Posterior Chamber Intraocular Lens Implantation Research Articles

Clinical Study of Scleral Fixated Posterior Chamber Intraocular Lens Implantation and its Morbidity

Clinical Study of Scleral Fixated Posterior Chamber Intraocular Lens Implantation and its Morbidity

Triple procedure in blood-stained cornea of a hemophilia patient

A 16-year-old male Type A hemophiliac patient has been reported with complaints of defective vision in the right eye (OD), following ocular trauma 9 months back for which he took treatment outside. On examination, he had blood staining of cornea and cataract in his right eye. His vision was perception of light + and projection of rays intact. After hematologist opinion, under peribulbar anesthesia, he underwent penetrating keratoplasty with pupillary membranectomy and cataractous lens removal with posterior chamber intraocular lens implantation under the cover of Factor VIII (antihemophilic factor). On day 21, the best-corrected visual acuity in OD was 6/6P. This case report emphasizes the fact that hemophiliac patients can be operated safely with appropriate hematological support.

Optimal timing of capsular tension ring implantation in pseudoexfoliation syndrome.

The aim of this study was to evaluate the appropriate timing of capsular tension ring implantation in cases of zonular weakness due to pseudoexfoliation syndrome. This prospective, comparative study was performed at the Ophthalmology Department of Inonu University, Malatya, Turkey. There were 43 patients included in the study. Group 1 (16 patients) had early capsular tension ring implantation, and group 2 (27 patients) had late capsular tension ring implantation. Patients with pseudoexfoliation syndrome who underwent phacoemulsification surgery, posterior chamber intraocular lens implantation, and capsular tension ring implantation were included in the study. Intraoperative complications and difficulties with either capsular tension ring implantation or cortex removal were evaluated in each eye. There was no significant difference between the groups in the difficulty of capsular tension ring implantation (p=0.124). The difficulty of cortex removal differed significantly between the groups (p=0.003). Intraoperative complications were observed in 3 patients in group 1 and 11 patients in group 2; the difference between the groups was not significant (p=0.18). Posterior capsule fluctuations were observed in 8 patients (29.5%) in group 2, which resulted in posterior capsule rupture in 2 patients. Cortex removal is more difficult with early capsular tension ring implantation, and posterior capsule fluctuations may cause problems with late capsular tension ring implantation. The surgeon must consider the risk-to-benefit ratio of early versus late insertion for the optimal timing of capsular tension ring implantation.

Extent of multifocality with corneal manipulation in manual small incision cataract surgery with monofocal posterior chamber intraocular lens implantation.

Purpose:To compare the visual outcome in terms of multifocality in Manual Small Incision Cataract Surgery (MSICS) with and without intraoperative manipulation of corneal curvature.Methods:This was a prospective study on 80 subjects (80 eyes) who underwent MSICS with monofocal posterior chamber intraocular lens (PCIOL) implantation between January 2018 and October 2019. Intraoperative manipulation of corneal curvature using viscoelastics was performed during MSICS in 40 subjects (cases) while this intraoperative manipulation was not performed in the remaining 40 subjects (controls). Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were compared at day 1, 7, 30 and 180postoperatively.Results:At 1 month and 6 months of follow up, UDVA was comparable in the 2 groups. UNVA was better in cases than controls at 1 month and6 months (P < 0.001). At 6 months of follow up,76% of cases with UDVA of 6/9 or better had UNVA of N8 while only 15% of controls with UDVA of 6/9 or better had UNVA of N8 (P <0.001). Mean near add requirement to achieve a best corrected near vision (BCNV)of N6 at 6 months was significantly lesser (P =0.002) in cases (+2.05 D) compared to controls (+2.43D).Conclusion:MSICS with intra operative manipulation of corneal curvature resulted in better unaided near visual acuity compared to that without intra operative manipulation of corneal curvature, without compromising unaided distant visual acuity.

Capsular Bag Distension Syndrome Following Phacoemulsification with Implantation of Intraocular Lens

Capsular bag distension syndrome is a rare complication following phacoemulsification with posterior chamber intraocular lens implantation. We describe the case of a middle-age male, who developed early onset capsular bag distension syndrome of the right eye after phacoemulsification with implantation of plate haptic posterior chamber intraocular lens (Zeiss CT ASPHINA 509MP). There was persistent poor vision during follow up at 1 week and 5 weeks post-surgery with a myopic shift of 2.5 diopters sphere (DS). The intraocular pressure was only elevated at 2 hours post-operative and was normal during the subsequent followup. Distension of capsular bag was confirmed with the IOP Master 700 which showed abnormal separation of posterior capsule from the intraocular lens. He was diagnosed with capsular bag distension syndrome secondary to retention of viscoelastic. Right eye removal of retained viscoelastic was performed and the capsular bag distension syndrome resolved successfully with best corrected visual acuity at 6/6. Hence, complete clearance of viscoelastic during phacoemulsification with plate haptic intraocular lens is important in order to prevent capsular bag distension syndrome.

Comparative analysis of secondary implantation of Iris claw intraocular lens (ICIOL) &amp; Scleral fixated intraocular lens (SFIOL) in terms of visual outcome and complications

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.

Efficacy and safety of glue assisted suture less trans-scleral fixation of posterior chamber intraocular lens (SF- PCIOL)

Context: Scleral-fixated posterior chamber lens implantation (SF-PCIOL) in eyes without sufficient capsular support remains a widely applied surgical procedure. Suture - less scleral IOL fixation, Is a new technique in which PC IOL is placed in eyes with deficient posterior capsule and the haptics are incarcerated in the scleral pocket which is sealed with quick-acting fibrin glue. Aims and Objectives: To evaluate the efficacy and feasibility of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation method in post cataract surgery. Material and Methods: The study includes 10 Patients presented with inadequate capsular support who underwent Glue assisted SF-PCIOL over a time period of 12 months at a tertiary care eye hospital. Statistical analysis was done on Microsoft excel. Results:In present study of ten eyes the final postoperative BCVA at 3rd month was improved or remained same in nine (90 %) patients and only one patient had reduced BCVA. Conclusion: Lots of complications are encountered with the use of sutures in the operative procedures; bio-adhesives fibrin glue have emerged as a viable alternative for glue assisted suture less transscleral fixation of posterior chamber intraocular lens (SF- PCIOL), over the last three decades. Keywords:Scleral-Fixated Posterior Chamber IOL (SF-PCIOL), haptics, Fibrin glue, Best Corrected Visual Acuity (BCVA)

Role of Optical Coherence Tomography (OCT) in Early Detection of Subclinical Cystoid Macular Edema after Nd-YAG Laser Capsulotomy

Purpose: To determine role of optical coherence tomography (OCT) in early detection of subclinical cystoid macular edema (CME) after Nd-YAG laser capsulotomy in patients with posterior capsular opacification (PCO).&#x0D; Study Design: Descriptive case-series.&#x0D; Place and Duration of Study: Department of Ophthalmology Unit 1, Dow University of Health Sciences and Civil Hospital Karachi from 1-July-2015 to 31-Dec-2015.&#x0D; Methods: A total of 72 eyes with unilateral or bilateral visually significant PCO following uncomplicated cataract surgery with posterior chamber intraocular lens implantation were included in the study. Patients with corneal opacities, glaucoma, retinopathy, maculopathy, optic neuropathy, complicated cataract surgery, previous ocular surgery other than cataract surgery and High refractive errors were excluded from the study. Best-corrected visual acuity (BCVA), Slit lamp examination, posterior segment examination and macular thickness was measured using spectral domain (TOPCON 3D OCT) optical coherence tomography before laser and at 1 week and at 1 month after laser.&#x0D; Results: Mean age was 55.76 ± 5.28 with Confidence interval of 55.02 – 56.49 years. Eighty-one were males and 122 were females. Subclinical cystoid macular edema (CME) was found in 10 (14%) patients. Out of the patients who had CME, 3 were in age group of 40-55 years and seven were in age group of 56-70 years. P value was found to be significant i.e. (P = 0.039).&#x0D; Conclusion: Optical coherence tomography OCT is a non invasive and useful tool for early detection and management of subclinical cystoid macular edema after Nd-YAG laser capsulotomy in patients having posterior capsular opacification (PCO).&#x0D; Key Words: Cystoid Macular Edema, Nd-YAG laser, Posterior Capsular Opacification. Optical Coherence Tomography (OCT).

Factors influence bullous keratopathy post cataract surgery at National Eye Center of Cicendo Eye Hospital (PMN RSMC), West Java, Indonesia

Background: Bullous keratopathy is one of the leading causes of vision loss following cataract surgery. Several factors have been elucidated regarding the influence of bulosa keratopathy post cataract surgery. This study aims to evaluate pre-, intra-, and postoperative predisposition factors for bullous keratopathy following cataract surgery.Methods: A retrospective descriptive study was done using data extracted from medical records. Patients diagnosed with bullous keratopathy after cataract surgery who underwent further examination procedures for at least 3 months were included. Patients with a history of glaucoma, Fuch's dystrophy, or other intraocular procedures were excluded. Data were analyzed by SPSS version 20 for Windows.Results: Fourteen cases were included in this study. Most cases were female (78.57%) aged ≥60 years old (64.29%). There were postoperative changes in visual acuity and corneal status in most patients without any change in intraocular pressure. The majority of patients underwent manual small incision cataract surgery with posterior chamber intraocular lens implantation. Intraoperative complications were vitreous prolapse and Descemet membrane stripping, while postoperative complications were uveitis and lens adhesion.Conclusion: Bullous keratopathy after cataract surgery was more common in elderly females. There were notable changes in visual acuity and corneal status postoperatively. Further large-scale analytic study is warranted to confirm the predictive factors and causality.

Comparison of the Surgical Outcomes of Single-Site, Mitomycin C-Augmented Trabeculectomy Combined with Phacoemulsification versus Manual Small-Incision Cataract Surgery.

Purpose:To compare the safety, efficacy, and outcome measures of a single-site, mitomycin C (MMC)-augmented trabeculectomy combined with phacoemulsification (PT) versus manual small-incision cataract surgery (MSICS) with the posterior chamber intraocular lens (PCIOL) implantation as a primary surgery in the patients with primary glaucoma coexistent with cataract.Methods:From April 2015 to August 2017, medical records of all the patients who underwent combined cataract surgery with PCIOL and MMC augmented trabeculectomy were reviewed. One hundred and thirty-seven eyes met the inclusion criteria. Ninety-seven eyes which underwent PT with MMC were compared with forty eyes that underwent MSICS combined with trabeculectomy (MSICST) MMC. Outcome measures were best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of anti-glaucoma medications (AGM). Complications, if any, were noted in both the groups.Results:The mean follow-up period after surgery was 18.6 ± 7.7 months (range, 12–40 months). At the last follow-up visit, there was no statistically significant difference between the groups, in terms of mean logMAR BCVA (PT: 0.22 ± 0.31, MSICST: 0.21 ± 0.33, P = 0.8), mean IOP reduction (PT: 13.9 ± 2.98 mmHg, MSICST: 14.1 ± 4.12 mmHg, P = 0.8), and mean number of AGM (PT: 0.03 ± 0.8, MSICST: 0.025 ± 0.7, P = 0.8). Complications were few and transient. One eye in the PT group was considered as a failure and had to undergo needling, repeat trabeculectomy, and later, cyclodestructive procedure. None of the eyes in the MSICST group required an additional procedure for IOP reduction.Conclusion:There was no difference in the mean IOP reduction, BCVA, and mean number of AGM between the two procedures, and both appeared to be safe and effective techniques as a primary surgery in the patients with coexistent cataract and glaucoma.

Cataract surgery in surgical camps: outcomes in a rural area of Cameroon.

To assess the complications and visual outcomes of cataract surgery during an outreach eye camp in Cameroon in which two foreign ophthalmologists operate alongside a local one. This is a retrospective and comparative cohort study. The patients were consecutively assigned to three groups depending on the ophthalmologist who performed the cataract surgeries. All eyes underwent manual sutureless incision cataract surgery with posterior chamber intraocular lens (PCIOL) implantation under peribulbar anesthesia. Postoperative visits were scheduled for the first day, first week and second month after the procedures. Intra- and postoperative complications, best-corrected visual acuity and also refractive errors were assessed. A total of 263 eyes underwent cataract extraction with PCIOL implantation. The percentage of eyes in which two or more lines of corrected distance visual acuity decreased were 2.4%, 2.7% and 0% for groups A, B and C, respectively. The percentage of eyes with good visual outcome (uncorrected distance visual acuity UDVA > 20/60) were, respectively, 82.09%, 81.43% and 80.82% for the three groups. Similar results were found between the three groups regarding complications. Ocular hypertension, transient corneal edema and hyphema were the incidences registered at the first postoperative control performed 24h after surgery. The most common complication observed 2months after surgery was posterior capsular opacity (2.6%). High-volume cataract surgery in low- and middle-income countries may have good visual outcomes and a low rate of complications when the procedures are performed by either foreign or local ophthalmologists. A program of high-volume cataract surgery carried out in a rural environment with few resources can give good visual outcomes in the hands of both foreign and local experienced ophthalmologists.

Cataract following electric shock - Case report

Ocular trauma is the under-recognized cause of unilateral blindness particularly in developing nations.The growing demand on generated electricity has also led to increase in electricity related occupational trauma. We report a case of bilateral cataract in a 22 years professional electrician. He survived a high voltage electric shock and sustained burn injury on the right side of his head. Ocular examination revealed typical anterior as well as posterior subcapsular cataract in right eye and visually insignificant early anterior subcapsular vacuoles in the left eye. There was a significant difference in lenticular opacification density in between these two eyes. Uneventful phacoemulsification and foldable posterior chamber intraocular lens implantation was performed in the right eye and the sufferer was rehabilitated with normal best corrected visual acuity. The possibility of ocular complications and importance of ocular screening is emphasized in the survivors of electrical injury. The lenticular opacities can be successfully managed with surgery, however the final visual acuity depends on damage to other vital ocular structures. The clinical features, pathogenic mechanism of these opacities and review of the literatures are discussed.

Accuracy evaluation of objective refraction using the wavefront aberrometer in pseudophakic eyes.

To evaluate the accuracy of wavefront-derived objective refraction in pseudophakic eyes. Retrospective case series. A total of 356 eyes (356 patients) that underwent phacoemulsification and posterior chamber intraocular lens implantation were included. Noncycloplegic subjective manifest refraction (MR) and objective refraction results from the wavefront aberrometer were obtained and compared. Subgroup analysis of objective refraction at 2.6-mm zone was performed based on axial length (AL) and average keratometry. The biases (at the 2.6-mm, 3-mm, and 4-mm zones) were - 0.29 ± 0.37D, - 0.53 ± 0.41D, and - 0.51 ± 0.60D for sphere; - 0.27 ± 0.36D, - 0.52 ± 0.38D, and - 0.53 ± 0.51D for spherical equivalent (SE); 0.03 ± 0.20D, 0.03 ± 0.22D, and 0.04 ± 0.27D for J0; and 0.01 ± 0.16D, 0.03 ± 0.22D, and 0.01 ± 0.22D for J45, respectively. Objective refraction for sphere, SE, and J0 (at 2.6mm, 3mm, and 4mm) was significantly different from MR (P < 0.05), while J45 values were equal. The objective refraction at 2.6mm was the most accurate in short eyes (≤ 22.5mm) with a minimum bias for SE (- 0.15 ± 0.28D) and highest percentage of SE within ± 0.25 to ± 0.75D of MR. However, there was no difference between the keratometry subgroups. The wavefront aberrometer achieved the best accuracy at 2.6mm in pseudophakic eyes with short AL. It still needs modification to be used as a substitute for MR in such patients.

Comparative study of outcome of cataract surgery in diabetic and non-diabetic patients

To compare the visual outcome following cataract surgery in diabetics and non-diabetics.A comparative study of 58 eyes in the diabetic and 58 eyes in the non-diabetic group that underwent small incision cataract surgery with posterior chamber intraocular lens implantation. Age, sex, surgical technique, follow up, pre- and postoperative best corrected visual acuity (BCVA) and post-op complications were evaluated.Out of 116 patients, 58 were diabetic and 58 were non diabetics. Small incision cataract surgery with posterior chamber intraocular lens implantation was done in all patients. Follow up duration was 4 weeks. The mean preoperative best corrected visual acuity in the diabetic group was 1.60±0.81 and in non-diabetic group was 1.62±0.87. The mean post-operative best corrected visual acuity in log MAR units in the diabetic group was 0.39±0.32 and in the non-diabetic group was 0.32±0.27. The difference in pre and post op visual outcome was statistically significant (p=0.001). Post-operative visual acuity of 6/12 or better was achieved in 62.1% eyes in diabetic patients and 69% among non-diabetic patients. Post-operative complications included: posterior capsular opacification, corneal edema, anterior chamber reaction, striate keratopathy, pigment dispersion, cystoid macular edema and vitreous loss. The incidence was higher in the diabetic group.Small incision cataract surgery in diabetics without diabetic retinopathy yields similar visual outcomes as non-diabetics. There is a higher incidence of post-operative complications among diabetics, which can be managed conservatively. So extra care should be taken intra-operatively and during post-op follow up.

Preoperative 532 double frequency YAG anterior capsulotomy in hypermature cataracts

Phacoemulsification in hyper-mature cataracts is a challenge due to high intra-lenticular pressure, resulting in the capsulorhexis extending to the periphery. A continuous curvilinear capsulorhexis (CCC) is crucial to uncomplicated, safe and successful phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Achieving a CCC in eyes with white hyper-mature cataract is challenging due to high intra-lenticular pressure and risk of extension of capsulorhexis (Argentinian flag sign). Various techniques such as double capsulorhexis, phacocapsulorhexis, massaging, anterior capsular puncture with a needle or YAG laser and femtosecond laser capsulorhexis have been described to prevent this complication.

Topical bromfenac versus prednisolone: post cataract surgery safety and efficacy

Background: Cataract surgery can result in postoperative inflammation which increases the risk of complications like increased intraocular pressure (IOP), uveitis and cystoid macular oedema. We aim to evaluate the effectiveness of topical non-steroidal anti-inflammatory drug bromfenac and topical prednisolone in controlling intraocular inflammation after uncomplicated cataract surgery and compare intraocular pressure (IOP) differences, degrees of anterior chamber inflammation and macular oedema between two different treatments.Methods: 100 patients undergoing manual small incision cataract surgery with PMMA posterior chamber intraocular lens implantation were randomly assigned to receive either Bromfenac (0.09%) eye drops or prednisolone acetate (1%) eye suspension as their postoperative anti-inflammatory medication with 50 cases in each group. The patients were examined at the day 1, day 7, day 15, and day 30 after surgery. Postoperative inflammation was evaluated subjectively by intraocular pressure, slit-lamp assessment of signs of inflammation in the form of aqueous cells and flare and optical coherence tomography to rule out post-operative macular oedema.Results: Both the drugs are equally effective in controlling post-operative inflammation and post-operative cystoid macular oedema.Conclusions: Bromfenac (0.09%) is an effective drug in controlling ocular inflammation after un-complicated cataract surgery having effect similar to topical Prednisolone acetate (1%) with minimal side effects and less frequent dosing.

Effects Occurring in Central Retina Detected by Optical Coherence Tomography before and after YAG Laser in Pseudophakic Patinets

Abstract Introduction Cataract is a consequence of the ageing of the lens and is the major priority in the global initiative to eliminate avoidable blindness by the year 2020. At present, the only means of treating cataract is by surgery, which initially restores high-quality vision and this is currently the most performed operation in developed countries. Aim of the Work to evaluate the influence of Nd:YAG laser capsulotomy on visual outcomes and macular thickness in patients with opacified posterior capsule. Patients and Methods This is a prospective comparative study done at the Nour Elein Hospital in Tanta. Thirty one pseudophakic eyes of patients (seven male, twenty four female), were included in the study with PCO following uncomplicated phacoemulsification with posterior chamber intraocular lens implantation. The age ranged from forty six years to sixty seven years old with a mean of (63.32±5.67) years. An informed consent was taken from each patient. All patients were treated by Nd: YAG laser capsulotomy between January 2017 till December 2017. The average time after cataract surgery was 18 months. Results Both groups had increased macular thickness at 1 week after Nd:YAG laser capsulotomy. The degree of macular thickening was similar in group 1 and group 2. Mean macular thickness was decreased to preoperative levels at 4 weeks after Nd:YAG laser capsulotomy in both groups volume. Conclusion Nd: YAG laser capsulotomy is the standard treatment for PCO and gives rise to rapid improvements in visual acuity, relieving the symptoms of blur, photophobia, and glare, and the size of capsulotomy opening does not affect the improvement in visual acuity, but it is better to avoid small sized capsulotomies to avoid post capsulotomy difractions.

Cautious about the indication expansion of intraocular refractive surgery

Myopic refractive surgery has developed vigorously in China during the past 30 years, and the number of surgeries is increasing year by year. Since intraocular refractive surgery has a wide range of correction, no need to cut the corneal tissue and a stable visual quality, it has been gradually promoted in clinical practice. Specialists from the Optometry Group of Chinese Ophthalmological Society have given guidance on the ocular indications, age, diopters and other aspects for the posterior chamber intraocular lens implantation. In this article, the authors expound that intraocular refractive surgery should not be recommended for low and moderate myopic eyes, neither for some special occupations at present. The complications of intraocular refractive surgery and the countermeasures are also discussed. The authors also put forward the principles of customized myopic refractive surgery and emphasize that the clinicians should be more cautious about the diopter range selection, occupational need evaluation, individual differences and complications of intraocular refractive surgery. (Chin J Ophthalmol, 2020, 56: 89-92).

Comparative study of secondary implantation of iris-claw lens and scleral-fixated intraocular lens in terms of visual outcome and complications

Introduction: The modern cataract surgery is involved in implanting the posterior chamber intraocular lens (PCIOL) in the intact posterior capsule. However, the implantation of PCIOL is not possible in case of weak or no capsular support. In such situations, iris-claw lens (ICIOL) and scleral-fixated intraocular lens (SFIOL) remain as treatment options. Objective: The objective was to analyze the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications. Materials and Methods: It was a prospective study with 30 aphakia patients fulfilling inclusion criteria. These patients were divided into two groups with 15 in each group. Group I patients underwent ICIOL and other 15 patients in Group II underwent SFIOL implantation. Patients with preexisting ocular pathologies were excluded. The preoperative and postoperative evaluation was done for the follow-up period of 6 months. Results were analyzed with Chi-square test and t-test using SPSS software. Results: In ICIOL group, 86.67% of patients and 80.6% of SFIOL patients had final best-corrected visual acuity (BCVA) 6/18–6/6. The mean logMAR BCVA in both groups was comparable. The surgical time in ICIOL was significantly less than SFIOL group (P = 0.00). Suture-related complications were significantly more in the SFIOL group. Complications found in the ICIOL group were harmless. Conclusion: The visual outcome was found to be comparable in both groups. ICIOL requiring less surgical time with fewer complications was found to be a good alternative to SFIOL in correction of aphakia.

Comparative clinical trial of intracameral ropivacaine vs. lignocaine in subjects undergoing phacoemulsification under augmented topical anesthesia.

Purpose:To compare intracameral Ropivacaine to Lignocaine during phacoemulsification under augmented topical anesthesia, in terms of efficacy and safety.Methods:This prospective, randomized, double-masked clinical trial included subjects planned for phacoemulsification with posterior chamber intraocular lens implantation for visually significant uncomplicated senile cataract, under augmented topical anesthesia. Cases were randomized into two groups, Group A (Ropivacaine 0.1%) or Group B (Lignocaine 1.0%). The pain experienced by the patients during the surgery, mydriasis, post-op inflammation and endothelial cell change at six weeks after the procedure was evaluated. Surgeon's feedback was recorded to evaluate the cooperation of the patient during surgery.Results:A total of 210 subjects were screened and 184 were randomized to have 92 subjects in each group. There was no statistically significant difference seen on comparing Group A and B with respect to Age (P = 0.05), painful surgical steps (P = 0.85), visual analog scale scores (P = 0.65), surgeon's score (P = 0.11), postoperative inflammation (P = 0.90) and average ultrasound time during phacoemulsification (P = 0.10). Subjects in Group A fared better when compared to Group B with respect to endothelial cell loss (P = 0.0008), and augmentation in mydriasis (P < 0.001).Conclusion:Intracameral Ropivacaine and Lignocaine, both are equally effective in providing analgesia during phacoemulsification. However, intracameral Ropivacaine is superior to Lignocaine with regards to corneal endothelial cell safety, and augmenting mydriasis.