and effective for ACG patients with cataract. For such patients, the Barrett Universal II intraocular lens measurement formula may be more accurate after surgery.

Changes in corneal curvature and astigmatism in senile cataract patients after phacoemulsification.

Analysis of changes in corneal curvature and astigmatism after phacoemulsification for senile cataracts. Retrospective collection of clinical data from patients who underwent uncomplicated phacoemulsification at the First Affiliated Hospital of Soochow University. The changes in total corneal curvature, anterior surface curvature, posterior surface curvature, and astigmatism were measured by the Sirius system. The axial length was measured by Lenstar 900. The total corneal curvature and anterior surface curvature at 3 months were all larger than those before phacoemulsification, and the difference was statistically significant (p < 0.05). Compared with preoperative results, there was no significant change in corneal posterior surface curvature and astigmatism 3 months after surgery (p > 0.05). Changes in corneal curvature and astigmatism were not significantly correlated with age at 3 months after surgery (p > 0.05). Postoperative astigmatism was increased with the growth of axial length, while corneal curvature was decreased (p < 0.05). Phacoemulsification can lead to increased postoperative corneal curvature in elderly cataract patients, and with the growth of the axial length, the corneal astigmatism was increased.

Prevention of Dry Eye Syndrome Before Phacoemulsification of Cataracts in Patients with a History of Cosmetic Procedures in the Periorbital Area

Prevention of Dry Eye Syndrome Before Phacoemulsification of Cataracts in Patients with a History of Cosmetic Procedures in the Periorbital Area

Alterations in anterior lens capsule structure and LTBP-2 expression in primary angle-closure glaucoma

ObjectiveThis study investigated the role of latent-transforming growth factor β-binding protein 2 (LTBP-2) in primary angle-closure glaucoma (PACG) by analysing its expression and the ultrastructure of the anterior lens capsule...

A Comparative Study of Tear Film Dysfunction After Small Incision Cataract Surgery and Phacoemulsification

A Comparative Study of Tear Film Dysfunction After Small Incision Cataract Surgery and Phacoemulsification

Resolution of myopic macular schisis following cataract phacoemulsification.

Resolution of myopic macular schisis following cataract phacoemulsification.

Traumatic Rosette cataract: A case report

Rosette cataract is characterized by a star-shaped opacity that forms in the lens of the eye after blunt or penetrating trauma. Traumatic cataracts constitute a significant portion of ocular injuries, with rosette cataract being a distinctive subtype. Understanding its formation and progression is critical for effective management. Blunt trauma to the eye causes a shock wave that disrupts the lens fibres. This disruption leads to the characteristic rosette pattern due to peculiar lens fibres arrangement. Patients may present with blurred vision, glare, and photophobia due to associated traumatic iritis. The rosette pattern may be visible upon slit-lamp examination. In early stages, observation and protective eyewear may be recommended. Significant visual impairment due to rosette cataract will require cataract surgery. Either small incision cataract surgery or Phacoemulsification with intraocular lens (IOL) implantation is the standard treatment for advanced cases. Timing of surgery depends on the degree of visual impairment and patient’s needs.

Evaluation of visual and optical quality following phacoemulsification cataract surgery with diffractive multifocal intraocular lens implantation: An observational study.

The assessment of patient satisfaction following cataract surgery is heavily reliant on the evaluation of visual quality, specifically after the placement of diffractive multifocal intraocular lenses (MIOLs) under varying pupil conditions. The objective of this study was to examine the visual and optical clarity following cataract phacoemulsification and the use of Tecnis ZMB00 MIOL for implantation. The study involved 116 individuals (135 eyes) who received cataract phacoemulsification and underwent Tecnis ZMB00 MIOL implantation. Assessments were conducted 1 week and 3 months after the surgery. These assessments involved measuring uncorrected and corrected visual acuity for distant, intermediate, and near vision. Additionally, scatter light values and wavefront aberrations were measured under different aperture settings of 3 and 5 mm. There was no noticeable disparity in visual acuity between 1 week and 3 months after the surgery. After 3 months of surgery, there was a considerable decrease in scatter light values and spherical aberrations compared to the values observed 1 week after surgery, under the setting of a 5 mm aperture. Moreover, the modulation transfer function values showed a significant rise after 3 months following the surgery, particularly under the 5 mm aperture condition. The most substantial increase was observed at the intermediate spatial frequency of 20 cycles per degree (cpd), in comparison to the values obtained 1 week after the operation. The combination of cataract phacoemulsification and Tecnis ZMB00 MIOL implantation yielded favorable visual acuity at various distances for patients. Furthermore, enhancements in the measurements of scattered light, higher-order aberrations, and modulation transfer function values were noted 3 months after the surgical procedure, specifically under the condition of a 5 mm pupil. These findings suggest an increase in visual clarity and night vision to a certain degree.

Safety of Phacoemulsification with Gradual Hydro Dissection on Posterior Polar Cataract

Introduction: Phacoemulsification has been a procedure of choice for treating cataractous lenses and restoring visual function. Posterior polar cataract have been one of many cases in which phaco surgeons should be careful and aware for more to perform phacoemulsification. One hydrodissection procedure is safe to perform as an alternative to hydrodileniation during phacoemulsification for posterior cataract. It is called gradual hydrodissection. Methods: This study performed a quasi-experimental pre-post study that tested the safety of gradual hydrodissection in phacoemulsification in 50 eyes of 50 patients. The safety parameter used in this study includes the incidence of posterior capsule rupture and nucleus drop during phacoemulsification until surgery is finished. Descriptive statistics were used to summarize the characteristics of the study participants, such as age, sex, race, eye laterality, and previous intraocular surgery. A paired student’s t-test was conducted to compare preoperative and postoperative values for visual acuity and intraocular pressure. The P &lt;0.05 was considered the level of statistical significance. Results: There was no complication of the posterior capsule during the hydrodissection procedure. There was a statistically significant difference in visual acuity and intraocular pressure before and after surgery by P value &lt;0.001. All of the phacoemulsification studies were considered uneventful and successful. Conclusions: Gradual hydrodissection may be safe to be performed in phacoemulsification for posterior polar cataract.

Clinical examples of correct orientation of a toric intraocular lens in patients with postkeratotomic corneal ectasia

BACKGROUND: Surgical treatment of cataract in patients with postkeratotomic corneal ectasia has various features. First, difficulties arise when calculating the optical strength of an intraocular lens and its cylindrical component and determining the location of the main axes of astigmatism for toric intraocular lens implantation. Additionally, not all modern keratotopography installations are able to accurately determine the refractive power of the cornea in such patients owing to pronounced irregular astigmatism and a large difference in keratometric parameters in the main meridians. CLINICAL CASES DESCRIPTION: Two clinical cases of surgical treatment of cataract in combination with postkeratotomic keratectasia are presented. Patients underwent a standard preoperative ophthalmological examination. TMS-4 Tomey keratotopograph was used to accurately determine the refractive power of the cornea. The optical power of toric intraocular lens were calculated using the Holladay 2 formula with amendments for radial keratotomy and the Johnson Johnson VISIC online calculator. SN6AT9 intraocular lens (Alcon) and a Tecnis ZCT800 toric intraocular lens (Johnson Johnson) were implanted in patients. The orientation of the position of the cylinder axis of toric intraocular lens was performed perpendicular to the most flattened meridian, corresponding to the position of the keratectasia zone, determined by the most expanded keratotomy scar. Before surgery, the best corrected visual acuity of patient M was OD=0.2, OS=0.4 and that of patient K was OD=0.4, OS=0.2. After surgery, the best corrected visual acuity of patient M was OD=0.8, OS=0.8 and that of patient K was OD=0.8, OS=0.7. CONCLUSION: This study aimed to familiarize practicing ophthalmologists, clinical residents, and postgraduates with a possible treatment option for cataracts by phacoemulsification with implantation of a toric intraocular lens in patients with postkeratotomic keratectasia. The resulting high visual acuity and subjective satisfaction of patients indicate the accuracy of chosen treatment tactics. A reliable visual guide for choosing the cylinder axis is the meridian of the greatest degree of keratectasia (cornea flattening), which is determined by the maximally expanded keratotomy scar position. The intraocular lens cylinder axis is oriented perpendicular to the keratectasia meridian. Ultrasound phacoemulsification of cataract with implantation of a toric intraocular lens is an effective method for correcting induced ametropia after radial keratotomy against the background of postkeratotomy keratectasia with high astigmatism.

Research of Bacterial Contamination of The Surgical Field During Phacoemulsification

Conditionally pathogenic conjunctival microflora is the most frequent cause of endophthalmitis after cataract phacoemulsification (“PEC”).The purpose. To evaluate the sterility of the surgical field and anterior chamber fluid (ACF) during elective (PEC).Materials and methods. 75 eyes were examined. Patients in the group I underwent standard treatment of the surgical field, in the group IA — the standard technique was supplemented with mechanical delimitation of the upper eyelid margin, in group II additional treatment of the surgical field with povidone iodine after blepharostat installation was performed. Microbiological material was collected preoperatively from three loci (conjunctival cavity, eyelid free margin, lacrimal ducts) and at different stages of surgery from the conjunctival cavity (after standard treatment, after blepharostat placement, after additional treatment). In addition, anterior chamber fluid (ACF) was examined — also during surgery. Microorganisms were identified by the MALDI­-TOF method, sensitivity was determined by the disc­diffusion method.Results. S. epidermidis prevails among all microorganisms. The percentage of the surgical field contamination by S.epidermidis after blepharostat setting was 33,33 %, 26 % and 40 % in the I, IA, II groups respectively; after additional treatment 6,6 % in the II group; in the ACF it was found in 23,33 %, 13 % and 0 % in the I, IA, II groups respectively.Conclusion. The additional treatment of the surgical field is the most effective technique to reduce the contamination of the conjunctival cavity by S.epidermidis after placing a blepharostat and the only one in the study to ensure its absence in the ACF. Standard treatments with and without mechanical delineation are less effective and do not prevent the contamination of the ACF.

Mix-­and­-match Implantation of Multifocal and Extended Depth of Focus IOLs

Purpose: Analysis of results of combined implantation of non­diffractive IOL with extended depth of focus and multifocal IOL.Materials and methods. The study included 40 patients (80 eyes) after cataract phacoemulsification or clear lens removal with a mean follow­up of 15.4 ± 1.2 (12–22) months. Women accounted for 60 % (n = 24) and men for 40 % (n = 16). 20 patients (40 eyes) with bilateral AcrySof IQ Vivity implantation formed the minimonovision group (group I), and 20 patients (40 eyes) with AcrySof IQ Vivity implantation in the dominant eye (n = 20) and Acrysof IQ Panoptix implantation in the non­dominant eye (n = 20) formed the group of mix­-and­-match implantation (group II).Results. At the maximum follow­up period of 3 months, UCNVA in group I was 0.61 ± 0.14, in group II — 0.82 ± 0.09 (p = 0.048), BCNVA — 0.66 ± 0.17 and 0.92 ± 0.14, respectively (p = 0.039). No significant differences were found between groups comparing UCIVA, BCIVA, UCDVA and BCDVA (p &gt; 0.1), but slightly higher values were determined in patients after bilateral implantation of Acrysof IQ Vivity IOLs. In group I, 2 patients (10 %) had glare and 2 (10 %) had halo. Patients did not complain about difficulties in driving in the darkness. In 9 cases out of 20 (45 %) patients required spectacle correction for reading. In group II, adverse optical phenomena were identified in 7 patients (35 %), of which 4 patients (20 %) had glare and 3 (15 %) had halo. None of the patients required spectacle correction for reading. In both groups, 95 % of cases (19 patients) rated the surgical outcome as “excellent” and 5 % (1 patient) as “good”. Conclusion. For the first time in Russia, the results of combined (mix­-and­match) implantation of EDOF and trifocal IOLs in comparison with bilateral IOL implantation in presbyopic patients were analyzed. The advantage of combined implantation for achieving better near visual acuity and comparable incidence of adverse optical phenomena was shown.

Development and Comprehensive Assessment of the Clinical Effectiveness of a Method For Cataract Phacoemulsification Based on a Single Tunnel Incision

Purpose. Development and evaluation of the clinical effectiveness of a technique for performing phacoemulsification of cataracts (FEC) based on a single tunnel incision.Patients and methods. We observed 96 patients (96 eyes, age 58.2 ± 1.2 years, 61 men, 35 women), divided into two groups equal in age, gender and visual status: control (CG, 46 patients, 46 eyes), for whom FEC was performed using the traditional method (total incision length 4.6 mm) and the main group (MG, 50 patients, 50 eyes), for whom FEC was performed using the developed method (total incision length 2.2 mm). The basis of the developed technique is to make a tunnel incision 2.2 mm long on the temporal side, followed by capsulorhexis, phacofragmentation, phacoemulsification of the lens nucleus and aspiration of the lens masses through a single tunnel incision. In this case, during phacofragmentation, a longitudinal fracture of the lens nucleus is performed along the axis 0–180°, the lens nucleus is rotated along the meridian 90–270° and another longitudinal fracture of the lens nucleus is performed along the axis 0–180°, and after phacoemulsification of the nucleus, aspiration is performed through a coaxial handle and IOL is implanted. A comparative assessment of the clinical effectiveness of the developed and traditional methods was carried out using clinical, refractive, morphological and biochemical parameters.Results. A higher clinical effectiveness of FEC using the developed method has been established (compared to the traditional one), which is confirmed by a decrease in the magnitude of surgically induced astigmatism (by 0.13 diopters, p &lt; 0.001) and a tendency towards higher postoperative uncorrected distance visual acuity (by 0.05 rel. units, p &gt; 0.05). Along with this, in the МG, compared with the CG, a pronounced decrease in the incidence of dry eye syndrome (by 3.4 %, p &lt; 0.05), C­reactive protein in the tear fluid (by 1.1 mg/l, p &lt; 0.05) and preservation of the number of endothelial cells (by 4.8 %, p &lt; 0.01).Conclusion. The developed technique for performing FEC is an effective prevention of surgically induced astigmatism and negative effects on the corneal endothelium and ocular surface, which is associated with a decrease in the total length of the incision (2.2 mm compared to 4.6 mm) and an intraoperative decrease in the total volume of circulating fluid.

Diagnosis of Dry Eye Syndrome During the Preparing Patients for Cataracts Phacoemulsification. Literature Review

The increasing patient demands for quality of life after surgery necessitate optimization of approaches in the field of surgical intervention, reduction of the frequency of refractive errors and correction of tactics of postoperative interventions. Literature data indicate that refractive errors are possible after surgical treatment for cataracts associated with the presence of dry eye syndrome in the preoperative period. Tear film is used as the first refractive medium, and the size of the refractive change at air­tear film interfaces is the most innovative of any interface in any other optical system. Thus, changes of tear film physiology affect overall vision with higher order aberrations and irregular astigmatism occurring. The presented literature review analyzes data from scientific studies aimed at studying risk factors for the development of dry eye syndrome and diseases associated with it when phacoemulsification of cataracts occurs. Considering the fact that, according to various studies, the incidence of dry eye syndrome after cataract surgery ranges from 9.8 to 96.6% in cataract surgery in collaboration with dry eye surgery, adequate approaches within the framework of preoperative preparation are an urgent development. The lack of clear recommendations for effective preoperative screening and respiratory preparation for surgery, unreliable biometric data, and lack of treatment strategy for postoperative dry eye syndrome are indicators of detectors to obtain the desired results. Adequate diagnosis and preparation of ocular surfaces before biometric measurements can reduce refractive errors after surgery.

Эффективность современных методов микробиологической диагностики инфекций в офтальмологии. Клинический пример

Purpose. To demonstrate the interaction of ophthalmic and microbiological services based on the use of technologies to minimize the time of microbiological diagnosis of ocular infection on a clinical example. Methods. A clinical example of an 82-year-old patient who underwent planned cataract phacoemulsification surgery with IOL implantation is presented. On the 3rd day after surgery, the patient was diagnosed with postoperative endophthalmitis. A rapid (48 h) microbiological diagnosis of the pathogen (E. faecalis), which made possible an early etiotropic adjustment of antibacterial treatment, provided maximum therapeutic effect, minimized the toxic side effects of pharmacotherapy and gave a good anatomical and functional result. Results The clinical case demonstrated organization of a precise interaction between ophthalmic service and the laboratory, which made it possible to identify the pathogen and determine the spectrum of its sensitivity to antibiotics during the first two days after diagnosis of postoperative endophthalmitis, prescribe etiotropic treatment with a good clinical and functional outcome. Key words: mass spectrometry; infection; microbiology; endophthalmitis.

Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics. To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine. This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included. Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears. Postoperative endophthalmitis incidence. Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000). No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

Granulomatosis with polyangiitis, complicated by ocular adnexa lesion and vascular changes in retina and choroid (literature review with a clinical case)

Granulomatosis with polyangiitis (GPA) is manifested as ocular pathology in almost a third of patients, which can either be detected at the onset of the disease or occur in the late stages. The pathological process involves the orbit, sclera, episclera, cornea, conjunctiva, eyelids, nasolacrimal system, optic nerve, retina and choroid. Lesion of eye and its surrounding structures determines the severity of the pathological process, the patient’s quality of life and prognosis. The article presents a clinical case of a 38-year-old man with an unfavorable course of GPA, lesion to upper and lower respiratory tract, kidneys, and musculoskeletal system. The authors consider ocular manifestations in the context of a systemic disease. An ophthalmological examination of the patient revealed changes in sclera and choroid, which had not previously been described in detail in the literature. The patient underwent cataract phacoemulsification in the right eye with implantation of a posterior chamber intraocular lens. The dynamics of clinical manifestations of eye lesion in the near future is positive, but in the long term it remains doubtful due to pronounced changes in the orbit and adnexa of the eye against the background of ongoing small vessels vasculitis. Early consultation with an ophthalmologist and optical coherence tomography in patients with GPA are necessary at any stage of the disease. The clinical case is presented with consideration to the CARE 2021 recommendations.

A comparative lens: Manual small incision cataract surgery versus phacoemulsification

A comparative lens: Manual small incision cataract surgery versus phacoemulsification