Technique Of Cataract Extraction Research Articles

Outcomes of manual extracapsular versus phacoemulsification cataract extraction by beginner resident surgeons

To evaluate the safety and efficacy of phacoemulsification cataract extraction and manual extracapsular cataract extraction (ECCE) performed by beginning resident surgeons. Dallas Veterans Affairs Medical Center, Dallas, Texas, USA. Retrospective cohort study. A review was performed of each resident's series of initial cataract surgery procedures as a late first-year or second-year resident. Data were collected for cases performed over almost a 6-year period during which initially the first primary surgeon cases were ECCE and later, the first primary surgeon cases were phacoemulsification. For each case, the following data were gathered: technique of cataract extraction, laterality, resident, vitreous loss or dropped nucleus, placement of posterior chamber intraocular lens (IOL), and need for reoperation within 90 days of surgery. Complications occurred in 6 (2.5%) of 244 cases in which phacoemulsification was performed by a beginner resident primary surgeon and in 7 (4.1%) of 172 cases in which ECCE was used (P=.40). Posterior chamber IOLs were placed in all but 2 phacoemulsification cases and 4 ECCE cases (P=.24). Moreover, 3 cases in the phacoemulsification group and 1 case in the ECCE group required a reoperation within 90 days (P=.65). Phacoemulsification cataract extraction can be taught safely and effectively to residents with no cataract surgery experience as a primary surgeon.

Phacoemulsification and intraocular lens implantation in cataract after glaucoma surgery

Objective To evaluate the clinical effect of combined phacoemulsification and foldable intraocular lens implantation for patients after glaucoma surgery. Methods 88 cases （90 eyes） of cataract patients after glaucoma surgery were randomly divided into treatment group （43 cases 45 eyes） and control group （45 cases 45 eyes）. Transparent cornea incision phaeoemulsification and foldable intraocular lens im- plantation were performed in the treatment group. Conventional extracapsular cataract extraction technique was used in the control group. The visual acuity and corneal astigmatism were measured at postoperative 1 week, I month and 3 months. Results The patients of uncorrected visual acuity over 0.5 in treatment group were more than that in control group 1 week, 1 month and 3 months after operation （P 〈 0.01 ）. 3 months af- ter surgery, there were statistical signifieant difference in the average changes of corneal astigmatism between two groups （P 〈 0.01 ）. Conclusion Transparent corneal incision phacoemulsification and foldable intraoc- ular lens implantation had good clinical efficacy after glaucoma surgery, and better visual acuity and less postoperative astigmatism can be obtained. Key words: Anti-glaucoma surgery ; Phacoemulsification; Cataract; Lens, intraoeular

Facoemulsificação versus extração extracapsular no sistema público de saúde: análise de custos para o hospital, para o governo e para a sociedade

PURPOSE: To compare the costs of cataract surgery for a public hospital, the government and the society between the techniques of phacoemulsification (PHACO) and extracapsular cataract extraction (EECP). METHODS: A review based on several clinical studies between 2002 and 2010 at the Ambulatorial Surgical Center of the University of São Paulo. RESULTS: The estimated expenses associated with medical supplies used for surgery were R$ 468.92 and R$ 259.96 in the PHACO and EECP groups respectivelly. The hospital expenditures in the [...]

Phacoemulsification versus extracapsular extraction: governmental costs

PURPOSETo evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country.METHODSA prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques.RESULTSOf the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated.CONCLUSIONUnder the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

Single-Injection Percutaneous Peribulbar Anesthesia with a Short Needle as an Alternative to the Double-Injection Technique for Cataract Extraction

We evaluated the efficacy of a single-injection technique for percutaneous peribulbar anesthesia with a short needle as an alternative to the double-injection technique for cataract extraction. We included 200 patients who underwent elective cataract surgery randomized into 2 equal groups. They received either single-injection peribulbar anesthesia with a 16-mm needle or double-injection peribulbar anesthesia with a 25-mm needle. Both techniques provided comparable akinesia. A similar number of patients in each group required supplementary injection. The total volume of local anesthetic used was less in the single-injection group. There were no serious complications in the 2 groups. The single-injection technique for percutaneous peribulbar anesthesia with a short needle is a suitable alternative to the double-injection technique for cataract surgery.

Endothelial Cell Loss and Surgically Induced Astigmatism After Sutureless Large-Incision Manual Cataract Extraction (SLIMCE)

To describe a modified manual cataract extraction technique, sutureless large-incision manual cataract extraction (SLIMCE), and to report its clinical outcomes. Case notes of 50 consecutive patients with cataract surgery performed using the SLIMCE technique were retrospectively reviewed. Clinical outcomes 3 months after surgery were analyzed, including postoperative uncorrected visual acuity, best-corrected visual acuity, intraoperative and postoperative complications, endothelial cell loss, and surgically induced astigmatism using the vector analysis method. At the 3-month follow-up, all 50 patients had postoperative best-corrected visual acuity of at least 20/60, and 37 patients (74%) had visual acuity of at least 20/30. Uncorrected visual acuity was at least 20/68 in 28 patients (56%) and was between 20/80 and 20/200 in 22 patients (44%). No significant intraoperative complications were encountered, and sutureless wounds were achieved in all but 2 patients. At the 3-month follow-up, endothelial cell loss was 3.9%, and the mean surgically induced astigmatism was 0.69 diopter. SLIMCE is a safe and effective manual cataract extraction technique with low rates of surgically induced astigmatism and endothelial cell loss. In view of its low cost, SLIMCE may have a potential role in reducing cataract blindness in developing countries.

Corneal oedema after cataract surgery: predisposing factors and corneal graft outcome

Pseudophakic bullous keratopathy (PBK) is one of the main indications for corneal transplantation. Graft survival and visual outcome in this group are often poorer than for other indications. The aim of this study was to find risk factors for developing corneal oedema after cataract surgery and factors that influence the subsequent survival of the graft and the visual outcome. We carried out an observational, retrospective cohort study using data from the Swedish Cornea Transplant Register and patient medical records. A total of 273 patients whose indication for corneal transplantation was corneal oedema after cataract surgery were included in the study. Multiple logistic regression analysis and, where appropriate, univariate analyses were applied. A total of 43% of the patients developed persistent corneal oedema immediately after cataract surgery, the main risk factors for which were phacoemulsification and pre-existing endothelial disease. Almost a third (32%) of the transplants for PBK failed within 2 years, for which rejection and other postoperative complications increased the risk. Half (50%) the patients had visual acuity < or = 0.1 at 2 years after keratoplasty. Comorbidity, increasing duration of the bullous keratopathy and increasing age affected the visual outcome negatively. Phacoemulsification was a risk factor for immediate persistent corneal oedema after cataract surgery, although it did not increase the overall risk of developing PBK. However, transplants for immediate PBK had a better survival rate than those for later onset PBK. Shorter duration of PBK and intraocular lens exchange at the time of penetrating keratoplasty increased the likelihood of good visual acuity.

Lensectomy Using a Bimanual Microincision Cataract Surgery Technique During Pars Plana Vitrectomy

Lens extraction during vitrectomy is sometimes necessary to obtain an adequate view of the retina. Currently, phacoemulsification through a clear corneal incision with implantation of a foldable intraocular lens has become the preferred technique for cataract extraction during pars plana vitrectomy. The authors described the technique of lensectomy using a bimanual microincisional cataract surgery technique during pars plana vitrectomy and insertion of the intraocular lens at the end of surgery, which has several advantages over conventional coaxial phacoemulsification procedures.

Extracapsular cataract extraction with a posterior chamber intraocular lens-technique and results.

The author's preferred technique for extracapsular cataract extraction with insertion of a posterior chamber intraocular lens implant is described. Although automated devices are not available and are unattractive to many ophthalmologists, the author finds such equipment provides the safest means of making the conversion from intracapsular to extracapsular cataract extraction. In the planned extracapsular cataract extraction, a "beer can" anterior capsulotomy is performed and the nucleus is removed as described. The residual lens cortical material is aspirated using the Cavitron machine. The Cavitron machine is also used for phacoemulsification which is performed in the posterior chamber. A Shearing type posterior chamber lens is used when indicated. A primary posterior capsulotomy is performed routinely. An analysis of the first 800 such procedures is made with each case being examined 11-14 months postoperatively. Compared to intracapsular cataract extraction with an intraocular lens, the results are favourable, especially regarding the rate of cystoid macular edema, retinal detachment, and corneal edema.

Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School

Aim:To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior...

Chirurgie combinée phacoexérèse, vitrectomie et implantation chez le patient diabétique avec phacoémulsification versus phacophragmentation

In diabetic patients, we often need to perform cataract and pars plana vitrectomy. Two different techniques are currently valid: 1) phacoemulsification and pars plana vitrectomy and 2)pars plana lensectomy and posterior vitrectomy. Retrospective study of two different groups of type 2 diabetic patients: those receiving 1) phacoemulsification and pars plana vitrectomy or 2) pars plana lensectomy and posterior vitrectomy. On statistical analysis there were no differences in complications between the two groups. The effect on visual acuity was similar in both groups. The association of cataract surgery and posterior vitrectomy is a valid technique for treating diabetic retinopathy complications. In the present study, the complications of the two techniques were similar, the most important concerning only anterior chamber opening in the first group. The two techniques of cataract extraction and pars plana vitrectomy at the same time have no differences in their results and are valid for treatment of diabetic patients.

The Kuwait Cataract Outcome Study: A 12-Month Evaluation

Objective: To assess the frequency of intraopertive difficulties, postoperative complications and the visual outcome in cataract surgery performed at the Al-Bahar Eye Center, Kuwait. Subjects and Methods: This case series study is comprised of 350 eyes from 325 subjects (169 male, 156 female; 30–78 years, mean age 64 years) undergoing consecutive cataract surgery performed at the Al-Bahar Eye Center, Kuwait from July 2001 to June 2002. All the eyes underwent extensive ophthalmic examinations before and after surgery. Details of surgical procedures, including the type of the cataract surgery, intraoperative difficulties or complications, postoperative complications, and the visual outcome were documented. Results: The extracapsular cataract extraction (ECCE) technique was used for 50.2% of the eyes and for the remaining 49.8%, the small-incision phacoemulsification technique was used. Of the 350 eyes operated upon, 9.7% had coexisting ocular disease which may have affected the best spectacle corrected visual acuity (BSCVA). Complications included posterior capsule tears and vitreous loss (10%), cystoid macular edema (0.6%) and endophthalmitis (0.9%) of the eyes. A BSCVA of 6/12 or better was achieved in 78.3% of the cases. Conclusion: A high success rate in terms of visual acuity outcome was achieved in the cataract surgery. The operative and postoperative complications were similar for both techniques, ECCE and phacoemulsification.

Postcataract Endophthalmitis in South India: Incidence and Outcome

To determine the incidence of acute-onset postcataract endophthalmitis, identify risk factors, and determine clinical outcomes in a tertiary eye care center in South India. Retrospective, interventional, observational case series. All patients who underwent cataract extraction from January 2002 to December 2003 at Aravind Eye Hospital, Madurai. The records of patients with acute endophthalmitis after cataract surgery were reviewed. Acute-onset postcataract endophthalmitis, incidence rates, risk factors, organisms cultured, and visual acuity outcomes after treatment. During the study period, 36072 cataract surgeries were performed; these included 22294 cases of phacoemulsification and 9503 cases of extracapsular cataract extraction. A total of 19 eyes developed acute endophthalmitis after cataract surgery (average 2-year incidence, 0.05%). Ten cases were culture positive (average 2-year incidence, 0.03%). In multivariate analysis, increased risk of endophthalmitis was associated with intraoperative complications, such as posterior capsular rent and vitreous loss (relative risk [RR], 6.57; 95% confidence interval [CI], 1.5-28.5; P = 0.05) for all endophthalmitis cases, age >60 years for culture-positive endophthalmitis cases (RR, 6; 95% CI, 0.7-47.8; P = 0.04), and an extracapsular cataract extraction technique for culture-positive endophthalmitis cases (RR, 4.9; 95% CI, 1.2-19.3; P = 0.001). After follow-up of 37 days, 5 (29.41%) of the 17 patients achieved a best-corrected visual acuity (BCVA) of 20/40, and the remaining 7 (32.3%) had a BCVA better than 20/200. Of the culture-positive cases, Nocardia species was the most common organism isolated, accounting for more than half of these cases (6/10 [60%]). This study found the incidence of acute postoperative endophthalmitis after cataract surgery to be 0.05%. Extracapsular cataract extraction technique and the occurrence of intraoperative complications are major risk factors for developing endophthalmitis. Visual outcome after endophthalmitis was generally poor. Nocardia is a lesser-known but virulent organism causing endophthalmitis, the management of which still poses a therapeutic dilemma.

Combining phacoemulsification and vitrectomy in patients with proliferative diabetic retinopathy.

Modern vitrectomy and cataract extraction techniques have reached levels not imagined 20 years ago. Combining pars plana vitrectomy with phacoemulsification and posterior capsulectomy now has the potential to condense three separate procedures: pars plana vitrectomy, phacoemulsification, and YAG capsulotomy into one procedure. Interest in combined surgery is increasing as reports in the literature documenting its safety and efficacy continue to be published. The purpose of this article is to review the recent trends in combined surgery. Studies have shown that when comparing sequential surgery to combined surgery, there is no significant difference in visual outcome. Multiple reports confirm the safety of combined surgery in patients with proliferative diabetic retinopathy. In select patients with diabetes, combining vitrectomy with phacoemulsification and posterior capsulectomy allows patients who often have bilateral vitreoretinal disease to come to a stable postoperative vision in the eye requiring vitreous surgery much earlier than three separate procedures spread out over months or years.

Clear lens extraction in high axial myopia

Several ophthalmologists, during these past 20 years, supported by the great improvement in the surgical techniques of cataract extraction, proposed again the surgical procedure of clear lens extraction (CLE) to correct high axial myopia. However, we have to remember that vitreous and retinal changes in high myopic eyes can lead to retinal detachment (RD), in some cases with a poor visual outcome even after successful surgery. Moreover, it is well known that cataract extraction is a major cause of later RD with a further significant increase of the incidence of RD after Nd:YAG laser capsulotomy. The increased risk rates of RD for high myopia and cataract extraction are probably to be additive; therefore, high myopic eyes are significantly more exposed to postoperative complications. The greater incidence of RD in these eyes can be explained considering the anomalous vitreous changes occurring in high myopia, precipitated by the molecular and structural changes of the vitreous following cataract surgery. There are anomalous vitreo-retinal separation that are most frequently observed in very high myopic eyes: anomalous posterior vitreous detachment (PVD) and posterior vitreous schisis (PVS), the latter generally observed in association with a prominent posterior stafiloma. Intraoperative observations and recent studies of the macular area by means of optical coherence tomography (OCT) allowed the detection in these eyes of a thin layer of epiretinal tissue strictly adherent to the retina involved by the staphyloma; in these cases tractional retinal detachment, macular schisis or holes can occur. There are only few reports on the vitreo-retinal complications of CLE; for this reason, most conclusions have been derived from studies on RD occurred after cataract extraction in high myopic eyes. These data suggest that the risk/benefit ratio for this operation is probably too high to be recommended.

Surgical Management of Coexisting Glaucoma and Cataract

The management of coincident glaucoma and cataract is not only a common clinical challenge but also an important research topic in the ophthalmic surgical field. The purpose of this article is to compare the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) control, success rates, and complication rates reported in the related literature, and to give advice on how to manage typical situations of patients with both glaucoma and cataract. Main topics were focused on indications and rationale of 3 surgical options (only cataract surgery first and later trabeculectomy, only trabeculectomy first and later cataract surgery, or simultaneous combined surgery). Modern clear corneal cataract extraction techniques resulted in a modest intermediate-term reduction of IOP and has considerably improved the success rates of combined glaucoma and cataract surgery. It also enabled future trabeculectomy to be successfully performed at a later date if necessary. Trabeculectomy alone achieved better IOP regulation than phacotrabeculectomy (combined surgery), but subsequent cataract surgery may compromise preexisting filtering bleb. Combined surgery augmented with mitomycin C achieved a lower IOP than combined surgery alone but had a higher complication rate. In conclusion, the choice of the preferred surgical method should be determined according to the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy with adjunctive mitomycin C offers visual improvement and achieves the best IOP lowering of all types of combined glaucoma and cataract surgery currently used but is associated with potentially sight-threatening complications.

Resident cataract surgical training in United States residency programs

A comprehensive survey was sent to the residency directors of 129 ophthalmology training programs in the United States. Forty percent of residents gained experience as primary surgeon during their first year; 43% performed only part of the surgery. Seventy-three percent began learning cataract extraction using the extracapsular cataract extraction (ECCE) technique, 24% began with phacoemulsification, and 2% began with either method. If beginning with ECCE, 18% must have completed more than 10 before moving to phacoemulsification, 37% more than 5, and 45% more than 1. Seventy-five percent learned various phacoemulsification techniques; 25% learned only 1 technique. If beginning with 1 technique, 44% began with the scleral tunnel combined with divide and conquer. Sixty-four percent learned phacoemulsification on the Alcon Legacy, 21% on the Alcon Legacy and Storz Millennium, and 6% on the Storz Millennium. Sixty-eight percent of residents rotated out of their main facility to perform cataract surgery. The mean and median number of cataract procedures a resident completed by the end of training was 113 and 100, respectively.

Nitric oxide levels in aqueous humor after lens extraction and poly(methyl methacrylate) and foldable acrylic intraocular lens implantation in rabbit eyes

Purpose To measure the nitric oxide (NO) level in the aqueous humor of rabbit eyes after common cataract surgery techniques. Setting Department of Ophthalmology, Military Medical University, and Department of Immunology and Immunotoxicology of Respiratory System, Clinic of Pneumonology and Allergology, Medical University of Łódź, Łódź, Poland. Methods Thirty rabbits were randomly divided into 4 groups, and surgery was performed as follows: Group 1, extracapsular cataract extraction (ECCE) and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation; Group 2, ECCE; Group 3, phacoemulsification and foldable acrylic IOL implantation; Group 4, phacoemulsification. The aqueous humor specimens were collected on days 1, 3, and 5. Nitric oxide measurements were performed indirectly with a spectrophotometer. The NO level in the aqueous humor collected before surgery served as a control group. Results In the physiological condition, the concentration of NO was 26.52 nm/dL ± 4.86 (SD). Postoperatively, the highest NO level in each groups was as follows: Group 1, 46.26 ± 5.23 nm/dL on day 3; Group 2, 72.46 ± 6.94 nm/dL on day 1; Group 3, 41.04 ± 7.31 nm/dL on day 1; and Group 4, 32.67 ± 2.84 nm/dL on day 3. Significantly higher levels of NO (P < .05) were observed in Groups 1 and 2 at each follow-up day; in Group 3, on days 1 and 3; and in Group 4, on day 3. Conclusions Techniques of cataract extraction caused the NO level to increase; however, phacoemulsification with a foldable IOL caused the smallest release of NO. Rapid postoperative NO changes may theoretically contribute to blood−aqueous barrier breakdown secondary to cataract surgery.

Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: An evidence-based review

Topic To analyze the literature pertaining to the techniques used in combined cataract and glaucoma surgery, including the technique of cataract extraction, the timing of the surgery (staged procedure versus combined procedure), the anatomic location of the operation, and the use of antifibrosis agents. Clinical relevance Cataract and glaucoma are both common conditions and are often present in the same patient. There is no agreement concerning the optimal surgical management of these disorders when they coexist. Methods/literature reviewed Electronic searches of English language articles published since 1964 were conducted in Pub MED and CENTRAL, the Cochrane Collaboration’s database. These were augmented by a hand search of six ophthalmology journals and the reference lists of a sample of studies included in the literature review. Evidence grades (A, strong; B, moderate; C, weak; I, insufficient) were assigned to the evidence that involved a direct comparison of alternative techniques. Results The preponderance of evidence from the literature suggests a small (2–4 mmHg) benefit from the use of mitomycin-C (MMC), but not 5-fluorouracil (5-FU), in combined cataract and glaucoma surgery (evidence grade B). Two-site surgery provides slightly lower (1–3 mmHg) intraocular pressure (IOP) than one-site surgery (evidence grade C), and IOP is lowered more (1–3 mmHg) by phacoemulsification than by nuclear expression in combined procedures (evidence grade C). There is insufficient evidence to conclude either that staged or combined procedures give better results or that alternative glaucoma procedures are superior to trabeculectomy in combined procedures. Conclusions In the literature on surgical techniques and adjuvants used in the management of coexisting cataract and glaucoma, the strongest evidence of efficacy exists for using MMC, separating the incisions for cataract and glaucoma surgery, and removing the nucleus by phacoemulsification.

Nucleus cryoinversion for extraction of highly complicated cataracts

We describe a technique for cataract extraction in vitrectomized eyes that uses secured removal of the nucleus with no manipulation of the capsular bag. After a large scleral tunnel is prepared and a capsulorhexis created, a 20-gauge retinal cryoprobe enveloped in a plastic or a silicone sleeve is introduced into the anterior chamber. The cryoprobe engages the nucleus by a “freeze-grip” and rotates it 180 degrees so that the nucleus is elevated into the anterior chamber with no force applied to the capsule and the cryoprobe supporting it from below. The cryoprobe is replaced by a vectis under the nucleus and with the help of another instrument from above, the nucleus is removed. Aspiration of cortical material under low-pressure fluid maintenance of the anterior chamber completes removal of the cataract. An intraocular lens is then implanted in the ciliary sulcus for maximum capsule support.