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PubMed2002

New phacoemulsification technologies.

To examine recent developments in the field of phacoemulsification, a literature review was conducted for each system described. the review included peer- reviewed articles, information from manufacturers, and meeting presentations by surgeons. our personal experience with systems we have used forms the underlying basis of our evaluation. data for erbium: YAG laser phacoemulsification came from an interim summary of the U.S. Food and Drug Administration monitored study. Data for NeoSoniX came from a prospective evaluation of phacoemulsification in 25 eyes performed at the Oregon Eye Surgery Center. The development of new technology has allowed safer, more efficient phacoemulsification. Each surgeon should evaluate new developments to achieve the greatest possible benefit for patients.

Animals↗

PubMed2003

Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia.

PURPOSE: To assess patient comfort with and without intravenous (i.v.) cannulation during 1-quadrant sub-Tenon's anesthesia during phacoemulsification. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This prospective masked controlled clinical trial comprised 119 patients having elective clear corneal phacoemulsification. Fifty had sub-Tenon's anesthesia with an i.v. cannula; 23, sub-Tenon's anesthesia without an i.v. cannula; and 46, topical anesthesia of proparacaine 0.5% without an i.v. cannula. No patient received sedation. All patients had clear corneal phacoemulsification with foldable posterior chamber intraocular lens implantation. The patients' subjective pain experience was measured immediately after surgery by a single independent observer using a 10-point visual analog scale. RESULTS: The mean patient-reported pain was low in all 3 groups. The mean i.v. cannula-related pain score in the sub-Tenon's group with an i.v. cannula (1.00; range 0 to 8) was higher than the mean general pain score (0.46; range 0 to 5) and worst pain experienced during surgery score (0.64; range 0 to 3). In the topical anesthesia group, 8 patients (17%) reported greater discomfort directly or indirectly related to the subconjunctival antibiotic injection at the end of surgery. CONCLUSION: Patient-reported pain caused by placing an i.v. cannula in the sub-Tenon's group significantly altered overall patient comfort during the surgical experience. Thus, the routine use of i.v. access during clear corneal phacoemulsification under sub-Tenon's anesthesia should be avoided to improve patient satisfaction.

Adult↗

PubMed2004

Phacoemulsification with topical anesthesia performed by resident surgeons.

PURPOSE: To evaluate and compare the outcomes in phacoemulsification cases performed by resident surgeons using topical anesthesia or retrobulbar anesthesia. SETTING: Department of Ophthalmology, Emory University, Atlanta, and Department of Veterans Affairs Medical Center, Decatur, Georgia, USA. METHODS: This was a retrospective review of phacoemulsification cases performed by resident surgeons during 1 academic year. Variables analyzed included patient age and sex, preexisting conditions limiting final acuity, and type of anesthesia used. Outcomes measured included intraoperative and postoperative complications and final visual acuity. RESULTS: Of the 291 cases analyzed, 119 (40.9%) were retrobulbar and 172 (59.1%) were topical. Residents began using topical anesthesia after a brief introductory period with retrobulbar anesthesia. Vitreous loss occurred in 15 cases (5.1%), 8 retrobulbar (6.7%) and 7 topical (4.1%) (P =.42). Postoperative complications occurred in 30 cases (10.3%), 17 topical (9.9%) and 13 retrobulbar (10.9%) (P =.85). Overall, 245 cases (84.2%) achieved a final best corrected visual acuity (BCVA) of 20/40 or better. When cases with preexisting conditions limiting final acuity were eliminated, 92.1% achieved a final BCVA of 20/40 or better. More topical cases (112, 65.1%) than retrobulbar cases (64, 53.8%) achieved a final BCVA of 20/25 or better (P =.06), and more topical cases (149, 86.6%) than retrobulbar cases (96, 80.7%) achieved a final BCVA of 20/40 or better (P =.19). CONCLUSION: Topical anesthesia is safe and efficacious for phacoemulsification performed by resident surgeons early in training after a brief introduction to phacoemulsification using retrobulbar anesthesia.

Adult↗

PubMed2004

Oxidative tissue damage after phacoemulsification: influence of ophthalmic viscosurgical devices.

PURPOSE: To quantify the oxidative tissue damage after phacoemulsification, correlate the damage to the energy applied, and investigate the influence of ophthalmic viscosurgical devices (OVDs). SETTING: Department of Ophthalmology, University of Mainz, Mainz, Germany. METHODS: The study comprised 130 eyes operated on by 1 surgeon using the same phacoemulsification machine. Some eyes received an OVD before phacoemulsification and some did not. Energy values were expressed as phaco time; that is, ultrasound (US) time (seconds) after conversion to 100% phaco power. Patients were grouped as follows: Group 1, phaco time less than 20 seconds and no OVD; Group 2, phaco time 20 to 40 seconds and no OVD; Group 3, phaco time more than 40 seconds and no OVD; Group 4, phaco time 20 to 40 seconds and hydroxypropyl methylcellulose 2% (HPMC); Group 5, phaco time 20 to 40 seconds and sodium hyaluronate 1%. Aqueous humor from pseudophakic eyes served as a control. At the end of surgery, anterior chamber fluid was analyzed for lipid peroxides using the thiobarbituric acid method. RESULTS: Lipid peroxides were detected in all groups. The values were significantly higher in Group 2 than in Group 1 (P<.01) and in Group 3 than in Groups 1 and 2 (P<.01). The differences in lipid peroxide values between all phaco groups and the control group were statistically significant. Sodium hyaluronate 1% and HPMC 2% produced significantly lower lipid peroxide values than in the respective phaco groups that did not receive an OVD (both P<.01). CONCLUSIONS: Oxidative tissue damage occurred during phacoemulsification. The damage, which correlated with the US energy applied, can be reduced by the use of OVDs.

Aged↗

PubMed2004

Clinical comparison of Healon5 and Healon in phacoemulsification and intraocular lens implantation; Randomized multicenter study.

PURPOSE: To compare the overall clinical performance during phacoemulsification and intraocular lens (IOL) implantation, the effect on intraocular pressure (IOP), and the effect on corneal endothelium of Healon5 (sodium hyaluronate 2.3%) and Healon (sodium hyaluronate 1.0%) ophthalmic viscosurgical devices (OVDs). SETTING: Multicenter study. METHODS: In this randomized prospective clinical study, the performance of Healon5 (viscoadaptive; dispersive and cohesive) and Healon (cohesive) during cataract surgery was evaluated in 157 patients, 79 with Healon5 and 78 with Healon. Surgeons evaluated the following on a 5-point scale: retention during phacoemulsification (primary endpoint), ease of injection, anterior chamber maintenance during continuous curvilinear capsulorhexis (CCC), facilitation of IOL implantation, and ease of removal from the eye. Masked examiners other than the surgeon performed the following measurements: IOP preoperatively and 5 and 24 hours, 7 days, and 3 months postoperatively; corneal thickness before and 24 hours, 7 days, and 3 months postoperatively; and corneal endothelial cell count preoperatively and 3 months postoperatively. RESULTS: Intraocular retention during phacoemulsification was assessed as good or very good in 77% in the Healon5 group and 8% in the Healon group; the difference was statistically significant (P<.0001, Wilcoxon rank sum test). The Healon5 group had significantly better scores for anterior chamber maintenance during CCC (P<.0001) and facilitation of IOL implantation (P =.032), and the Healon group had significantly better scores for ease of injection (P<.0001) and ease of removal (P<.0001). There were no statistically significant between-group differences in IOP, corneal endothelial cell count, or corneal thickness. CONCLUSIONS: Surgeons rated Healon5 better than Healon in retention during phacoemulsification, anterior chamber maintenance during CCC, and facilitation of IOL implantation. They assessed Healon as easier to inject and remove. There was no difference in safety-related parameters between the 2 OVDs. These findings indicate that Healon5 is effective in cataract surgery.

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PubMed1995

Complications and results of phacoemulsification performed by residents.

The use of phacoemulsification by ophthalmic surgeons has increased markedly over the past five years. Previous studies have reported relatively high rates of vitreous loss by residents learning phacoemulsification. We retrospectively analyzed the complications and results in 300 cases of phacoemulsification with intraocular lens implantation performed by residents. The first 40 cases done by four residents in their second year of training were compared with approximately the last 40 cases done by each resident at the end of the third year. The overall rate of surgical complications was 6.3%, and the total rate of vitreous loss was 3.3%. The rate of surgical complications during the initial surgeries in the second year of residency was 9.3%; it was 3.3% by the end of the third year. The rate of vitreous loss was 5.3% in the second year and 1.3% during the third year. Postoperatively, 90.6% of all eyes had a final best corrected visual acuity of 20/40 or better (95% excluding patients with pre-existing ocular disease). With proper training and supervision, the rate of surgical complications for residents learning phacoemulsification is acceptably low when compared with the rate of extracapsular cataract extraction.

Clinical Competence↗

PubMed1996

Combined endocapsular phacoemulsification, pars plana vitrectomy, and intraocular lens implantation.

OBJECTIVE: To determine whether a combined vitrectomy and phacoemulsification is a safe and feasible approach in patients requiring a vitrectomy who have a concomitant significant lens opacity. SETTING: Royal Victoria Eye and Ear Hospital, Dublin, Ireland. METHODS: This retrospective study comprised five patients with significant lens opacities who had combined trans pars plana vitrectomy and phacoemulsification with intraocular lens implantation. Main outcome measures were visual acuity and intraoperative and postoperative complications. RESULTS: The combined surgical approach resulted in minimal complications, and postoperative visual acuity was satisfactory. CONCLUSION: In the hands of experienced phacoemulsification and vitrectomy surgeons, combined trans pars plana vitrectomy and phacoemulsification can be a safe approach in treating patients requiring a vitrectomy who have significant lens opacities precluding a view of the posterior segment.

Adult↗

PubMed1996

Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: aqueous flare and cells.

PURPOSE: To compare the postoperative blood-aqueous barrier (BAB) breakdown induced by phacoemulsification with continuous curvilinear capsulorhexis (CCC) and by extracapsular cataract extraction (ECCE) with a linear capsulotomy. SETTING: Cataract and Refractive Surgery Research Unit, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: Anterior chamber flare and cells were measured preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively in two parallel groups of 31 consecutive cataractous eyes. In Group 1, one surgeon performed ECCE with a linear capsulotomy; in Group 2, a second surgeon performed divide and conquer phacoemulsification with CCC. The preoperative, intraoperative, and postoperative medication regimen was the same in both groups. RESULTS: Group 2 eyes had significantly lower anterior chamber flare and cell measurements in the first postoperative month than Group 1 eyes (.01 < P < .00001). CONCLUSIONS: Phacoemulsification with CCC induced a less severe BAB breakdown than ECCE with a linear capsulotomy. Phacoemulsification with CCC may be preferable in high-risk eyes such as those with glaucoma, diabetes, or uveitis, which are prone to complications resulting from postoperative BAB breakdown.

Aged↗

PubMedDate not supplied

Incidence of lens matter dislocation during phacoemulsification.

PURPOSE: To assess the incidence and visual morbidity of lens matter dislocation during phacoemulsification and the relationship between this complication and surgical experience. SETTING: Teaching and district general hospitals. METHODS: A multiple-choice questionnaire was sent to members of the Northern and Midlands Ophthalmological Societies. They were asked about the incidence of lens matter dislocation, the visual outcome of the cases, and their surgical experience. RESULTS: Forty-seven of the 177 survey respondents (26.5%) were using phacoemulsification. The incidence of lens matter dislocation was 1.1%; 49.0% of the surgeons had experienced at least one case. The incidence increased significantly when surgeons assessed their expertise with phacoemulsification toward the expert end of the scale. Final visual acuity was worse than 6/12 in 35.0% of cases. CONCLUSIONS: The incidence of lens matter dislocation with phacoemulsification is significant and related to an incorrect assessment of expertise by the surgeons. The considerable visual morbidity associated with this complication can be minimized using the management strategy discussed.

Clinical Competence↗

PubMed1997

Corneal endothelial changes after divide and conquer versus chip and flip phacoemulsification.

PURPOSE: To evaluate changes in central corneal endothelial cells and corneal thickness after divide and conquer phacoemulsification and chip and flip phacoemulsification. SETTING: Houston Eye Clinic, Houston, Texas, USA. METHODS: Forty-four eyes were randomly assigned to one of two groups to have divide and conquer (D/C Group) or chip and flip (C/F Group) phacoemulsification with implantation of a posterior chamber, foldable, silicone intraocular lens performed by one surgeon. Of these, 41 eyes of 37 patients (22 D/C Group, 19 C/F Group) met the inclusion criteria. All surgeries were uneventful. A complete eye examination including specular microscopy and pachymetry was performed preoperatively and 1 week and 1 and 3 months postoperatively. RESULTS: There were no significant between-group differences in any of the following means: sex; age; time at 70% phaco power; total phacoemulsification time. No correlation was found between ultrasound time and increased corneal thickness except for a significant increase in percentage of hexagonal cells in the C/F Group at 1 month. The only statistically significant between-group differences were greater endothelial cell loss in the C/F Group at 1 month and the percentage change in hexagonal cells at 1 week (1.1% increase, D/C Group; 10.7% decrease, C/F Group). CONCLUSION: The divide and conquer technique led to less endothelial loss and hexagonal cell change than the chip and flip technique, although at 3 months the differences were not significant.

Aged↗

PubMedDate not supplied

Half-life of intracameral gentamicin after phacoemulsification.

PURPOSE: To determine the half-life of intracameral gentamicin administered during phacoemulsification. SETTING: Southampton Eye Unit, Southampton General Hospital, England. METHODS: Thirty-one patients having scleral tunnel phacoemulsification were given intracameral gentamicin in the irrigation fluid. Samples of fluid were taken from the anterior chamber at the end of the operation and at various times postoperatively. The concentration of gentamicin in the samples was determined by fluorescence polarization immunoassay and the half-life calculated for a single compartment model using a peeling algorithm. RESULTS: The concentration of gentamicin in the anterior chamber after phacoemulsification decreased by half every 51 minutes (95% confidence interval, 42 to 66 minutes). CONCLUSION: Intracameral gentamicin was cleared from the anterior chamber after phacoemulsification at a rate that prevents the maintainance of the bactericidal levels required for reliable antibiotic prophylaxis.

Anterior Chamber↗

PubMed1997

Temporal versus superior approach phacoemulsification: short-term postoperative astigmatism.

PURPOSE: To compare short-term clinical, postoperative astigmatism, and uncorrected visual acuity results 2 months after no-stitch phacoemulsification using a temporal clear corneal approach and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation through a 5.2 mm incision with those after no-stitch superior corneoscleral phacoemulsification. SETTING: University Eye Clinic of Palermo, Italy. METHODS: This prospective clinical trial comprised 80 patients with senile cataract who were randomly assigned to have phacoemulsification using a temporal approach or a superior approach. Surgically induced astigmatism (SIA) was calculated using Naeser's polar value method for determining with-the-rule (WTR) or against-the-rule (ATR) change. RESULTS: There was a highly significant between-group difference in SIA at each examination (P < .001; t-test) because of positive (WTR) SIA in the temporal approach group and negative (ATR) SIA in the superior approach group. No other significant differences between groups were found (P < .05, t-test). More patients in the temporal group had an uncorrected visual acuity of 20/25 or better 2 weeks postoperatively, although the difference between groups was not statistically significant (P = .562; chi-square). CONCLUSION: Phacoemulsification using a no-stitch, temporal, 5.2 mm clear corneal incision produced results comparable to those using a corneoscleral superior approach. A longer study of a larger series should be done to confirm the findings.

Aged↗

PubMed1998

Surgical outcomes of cataract extractions performed by residents using phacoemulsification.

PURPOSE: To assess whether changes in surgical technique, resident training, and phacoemulsification equipment affected the complication rate for cataract extractions performed by residents. SETTING: Combined urban and rural setting at a tertiary care academic center and a general care Veterans Administration Hospital, Salt Lake City, Utah, USA. METHODS: This retrospective study analyzed 396 patients who had cataract surgery by phacoemulsification and intraocular lens implantation performed by four residents. The residents' first 50 cases were compared with the last 50 cases performed at the end of their training. Surgical and 1 day postoperative complications were examined. RESULTS: Twenty of 396 surgical cases (5.1%) involved complications, and the overall vitreous loss rate for the four residents was 1.8%. A statistically significant difference was observed between the two residents with the highest and lowest number of intraoperative complications (P < .05) and between the two residents with the highest and lowest number of 1 day postoperative complications (P < .05). The rate of posterior capsule rupture with vitreous loss was 2.6% in the residents' early cases; the decrease to no cases of posterior capsule rupture in the late cases was also statistically significant (P < .02). CONCLUSION: The results indicate that with proper training and supervision, residents can obtain an acceptably low complication rate using phacoemulsification. As their skill increased, they were able to use phacoemulsification successfully on more complicated cases. Individual skill was also an important factor in the complication rate.

Clinical Competence↗

PubMed1998

Phacoemulsification in eyes with pseudoexfoliation.

PURPOSE: To compare intraoperative and postoperative complications in eyes with and without pseudoexfoliation having cataract surgery by phacoemulsification. SETTING: Department of Ophthalmology, National Hospital, Oslo, Norway. METHODS: Of 1152 consecutive phacoemulsification procedures, 164 cases with pseudoexfoliation (Group 1) and 916 cases without (Group 2) were followed for 4 months after cataract surgery in a prospective study. Of all cataract operations performed during that time, 96.2% were phacoemulsification procedures; 90.4 and 97.4% in eyes with and without pseudoexfoliation, respectively (P < .0005). RESULTS: The frequency of capsular/zonular tear or vitreous loss was 9.6 and 3.7% in Groups 1 and 2, respectively (P = .0002). A visual acuity of 0.5 or better was achieved in 86.5% of eyes in Group 1 and 92.4% in Group 2 (P = .02). There were no statistically significant between-group differences in the frequency of a postoperative inflammatory response 1 day (6.7 versus 4.4%), 1 week (2.4 versus 1.6%), or 4 months (1.8 versus 0.9%) postoperatively. CONCLUSION: Phacoemulsification was safe in most eyes with pseudoexfoliation even though significantly more complications occurred intraoperatively in these eyes. The low frequency of an inflammatory response indicates that the presence of pseudoexfoliation does not significantly increase the risk of inflammation.

Adolescent↗

PubMed1998

Comparison of energy required for phaco-chop and divide and conquer phacoemulsification.

PURPOSE: To evaluate the safety and usefulness of phaco-chop cataract extraction. SETTING: A university-associated, multispecialty ophthalmology practice. METHODS: Fifty-three patients in a university-associated ophthalmology practice had cataract extraction, 32 by the phaco-chop technique and 21 by four-quadrant divide and conquer phacoemulsification. Phacoemulsification energy and complication rates were compared. RESULTS: Mean phacoemulsification energy was significantly lower in the phaco-chop group (mean 782 J +/- 446 [SD]) than in the divide and conquer group (mean 3264 +/- 1218 J)(P < .00001). No complications occurred in either group. CONCLUSION: The phaco-chop technique provided safe, effective cataract extraction with significantly less energy than that required for divide and conquer phacoemulsification.

Humans↗

PubMed1999

Correlation between early, measurable improvement in quality of life and speed of visual rehabilitation after phacoemulsification.

PURPOSE: To assess whether improvements in measurable health-related quality-of-life (HR-QoL) functions parallel the rapid visual recovery after phacoemulsification. SETTING: The Cataract Treatment Center, Sunderland Eye Infirmary, Sunderland, England. METHODS: This study comprised 144 patients having first-eye phacoemulsification cataract extraction. They were assessed using a standard EuroQoL generic (non-disease specific) multidimensional HR-QoL instrument to evaluate preoperative and 1 month postoperative health profile measures in social, psychological, and general health aspects. RESULTS: Within 1 month of phacoemulsification, change in vision was accompanied by significant changes in HR-QoL functions such as home activities, social activities, self-care, mobility, and psychological well-being. CONCLUSION: The speed of visual rehabilitation after phacoemulsification was paralleled by improvement across HR-QoL functions, resulting in the rapid recovery of functional independence and health status.

Adult↗

PubMed2000

Latanoprost versus timolol gel to prevent ocular hypertension after phacoemulsification and intraocular lens implantation.

PURPOSE: To evaluate the efficacy of latanoprost and timolol gel in preventing ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. SETTING: Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China. METHODS: This prospective randomized double-masked clinical trial comprised patients with uncomplicated cataract having phacoemulsification with PC IOL implantation. They were randomly assigned to 1 of 3 groups: postoperative application of timolol 0.5% gel-forming solution (Timoptol-XE(R)) (Group 1), latanoprost 0.005% (Group 2), and control (Group 3). Intraocular pressure (IOP) was measured 2, 4, and 24 hours postoperatively. The anterior chamber was examined for the levels of cells and flare using slitlamp biomicroscopy. RESULTS: Group 1 had a significantly greater reduction in mean IOP 2, 4, and 24 hours after phacoemulsification and PC IOL implantation than Group 3 (P <.05). There were no significant differences between Groups 2 and 3 at any interval (P. 05). No excessive postoperative anterior chamber inflammation was observed in any group. CONCLUSIONS: A single dose of latanoprost given after phacoemulsification and PC IOL implantation did not produce a significant IOP-lowering effect when compared with a control group in the first 24 hours postoperatively. A single dose of timolol gel produced a significant postoperative IOP decrease as soon as 2 hours and up to 24 hours after surgery. Timolol gel and latanoprost are safe, but timolol is more effective than latanoprost in preventing postoperative ocular hypertension.

Adrenergic beta-Antagonists↗

PubMed1999

Macular edema induced by phacoemulsification.

PURPOSE: To characterise the association between lens phacoemulsification and the development of macular edema. METHODS: We studied 15 patients who underwent lens phacoemulsification in our clinic between January and April 1998 performed by the same surgeon. Ultrasound power and cumulative time was noted. Follow-up was performed at 1 day, 1 week, 1, 3 and 6 months after operation. On each visit corneal thickness, best corrected visual acuity, biomicroscopy and fluorescein angiography were performed. Patients with systemic diseases and/or retinal diseases were not included. RESULTS: Visual acuity was inversely related to the amount of energy delivered during phacoemulsification. In patients who had received more than 1 Joule of energy, fluorescein angiography revealed a higher incidence of blood retinal barrier breakdown. Corneal thickness was not correlated with the ultrasound energy used. CONCLUSIONS: Excessive use of power during phacoemulsification may hamper the postoperative evolution of cataract surgery.

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