Phacoemulsification Technique Research Articles

Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery.

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

The change of Astigmatism before and after phacoemulsification cataract surgery with temporal incision in senile cataract patients at RSUP Fatmawati year 2015 – 2016

Azhardin Maralaut Siregar. Medical Studies and Medical Eduaction Program. The change of Astigmatism Before and After Phacoemulsification Cataract Surgery with Temporal Incision in Senile Cataract Patients at RSUP Fatmawati year 2015-2016.Background: Cataract is a common disease in the elderly. Treatment of cataracts to date is by surgery, one of them with phacoemulsification technique, which is considered to have the best results because it gives the very small effect of change in astigmatism. Some of the factors that cause astigmatism change are the surgical techniques as well as the large and the location of the incision.Objective: To know the change of astigmatism in senile cataract patient before and after surgery with phacoemulsification technique at RSUP Fatmawati.Method: This research uses cross sectional design conducted in February 2017 until August 2017 at RSUP Fatmawati. The study used secondary data taken from a medical record of senile cataract patients who had undergone phacoemulsification technique surgery performed by one ophthalmologist in January 2015 to December 2016.Results: Respondents numbered 52 eyes from 52 patients aged ≥50 years. Analyzed using kolmogorov-smirnov test, it was found that the astigmatism change was not significant in the first week after surgery with p value 0.319, the insignificant astigmatism change in the third week after surgery with p value 0,505, the insignificant astigmatism change in the sixth week after surgery of astigmatism before operation with p value 0.311. But there was an increasing number of astigmatism patients from 32 (65%) to 39 patients (75%). Conclusions: There was an insignificant astigmatism change in the first, third and sixth weeks after phacoemulsification surgery of senile cataracts.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 55-61

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.

Considerations regarding the tilt-and-crush phacoemulsification technique.

Considerations regarding the tilt-and-crush phacoemulsification technique.

A comparative study of effectiveness of topical with supplemental intracameral lignocaine versus peribulbar anaesthesia for phacoemulsification with foldable intraocular lens implantation

To assess the quality of analgesia, level of comfort of patients and surgeons and incidence of complications after topical anaesthesia with supplemental intracameral lignocaine as compared to peribulbar block in patients undergoing phacoemulsification.It was a prospective observational study done in 66 patients having uncomplicated senile cataracts who underwent phacoemulsification with foldable IOL implantation of both eyes. One eye of each patient was operated under peribulbar blockand the other eye under topical anaesthesia with supplemental intracameral lignocaine after 2 weeks. In Group T, topical anaesthesia was achieved by instilling proparacaine hydrochloride 0.5% and preservative free 1% lignocaine was used for intracameral analgesia. Peribulbar block was administered with 5-7 ml of 2% lignocaine with 1:10000 adrenaline. Patient comfort, feeling of pressure during block, quality of analgesia intraop and 4 hours postop, and surgeon’s comfort were documented. Group P patients had significantly higher pain score, discomfort and pressure on eye during administration of block compared to Group T. Both groups had comparable pain scores and patient’s discomfort. Pressure on eye intraop and postop and intraoperative positive pressure were also similar in both groups. Group P had significantly higher incidence of subconjunctival hemorrhage (80% vs 10%) and chemosis of conjunctiva. (80% vs 0%). Topical anaesthesia with supplemental intracameral lignocaine can be considered as a superior anaesthetic technique for phacoemulsification than peribulbar block as it is associated with significantly higher patient comfort and lower complications with comparable surgeon’s comfort.

Femtosecond laser-assisted cataract surgery in a patient with traumatic cataract and corneal opacity after LASIK: a case report

BackgroundFemtosecond laser-assisted cataract surgery (FLACS) has been reported to reduce phacoemulsification time and energy compared to the manual phacoemulsification technique. This technique has been used in several complex cases such as zonular weakness, subluxated lens and traumatic cataracts because it causes less damage to weakened zonules. However, corneal opacity is considered a relative contraindication to FLACS, as it may interfere with laser beam delivery, thus causing unpredictable capsulorhexis and lens fragmentation/liquefaction.Case presentationWe present here a case with traumatic cataract and corneal opacity after laser-assisted in situ keratomileusis (LASIK). The patient was successfully treated using FLACS, capsular tension ring and intraocular lens (IOL) implantation. Posterior capsule rupture and vitreous loss were noted during the operation. However, the intraocular lens was successfully captured because of a complete capsulorhexis performed by FLACS.ConclusionThis case report demonstrates that FLACS is a useful tool in selected patients with concurrent corneal opacity and traumatic cataract.

Stop and Flip: A Simple and Safe Phacoemulsification Technique.

We introduce a simple, easy to learn, fast and safe technique to facilitate nucleus management in patients with zonular weakening in uncomplicated cases. The surgery begins with a temporal 3.2 mm clear corneal incision under topical anesthesia. Two side-port incisions are made on the inferior and superior sides. Anterior continuous curvilinear 5–6 mm diameter capsulorhexis and hydrodissection are performed to loosen capsule cortical attachments. The nucleus is not rotated, and an appropriated groove (80–90% depth) is sculpted using phaco machine. The groove is cracked into two hemispheres; lateral pressure and a side port manipulator. Then, 15–30 degree phaco tip is introduced and embedded into one hemisphere of nucleus beside the capsulorhexis edge at temporal or nasal part. After complete removal of the first hemisphere, the second is flipped again from bag into iris plane and phacoemulsified in the same manner.

Impact of cataract surgery on vision-related quality of life

Background: Blindness and visual impairment have been shown to reduce vision-related quality of life (VRQoL), general health and social status and increase mortality. Understanding the influence of different cataract surgery techniques on VRQoL can enhance the understanding of which technique may be most suitable to achieve the best outcomes from a patient’s perspective. Previous studies have focused exclusively on the phacoemulsification technique, with limited attention on other techniques that are common in developing countries, such as the extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS) techniques. Aim: To evaluate the impact of cataract surgery on VRQoL for the ECCE and MSICS techniques. Setting: The study was conducted at the Themba Hospital in the Mpumalanga province. Methods: A case study research design was used at the Themba Hospital. Participants underwent either the ECCE or the MSICS technique and were followed for a period of 6-weeks post-surgery. The VRQoL was assessed using the 33-item Indian Vision Functioning Questionnaire (IND-VFQ-33). Data were presented using frequencies, percentages and means ± standard deviations. Results: The sample included 101 participants, with a mean age of ~66 years. Following cataract surgery, there was an increase in the frequency of the ‘not at all’ response for the majority of the questions in the IND-VQ-33 questionnaire in all three domains. There were statistically significant differences ( p < 0.05) between the pre-surgery and post-surgery mean scores for all the questions, with the exceptions being those related to problems experienced when seeing outside in bright sunlight, bright light hurting the eyes and closing the eyes because of light from vehicles. Conclusion: Individuals who underwent both the ECCE and MSICS techniques showed improvement in VRQoL in terms of general functioning, psychosocial impact and vision symptoms domains.

Distinctive features of phacoemulsification in previously vitrectomized eyes

The review presents the main pathogenetic mechanisms of cataract development in an avitic eye as well as anatomical and functional changes of the eye in the state of avitria. The authors have also analyzed distinctive behavior of such eyes during phacoemulsification and surgical techniques used to answer specific avitreal phenomena.

Scoop and chop - A modified phaco-chop technique for pseudoexfoliation and cataract.

PURPOSE:The purpose is to evaluate the results of the modified direct phaco-chop technique of cataract surgery in eyes with pseudoexfoliation.METHODS:All patients with pseudoexfoliation and visually significant cataract with normal intraocular pressure (IOP) and optic nerve that underwent cataract surgery by the same surgeon using Infiniti®, OZil® Torsional handpiece (Alcon Labs), were included for this retrospective hospital-based study. Direct vertical or horizontal chop technique was used in all cases with parameters set as required for quadrant removal with high vacuum after the initial cleanup of cortex under the capsulorhexis. To allow better visualization of the hardness of the nucleus core, the sides of the lens were scooped out a central well with vacuum with maximum chopping done centrally within the rhexis as the first step to enable better assessment of the depth of burying the chopper for direct chop. Intraoperative details recorded and analyzed included ultrasound time and cumulative dissipated energy. The mean visual acuity and IOP before and after surgery were recorded at 1 day, 1 week, and 1 month. Complications during or after surgery were noted.RESULTS:A total of 138 patients with a mean age of 62 ± 6.7 years underwent phachop technique of phacoemulsification for nuclear cataract grades of nuclear sclerosis 2–4 with significant improvement in visual acuity from baseline (0.26) to 3 months (0.82), P < 0.001. The mean ultrasound torsional amplitude and cumulative dissipated energy (CDE) were greater for brown cataract of grading >3, P = 0.02. A total of 8 patients had intraoperative zonular dialysis in 1 quadrant (none in >1 quadrant), which was not associated with intraoperative vitreous prolapse in 6 eyes.CONCLUSIONS:Direct modified phaco-chop technique may be a safe technique in pseudoexfoliation due to minimal zonular stress with successful outcomes and reduced complications.

Morphological and functional condition of the macula after different types of phaco cataract surgeries

To evaluate morphological and functional condition of the macular area after different types of phaco cataract surgeries. Two groups were formed for comparative study in accordance with criteria for standardization and maximum mitigation of the impact of other factors on the condition of the retina - with standard ultrasound and hybrid (femtolaser-assisted) phacoemulsification (30 operations in each group). Examinations were performed initially, then 7-10 days, and 2-3 month after the surgery. Optical coherence tomography (OCT) and multifocal electroretinography (mfERG) were performed for evaluation of the morphological and functional condition of the macular area. There was no statistically significant dependence of linear and volumetric measures in the macular area on phaco surgery method, and the few variations were most likely related to increasing the time of ultrasound action in standard phacoemulsification. Revealed changes turned out to be significantly less marked than what is considered critical for development of macular edema. Improvement of baseline multifocal electroretinography measurements (increase of the density of retinal biopotential and decrease of latent time) just after the surgery results from the effect the lens opacification has on basic parameters, regardless of phacoemulsification technique. There were no significant differences in postsurgical measurements of multifocal electroretinography obtained in similar periods of postsurgical assessment after standard ultrasound and hybrid phacoemulsification. The results prove the safety of phaco surgery methods and the absence of negative impact of femtolaser component of hybrid phacoemulsification on structural and functional condition of central retina.

Reopacification of posterior capsular opening after ND: YAG capsulotomy: 2 cases with the different presentation

Purpose: To report the complete opacification of posterior capsulotomy opening after neodymium: yttrium-aluminium-garnet (ND: YAG) posterior capsulotomy for posterior capsular opacification. Methods: A 70-year-old female had uneventful cataract surgery by phacoemulsification technique with implantation of in the bag hydrophilic intraocular lens (IOL) in her left eye. Eight months after surgery, the patient developed posterior capsular opacification (PCO) for which ND: YAG capsulotomy was performed. However, she returned after 7 months first post ND: YAG capsulotomy with the blurring of vision and glare at night. Slit lamp examination revealed pearl like opacification of posterior capsule occupying the YAG capsulotomy opening. A repeated ND: YAG capsulotomy restored her vision to 20/ 20. Another patient operated for posterior polar cataract had dehiscence in the posterior capsule during cataract surgery. The patient was implanted with hydrophobic IOL in the capsular bag without performing an optic capture. The patient presented 3 years later with occlusion of the posterior capsular opening with mixed pearl-like and fibrotic PCO. Conclusion: Occlusion of the posterior capsular opening may occur after ND: YAG capsulotomy and may cause a reduction in visual acuity. Pearl-like opacification is common to occur in reopacification of posterior capsular opening.

Progressive cracking technique for phacoemulsification of superhard cataracts: a case report

BackgroundComplete nuclear disassembly of superhard cataracts cannot always be achieved by phaco chop, which is considered one of the best techniques for dealing with hard cataracts. We present a phaco chop-progressive cracking technique to divide superhard cataracts completely.Case presentationWe presented a case of cataract with over Grade V nucleus sclerosis and very low density of corneal endothelial cell (812 cells/mm2). By performing the cataract surgery with our phaco chop-progressive cracking technique, the corneal endothelial cells were well protected and the patient’s visual acuity was markedly improved from finger counting at 40 cm to 20/200 the day after surgery without obvious corneal edema.ConclusionsAlthough an initial learning curve was needed, this phaco chop-progressive cracking technique could be of particular benefit to the superhard cataract, especially in patients with low density of corneal endothelial cells.

Face and content validation of Phacoemulsification Techniques Related To Surgically Induced Astigmatism questionnaire

Phacoemulsification surgical techniques are associated with surgically induced astigmatism (SIA) in post-cataract surgery. However, no established tool is currently available to gather information on the surgeon's phacoemulsification techniques. This study aimed to validate a newly developed ‘Phacoemulsification Techniques Related to Surgically Induced Astigmatism’ (PTechSIA) questionnaire. PTechSIA questionnaire was designed to collect information on surgical techniques used by surgeons during phacoemulsification. Questionnaire items were generated based on peer-reviewed literature of related domains to phacoemulsification surgical techniques. The self-administered tool consisted of fifteen close-ended questions. Ten subject-matter experts (SMEs) were recruited for face validation using qualitative approach and content validation using Lawshe’s method. The items in the questionnaire were modified based on feedback from the SMEs. Content validation ratio (CVR) was calculated for each item; items with CVR value of less than 1.00 were eliminated, and the final content validity index (CVI) of the questionnaire was obtained. Out of fifteen items, six items with CVR value of less than 1.00 were eliminated (items number 2, 7, 11, 13, 14, 15) with initial CVI of 0.61. After the modification process, the number of final items was nine, with an overall final CVI score of 1.00. Overall, the finalised PTechSIA questionnaire achieved appropriate validity. Hence, the findings indicate that the PTechSIA questionnaire can be utilized for future assessments of surgical techniques and its association with SIA.

The Effectivity of Therapeutic Communication on Pre-Surgery Education of The Implementation of Phacoemulsification technique Cataract Surgery With Local Anesthesia

Surgery, whether it is elective or emergency, is a complex event that triggers stress both on the patient and the family. Not only extending the surgery wait time, postponing or cancelling the surgery could increase the severity of the cataract that may result in blindness. This research goal is to know the effectivity of therapeutic communication on the implementation of cataract surgery. This research uses Pre-Experimental design with Post Test Only Control Group approach. A population of 176 respondents will be scheduled for cataract surgery to meet the inclusion criteria. The sampling technique is using simple random sampling technique and 64 respondents are divided into control and intervention groups. The data analysis is using Paired Sample T-test statistical test. The research result shows that almost all of the respondents who continue to the surgery with a number of 30 respondents (93,8%) and the number of respondents who postpone the surgery is only 2 respondents (6,2%), while those who implements daily communication shows that 22 respondents (68,8%) continue to the surgery and the 10 respondents (34,2%) postpone the surgery. The result of Paired Sample T-test statistical test shows that P value = 0,003 &lt; 0,05 means that there is a difference in the surgery between the intervention and the control group. The implications of this research can be applied by nurses to be more creative and innovative, professional and skilled in applying therapeutic communication when providing pre surgery cataract education.

Comparison of Phaco-chop and Divide and Conquer Methods in Grade 3-4 Cataract Patients

Purpose: To compare the outcomes of Grade3-4 cataract surgery performed with 2 phacoemulsification techniques (phaco-chop and divide-and-conquer).&#x0D; Setting: Ministry of Health Tuzla State Hospital, Istanbul, Turkey.&#x0D; Design: Prospective randomized clinical trial.&#x0D; Methods: This is prospective and randomized(double blind) study cataract surgery using two different techniques of nuclear fragmentation performed at the Tuzla State Hospital.100 patients eye with nuclear density from grade 3 to 4 were randomly subdivided into 2 groups (phaco-chop and divide-and-conquer). Intraoperative measurements included Phaco time (PT), effective phaco time(EPT), mean phaco power(MPP). Clinical measurements included preoperative and postoperative 1.day , 7. day, 30. day, and 60.day corrected distance visual acuity(BCVA), time to achieve BCVA, corneal edema rate and time to disappear corneal edema.&#x0D; Results: Intraoperative measurements showed significantly less PT, EPT, and corneal edema with the phaco-chop technique than divide-and-conquer techniques in the grade 3-4 cataract density group (P&lt;0.05).&#x0D; Conclusions: 2 techniques may be effective for cataract surgery in mild and moderate cataracts. However, in eyes with hard cataract the phaco-chop technique can be more effective for lens removal, with less Phaco time and corneal edema, then the divide-and-conquer technique.&#x0D; Financial Disclosure: No author has a financial or proprietary interest in any material, method or device mentioned.

A Clinical Prospective Study: Corneal alterations after cataract surgery with the technique of phacoemulsification

Abstract The purpose of this study is to investigate the effect of ultrasound energy used during phacoemulsification on corneal structure, which is the most important refractive part of the eye. This will be achieved with the comparison of preoperative and postoperative parameters related to corneal thickness and endothelium and their correlation with clinical, intrasurgical and imaging diagnostic findings. Methods: This is a clinical prospective study conducted in Evangelismos G.H.A. The patients’ enrollment was based on detailed medical history assessment, medication records as well as meticulous slit lamp examination, tonometry, best corrected visual acuity evaluation and thorough fundoscopy. Nuclear cataract sclerosis was evaluated with Lens Opacities Classification System III, and patients were scheduled for surgery. Preoperatively, with the use of specular microscopy (Tomey EM-3000; Tomey, Tennenlohe, Germany), central corneal thickness and several endothelial indices were recorded. The same measurements took place the 1st, 7th and 30th postoperative day. All the surgical operations were done without complications. Results: statistical analysis from preoperative and postoperative data showed that central corneal thickness, although elevated during the 1st and 7th postoperative day, did not present statistical significant difference in the final evaluation, with a mean elevation of only 3,9μm. Endothelial cell density levels though were reduced in all postoperative measurements (p<0,001). The final percentage endothelial cell loss was18,58%, with the most profound loss being accounted in the first postoperative week. Corneal edema and endothelial cell loss were correlated with poor visual acuity, reduced corneal curvature, increased nuclear sclerosis and prolonged time of ultrasound metrics. Conclusion: the use of confocal microscopy is a useful tool in pointing significant differences of corneal structure after uneventfull cataract phacoemulsification. The evaluation of a larger cohort of patients and a prolonged follow up procedure could give further information concerning corneal alterations after surgery. Key words: cataract, phacoemulsification, cornea, lens, endothelium, ultrasound, confocal microscopy List of Abbreviations: CCT: central corneal thickness, SD: standard deviation, CV: coefficient of variation, , ECD: endothelial cell density, ECL%: endothelial cell loss%,

Precision pulse capsulotomy in challenging cataract surgery cases.

PurposeTo evaluate the use of the precision pulse capsulotomy (PPC) device for challenging cataract surgery cases.Patients and methodsThis single-center retrospective case series study comprised of 43 eyes (from 35 patients) that were challenging cataract surgery cases with poorly dilated pupils, anterior subcapsular opacity, white cataract, brunescent cataract, and corneal opacity. This was conducted at the Busan Sungmo Eye Hospital (Busan, Republic of Korea) to assess the performance of the PPC device through a 2.2-mm clear corneal incision width, followed by the phacoemulsification technique and intracapsular intraocular lens fixation. The main outcome measurement was the anterior capsulotomy performance of the PPC device and the development of intraoperative complications. At postoperative 2 months, visual acuity, endothelial cell count, and refractive error were measured.ResultsNo cases of anterior capsule tears or tags occurred. All 43 eyes received circular, 360-degree, free-floating, and appropriately sized anterior capsulotomies. During 2 months of follow up, no postoperative complications occurred in association with the PPC device.ConclusionThe PPC device facilitated the creation of a precise, round, appropriately sized anterior capsulotomy in challenging cataract surgery cases. Further investigations are required to understand the long-term safety and efficacy of the PPC device.

Comparison of Schirmer and Tear Break Up Time (TBUT) Diagnostic Test of Dry Eye Following Phacoemulsification Cataract Surgery

Abstract&#x0D; Background: Phacoemulsification is a technique of modern cataract surgery with smaller corneal incision than conventional techniques but uses various effects on springs that cause dry eye syndrome (DES). DES is a multifactorial defect of tears and ocular surfaces characterized by eye discomfort. Examination of DES can be done by examining Schirmer 1 and Tear Break Up Time (TBUT).&#x0D; Purpose: To determine the accuracy, sensitivity and specificity of the Schirmer test dan TBUT in postoperative patients with phacoemulsification techniques at the Rumah Sakit Khusus Mata Province of South Sumatra.&#x0D; Method: Diagnostic test has been done in order to the accuracy, sensitivity and specificity of the Schirmer test dan TBUT on DES in post operative cataract surgery with phacoemulsification techniques. This study has been conduct Schirmer 1 test and TBUT was done periodically from 1 week, 2 weeks and 1 month after cataract surgery. The data analysis has been done with diagnostic research by SPSS version 20.0 (SPSS, Inc Chicago, Illinois).&#x0D; Result: 40 study samples of post operative cataract surgery with phacoemulsification technique obtained by female sex with 22 out of samples were (55%), with an average age of patients between of 60-70 years.The accuracy of Shirmer 1 and TBUT test was 0,425 and the sensitivity value was 39.5% and also the specificity value was 100%.&#x0D; Conclusion: Schirmer 1 test and TBUT in patients of post cataract surgery with phacoemulsification techniques are specific (100%) but less sensitive (39,5%)

Supracapsular phacoemulsification: Description of the “Garde à vous” technique and comparative clinical results

Phacoemulsification techniques can be divided into 2 categories: endocapsular and supracapsular techniques. Supracapsular techniques involve phacoemulsification of the nucleus outside and above the capsular plane. The "Garde-à-vous" technique described in this manuscript is a modified and improved version of the supracapsular procedure with up-to-date technology in micro-coaxial surgery. It maintains the known advantages of supracapsular techniques such as faster surgical times and lower rates of capsular tears and brings a standardized technique with well-defined surgical steps in order to achieve tilting of the nucleus in a vertical or oblique position in almost 100% of cases by performing a double-wave hydro-dissection. The authors also give the results of a non-randomized prospective study, comparing the "Garde-à-vous" technique and the standard "cracking" technique in 2856 cases. The results show that for the "Garde-à-vous group", the patients were significantly younger (P<0.001), the power of ultrasound used was greater (P<0.001) for lower UST (ultrasound time or average phacoemulsification time APT) and EPT (effective phacoemulsication time) (P<0.001), the duration of the procedure was shorter (P<0.001), patient discomfort was less (P<0.001), and the power of the implants used was lower (P<0.01). With regard to the gender of the patients, the percentage of topical anesthesia and the rate of intraoperative complications (posterior capsular rupture), there was no statistically significant difference.