Total Ultrasound Time Research Articles

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

A Meta-Analysis of Changes in the Retinal Thickness and Vasculature after Phacoemulsification Surgery

Background Phacoemulsification is the most popular cataract surgery nowadays. However, phacoemulsification provokes discharge of pro-inflammatory molecules not only affecting the anterior but also posterior eye segments. Aim of the Work the aim of the study was to evaluate through the available literature the correlation between cumulative dissipated energy and total ultrasound time in one hand, and retinal thickness and vasculature in the other hand after phacoemulsification surgery through systematic review and meta-analysis. Subjects and methods This meta-analysis study included randomized controlled trials and retrospective or prospective observational studies evaluating the correlation between cumulative dissipated energy, and total ultrasound time and retinal thickness and vasculature after phacoemulsification surgery. In this systematic review a thirty studies were included in the period from 2006 to 2020 with 29 prospective studies and one Quasiexperimental study. Results The mean preoperative central foveal retinal thickness (μm) was 232.6±25.8(μm) and increased to 243.66±29.2(μm) Postoperatively. Mean preoperative average RNFL thickness was 89±10.2 (μm) and increased to 96.6±10.0 (μm) postoperatively. mean GCL thickness (μm) was 80.56±60(μm) preoperatively and increased to 84.74±7.20(μm) postoperatively. parafoveal perfusion density percentage was 0.28% pre-operative and increased post- operative to be 0.29%, the pre-operative perifoveal perfusion density percentage was 0.45% which increased post-operatively to be 0.53%, the pre-operative peripapillary perfusion density percentage value was 0.49% which increased to 0.53% post operatively. Conclusion the retinal vessel density and vascular perfusion were found to be increased significantly in both macular and peripapillary areas p = 0.003. This increase was accompanied with changes of retinal layer thickness p = 0.00001.

Effect and Safety of Pressure Sensor-equipped Handpiece in Phacoemulsification System.

To evaluate the effect of the Active Sentry handpiece of the Centurion Vision System compared to the Centurion Ozil handpiece for phacoemulsification in cataract surgery. A retrospective study was conducted on 281 patients (449 eyes) who underwent cataract surgery between August 2020 and June 2021. Preoperative measurements, intraoperative parameters, complication rate, and postoperative outcomes were compared between the Active Sentry handpiece and the Centurion Ozil handpiece groups. Additionally, the parameters were compared in different cataract severity groups and multiple predictive factors for the number of active surge mitigation (ASM) actuations were assessed with the Active Sentry handpiece. There were 198 eyes in the Active Sentry group and 251 eyes in the Centurion Ozil group. There were no statistically significant differences between the two groups, as the cumulative dissipated energy in the Active Sentry and Centurion Ozil groups were 8.32 ± 7.74 and 7.87 ± 9.25 μJ, respectively (p = 0.576). Total surgery time, ultrasound usage time, aspiration time, amount of fluid aspirated, postoperative corrected distant visual acuity, and postoperative decrease in corneal endothelial cell density were comparable between the two groups. The significant contributors to the number of ASM actuations were age, preoperative corrected distant visual acuity, axial length, and total ultrasound time. There was no clear advantage of the Active Sentry handpiece compared to the Centurion Ozil handpiece. ASM actuation increases with age, poor visual acuity before surgery, short axial length, and prolonged ultrasound usage time. It is expected that in more severe and high-risk cataract surgery, the Active Sentry handpiece functions more effectively, possibly affecting the safety and prognosis.

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery

BackgroundIntracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®).MethodsAn observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis.ResultsThe median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds.ConclusionsThe endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Correlation Between Lens Density Measured by Swept-Source Optical Coherence Tomography and Phacodynamic Parameters of Centurion Phacoemulsification

Purpose To evaluate the correlation between lens density measured by IOL-Master 700 based on swept-source optical coherence tomography (SS-OCT) technology and the phacodynamic parameters of Centurion phacoemulsification in cataract surgery. Methods This prospective study included 66 patients (83 eyes) with age-related cataracts. Using the Lens Opacities Classification System III (LOCS III), the lens nuclear color (NC), lens nuclear opalescence (NO), cortical (C), and posterior subcapsular (P) opacities were obtained. Six meridian orientations of IOL-Master 700 images were captured, and the lens and nuclear regions were analyzed using ImageJ to generate the average lens nucleus density (AND) and average lens density (ALD). Phacodynamic parameters were recorded. The correlation between lens density and the phacodynamic parameters was analyzed. According to the AND, patients were divided into four groups (soft, medium-hard, hard, and extremely hard nucleus), and the phacodynamic parameters were compared among groups. Results The correlation between the AND obtained by LOCS III grading and SS-OCT-based cataract quantification system score (NC and NO) was statistically significant (r NC = 0.795, r NO=0.794, both p = .000). AND correlated significantly with cumulative dissipated energy (CDE, r = 0.545, p = .000), total ultrasound time (TUST, r = 0.354, p = .001), and total torsional ultrasound time (TTUT, r = 0.314, p = .004). Among the four groups divided by AND, the difference in CDE (P 13 = 0.002, P 14 < 0.001, P 24 = 0.002) was statistically significant. Conclusion AND measured by IOL-Master 700, SS-OCT correlated significantly with LOCS III classification and phacodynamic parameters of the Centurion system, especially with CDE, TUST, and TTUT. AND can be used as an indicator for quantitative evaluation and help inform the surgical plan.

Comparisons of the energy efficiency and intraocular safety of two torsional phacoemulsification tips

BackgroundDuring cataract phacoemulsification surgery, an Intrepid® balanced (IB) tip can achieve a larger amplitude, which may lead to higher energy efficiency than a Kelman (K) tip when paired with a torsional phaco platform. In this retrospective cohort study, we compared their energy efficiency and damage to the cornea under a new energy setting.MethodsThe medical records of 104 eyes of 79 patients were reviewed, with 47 eyes belonging to the IB group and 57 eyes belonging to the K group. All surgeries were performed on an Alcon Centurion® platform with gravity infiltration. Surgical parameters, visual outcome, central corneal thickness (CCT) changes, and endothelial cell density (ECD) loss rate were recorded and calculated.ResultsNo significant differences in postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), total ultrasound time, estimated fluid aspirated, CCT changes, or ECD loss rate were observed between the two groups. We divided the included eyes into soft nucleus and hard nucleus subgroups and found lower cumulative dissipated energy (CDE, 8.15 ± 8.02 vs 14.82 ± 14.16, P = 0.023), cumulative torsional energy (CTE, 8.06 ± 7.87 vs 14.13 ± 13.02, P = 0.027), and cumulative longitudinal energy (CLE, 0.09 ± 0.17 vs 0.69 ± 1.37, P = 0.017) in the IB group than in the K group, implying less energy used and higher energy efficiency of the IB tip.ConclusionLower CLE in the IB group indicates fewer phaco tip obstructions and a significantly higher capability to conquer hard nuclei with IB tips with statistical significance. With an ultra-perfusion cannula, the balanced tip does not cause more corneal damage.

Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study.

Purpose:To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip.Methods:Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively.Results:Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05).Conclusion:Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.

Comparison of clinical and functional results of conventional and femtosecond laser-assisted cataract phacoemulsification

To perform a comparative analysis of ultrasound and hydrodynamic parameters, and the outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study included 246 eyes. The first group consisted of 138 patients who underwent FLACS, second group - 108 patients after CPCS. Total ultrasound time was 95.36±47.93 and 113.3±97.71 seconds (p=0.04) in the 1st and the 2nd groups, respectively. The duration of torsional ultrasound was 84.72±50.03 seconds in 1st group (p=0.04) and 113.3±97.71 seconds in the 2nd group (p=0.04). Aspiration time was 208.3±95.86 seconds in the 1st group (p=0.04) and 258.43±158.81 seconds in the 2nd group (p=0.04). On the 3-4th day after the surgery, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly better in the 1st group - 0.62±0.21 (LogMAR 0.20±0.19) and 0.53±0.15 (LogMAR 0.30±0.21) (p=0.01), respectively, compared to the 2nd group with UDVA of 0.75±0.18 (LogMAR 0.10±0.16) and CDVA of 0.69±0.19 (LogMAR 0.20±0.15) (p=0.04). Central corneal thickness (CCT) was 573.41±33.12 and 632.43±58.30 μm in the 1st and 2nd groups, respectively (p=0.020). At 1 month post-op there were no statistically significant differences in UDVA (p=0.17), CDVA (p=0.40) or CCT (p=0.50) between the groups. Compared with CPCS, total ultrasound time (p=0.04), torsional ultrasound time (p=0.04) and aspiration time (p=0.04) were significantly lower in the FLACS group. CCT was significantly lower (p=0.02), while UDVA (p=0.04) and CDVA (p=0.01) were significantly higher in the FLACS group in the early post-operative period (3-4 days after surgery). There were no statistically significant differences in the parameters between the groups 1 month after the surgery.

Differences in energy and corneal endothelium between femtosecond laser-assisted and conventional cataract surgeries: prospective, intraindividual, randomized controlled trial.

To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) cataract surgery. Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus® femtosecond laser platform and Infinity® Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6mo after surgery. Secondary outcome measures included central corneal thickness (CCT), average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy (CDE), total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density (cells/mm2) between groups (2211.88±392.49 CP; 2246.31±403.48 FLACS) was not statistically significant (P=0.869). Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group (P<0.05). Other parameters did not show statistically significant difference between FLACS and CP. FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.

Contralateral eye comparison of the phacoemulsification metrics, patient experience and clinical outcomes in patients undergoing bilateral cataract surgery with two commonly used femtosecond laser systems.

PurposeThe purpose of the study was to compare phacometrics, patient experience factors and clinical outcomes in patients undergoing bilateral laser-assisted cataract surgery using two common femtosecond laser platforms.SettingThis study was conducted in Beverly Hills Institute of Ophthalmology, Beverly Hills, California, USA.Study designThis was a prospective, comparative, contralateral eye study.MethodsFemtosecond laser-assisted cataract surgery was performed in the first eye of 50 patients with bilateral cataract (mean age 69.9 ± 8.61 years) using either the Catalys (Johnson & Johnson Vision) or the LenSx (Alcon Laboratories, Inc.) laser system. The fellow eye was treated with the laser not used in the first eye. The primary outcome measures included overall procedural times, and the secondary outcome measures included patient experience with the two laser systems.ResultsThere were no statistical differences between the two groups in terms of patient interface preparation time and number of docking attempts as well as effective phaco time, average phaco power, total ultrasound time and nucleus removal time. However, the LenSx group demonstrated a significantly longer cortex removal time and higher perception of pressure and vision loss (p < 0.001) compared to the Catalys group. A significantly higher number of Catalys eyes achieved complete capsulotomy (p < 0.001). The ease of cortex removal was also better in the Catalys group. Postoperative visual acuity, keratometry, endothelial cell count and intraocular pressure were comparable in the two groups.ConclusionWith similar phacometric and clinical outcomes, both laser platforms were efficient, safe and effective during cataract surgery; however, the Catalys group demonstrated superior outcomes in terms of the patient experience, completeness of capsulotomy and ease of cortex removal.

Comparability of subjective and objective measurements of nuclear density in cataract patients

To evaluate the relationship between subjective and objective measurements of lens density and the energy of phacoemulsification. University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands. Cross-sectional study. The study population included 69 patients. Nuclear opalescence (NO) was graded with the Lens Opacities Classification System III (LOCS III). Thereafter, lens density was measured objectively with Scheimpflug imaging, anterior segment optical coherent tomography and spectral fundus reflectometry (SFR). Cumulative dissipative energy (CDE) and total ultrasound time (US t.t.) of the phacoemulsification were noted. The relationship between the different measurement techniques and energy of phacoemulsification was assessed using Spearman's correlation coefficients. We found moderate to strong correlations between LOCS III and objective measurements of the lens density (rho's from 0.53 to 0.78, p<0.05) and a moderate correlation between three objective measurement techniques (rho's between 0.29 and 0.57, p<0.05). There was a moderate correlation between CDE, US t.t. and lens density measurements (rho's from 0.29 to 0.55, p<0.05), and the highest correlation was found between CDE and NO scores. Exclusion of patients with advanced cortical and posterior subcapsular opacities improved the correlation between SFR and lens density measurements but not the correlation with the energy of phacoemulsification. Lens Opacities Classification System III has shown the highest correlation with phacoemulsification energy and may be a preferred technique for prediction of use of phacoemulsification energy. Advanced cortical and posterior opacities may interfere with the quality of objective measurements but do not affect the correlation between lens density measurements and phacoemulsification energy.

SUTURELESS CLEAR CORNEAL ULTRASONIC FRAGMENTATION FOR RETAINED LENS FRAGMENTS

To describe the safety and efficacy of removing posteriorly dislocated lens fragments with the use of intravitreal ultrasonic fragmentation through a limbal, clear cornea self-sealing incision. Patients presenting with posteriorly luxated nuclei were enrolled in this prospective case series. Preoperative examination included evaluation of the corneal endothelium by means of specular microscopy. A 3-port 25+ pars plana vitrectomy was initially performed. Following vitrectomy, sclerotomies were sealed using scleral plugs and a limbal/clear corneal incision was performed for the insertion of the fragmatome probe. The incision was slightly larger (1 mm) than the diameter of the fragmatome probe (20 gauge = 0.81 mm) to avoid wound overheating. At the end of the procedure, an appropriate intraocular lens either sulcus-fixated or angle-supported was implanted. Primary outcome measures were mean postoperative best-corrected visual acuity, intraoperative or postoperative complications, and intraoperative challenging features. In all eyes, fragmentation was completed successfully with a mean total ultrasound time of 113.4 seconds. Nucleus density was ≥3 in all cases (mean ± SD = 3.8 ± 0.4). Intraoperative challenges included viewing difficulties because of corneal distortion, fragment turbulence, and leakage through the limbal incision potentially compromising fundus visualization. There was statistically nonsignificant reduction in endothelial cell density ranging between 1932 ± 187 cells per square millimeter preoperatively to 1789 ± 213 cells per square millimeter at the first month postoperatively (P = 0.79). Clear corneal, sutureless ultrasonic fragmentation seems to be a novel, safe, and efficient method for the removal of hard posteriorly dislocated lens fragments, sparing the need for a 20-gauge scleral port.

Effect of balanced phacoemulsification tip on the outcomes of torsional phacoemulsification using an active-fluidics system

To compare the outcomes of torsional phacoemulsification with a new balanced tip (Intrepid) and a conventional tip (Kelman) using a single active-fluidics torsional phacoemulsification machine (Centurion). Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Prospective comparative case-control study. Patients with senile cataract had torsional phacoemulsification with the Kelman conventional tip or the new Intrepid balanced tip using the active-fluidics torsional machine. Intraoperative parameters, such as cumulative dissipated energy (CDE), total ultrasound (US) time, torsion use time, torsion amplitude, aspiration time, and fluid use, were noted and compared. Endothelial cell loss and central corneal thickness (CCT) changes were evaluated at 1month. The new tip showed significantly less CDE, total US time, torsion amplitude, aspiration time, and fluid use (8.55±6.9 [SD], 33.59±28.12seconds, 37.8±13.42, 173.19±47.26seconds, and 66.59±20.44mL, respectively) than the conventional tip (13.47±10.65, 42.8±33.46seconds, 42.58±16.38, 202.25±71.28seconds, and 97.14±36.86mL, respectively) (P<.01), especially in higher grades of cataract. Anterior capsulorhexis margin tear occurred in 2 patients with the new tip. There were no corneal burns in either group. The mean endothelial cell loss and the percentage change in CCT were not significantly different at 1month. The new balanced tip performed phacoemulsification more efficiently, especially in hard cataracts requiring higher energy and prolonged phacoemulsification time.

Application of different Scheimpflug-based lens densitometry methods in phacodynamics prediction.

PurposeTo evaluate the correlations between preoperative Scheimpflug-based lens densitometry metrics and phacodynamics.MethodsThe Lens Opacities Classification System III (LOCS III) was used to grade nuclear opalescence (NO), along with different methods of lens densitometry evaluation (absolute scale from 0% to 100%): three-dimensional (3D), linear, and region of interest (ROI) modes. Cumulative dissipated energy (CDE) and total ultrasound (US) time were recorded and correlated with the different methods of cataract grading. Significant correlations were evaluated using Pearson or Spearman correlation coefficients according to data normality.ResultsA positive correlation was detected between the NO score and the average density and the maximum density derived from the 3D mode (r=0.624, P<0.001; r=0.619, P<0.001, respectively) and the ROI mode (r=0.600, P<0.001; r=0.642, P<0.001, respectively). Regarding the linear mode, only the average density parameter presented a significant relationship with the NO score (r=0.569, P<0.001). The 3D-derived average density and maximum density were positively correlated with CDE (rho =0.682, P<0.001; rho =0.683, P<0.001, respectively) and total US time (rho =0.631 and rho =0.668, respectively). There was a linear relationship between the average density and maximum density of the ROI mode and CDE (rho =0.686, P<0.001; rho =0.598, P<0.001, respectively) and total US time (rho =0.642 and rho =0.644, respectively). The average density was the only parameter derived from the linear mode that showed a significant correlation with CDE (rho =0.522, P<0.001) and total US time (rho =0.450, P<0.001).ConclusionSpecific Scheimpflug-derived densitometric parameters of the nucleus correlated with phacoemulsification parameters. The use of the appropriate densitometry approach can predict more efficiently the phacodynamics.

Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification.

To compare the intraoperative performance and postoperative outcome after microcoaxial torsional phacoemulsification using either a Kelman or balanced phaco tip. Cataracts were treated using 2.2 mm microcoaxial torsional phacoemulsification using either a 45-degree mini-flared Kelman(®) or a 45-degree Intrepid(®) Balanced phaco tip. Intraoperative measurements included total ultrasound (US) time, cumulative dissipated energy (CDE), torsional US time, and balanced salt solution (BSS) use. The central endothelial cell density (ECD) and central corneal thickness (CCT) were evaluated preoperatively and postoperatively 1, 7, and 30d after surgery using noncontact specular microscopy. The 116 enrolled eyes (116 patients) were divided equally between the Kelman and balanced tip groups. Intraoperative measurements showed significantly less total US time, torsional US time, CDE, and BSS use in the balanced group than in Kelman group (P<0.05). The total US time, torsional US time, CDE, and BSS use were 17.45±14.53s, 16.63±13.97s, 6.38±5.26, and 48.21±17.21 mL in the Kelman group and 11.39 ± 9.60s, 10.90 ± 9.25s, 4.04 ± 3.42, and 41.36 ± 12.70 mL in the balanced group, respectively. Torsional phacoemulsification performed with a balanced tip provided more effective lens removal with less total US time, torsional time, CDE, and BSS use, as well as similar changes in ECD with a Kelman tip in all cataract grades. This special designed phaco tip for torsional phacoemulsification provides an alternative phaco tip for many surgeons' preference with straight phaco tip.

Incision-Site Descemet Membrane Detachment During and After Phacoemulsification: Risk Factors and Management.

To evaluate the occurrence of localized incision-site Descemet membrane detachment (DMD) during and after phacoemulsification and to study its relationship with phacoemulsification parameters. Forty-three, consecutive uneventful cases of phacoemulsification through 2.8-mm clear corneal incision were included in this prospective study. Preoperatively, the grade of cataract was assessed. The phacoemulsification parameters noted were phacoemulsification time, aspiration time, cumulative dissipated energy (CDE), ultrasound time, and total fluid volume. Anterior segment optical coherence tomography (AS-OCT) was performed on postoperative days 1 and 7 to study the course of the incision-site DMD. Fourteen of 43 cases (32%) showed localized incision-site DMD either intraoperatively or on AS-OCT on the first postoperative day. Of these, nine cases were detected intraoperatively, and six cases were detected on AS-OCT on the first postoperative day. All cases were of planar type and resolved spontaneously. A single case showed a concurrent DMD involving central cornea, which resolved without any surgical intervention. The occurrence of DMD was significantly higher in those with the total ultrasound time greater than 60 sec (P=0.038) (odds ratio: 7.639). The CDE was higher in cases with DMD; however, the result was not statistically significant (P=0.062). Torsional equivalent in level-3, total torsional time, equivalent torsional time, aspiration time, and the total fluid volume were comparable (P>0.05) between cases with and without incision-site DMD. Postphacoemulsification incision-site DMD may occur in up to one third of cases and is associated with increase in the total ultrasound time.

The bubble study: ultrasound confirmation of central venous catheter placement

Study objectiveThe objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department. MethodsThe study included a convenience sample of emergency department patients with supradiaphragmatic CVCs and a CXR for confirmation. Ultrasound was used for CVC confirmation by visualizing microbubble artifact in the right atrium after injection of saline through the distal port. To evaluate for pneumothorax (PTX), “sliding sign” of the pleura was noted on US of the anterior chest. Blinded chart review was performed to assess CXR timing, catheter position and CVC complications. Student's t test was used to compare US time to CXR performance time and radiologist reading time. ResultsFifty patients were enrolled; 4 were excluded because of inadequate views. Forty-six patients were included in the final analysis. Mean total US time was 5.0 minutes (95% confidence interval [CI], 4.2-5.9) compared to 28.2 minutes (95% CI, 16.8-39.4) for CXR performance with a mean difference of 23.1 minutes (95% CI, −34.5 to −11.8; P < .0002). When comparing only US CVC confirmation time to CXR time, US was an average of 24.0 minutes (95% CI, −35.4 to −12.7; P < .0001) faster. Comparing total US time to radiologist CXR reading time, US was an average of 294 minutes faster (95% CI, −384.5 to -203.5; P < .0000). There were a total of 3 misplaced lines and 2 patients with PTX, all of which were identified correctly on US. ConclusionUltrasound can confirm CVC placement and rule out PTX significantly faster than CXR, expediting the use of CVCs in the critically ill.

P.1.g.008 Effect of resveratrol on BDNF in a chronic unpredictable mild stress model: an immunohistochemical study

To compare clinical results of biaxial small-incision torsional phacoemulsification and biaxial small-incision longitudinal phacoemulsification.Department of Ophthalmology, School of Medicine, Namik Kemal University, Tekirdag, Turkey.Randomized controlled clinical trial.Eyes with high-density nuclear cataract were assigned to have biaxial longitudinal (microburst mode) or biaxial torsional phacoemulsification. The main outcomes included corrected distance visual acuity (CDVA), central corneal thickness (CCT), central endothelial cell density (ECD), total ultrasound time (UST), cumulative dissipated energy (CDE), percentage total equivalent power in position 3, and balanced salt solution volume. Postoperative follow-up was at 1 day, 1 week, and 1 and 3 months.Each group comprised 35 patients (35 eyes). Three months postoperatively, the mean CDVA for each group was 0.02 logMAR and the mean CCT returned to the preoperative level (P=.589 and P=.554, respectively). During the postoperative follow-up, the percentage of mean endothelial cell loss in both groups was between 35.4% and 39.1%; there was no statistically significant difference between the groups (P>.05). The mean CDE, UST, percentage total equivalent power in position 3, and balanced salt solution volume values were similar in the 2 groups (P>.05).The risk for high endothelial cell loss should be considered when the phacoemulsification of high-density nuclear cataracts is performed using either method.No author has a financial or proprietary interest in any material or method mentioned.

Endothelial cell loss: Biaxial small-incision torsional phacoemulsification versus biaxial small-incision longitudinal phacoemulsification

To compare clinical results of biaxial small-incision torsional phacoemulsification and biaxial small-incision longitudinal phacoemulsification. Department of Ophthalmology, School of Medicine, Namik Kemal University, Tekirdag, Turkey. Randomized controlled clinical trial. Eyes with high-density nuclear cataract were assigned to have biaxial longitudinal (microburst mode) or biaxial torsional phacoemulsification. The main outcomes included corrected distance visual acuity (CDVA), central corneal thickness (CCT), central endothelial cell density (ECD), total ultrasound time (UST), cumulative dissipated energy (CDE), percentage total equivalent power in position 3, and balanced salt solution volume. Postoperative follow-up was at 1 day, 1 week, and 1 and 3 months. Each group comprised 35 patients (35 eyes). Three months postoperatively, the mean CDVA for each group was 0.02 logMAR and the mean CCT returned to the preoperative level (P=.589 and P=.554, respectively). During the postoperative follow-up, the percentage of mean endothelial cell loss in both groups was between 35.4% and 39.1%; there was no statistically significant difference between the groups (P>.05). The mean CDE, UST, percentage total equivalent power in position 3, and balanced salt solution volume values were similar in the 2 groups (P>.05). The risk for high endothelial cell loss should be considered when the phacoemulsification of high-density nuclear cataracts is performed using either method. No author has a financial or proprietary interest in any material or method mentioned.

Impact of intelligent phacoemulsification software on torsional phacoemulsification surgery

The purpose of this study was to compare phacoemulsification energy parameters during torsional phacoemulsification with or without the use of intelligent phacoemulsification (IP) software. One hundred and twenty-eight eyes with nuclear grades ranging from 1 to 5 were enrolled in this randomized prospective study. Operated eyes were divided into two groups, ie, those operated on using IP software (Group 1, n = 67) and those operated on without IP software (Group 2, n = 61). The two groups were compared in terms of ultrasound energy level, ultrasound energy time, aspiration time, and amount of fluid used during surgery. Operated eyes were further grouped according to soft (grade 1 and 2, n = 37), medium (grade 3, n = 46), and hard (grade 4 and 5, n = 31) nuclear densities. Both the study and the control groups were similar in distribution of nuclear density (P > 0.05). Cumulative dissipated energy was measured as 14.06 ± 9.92 in Group 1 and 14.22 ± 10.99 in Group 2 (P = 0.92). Total ultrasound time was 49 seconds in Group 1 and 52 seconds in Group 2 (P = 0.58). Although the torsional amplitude used was similar (P = 0.86) when IP was either on (71%) or off (68.4%), aspiration time was found to be 4 minutes 17 seconds in Group 1 (P = 0.86) and 5 minutes and 17 seconds in Group 2 (P = 0.007). Total fluid used was measured as 91 cc (P = 0.86) in Group 1 and 109 cc (P = 0.02) in Group 2. The new IP software did not cause a difference in ultrasound energy levels. However, the new software was found to be advantageous in regards to fluid use and aspiration time.