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PubMedDate not supplied

Comparison of the clinical performance of Healon 5 and Healon in phacoemulsification.

PURPOSE: Healon 5 is a high-molecular-mass fraction of sodium hyaluronate. Its density endows it with a number of viscoelastic characteristics. In this prospective, randomised clinical study we compared the performance of Healon 5 and Healon in phacoemulsification. SETTING: Institute of Ophthalmology, University of Modena and Reggio Emilia, Italy. METHODS: Two groups of patients underwent phacoemulsification and intraocular lens (IOL) implantation. In the first 27 patients Healon 5 was used as viscoelastic substance during surgery, and in the second 27 Healon was used. The surgeons subjective comments on the performance of these viscoelastic agents were recorded at the different steps of surgery: injection, capsulorhexis, phacoemulsification, IOL implantation, removal of viscoelastic agent and trasparency throughout the operation. The surgeon's overall impression of the viscoelastics during the whole operation was noted. Tonometry and endothelial cell count were performed in all patients before and after operation. RESULTS: There was no statistical difference between the two groups as regards visual acuity, ocular pressure and endothelial damage. Healon 5 showed excellent ability to maintain the anterior chamber during capsulorhexis, phacoemulsification and IOL implantation. Removal time with Healon 5 was not appreciably longer than Healon. CONCLUSIONS: Healon 5 emerges as a very interesting viscoelastic substance. Visibility is better if the anterior chamber is filled completely. Removal is easier if it is aspirated while moving the irrigation aspiration tip with circular movements over the top and around the border of the IOL.

Adult↗

PubMedDate not supplied

A comparison of endophthalmitis after phacoemulsification or extracapsular cataract extraction in a socio-economically deprived environment: a retrospective analysis of 2446 patients.

PURPOSE: To assess which cataract operation technique involves least risk of postoperative endophthalmitis, when performed in a population living in poor hygiene conditions. METHODS: This retrospective clinical study evaluated 2446 cases at the Eye Clinic of the Komotini General Hospital, Greece, between January 1998 and January 2001. RESULTS: Endophthalmitis arose in 12/1055 patients (1.13%) after extracapsular cataract extraction (ECCE) and in 8/1391 after phacoemulsification (0.57%). The mean time to onset of endophthalmitis was 23 and 73 days respectively after phacoemulsification and ECCE. This difference was statistically significant. CONCLUSIONS: Endophthalmitis develops considerably later after ECCE than phacoemulsification. Thus it would appear that hygiene conditions have a stronger effect in patients operated with the ECCE technique. In order to reduce the risk of endophthalmitis after cataract extraction in patients living in substandard conditions, phacoemulsification is proposed as preferable to ECCE.

Cataract Extraction↗

PubMedDate not supplied

Phacoemulsification in previously vitrectomized patients: an analysis of the surgical results in 100 eyes as well as the factors contributing to the cataract formation.

PURPOSE: To evaluate the safety and effectiveness of phacoemulsification with clear corneal incision in previously vitrectomized patients as well as factors affecting the development time and type of cataract occurring after pars plana vitrectomy (PPV). METHODS: The authors conducted a prospective study of 100 consecutive eyes of patients who developed a cataract after PPV. Three groups were established based on the underlying vitreoretinal pathology. The main outcome measurements were intraoperative and postoperative complications and changes in best-corrected visual acuity (BCVA). RESULTS: The median interval between PPV and phacoemulsification was 11.5 months. Patients with proliferative diabetic retinopathy required phacoemulsification earlier (p=0.018). Posterior subcapsular cataracts developed more frequently in patients <50 years (73.7%, p=0.000) and affected those who underwent vitrectomy primarily for complicated retinal detachment (48.8%, p=0.046). Intraoperative complications included posterior capsular tears (4%), luxated nucleus into vitreous (2%), and zonular dialysis (5%). Postoperative complications were vitreous hemorrhage (6%), retinal redetachment (4%), pupillary synechiae (6%), ocular hypertension (4%), and Seidel phenomenon (3%). Posterior Nd:YAG laser capsulotomy was required in 44% of eyes. BCVA was improved in 85% of cases at the end of follow-up (median, 15.5 months). Twenty-one patients with one functioning eye (61.9%) demonstrated visual improvement compared with 79 patients with bilateral vision (91.1%; p=0.003). CONCLUSIONS: The technique allows stable improvement in BCVA through long follow-ups. It is more risky than in nonvitrectomized eyes. The visual results after phacoemulsification in vitrectomized eyes seem to be limited by retinal comorbidity and surgical complications.

Adult↗

PubMedDate not supplied

Surgically induced astigmatism after manual extracapsular cataract extraction or after phacoemulsification procedure.

Astigmatic changes in three series of cataract surgical procedures were compared. The first two series comprised eyes having a manual extracapsular cataract extraction (ECCE) through a 12.0 mm or 8.0 mm incision and implant of a PMMA posterior chamber lens. The third series comprised eyes having phacoemulsification through a scleral pocket and implant of a PMMA posterior chamber lens. Preoperative keratometry measurements and corneal topography maps were compared with those obtained two days, one week, one, three and six months postoperatively. The keratometry measurements, obtained with computerized videokeratography, revealed: on day 2, 4.89 D (1st series), 3.95 D (2nd series), 2.66 D (3rd series); one week, respectively 4.46 D, 3.51 D and 2.14 D; one month, 0.65 D, 0.53 D and 0.05; three months, 1.44 D, 0.35 D and 0.36 D; six months, 1.36 D, 0.42 D and 0.48 D. The surgically-induced cylinder at three months was four times greater in the manual ECCE 12.0 mm incision series than in the phacoemulsification series. However, by six months all differences were markedly reduced. The results add to the growing evidence that the phacoemulsification procedure produces less astigmatism and more rapid visual rehabilitation than the manual ECCE procedure. Topographic analysis showed much less corneal steepening after phacoemulsification than after manual ECCE. However, all three surgical procedures offered satisfactory clinical results.

Aged↗

PubMed2005

Comparative evaluation of efficacy and safety of ophthalmic viscosurgical devices in phacoemulsification [ISRCTN34957881].

BACKGROUND: Various ophthalmic viscosurgical devices (OVD) are used to perform phacoemulsification and other intraocular surgeries. We performed a study to compare the efficacy and safety of three ophthalmic viscosurgical devices that are routinely used in phacoemulsification. METHODS: Fifty-six patients of immature senile cataract with hard nucleus (grade 3 and 4) who underwent phacoemulsification were included. Depending upon the type of OVD, patients were randomly allocated into three groups; group 1 (n = 19), Viscoat was used; group 2 (n = 19), Healon GV was used; group 3 (n = 18), Healon 5 was used. Parameters evaluated were uncorrected and best corrected visual acuity, specular microscopy, intraocular pressure and pachymetry both preoperatively and postoperatively on day 1, 1 week, 1 month and 3 months and development of any complication both intraoperative and postoperative were also noted. RESULTS: The mean increase in central corneal thickness was 15.17% (group 1); 17.26% (group 2) and 16.21% (group 3) on first postoperative day and was comparable in the three groups. The density of endothelial cells decreased postoperatively (day 1) by 12.54% (group 1), 13.76% (group 2) and 13.06% (group 3) and was comparable. The mean preoperative intraocular pressure in groups 1, 2 and 3 were 13.3 +/- 2.0, 14.0 +/- 2.2 and 13.2 +/- 3.2 mmHg respectively, which changed to 16.0 +/- 4.7, 12.2 +/- 4.7 and 12.3 +/- 4.8 respectively on first postoperative day and the change in intraocular pressure was significantly higher in group 1 (1 vs 2 & 1 vs 3; p = 0.02; oneway ANOVA). CONCLUSION: Viscoat, Healon GV and Healon 5 give comparable results in terms of efficacy and safety in performing phacoemulsification.

Acrylic Resins↗

PubMed2005

[Comparison between the pain induced by phacoemulsification with topical anesthesia and by peribulbar anesthesia without sedation].

PURPOSE: To compare pain sensation induced by phacoemulsification with topical anesthesia with that by peribulbar anesthesia, without sedation. METHODS: Using a 10-level visual pain analogue scale, the pain induced by phacoemulsification with topical anesthesia (2% tetracaine drops) was measured in 20 patients. The same scale was used to measure the pain induced by peribulbar anesthesia (2% lidocaine and 0.5% bupivacaine) in 21 patients. The same surgeon performed peribulbar infiltrations and surgeries. The phacoemulsifications were done using clear corneal approach followed by in-the-bag intraocular lens implantation. Pain comparison between the two groups was performed by the non-parametrical U Mann-Whitney test. RESULTS: The distribution of the pain scores of the patients who underwent cataract extraction with topical anesthesia ranged from 0 to 5 (median value = 2). The scores of the patients who underwent peribulbar infiltration ranged from 0 to 7 (median value = 3). The mean rank of the group of patients who had surgery with topical anesthesia (15.78) was significantly different from the mean rank of the patients who received peribulbar anesthesia (25.98) (p = 0.0057). CONCLUSION: Without sedation, the pain induced by phacoemulsification with topical anesthesia was milder than the pain induced by peribulbar infiltration.

Aged↗

PubMed2004

[Combined surgery for cataract and glaucoma: phacoemulsification, foldable intraocular lens implantation and viscocanalostomy].

OBJECTIVE: To assess the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with viscocanalostomy (P-C group), compared with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T group). METHODS: Combined phacoemulsification with corneal incision, foldable intraocular lens implantation and viscocanalostomy was performed in 21 eyes of 19 cataract patients with primary open-angle glaucoma. All patients were followed up for 3 - 6 months. RESULT: Intraocular pressure (IOP) was significantly lower in both P-C group and P-T group (P=0.000). There was no statistically significant difference between two groups. Visual outcome was similar in both groups. Complications of P-C group included Descemet's membrane puncture in 2 eyes, Schlemm's tube puncture in 2 eyes and IOP spikes in 3 eyes (at 24 hours postoperatively). The P-C group experienced significantly less inflammation than the P-T group. CONCLUSION: Phacoemulsification-IOL implantation combined with viscocanalostomy is a safe and effective surgery, with lower complicatin rate and easier ambulatory care.

Aged↗

PubMedDate not supplied

Intraoperative arcuate transverse keratotomy with phacoemulsification.

PURPOSE: To evaluate the efficacy of paired intraoperative arcuate transverse keratotomy at a 7-mm-diameter zone along with a 3.5-mm clear corneal phaco tunnel in the steeper axis to correct pre-existing astigmatism. METHODS: A prospective randomized case-control study was conducted on 34 eyes of 28 patients with immature senile cataract. They were divided into two groups; in one group (17 eyes) intraoperative arcuate keratotomy was coupled with phacoemulsification in the steeper meridian (arcuate keratotomy group; mean preoperative astigmatism 2.28 +/- 0.89 D) and the other group (17 eyes) phacoemulsification was performed in the steeper meridian without arcuate keratotomy (control group; mean preoperative astigmatism 2.04 +/- 0.50 D). The patients were examined at 1 day, and 1, 4, and 8 weeks postoperatively. Correction of keratometric astigmatism, surgically induced refractive changes, magnitude and axis of cylinder, spherical equivalent refraction, with and against the wound change, and coupling ratio were evaluated. RESULTS: Mean reduction in keratometric astigmatism in the keratotomy group was 1.26 +/- 0.54 D (P = .0067) and in the control group was 0.48 +/- 0.60 D (P = .0423). The difference in reduction of keratometric astigmatism between the two groups was statistically significant (P = .0296). Surgically induced refractive change at 8 weeks follow-up was 2.15 +/- 1.13 D in the keratotomy group and 1.50 +/- 1.32 D in the control group (P = .046). Coupling ratio was -1.10 +/- 0.43 in the keratotomy group at 8 weeks after surgery while the control group was -0.82 +/- 0.38. CONCLUSION: A combination of intraoperative arcuate keratotomy with steep axis phacoemulsification incision is more effective than steep axis phacoemulsification incision alone in reducing pre-existing astigmatism.

Aged↗

PubMed1999

Using the second instrument peripheral corneal incision in phacoemulsification as a blow-off valve.

PURPOSE: To assess the rise in intraocular pressure following phacoemulsification and whether it can be modified by the architecture of the peripheral corneal incision for the second instrument. SETTING: Frimley Park Hospital, Frimley, United Kingdom. METHOD: Forty-two patients had intraocular pressures measured from both eyes preoperatively, then underwent routine scleral section phacoemulsification. They were randomly assigned to perpendicular (blow-off valve) and oblique (water-tight) peripheral corneal incision groups. Postoperative intraocular pressures were measured at 3, 6, 12 and 18 hours. Pressures from the unoperated eyes were used as controls. Aqueous release from the second instrument peripheral corneal incisions and frown scleral incision were assessed using the Seidel's test. RESULTS: There was a rise in intraocular pressure in both groups compared to the control eyes (mean 10.95+/-2.19 mmHg, P<0.00005) at 6 hours. The difference between the groups was significant at 12 hours (mean difference 3.35 mmHg, P<0.05); 63.6% of the perpendicular incisions and 15% of the oblique incisions were Seidel's positive. The frown incision did not leak. CONCLUSION: This study documents the natural history of the rise in intraocular pressure following phacoemulsification peaking at 6 hours. Pharmacological agents should be administered to cover this period. The perpendicular peripheral corneal incision had a tendency to act as a blow-off valve allowing release of aqueous when intraocular pressures were elevated in the first 18 hours following phacoemulsification. This phenomenon is likely to result in a reduction in rise of intraocular pressure compared to the oblique peripheral corneal incision group which tended to be water-tight.

Aged↗

PubMedDate not supplied

Petalloid phacoemulsification.

Hard grade IV nuclei are difficult to emulsify without causing additional stress on the zonular apparatus. We herein, describe a method to accomplish successful phacoemulsification in hard cataracts. This technique of "petalloid phacoemulsification" consists of partial central debulking, followed by sequential chopping to create petal-shaped nuclear fragments emanating from the partially debulked center. The rim of the petals are emulsified followed by the emulsification of the central disc and the base of the petal. Twenty eyes with grade IV nuclei underwent uncomplicated petalloid phacoemulsification. The mean phaco time was 1.02 +/- 0.06 minutes and mean percentage endothelial loss was 4.2 +/- 0.8%. Petalloid phacoemulsification is a safe and useful technique in cases of hard cataracts.

Humans↗

PubMed1999

Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification.

PURPOSE: To report the incidence, management and complications of nucleus dislocation into the vitreous during phacoemulsification. METHODS: Retrospective review of 1250 consecutive phacoemulsification performed by consultants and residents in a teaching hospital. RESULTS: The incidence of nucleus drops was 0.8% (10 out of 1250). Loss of nuclear fragments occurred during phacoemulsification in 9 patients. In one, the dislocation was caused by hydro-dissection. All except one patient (who refused further intervention) underwent pars plana vitrectomy with removal of nuclear fragments. Eight of them had intraocular lens (IOL) inserted at the time of cataract surgery or at vitrectomy; one patient was scheduled for a secondary IOL. Postoperative best corrected visual acuity ranged from 6/24-6/6; 8 patients achieved a vision of 6/12 or better. Complications included cystoid macular oedema (5 patients), retinal break (1 patient) and retinal detachment (1 patient). CONCLUSION: Appropriate management of posteriorly dislocated nucleus can restore good visual acuity. The use of phacoemulsification mandates availability of referral facilities for management of complications.

Humans↗

PubMed2001

[Analysis, prospect and treatment of causes of phacoemulsification complications].

OBJECTIVE: To analyse the causes of different complications of phacoemulsification and to investigate their principles of treatment and prevention. METHOD: The causes of different complications in 187 (180 cases) of 2,250 eyes having undergone phacoemulsification were analyzed. RESULTS: Intraoperatively, the common complications of phacoemulsification were posterior capsular rupture in 70 eyes (3.1%), iris damage in 16 eyes (0.7%), iris prolapse in 6 eyes (0.3%), drop of lens fragments into vitreous in 3 eyes (0.1%) and tear of Descernent's membrane in 4 eyes (0.2%). The common complications after the operation were corneal endothelial edema in 89 eyes (4.0%), corneal decompensation in 2 eyes (0.1%), temporary intraocular hypertension in 28 eyes (1.2%), pupillary dilatation in 7 eyes (0.3%), retinal detachment in 8 eyes (0.4%), cystoid macular edema in 24 eyes (1.1%) and displacement of intraocular lens in 8 eyes (0.4%). CONCLUSIONS: The different complications can be diminished following the popularization and development of phacoemulsification. It should be properly managed once the complication has occurred, and good operative effects can be obtained.

Eye Diseases↗

PubMed2001

Endothelial cell loss induced by phacoemulsification occurs through apoptosis.

BACKGROUND: Cornea endothelial cells are nondividing cells containing pumping function which is crucial for cornea clarity and integrity. Endothelial cell loss occurs after cataract surgical procedures such as phacoemulsification. The authors hypothesize that endothelium damage occurs through apoptosis. METHODS: Ultrasound was achieved by placing a phacoemulsification probe in the anterior chamber and delivering 0% or 50% of maximum power for 2.5 min. The corneal tissue was harvested immediately, and at 1 and 7 days after the operation. Corneal tissue was stained by hemotoxylin and eosin (H&E) and evaluated by light microscopy. Endothelium apoptosis was monitored using the terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) assay to detect DNA fragmentation. RESULTS: In corneas which underwent phacoemulsification with 0% energy, no cell loss or apoptosis was identified immediately, 1 or 7 days after the operation. Likewise, in corneas exposed to 50% energy, no cell loss or apoptosis was detected immediately after phacoemulsification. However, minimal amount of cell loss but prominent apoptosis was detected with the TUNEL assay 1 day after the operation, whereas significant cell loss but no apoptosis was detected 7 days after the operation by H&E stain. CONCLUSIONS: These results demonstrate that corneal endothelial cell loss induced by ultrasound damage occurs through apoptosis.

Animals↗

PubMed2000

[Cause and management of dislocated nuclear fragments during phacoemulsification].

OBJECTIVE: To investigate the cause and management of posteriorly dislocated lens nucleus in the vitreous cavity during phacoemulsification. METHODS: The authors performed a retrospective study of 18 patients with dislocation of nuclear fragment into vitreous cavity during phacoemulsification at Tong Ren Hospital from August 1994 to January 1999. RESULTS: 4 cases with dislocated nuclei floated in the anterior vitreous were removed by a lens loop from limbal extensive incision. 2 cases with their dislocated nuclei less than 1/4 of the normal size were under follow-up for 3 - 4 years, and no complications were observed. The final outcome in 1 case with a dislocated nucleus half of its normal size was ocular atrophy as a result of phacoanaphylactic endophthalmitis. 11 cases underwent pars plana vitrectomy. In the operation the nuclei were floated anteriorly by injection of perfluoro-1, 3-dimethylcyclohexane, then they were removed by a lens loop through the limbus and in 2 cases they were fragmented by ultrasound. The main post-operative complication was corneal edema. The final visual acuities generally were improved in varying degrees in 1 month to 4 years of follow-up. CONCLUSIONS: During phacoemulsification, the dislocation of a nucleus is liable to first occur in the peripheral sculpting stage, and secondly in central sculpting stage. A radial tear extending posteriorly from a discontinuous anterior capsulorrhexis is the major risk factor predisposing to posterior dislocation of the nucleus or nuclear fragment. During phacoemulsification, vitrectomy should be performed as soon as possible for a nucleus dislocated into middle or posterior vitreous cavity, and it is a safe and effective method for management of dislocated nucleus.

Adult↗

PubMed2002

[Macular image changes of optical coherence tomography after phacoemulsification].

OBJECTIVE: To investigate the effects of phacoemulsification on the macula following uncomplicated phacoemulsification by optical coherence tomography (OCT). METHODS: Eighty eyes of the senile cataract were chosen randomly. The uncomplicated phacoemulsification was performed. OCT was examined preoperatively and 1 week after the surgery. Preoperative visual acuity, the retinal thickness and phaco power were compared with those after surgery. RESULTS: In 80 eyes, the preoperative mean foveal thickness was (142.9 +/- 16.7) micrometer and the postoperative (157.9 +/- 36.7) micrometer, the difference being not significant (P > 0.05). Three eyes had macular edema 1 week after surgery. In 11 eyes with Tyndall sign (+ +), the mean postoperative foveal thickness was thicker than the mean preoperative value (P < 0.05). In lower phaco power group, the mean postoperative foveal thickness was (156.2 +/- 18.3) micrometer and the higher phaco power group was (172.6 +/- 32.9) microm (P < 0.05). The best corrected visual acuity after surgery had a negative correlation with the retinal thickness. CONCLUSIONS: The retinal thickening and macular edema can be found after uncomplicated phacoemulsification. The higher phaco power results in significant inflammation and thicker retina. The visual consequences were proportional to the degrees of macular thickening.

Aged↗

PubMed2002

[Clinical significance of accumulated energy complex parameter in phacoemulsification].

OBJECTIVE: The accumulated energy complex parameter [AECP, AECP = actual power (AP) x time (T)] was put forward and used to analyze the correlation between phacoemulsification energy and postoperative complication. METHODS: Ninety-two cases with senile cataract who underwent phacoemulsification were observed. The correlation between AECP and postoperative corneal edema rate (CER) was analyzed. The difference of AECP between the method of divided-conque and that of epi-capsular rotated-chipping was compared for the same hard nucleus (IV) cataract extraction. RESULTS: The positive correlation was observed between AECP and CER (r = 0.974, t = 5.643, P < 0.05). The difference of the average AECP values existed between the two methods (t = 2.947, P < 0.01). The AECP and CER were lower in the method of divided-conque than that in epi-capsular rotated-chipping. CONCLUSION: AECP can be used as a dynamic index to control the phacoemulsification energy in order to decrease CER predictably. Our study suggests that AECP provide an important integrated energy index to evaluate phacoemulsification.

Adult↗

PubMed2001

[The cause and management of acute high intraocular pressure in phacoemulsification].

OBJECTIVE: To investigate the cause and management of acute high intraocular pressure and shallow anterior chamber in phacoemulsification. METHODS: A retrospective study was done on 1,500 eyes performed phacoemulsification. Eleven of 1,500 eyes showed higher intraocular pressure and shallowing of the anterior chamber during phacoemulsification. But phacoemulsification was successfully achieved after giving hyperosmotic agents, increasing infusion pressure and reducing aspiration rate as well as flow rate. RESULTS: Of 11 eyes, 10 eyes were treated by management of non vitrectomy. One of 11 eyes was unresponsive to medical management and require the use of pars plana vitrectomy. Phaco was performed in all patients. In 4 of 11 eyes, visual acuity postoperatively were 0.7 or better. Five of 11 eyes were 0.3 to 0.5. One eye was 0.05 and one was HM/30 cm. CONCLUSION: Aqueous misdirection, retrobulbar hemorrhage and intraoperative suprachoroidal hemorrhage are common causes of acute high intracular pressure in phaco. Most of patients could be performed phaco after medical treatment. If patients failed to improve after medical treatment, par plana vitrectomy is a useful method.

Aged↗

PubMed2000

[Surgical techniques to deal with lens nucleus' fragment of posterior capsular rupture during the phacoemulsification].

OBJECTIVE: To investigate some surgical techniques in dealing with a impending dropped nucleus when posterior capsular rupture during the phacoemulsification. METHODS: The postoperative results of 18 cases (18 eyes) whose posterior capsular of lens ruptured with a impending dropped nucleus during the phacoemulsification were studied retrospectively. Three surgical techniques to prevent lens nucleus' fragments dropping into the vitreous cavity were applied. They are consecutive phacoemulsification with lower flowing rate and lower irrigation, injection of viscoelastic substance with high elasticity and anterior segment vitrectomy with no irrigation. The follow-up was 12-24 months (average, 18.2 months). RESULTS: Except for a special case, no lens nucleus' fragments dropped into the vitreous cavity. Posterior chamber intraocular lens(IOL) was implanted primarily in all cases (18 eyes). Best corrected visual acuity was above 0.5 in 15 eyes (83.3%). The main complications included corneal edema and cystoid macular edema. CONCLUSION: With safety, effectiveness and less complications, these three surgical techniques are suitable to deal with different types of impending dropped lens nucleus' fragments during the phacoemulsification. It is advisable to apply these techniques in clinical practice.

Adult↗