Phacoemulsification Time Research Articles

Novel nucleus management technique in hypermature morgagnian cataracts with liquified cortex during phacoemulsification.

To describe a novel nucleus management technique of variable size mobile nucleus in Hypermature Morgagnian cataracts. In this technique, under topical anesthesia, temporal tunnel incision and capsulorhexis were performed, and the capsular bag was inflated with 2% w/v hydroxypropylmethylcellulose. A chopper and phacoemulsification probe were used to consciously nudge the nucleus towards the capsular periphery (fornix) to immobilize the floating nucleus against the capsular bag recess. Firm nuclear impaling was achieved using longitudinal power in linear mode (range 0-70%), 650 mmHg vacuum, and aspiration flow rate of 42 ml/min. The nucleus was chopped by direct chop technique, total separation achieved, and fragments emulsified. Primary outcome measures included ease of nuclear holding, iatrogenic zonular stress/damage, posterior capsule tear, and endothelial cell loss. This technique was performed in 29 consecutive cases from June 2019 - December 2021, and no intraoperative or postoperative complications were noted. The average phacoemulsification time and cumulative dissipated energy (CDE) were nearly similar in all cases. This technique would make phacoemulsification much safer in eyes with hypermature cataract and liquified cortex with lower complication rates and maintenance of better endothelial integrity.

Efficacy of a new fragmentation pattern in femtosecond laser-assisted cataract surgery with the Ziemer FEMTO LDV Z8.

To determine the efficacy of different fragmentation patterns in femtosecond laser-assisted cataract surgery (FLACS) using Ziemer FEMTO LDV Z8. We compared three different types of surgery: conventional cataract surgery (CCS), FLACS with conventional radial slices (named No-Spiderweb), and FLACS with a novel fragmentation pattern (radial slices combined with one or two rings) called "Spiderweb." Visual acuity (VA), nuclear opacity (NO) according to the Lens Opacities Classification System (LOCS lll), effective phacoemulsification time (EPT) and vacuum time were obtained for 845 eyes. Using FLACS (Spiderweb + No-Spiderweb), EPT was significantly reduced by 26% compared to CCS (FLACS: 2.46 ± 2.60s; CCS: 3.34 ± 2.89s; ΔM = - 0.88s, p < .001). Furthermore, EPT as a function of progression of lens opacity was found to be not only lower in Spiderweb compared to CCS, but also in comparison with No-Spiderweb. At NO3, a significant reduction of 65% in EPT was observed by using Spiderweb compared to CCS (Spiderweb:0.68 ± 1.23 s; CCS: 1.96 ± 1.53 s; ΔM = - 1.28 s, p <.001). Interestingly, EPT at NO3 was also significantly reduced by 57% in Spiderweb compared to No-Spiderweb (Spiderweb:0.68 ± 1.23 s; No-Spiderweb: 1.57 ± 1 .59 s; ΔM = - 0.90 s, p <.001). The use of Spiderweb only marginally extends the vacuum time compared to No-Spiderweb by 11s (Spiderweb:209.13 ± 35.83s; No-Spiderweb: 198.35 ± 36.84s; p = .003) and the postoperative improved VA showed no significant difference among the different types of surgery (all ps ≥ .05). FLACS significantly reduces EPT compared to CCS. Furthermore, the novel Spiderweb pattern significantly reduces EPT in patients with a cataract of NO3 compared to CCS, but also to FLACS with the existing radial pattern (No-Spiderweb).

Real-time corneal thickness changes during phacoemulsification cataract surgery.

To observe the changes in corneal thickness during phacoemulsification cataract surgery and to analyze the influencing factors. One hundred two patients (102 eyes) with cataracts undergoing phacoemulsification cataract surgery at Shandong Eye Hospital between July and October 2021 were included. Intraoperative OCT was applied to capture real-time images preoperatively, before and after ultrasonic emulsification, at the end of irrigation aspiration and the end of surgery. Then, the corneal thickness at the above time points was measured using Photoshop software. The corneal thickness of 102 cataract patients was 511.79 ± 31.46μm before operation and 512.71 ± 31.51μm at the beginning of phacoemulsification, which increased by 0.91 ± 1.48μm (0.2%). At the end of ultrasonic emulsification, the corneal thickness was 521.58 ± 32.75μm and 8.87 ± 8.71μm (1.7%) thicker than that before the procedure. After irrigation aspiration, the corneal thickness reached 528.09 ± 33.87μm, which increased by 6.52 ± 6.38μm (1.3%) compared with that of the previous step. At the end of the operation, the corneal thickness was 539.19 ± 33.88μm, 11.09 ± 10.92μm, and 27.37 ± 13.64μm thicker than that of the previous step and the preoperative thickness, respectively, with an overall increase of 5.3%. The differences were statistically significant at all time points (all P < 0.001). Correlation analysis showed that postoperative corneal thickness changes were correlated with age, cataract lens nuclear grade, actual phacoemulsification time (APT), effective phacoemulsification time (EPT), average phacoemulsification energy (APE), total surgery time (TST), cell density (CD), maximum cell area (MAX), and cell area standard deviation (SD) (all P < 0.05), while the changes in thickness were not correlated with gender, cell area coefficient of variation (CV), percentage of hexagonal cells (6A), average cell area (AVE), or minimum cell area (MIN) (all P > 0.05). During phacoemulsification cataract surgery, corneal thickness gradually increases in real time with the increase of perfusion pressure and intraocular manipulation time. The real-time magnitude of intraoperative corneal thickness change is closely related to lens nucleus hardness, corneal endothelial cell density, ultrasound energy, and time for emulsification.

Early OCT Angiography Variations in Macular and Peripapillary Area after Uncomplicated Cataract Surgery and Correlation with Intraoperative Parameters

Background: We evaluated changes in both macular and peripapillary vascular parameters, evaluated by OCT angiography (OCTA), after uncomplicated cataract surgery, as well as the influence of effective phacoemulsification time (EPT) and cumulative dissipated energy (CDE). Methods: This is prospective study on 130 eyes of 65 individuals who underwent unilateral phacoemulsification, with fellow eyes data taken as control group. We collected cataract grading, EPT and CDE. Best corrected visual acuity (BCVA), superficial vessel density, deep vessel density, foveal avascular zone (FAZ) parameters and peripapillary capillary density were measured at baseline, one week and one month following surgery. Results: When compared to baseline, there was a significant increase in both superficial and deep foveal density at last follow up (from 42.9 ± 4.2 and 37.3 ± 7.4 to 45.6 ± 5.4 and 43.7 ± 9.0%, p = 0.002 and p = 0.0001, respectively). Both foveal avascular zone’s area and perimeter showed a significant decrease compared to the preoperative value (p &lt; 0.05). On the other hand, peripapillary vascular density showed a significant increase at week one (from 49.6 ± 2.7 to 51.4 ± 4.6%, p = 0.01), which returned to preoperative values at last follow up (49.3 ± 4.0%, p = 0.95). We found no significant differences when dividing the cohort for cataract severity. Moreover, no significant effect of the EPT and CDE on vascular changes were reported. Conclusions: We found a significant increase in the vascular parameters of the macular area after cataract surgery, while peripapillary vascular density only experienced a transient increase, suggesting an adaptative metabolic mechanism in response to increased light exposure after surgery.

Phacoemulsification with and without iStent: A Systematic Review and Meta-Analysis of Comparative Studies

Background: The iStent (Glaukos Corporation; Laguna Hills, CA, USA) is one of the minimally invasive glaucoma devices. It can be inserted at the time of phacoemulsification or as a stand-alone procedure to lower the intraocular pressure (IOP). Objective: Our aim was to conduct a systematic review and meta-analysis comparing the effect of iStent insertion at the time of phacoemulsification with phacoemulsification alone in patients with ocular hypertension or open-angle glaucoma. Methods: We searched EMBASE, MEDLINE (OVID and PubMed), CINAHL, and Cochrane Library for articles published between 2008 and June 2022 (PRISMA 2020 for the checklist). Studies comparing the IOP-lowering effect of iStent with phacoemulsification versus phacoemulsification alone were included. The endpoints were IOP reduction (IOPR) and the mean reduction in the number of glaucoma drops. A quality-effects model was used to compare both surgical groups. Results: Ten studies were included, reporting on 1,453 eyes. Eight hundred fifty three eyes had the combined iStent and phacoemulsification, and 600 eyes underwent phacoemulsification alone. IOPR was higher in the combined surgery at of 4.7 ± 2 mm Hg compared to 2.8 ± 1.9 mm Hg in phacoemulsification alone. A greater decrease in postoperative eye drops was noted in the combined group having a decrease of 1.2 ± 0.3 eye drops versus of 0.6 ± 0.6 drops in isolated phacoemulsification. The quality effect model showed an IOPR weighted mean difference (WMD) of 1.22 mm Hg (confidence interval [CI]: [–0.43, 2.87]; Q = 315.64; p < 0.01; I2 = 97%) and decreased eye drops WMD 0.42 drops (CI: [0.22, 0.62]; Q = 42.6; p < 0.01; I2 = 84%) between both surgical groups. Subgroup analysis shows that the new generation iStent may be more effective in reducing IOP. Conclusion: iStent has a synergetic effect with phacoemulsification. The reduction of IOP and glaucoma eye drops was higher when iStent is combined with phacoemulsification compared with isolated phacoemulsification.

Effect of pre-fragmentation on efficacy and safety for phacoemulsification in femtosecond laser-assisted cataract surgery: a non-randomized clinical trial.

Ultrasound energy during phacoemulsification results in the endothelial cell loss of cornea. Crystallin lens fragmentation with softening before phacoemulsification can be used with femtosecond laser-assisted cataract surgery (FLACS) device. This non-randomized clinical trial included patients who underwent cataract surgery and not had corneal opacity. Patients who were not possible to apply the interface on the ocular surface, were excluded. Each subject was allowed to decide the surgical method by himself/herself. Cataract surgery was performed with FLACS (groups I and II) or conventional surgical technique (group III). The FLACS group was further subdivided into two groups according to whether a lens softening procedure was performed (group I) or not (group II). The nuclear density of cataract was objectively classified by Pentacam nuclear staging (PNS), preoperatively. Surgical parameters including total phacoemulsification time (TPT), cumulative dissipated energy (CDE), and the balanced salt solution (BSS) volume consumed, were measured during the surgery. Postoperative visual outcomes were evaluated at three months after the surgery, and corneal endothelial cell count (ECC) loss were calculated based on ECC measured before the surgery and two months after the surgery. Eighty-nine eyes from 89 patients were enrolled. Fifty-three were treated using FLACS (groups I; quadrant pattern with softening of pre-fragmentation, n=31 and II; sextant pattern without softening of pre-fragmentation, n=22) and 36 (group III) with the conventional manual technique. The FLACS groups (groups I and II) had statistically significant lower TPT (P<0.001), CDE (P<0.001), and BSS volumes (P<0.001) used in the nucleus removal step compared to group III. Furthermore, ECC loss in groups I (4.59%±2.57%) and II (6.10%±3.30%) were also statistically lower compared to group III (13.49%±10.55%, P<0.001). From subgroup analysis with the PNS 2, group I showed lower pre-fragmentation time, lower CDE, lower BSS volume used during nucleus removal, and lower ECC loss compared to group II (all P<0.001). Pre-fragmentation using FLACS may reduce intraoperative ultrasound energy and intraocular manipulations compared to conventional cataract surgery.

Femtosecond Laser-Assisted Cataract Surgery: Analysis of Surgical Phases and Comparison with Standard Phacoemulsification in Uncomplicated Cataracts.

The aim of this work is to compare the time of surgical phases and the cumulative dissipated energy (CDE) of the phacoemulsification phase in femtosecond laser-assisted cataract surgery (FLACS) and in standard surgical procedures of phacoemulsification (PCS). This prospective, non-randomized study analyzed the data of 100 cataract surgeries, 66 using FLACS and 34 with standard PCS. The time of surgical phases was recorded by a digital chronometer; an additional parameter recorded was the CDE of the phacoemulsification phase. The mean time of femtosecond laser phase was 121.7 ± 27.3 s with minimal fluctuations in duration; the mean opening time of the corneal tunnel and the service incisions was 60.5 ± 20.4 s in the PCS, and 48.8 ± 17.4 s in FLACS (p = 0.04); the mean time of capsulorhexis was 39.6 ± 12.9 s in the PCS and 7.0 ± 5.2 s in FLACS (p &lt; 0.0001); the mean time of phacoemulsification was 180.1 ± 45.6 s in the PCS and 163.0 ± 38.2 s in FLACS (p = 0.12); the mean aspiration time of the residual cortical was 66.3 ± 27.5 s in the PCS and 91.5 ± 35.7 s in FLACS (p = 0.02). Overall, the total surgical time of the cataract surgery was 742.3 ± 185.8 s in PCS and 985.1 ± 118.6 s in FLACS (p = 0.03). The mean CDE was 11.35 in the PCS and 8.3 in FLACS (p = 0.01). In conclusion, the greatest advantage obtained from the use of the femtosecond laser was the reduction of the duration of the phacoemulsification time and of the CDE parameter.

Retrospective investigation of perioperative risk factors for immediate postoperative corneal erosions in dogs undergoing phacoemulsification.

To characterize the incidence, contributing risk factors, and healing characteristics of immediate postoperative corneal erosions (IPCE) in dogs undergoing routine phacoemulsification. Medical records of 313 canine eyes (159 dogs) undergoing routine phacoemulsification surgery. Medical records of dogs undergoing planned cataract surgery at UW Veterinary Care were retrospectively reviewed. Patient-related variables including age, skull conformation, diabetes status, and cataract stage at the time of surgery were recorded. Intraoperative variables per eye were also recorded including surgical technique, surgeon expertise level, average phacoemulsification power, and phacoemulsification time. Diagnosis of IPCE ≤ 24 h after completion of surgery and time to IPCE healing were recorded where follow-up data were available. Immediate postoperative corneal erosions were observed in 48/313 (15.3%) operated eyes. The presence of diabetes mellitus or brachycephalic skull conformation, preoperative Schirmer tear test (STT) value, surgical technique and surgeon experience level, phacoemulsification time, and absolute phacoemulsification time were not statistically significant risk factors for IPCE. Average phacoemulsification power was associated with IPCE (RR 1.52, p=.001). Time to IPCE healing was similar in diabetic and non-diabetic dogs (median [IQR] 8 [6-11] days and 8 [6-15] days, respectively). Diabetes mellitus, brachycephaly, and phacoemulsification parameters were not associated with IPCE healing at 7 or 14 days postoperatively. Higher average phacoemulsification power may be associated with the development of IPCE in canine eyes. The presence of diabetes mellitus or brachycephaly are not risk factors for the development of IPCE, nor are they factors that influence IPCE healing.

Construction and Characterization of Novel Hydrophilic Nanospheres Loaded with Lambda-Cyhalothrin via Ultrasonic Emulsification-Solvent Evaporation.

Safe and efficient pesticide formulations have attracted great attention for the prevention and control of diseases and pests. In recent years, improving the effectiveness and duration of pesticides through nanotechnology has become a research hotspot in the field of pesticide formulations. Here, we develop a novel hydrophilic lambda-cyhalothrin nanospheres encapsulated with poly(styrene-co-maleic anhydride) (PSMA) via the ultrasonic emulsification-solvent evaporation method, which exhibited better particle size uniformity and dispersion in comparison with the traditional method. The effects of PSMA content, oil phase/water phase ratio and phacoemulsification time on the particle size and morphology of nanoparticles were investigated to optimize preparation process parameters. Meanwhile, the wettability and adhesion behavior on the leaf surface, the release properties, and the storage stability of nanoparticles were characterized to evaluate the performance of the novel nano-formulation. This work not only establishes a facile and promising method for the applicable of insoluble pesticides, but also develops an innovative nano-formulation with hydrophilicity and high leaf adhesion, which opens a new direction in plant protection and residue reduction.

Feasibility assessment of the Eye Scan Ultrasound System for cataract characterization and optimal phacoemulsification energy estimation: protocol for a pilot, nonblinded and monocentre study

BackgroundCataracts are lens opacifications that are responsible for more than half of blindness cases worldwide, and the only treatment is surgical intervention. Phacoemulsification surgery, the most frequently performed cataract surgery in developed countries, has associated risks, some of which are related to excessive phacoemulsification energy levels and times. The protocol proposed in herein will be used to evaluate the feasibility of a new experimental medical device, the Eye Scan Ultrasound System (ESUS), for the automatic classification of cataract type and severity and quantitative estimation of the optimal phacoemulsification energy.MethodsThe pilot study protocol will be used to evaluate the feasibility and safety of the ESUS in clinical practice. The study will be conducted in subjects with age-related cataracts and on healthy subjects as controls. The procedures include data acquisition with the experimental ESUS, classification based on the Lens Opacity Classification System III (LOCS III, comparator) using a slit lamp, contrast sensitivity test, optical coherence tomography, specular microscopy and surgical parameters.ESUS works in A-scan pulse-echo mode, with a central frequency of 20 MHz. From the collected signals, acoustic parameters will be extracted and used for automatic cataract characterization and optimal phacoemulsification energy estimation.The study includes two phases. The data collected in the first phase (40 patients, 2 eyes per patient) will be used to train the ESUS algorithms, while the data collected in the second phase (10 patients, 2 eyes per patient) will be used to assess the classification performance. System safety will be monitored during the study.DiscussionThe present pilot study protocol will evaluate the feasibility and safety of the ESUS for use in clinical practice, and the results will support a larger clinical study for the efficacy assessment of the ESUS as a diagnostic tool. Ultimately, the ESUS is expected to represent a valuable tool for surgical planning by reducing complications associated with excessive levels of phacoemulsification energy and surgical times, which will have a positive impact on healthcare systems and society. The study is not yet recruiting.Trial registrationClinicalTrials.gov identifier NCT04461912, registered on July 8, 2020.

Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial.

To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts. In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6months. Both FLACS and CPS resulted in similar and significant IOP reductions through 6months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.

Changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography.

To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA). Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery. In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001). Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.

Long-Term Variations in Retinal Parameters after Uncomplicated Cataract Surgery.

Background: Cataract phacoemulsification surgery provides excellent refractive results; however, it also elicits changes in the posterior segment of the eye. This study aimed to determine changes in retinal parameters measured by spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) after an uncomplicated cataract surgery, including the impact of effective phacoemulsification time (EPT). Methods: The study included 44 patients without retinal abnormalities, followed up after unilateral uncomplicated cataract phacoemulsification in a single ophthalmological unit. Patients were evaluated for the following parameters at baseline and at 2 weeks, 3 months, and 12 months after the surgery: best corrected visual acuity, central retinal thickness (CRT), average central retinal thickness (CRTA), central retinal volume (cube volume (CV)), vessel density central (VDC), vessel density full (VDF), vessel perfusion central (VPC), and vessel perfusion full (VPF). The EPT recorded at each procedure was used as a covariant for the evaluation of changes in retinal parameters after the surgery. Analysis included 44 eyes for SD-OCT and 17 for OCTA evaluation, according to adopted scan quality thresholds. Results: A significant increase in CRT, CRTA, and CV was noted at each follow-up point compared with baseline. The rising tendency was observed in the first 3 months after the surgery, with a decline over the subsequent months. The VPF parameter showed a stable improvement after the surgery. The analysis of covariance did not confirm any significant effect of the EPT on variations in CRT, CV, CRTA, VDC, and VPF and there was a weak effect on the VDF parameter. Conclusions: Uncomplicated cataract surgery results in an increase in retinal thickness and volume in the first few months after the surgery, followed by a spontaneous decline in these parameters in the subsequent months. A long-standing improvement is noted in the VPF parameter.

Central Macular Thickness in Uneventful Phacoemulsification Employing Optical Coherence Tomography

Introduction: Cataract is the most common cause of blindness affecting the global population which can be cured by phacoemulsification surgery. The study aimed to evaluate the central macular thickness following uneventful phacoemulsification surgery and analyze its relation to various factors. Methods: This prospective study comprised of 63 subjects diagnosed as age-related cataract on the basis of lens opacities classification system III and undergoing uneventful phacoemulsification surgery with capsular bag intraocular lens implantation. The central macular thickness was evaluated using optical coherence tomography at preoperative period and postoperatively on 1st day, 1st week and 5th week. Effective phacoemulsification time was measured intraoperatively. Results: The mean effective phacoemulsification time was 17.95±14.01 seconds. Best corrected visual acuity improved significantly postoperatively (p=0.03). Mean central macular thickness increased significantly on the 5th postoperative week compared to preoperative assessment (p=0.002). No significant association was detected between patient’s age and preoperative and postoperative central macular thickness. No correlations were observed between effective phacoemulsification time and central macular thickness. Significant association was not noted between central macular thickness and best corrected visual acuity on pre and postoperative examinations. Conclusion: There was a decrease in central macular thickness on the 1st day and 1st week postoperatively followed by a significant increase on the 5th postoperative week compared to the preoperative period, which was independent of effective phacoemulsification time. Increase in central macular thickness in the postoperative period did not affect the quality of vision.

Comparison of effective phacoemulsification time and corneal endothelial cell loss using three different ultrasound frequencies: A randomized controlled trial.

Purpose:Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer.Methods:A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6–6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28-kHz frequency, group II with 42-kHz frequency, and group III with 53-kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months.Results:The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperativelyConclusion:Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts.

Correction of pre-existing astigmatism with phacoemulsification using toric intraocular lens versus spherical intraocular lens and wave front guided surface ablation

BackgroundThis study aimed to evaluate toric intraocular lens to correct of pre-existing astigmatism at the time of phacoemulsification compared to using of spherical intraocular lens followed by wavefront guided surface ablation.ResultsThe patients were classified into three groups: Group A with 20 eyes of 19 patients having phacoemulsification with spherical intraocular lens only as a control group, group B with 20 eyes of 14 patients had phacoemulsification with toric intraocular lens and group C with 20 eyes of 16 patients had phacoemulsification with spherical intraocular lens and wavefront guided PRK three months later. Comparison pre-operative data for all groups showed no statistically significant difference regarding UCVA, BCVA, MRSE, and refractive astigmatism (P>0.05). Post operatively, there was a statistically significant difference for UCVA, BCVA, MRSE, and refractive astigmatism for group A compared to group B (P<0.05) and group A compared to group C but there was no statistically significant difference for group B compared to C regarding all these parameters (P>0.05).ConclusionIn this study, we found similar effects for both techniques in astigmatism corrected groups while both differed from the control group that was not corrected. Correcting preexisting astigmatism during cataract surgery should be in mind in every case to improve visual outcomes. Longer period of follow up are required to evaluate stability of these techniques and possibility of regression.

Retrospective evaluation of phacoemulsification and aspiration in 182 eyes: Visual outcomes and CDE-predictive value.

To determine the effect of cumulative dissipated energy (CDE) on complications and visual outcome following cataract surgery in dogs. Records of 182 canine eyes that had undergone cataract surgery. Retrospective medical record review was conducted on dogs that underwent unilateral or bilateral elective cataract surgery by a single surgeon. Preoperative variables such as age, cataract duration, and pre-existing conditions were recorded. Intraoperative variables such as intraocular lens (IOL) status, phacoemulsification time, average power, irrigation fluid volume, and CDE were recorded. Postoperative complications and visual status at last follow-up were compared to these variables. Eighty-six percent of dogs were visual in one or both eyes at last follow-up (LFU) examination. Median follow-up time was 186days postoperatively. Eyes that developed glaucoma had a significantly greater mean CDE (77.73±80.11) than eyes that did not develop glaucoma (49.21±38.93). Eyes that remained visual at the LFU examination had a significantly lower mean CDE (48.31±37.14) than eyes that were blind at LFU (82.05±82.73). Significantly lower mean CDEs were found in diabetic eyes, younger eyes, early-operated eyes (<1month duration), and eyes with preoperative lens-induced uveitis. Higher CDE may be associated with an increased risk of postoperative glaucoma and loss of vision in dogs. Cumulative dissipated energy may be a useful prognostic indicator for success of canine cataract surgery.

Comparative evaluation of modified crater (endonucleation) chop and conventional crater chop techniques during phacoemulsification of hard nuclear cataracts: A randomized study.

Purpose:To compare the clinical outcomes of endonucleation chop (EC) versus conventional crater (CC) chop techniques in phacoemulsification of hard nuclear cataracts.Methods:In this Prospective, longitudinal, randomized controlled study with double-blinding. Hundred consecutive eyes with uncomplicated cataracts (nucleus grades 3 and 4) were equally divided into Group A (EC) and Group B (CC). Intraoperative effective phacoemulsification time (EPT) and balanced salt solution (BSS) volume used was noted. Postoperative central corneal thickness (CCT), endothelial cell density (ECD), uncorrected Visual Acuity (UCVA), best-corrected visual acuity (BCVA), and IOP were recorded at days 1, 7, 30, and 90 postoperatively. The Chi-square test (categorical data), Mann–Whitney U test, and t-tests for other parameters were done.Results:The mean EPT in Groups A and B were 6.6 and 14.25 s, respectively (P < 0.001). The BSS volume used was 105.9 and 221.7 mL, respectively (P < 0.001). At 3 months, the ECD loss was 4.35 and 8.6%, respectively (P = 0.025). The-first day CCT was significantly increased in Group B but was the same in both groups at 3 months. A significant improvement in BCVA was noted in both groups. This new technique significantly reduces EPT, the BSS used, and ECD loss.Conclusion:Compared with the CC chop technique, the EC technique for phacoemulsification of hard nuclear cataracts conserved phacoemulsification energy and minimized exposure to the intraocular irrigating solution, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation.

Comparison of clinical outcomes between cystotome-assisted prechop phacoemulsification surgery and femtosecond laser-assisted cataract surgery for hard nucleus cataracts.

To compare the safety and efficacy of cystotome-assisted prechop phacoemulsification surgery (CAPPS) and femtosecond laser-assisted cataract surgery (FLACS) in patients with hard nucleus cataract. Ninety-six eyes of 64 patients with grade IV hard nucleus cataract were assigned to 1 of the 2 groups (49 CAPPS and 47 FLACS). Follow-up visits were performed at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, and the outcome measures comprised ultrasound power, effective phacoemulsification time (EPT), corrected distance visual acuity (CDVA), endothelial cell density (ECD), corneal endothelium cell loss rate (ECL), central corneal thickness (CCT), and intraoperative and postoperative complications. The ultrasound power and EPT were lower in the CAPPS group (p = 0.03 and <0.0001, respectively). Patients in both groups gained better CDVA postoperatively. The ECD value decreased at each follow-up visit and did not return to the preoperative level; FLACS resulted in greater endothelial cell loss compared to CAPPS. CCT increased immediately after the surgery and decreased thereafter. The mean CCT value returned to the preoperative level 3 months postoperatively in the CAPPS group, while in the FLACS group, CCT value took 6 months to return to the preoperative level. Miosis was more likely to occur in the FLACS group. Due to its efficacy and cost-effectiveness, CAPPS is worth promoting and applying to clinical work in the future.

Impact of Phacoemulsification Cataract Surgery to Number of Corneal Endothelial Cells: A Descriptive Study

The main optical structure of the eyes is the lens and corneal because lens with the cornea, focuses image of the visual world onto the retina. Both of the main optical structure is affected by age, it affects the corneal endothelial cells and transparency of the lens. By aging the corneal endothelial cells decrease and the lens loses its transparency then the cataract appears [1,2]. it is known that cataract surgery effecting the corneal endothelial cells number. The surgery will be decreasing the corneal endothelial cells number. The severity to which endothelium is affected depends on many factors, such as phacoemulsification time and energy, surgical technique, anterior chamber depth, and use of ophthalmic viscoelastic devices (OVDs) [3]. A total of 52 people with cataracts were enrolled in this descriptive investigation. The study is included 52 eyes. Ages ranged from 43-77 years, with a mean age of 57,7 years. From this study 59,6% were men and the rest are women, which 79% were diagnosed with immature cataract, and 21% were diagnosed with mature cataract. It was found that 86,5% of eyes experienced a decrease in the number of corneal endothelial cells after cataract phacoemulsification surgery. The mean of corneal endothelial density pre surgery is 3126 cells/mm2 ± 246,1 and the mean of corneal endothelial density post-surgery is 3029 cells/mm2. The range of surgery time is 6-30 minutes. With the mean time of surgery 13,7 ± 5,8 minutes. From 52 eyes there are 45 eyes with corneal endothelial cells loss 7 days after surgery, with the mean of corneal endothelial cells loss after cataract phacoemulsification surgery are 152,3 ± 68 cells/mm2, the percentage mean was 6%, and we found decreasing in central corneal thickness, corneal endothelium density, hexagonality and increasing coefficient of variety.