Phacoemulsification In Patients Research Articles

Risk of corneal transplantation after phacoemulsification in patients with cornea guttata

AbstractPurposeTo investigate the risk of corneal transplantation after phacoemulsification related to cornea guttata.MethodsIn this retrospective registry‐based cohort study, patient data from the Swedish National Cataract Register for years 2010‐2012 were linked with data from the Swedish Cornea Transplant Register for years 2010‐2017. Altogether, data from 276,354 cataract patients was linked with data from 2,091 patients with primary and secondary endothelial failure as indication for corneal transplantation. Other surgical methods for cataract extraction than phacoemulsification were excluded. If both eyes had surgery, one eye was randomly selected to obtain unrelated samples. A Kaplan‐Meier curve and Cox regression analysis were used to investigate the risk for corneal transplantation due to endothelial failure after phacoemulsification.ResultsOut of the 3,346 phacoemulsification patients with cornea guttata, 153 underwent corneal transplantation within 6.2 years in median. The cumulative transplantation rate, 6 years after the phacoemulsification was 4.8% in the group with cornea guttata and 0.08% in the group without. The annual transplantation rate among the cornea guttata patients during the first year was 1.64% and diminished the following 5 years to 0.55% in average. The annual transplantation rate among the patients without cornea guttata was 0.01% in average after phacoemulsification during the same period of time. The transplantation hazard ratio for cornea guttata present at the phacoemulsification was 67.6 (95% CI: 53.6.0‐85.3, p < 0.001), when adjusting for potential confounders.ConclusionsThe hazard of corneal transplantation after phacoemulsification was 67.6 times higher with cornea guttata than without. Still, the great majority of the patients with cornea guttata did not undergo corneal transplantation during the study period.

Surgical techniques of intraocular lens-capsular bag complex stabilization during cataract phacoemulsification in patients with lens subluxation

Aim. To develop and to assess the efficacy of the method of one-step upper fixation of a single-piece intraocular lens to the iris during cataract phacoemulsification in patients with lens subluxation.
 Methods. The study included 32 patients (37 eyes) with complicated cataract grade 23 combined with grade 12 lens subluxation. Both groups underwent cataract phacoemulsification with consequent implantation of a capsular tension ring and a single-piece intraocular lens. Group 1 (21 eyes) underwent intraoperative one-step upper haptic fixation of a single-piece intraocular lens in vertical position. In group 2 (16 eyes) in 13 cases 61.5 months later a single piece intraocular lens was repositioned and both haptics were sutured to the iris.
 Results. In both groups no intraoperative complications occured. Visual acuity in group 1 on days 13 after the surgery was 0.770.19 and was stable during the follow-up. Intraocular pressure was 17.20.99 mm Hg. In group 2 the obtained good functional results 0.780.18 declined due to intraocular lens decentration, the intraocular pressure increased by 6.01.25 mm Hg (up to 24.20.65 mm Hg) which required an intraocular lens reposition in 81.3% of cases. According to ultrasound biomicroscopy, in both groups intraocular lens in all cases had intracapsular fixation and was in a central position.
 Conclusion. The developed method of a one-step single piece intraocular lens fixation by suturing the upper haptic to the iris during cataract phacoemulsification in patients with lens subluxation is an effective and safe procedure that allows complete rehabilitation of patients with phacodonesis during a one-step surgical intervention.

Анализ динамики аксиальных смещений интраокулярной линзы и связанных с ними изменений рефракции после факоэмульсификации у пациентов с короткой длиной глаза при наличии или отсутствии псевдоэксфолиаций

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Comparison of Post Inflammatory Pattern between Intracameral Ceftazidime and Cefuroxime Used for the Prevention of Post-operative Endophthalmitis

Purpose: To compare the post operative inflammatory pattern after phacoemulsification in patients receiving intra-cameral injection of ceftazidime and cefuroxime per-operatively for the prevention of post-operative endophthalmitis. Study Design: Quasi experimental study. Place and Duration of Study: Ophthalmology Department Unit-1, Lahore General Hospital, Lahore from November 2016 to March 2018. Material and Methods: Patients undergoing phacoemulsification with intraocular lens implantation were divided into 2 groups by convenient sampling. Group A received Cefuroxime and group B received Ceftazidime both as 1 mg/0.1ml intra-cameral injections at the end of the routine surgery. The patients were examined pre and post operatively on slit lamp and the number of cells in the anterior chamber (A/C) were counted on first day, first week and 6 weeks after surgery. Results: Out of 260 patients there were 130 in each group. On the first post-operative day in group A there were grade 1 cells in A/C in 22 patients, grade 2 in 93 patients, grade 3 in 14 patients and Grade 4 in 1 patient. In group B there were grade 1 cells in A/C in 11 patients, grade 2 in 96 patients, grade 3 in 20 patients and grade 4 in 3 patients. After one week, in group A, cell counts were grade 0 in 27 patients while in group B, cell counts were grade 0 in 23 patients. After 6 weeks no patient in any group showed any activity in the anterior chamber. Conclusion: There is little difference in post operative inflammatory pattern of intracameral ceftazidime antibiotic prophylaxis as compared to intracameral cefuroxime. Key Words: Endophthalmitis, Cataract Surgery, Cefuroxime, Ceftazidime.

Phacoemulsification in uveitic cataract at a tertiary care teaching center

Introduction: Due to variation in etiology and presentation, it is difficult to predict the outcomes of phacoemulsification in patients suffering from uveitis. The present study evaluated outcomes of surgery at a tertiary care teaching hospital. Materials and Methods: 64 eyes of 64 patients with uveitis were retrospectively studied for vision related outcome and complication rate after phacoemulsification surgery. However, after exclusion, 46 eyes were analysed. Results: The mean age of patients with uveitis enrolled was 46.7±2.3 (range, 28-56 years). The mean duration of follow-up was 12.6±3.4 (range, 8-16 months). Improvement in vision was significantly better in males (P=0.05). Uveitis was silent for 6.3±2.6 months prior to performing surgery. Tuberculosis was the most commonly identified etiological factor followed by Fuch’s iridocyclitis and Vogt’s Koyanagi Harada disease, respectively. The frequent complications of surgery were recurrent uveitis, cystoid macular edema and after-cataract. Factors influencing vision were location of uveitis, intake of preoperative steroids and posterior segment pathology. At final follow-up, the vision was 0.24±0.07 Log MAR units. Conclusion: Thorough control of inflammation prior to performing surgery is the key to good visual outcome in uveitis. Phacoemulsification with posterior chamber IOL implantation provided good vision when the inflammation is confined to the anterior segment of the eye. Visual prognosis compromise in diseases involving the central fundus. Keywords: Cataract, Cystoid macular oedema, Intraocular lens implantation, Posterior capsule opacification, Uveitis, Vision.

Influence of preoperative astigmatism on corneal biomechanics and accurate intraocular pressure measurement after micro-incision phacoemulsification.

To define the corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) prior to and following coaxial micro-incision phacoemulsification in patients with corneal astigmatism. Of 97 patients with cataracts were enrolled in the study. Group 1 included patients with corneal astigmatism (K1-K2) values of K1-K2<+1.0 D, and group 2 with values of K1-K2 ≥+1.0 D and ≤+2.25 D. Coaxial micro-incision phacoemulsification of a corneal incision of 2.0 mm with intraocular lens (IOL) implantation was performed. CH, CRF, IOPg, IOPcc, waveform score (WS) were measured preoperatively and one week, one month postoperatively using an Ocular Response Analyzer. Axial length (AXL) was calculated by Tomey Optical Biometer OA 2000. Group 1 consisted of 51 patients with mean corneal astigmatism value of +0.49±0.25 D. Group 2 included 46 patients with astigmatism of +1.43±0.43 D. In group 1, CRF (t=2.68, P<0.05), CH (t=2.64, P<0.05) and WS (t=3.51, P<0.05) were significantly lower one week postoperatively, when compared to the preoperative values. CRF significantly decreased (t=3.61, P<0.05) when measured one month following the surgery. In group 2 CH (t=5.92, P<0.05), and WS (t=3.96, P<0.05) were significantly lowered one week after cataract surgery. Moreover, we observed a significant decrease in IOPg (t=2.24, P<0.05), CRF (t=5.05, P<0.05) and CH (t=2.31, P<0.05) one month after phacoemulsification. There was no statistically significant (t=-0.83, P=0.41) difference in AXL between study groups. CRF, CH and IOPg are reduced in patients with preoperative corneal astigmatism equal or higher than +1.0 D and lower than +2.25 D. Hence, bias of IOPg measurement in these patients may cause underestimation of the real IOP both before and after cataract surgery. The measurement of IOPcc allows the precise assessment of IOP pre- and postoperatively, independently on corneal astigmatism, CH and CRF values.

Effect of corneal protective agent on ocular surface after phacoemulsification in patients with type 2 diabetes

Effect of corneal protective agent on ocular surface after phacoemulsification in patients with type 2 diabetes

Central corneal thickness changes following manual small incision cataract surgery versus phacoemulsification for white cataract

Aim: To assess the central corneal thickness (CCT) and endothelial cell loss after manual small-incision cataract surgery and phacoemulsification in patients with white cataract. Material and methods: This is a comparative, prospective, non-randomized study on 42 patients with white cataract, who underwent cataract surgery. The patients were divided into manual small-incision cataract surgery (21 eyes, MSICS group) and phacoemulsification cataract surgery group (21 eyes, phaco group). The endothelial cell density (ECD), central cornea thickness (CCT), and corrected distance visual acuity (CDVA) were evaluated at 1 day, 1 week, 4 weeks, and 3 months postoperatively. The results of 20 cases of nuclear sclerosis grade II-III (LOCS III) who underwent phacoemulsification by the same surgeon were also compared. Propensity scoring was used to adjust for confounding by selection bias. Results: The CCT increased after surgery in both groups. The thickness was greater in the phaco group on first day postoperatively (73 µ increase in MSICS group and 138 µ in phaco group, p=0.008) and it returned to preoperative levels 1 month postoperatively. The endothelial cell loss was lower in the MSICS group at 3 months postoperatively (11.8% in MSICS group and 15.8% in phaco group, p=0.111). The CDVA was not different in both groups at 1 week and 4 weeks postoperatively (p>0.05). Conclusions: Manual small-incision cataract surgery for white cataract provided less central corneal thickness changes compared to conventional phacoemulsification. Abbreviations: CCT = central corneal thickness; ECD = endothelial cell density; CDVA = corrected distance visual acuity; APT = absolute phacoemulsification time; EPT = effective phacoemulsification time; MSICS = Manual small-incision cataract surgery in white cataract; Phaco II = Phacoemulsification in white cataract; Phaco I = phacoemulsification in NS 2 + Cataract; Phaco = Phacoemulsification in white cataract; APACRS = Asia-Pacific Association of Cataract and Refractive Surgeons.

Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus.

Objective:To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients.Methods:This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed.Results:Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant.Conclusion:There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery.

Effects of anterior chamber depth and axial length on corneal endothelial cell density after phacoemulsification.

Objective:To evaluate mean decrease in Corneal Endothelial cell Density (CED) after phacoemulsification in patients with different Anterior Chamber Depths (ACDs) and Axial Lengths (ALs).Methods:This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. One hundred eyes of 90 patients, scheduled to undergo phacoemulsification surgery, were included. AL and ACD of each patient were calculated preoperatively using IOL Master. Cataracts were classified according toLens Opacities Classification System III (LOCS III) giving nuclear opalescence (NO) grades on slit lamp examination and only patients with grades NO2 and NO3 were included. Eyes were divided into two groups according to ACD and AL: Group-I: ACD 2.0mm – 3 mm and AL 22mm – 23.5mm; Group-II: ACD 3.1 mm -4.0 mm and AL 23.6mm – 25mm. CED measurements were done preoperatively and 2 month postoperatively using specular microscopy. The difference in CED change (Endothelial Cell Loss) between the two groups after surgery was analyzed using SPSS, v 22; IBM Corporation, Armonk, NY.Results:Differences in gender, laterality, age and preoperative CED between two groups were not significant. Difference in postoperative CED was also not significant, however difference in mean change and mean frequency change in CED between two groups was found to be statistically significant.Conclusion:ACD and AL affect the CED during phacoemulsification and Intraocular Lens(IOL) implantation and can be considered as risk factors of peroperative endothelial cell loss.

Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis

Bacground:The aim of this study was to conduct a meta-analysis to compare the overall intraocular pressure (IOP)-lowering effect of iStent or CyPass as isolated procedures or in combination with ca...

Phacoemulsification in Patients with Fuchs Heterochromic Iridocyclitis

Phacoemulsification in Patients with Fuchs Heterochromic Iridocyclitis

Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis.

Bacground:The aim of this study was to conduct a meta-analysis to compare the overall intraocular pressure (IOP)-lowering effect of iStent or CyPass as isolated procedures or in combination with cataract extraction.Materials and methods:Cochrane review manager 5.3 software (RevMan® 5.3) was used for a meta-analysis of IOPs and the number of antiglaucoma medications in six groups according to the type and number of stents and whether the procedure was isolated or in combination with cataract extraction.Main results:A total of 33 out of 446 publications retrieved have been enrolled. The mean changes in IOP in the groups with one iStent and more than two iStents with concurrent cataract extraction were −3.78 ± 0.53 mmHg and −3.89 ± 0.73 mmHg, respectively. The mean differences in IOP in the groups with one iStent and more than two iStents without concurrent cataract extraction were −3.96 ± 0.25 mmHg and −7.48 ± 0.55 mmHg, respectively. The mean changes in IOP in the groups with CyPass implantation with and without concurrent cataract extraction were −4.97 ± 1.38 mmHg and −8.96 ± 0.16 mmHg, respectively.Conclusions:Both iStent and CyPass either in combination with cataract extraction or as isolated procedures effectively decrease IOP. This effect is greatest with isolated implantation of CyPass followed by multiple iStents and then single iStent implantation and lasts up to 2 years.

Effects of Bifocal versus Trifocal Diffractive Intraocular Lens Implantation on Visual Quality after Cataract Surgery.

PurposeTo compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts.MethodsEighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas.ResultsUncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were −0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group (p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups.ConclusionsTrifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies.

Letter to the editor: Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis.

Letter to the editor: Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis.

Corneal Endothelial Cell Density and Morphology After Phacoemulsification in Patients With Primary Open-Angle Glaucoma and Cataracts: 2-Year Results of a Randomized Multicenter Trial.

To evaluate corneal endothelial cell density (ECD) and morphology 2 years after phacoemulsification in subjects from the COMPASS trial (ClinicalTrials.gov, NCT01085357) who had mild-to-moderate primary open-angle glaucoma and visually significant cataracts. The central corneal endothelium was evaluated by serial specular microscopy at 0 to 24 months. ECD, coefficient of variation, and percentage of hexagonal cells were evaluated by a central image analysis reading center and central corneal thickness (CCT) was evaluated by ultrasound pachymetry. Of 131 subjects who underwent routine phacoemulsification, analyzable endothelial images at 24 months were available for 126 subjects (96.2%). Mean ± SD central ECD at baseline was 2453 ± 359 cells/mm, decreasing by 10% ± 14% to 2195 ± 517 cells/mm at 3 months (P < 0.001) but stabilizing thereafter with mean endothelial cell loss (ECL) from baseline to 24 months of 9% ± 13% (P < 0.001). Twelve (9.5%) and 10 (7.9%) subjects experienced >30% ECL at 12 and 24 months, respectively. Neither coefficient of variation nor percentage of hexagonal cells changed significantly from baseline at any time point. Mean CCT was similar at baseline (550 ± 35 μm) and at 12 months (551 ± 37 μm) and 24 months (555 ± 35 μm). Age was significantly associated with ECL after cataract surgery (P = 0.02), but baseline intraocular pressure, number of glaucoma medications, and CCT were not. Similar results were observed in patients who underwent CyPass micro-stent implantation accompanying phacoemulsification. Phacoemulsification in eyes with mild-to-moderate primary open-angle glaucoma results in early ECL, with ECD stabilizing after 3 months and no effect on other endothelial stress markers up to 2 years postoperatively.

Optimization of the Lens Nucleus Fragmentation during Phacoemulsification in Patients with Pseudoexfoliation Syndrome

Objective:Comparative analysis of the results of phacoemulsification (FEC) with the use of developed and classic technologies for fragmentation of the lens nucleus in patients with pseudoexfoliation syndrome (PES).Patients and methods.The proposed technology is gentle crushing of the lens nucleus in patients with PES, you can reduce the pressure on the fibers of the zonule, the probability of damage to the ligaments and posterior capsule of the lens based on the use of phacofragmentation original design. To determine the radius of curvature of the working part of the tool a morphometrical measurement of the curvature of the equatorial zone of the lens cores removed during extracapsular and intracapsular cataract extraction in patients with PEX subluxation of the lens was carried out. A comparative analysis of the operation and the results of surgical treatment of cataract in patients with PEX with the use of the proposed (n = 58) and standard (n = 56) technologies of the nucleus fragmentation in phacoemulsification was made. The following ultrasound parameters were estimated: the average capacity in % (AVEUS), the average values of the absolute time ultrasound (APT) and average values of effective (EPT) time of ultrasound, in seconds, during phacoemulsification; structural-morphological changes in the posterior epithelium of the cornea according to the endothelial microscopy; the frequency and nature of complications, the visual acuity.Results.Morphometry of the lens nuclei in patients with pseudoexfoliation syndrome allowed to determine the average radius of curvature of the nucleus equator, which is made up 2.89 ± 0.14 mm, according to the performance curve of the Gauss — 2.895– 3.530 mm. These data are taken into account when selecting the radius of curvature of the working part of phacofragmentation (the radius of curvature of 3.0 mm) used with FEC in patients with PES (Patent RU152761 from 25.05.2015). The proposed chopper due to the conformity of the working part curvature of the tool and the Equatorial zone of cataract kernel can reliably capture and grind it, thus eliminating excessive pressure on the ligaments of the crystalline lens in patients with PES. Developed technology contributes to significantly reduction of the energy performance of ultrasound: AVEUS — 2.64–10.00 %; APT — 3.38–14.00 %; EPT — on 3.76– 16.00 % by 6.76 % in patients with different of the lens nucleus density degree, decrease operative and postoperative complications twice, 1.5 times less cell loss back the corneal epithelium. Visual acuity without correction from the first days after surgery was higher than 0.5 (average of 0.70 ± 0.05) in all the patients and increased to an average of 0.91 ± 0.01 within 12 months in patients of the main and 0.85 ± 0.02 — control groups.Conclusion.The developed technology of fragmentation of the lens nucleus reduces the time of phacoemulsification, reduces the ultrasound load, causes a smaller loss of cells at the back of the corneal epithelium, reduces the possible complications of the iris and ciliary body, which increases the efficiency of surgical treatment of cataract in patients with PEX.

CO2 Laser-assisted Deep Sclerectomy Combined With Phacoemulsification in Patients With Primary Open-angle Glaucoma and Cataract.

To assess the safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) combined with phacoemulsification in patients with primary open-angle glaucoma (POAG) and visually significant cataracts. This was a prospective, uncontrolled, interventional case series. Seventeen patients (17 eyes) diagnosed with POAG and cataracts were enrolled starting from November 2015. All subjects underwent CLASS combined with phacoemulsification surgery by the same surgeon. After the surgery, all patients were followed for 12 months. The preoperative to postoperative changes in intraocular pressure (IOP), glaucoma medication requirements, best-corrected visual acuity and adverse events were recorded. The results of 17 eyes of 17 patients were included in the statistical analysis. The baseline mean IOP was 23.94±8.57 mm Hg (mean±SD), and patients used 2.18±0.88 types of antiglaucoma medication. At 12 months postsurgery, the mean IOP was 14.67±2.97 mm Hg, and patients used 0.59±0.87 types of antiglaucoma medication (both P<0.001). The logarithm of the minimal angle of resolution of the best-corrected visual acuity improved from 0.77±0.42 preoperatively to 0.33±0.47 postoperatively (P<0.05). Two patients experienced intraoperative perforation accompanied by iris prolapse. One patient exhibited postoperative choroidal detachment. CLASS with phacoemulsification may become a safe and effective intervention for patients with POAG and visually significant cataracts.

Особенности факоэмульсификации у больных миопией высокой степени

Особенности факоэмульсификации у больных миопией высокой степени

Сравнительный анализ клинико-функциональных результатов и положения торической интраокулярной линзы после фемтолазер-ассистированной и стандартной факоэмульсификации у пациентов с роговичным астигматизмом (предварительное сообщение)

Сравнительный анализ клинико-функциональных результатов и положения торической интраокулярной линзы после фемтолазер-ассистированной и стандартной факоэмульсификации у пациентов с роговичным астигматизмом (предварительное сообщение)