Phacoemulsification Procedure Research Articles

Assessing the surgical competency of novice surgeons by using a three-dimensional heads-up display microscope.

To evaluate the surgical performance of novice surgeons operating on a three-dimensional (3D) heads-up display system compared to those using a traditional microscope (TM). Prospective study design in a private practice setting. Twenty novice surgeons with similar experiences in cataract surgery were selected. Each surgeon performed 20 phacoemulsification cataract surgeries: 10 surgeries on the 3D heads-up display microscope, and 10 surgeries using a TM system. Data were collected from a total of 400 patients operated on by 20 surgeons. Outcome measures were recorded and graded according to the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric-Phacoemulsification system. The main outcome measure was mean surgical competency scores. Overall, 400 data points were equally distributed between TM (200) and 3D (200) surgeries. The mean surgical competency scores were 60.19 (11.41) for TM surgeries and 62.99 (11.11) for 3D surgeries. 3D surgeries had significantly higher surgical competency scores than TM surgeries (P = 0.013). The mean surgical duration for TM and 3D surgeries was 35.98 (6.02) min and 34.31 (7.12) min, respectively. 3D surgeries took significantly less time than TM surgeries (P = 0.012). The overall mean best corrected visual acuity in the logarithm of the minimum angle of resolution units was 0.27 (0.42); in TM and 3D surgeries, it was 0.28 (0.43) units and 0.26 (0.41) units, respectively. The 3D heads-up display system enhances stereopsis in cataract surgery, making it a valuable training tool for novice surgeons in phacoemulsification procedures.

Tear film assessment before and after phacoemulsification in patients with age-related cataracts

BackgroundThe study aims to assess the tear film before and after phacoemulsification in patients with age-related cataracts.MethodsA prospective observational study of 41 age-related cataract patients undergoing phacoemulsification procedure. Tear Film Break-Up Time (TBUT), Tear Film Meniscus Height (TMH), Meibomian glands (MG), and Lipid Layer Thickness (LLT) were assessed by a non-invasive Dry Eye Diagnostic System. All measurements were taken preoperatively, one week, one month, and three months postoperatively. The Marginal homogeneity and The Cochran Q tests were used in the statistical analysis.ResultsThe value of Non-Invasive Break-Up Time (NITBUT) was statistically significantly lower at one week (7.15 ± 3.31), one month (7.61 ± 3.41), and three months (7.66 ± 3.36) postoperatively than preoperatively (10.71 ± 2.71), p < 0.001. The Non- Invasive Tear Meniscus Height (NITMH) was significantly lower at one week (0.18 ± 0.0), one month (0.20 ± 0.09), and three months (0.20 ± 0.09) postoperatively than preoperatively (0.30 ± 0.113) p < 0.001. By the first month, both (NITBUT) and (NITMH) improved significantly compared to the first post-operative week. There was no statistically significant difference between one month and three months. The (NITMH) improved to a healthy level of ≥ 0.2 mm by the first month through the third month. Both (NITBUT) and (NITMH) did not reach the baseline by the third month. The meibomian glands and the lipid layer thickness had the same preoperative grade distribution without changes.ConclusionPhacoemulsification surgery can cause post-operative deterioration in the tear film, which starts within a week of the procedure, followed by gradual recovery over the next weeks and months. The phacoemulsification procedure mainly affects the tear break-up time and tear meniscus height. Both the lipid layer and meibomian glands are not affected.

A Cataract Surgery in A Camp Patient; A Study on Visual Outcomes

Cataract is the leading cause of blindness and visual impairment among cataract patient globally including in Libya. Phacoemulsification is a commonly performed procedure to improve visual outcome among senile cataract patients because of its advantages compared to other techniques. This study was aimed to determine visual outcome improvement after phacoemulsification among cataract patient. A descriptive study was carried out among cataract patients who underwent phacoemulsification procedure. A total number of 100 operated eyes were followed-up to obtain their postoperative visual acuity (VA) and complications. There were significant improvements of VA resulting in an increase in the number of patients with good vision (normal to mild visual impairment) to 86% after phacoemulsification procedure. There was also low rate of postoperative complications. High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog.

Neuro-ophthalmic Tests for Assessment of Vision Before and After Phacoemulsification in Cataractous Dogs

Background: The aim of current study was to assess pre and post-operative vision status through neuro-ophthalmic examination of 24 canine eyes after phacoemulsification with implantation of different acrylic intra ocular lenses. Methods: The study was conducted on 24 canine eyes. Preoperatively, detailed neuro-ophthalmic tests viz. Menace response, Pupillary light reflex (PLR), Obstacle Course and Moving object (cotton ball) were conducted for assessment of vision due to cataract and to exclude other ocular pathologies. Dogs were divided in four groups with 6 eyes in each group and subjected to phacoemulsification procedure for removal of cataractous lens and implanted with square edge or round edge, hydrophilic or hydrophobic intra ocular lenses (IOL). Post operatively, aforementioned neuro-ophthalmic tests were conducted on 3, 7 and 15 days and scores were given and comparatively analysed for vision acuity. Result: Preoperatively, neuro-opthalmic tests indicated poor and absent vision in eyes affected with various stages of cataract. Post operatively, the visual outcome in dogs of all treatment groups were assessed from the scores obtained in various neuro-ophthalmic tests. Neuro-ophthalmic evaluation revealed restoration of vision in 50% dogs in group I, II, IV and in 66.66% dogs of group III on day 15 after phacoemulsification and intraocular lens (IOL) implantation. It was concluded that neuro-ophthalmic tests are useful and mandatory protocols for pre and post-operative vision assessment in dogs with cataract.

Visual Outcome and Complications in Combined Phaco-Vitrectomy Versus Separate Phaco followed by Vitrectomy for Macula Off Rhegmatogenous Retinal Detachment

Background: Cataract formation is common with pars plana vitrectomy (PPV). Removal of cataract by phacoemulsification can be done combinedly with PPV in the same settings or as separate procedure of phacoemulsification followed by PPV. Objectives: The objective of the study is to check the visual outcome, inflammation and complications in combined phaco-PPV procedure versus separate Phaco followed by PPV.Material and Methods: It was a quasi-experimental study carried out in Ophthalmology Department, Khyber Teaching hospital Peshawar from 1st May 2023 to 31st October 2023. A total of 60 patients were included and divided into 2 groups of 30 patients each. One group undergone combined phaco-PPV and the second group separate phaco followed by PPV. Results: The mean age of participants were 57.8 ± 8.24 years with 58.3% male and 41.7% female. On first post-operative day there was statistically significant difference between the visual acuity, inflammation and complications rate in combined phaco-PPV patients than separate procedure with a p-value of 0.01. There was no statistically significant difference in between the two groups in the final visual acuity, inflammation and complication rate 2 weeks after removal of silicone oil with visual acuity p-value 0.99, inflammation p-value 0.99, complications p-value 0.108Conclusion: There is no significance difference between combined phaco-PPV versus separate phaco followed by PPV in terms of visual acuity, inflammation and complication rate.Keywords: Phacoemulsification, Visual outcome, Vitrectomy

Effectiveness and safety of XEN 63 in patients with primary-open-angle glaucoma

This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.

SICS as a procedure for cataract with severe corneal scar: a case report

Introduction : Cataracts are the most common cause of visual impairment and blindness in Indonesia, according to the Rapid Assessment of Avoidable Blindness (RAAB) survey, which is around 70-80% of patients. Meanwhile, corneal disorders are the second cause of blindness after cataract in the world. Incidence of corneal scar in patients with cataracts can exacerbate visual disturbances to cause blindness and require special treatment.&#x0D; Case Illustration : A 75 years old woman with blurry eyes since 1 year ago. Acuity of the right eye (OD) was 1/300 and the left eye (OS) was 1/300. Extensive and severe scars were found on the corneas of both eyes. Lens opacities were found in the anterior eye segment. Patient was diagnosed with ODS mature senile cataract and ODS corneal scar. Surgical treatment was carried out using the small-incision cataract surgery (SICS) method, IOL inserted and iridectomy.&#x0D; Discussion : Mature cataract patients with advanced age tend to have a denser and harder lens. Cataract extraction performed by phacoemulsification procedure in very dense and hard cataracts requires higher ultrasound energy settings thereby increasing the risk of corneal endothelial trauma and burns which will exacerbate corneal scarring in patients. SICS is a better treatment compared to phacoemulsification in patients with complex situations such as corneal scarring in dense and hard cataracts with minimal surgical complications and optimal results. Iridectomy in cataract surgery can be performed if iris prolapse occurs due to high pressure from the posterior segment of the eye.&#x0D; Conclusion : The SICS procedure shows good results for cataract patients with severe corneal scars

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Retrospective Analysis of Perioperative Dexmedetomidine Use in Retina Surgeries: Impact on Postanesthesia Care.

Dexmedetomidine (Precedex®) has been linked to depressive hemodynamic effects and increased length of stay in the post-anesthesia care unit (PACU) when used in ambulatory phacoemulsification procedures. We aimed to determine the prevalence and impact of dexmedetomidine use during ambulatory vitreoretinal procedures. This retrospective cohort study involved 9,666 adult vitrectomies. Cases were divided into groups by anesthesia type: general anesthesia (GA) and monitored anesthesia care (MAC). For each group, various factors were compared between those who did and did not receive dexmedetomidine. Chi-squared and t tests were used for comparisons. Changes in mean arterial pressure in the MAC group were -1.69 ± 0.23 mmHg for no dexmedetomidine patients and -6.31 ± 0.39 mmHg for dexmedetomidine patients (P < 0.01). In the GA group, mean arterial pressure was -6.1 ± 0.35 mmHg for no dexmedetomidine patients and -11.18 ± 0.88 mmHg for dexmedetomidine patients (P < 0.01). PACU Phase II time in the MAC group was 36.93 ± 0.37 minutes and 40.67 ± 0.86 minutes for no dexmedetomidine and dexmedetomidine patients, respectively (P < 0.01). In the GA group, PACU Phase II time was 58.63 ± 0.95 minutes and 65.19 ± 2.38 minutes for no dexmedetomidine and dexmedetomidine patients, respectively (P < 0.01). Dexmedetomidine use in vitrectomies was associated with significant PACU delays. These delays may stem from adverse hemodynamic effects. [Ophthalmic Surg Lasers Imaging Retina 2024;55:86-91.].

Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial

BackgroundThis study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification.MethodsThis double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher’s exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors.ResultsIn total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique.ConclusionsThe addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage.Trial registrationTrial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.

Assessment of safety profile of phacoemulsification in hard cataract

Purpose: The aim of the study was to assess safety of phacoemulsification in hard cataract by evaluating the post-operative endothelial cell loss and visual acuity. Materials and Methods: This is a hospital-based, prospective study conducted on 70 eyes of 70 patients with hard cataract. At the time of admission, detailed evaluation of anterior segment using slit lamp bio microscopy was done and cataract graded using LOCS III. Posterior segment was evaluated using indirect ophthalmoscopy under 20D/B-Scan. All patients with hard cataract underwent phacoemulsification procedure. The visual acuity and endothelial cell density assessed using Snellens chart and specular microscopy pre-operatively and post-operatively on Day 1, Day 7, and Day 30, respectively. Descriptive statistics, namely, mean, standard deviation to express continuous variables wherever applicable. Correlation between endothelial cell loss and cataract grading and correlation between final endothelial cell loss and final best-corrected visual acuity (BCVA) is analyzed by using Pearson’s Chi-square test and Pearson’s correlation coefficient. P value &lt;0.05 is considered as statistically significant. Results: Among 70 eyes, 40 (57.1%) had NO4-NC4, 18 (25.70%) had NO5-NC5, and 12 (17.1%) had NO6-NC6 cataract grading. The endothelial cell loss was 4.28%, 6.19%, and 7.15% on post-operative day 1, 7, and 30, respectively. There was a positive correlation showing that, as the cataract grading increased the endothelial cell loss increased too. The BCVA of 6/9 was achieved in 2 (2.8%), 6/6 in 68 (97.2%) at the end of four weeks. Conclusion: Although density of cataract has unfavorable influence on early post-operative corneal endothelial cell loss, it did not significantly influence final BCVA. The technique of phacoemulsification for hard nuclear cataract is worthy to be spread due to safety, effectiveness with good visual outcomes.

Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia.

To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome. This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes. A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract. All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.

Morphological Changes in the Endothelium of Cornea after Cataract Surgery: A Comparison between Phacoemulsification and Manual Small Incision Cataract Surgery

Background: Endothelial cell loss and corneal decompensation after cataract surgery is well-documented. After endothelial cell loss, the adjacent cells enlarge and slide over to maintain endothelial cell continuity, which is observed as a change in the endothelial cell density and morphology of the cornea. Objective: The study aims to assess and compare morphological changes (i.e., endothelial cell loss) in cornea after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. Methods: This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change. Results: The mean endothelial cell count was found decreased at day 1 (2585.07±355.65/mm2 vs. 2598.07±385.76/mm2), after 1 week (2564.72±347.23/mm2 vs. 2388.77±326.46/mm2) and after 3 months (2476.72±346.69/mm2 vs. 2248.77±354.47/mm2) following phacoemulsification and MSICS from their preoperative values (2745.35±395.27/mm2 vs. 2673.04±388.28/mm2) respectively. However, no significant difference was observed in mean endothelial cell count of both groups (P&gt;0.05). The mean percentage of endothelial cell loss were observed 5.84±10.02% and 2.80±0.65% at day 1, 6.58±12.15% and 10.63±15.92% at 1 week, 9.78±12.29% and 15.87±8.71% at 3 months after phacoemulsification and MSICS. However, the difference observed in amount of endothelial cell loss between the groups was not statistically significant (P&gt;0.05). Conclusion: To summarize, a decreased endothelial cell count was observed after cataract surgery in both phacoemulsification and MSICS procedures from their preoperative values respectively. However, the difference was not significant between two procedures. Mugda Med Coll J. 2023; 6(1): 11-15

Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery.

The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy. The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction. The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit ( P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was -4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found. Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.

Modelling of an ultrasound-based system for cataract detection and classification

Cataract is a cloudiness in the lens of the eye affecting its transparency. Surgical cataract removal is the only therapeutic approach. Phacoemulsification is the most common surgical procedure, in which ultrasound energy is used to emulsify the cataractous lens. The hardness of the cataract determines the optimal energy for the phacoemulsification procedure. The objective of this work is to model an ultrasoundbased system for cataract detection and classification. It was developed a computational tool for simulating the propagation of A-scan ultrasound in the eye, using the k-Wave MATLAB toolbox. Considering the computational resources available and the dimensions of cataractous microstructures, it was determined a suitable resolution that enables the simulation of ultrasound propagation through the cataractous eye in 2D and 3D. Being so, a pixel size of 8 µm was stablished. A matrix representing the eye structures was constructed in MATLAB. Since on simulations it was considered a focalized probe only the central part of the eye matrix was used. It was observed that 2D and 3D simulated signals present some differences, mainly in the amplitudes of the echoes corresponding to the interfaces of the eye. The chosen resolution was suitable for the purpose of this work. The simulation tool shows good versatility for evaluating diverse aspects of A-scan biometry.

Clinical Observation of Non-Staining Circular Capsulorhexis for Hypermature Cataract

Objective: To explore the circular capsulorhexis method and its clinical effect in phacoemulsification of hypermature cataract without staining. Methods: In this prospective randomized case-control study, 22 patients (22 eyes) with hypermature cataract were randomly divided into a staining agent group (10 cases, 10 eyes) and a non-staining agent group (12 cases, 12 eyes). Both groups underwent phacoemulsification with foldable intraocular lens implantation under topical anesthesia. In the staining agent group, 0.5% indocyanine green was used to stain the anterior lens capsule to assist in circular capsulorhexis; in the non-staining agent group, after puncturing the anterior lens capsule and aspirating the liquefied cortical material, the capsular bag was filled with viscoelastic agent to increase the contrast prior to circular capsulorhexis. The operability of the anterior capsule without staining in capsulorhexis was observed, and the effect of capsulorhexis, diameter of capsulorhexis opening, and operative time were compared and analyzed between the two groups. Results: Both groups successfully underwent circular capsulorhexis, with a success rate of 100%. The diameters of capsulorhexis opening in the staining agent group and non-staining agent group were 5.68 ± 0.15 mm and 5.54 ± 0.16 mm, respectively, without any statistical difference between the groups (P &gt; 0.05); the operative time of the staining agent group (40.40 ± 5.42 s) was shorter than that of the non-staining agent group (50.92 ± 3.97 s), and the difference was statistically significant (P &lt; 0.001). In both groups, phacoemulsification was successful, and intraocular lens were implanted into the capsular bags; their visual acuity showed significant improvement during the 1-month follow-up period after surgery, without any surgical complications. Conclusion: In hypermature cataract, injecting viscoelastic agent into the capsular bag for volume replacement, given a lack of capsule staining agent, can increase the contrast for capsulorhexis and reduce the risk of large capsular bag collapse on the zonular ligament. Thus, it is considered safe and effective. Circular capsulorhexis is conducive to a smooth phacoemulsification procedure.

Topical nonsteroidal anti-inflammatory drugs in the prevention of pseudophakic cystoid macular edema following phacoemulsification: A systematic review

Introduction: The goal of surgeons to avoid Pseudophakic Cystoid Macular Edema (PCMO) has led to the widespread use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) after cataract surgery, although current research into the best anti-inflammatory drugs to avoid PCMO is still underway. This review aimed to determine the efficacy of topical NSAIDs in preventing PCMO following phacoemulsification. Methods: This systematic review was built on the recommended reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for papers during the previous 10 years. The keywords was searched by Boolean operator: “NSAIDs” AND “Prevention” AND “Cystoid Macular Edema” AND “Optical Coherence Tomography” AND “Phacoemulsification”. According to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, the quality of each chosen article was evaluated. Results: We have selected five articles of prospective cohort studies, which involved 756 patients whom received topical NSAIDs (Nepafenac 0.3%, Ketorolac Tromethamine 0.4%Nepafenac 0.1%, , and Diclofenac 0.1%) in treatment group and 700 patients received Placebo (Artificial tears) in control group. There was significant difference of central macular thickness based on OCT results between NSAIDs and control (placebo) group after uneventful phacoemulsification. Additionally, NSAIDs used as a preventative before phacoemulsification procedure exhibited a significantly reduced rise in central foveal thickness compared to placebo. There were changes of central macular thicknes postoperatively, and were significantly different from preoperative. Conclusion: It has been demonstrated that topical NSAIDs successfully lower the incidence of Pseudophakic Cystoid Macular Edema following phacoemulsification.

Efficacy and Safety of Pairing iStent Inject Trabecular Micro-Bypass and iAccess Precision Blade Goniotomy in Patients with Open-Angle Glaucoma.

This study evaluated efficacy and safety of implanting two second-generation trabecular micro-bypass stents (iStent inject/iStent inject W) with phacoemulsification, either with or without iAccess Precision Blade goniotomy, in patients with mild-to-moderate open-angle glaucoma (OAG). This retrospective, non-randomized, unmasked, dual-arm, single-site, multi-surgeon, consecutive case series evaluated all OAG eyes that underwent phacoemulsification and iStent inject implantation either as a dual procedure (group A) or paired with iAccess goniotomy (group B) from July 2020 to May 2022. Effectiveness outcomes analyzed from 1month onward included intraocular pressure (IOP), proportions of eyes with IOP ≤ 12/≤ 15/≤ 18, proportion medication-free, and medication number. Safety outcomes at all timepoints included adverse events and secondary surgeries. In group A, mean IOP reduced from 14.9 ± 3.2mmHg on 1.22 ± 1.31 mean medications preoperatively (n = 63) to 13.5 ± 2.5mmHg on 0.24 ± 0.61 medications at month3 (n = 34; p = 0.048 IOP, p < 0.001 medications). In group B, mean IOP reduced from 16.0 ± 4.2mmHg on 1.12 ± 1.07 medications preoperatively (n = 93) to 12.2 ± 2.3mmHg on 0.57 ± 1.27 medications at month3 (n = 23; p < 0.001 IOP, p = 0.003 medications). From preoperative to 3months, the percent of eyes with IOP ≤ 12mmHg remained at 32.4% in group A (p = 1.0) and rose from 21.7% to 60.9% in group B (p = 0.0177); eyes with IOP ≤ 15mmHg rose from 52.9% to 76.5% in group A (p = 0.0963) and from 43.5% to 91.3% in group B (p = 0.0034). Adjusting for baseline between-group differences, group B had significantly greater postoperative IOP reduction than group A (p = 0.043); medication reductions were similar. Safety was favorable in both groups. Phacoemulsification and iStent inject with or without iAccess Precision Blade goniotomy produced clinically meaningful and safe IOP and medication reductions. The paired iStent inject + iAccess + phacoemulsification procedure enabled greater IOP reduction and lower IOP thresholds than iStent inject + phacoemulsification. The study provides some of the first data on this paired approach and on the novel iAccess Precision Blade.

Use of Cryopreserved Amniotic Membrane During Pterygium Excision: Health Economic Analysis.

To determine the health economic opportunity cost or gain associated with performing pterygium excision surgery using the TissueTuck technique with cryopreserved amniotic membrane (AM) instead of conjunctival autograft (CAU). We performed a literature review to determine the average surgical duration of pterygium surgery using CAU with fibrin glue or sutures to calculate the average time saved with the TissueTuck technique. Such time savings was then used to determine the opportunity revenue gain per national average Medicare reimbursement if adjusted to the average surgical duration of cataract surgery. The time savings achieved using the TissueTuck technique over CAU with fibrin glue is 8.9 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $1167 or $762 per 2022 National Average Medicare reimbursement, respectively. After subtracting the current list cost of AmnioGraft (ie, $645), the opportunity gain is $522 or $117 if the time saving is applied to the above procedures, respectively. Alternatively, the time savings achieved by using the TissueTuck technique over CAU with sutures is 23.4 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $3068 and $2004 per TissueTuck procedure or $2423 or $1359 when accounting for the list cost of AmnioGraft, respectively. The TissueTuck surgical technique using cryopreserved AM for pterygium takes less time, has lower recurrence rates, and provides an opportunity gain compared to pterygium excision with CAU.

Effect of Nondominant Left-Handed Phacoemulsification Surgery on Corneal Endothelium.

To evaluate the effect of phacoemulsification surgery performed with the nondominant left hand on the corneal endothelium. The study included 160 patients who were followed up for at least six months after uneventful cataract surgery. Seventy-seven patients who underwent nondominant left-handed phacoemulsification were evaluated as Group 1 and 83patients who underwent dominant right-handed phacoemulsification were evaluated as Group 2. In all the patients, preoperative axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were evaluated. All phacoemulsification procedures were undertaken with the same device by two surgeons using the same technique, and the intraoperative cumulative dissipated energy (CDE) value, effective phacoemulsification time, and total operative time were recorded. Corneal endothelial cell density (ECD), coefficient of variation (CV) percentage, hexagonal cell percentage (HCP), and central corneal thickness (CCT) measurements were evaluated by specular microscopy preoperatively and at the postoperative first and sixth months. The two groups had a similar age and gender distribution and did not significantly differ in terms of the preoperative AL, AD, ACD, LT, intraoperative CDE, effective phacoemulsification time, and total operative time with similar age and gender distribution (p > 0.05 for all). The preoperative and postoperative first- and sixth-month specular microscopy measurements of ECD, CV, HCP, and CCT ​​were also similar in the groups (p > 0.05 for all). In this study, it was observed that nondominant left-handed phacoemulsification resulted in similar changes in endothelial cell count and morphology to those obtained from dominant-handed phacoemulsification.