Technique Of Cataract Extraction Research Articles

Intraocular aphakia correction in patients with prior keratorefractive surgery: literature review. Part 1

Introduction. An increasing number of patients with a history of keratorefractive surgeries are presenting to ophthalmologists with complaints of vision loss due to cataracts. Treating this group poses surgeons with a range of unique challenges: high demands for vision quality, complexities in selecting the appropriate intraocular lens (IOL) power calculation formula and IOL model, target refraction, as well as the need to modify cataract extraction techniques and address specific postoperative considerations. Despite advancements in the development of new IOL designs and calculation formulas, clinical and functional outcomes in this group remain inferior to those in patients without prior keratorefractive procedures. A paradigm shift is emerging, advocating for a personalized approach in the diagnosis and management of cataracts in these patients. However, discussing all aspects within a single review proved impractical, leading us to divide it into two parts. The objective of the first part of this study is to assess the specific considerations for aphakia correction in patients who have undergone keratorefractive procedures, based on literature data, while taking into account the long-term complications of refractive surgery. Additionally, this part will address the fundamental principles of the design and functionality of pseudoaccommodating intraocular lenses (IOLs). Materials and methods. A selection of over 200 peer-reviewed publications from resources such as PubMed, eLibrary, CyberLeninka, Science Direct, and Google Scholar over the past 30 years was conducted. The first part of the review includes 49 publications. This work represents an analysis of contemporary literature, reflecting the impact of keratorefractive surgeries on the successful performance of phacoemulsification with IOL implantation. Results. The findings from the first part of the analysis indicate that a detailed medical history of previously performed keratorefractive corrections – specifically their type and potential long-term complications – play a significant role in determining the surgical treatment strategy. Standard examination methods do not always fully reflect the optical characteristics of the cornea in these patients. Extended preoperative assessments, including specialized techniques such as keratotopography and keratotomography, are crucial for identifying corneal irregularities and for the subsequent selection of the type of intraocular lens (IOL) for aphakia correction in patients who have undergone keratorefractive surgeries. Studies show high effectiveness not only in using monofocal lenses but also in the potential application of pseudoaccommodating IOLs, including those with extended depth of focus and multifocal lenses. The selection of optimal formulas for IOL calculation, as well as the clinical aspects influencing refraction in the postoperative period, will be addressed in the second part of the literature review. Conclusion. The increase in the number of refractive surgeries has led to a growing population of patients with cataracts following ametropia correction. This has spurred the development of new IOL variants with extended depth of focus. However, literature data on their effectiveness in patients who have undergone keratorefractive procedures remain limited. Multicenter prospective studies are needed to evaluate new IOL models and to determine the optimal surgical strategies for this category of patients.

Progression in the Number of Cataract Surgeries in Brazil: 10 Years of Evolution

ABSTRACT Objective This study aimed to assess the frequency of cataract surgery in Brazil between 2010 and 2019 and determine the impact of public policies on preventing blindness, thereby providing evidence to conduct healthcare programs. Methods An analytical epidemiological approach was employed, which used data from public databases, specifically the Hospital Information System (SIH-SUS) and the Outpatient Information System (SIA-SUS). We focused on cataract surgeries conducted via phacoemulsification and extracapsular cataract extraction techniques between 2010 and 2019, mainly targeting senile cataracts within the Brazilian public health system. Data were analyzed on an annual basis and stratified by region. Trends over time were assessed using generalized additive models. Results A statistically significant upward trend in cataract surgeries was observed both nationally and within the South region (p < 0.05). Nationally, there was a 40.22% increase in surgeries between 2010 and 2019. Furthermore, the surgery rate per 1000 individuals aged ≥50 years varied across regions: nationally, it was 10.85, with rates of 9.23 in the Southeast, 13.86 in the Northeast, 9.23 in the South, 11.94 in the Midwest, and 14.2 in the North. Conclusion All regions of the country, a satisfactory number of cataract surgeries were performed at some point. Only the Southern region demonstrated a notable upward trend in the number of cataract surgeries. Conversely, the remaining regions failed to sustain surgical performance, hindering consistent improvement in cataract-related conditions. To accurately gauge the prevalence of blindness in Brazil, it is crucial to examine the population growth among individuals aged ≥50 years.

Teaching of manual cataract extraction in ophthalmic surgical training programmes

BackgroundManual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.AimsThis study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.MethodsAn electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.ResultsNineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1–3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.ConclusionsThere is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.

Comparative Evaluation of Astigmatic Changes Induced by Superior and Temporal Corneal Incisions in Sutureless Phacoemulsification Surgery: A Case Series.

Background In cataract surgery, the effect of corneal incision astigmatism has been widely recognized for many years. The incision's size, shape, and location can all impact the patient's postoperative visual outcomes. Currently, phacoemulsification is considered the most preferred surgical technique for cataract extraction. However, there is still some debate about whether temporal incisions, which are smaller and considered nearly astigmatic neutral, result in more astigmatism than other incisions. As a result, it is important to continue studying the refractive changes induced by corneal incisions made at different sites during phacoemulsification surgery. Aim and objective To compare the incidence, extent, and course of postoperative astigmatic changes associated with superior versus temporal clear corneal incisions for sutureless phacoemulsification cataract surgery. Materials and method In this prospective study, 50 patients of the civil hospital in Gujrat with cataracts who underwent sutureless, small incision (2.8 mm) phacoemulsification surgery were included. The preoperative evaluation comprised visual acuity assessment, refraction, keratometry, fundus examination, and intraocular lens (IOL) power calculation. The superior incision was made in 25 patients, and the temporal incision was made in another 25 patients. Patients were examined preoperatively on day 1, at one week (day 7), after one month (day 30), and after two months (day 60). Result Postoperatively, two months (on day 60) postoperatively, in group A (superior approach), the mean surgically induced astigmatism (SIA) was 0.39±0.34 SD diopters, and in group B (temporal approach), it was 0.5±0.42 SD diopters. A significant statistical difference was not seen between these two groups. Conclusion Surgically induced astigmatism was minimal and comparable with both superior and temporal approaches to clear corneal incisions for phacoemulsification surgery.

Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery.

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.

Minimal anesthetic manual small-incision cataract surgery (MSICS): A novel technique in use for anesthesia in MSICS.

Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5-2 milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o'clock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.

Two-mm chord manual small-incision cataract surgery with phacofracture: A brief exposition of the surgical technique.

We describe a surgical technique for manual small-incision cataract extraction with 2-mm chord incision with phacofracture. The authors describe a curvilinear 2-mm chord incision 1.5 mm behind the limbus and antiparallel to the limbus with back cuts of variable length; 1.5 mm for foldable lenses and 2.5-3 mm for the rigid nonfoldable lenses. Continuous curvilinear capsulorhexis with a 26-G bent needle cystitome (or Utrata forceps) is followed by cortical cleaving hydrodissection and cartwheeling of the nucleus into the anterior chamber. A specially designed Sahu modified vectis (SMV) and a flattened visco cannula are used for the phacofracture. The heminuclei are removed along their longitudinal axis and direct implantation of the pseudophakos. Surgically induced astigmatism was found to be a mean change in astigmatism of 0.14 DCyl when the axis was ignored. Corneal endothelial counts were not vastly different from the routine manual small-incision and phacoemulsification at 3 months of follow-up. The technique used here by the surgeon for cataracts of any C (1-5) or any P (1-5) to grade NC4 NO4 as graded by the LOCS III. Case selection is of paramount importance. Two-millimeter chord MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery.

Sub-tenon Versus Sub-conjunctiva Anaesthesia for Intraocular Surgery.

To compare the pain relief achieved using sub-Tenon anesthesia with that of sub-conjunctival anesthesia technique in intraocular surgery at the Guinness Eye Centre Onitsha Nigeria. Consecutive adult patients who had intraocular surgery under local anesthesia were randomized into having sub-Tenon (3 mL) or sub-conjunctival (0.5 mL) injections using xylocaine ± adrenaline. The manual suture-less surgery technique was used for cataract surgery alone and cataract surgery with pterygium excision; the extra-capsular cataract extraction technique was adopted for combined trabeculectomy and cataract surgery. Surgery duration was recorded. Patient's pain perception graded as none, mild, moderate or severe. 100 patients made up 51 (51.0%) males and 49 (49.0%) females, age range was 31-88 years, median - 68 years, participated. Sub-Tenon anesthetic technique was used in 52 (52.0%) and sub-conjunctival in 48 (48.0%) participants. Seventy-eight (78.0%) patients had cataract surgery; 10 (10.0%) had trabeculectomy; 7 (7.0%) had combined trabeculectomy and cataract surgery and 5 (5.0%) had pterygium excision with cataract surgery. The mean surgery duration in the sub-Tenon anesthesia group was 31.8 ± 8.5 minutes and 30.2 ± 9.8 minutes in the sub-conjunctival group (P > 0.05). Fifty (96.2%) patients in the sub-Tenon group and 38 (79.2%) in the sub-conjunctival group experienced mild or no pains; 2 (4.2%) patients in the sub-Tenon group and 10 (20.8%) in the sub-conjunctival group experienced moderate to severe pains (P < 0.05). Both sub-conjunctival and sub-Tenon anesthetic achieved effective analgesia in intraocular surgery. But sub-Tenon anesthesia is significantly associated with lower incidence of severe pains.

Cataract surgery outcomes: comparison of the extracapsular cataract extraction and manual small incision cataract surgery techniques.

Blindness and visual impairment are public health problems and constitute an important socio-economic burden in sub-Saharan Africa. Understanding the outcomes of cataract surgery will improve our knowledge of risk factors for poor outcomes. Previous studies have focused exclusively on the phacoemulsification technique with limited attention to the extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) techniques. To compare the cataract surgery outcomes between the ECCE and MSICS techniques. The study was an observational research design that used the LogMAR visual acuity (VA) chart, subjective refraction, slit lamp and ophthalmoscope to collect data. The participants were followed for a period of six-weeks post-surgery and outcomes were recorded. Data were presented using frequencies, percentages and means ± standard deviation. The sample included 101 participants, with a mean age of 66.32 ± 15.99 years. Fifty and 51 participants had undergone the ECCE and MSICS techniques respectively. Overall, one-hundred participants had poor pre-surgery VA and subjective refractions were generally not possible due to the severity of cataracts present. The mean aided post-surgery VA was 0.31 LogMAR and 0.13 LogMAR in the ECCE and MSICS groups respectively (p < 0.001). The mean post-surgery refractive astigmatism was similar in the ECCE (-2.06 D) and MSICS (-1.80 D) groups (p = 0.110). The spherical equivalence was approximately -0.50 D higher in the MSICS group, but not statistically significant (p = 0.330). Approximately one out of every five participants (n = 21) had post-surgery ocular complications such as corneal opacity and haziness as well as posterior capsular absence. The MSICS technique showed better post-surgery outcomes than the ECCE technique.

Ferning, Schimer I and Tear Break Up Time (TBUT) Accuracy Test in Post-Operative Cataract Patient with Extra Capsular Cataract Extraction (ECCE) Technique

A B S T R A C TObjective: To determine the accuracy of the Ferning, Schimer I and TBUT test incataract patients after cataract surgery with the ECCE technique at the EyePolyclinic at Mohammad Hoesin Hospital Palembang and the Special Eye HospitalPalembang Methods: Diagnostic test was undertaken at the Eye Polyclinic atMohammad Hoesin Hospital Palembang and the Special Eye Hospital Palembangfrom May 2019 to January 2020. There were 42 postoperative cataract patients whomet the inclusion criteria. Ferning, Schimer I and TBUT tests were performed beforesurgery and one month after surgery. Data analysis using SPSS version 22.0 (SPSS,Inc Chicago, Illinois). Results: Fourty two samples of postoperative cataract surgerywith ECCE technique obtained by female sex (57,1%) with a mean age of cataractpatients of approximately 58.09 years. The accuracy of Schimer I and TBUT is 0.952with 100% sensitivity, 50% specificity, 95% positive predictive value (PPV) and 100%negative predictive value (NPV), the accuracy of TBUT and Ferning is 0.881 with90.2% sensitivity, 0% specificity , positive predictive value (PPV) 97.4% and negativepredictive value (NPV) 0% while the accuracy of Ferning and Schimer I was 0.928with a sensitivity of 97.5%, specificity of 0%, positive predictive value (PPV) of 95.1%and negative predictive value (NPV) 0%. Conclusion: Schimer I test is more accurateto use as a predictor of dry eye in postoperative cataract patients than Ferning andTBUT

Primary outcomes of combined cataract extraction technique with Ab-Interno trabeculectomy and endoscopic Cyclophotocoagulation in patients with primary open angle Glaucoma

BackgroundGlaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma.MethodsA retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. Inclusion criteria: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP < 14 mmHg either with no medications (complete success) or with medications (qualified success).ResultsA total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0 ± 3.7 mmHg and postoperatively was 11.6 ± 1.9 mmHg and 11.4 ± 1.8 mmHg (P < 0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9 ± 1.4 to 0.56 ± 1.05 at 9 month follow-ups (P < 0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4 ± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months.ConclusionsIn patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

Comparison of outcome between single site versus double site injection of peribulbar anaesthesia for cataract surgery

To compare the efficacy and safety of single injection technique of Peribulbar anaesthesia with that of double site injection technique for cataract extraction in terms akinesia, analgesia, onset and duration of the action of analgesia and incidence of complications.A cross-sectional study involving 342 eyes which were randomised into two groups of 171 group A (single site injection peribulbar anaesthesia) and group B (double site injection peribulbar anaesthesia) by simple randomization. All the patients underwent similar protocol for standard cataract evaluation. Peribulbar anaesthesia was given in both the group before surgery and effect of anaesthesia were analysed in terms of analgesia and akinesia.Analgesia (P = 0.074) and akinesia (P = 0.054) were good in both the group but the results were not statistically significant between the 2 groups. At the end of 15 minutes all the patients attained akinesia and analgesia in both the (P= 0.053). Complications were more in group B than in group A. Single site injection of peribulbar anaesthesia is less painful during administration compared to double site peribulbar anaesthesia. Complications are more in double site injection comparatively.

Comparison of astigmatism after phacoemulsification and extracapsular cataract extraction

Objective: To compare astigmatism after phacoemulsification and extracapsular cataract extraction technique. Method: It was a hospital-based cross-sectional study conducted at Zainab Medicare hospital Haroonabad from September 2018 to May 2019. A sample size of 80 patients having cataract, age 41 to 70 years was included in this study. Slit lamp examination was performed for anterior segment evaluation and astigmatism was determined with autorefraction and keratometry. Result: Phaco technique was more reliable. The means and the standard deviation of phaco post op astigmatism was 0.7860 ±.48880 and ECCE post op astigmatism was 3.6310±1.96236 which indicated that the degree of astigmatism increases after extra capsular cataract extraction technique. The significant level was 0.00 which showed that the phaco technique is highly significant. Conclusion: Corneal astigmatism was almost similar in two groups prior to surgery but after the cataract surgery the astigmatism significantly decreased after phacoemulsification group at 2 weeks follow-up, the results indicated that phaco may be considered superior to ECCE. No suturing is required in phaco and hence lesser chances of post op astigmatism.

Impact of cataract surgery on vision-related quality of life

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

Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh.

Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

The technology of laser cataract extraction in diabetic patients

In 1994, academician S.N. Fyodorov directed the development of laser cataract extraction (LCE) technique, which does not require manual or ultrasonic lens fragmentation. To determine the effectiveness and safety of Russian LCE technology in patients with diabetes mellitus using comparative analysis, and to develop practical guidelines. The study analyzed the results of 154 operations in patients with complicated cataract and diabetes mellitus (DM). 80 LCE operations and 74 ultrasonic cataract phacoemulsification (PhEC) surgeries including implantation of intraocular lens were performed. The duration of DM was 12.5±7.1 years in the LCE group and 11.9±7.3 years in the PhEC group. The energy of neodymium Nd:YAG laser endo-dissector with original wavelength of 1.44 μm together with low-intensity He-Ne laser radiation of 0.63 μm were delivered simultaneously to the eye cavity. Corneal endothelial cells loss was significantly lower (by 1.8 times) after LCE, in the early postop period, in 1 year, and 2 years after the surgery; the incidence of intraocular pressure increase and ciliary body edema were lower as well. Moreover, there is no negative influence on the posterior segment of the eye because the radiation of laser endo-dissector during the duty cycle of cataract removal does not extend beyond the lens capsule, and does not affect other tissues of the eye. In comparison to ultrasound cataract surgery, LCE is a more safe and effective method of removing complicated cataracts in diabetic patients with any degree of lens density.

Assessment of sclerocorneal incision architecture after phacoemulsification using AS-OCT

Introduction The construction of the main incision is crucial for the outcome of cataract surgery. There are many considerations including: wound preparation and stability, surgically induced astigmatism, stability of anterior chamber, and wound closure stability with rising intraocular pressure (IOP). Irrespective of modality, the main goal is to achieve stable watertight self-sealing wound in order to avoid possible intra- and postoperative complications. Therefore, evaluating the architecture and healing of the surgical wound would be of benefit, as the integrity of incisions may decrease the risk of endophthalmitis or other problems. Anterior segment OCT (AS-OCT) provides the opportunity to visualize anterior chamber structures and cornea in particular. In the interest of the current study this was used to examine the anatomy of the main incision in vivo and evaluate its changes over time. Aim The aim of this article is to examine the architecture of the main incision in vivo and evaluate its changes over time, using anterior segment optical coherence tomography (AS-OCT). Materials and Methods Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction, under local anesthesia, was used. Patients with previous ocular surgery or trauma, and other ocular pathology, as well as cases with complications were not included in the study. Wound anatomy was visualized using AS-OCT (Topcon 3D SD OCT 2000) at three postoperative visits: day 1, day 7, and day 30. The following features were examined and analyzed: external gaping, endothelial (internal) alignment and gaping, localized DMD, loss of coaptation, wound retraction, and other changes on the external or the internal side of the wound. Results Sixty eyes of 51 patients were examined, of whom 23 were men and 28 women, aged between 53 and 87 years (mean 72 years). The scleral tunnel incisions had a three-plane architecture and all of them were watertight with no leakage at any time. Several architectural features were assessed, including epithelial gaping, endothelial gaping and misalignment, local Descemet`s membrane detachment (DMD). Conclusion AS-OCT is a risk-free, quick, high-informative method for visualization of the morphological characteristics of cataract surgical incisions and their evolution over time. Hence, this technology is indispensable in evaluating the integrity of the wound, and the information obtained could be used to develop a consistent technique to create self-sealing incisions and decrease the risk of endophthalmitis.

One-handed revolving technique for soft cataract extraction.

This study describes a new one-handed revolving technique for soft cataract extraction. Following hydrodissection, the endonucleus is removed piecemeal while the lens is rotated using a phaco tip. A peripheral groove is created in the 6 o’clock direction and, after lens rotation through 180° using the phaco tip, another 6 o’clock groove is created. After a further 90° of lens rotation, the residual plate is readily flipped over and emulsified. The entire procedure requires only a phaco tip; it is not necessary to create a corneal side port or use any instrument.

Сравнительный анализ эффективности различных методик экстракции катаракты

Сравнительный анализ эффективности различных методик экстракции катаракты

Lancaster's Technique of Cataract Extraction

Modifications in technique of cataract extraction continue to be advocated and to appear in the literature. It would seem that the major variations would have been long since exhausted. Nevertheless, ophthalmologists continue to spend considerable time in working out new techniques, and fortunately so, as is proved by Dr. Walter B. Lancaster's technique, which I have found such a safe procedure that I particularly recommend it to young ophthalmologists who need to utilize every precaution to insure success in their first operative cases.