Phacoemulsification For Age-related Cataract Research Articles

Swab Pressing vs Stromal Hydration to Prevent Incision Leakage and Transient Collapse of Anterior Chamber in Phacoemulsification

During phacoemulsification, incision leakage and the subsequent anterior chamber collapse often occur after the withdrawal of the handpiece, which cannot be prevented by current sealing techniques. A new technique called swab pressing is proposed here to apply pressure with a cotton swab to seal the incision immediately, but efficacy remains unknown. To determine if swab pressing is noninferior to stromal hydration, the current practice, in sealing incisions in phacoemulsification for age-related cataract. This noninferiority randomized controlled clinical trial was conducted between February 2022 and September 2022 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients aged 60 to 90 years with age-related cataract were enrolled. Participants were randomly assigned (1:1) to receive swab pressing or stromal hydration. All surgeries were performed by a single experienced surgeon who was unmasked to the assignment. The proportion of closed clear corneal incisions evaluated using intraoperative optical coherence tomography. A total of 126 eyes of 126 participants were randomized into the swab pressing group (63 [50%]) and stromal hydration group (63 [50%]). The mean (SD) age of participants was 69.2 (6.14) years and 70.1 (7.67) years in the pressing and stromal hydration groups, respectively. A total of 39 participants (61.9%) in the pressing group and 35 (55.6%) in the modified group were female. The proportion of closed incisions was 96.8% (61 of 63) in the swab pressing group and 93.7% (59 of 63) in the stromal hydration group. Noninferiority was met, as the lower 95% CI of -5.83 percentage points was greater than the prescribed noninferiority margin of -6.60 percentage points (difference, 3.17 percentage points; 95% CI, -5.83 to 12.18 percentage points). The rate of anterior chamber collapse (pressing: 0 of 63 vs stromal hydration: 35 of 63 [55.6%]; P < .001) was lower in the swab pressing group. There were no differences between the 2 groups in the proportion of closed incisions and central anterior chamber depth at postoperative hour 1 and day 1. In this study, swab pressing was noninferior to stromal hydration in sealing clear corneal incisions in phacoemulsification for age-related cataract. While this trial involved only 1 surgeon who was not masked to the interventions, the results suggest that swab pressing is feasible and further investigations would be warranted to determine if it prevents the intraoperative transient collapse of anterior chamber or affects visual acuity outcomes. ClinicalTrials.gov Identifier: NCT05242653.

Active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract (AGSPC): study protocol for a prospective, randomised, double-blind, controlled clinical trial

IntroductionThe active-fluidics system is a new irrigation system of phacoemulsification that automatically detects and maintains stable intraocular pressure at the set value. This trial is designed to compare the efficacy,...

Клинический случай консервативного лечения отслойки сосудистой оболочки, развившейся в отдаленные сроки после факоэмульсификации возрастной катаракты

A clinical case of successful conservative treatment of choroidal detachment (CD), which developed in the long term after phacoemulsification of age-related cataract (PEC), is presented. The patient underwent PEC of the left eye 3 months ago with implantation of a posterior chamber intraocular lens, while an antiglaucoma operation was performed a year earlier. The patient was canceled the hypotensive regimen and conservative treatment was prescribed – instillation of Midrimax drops (Phenylephrine 5.0% + Tropicamide 0.8%) 2 times a day, Dexamethasone 0.1% – 4 times a day, subconjunctival injections of 2 mg Dexamethasone and 0.1 ml of 0.1% solution of Atropine sulfate. The prescribed conservative treatment made it possible to arrest the CD in the pseudophakic eye, which arose in the late postoperative period, and made it possible to avoid the need for posterior sclerectomy. Key words: choroid detachment, phacoemulsification of age-related cataract, conservative treatment.

Role of Tear Substitutes on Ocular Comfort and Tear Film Stability after Phacoemulsification for Age-Related Cataract

Role of Tear Substitutes on Ocular Comfort and Tear Film Stability after Phacoemulsification for Age-Related Cataract

Частота спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок» в различные сроки послеоперационного периода факоэмульсификации возрастной катаракты

Purpose . To study frequency of spontaneous dislocation of intraocular lens – capsular bag complex in various periods after phacoemulsification (PE) of age-related cataracts, develop its clinical classification based on objective criteria for gradation of degrees of severity. Material and methods . All cases of intraocular lens – capsular bag complex dislocation occurred in our clinic in different periods after PE of age-related cataract in 2010–2018 were selected. 24231 PE of agerelated cataract were performed in our clinic during this period. The proportion of spontaneous dislocations of intraocular lens – capsular bag complex having non-traumatic origin was at least 0.26%. We carried out retrospective analysis of the possible causes of spontaneous dislocation of intraocular lens – capsular bag complex in these patients. Results . All 63 patients with dislocation of intraocular lens – capsular bag complex presented themselves to the clinic. There were 39 men and 24 women. Their age ranged from 50 to 89. The time of formation of intraocular lens – capsular bag complex dislocations was conditionally estimated according to the data presented by the patients. It varied widely from 3 months to 14 years, averaging 5.45±3.6 years. In the course of time after performing PE, the frequency of dislocation progressively increased. Conclusion . The criteria for the presence and severity of spontaneous dislocation of intraocular lens – capsular bag complex was: 1) severity of dislocation of intraocular lens – capsular bag complex from its correct anatomical position, based on biomicroscopy, 2) uncorrected visual acuity, 3) intraocular pressure, 4) risk of intraocular complications. Our in-depth clinical analysis of the severity of postoperative dislocation of intraocular lens – capsular bag complex allowed us to create simple and affordable clinical classification of this condition.

Comparison of the Effect of Diclofenac 0.1% and Nepafenac 0.1% on Aqueous Flare in Patients Undergoing Cataract Surgery: A Prospective Randomized Study

ABSTRACT Objectives To compare, using laser flare meter (LFM), the efficacy of topical nepafenac 0.1, % and diclofenac 0.1% ophthalmic solution in the control of anterior chamber inflammation after uncomplicated cataract surgery. Methods Patients undergoing phacoemulsification for age-related cataract were recruited. Complete evaluation with visual acuity, slit-lamp examination, endothelial cell density, intraocular pressure, retinal tomography and anterior chamber flare evaluation was performed before surgery and 1, 15, 30 and 60 days after surgery. Patients were randomly assigned to receive topical diclofenac 0.1% 4 times a day for four weeks or nepafenac 0.1% 3 times a day for three weeks in addition to topical steroids and antibiotic. Results 64 (31 males, mean age 77.3 ± 5.9) patients were enrolled. Half of them were randomly assigned to group A (diclofenac 0.1%) and half to group B (nepafenac 0.1%). There was a statistically significant visual acuity improvement postoperatively in both groups, with no statistical difference between the groups. Intraocular pressure, corneal thickness, endothelial cells count and macular thickness parameters didn’t significantly vary between before and after surgery. One-day after surgery, aqueous flare was significantly higher (22,27 ± 9,25 ph/ms in group A and 22,36 ± 7,47 in group B) than before surgery (14,59 ± 7,16 ph/ms in group A and 11,84 ± 4,44 in group B) in both groups, then declining in the first month and reaching preoperative levels again by 2 months in both groups. In group B, LFM values at 15 and 30 days after surgery were significantly lower (13,59 ± 4,80 and 14,07 ± 5,01) than in group A (17,00 ± 6,97 and 16,96 ± 6,13). Conclusions Nepafenac ensured a better inflammation control than diclofenac during the first month.

Изучение субъективного восприятия пациентом состояния структур глазной поверхности в зависимости от исходного уровня слезопродукции после факоэмульсификации возрастной катаракты

«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.

Multiquadrant versus single quadrant cortical cleaving hydrodissection during phacoemulsification of age related cataract

PurposeTo evaluate and compare single and multiquadrant hydrodissection in age related cataract. DesignProspective, observational case series. MethodsIn this study, 220 patients were consecutively assigned to either single (n = 110) or multiquadrant (n = 110) hydrodissection during phacoemulsification. Patients having operable cataract in the nuclear grade of 1–3 of Lens Opacities Classification System III were included in the study. After hydrodissection of the nucleus nuclei were not rotated. Parameters assessed were amount of balanced salt solution (BSS) required to accomplish the hydrodissection, nucleus emulsification time (NET), and cortical aspiration time (CAT). Ease in nucleus rotation during chopping of the nucleus, cortical aspiration (easy, difficult, or very difficult) and intraoperative surgical complications were qualitatively assessed. ResultsAverage amount of BSS required in multiquadrant hydrodissection was 1.7 ml (±0.9), which was more than double the single quadrant group 0.71(±0.17), p = 0.001. No statistically significant differences were observed between the two studied groups with respect to the following parameters: mean NET (single quadrant 277 sec ± 95.5, multiquadrant 267 sec ± 98.8, p = 0.379), CAT (single quadrant 75.7 sec ± 31.2, multiquadrant 73.4sec ± 33.9p = 0.301), and total fluid required (single quadrant 154 ml ± 64.9, multiquadrant 157 ml ± 66.4p = 0.708).Almost equal number of patients in both the groups had easy rotation of the nucleus (single quadrant: n = 105, 95.45% and multiquadrant n = 103, 93.64%) and cortical aspiration (n = 102, 92.72% both the groups). Three patients in multiquadrant group had posterior capsular rupture during hydrodissection. ConclusionsA single quadrant hydrodissection is sufficient for the efficient removal of nucleus and cortex.

Clinical Evaluation of Modified 2.2mm Microincision Phacoemulsification for Age-related Cataract

Clinical Evaluation of Modified 2.2mm Microincision Phacoemulsification for Age-related Cataract

年龄相关性白内障超声乳化手术后眼轴的变化分析

年龄相关性白内障超声乳化手术后眼轴的变化分析

Технические особенности формирования основного доступа при факоэмульсификации возрастной катаракты с имплантацией ИОЛ у пациентов после фоторефракционной хирургии роговицы

Технические особенности формирования основного доступа при факоэмульсификации возрастной катаракты с имплантацией ИОЛ у пациентов после фоторефракционной хирургии роговицы

Changes of macular thickness after phacoemulsification of age-related cataract

Objective To study the thickness of foveal and macular retina before and after phacoemulsification and intraocular lens implantation of age-related cataract using optical coherence tomography （OCT）. Methods Retinal thickness of foveal and maeular sectors were measured using OCT in 104 eyes of 86 patients with age-related catract who underwent phacoemulsification. Data were collected at 1 day before the operation, and postoperatively at 1 week, 1 and 3 months. Results Postoperative best- corrected visual acuity （BCVA） were between 0. 3 to 1. 0 and improved in all eyes compared with preoperative BCVA. The OCT results showed that the difference was not statistically significant in fovea centralis thickness between preoperation and 1 week after operation （t = - 1. 554, P = 0. 122） , but the difference was statistically significant in thickness of macular area between the two time points （ t = - 2. 557, P =0.011 ）. There were statistically significant differences in the thickness of fovea centralis and maeular area between preoperation and 1 month after operation（ t = - 3.975, P = 0. 000 ; t = - 2. 862, P = 0. 005）. But between preoperation and 3 months after operation, the differences in the thickness of these two areas were not statistically significant （ t = - 1. 568, P = 0. 118 ; t = - 0. 197, P = 0. 844 ）. Conclusion The detecting of macular thickness using OCT may provide an earlier and more comprehensive description of the postoperative macular edema than the only detecting of the foveal thickness. Key words: Cataract ; Tomography, coherence, optical ; Thickness, fovea centralis ; Thickness, macular area

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification

To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Department of Ophthalmology, University of Leipzig, Germany. Randomized single-center clinical trial. Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract.