Quadrant Removal Research Articles

Patient demographics and surgical outcomes of dropped nucleus in cataract surgery

Aims/Purpose: To analyse the baseline demographic/clinical characteristics and visual outcomes of patients who experienced nucleus drop during cataract surgery with subsequent need for pars plana vitrectomy (PPV).Methods: Retrospective case series of patients who underwent phacoemulsification for non‐traumatic cataract and experienced nucleus drop during surgery, with subsequent need for PPV to extract the dropped fragments. Demographic data, ocular comorbidities (such as ocular hypertension – OHT/glaucoma, pseudoexfoliation – PEX, presence of advanced white or brunescent cataract, shallow anterior chamber or previous intravitreal injections – IVI), timing of nucleus drop, intraoperative complications and post PPV visual outcomes and complications, for the study period (2018 to 2023), were collected.Results: Over the study period 33 eyes of 33 patients experienced nucleus drop. 17 (52%) were male with a mean age of 74.4±9.4 (45‐92) years. Pre‐operative visual acuity ranged from light perception to 0.22 logmar. Three patients (9.1%) had previously undergone IVI and 7 (21.2%) had glaucoma or OHT; 9 (27.3%) had PEX ‐ all but one had poor pupillary dilation ( < 5 mm). A significant proportion of patients (13, 40.4%) presented with advanced brunescent/white cataracts. Most nucleus drops occurred following a posterior capsular rupture during quadrant removal (18 cases – 54.5%) or hydro‐dissection (8 cases – 24.3%); remaining cases occurred following a radialized capsulorhexis with posterior extension or due capsular bag‐nucleus luxation to the vitreous. PPV was uneventful in most cases – one patient developed an epiretinal membrane 2 years after PPV. Visual acuity improved by an average of ‐0.96 logmar in the post‐operative period.Conclusions: PPV is the preferred management for nucleus drop after complicated cataract surgery. Current devices and surgeon expertise allow for a low risk of complications and good visual/anatomical outcomes.

Patient demographics and surgical outcomes of dropped nucleus in cataract surgery

Aims/Purpose: To analyse the baseline demographic/clinical characteristics and visual outcomes of patients who experienced nucleus drop during cataract surgery with subsequent need for pars plana vitrectomy (PPV).Methods: Retrospective case series of patients who underwent phacoemulsification for non‐traumatic cataract and experienced nucleus drop during surgery, with subsequent need for PPV to extract the dropped fragments. Demographic data, ocular comorbidities (such as ocular hypertension – OHT/glaucoma, pseudoexfoliation – PEX, presence of advanced white or brunescent cataract, shallow anterior chamber or previous intravitreal injections – IVI), timing of nucleus drop, intraoperative complications and post PPV visual outcomes and complications, for the study period (2018 to 2023), were collected.Results: Over the study period 33 eyes of 33 patients experienced nucleus drop. 17 (52%) were male with a mean age of 74.4 ± 9.4 (45‐92) years. Pre‐operative visual acuity ranged from light perception to 0.22 logmar. Three patients (9.1%) had previously undergone IVI and 7 (21.2%) had glaucoma or OHT; 9 (27.3%) had PEX – all but one had poor pupillary dilation ( < 5 mm). A significant proportion of patients (13, 40.4%) presented with advanced brunescent/white cataracts. Most nucleus drops occurred following a posterior capsular rupture during quadrant removal (18 cases – 54.5%) or hydro‐dissection (8 cases – 24.3%); remaining cases occurred following a radialized capsulorhexis with posterior extension or due capsular bag‐nucleus luxation to the vitreous. PPV was uneventful in most cases – one patient developed an epiretinal membrane 2 years after PPV. Visual acuity improved by an average of ‐0.96 logmar in the post‐operative period.Conclusions: PPV is the preferred management for nucleus drop after complicated cataract surgery. Current devices and surgeon expertise allow for a low risk of complications and good visual/anatomical outcomes.

Intraoperative phacoemulsification tip fracture

Introduction: Intraoperative instrument fractures pose a serious risk during cataract surgery through the retention of metallic foreign bodies and subsequent injury to intraocular structures. Patient and Clinical Findings: An 83-year-old woman underwent phacoemulsification and insertion of an intraocular lens, during which an intraoperative phacoemulsification tip fracture was encountered during quadrant removal. Diagnosis, Intervention, and Outcome: A thorough examination of the operative field revealed the broken tip fragment in the drape bag, with no intraocular fragments. The surgery was completed with a replacement phacoemulsification probe without issues, and the patient made an uneventful recovery. Conclusions: Early diagnosis and management after instrument breakage are necessary to prevent the retention of metallic foreign bodies.

Assessing the phacoemulsification learning curve using duration of each step.

To assess the phacoemulsification learning curve for ophthalmology residents using duration for each step. Single tertiary, training site hospital. Cross-sectional study. Emory ophthalmology postgraduate year (PGY) 3 and PGY-4 residents operating at Grady Memorial Hospital between April 2017 and February 2018 were eligible to participate. Duration in seconds for each step of surgery was calculated for incisions, continuous curvilinear capsulorhexis (CCC), hydrodissection, nucleus disassembly, quadrant removal, cortical cleanup, intraocular lens insertion, and closure, and this outcome was analyzed as a function of different experience levels. A total of 528 surgeries were included of 549 total surgeries recorded. 6 categories of experience levels were established as A to F, increasing by increments of 50. There was an overall downward trend across various steps across the 8 case categories, and several adjacent categories demonstrate statistically significant differences. The 3 most time-intensive steps early in training were nucleus disassembly (336.5 ± 16.5 seconds), quadrant removal (275.1 ± 18.0 seconds), and cortical cleanup (244.2 ± 24.6 seconds). There was a sustained drop in mean duration for all steps through at least category D, with most steps showing a drop through category F. There is a benefit to a higher caseload, well above the Accreditation Council for Graduate Medical Education-mandated 86 cases. Improvements in efficiency were observed after 250 cases, with nuclear disassembly and CCC demonstrating a significant decrease in operative time.

Qualitative Alterations on Corneal Endothelial Cell Morphometry and Hexagonality After Cataract Surgery.

AimTo deeply analyze quantitative and qualitative changes of corneal endothelium after longitudinal phacoemulsification.MethodsIn this prospective interventional case series study, 50 eyes with age-related cataract have been evaluated preoperatively, intraoperatively and postoperatively. The measured parameters were surgically induced endothelial cell loss (ECL), average endothelial cell area (AVG) and hexagonality (HEX).ResultsThe relationship among the measured parameters and the energy dissipated during the two phases of phacoemulsification, sculpting and quadrant removal, has been analyzed with regard to the 5-score harm scale, a new method suggested to categorize cataracts. Two phases of phacoemulsification are linearly related (r = 1.5, P < 0.001, r2 = 79%). Plus, a quadratic model described the correlation between the percentages of ECL and AVG (P < 0.0001), while there was no specific model for the correlation between ECL and HEX.ConclusionThe 5-score harm scale allows to predict the mean changes in percentages of ECL, AVG and HEX of endothelial cells after longitudinal phacoemulsification. Also, this study confirms that the main damage on corneal endothelium is due to the energy delivered in the second phase of phacoemulsification.

Surgical Instrument’s Tip Fracture During Cataract Surgery

Purpose: To describe a case of a surgical instrument’s tip fracture during cataract surgery. Method: Case report. Results: We report a case of a 60-year-old gentleman who underwent phacoemulsification of the left eye. It was noted that the tip of the second instrument (lens chopper) was fractured during the last quadrant removal of the opacified lens, which disappeared posteriorly. The surgery was successfully completed, and the intraocular lens appeared stable without posterior capsular rent. An urgent computed tomography scan (CT scan) of orbit was arranged. It showed a round radio opaque foreign body near the lens at the lateral aspect of the left intraocular lens (IOL), measuring approximately 0.3cm. The patient underwent foreign body removal using an intraocular magnet by a vitreoretinal surgeon two days after the phacoemulsification surgery. The patient had an uneventful recovery with a vision of 6/60 pinhole 6/6 at six weeks post operatively. Conclusion: Surgical instrument’s tip fracture is a known complication during phacoemulsification; however, it was under-reported among surgeons. Careful inspection of all instruments before introducing them to the eye is mandatory, and early identification of this condition during surgery may avoid major complications.

Ultrasound-Energy Consumption During Phases of Phacoemulsification of Nuclear Cataracts Using Femtosecond Laser: A Comparative Study.

PurposeTo compare ultrasound (US) energy utilized in different phases of nuclear cataract removal in femtosecond laser–assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS) in relation to different nuclear densities.MethodsA prospective nonrandomized comparative study was conducted at Ain Shams University and Al Watany Eye Hospital, Cairo, Egypt on 250 eyes with senile nuclear cataracts (NCs) of different nuclear densities (1–6). Eyes were divided into two groups — FLACS and CPS — and each group was subdivided according to cataract density into subgroups A (NC 1–2), B (NC 3–4) and C (NC 5–6). sextant-softened fragmentation patterns were assessed in the FLACS group and the quick-chop technique used in the CPS group. US energy required for nucleus cracking (EFX split) and for quadrant removal (EFX quadrant) was recorded.ResultsTotal eyes included in the FLACS and CPS groups were 117 and 133, respectively. No significant differences between the groups for EFX quadrant and EFX split groups were observed (P=0.18 and P=0.49, respectively). For subgroup A, no significant difference was found between FLACS and CPS on EFX split (P=0.08) and EFX quadrant (P=0.49). For subgroup B, significantly lower values of EFX split (P=0.0001) and EFX quadrant (P<0.0001) were obtained with FLACS than CPS. For subgroup C, no significant difference was found for EFX split (P=0.86); however, EFX quadrant was significantly lower in the FLACS group (P=0.05).ConclusionFLACS lowers US energy utilized during quadrant removal at different nuclear densities, with highest significance in medium-density nuclear cataracts. Nucleus cracking by femtosecond laser is less effective in very hard cataracts. However, femtosecond-laser softening of hard nuclei is capable of of US-energy reduction during quadrant removal.

Propensity and quantification of aerosol and droplet creation during phacoemulsification with high-speed shadowgraphy amid COVID-19 pandemic.

To study propensity of aerosol and droplet generation during phacoemulsification using high-speed shadowgraphy and quantify its spread amid COVID-19 pandemic. Aerosol and droplet quantification laboratory. Laboratory study. In an experimental set-up, phacoemulsification was performed on enucleated goat eyes and cadaveric human corneoscleral rims mounted on an artificial anterior chamber. Standard settings for sculpt and quadrant removal mode were used on Visalis 100 (Carl Zeiss Meditec AG). Microincision and standard phacoemulsification were performed using titanium straight tips (2.2 mm and 2.8 mm in diameter). The main wound incisions were titrated equal to and larger than the sleeve size. High-speed shadowgraphy technique was used to detect the possible generation of any droplets and aerosols. The visualization and quantification of size of the aerosols and droplets along with calculation of their spread were the main outcome measures. In longitudinal phacoemulsification using a peristaltic pump device with a straight tip, no aerosol generation was seen in a closed chamber. In larger wounds, there was a slow leak at the main wound. The atomization of balanced salt solution was observed only when the phacoemulsification tip was completely exposed next to the ocular surface. Under this condition, the nominal size of the droplet was approximately 50 µm, and the maximum calculated spread was 1.3 m. There was no visible aerosol generation during microincision or standard phacoemulsification. Phacoemulsification is safe to perform in the COVID-19 era by taking adequate precautions against other modes of transmission.

Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees' perspective.

To examine the incidence, characteristics and outcomes of posterior capsular rupture (PCR) cases amongst the ophthalmology trainees and to evaluate the trainees' confidence in managing PCR. A two-staged cross-sectional study was carried out between September 2017 and April 2018 in the North East of England, UK. All ophthalmology trainees were surveyed on their confidence level in managing PCR and the characteristics and outcomes of their PCR cases. Fifteen (71.4%) out of 21 trainees completed the study. The mean number of phacoemulsification was 268.9 ± 250.9 cases (range, 0-705) per trainee. There were 82 (1.9%) cases of PCR reported among 4303 phacoemulsification. PCR occurred most commonly during quadrant removal (44.0%) and cortex removal (21.3%). The best-corrected visual acuity (in logMAR) improved significantly from 0.47 ± 0.32 preoperatively to 0.20 ± 0.19 postoperatively (p < 0.001). The supervising consultant took over 80.5% of the PCR cases. The PCR rate decreased significantly from 3.1% at 0-100 cases to 0.6% at 301-400 cases (p = 0.004) and to 0.4% at >500 cases (p = 0.005). Confidence in managing PCR (without supervision) improved from 0% (9/9) at junior level to 50% (3/6) at senior level, and the average number of anterior vitrectomies performed was 0.6 ± 0.9 (range: 0.0-2.0). We observed a low PCR rate among the trainees in our region, with the majority of cases achieving good visual outcome. A significant reduction in PCR rate was observed at the threshold of >500 cases. There is however a lack of confidence among trainees in managing PCR, highlighting the need for devising new training strategies in this area.

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.

Distance Surgical Mentorship for Ophthalmologists in Northern Peru.

This article was migrated. The article was marked as recommended. Purpose: To evaluate the quality of live distance surgical mentorship as an alternative way to provide continuing professional development (CPD) to practicing ophthalmologists. An activity which could be particularly beneficial to surgeons in remote locations where CPD is difficult to access. Methods: Orbis paired ophthalmologists from the Regional Institute of Ophthalmology (IRO) in Trujillo, Peru and a senior ophthalmologist from Vanderbilt Eye Institute in Tennessee, USA (LW). One week in advance, the Peruvian surgeon sent the mentor patient information confidentially via Cybersight.org, Orbis' telemedicine platform. The mentor reviewed the preoperative information to determine if the case was appropriate for remote guidance and formulated questions to help guide the educational experience. The mentor and mentee also consulted on specific learning objectives. The mentor observed live phacoemulsification surgery over the Internet using audio-visual equipment and Zoom desktop video conferencing software, allowing her to see through the operating microscope in real-time and have constant voice contact with the local surgeon. Post-mentorship a survey was administered to gauge acceptability of the CPD method, as well as their self-assessment on its impact on their skill development. Results: Latency experienced was well within the suggested margin of acceptability and the video quality was broadcast-grade, allowing the mentor to clearly see the anatomy and instrument manipulation. Seven surgeons over four sessions performed twelve phacoemulsification surgeries in Peru, 91.67% of those 12 patients achieved postoperative best corrected visual acuity ≥6/18. Four surgeons completed the survey and 100% agreed or strongly agreed that their objectives had been met and that the CPD had increased their confidence and their surgical skills. The step in the procedure most commonly reported for improvement was nuclear cracking (75% of respondents), followed by hydrodissection, quadrant removal and wound closure (50% each). Conclusions: Distance surgical mentorship in phacoemulsification is an acceptable form of CPD for consultant ophthalmologists. We describe a program with positive user feedback and experiences of improved confidence and microsurgical skill among participants.

Resident Stress Level during Steps of Cataract Surgery

Purpose To investigate intraoperative stress levels using heart rate monitoring during each step of cataract surgery. Setting Single tertiary hospital. Design Observational study recording resident heart rate as a measure of acute stress level during cataract surgeries. Methods Emory ophthalmology postgraduate year (PGY) 3 and PGY-4 residents operating at Grady Memorial Hospital during the time period of the study were eligible to participate. Chest-strapped Bluetooth devices recorded heart rate during the surgeries. The mean, maximum, and minimum heart rates were then analyzed individually for the following steps of surgery: incisions, continuous curvilinear capsulorhexis, hydrodissection, nucleus disassembly, quadrant removal, cortical cleanup, intraocular lens insertion, and closure. Data collection started in April 2017 and ended in February 2018. Results Out of the 549 surgeries recorded, 427 yielded viable data. Across that dataset, quadrant removal had the highest adjusted mean heart rate value (90.3; 95% confidence interval [CI]: 82.9–97.7; p &lt; 0.0001), highest adjusted maximum heart rate value (97.3; 95% CI: 89.5–105.3; p &lt; 0.0001), and highest adjusted minimum heart rate value (82.1; 95% CI: 75.2–89; p &lt; 0.0001). Nuclear disassembly and incisions were second and third highest, respectively. Conclusions Quadrant removal, nucleus disassembly, and incisions are the three most stressful steps for resident surgeons. This knowledge should be applied to enhance the resident experience by emphasizing these steps during surgical preparation and training. Future studies using intraoperative heart rate monitoring may be warranted to better understand the resident and attending experience and ultimately improve surgical outcomes.

Robotic surgery ‐ a new way to perform cataract surgery

PurposeTo demonstrate the feasibility of robot‐assisted simulated cataract surgeryMethodsWe performed cataract surgeries on a Kitaro cataract wet lab training system using simultaneously the DaVinci Xi robotic surgical system and a phacoemulsification system. For each procedure, duration and successful completion of the surgery with or without ocular complications were assessed.ResultsProcedures were successfully performed on 27 lens nuclei. Feasibility of robot‐assisted simulated cataract surgery is confirmed. The DaVinci Xi system provided the intraocular dexterity and operative field visualization necessary to perform the main steps of the phacoemulsification procedure: corneal incisions, capsulorhexis, grooving, cracking, quadrant removal and infusion‐aspiration of the viscoelastic. The intervention of a second surgeon was required for the intraocular injections of viscoelastic, balanced salt solution and intraocular lenses. Mean operative time was 26 minutes. All lens nuclei were removed. Inadvertent enlargement of the main corneal incision caused by the phaco hand piece was observed in 2 cases.ConclusionsExperimental robot‐assisted cataract surgery is technically feasible using the new DaVinci Xi robotic Surgical System combined with a phacoemulsification machine.

Robot-assisted simulated cataract surgery

To evaluate the feasibility of robot-assisted simulated cataract surgery. Institut de Recherche Contre les Cancers de l'Appareil Digestif, European Institute of Telesurgery, and Strasbourg University Hospital, Strasbourg, France. Experimental study. Cataract surgeries were performed on a Kitaro cataract wet-lab training system simultaneously using the Da Vinci Xi robotic surgical system and the Whitestar Signature phacoemulsification system. For each procedure, the duration and successful completion of the surgery with or without ocular complications were assessed. Procedures were successfully performed on 25 lens nuclei. The feasibility of robot-assisted simulated cataract surgery was confirmed. The robotic surgical system provided the intraocular dexterity and operative field visualization necessary to perform the main steps of the phacoemulsification procedure; that is, corneal incisions, capsulorhexis, grooving, cracking, quadrant removal, and irrigation/aspiration of the ophthalmic viscosurgical device (OVD). The intervention of a second surgeon was required for the intraocular injections of OVD, balanced salt solution, and intraocular lenses. The mean operative time was 26.44minutes±5.15 (SD). All lens nuclei were removed. Inadvertent enlargement of the main corneal incision caused by the phaco handpiece was observed in 2cases. Experimental robot-assisted cataract surgery was technically feasible using the new robotic surgical system combined with a phacoemulsification machine.

Two-speed phacoemulsification for soft cataracts using optimized parameters and procedure step toolbar with the CENTURION Vision System and Balanced Tip.

PurposeTo present a cause of posterior capsule aspiration and a technique using optimized parameters to prevent it from happening when operating soft cataracts.Patients and methodsA prospective list of posterior capsule aspiration cases was kept over 4,062 consecutive cases operated with the Alcon CENTURION machine and Balanced Tip. Video analysis of one case of posterior capsule aspiration was accomplished. A surgical technique was developed using empirically derived machine parameters and customized setting-selection procedure step toolbar to reduce the pace of aspiration of soft nuclear quadrants in order to prevent capsule aspiration.ResultsTwo cases out of 3,238 experienced posterior capsule aspiration before use of the soft quadrant technique. Video analysis showed an attractive vortex effect with capsule aspiration occurring in 1/5 of a second. A soft quadrant removal setting was empirically derived which had a slower pace and seemed more controlled with no capsule aspiration occurring in the subsequent 824 cases. The setting featured simultaneous linear control from zero to preset maximums for: aspiration flow, 20 mL/min; and vacuum, 400 mmHg, with the addition of torsional tip amplitude up to 20% after the fluidic maximums were achieved. A new setting selection procedure step toolbar was created to increase intraoperative flexibility by providing instantaneous shifting between the soft and normal settings.ConclusionA technique incorporating a reduced pace for soft quadrant acquisition and aspiration can be accomplished through the use of a dedicated setting of integrated machine parameters. Toolbar placement of the procedure button next to the normal setting procedure button provides the opportunity to instantaneously alternate between the two settings. Simultaneous surgeon control over vacuum, aspiration flow, and torsional tip motion may make removal of soft nuclear quadrants more efficient and safer.

Results of endocapsular phacofracture debulking of hard cataracts.

Purpose/aim of the studyTo present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal.Materials and methodsA phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses.ResultsNo complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories.ConclusionThe endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.

Intraoperative fracture of phacoemulsification sleeve

BackgroundWe describe a case of intraoperative fracture of phacoemulsification sleeve during phacoemulsification surgery.Case presentationPhacoemulsification surgery was performed in the left eye of a 58-year-old lady with grade II nuclear sclerosis & grade I cortical cataract. Towards the end of quadrant removal, there was anterior chamber instability with impaired followability of nuclear fragments. The distal part of the fractured sleeve remained inside the anterior chamber upon removal of the phacoemulsification probe. The retained sleeve was retrieved with a pair of forceps through the corneal incision site, which did not require widening. There was no missing fragments retained intraocularly and the patient had an uneventful recovery with vision of 20/25 at three months post-operatively.ConclusionPhacoemulsification sleeve fracture is an uncommon complication. With early identification of this condition and proper management, major complications can be avoided.

Half-moon supracapsular nucleofractis phacoemulsification: Safety, efficacy, and functionality

To compare the safety, efficacy, and functionality of half-moon supracapsular phacoemulsification, a variation of the nucleofractis technique, with those of the stop-and-chop technique. Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. This prospective randomized study comprised 100 eyes having phacoemulsification with the half-moon supracapsular (Group 1, 50 eyes) or stop-and-chop (Group 2, 50 eyes) technique. The half-moon supracapsular technique is based on hydrodissection-assisted partial prolapse of the nucleus. After the prolapsed nucleus is chopped horizontally and the first wedge removed, quadrant removal is performed endocapsularly. Follow-up examinations were at 1, 7, 30, and 90 days. The 2 groups were similar in demographic features and surgical difficulty factors. There was no difference in the complication rate. The phaco time (mean: Group 1, 0.2 minutes +/- 0.1 (SD); Group 2, 0.4 +/- 0.4 minutes), average power (mean 11.3% +/- 6.9% and 18.3% +/- 7.3%, respectively), effective phaco time (1.7 +/- 1.8 seconds and 4.8 +/- 6.5 seconds, respectively), and total operation time (12.3 +/- 3.2 minutes and 14.3 +/- 4.3 minutes, respectively) were significantly lower in Group 1 than in Group 2. One day postoperatively, the increase in central corneal thickness increase was significantly greater in Group 1 (P = 0.011), with no significant differences thereafter. The visual acuity increase and contrast sensitivity scores at 90 days were similar in the groups. The half moon supracapsular technique shortened the phacoemulsification procedure and lowered phaco energy, indicating it protects surrounding intraocular tissue. There was no difference between techniques in reliability and functionality.

Comparison of Ultrasonic Energy Expenditures and Corneal Endothelial Cell Density Reductions During Modulated and Non-Modulated Phacoemulsification

To compare the Legacy 20000 Advantec continuous and Infiniti hyperpulse modes (Alcon Laboratories, Fort Worth, TX) with respect to average power, machine-measured phacoemulsification time, total stopwatch real time spent within the phacoemulsification process, balanced salt solution (BSS) volume, and corneal endothelial cell density losses. A background study was done of consecutive patients operated on with the Legacy (n = 60) and Infiniti (n = 40) machines programmed with identical parameters and using the continuous mode only. A primary study of another set of consecutive cases was operated on using the Legacy (n = 87) and Infiniti (n = 94) with the same parameters, but using the hyperpulse mode during quadrant removal with the Infiniti. Measurements for each set included average power and phacoemulsification time with corneal endothelial cell densities, BSS volume, and time spent in the phacoemulsification process. Similarities were found in the background study for average power percent and average minutes of phacoemulsification time. In the primary study, similarities were found for total minutes in the phacoemulsification process, BSS usage, and ECD losses, and differences were found for average power percent (P< .001) and machine-measured phacoemulsification minutes (P< .001). The Legacy and Infiniti performed similarly in continuous mode. With the Infiniti hyperpulse mode, a total ultrasonic energy reduction of 66% was noted. The machines required the same amount of total stopwatch measured time to accomplish phacoemulsification and produced the same 5% corneal endothelial cell loss. Therefore, clinically, these two machines behave in a comparable manner relative to safety and effectiveness.