Phacoemulsification Group Research Articles

Efficacy and safety of XEN 45 gel stent alone or in combination with phacoemulsification in advanced open angle glaucoma patients: 1-year retrospective study.

To assess the effectiveness of the XEN 45 gel stent, either alone or combined with cataract surgery, in advanced stage open angle glaucoma (OAG) patients. Retrospective and single-center study conducted on consecutive OAG patients who underwent a XEN 45 gel stent implantation surgery, between July 2017 and September 2018. The primary efficacy end-point was the mean intraocular pressure (IOP) reduction at the end of the follow-up period. Success was defined as an IOP reduction of at least 20% and an IOP value ≤18 mm Hg without (complete) or with (qualified) hypotensive medication. Seventy-four patients (80 eyes) were included in the study. In the overall study sample, XEN implant significantly reduced IOP from 21.0 (19.8 to 22.1) mm Hg at baseline to 9.3 (8.2 to 10.4), 10.7 (9.6 to 11.9), 13.4 (12.2 to 14.7), 14.5 (13.6 to 15.4), 14.7 (13.8 to 15.6), and 14.7 (13.9 to 15.4) mm Hg at 1d, 1wk, 1, 3, 6, and 12mo of follow-up, respectively (P<0.0001 each). In the overall study population, at the end of the study the mean IOP reduction was 27.4% (23.3% to 31.5%). Adjusted IOP reduction was similar in XEN and XEN+phacoemulsification groups [30.0 (23.4 to 36.4) mm Hg vs 24.8 (18.4 to 31.2) mm Hg, respectively, P=0.2939]. At the last follow-up visit, 52 (65.0%) eyes were considered success, 29 (36.3%) eyes as complete success and 23 (28.7%) as qualified success. Mean number of hypotensive medications was significantly reduced from 2.8 (2.7 to 3.0) at baseline to 1.1 (0.8 to 1.3), P<0.0001. Kaplan-Meier survival analysis did not find any difference in the success rate between XEN and XEN+PHACO, mean hazard ratio 0.56, 95%CI 0.26 to 1.23; P=0.1469. Needling was performed in 7 (8.8%) eyes at months 1 (n=3); 3 (n=2); 4 (n=1) and 11 (n=1). Eleven (13.8%) eyes presented adverse events. XEN implant, either alone or in combination with phacoemulsification, significantly reduced the IOP and the number of hypotensive medications in patients with OAG in advanced stage.

Clinical outcomes of trabecular microbypass stent (iStent) implantation in medically controlled open-angle glaucoma in the Korean population

To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.Mean IOP was reduced from 15.8 ± 2.8 mm Hg to 14.5 ± 2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ± 1.2 to 0.8 ± 1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799–10.454) and 3.717 (95% confidence interval: 1.516–9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ± 0.10 to 0.09 ± 0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.

Comparison of astigmatism after phacoemulsification and extracapsular cataract extraction

Objective: To compare astigmatism after phacoemulsification and extracapsular cataract extraction technique. Method: It was a hospital-based cross-sectional study conducted at Zainab Medicare hospital Haroonabad from September 2018 to May 2019. A sample size of 80 patients having cataract, age 41 to 70 years was included in this study. Slit lamp examination was performed for anterior segment evaluation and astigmatism was determined with autorefraction and keratometry. Result: Phaco technique was more reliable. The means and the standard deviation of phaco post op astigmatism was 0.7860 ±.48880 and ECCE post op astigmatism was 3.6310±1.96236 which indicated that the degree of astigmatism increases after extra capsular cataract extraction technique. The significant level was 0.00 which showed that the phaco technique is highly significant. Conclusion: Corneal astigmatism was almost similar in two groups prior to surgery but after the cataract surgery the astigmatism significantly decreased after phacoemulsification group at 2 weeks follow-up, the results indicated that phaco may be considered superior to ECCE. No suturing is required in phaco and hence lesser chances of post op astigmatism.

The small incision manual cataract surgery for hard nucleus cataract——the superiority on improvement of quality of visual acuity and life

Objective To observe the visual acuity, corneal astigmatism and quality of life of patients with hard nucleus cataract after small incision manual nuclear extraction (non-phacoemulsification). Methods Prospective cohort study.Total of 440 eyes of 440 cases with hard nucleus cataract from Jan.2014 to Jan.2019 in Yuyao Maternal and Child Health Hospital were randomly divided into two groups.There were 198 cases in small incision manual nuclear extraction group (manual group) and 242 cases in phacoemulsification group (phaco group). Follow-up time was 3 months. Results At 1 month after operation, the complication rate in the manual group was lower than that in the phaco group (P=0.028). At 3 months after operation, there was no significant difference in distribution of uncorrected visual acuity between the two groups (P=0.776, 0.712, 0.810). The corneal astigmatism of the manual group was lower than that of the phaco group (P=0.000). There was no significant difference in general health status, far work, ophthalmodynia, social function, social role limitation, independence, or mental health questionnaire score between the two groups (P=0.230, 0.601, 0.259, 0.296, 0.544, 0.492, 0.547). The score of overall vision, near work, color vision and peripheral vision in the manual group were higher than those of the phaco group (P=0.000). Conclusion Small incision manual cataract surgery for the treatment of hard nucleus cataract can not only improve the visual acuity, but also reduce corneal astigmatism and the incidence of complications, and improve the visual related quality of life of patients. Key words: Cataract, hard nucleus; Delivery, nucleus, manual, non-phacoemulsification, small incision; Phacoemulsification; Quality of life

Comparison of Morphological and Functional Corneal Endothelial Changes after Cataract Surgery under DBCS Program at a Tertiary Care Centre

Introduction: Cataract extraction constitutes the largest workload through DBCS program in ophthalmic units in India. Both SICS & Phacoemulsification surgery are performed in a limited, confined space; however, securing adequate surgical space during cataract surgery can decrease the risk of corneal endothelial cell loss.1 Thus, anatomical and surgical factors, such as adequate Anterior Chamber Depth (ACD), are important for preserving these cells from the mechanical and thermal damage that can occur during the procedure. Under normal circumstances, corneal endothelial cells do not proliferate because they are stuck in G1 phase of cell cycle. The central corneal endothelial cell density gradually decreases at an average of about 0.6% per year, reducing approximately from 3400 cells/mm2 at age 15 to 2300 cells at age 80 years. Two important factors in maintaining corneal transparency are the number and the integrity of the corneal endothelial cells.3 Corneas with cell densities as low as 500 cells/mm2 and average cell area of approximately 2000-3000 μm2 can remain clear. Protection of corneal endothelium during cataract surgery is critical for achieving good visual outcomes. Objectives: To study the endothelial cell loss in SICS and Phacoemulsification and compare the cell loss between two surgeries and to compare morphological and functional changes in corneal endothelium between the two surgeries. Materials and methods: A comparative prospective study is performed in 200 eyes of 200 patients attending DBCS Camp at Babuji Eye Hospital and Chigateri General Hospital attached to JJM Medical College Hospital, Davanagere from July 2018 to October 2019 for cataract surgery. Patients were randomly allocated to two groups. One group underwent small incision cataract surgery and the other group underwent phacoemulsification. Corneal endothelial assessment was done for patients undergoing both the surgeries using non-contact specular microscopy Tomey EM 3000 preoperatively and postoperatively at 1 week and 6 weeks. Results: In SICS group, corneal endothelial count was 2303.0 ± 329.1 preoperatively, postoperatively it was reduced to 2068.9 ± 381.1 at 1 week and 1980.3 ± 401.5 at 6 weeks. In phacoemulsification group, it was found to be 2213.9 ± 442.3 preoperatively and which reduced to 1878.7 ± 458.3 at 1 week and 1796.4 ± 467.3 at 6 weeks postoperatively. Cases in SICS group showed 10.2% loss at 1 week and 14% cell loss at 6 weeks while phacoemulsification group showed 15.1% cell loss at 1 week and 18.9% cell loss at 6 weeks. Polymegathism was increased in both the groups while hexagonality was decreased in both groups. No significant difference in functional parameters like central corneal thickness (CCT) and best corrected visual acuity (BCVA) was observed in both SICS and Phacoemulsification group at the end of 6 weeks. Conclusion: The study shows that phacoemulsification is safe procedure in experienced hands. Compared to phacoemulsification, small incision cataract surgery is associated with lower post-operative endothelial damage. It is suggested that SICS should be used in patients at risk for endothelial damage in cataract surgery.

Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts.

PURPOSE:To compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II and III) with pseudoexfoliation syndrome (PXF).METHODS:It is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery.RESULTS:The mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (P < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (P < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (P < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (P 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B.CONCLUSION:In moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

A comparative study of post-operative astigmatism induced by phacoemulsification and manual small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery.AIM: The aim of the study was to compare the effect of surgically induced astigmatism in SICS and Phacoemulsification after taking the incision in the steepest meridian.Setting: Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, Karnataka.Design: Prospective observational study. Material and Methods: A total of 200 eyes of 200 patients with mean age of 62 years were included in the study. Consecutive patients with cataract were randomly assigned to undergo phacoemulsification or manual SICS by a single surgeon experienced in both techniques. Group A underwent SICS (Small Incision Cataract Surgery) and group B had phacoemulsification. Surgically induced astigmatism was analyzed by SIA software.Statistical analysis: Non-parametric method (Mann whitney U test).Results: The measurement of induced astigmatism was taken: dK, the net keratometric change in corneal toricity. Average dK for Group A (SICS) was +0.05 D and for Group B (Phacoemulsification) was -0.53 D. There was a difference of -0.49 D between the two groups in terms of induced keratometric astigmatism. The SICS group actually demonstrated on the average a greater iatrogenic astigmatism than the phacoemulsification group keratometrically. This is clinically or statistically significant (P

Impact of Phacoemulsification Combined with XEN Gel Stent Implantation on Corneal Endothelial Cell Density: 2-Year Results

Corneal integrity has long been a preoccupation of glaucoma surgeons considering glaucoma drainage device surgery or antimetabolite-enhanced trabeculectomy. Despite having demonstrated a good safety profile and significant intraocular pressure-lowering capacities, the impact of XEN gel stents on endothelial density was never specifically investigated. The purpose of this study is to assess the effect of XEN gel stents on central endothelial cell density (ECD) over 24 months. To achieve this, we compared the effect on ECD of combined XEN surgery with that of a standard phacoemulsification procedure. This was an investigator-initiated, retrospective study, conducted at a single tertiary glaucoma center. Patients with primary or secondary open-angle glaucoma who underwent XEN implantation combined with phacoemulsification between January 2015 and June 2016 were retrospectively enrolled. Patients who had undergone standalone phacoemulsification over the same period of time were enrolled to form the control group of this comparative study. The primary outcome measure was the ECD. Patients who had undergone standalone XEN implantation and patients for whom both a baseline and 24-month ECD could not be obtained were excluded from the analysis. Percentages of ECD reductions were calculated for each studied eye, and the mean of ECD reductions was calculated for each group as well as for subgroups. Thirty-two eyes of 23 patients (mean age=76.0±7.9 y, 60% female) underwent standalone phacoemulsification (n=15) or combined XEN surgery (n=17) and had an ECD both at baseline and 24-month postoperatively. Mean baseline ECDs were 2568±491 versus 2379±335 cells/mm, respectively (P=0.21). In the combined XEN surgery group, 58.8% of eyes (n=10) required at least 1 mitomycin C (MMC)-enhanced needling revision to maintain their target intraocular pressure. In the standalone phacoemulsification group, ECD decreased by a mean 14.5%, from 2567.7±491.2 to 2196.1±591.9 cell/mm (P=0.072). In the combined XEN surgery group, ECD decreased by a mean 14.3%, from 2378.8±334.7 to 2039.6±451.1 cell/mm (P=0.018). The difference in percentage reduction of ECD between the 2 groups was not statistically significant (P=0.226). Within the combined XEN surgery group, the ECD decreased by a mean of 15.4% in patients who did not undergo needling revisions and by 13.1% in patients who underwent the MMC-augmented procedure (P=0.485). In the 3 patients who underwent >1 needling revision, a 21.3% reduction in ECD was observed, but the difference was not statistically significant (P=0.653). Neither the time of the first needling (P=0.452), the patients' age (P=0.285), or sex (P=0.308) was statistically associated with ECD loss. The present study demonstrated that the XEN gel implant combined with phacoemulsification produces 24-month ECD loss of a similar magnitude to that observed following standalone phacoemulsification. MMC-augmented needling revisions do not appear to have an impact on ECD.

A randomized comparative study of visual outcome and complications following manual small incision cataract surgery and phacoemulsification

A randomized comparative study of visual outcome and complications following manual small incision cataract surgery and phacoemulsification - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.125, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin E

Trabeculectomy followed by phacoemulsification versus trabeculectomy alone: The Collaborative Bleb-Related Infection Incidence and Treatment Study.

PurposeThis study aims to compare the rate of surgical failure after trabeculectomy followed by phacoemulsification vs trabeculectomy alone for 5 years.MethodA total of 1,098 eyes of patients with glaucoma who underwent trabeculectomy with mitomycin C at 34 clinical centers included in CBIITS were analyzed. During follow-up, some eyes were treated with phacoemulsification because of cataract progression. The patients were divided into the “trabeculectomy followed by phacoemulsification” and “trabeculectomy alone” groups, and surgical probabilities were compared. Surgical failure was defined on the basis of mean IOP as follows; < 20% reduction in preoperative IOP or IOP ≥ 21 mmHg (criterion A), IOP ≥ 18 mmHg (criterion B), or IOP ≥ 15 mmHg (criterion C).ResultIn total, 40 eyes were treated with trabeculectomy followed by phacoemulsification and 208 with trabeculectomy alone. Preoperative intraocular pressure was 22.1 ± 8.7 mmHg in the trabeculectomy followed by phacoemulsification group and 20.5 ± 6.3 mmHg in trabeculectomy alone group (P = 0.47). The 5-year cumulative probabilities of success in the trabeculectomy followed by phacoemulsification and trabeculectomy alone groups were respectively 40.0% and 59.1% for criterion A (P = 0.01), 35.0% and 52.9% for criterion B (P = 0.01), and 25.0% and 37.5% for criterion C (P = 0.08). Cox proportional hazards regression model indicated that shorter time gap between trabeculectomy and phacoemulsification was associated with surgical failure.ConclusionPhacoemulsification following trabeculectomy adversely affects surgical outcomes. In particular, a shorter time gap between trabeculectomy and phacoemulsification reduces the probability of success.

Comparison of lens anterior capsular changes between femtosecond laser-assisted phacoemulsification and conventional phacoemulsification for cataract patients with diabetes

Objective To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation. Results Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73.602, P<0.001; Ftime=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule. Key words: Cataract/surgery; Diabetic mellitus; Laser/therapy use; femtosecond laser-assisted phacoemulsification; Anterior capsular membrane, lens

Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy

BackgroundGlaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy.MethodsRetrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone (n = 309) or phacoemulsification with KDB goniotomy (n = 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D).ResultsRefractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group (p = 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group (p = 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses.ConclusionThere was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.

Cataract Surgery by small incision a better alternative to phacoemulsification- A comparative study

Introduction: The World Health Report estimated that there were 19.34 million people who are bilaterally blind from age-related cataract. The number of blind people in the world and the proportion due to cataract is increasing due to: population growth will increase to around 800 million in 2020 improve, the degree of visual loss. Our study was to evaluate SICS as a substitute to Phacoemulsification by comparing clinical parameters, astigmatism, visual acuity and post-operative complications. Materials and Methods: This is a prospective study of 30 patients, assigned for cataract surgery by small incision (15 cases) and Phacoemulsification (15cases).Patients were selected evaluated and IOL power calculation was done by using SRK II formula. 30 subjects were choosen who were above age of 50yrs. Results: Mean Pre-operative Astigmatism in both SICS group and Phacoemulsification group is 0.68D, and Mean Post- operative Astigmatism SICS group and Phacoemulsification group is 1.68D and 1.65D respectively. In both cataract surgery by small incision and Phacoemulsification statistically significant post-operative shift to ATR Astigmatism was 86.70% and 76.70%. At 6 weeks follow up, >90.00% patients in the Phacoemulsification group as well in the SICS group had BCVA of better than or equal to 6/18. The post-operative complications are and corneal oedema, Striate Keratopathy and Post operative anterior Uveitis in both SICS and Phacoemulsification groups respectively. Conclusion: Cataract surgery by small incision wound healing is fast, postoperative complications are few and less frequent follow-ups and minimal damage to coreneal endothelium. So MSICS has an edge over phacoemulsification, because off its low cost and least learning curve. Keywords: Cataract surgery, Post- operative astigmatism, Phacoemulsification, Small incision.

Phacoemulsification vs Manual Small Incision Cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III Cataracts

PurposeTo compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II & III) with pseudoexfoliation syndrome (PXF). MethodsIt is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. ResultsThe mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (p < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (p < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (p < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (p 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. ConclusionIn moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

Effects of ultrasound energy on the porcine corneal endothelium - Establishment of a phacoemulsification damage model.

The purpose of this study was to establish a standardized in vitro phacoemulsification damage model for future investigations of the effects of phacoemulsification, surgical devices, protective ophthalmic viscoelastic devices (OVDs), irrigation solutions and other aspects related to cataract phacoemulsification surgery on the corneal endothelium using porcine eyes. Thirty-four porcine eyes were randomly assigned to three groups (phacoemulsification (n=13), irrigation (n=9), control (n=12)). A total of 5min of ultrasound energy with intermittent irrigation/aspiration was applied in the eyes of the phacoemulsification group. The eyes of the irrigation group received the identical treatment, but without the application of ultrasound energy. The control group was left untreated. All eyes were then prepared to split corneal buttons followed by 15days of cultivation. Endothelial cell density (ECD) was assessed blinded on day 15. Endothelial cell density declined significantly more until day 15 in the phacoemulsification group (2567±317/267 cells/mm² (median±25%/75%-quartiles), -32.5±7.0/6.4%) compared to the irrigation (3450±350/383 cells/mm², -11.8±5.3/2.6%; p<0.001) and the control group (3650±288/258 cells/mm², -10.2±3.2/4.6%; p<0.001). The phacoemulsification damage model presented in this study is sensitive to phacoemulsification energy and may reliably be used to investigate various factors involved in phacoemulsification with regard to their influence on corneal endothelial cells. This method is able to replace animal experiments or in vitro cell culture experiments that often do not translate well to the in vivo situation in humans.

Comparison of visual outcomes in patients undergoing small incision cataract surgery versus phacoemulsification at Divisional Headquarters Hospital, New Mirpur, Azad Kashmir.

Cataract extraction is one of the commonest surgical procedures in Ophthalmology globally. Extracapsular cataract extraction ECCE), through a small incision (SICS), with insertion of an intraocular lens has been the most widely used method from 1990s until recently. Technological advances have led to the increasing use of phacoemulsification (PE) to emulsify and remove the lens. The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this we compared the visual outcomes of patients undergoing both surgical techniques at a public sector hospital in Mirpur. Study Design: Single-center retrospective cohort study. Setting: Department of Ophthalmology, Divisional Headquarters Hospital, New Mirpur, AJK. Period: Cataract surgery cases from January 2018 to February 2019. Materials and Methods: 196 patients with age related cataract were included in the SICS group and 115 in the phacoemulsification group. The main comparative outcome was uncorrected visual acuity 4 weeks after surgery. Results: In this study, it was found that the primary post-operative visual outcome for small incision cataract surgery and phacoemulsification was comparable in terms of uncorrected visual acuity. No statistically significant difference was found in the proportions of SICS and phacoemulsification groups when compared for UCVA of 6/9 or better, 6/60 or better and 6/60 and worse.

Comparative Study between The Refractive Outcome Following Phacoemulsification and Small Incision Cataract Surgery

Background: phacoemulsification is the preferred technique for cataract surgery for most surgeons. An alternative surgical technique MSICS has been gaining popularity, because of this technique has been shown to yield comparable surgical outcomes as phacoemulsification. Objective: In our study we compared the two techniques as regard their effect on visual acuity, surgically induced astigmatism (SIA). Patients and Methods: forty patients were included in this study. Patients were divided into two groups: Group A (20 patients) underwent phacoemulsification and Group B (20 patients) underwent MSICS. Results: both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) andsurgically induced astigmatism (SIA). We found that both techniques give excellent postoperative visual results and that the SIA was 0.43±0.25 in phacoemulsification group and 0.61 ±0.55 in MSICS group at 3 month postoperative with no statistical difference between both groups (p=0.348) . Conclusion: according to our study, it is recommended for all surgeons to master MSICS technique for its excellent results which are comparable to phacoemulsification. For the beginners it could be considered like a step to phacoemulsification due to many common steps between the two techniques, also for expert surgeons it could be useful and can replace phacoemulsification efficiently in very hard nuclei and could be done if conversion is decided during phacoemulsification surgery.

Comparative Study between The Refractive Outcome Following Phacoemulsification and Small Incision Cataract Surgery

Background: phacoemulsification is the preferred technique for cataract surgery for most surgeons. An alternative surgical technique MSICS has been gaining popularity, because of this technique has been shown to yield comparable surgical outcomes as phacoemulsification. Objective: In our study we compared the two techniques as regard their effect on visual acuity, surgically induced astigmatism (SIA). Patients and Methods: forty patients were included in this study. Patients were divided into two groups: Group A (20 patients) underwent phacoemulsification and Group B (20 patients) underwent MSICS. Results: both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) andsurgically induced astigmatism (SIA). We found that both techniques give excellent postoperative visual results and that the SIA was 0.43±0.25 in phacoemulsification group and 0.61 ±0.55 in MSICS group at 3 month postoperative with no statistical difference between both groups (p=0.348) . Conclusion: according to our study, it is recommended for all surgeons to master MSICS technique for its excellent results which are comparable to phacoemulsification. For the beginners it could be considered like a step to phacoemulsification due to many common steps between the two techniques, also for expert surgeons it could be useful and can replace phacoemulsification efficiently in very hard nuclei and could be done if conversion is decided during phacoemulsification surgery.

Outcome of cataract extraction with IOL implantation after coaxial and bimanual phacoemulsification

Purpose: To compare the outcome of cataract extraction with IOL implantation after coaxial and bimanual phacoemulsification. Materials and Methods: A prospective study was done to compare the outcome of cataract extraction with IOL implantation after coaxial and bimanual phacoemulsification. The study included 200 patients visiting ophthalmology OPD of Punjab Institute of Medical Sciences who were diagnosed as having cataract and were fit to undergo surgery. Of these 100 patients were randomly assigned to each group. Data analysis included demographics and evaluation of visual acuity (VA) outcome, surgically induced astigmatism, mean phacoemulsification time, effective phacoemulsification time and amount of BSS used. Results: Age and sex distribution was similar in two groups. The mean BCVA in the coaxial and bimanual groups was 0.294 and 0.2903 respectively. The magnitude of surgically induced astigmatism had a mean of 0.845 in the coaxial group and a mean of 0.855 in the bimanual group; hence the difference was not statistically significant. Statistically significant differences were found in mean phacoemulsification time (p = 0.01) which was significantly lower in bimanual phacoemulsification group than the coaxial group. Effective phacoemulsification time (p = 0.022) was significantly lower in bimanual phacoemulsification group (mean = 6.86) than the coaxial group (mean = 12.87). The total surgical time was lower in the bimanual group (mean = 21.94) than the coaxial group (mean= 24.29) and the difference was statistically significant. Conclusion: Both techniques were considered safe and equally effective with regard to cataract surgery with minor differences which did not affect the final outcome and resulted in early post-operative visual rehabilitation with minimal post-operative morbidity, thus leading to increased patient comfort. Keywords: Bimanual, Cataract, Coaxial, Microincision, Phacoemulsification, Surgical time.

Torsional and burst mode phacoemulsification for patients with hard nuclear cataract: A randomized control study.

This article aims to evaluate the outcomes of torsional and burst mode phacoemulsification in hard nuclear cataracts.Eighty eyes with grade IV or V nuclear opalescence were treated with phacoemulsification and intraocular lens implantation using conventional mode (Group A, n = 40) or torsional and burst mode phacoemulsification (Group B, n = 40). For good visualization of anterior capsule, trypan blue was injected to the anterior chamber before continuous circular capsulorhexis. The mean cumulative dissipated energy and ultrasound time were recorded. The best-corrected visual acuity, endothelial cell density, and central corneal thickness were measured before and at 1 month after surgery.The cumulative dissipated energy and ultrasound time of Group B were significantly less than that of Group A. The postoperative best-corrected visual acuities of the 2 groups were comparable. At 1 month after surgery, the changes in the endothelial cell density were significantly greater in Group A than in Group B, and the changes in the central corneal thickness were not significantly different between the 2 groups.Torsional and burst mode is a safe and effective surgical method for treating hard cataracts.