Undergoing Phacoemulsification Cataract Surgery Research Articles

Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

PurposeTo assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD).MethodsThis prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group.ResultsMultiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis.ConclusionsRisk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.

Development and Progression of Diabetic Retinopathy 12 Months after Phacoemulsification Cataract Surgery

To assess whether phacoemulsification cataract surgery exacerbates the development and progression of diabetic retinopathy (DR) in a cataract surgical cohort. Clinic-based cohort study. Patients aged 65+ years undergoing cataract surgery at an eye clinic in Sydney, Australia, between 2004 and 2006. Digital retinal photography was performed after pupil dilation preoperatively and at 1-, 6-, and 12-month postoperative visits. DR was assessed using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Preoperative and 1-month postoperative (baseline) photographs were compared side-by-side with 12-month postoperative photographs. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for DR progression in operated (pseudophakic) compared with nonoperated (phakic) eyes, adjusted for age, sex, diabetes duration, and preoperative glycosylated hemoglobin level. Incident DR was defined in eyes without DR at baseline in which DR was detected at 12-month postoperative visits. DR progression was defined as an increase of 1 or more ETDRS steps during the same period, including incident cases. Of 1994 surgical patients recruited, 190 (9.53%) with diabetes and complete data and thus were included. There were 56 patients with unilateral surgery performed before baseline (mean postoperative duration 3.3+/-3.3 years). The prevalence of DR at baseline was higher in these 56 pseudophakic eyes than in 324 phakic eyes (71.4% vs. 48.2%, respectively, adjusted OR 2.16; 95% CI, 1.16-4.03). Of the 190 patients, 169 were followed for 12+ months postoperatively; 278 eyes were pseudophakic, and 60 eyes remained phakic at 12 months. During the 12-month postoperative period, incident DR developed in 28.2% of pseudophakic eyes and 13.8% of phakic eyes (adjusted OR 2.65; 95% CI, 1.06-6.61). In a paired-eye comparison of 45 patients who remained unilaterally pseudophakic at 12 months and were at risk of DR progression, 35.6% of pseudophakic eyes exhibited DR progression compared with 20.0% of the fellow phakic eyes (adjusted OR 2.21; 95% CI, 0.85-5.71). Diabetic patients undergoing phacoemulsification cataract surgery appear to have a doubling of DR progression rates 12 months after surgery. This outcome, however, represents less progression than was previously documented with intracapsular and extracapsular cataract surgical techniques.

Profilaxis de la endoftalmitis postquirúrgica con cefuroxima intracamerular: experiencia de cinco años

To present the outcomes of prophylaxis of postoperative endophthalmitis following cataract surgery with intracameral Cefuroxime. A retrospective study was done on 4281 eyes that underwent cataract surgery from October 2003 to September 2008. All patients underwent phacoemulsification cataract surgery. All cases received an injection of 0.1 ml intracameral Cefuroxime (1 mg) at the end of surgery except those patients allergic to penicillin and cephalosporin until September 2007 and thereafter only those with demonstrated allergy to cefuroxime. The rate of postoperative endophthalmitis was 0.11% (5 cases). Four of them had a positive culture. We found no evidence of clinical ocular toxicity. Intracameral cefuroxime works very well for reducing the incidence of postoperative endophthalmitis. It appears safe to use and is easy to prepare.

Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac

To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery. This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery. The difference in mean pupil size, at the end of surgery, between the control group (6.84 +/- 0.93 mm) and the nepafenac group (7.91 +/- 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group. Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis.

Prophylaxe der postoperativen infektiösen Endophthalmitis durch intrakamerale Cefuroximgabe – auf dem Weg zum Therapiestandard?

Several studies investigating the antibiotic prophylaxis of acute postoperative endophthalmitis provide very different results concerning the incidence and prophylaxis of this very severe complication of cataract surgery. For a long time the preoperative use of povidione-iodine had been the only procedure with overall acceptance and proven benefit. Following findings in Sweden that supported the advantages of the use of intracameral cefuroxime, the European Society of Cataract and Refractive Surgeons (ESCRS) performed a study to confirm the Swedish results and to lead to a revision of ESCRS guidelines. In a randomised, partially masked and placebo-controlled study 16,211 patients undergoing phacoemulsification cataract surgery were included. 25 ophthalmological units in 9 European countries took part in this study. The study consists of a 2 x 2 factorial design, dividing patients into 4 treatment groups. Two out of the 4 groups were treated with 1 mg intracameral cefuroxime (in 0.1 mL isotonic NaCl solution). In parallel, two groups (one treated with cefuroxime, one untreated) received topical levofloxacin 0.5% in a standard regimen. If clinical signs like pain or loss of vision indicated a postoperative endophthalmitis, suspicious results were confirmed by culture, Gram stain and PCR. In a follow-on study, Sundelin (Sweden) and colleagues included 30 patients who received topically-applied levofloxacin 0.5% following the ESCRS dosing scheme, in addition to intracameral administration of cefuroxime. Aqueous humour samples were taken at the end of surgery and at a second time point postoperatively. The levofloxacin concentration was measured by HPLC. The median maximal concentration (Cmax) was compared with the MIC90-values of relevant bacterial isolates. 29 patients developed a postoperative endophthalmitis, of whom 20 were classified as having a proven infectious cause. The absence of a prophylactic intracameral cefuroxime administration at 1 mg in 0.1 mL isotonic NaCl was associated with a 4.92-fold increase in the risk of postoperative endophthalmitis (95% CI 1.87-12.9). A clear corneal incision (CCI) or the use of silicon based IOL optic material accounted as additional risk factors for postoperative endophthalmitis. While the use of CCI was associated with a 5.88-fold higher risk of infection compared to STI (scleral tunnel incision), the implantation of silicon based IOL was associated with a 3.13-fold higher risk. Intraoperative complications were also associated with a higher risk of postoperative endophthalmitis (4.95-fold higher risk). Intracameral injection of cefuroxime reduces the risk of postoperative infectious endophthalmitis following phacoemulsification cataract surgery. Additional risk factors are the use of CCI and silicon based IOL implants.

The IOL-Vip System: A Double Intraocular Lens Implant for Visual Rehabilitation of Patients with Macular Disease

To investigate the efficacy of a new surgical and rehabilitative procedure designed to improve vision in patients with central scotoma due to macular diseases. Case series of 40 consecutive surgical and rehabilitative procedures. Forty eyes of 35 consecutive patients with a stable central scotoma due to macular disease underwent phacoemulsification cataract surgery with the implant of the IOL-Vip System. The IOL-Vip System consists of a biconcave high minus-power intraocular lens (IOL) in the capsular bag and a biconvex high plus-power IOL in the anterior chamber, reproducing an intraocular Galilean telescope with x1.3 magnification for distance. Selection of the candidate patients was carried out by means of a low-vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates the residual visual function of patients and prognosis for visual improvement based on simulation of the postoperative condition. The software also designs the rehabilitation strategies based on preoperative and postoperative training of the preferred retinal locus. Best-corrected visual acuity (BCVA), evaluated by means of the Early Treatment Diabetic Retinopathy Study charts and procedure; reading magnification; and reading distance. All patients showed an improvement of visual acuity (VA) due to the surgical and rehabilitative procedure, confirming or exceeding the preoperative expected results. Mean postoperative BCVA was 0.77 (logarithm of the minimum angle of resolution), compared with 1.28 preoperatively. The mean postoperative best reading magnification gain was x6.2, and the mean postoperative reading distance gain was 7.66 cm. No cases of intraoperative or postoperative complications were detected, and the implant was subjectively well tolerated in both monocular and binocular procedures. In this pilot study, the IOL-Vip System was shown to be effective and apparently well tolerated in improving the vision of patients with macular disease. Best-corrected VA, reading magnification, and reading distance improved in all cases of this low-vision patient series.

Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery

Aim:To determine the elimination kinetics of intracameral vancomycin administered as a bolus injection at the end of phacoemulsification cataract surgery.Methods:Vancomycin 1 mg/0.1 ml saline solution was administered to 19 patients...

Pain Induced by Phacoemulsification Performed by Residents Using Topical Anesthesia

To evaluate patient-reported pain induced by phacoemulsification performed by residents using topical anesthesia. This prospective study comprised 81 eyes of 76 consecutive patients having phacoemulsification under topical anesthesia. Surgery was performed by an experienced surgeon (group 1; n=41 eyes) or by two residents (group 2; n=40 eyes). No sedation or intracameral anesthesia was used in either group. Eighty eyes had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Patients were asked postoperatively to grade the pain they experienced during the procedure using a visual analog pain scale from 0 to 10. The median pain score for the overall pain was 1.59 +/- 1.43 (range: 0 to 6) in group 1 and 1.95 +/- 1.64 (range: 0 to 7) in group 2 (P = .291). The mean pain score for the maximum pain perceived was 2.39 +/- 1.86 (range: 0 to 7) in group 1 and 2.53 +/- 1.67 (range: 0 to 7) in group 2 (P = .734). There was no significant correlation between the duration of surgery and the overall pain score (r = 0.102, P = .365). Topical anesthesia had sufficient analgesic effects in selected patients undergoing phacoemulsification cataract surgery by resident surgeons. The pain felt during the operation was low and tolerable.

Effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer

PURPOSE: To determine the effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer. DESIGN: Cohort study. METHODS: Thirty-four eyes of 33 patients undergoing phacoemulsification cataract surgery with intraocular lens were imaged using the GDx Nerve Fiber Analyzer within 4 weeks before and at least 4 weeks after cataract surgery. Preoperative and postoperative mean images were compared. The effects of cataract severity and type, and intraocular lens material, were also examined. RESULTS: Comparison of preoperative and postoperative mean scanning laser polarimetry measurements revealed that eyes in which acrylic intraocular lenses (n = 11) were placed had a significant increase in scanning laser polarimetry for the total band circumference, and superior, inferior, and nasal quadrants ( P ≤ .041). Placement of silicone (n = 15) and polymethylmethacrylate (n = 8) intraocular lenses did not result in statistically significant changes in scanning laser polarimetry measurements. However, eight of 34 eyes (23.5%) had changes of 15% or more postoperatively in the total circumference measurement, including eyes with acrylic, silicone, and polymethylmethacrylate intraocular lenses. CONCLUSIONS: Cataract extraction with intraocular lens was associated with a statistically significant change in mean scanning laser polarimetry values in eyes that received an acrylic intraocular lens. In individual patients, clinically important changes (15% or greater) in scanning laser polarimetry measurements were not uncommon irrespective of intraocular lens type. New baseline scanning laser polarimetry measurements may be warranted in eyes that undergo cataract extraction with intraocular lens.

Calculation of Intraocular Lens Power After Radial Keratotomy With Computerized Videokeratography

Because standard methods to determine intraocular lens power are not adequate in eyes that have had radial keratotomy, we undertook this study to evaluate the corneal power derived from computerized videokeratography for use in intraocular lens power calculations. We examined four eyes of three patients who had radial keratotomy and who underwent phacoemulsification cataract surgery with implantation of a posterior chamber intraocular lens. We used a computerized videokeratography-derived corneal curvature value in the Holladay formula for intraocular lens calculations. We determined the ideal intraocular lens power and the keratometric value that would have led to the ideal intraocular lens power from the postoperative refraction at 6.1 +/- 1.1 months after cataract extraction. The ideal keratometric value was compared with the keratometric values derived from computerized videokeratography, standard keratometry, contact lens overrefraction, and refractions before and after radial keratotomy. The postoperative refraction at approximately six months averaged -0.32 +/- 0.63 diopter (range, -0.88 to +0.75 diopter) different than the aim. The mean power in ring 3, which was the closest keratometric value to the ideal, disclosed only 0.09 +/- 0.73 diopter and -0.10 +/- 0.72 diopter of deviation from the ideal keratometric and intraocular lens powers, respectively. One to two weeks after phacoemulsification cataract surgery with implantation of a posterior chamber intraocular lens, the videokeratographic differential map disclosed steepening at the wound site with variable regression by six months in all patients. Results suggest that, after radial keratotomy, using the keratometric value derived from computerized videokeratography in intraocular lens calculations is more accurate than using keratometric values measured by routine methods.

Wide angle high speed lens

To investigate the efficacy of a new surgical and rehabilitative procedure designed to improve vision in patients with central scotoma due to macular diseases.Case series of 40 consecutive surgical and rehabilitative procedures.Forty eyes of 35 consecutive patients with a stable central scotoma due to macular disease underwent phacoemulsification cataract surgery with the implant of the IOL-Vip System.The IOL-Vip System consists of a biconcave high minus-power intraocular lens (IOL) in the capsular bag and a biconvex high plus-power IOL in the anterior chamber, reproducing an intraocular Galilean telescope with ×1.3 magnification for distance. Selection of the candidate patients was carried out by means of a low-vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates the residual visual function of patients and prognosis for visual improvement based on simulation of the postoperative condition. The software also designs the rehabilitation strategies based on preoperative and postoperative training of the preferred retinal locus.Best-corrected visual acuity (BCVA), evaluated by means of the Early Treatment Diabetic Retinopathy Study charts and procedure; reading magnification; and reading distance.All patients showed an improvement of visual acuity (VA) due to the surgical and rehabilitative procedure, confirming or exceeding the preoperative expected results. Mean postoperative BCVA was 0.77 (logarithm of the minimum angle of resolution), compared with 1.28 preoperatively. The mean postoperative best reading magnification gain was ×6.2, and the mean postoperative reading distance gain was 7.66 cm. No cases of intraoperative or postoperative complications were detected, and the implant was subjectively well tolerated in both monocular and binocular procedures.In this pilot study, the IOL-Vip System was shown to be effective and apparently well tolerated in improving the vision of patients with macular disease. Best-corrected VA, reading magnification, and reading distance improved in all cases of this low-vision patient series.