Underwent Phacoemulsification Surgery Research Articles

Pain Perception and Acceptance of Illness in Patients Undergoing Phacoemulsification Cataract Surgery under Drip Anesthesia.

For many years, cataracts have been the main cause of vision loss and vision impairments in the world (43% and 33%, respectively). Currently, the most common surgical method for treating cataracts is phacoemulsification. The aim of this study was to assess the pain perception and acceptance of illness connected with awaiting phacoemulsification cataract surgery under intravenous drip anesthesia, as well as to determine the effect of selected sociodemographic factors on the above. Methods: The study was conducted in a group of patients of the Department of Ophthalmology, University Clinical Hospital in Białystok, Poland suffering from cataracts, who underwent phacoemulsification surgery under intravenous drip anesthesia. The study group consisted of 151 people. The study used an original short questionnaire and three standardized psychometric scales: The acceptance of illness scale (AIS), the Beliefs about Pain Control Questionnaire (BPCQ), and the Coping Strategies Questionnaire (CSQ). Results: The median overall AIS point value was 24 points, which is considered an average score in terms of disease acceptance. Respondents assessed the influence of individual factors on the level of perceived pain and the impact of individual strategies for coping with pain similarly. The level of perceived pain decreased with the patient’s age. People with a higher education level experienced a greater level of pain; however, this relationship was not statistically significant. The place of residence did not affect the level of pain experienced during the procedure. Women had a greater level of acceptance of illness. The respondents’ education level negligibly differentiated the approach to the disease. The place of residence also did not affect the assessment of illness acceptance as measured by the AIS. Whether the surgery pertained to the first or second eye did not significantly affect the approach to the disease. Conclusions: The level of acceptance of illness and pain perception were at a moderate level among the patients. The acceptance of illness was significantly influenced by the age of patients and the waiting period for phacoemulsification, and this level of acceptance decreased significantly with the increasing age of patients. The longer the waiting period for surgery, the lower the acceptance of illness. Sex significantly differentiated the level of pain experienced during the procedure. Education and place of residence did not significantly affect the acceptance of illness and the feeling of pain.

Safety & efficacy of single subconjunctival triamcinolone 5 mg depot vs topical loteprednol post cataract surgery: less drop cataract surgery.

To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide (SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. A total of 400 patients were randomized into 2 groups; Group A (200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine (0.5%) with ofloxacin (0.3%) combination for 3wk. Group B (200 patients) received tapering topical loteprednol etabonate (0.5%) along with ofloxacin (0.3%) and ketorolac tromethamine (0.5%) for 3wk. Outcomes evaluated were intraocular pressure (IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12wk. Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A (P=0.82) and Group B (P=0.61) and postoperative IOP values in between both groups (P=0.14) at 1wk. Incidence of cells/flare postoperative was statistically not significant (P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. SCTA appears to be an effective alternative to prolong postoperative topical steroid use.

Optical coherence tomography based analysis of changes in macula in diabetes after phacoemulsification surgery

Purpose: To assess quantitative changes of the macula after cataract surgery using optical coherence tomography (OCT) in diabetic eyes and to estimate the incidence of development of macular edema (ME) in type II diabetic eyes. Materials and Methods: In this prospective observational case control study, 100 eyes out of which 50 are of type II diabetic patients and 50 are non-diabetic patients who underwent phacoemulsification surgery with acrylic foldable IOL lens implantation were evaluated at post op day 1, day 7, 1 month and 3 months post operatively. Macular thickness as described in early treatment of diabetic retinopathy study (ETDRS) with OCT was evaluated in 9 zones. 4 patients developed DME at 1 month after surgery and were withdrawn from further analysis. Result: The mean central foveal thickness of the diabetic group preoperatively was 231.06±38.785µ. The increase in central foveal thickness was statistically significant at 1 month postoperatively (p=0.004). The mean perifoveal thickness changes in the inferior and temporal quadrants was also statistically significant at 1 month postoperatively (p=0.002). However, the overall change in macular thickness was found to be insignificant at 3 months postoperatively. The incidence of diabetic macular edema was found to be 8%. Conclusion: We found that after uncomplicated phacoemulsification, changes in macular thickness as measured by OCT was without any significance. Keywords: Cataract, Diabetes, Macular edema, OCT.

Intracameral air injection after completion of phacoemulsification cataract surgery: Evaluation of corneal incisions with optical coherence tomography

PurposeTo evaluate the effects of air bubbles on clear corneal incision (CCI) in patients who had phacoemulsification surgery, and to compare this type of CCI architecture with patients who had no air bubbles after phacoemulsification surgery, using anterior segment optical coherence tomography (AS-OCT). MethodsEyes which had undergone uneventful phacoemulsification cataract surgery with implantation of a posterior chamber intraocular lens (IOL) were equally randomized into two groups. Group 1 comprised patients with anterior chamber air bubble injection after phacoemulsification, and Group 2 comprised patients who had undergone phacoemulsification surgery without anterior chamber air bubble. Postoperative evaluation included AS-OCT (Heidelberg Engineering, Germany) and pneumatic tonometry (Nidek NT-1000 Pneumatic Tonometer, Japan) in the 2nd hour, then at 1 week, and 1 month. Astigmatic changes assessed with corneal topography after phacoemulsification cataract surgeries were noted. ResultsEvaluation was made of 40 eyes of 28 patients (10 female, 18 male) as 20 eyes in Group 1 and 20 eyes in Group 2. On the first postoperative day, the endothelial gap rate was 13.3% in Group 1 and 57.1% in Group 2 (P = 0.02), and this continued until the 1-month follow-up examination. The Descemet's membrane detachment (DMD) rate was 0% in Group 1 and 42.8% in Group 2 on postoperative day 1 (P = 0.006), and this continued at the 1-month follow-up examination. At 1 month postoperatively, the rates of optical coherence tomography (OCT) parameters were similar. There were no significant differences between preoperative astigmatism and postoperative astigmatism in the group analyses. ConclusionIn this study, air bubbles decreased the rate of DMD and of endothelial and epithelial gap during the early postoperative period.

Impact of 0.1% sodium hyaluronate and 0.2% sodium hyaluronate artificial tears on postoperative discomfort following cataract extraction surgery: a comparative study

BackgroundRecent artificial tear preparations have provided 0.2% concentration of sodium hyaluronate. However, no published data exist on their potential superiority against 0.1% in alleviating dry-eye-disease symptoms in cataract extraction surgery.MethodsA total of 180 patients that underwent cataract extraction surgery were randomly divided into 2 groups according to their postoperative regime: Study group (SG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.2% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. Control group (CG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.1% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. The following indexes were evaluated at 3 postoperative checkpoints: 1) Surface discomfort index (SDI) which was derived by four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Schirmer’s test, 4) Central corneal thickness (CCT), and 4) Central Corneal Sensitivity (CCS).ResultsBoth groups showed reduced CCS values at all postoperative examination points; however, SG participants had significantly better CCS (all p < 0.05). SG had better TBUT than CG at the 3rd (p = 0.03) and 6th examination points (p = 0.04). Moreover, SG had better SDI scores at the 3rd (SDI = 9.26 ± 0.55) and 6th weeks (SDI = 9.47 ± 0.48) vs. CG participants (p = 0.03 and p < 0.01, respectively).ConclusionThe increased 0.2% sodium hyaluronate concentration in the artificial tears provided in the COMOD® device seems to address dry-eye-disease symptoms better in patients who underwent phacoemulsification surgery than the 0.1% concentration.Trial registrationClinicalTrials.govIdentifier:NCT03705949 Oct 15, 2018, retrospectively registered.

Oral Acetazolamide Administration to Control Intraocular Pressure on First Day Post Phacoemulsification Surgery : Is It Necessary ?

&#x0D; &#x0D; &#x0D; Introduction : The incidence of early postoperative intraocular pressure (IOP) increase is reported to be 2.3–8.9% in phacoemulsification surgery. This increase typically peaks at 3–7 hours after surgery and persists during the first 24 hours. Although most eyes can tolerate the transient IOP elevation that occurs after cataract surgery, IOP spikes are potentially more dangerous if it persist. In order to minimize postoperative intraocular pressure (IOP) rise, routine medication by oral acetazolamide has been widely used among ophthalmologists. Objective of this study is to investigate the relationship between IOP changes on first day after phacoemulsification with administration of oral acetazolamide. &#x0D; Method : This is a descriptive study. The samples were include 50 patients diagnosed with cataract who underwent phacoemulsification surgery with intraocular lens implantatios. Samples were randomized divided into two groups. First group is patient who treated with 250 mg acetazolamide post operative and other group is untreated. All respondents must have no history of glaucoma or ocular hypertensive and attend follow up on the first day postoperative. IOP is measured with non-contact tonometer. &#x0D; Results : Mean age of respondents is 61  9.8 years old. Preoperative IOP mean is 18.04  3.6 mmHg and postoperative IOP mean is 18.58  6.9 mmHg. This study revealed that there is no significant relation between oral administration of acetazolamide and the lowering of intraocular pressure on first day post phacoemulsification(p = 0.2) Visual acuity pre operative and nuclear density of cataract are also no relationship with the IOP on first day postoperative (p = 0.2 ) &#x0D; Conclusion : The use of oral acetazolamide is not significantly related to the IOP on first day post phacoemulsification surgery. &#x0D; &#x0D; &#x0D;

Balanced Salt Solution-Assisted Intraocular Lens Implantation in Phacoemulsification Surgery: Intraocular Pressure and Endothelial Cell Effects.

Objectives:The purpose of this study was to evaluate the effect of balanced salt solution (BSS)-assisted intraocular lens (IOL) implantation on postoperative intraocular pressure (IOP) and endothelial cells and to compare BSS-assisted IOL implantation with the use of ophthalmic viscosurgical devices during IOL implantation.Methods:A total of 52 eyes of 40 patients (25 female, 15 male) with a cataract who underwent phacoemulsification surgery with BSS-assisted (26 eyes) or viscoelastic-assisted IOL implantation (26 eyes) were evaluated. BSS-assisted IOL implantation was performed with the aid of irrigation cannula and BSS without using a viscoelastic substance. Viscoelastic-assisted IOL implantation was performed according to standard procedures to facilitate IOL implantation. IOP measurements and endothelial changes after phacoemulsification surgery, as well as the surgical time were noted and compared. The eyes were also evaluated in terms of cataract density preoperatively and phaco parameters were assessed peroperatively.Results:The mean age of the patients was 67.5±7.8 years in the BSS-assisted group and 67.8±9.4 years in the viscoelastic group. The mean preoperative IOP and postoperative IOP on day 1, week 1, and month 1 was 14.2±2.3, 14.7±3.1, 13.2±1.5, and 13.8±2.7 mmHg, respectively, for the BSS-assisted group and 14.1±2.9, 19.1±3.4, 13.8±3.1, and 13.2±2.9 mmHg, respectively, for the viscoelastic-assisted IOL implantation group. The IOP increase was significantly greater on the first day in the viscoelastic-assisted IOL implantation group (p=0.007). The surgical time was 12.3±2.1 minutes in the BSS group and 14.6±3.1 minutes in the viscoelastic group (p=0.035). The difference in endothelial changes was not statistically significant between groups (p=0.88).Conclusion:IOL implantation using BSS in phacoemulsification surgery is a reliable technique, and this method has a significantly shorter surgery time and a much smaller postoperative IOP increase. The reduced IOP increase after cataract surgery might be particularly helpful for glaucoma patients.

Accuracy of Intraocular Lens Power Calculation Formulae

Aim: To investigate the accuracy of seven currently-used intraocular lens (IOL) power calculation formulae. Patients and methods: A total of 429 eyes of 429 patients were retrospectively analyzed. A low-optical coherence reflectometry device (Lenstar, Haag-Streit) was used for the calculations. SRK/T, Hoffer Q, Haigis, Holladay-2, Olsen, Hill-RBF and Barrett Universal II formulae were studied. The study included patients who underwent phacoemulsification surgery with a 2.8 mm corneal cut by a single surgeon. Refraction measurement was done at the first postoperative visit, and then spherical equivalent values were recorded for each patient. Mean absolute error (MAE) was calculated as the absolute value of postoperative spherical equivalent value minus predicted error for each formula. Results: The mean age of the patients was 67.51 ± 5.75 years. Mean axial length was 23.42 ± 2.02 mm (min: 20.03, max: 32.68, median: 23.09). Mean IOL power was 21.1 ± 5 diopters (min: -1.5, max: 3.5). Postoperative spherical values were between -1.50 and +1.00 diopters. Mean absolute errors were 0.317 for SRK/T, 0.280 for Holladay-2, 0.273 for Hoffer Q, 0.264 for Haigis, 0.347 for Barrett Universal II, 0.339 for Hill-RBF, and 0.351 for Olsen. Conclusion: Hoffer Q, Holladay-2, and Haigis formulae had significantly lower MAE values than SRK/T, Barrett Universal II, Hill-RBF, and Olsen formulae. Although the Haigis formula gave the lowest MAE value, there was no significant difference with the Hoffer Q and Holladay-2 formulae.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain.

To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus.

Objective:To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients.Methods:This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed.Results:Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant.Conclusion:There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery.

YKL-40 is a local marker for inflammation in patients with pseudoexfoliation syndrome.

To investigate the YKL-40, as a marker of inflammation, in aqueous humor and serum of cataract patients with and without pseudoexfoliation syndrome (PEX). Aqueous humor and serum samples were obtained from 44 patients who underwent phacoemulsification surgery. All patients were divided into two groups: PEX (n = 24) and control (n = 20). YKL-40 levels were measured with enzyme-linked immunosorbent assay (ELISA). The differences between the groups were assessed by using Chi-square and independent sample t-tests. The Pearson correlation coefficient was used to evaluate the correlation between variables. There was a significant difference between the mean YKL-40 levels in the aqueous humor of PEX group (112.0 ± 35.8 ng/mL) and control subjects (88.2 ± 30.6 ng/mL) (P = 0.025). However, the difference between the mean YKL-40 levels in the serum of PEX group (53.5 ± 29.1 ng/mL) and control subjects (44.6 ± 30.2 ng/mL) was non-significant (P = 0.326). The correlation between aqueous humor and serum YKL-40 concentrations was significant in both the groups (r = 0.833, P < 0.001; r = 0.840, P < 0.001, respectively). Increased aqueous humor levels of YKL-40 demonstrate that it is local, but not a systemic marker for inflammation in patients with PEX.

Cystoid macular edema following selective laser trabeculoplasty in a patient with ocular hypertension

Presentation of a case with ocular hypertension who developed cystoid macular edema (CME) following selective laser trabeculoplasty (SLT). A 62-year-old male patient who had undergone phacoemulsification surgery for traumatic cataract 9 years ago was on ocular hypertension treatment for the last 5 years. Due to uncontrolled intraocular pressure and side effect of medications, a 360° SLT was performed. The patient returned with decrased visual acuity 1 week after the procedure. There was CME in the treated eye. It healed completely after topical prednisolone acetate QID and nepafenac QID for 1 week, and no recurrence was observed during follow-ups. Cystoid macular edema may occur following SLT treatment in patients with previous traumatic cataract surgery which responds to topical treatment.

Use of the Posterior/Anterior Corneal Curvature Radii Ratio to Improve the Accuracy of Intraocular Lens Power Calculation: Eom's Adjustment Method.

To evaluate the accuracy of IOL power calculation using adjusted corneal power according to the posterior/anterior corneal curvature radii ratio. Nine hundred twenty-eight eyes from 928 reference subjects and 158 eyes from 158 cataract patients who underwent phacoemulsification surgery were enrolled. Adjusted corneal power of cataract patients was calculated using the fictitious refractive index that was obtained from the geometric mean posterior/anterior corneal curvature radii ratio of reference subjects and adjusted anterior and predicted posterior corneal curvature radii from conventional keratometry (K) using the posterior/anterior corneal curvature radii ratio. The median absolute error (MedAE) based on the adjusted corneal power was compared with that based on conventional K in the Haigis and SRK/T formulae. The geometric mean posterior/anterior corneal curvature radii ratio was 0.808, and the fictitious refractive index of the cornea for a single Scheimpflug camera was 1.3275. The mean difference between adjusted corneal power and conventional K was 0.05 diopter (D). The MedAE based on adjusted corneal power (0.31 D in the Haigis formula and 0.32 D in the SRK/T formula) was significantly smaller than that based on conventional K (0.41 D and 0.40 D, respectively; P < 0.001 and P < 0.001, respectively). The percentage of eyes with refractive prediction error within ± 0.50 D calculated using adjusted corneal power (74.7%) was significantly greater than that obtained using conventional K (62.7%) in the Haigis formula (P = 0.029). IOL power calculation using adjusted corneal power according to the posterior/anterior corneal curvature radii ratio provided more accurate refractive outcomes than calculation using conventional K.

Comparison of corneal endothelial cell count and intraocular pressure in pure-dispersive and dispersive-cohesive viscoelastic protection in phacoemulsification surgery

There are so many aspects should be regarded when use viscoelastic device during phacoemulsification surgery. The advantages and disadvantages of pure-dispersive viscoelastic and dispersive-cohesive viscoelastic always require more our attention to use it conveniently. The purpose of the study was to compare between pure-dispersive viscoelastic versus dispersive-cohesive viscoelastic in phacoemulsification surgery in that of corneal endothelial cell count and intraocular pressure (IOP) change. This was a cross-sectional study involving 41 eligible patients who underwent phacoemulsification surgery by single operator. Data including characteristics of cataract patients, corneal endothelial cell count and IOP were taken before and after surgery. Data of characteristics of cataract patients were reported descriptively and compared using Anova and t-test. The mean change in corneal endothelial cell count on pure-dispersive viscoelastic group (71.99±71.20 cells/mm²) was lower than that on the dispersive-cohesive viscoelastic group (117.62±78.29 cells/mm²). However, it was not significantly different. The mean change in IOP on pure-dispersive viscoelastic group (0.75±1.626 mmHg) was significantly lower than that on dispersive-cohesive viscoelastic group (1.90±0.995 mmHg) (p=0.000). In conclusion, the increase of IOP in dispersive-cohesive viscoelastic group is higher than that on pure-dispersive viscoelastic group. However, there is no significant difference of the mean change in corneal endothelial cell on the both groups.

Comparison of biometric predictability and final refraction expected in phacoemulsification surgery with and without trabeculectomy

Abstract Objective: The main purpose of this article is to compare the predictability of biometric results and final refractive outcomes expected in patients undergoing cataract surgery through phacoemulsification with and without associated trabeculectomy. Methods: Cataract patients who have undergone phacoemulsification surgery alone (control group) or associated with trabeculectomy (study group) screened. All surgeries were performed following standard protocol. For enrollment, biometrics calculated by IOL Master (Carl Zeiss Meditec, Inc.) biometry, refraction and intraocular pressure (IOP) before and after surgery were required. Data was compared between groups in addition to the correlation between variation of IOP and final refraction. Results: Thirty eyes per group were enrolled. Only prior IOP (p <0.001), IOP post-surgery (p = 0.01) and the difference in IOP (p <0.001) were statistically significant. Axial length, IOL diopter used, expected spherical refraction by biometrics and astigmatism pre- and post-surgery were similar in both groups (p=0.1; 0.4; 0.4; 0.5 and 0.3, respectively). Spherical predictability by biometrics within 0.25 diopters was noted in both the control group (range 0.06 ± 0.45) and study group (range 0.25 ± 0.97, p = 0.3). There was no statistical significance between groups for the difference between final cylinder and corneal astigmatism (p = 0.9), and the difference between axis of refractive and corneal astigmatism (p = 0.7). Conclusion: The biometric predictability in phacoemulsification surgery and the expected final refraction are significant, andare not modified by trabeculectomy in the combined surgeries.

Comparison of SRK/T and Haigis formulae in the prediction of refractive outcome after phacoemulsification

Purpose To compare the accuracy of SRK/T and Haigis formulae used for intraocular lens (IOL) power calculation by a partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods A prospective interventional clinical study included 70 eyes of 60 patients, who underwent uncomplicated phacoemulsification with IOL implantation from October 2015 to December 2017. Preoperative axial length (AL), corneal curvature (keratometry), and preoperative anterior chamber depth (preoperative ACD) were measured using Nidek AL-scan optical biometer and the IOL power was determined using both SRK/T and Haigis formulae. The difference between the predicted value and the postoperative spherical equivalent was calculated for both the formulae by the end of the follow-up (3 months postoperatively). Results The mean errors of the two formulae were SRK/T: −0.225±0.61 D and Haigis: 0.171±0.68 D; the mean absolute errors of the two formulae were 0.534±0.36 and 0.533±0.44 D, respectively. There was no statistically significant difference between the mean error of the two formulas used in the overall performance, but was significant in eyes with an AL of more than 25 mm. The proportion of patients having a prediction error within ±0.50 D of SRK/T formula (54.29%) was comparable to those of Haigis (55.71%) and the prediction errors within ±1.0 D were 87.14 and 85.71%, respectively. There is a weak correlation between the mean AL, keratometry and the Haigis–SRK/T prediction differences (r 2=0.273). Conclusion The calculation of IOL power using SRK/T and Haigis formulae resulted in an accurate postoperative refraction. In long AL subcategory, the mean absolute error of Haigis was less compared with the SRK/T formula.

Comparison of Preoperative Infusion of Magnesium Sulfate and Mannitol on Intraocular Pressure Changes in Patients Undergoing Phacoemulsification Surgery.

Background:The present study has been designed to compare the effect of magnesium sulfate with mannitol on reducing intraocular pressure (IOP).Materials and Methods:During the phacoemulsification surgery, 105 patients randomly divided into three groups receiving 20% mannitol at a dose of 0.3 g/kg, 50% magnesium sulfate at a dose of 20 mg/kg, and placebo (normal saline), with the same volume (100 ml) and infusion time (10 min), were used for the first, second, and third groups, respectively. The IOP was measured before and immediately after the injection and 5 min after the end of the surgery and compared between the groups.Results:The mean IOP immediately after the injection had a significant difference in three groups (mannitol: 15.2 ± 2.5, magnesium sulfate: 14.7 ± 1.9, and normal saline: 13.8 ± 2.8; P = 0.044), and the IOP had a significant difference between normal saline and mannitol groups (0.027) while there was no significant difference between mannitol and magnesium sulfate groups (P = 0.34) and also between magnesium sulfate and normal saline groups (P = 0.2).Conclusion:Using magnesium sulfate had no effect on changes in the IOP and hemodynamic of patients during the surgery. Using mannitol may be effective in reducing IOP while no effect of magnesium sulfate on IOP was found.

Evaluation of small-volume (3 ml) ophthalmic anaesthesia for both subtenon anaesthesia using blunt-tipped curved needle and single medial canthal injection with sharp needle for phacoemulsification surgery

Introduction Medial canthus injection as well as subtenon anaesthesia has been used in anterior segment surgery. In this research, we compared the effectiveness and safety of small volume (3 ml) for either technique. Patients and methods Forty eyes of 40 patients undergoing phacoemulsification surgery at the Research Institute of Ophthalmology, Giza, Egypt, were divided into two groups: group A (20 eyes) included eyes of patients who received subtenon injection with blunt-tipped curved needle and group B (20 eyes) included eyes of patients who received single injection at medial canthus with sharp needle. Following either injection, the akinesia score and surgeon and patient satisfaction scores were reported as well as any related complications. The studied data were subjected to statistical analysis and results emphasized. Results In our study, the akinesia score had a mean value of 6±2.43 for subtenon group and 3.25±2.61 for the single injection medial canthus group, with a highly significant difference (P 0.05). Conclusion For phacoemulsification, subtenon anaesthesia using small volume of 3 ml was more effective regarding better akinesia score compared with a similar volume of medial canthus injection, with lower rate of supplemental injection as well as better patient and comparable surgeon satisfaction. The main disadvantage was a higher rate of pain to injection as well as more need for facial supplementation.

Advanced Subconjunctival Anesthesia for Cataract Surgery.

Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position. Nonrandomized case series at a rural health service. Advanced subconjunctival anaesthesia was performed on 60 elective adult patients undergoing phacoemulsification surgery. The technique involves piercing the conjunctiva and Tenon's capsule in the superior outer quadrant of the globe with a 25-gauge, 16 mm needle, using either lignocaine 2% plain or in equal mix with bupivicaine 0.5%. Up to 10 mL of anesthetic with hyaluronidase 30 IU/mL is injected in a posterior direction into the sub-Tenon's space. Ocular motor functions were assessed 10 minutes after ASCAN using a Brahma scale. Pain was assessed during surgery and at the end of surgery after subconjunctival injection of antibiotic and steroid using a verbal Numeric Rating Scale. All patients completed surgery without needing supplemental anesthesia. Fifty-eight patients (97%) were pain free, whereas 2 patients experienced transient mild pain. Adequate globe akinesia and reliable lid paralysis was achieved comparable to other studies, with no major surgical or anesthetic complications. Advanced subconjunctival anesthesia is a visually guided, minimally invasive technique, achieving satisfactory analgesia and akinesia for phacoemulsification surgery.

Accuracy of the SRK/T Formula Using Partial Coherence Interferometer, Al-Scan after Phacoemulsification

Purpose: To evaluate the accuracy of SRK/T formula used for IOL power calculation by partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods: A prospective interventional clinical study included 40 eyes of 34 patients who underwent uncomplicated phacoemulsification with IOL implantation from March 2015 to March 2017. Biometries were measured using ultrasound or AL-scan and intraocular lens power was calculated using the SRK-T formula. Patients were divided into 2 groups based on device used for IOL power calculation: AL-scan or ultrasound ; Axial length: >=25 mm or < 25mm; or lens opacity: Cataractous or clear lens. The mean error (ME) was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error by the end of the followup (3 months postoperative). Results: Mean axial length measured preoperatively was 27.47 ± 316mm (21.55-34.05) mm. 60 percent of the patients were within 0.5 D of the predicted refractive error and 90 percent were within 1.0 D. There was no statistically significant difference in the overall performance of the SRK/T formula between the mean error when dividing the patients into 2 groups according to: device used for IOL power calculation (P= 0.274); Axial length (P= 0.46); or lens opacity (P= 0.18) in precision of predicting postoperative refraction. Conclusions : SRK/T formula helps in improvement of the accuracy of IOL power calculation and decreasing the postoperative refractive error. By using SRK/T formula, there was no statistically significant difference between the AL-scan or applanation ultrasound used in biometry.