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Results for “Phacoemulsification”

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PubMed1996

Cataract extraction by phacoemulsification in situ and elliptical intraocular lens implantation.

OBJECTIVE: To investigate the technique of phacoemulsification in situ for cataract extraction and elliptical intraocular lens (IOL) implantation. METHODS: 60 eyes of 57 cases with cataract were included and the hardness of nucleus was grade-1-2 in 25 eyes, grade-3 in 27 eyes and grade-4 in 8 eyes. Tunnel incision was made and in situ phacoemulsification with elliptical (5 mm x 6 mm) IOL implantation was performed on all the cases. RESULTS: Phaco-spent-time was 45 seconds to 3 minutes 45 seconds (average 1 minute 52 seconds). Phacoemulsification in 53 eyes (88.3%) was successful in situ Visual acuities of 0.5 or better and 1.0 or better at postoperative one week were obtained in 75.0% and 56.7%, and at 1-12 month follow-up in 85.0% and 71.7% respectively. CONCLUSION: The technique of phacoemulsification in situ and elliptical IOL implantation is worthy to be spread due to minimum postoperative astigmatism and fast restoration of visual acuity.

Adult↗

PubMed1998

[Intracameral lidocaine and phacoemulsification under topical anesthesia. Apropos of 80 operations].

PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.

Administration, Topical↗

PubMed1992

Management of dislocated lens fragments during phacoemulsification.

BACKGROUND: Dislocation of nuclear lens fragments during phacoemulsification can lead to a high incidence of glaucoma, uveitis, and poor visual acuity. The correct approach to these patients is uncertain. The authors report on eight patients who underwent pars plana vitrectomy with removal of lens fragments. METHODS: Charts of eight consecutive patients who developed dislocation of nuclear lens fragments into the vitreous cavity during phacoemulsification were retrospectively reviewed. All patients underwent a standard three-port pars plana vitrectomy with removal of the dislocated nuclear fragments by pars plana fragmentation. After the vitrectomy, the retina was inspected with indirect ophthalmoscopy. Tears were treated with cryopexy. A fluid-air exchange and scleral buckle were performed when indicated. RESULTS: Retinal tears were located at the vitreous base in four of eight patients. After vitrectomy, visual acuity improved in all patients, with 7 of 8 patients achieving visual acuity of 20/40 or better. The type of pseudophakia did not influence the final visual acuity. There were no cases of glaucoma, uveitis, or macular edema with up to 22 months of follow-up. CONCLUSIONS: These results suggest that large nuclear fragments dislocated into the posterior segment during phacoemulsification can be removed safely with pars plana vitrectomy and lensectomy with an excellent visual prognosis. Attempts to remove lens fragments during the phacoemulsification through an anterior wound should be avoided because of excessive vitreous traction, leading to retinal break formation.

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PubMed1990

Multilamellar hydrodissection in phacoemulsification and planned extracapsular surgery.

Multilamellar hydrodissection is the injection of balanced salt solution into multiple lamellae of the lens, cleaving it into a small nucleus and multiple layers of cortex. In phacoemulsification, the smaller nucleus reduces phacoemulsification time, and the thicker bed of cortex provides greater protection for the posterior capsule. In extracapsular extraction, the smaller nucleus can be more readily extracted, which is particularly advantageous when capsulorhexis is performed. Creation of multiple cortical lamellae facilitates their aspiration, either with the phacoemulsification or irrigation/aspiration tips. Multilamellar hydrodissection increases the predictability and safety of phacoemulsification and planned extracapsular cataract extraction.

Cataract Extraction↗

PubMed1992

Comparison of small-incision phacoemulsification with standard extracapsular cataract surgery: post-operative astigmatism and visual recovery.

A prospective study compared post-operative astigmatism and visual acuity (corrected and uncorrected) following phacoemulsification and extracapsular surgery. Fifty eyes had implantation of a 7 mm diameter optic intraocular lens (IOL) following conventional extracapsular cataract extraction (ECCE) with a 10 mm corneal incision. Forty-seven eyes were implanted with a 5 x 6 mm optic IOL through a 5 mm scleral incision after phacoemulsification. Uncorrected visual acuity of 6/9 or better was achieved in 25% of eyes on the first day following phacoemulsification, 36% at 1 week and 57% at 12 weeks. These results (and also the best corrected acuity) were significantly better than those following ECCE. Less astigmatism was induced by phacoemulsification than extracapsular surgery, measured at all post-operative time intervals.

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PubMed1993

Phacoemulsification during the learning curve: risk/benefit analysis.

To assess prospectively the complications and outcomes in a single-surgeon series during the phacoemulsification learning curve a prospective analysis of 400 phacoemulsification procedures in 358 patients was carried out. The main outcome measures were capsular tear, vitreous and nuclear loss, best corrected post-operative visual acuity and refractive cylinder. Capsular tears occurred in 6.3% of phacoemulsification procedures, with vitreous loss in 1.5%. One nucleus was lost into the vitreous. Best corrected visual acuity, including pre-existing pathology, was 6/9 or better in 83.6% of eyes. There was 1 dioptre or less change of astigmatism from pre-operative to 6 weeks in 91% of eyes. It is concluded that phacoemulsification with careful patient selection can be a safe procedure even during the learning curve.

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PubMed1994

Learning phacoemulsification: the surgeon-in-training.

With the increasing trend towards phacoemulsification a perceived increased complication rate during the learning curve gives rise to a dilemma as to the best stage at which a surgeon-in-training can safely learn the technique. We prospectively analysed the complications and visual outcome of the first 160 phacoemulsification procedures performed by three surgeons-in-training. The main outcome measures included posterior capsule tear, vitreous and nuclear loss, surgical re-intervention rate and visual outcome. Posterior capsule tear occurred in 7 eyes (4.4%) and vitreous loss in 6 (3.8%). No nucleus was lost in the vitreous. Surgical re-intervention was required in 1 eye. Best corrected visual acuity was 6/12 or better in 88% of eyes. These results compare favourably with reports of surgeons-in-training learning extracapsular surgery and also with recently reported phacoemulsification series. This study indicates that with careful case selection and supervision phacoemulsification can be a safe procedure.

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PubMed1992

[Phacoemulsification: technical initiation at what price?].

Phacoemulsification of the cataract is perhaps technically superior which is considered "classic". This technic consists however of a number of difficulties that may be mastered during an apprentiship. Considerable complications may arise during this initiation periods; imposing this surgical method on patients is thus an ethical problem. If the risks encountered during the apprentiship of phacoemulsification appear comparable to those during the classic extracapsular technique, phacoemulsification may be recommended with less reservation. We have compared 250 initial cases of classic extracapsular extraction with 250 "initial cases" of phacoemulsification, taking into account operative and post-operative complications and final functional results.

Adult↗

PubMedDate not supplied

Microbial contamination of the anterior chamber during cataract phacoemulsification and intraocular lens implantation in dogs.

The objective of this study was to determine the frequency of intraoperative contamination of the anterior chamber with viable microorganisms during cataract phacoemulsification and intraocular lens implantation, and to evaluate the relationship of contaminant microorganisms to patients' extraocular and nasal cavity floras. Also, the impact of various aspects of the patient history and phacoemulsification procedure on the incidence of positive postoperative anterior chamber cultures was investigated. Twenty-two eyes from 13 dogs presented for elective cataract phacoemulsification and intraocular lens implantation were studied. Preoperatively, microbiologic samples of the conjunctiva, eyelid margins, nares, and rostral nasal cavity were collected. Postoperatively, anterior chamber fluid was aspirated. Samples were submitted for aerobic/anaerobic bacteriologic culture and antimicrobial susceptibility, Mycoplasma culture, and fungal culture. Anterior chamber aspirates collected at the conclusion of surgery were culture positive for at least one organism in 22.7% of eyes. Three aerobic bacteria and three fungi were isolated from the anterior chamber aspirates. Two fungi and one bacterium isolated from the anterior chamber were typed identically, and the bacterium had a similar antibiogram to organisms recovered from the patient's conjunctiva and eyelid margin. No statistically significant difference in contamination frequency was found for the investigated patient and surgical variables. We conclude that intraoperative contamination of the anterior chamber with viable bacterial and fungal organisms is a common occurrence in canine patients undergoing cataract phacoemulsification and intraocular lens implantation, and the external ocular flora is a likely source of some of these contaminating microorganisms. This contamination is independent of the patient and surgical variables investigated.

Animals↗

PubMed1990

[Reflections and conclusions after evaluation of 100 cases of phacoemulsification following the introduction of this method].

Presented are the difficulties encountered by the surgeon during the self-dependent acquiring of practical skill of cataract extraction by means of phacoemulsification. The observations were made in the course of performance of one hundred operations. The most frequent causes of failure and complications accompanying the first operations are cited. Attention is called to the tractability of the lenses to phacoemulsification in dependence of the property of the lens. These properties should be taken under consideration by the surgeon familiarizing himself with phacoemulsification in selection of cases for surgery. According to the author the acquiring the skill for phacoemulsification needs an adequate mastering of ocular microsurgery and the help of a surgeon who is familiar exactly with the secrets of this method.

Adult↗

PubMed1993

[Cataract surgery using phacoemulsification].

Clinical results are reported in a consecutive series of 111 patients undergoing cataract surgery by phacoemulsification. On the first day after surgery, 69% of all cases had a visual acuity of 20/40 or better without any spectacle correction. Four months later this percentage had increased to 79%. Compared with a series of patients, operated by conventional extracapsular extraction, the corneal astigmatism was found to be significantly reduced in the phacoemulsification series (p < 0.001). The decrease in surgically induced astigmatism together with tailoring of the power of the intraocular lens (IOL) accounted for the good unaided visual acuity in the phacoemulsification group. Phacoemulsification is concluded to offer good optical control of the postoperative refraction in cataract patients.

Adult↗

PubMed1993

[Capsular sack suture PMMA intraocular lens. Comparative study of centering behavior after phacoemulsification and planned extracapsular cataract extraction].

The position of bag-fixated intraocular lenses after phacoemulsification or extracapsular cataract extraction (ECCE) was compared in order to determine the relationship to the method of operation and the type of capsular opening. Photographs were taken from 71 eyes 6 months after in-the-bag implantation of a one-piece posterior chamber lens. Centering was determined with respect to the pupillary center. Forty-six eyes were operated on by phacoemulsification after continuous circular capsulorhexis with closed edges and 25 eyes by ECCE after capsulorhexis with a radial incision of the capsular rim at the 12 o'clock position. Ninety-four percent of the intraocular lenses implanted after phacoemulsification and 92% of the intraocular lenses implanted after ECCE were decentered less than 0.5 mm. The centering of bag-fixated intraocular lenses is related to the technique of opening the anterior capsule. Phacoemulsification with continuous capsulorhexis offers conditions similar to that in ECCE with capsulorhexis and radial capsular rim incision for good centering of one-piece posterior chamber lenses.

Adult↗

PubMed1977

Phacoemulsification visual results and complications: report of 800 cases.

The visual results and complications of 700 Kelman-Phacoemulsification operations have been presented. Early in this series, corneal opacification and vitreous loss were a major concern. Complications decreased with experience and at the present time visual results are at least as good as they were with routine intracapsular cataract extractions. Kelman has stated that the phacoemulsification operation is not an easy operation to learn. It is, to say the least, not a watch-one, do-one, teach-one procedure. If one is an average surgeon, however, he can with persistance and perseverance master the technique. The procedure, however, I feel is not for the occasional operator. The phacoemulsification operation has essentially been under trial these past few years. Its advocates, however, have continued to grow in number and as the statistics come in, it appears that at least for the present, the Kelman-Phacoemulsification operation in one form or another is going to take a very active part in the treatment of the patient with cataract formation.

Adult↗

PubMed2001

Clear corneal wound infection after phacoemulsification.

OBJECTIVE: To evaluate clear corneal wound infections after phacoemulsification. MATERIALS AND METHODS: The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and signs after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, culture and antibiotic sensitivity results, treatment regimen, and outcome. RESULTS: The median onset of signs and symptoms after surgery was 10 days (range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphylococcus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphylococcus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patient. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture-positive cases, the isolated microorganisms were resistant to the perioperative prophylactic antibiotics (fluoroquinolones and tobramycin) that were used. No possible risk factors were noted except use of topical steroids 4 times a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiotic therapy. One of the patients required lamellar keratectomy and conjunctival flap for complete healing. In 4 of the 7 cases, best-corrected visual acuity at the last follow-up visit was better than 20/40. CONCLUSIONS: Clear corneal wound infection after phacoemulsification is a serious complication of cataract surgery. Infections are caused by gram-positive organisms sensitive to bacitracin and the combination of trimethoprim-sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinolones.

Aged↗

PubMed2002

Free radicals in phacoemulsification and aspiration procedures.

OBJECTIVES: To detect free radicals in phacoemulsification and aspiration procedures using electron-spin resonance and to observe the effect of ophthalmic viscosurgical devices (viscoelastic agents) on free radical intensity. METHODS: (1) A test tube containing BSS Plus (Alcon Laboratories, Inc, Fort Worth, Tex) with 1% of the spin-trapping agent, 5,5'-dimethyl-1-pyrroline N-oxide, without irrigation and aspiration, was exposed to ultrasound (100% for 20 seconds). A preparation of hyaluronate sodium (Healon [a cohesive agent that contains 1% hyaluronate sodium] (Pharmacia, Uppsala, Sweden) or Viscoat [a dispersive agent that contains 3% hyaluronate sodium and 4% chondroitin sulfate] (Alcon Laboratories, Inc)) was added to the solution to observe inhibitory effects. (2) To simulate a clinical procedure, an eye model with irrigation and aspiration of a combination of 1% 5,5'-dimethyl-1-pyrroline N-oxide and BSS Plus, 25 mL/min, as the irrigating solution was exposed to ultrasound (for 10, 20, or 30 seconds). Healon or Viscoat was injected into the anterior chamber. Free radicals were measured by an electron-spin resonance spectrometer. RESULTS: (1) A characteristic signal corresponding to hydroxyl radicals was detected. Similar inhibition by Healon and Viscoat was observed. (2) Two ophthalmic viscosurgical devices similarly suppressed the signal at 10 seconds. The inhibition by Healon ceased at 20 seconds, whereas Viscoat suppressed the signal throughout the time course. CONCLUSIONS: Phacoemulsification produces hydroxyl radicals in the anterior chamber even with irrigation and aspiration. The effect of ophthalmic viscosurgical devices on free radicals depends on the retention of the materials within the anterior chamber. CLINICAL RELEVANCE: There are complications associated with phacoemulsification.

Anterior Chamber↗

PubMed1997

Corneal endothelial damage by air bubbles during phacoemulsification.

OBJECTIVE: To characterize the mechanism by which air bubbles damage the corneal endothelium during phacoemulsification. MATERIALS AND METHODS: A series of experiments was conducted to expose the corneal endothelium of New Zealand white rabbit and human eyes that were obtained from an eye bank to air under different conditions. Phacoemulsification at different power settings and irrigation with and without the introduction of air into the anterior chamber were performed. Corneal endothelial perfusion experiments were conducted with air bubbles that were introduced into the perfusion chamber for 2 seconds to 1 hour. Air was also injected into the anterior chambers of anesthetized rabbits for 2 minutes to 3 hours. Corneas were stained with nitrobenzo-xadiazole-phallacidin and examined with fluorescence microscopy. Selected corneas were also examined with scanning and transmission electron microscopy. RESULTS: Intracameral air bubbles during phacoemulsification, irrigation, and perfusion studies resulted in a severe injury to the corneal endothelium in as little as 20 seconds. Intracameral air bubbles in a living rabbit resulted in a slower injury that was morphologically different from the more rapid injury. CONCLUSIONS: Air bubbles in intraocular fluids with a high surface tension can cause a ring-shaped pattern of damage to the corneal endothelium. The mechanism that caused this pattern of damage appears to be a surface tension phenomenon.

Air↗

PubMed1997

Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study.

OBJECTIVE: To determine the results of temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy plus low-dose 5-fluorouracil compared with trabeculectomy plus low-dose 5-fluorouracil. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive case patients who underwent temporal corneal phacoemulsification combined with superior trabeculectomy plus low-dose 5-fluorouracil (case [combined surgery] group) and 40 control patients, matched for age race, preoperative intraocular pressure (IOP), number of preoperative antiglaucoma medications, and number of 5-fluorouracil injections, who underwent trabeculectomy alone plus low-dose 5-fluorouracil (control [trabeculectomy] group). MAIN OUTCOME MEASURES: Survival analyses for IOP control compared between the 2 groups. METHODS: The medical records of 40 consecutive case patients were reviewed to determine the effect of their treatment on IOP, visual acuity, and requirement for glaucoma medications. In the control group, 40 eyes (1 eye per patient) were randomly selected for comparison with the case group. In both groups, the trabeculectomy was located superiorly and performed with the same technique and using a limbus-based conjunctival flap. In the case group, temporal corneal phacoemulsification immediately preceded trabeculectomy and used a 3.2-mm incision and a 1-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-fluorouracil injections of 5 mg each within the first 11 postoperative days. Patients were followed up for at least 1 year. Success of surgery was defined as an IOP of less than 22 mm Hg and a 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications. RESULTS: The mean (+/-SD) postoperative IOP was statistically higher in the case group than in the control group at each follow-up interval (P < .05). The mean (+/-SD) IOP reductions at 1 year were 6.8 +/- 5.5 mm Hg and 10.3 +/- 7.6 mm Hg (39.2% +/- 18.8%) in the case and control groups, respectively (P = .04). The reductions in the mean (+/-SD) number of antiglaucoma medications at 1 year were 1.6 +/- 0.9 and 2.0 +/- 1.0 in the case and control groups, respectively (P = .06). In the case group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < .001). Kaplan-Meier survival analysis showed that the cumulative success rates at 2 years were 62.1% and 85.8% in the case and control groups, respectively. The survival time to failure was significantly shorter (P = .04) in the case group by the log-rank test. CONCLUSIONS: Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone despite identical trabeculectomy techniques used in both groups. Nevertheless, combined surgery lowers IOP and reduces the long-term requirement for antiglaucoma medications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.

Aged↗

PubMed1998

[Experiences with "reversed tip and snip" phacoemulsification].

UNLABELLED: The endothelial cell count after phacoemulsification serves as a sensitive indicator for the level of corneal traumatization caused by different phacoemulsification techniques concerning the used phacotime and phacoenergy/s. PATIENTS: In a prospective and randomized study, the "reversed tip and snip" technique and the "divide and conquer" technique were performed in groups of 30 patients each. The corneal endothelial cell count was measured preoperatively as well as 4 weeks and 3 months postoperatively. In a second study the phacotime and phacoenergy used/second and the endothelial cell loss were compared between patients 1-30 and 31-60 who were operated on with the "reversed tip and snip" technique, demonstrating the learning curve of this technique. RESULTS: The endothelial cell count showed significant (P < 0.001) reduction by about 10% after the "reversed tip and snip" technique and by about 15% after the "divide and conquer" technique. The latter produced significantly greater cell loss. The phacotime (mean: 22-17) and phacoenergy/s (mean: 23-16) were reduced significantly (P < 0.05) when patients 1-30 were compared with 31-60. CONCLUSION: The "reversed tip and snip" phacoemulsification technique produces less endothelial cell loss than the "divide and conquer" technique. There is a short learning curve by using the "reversed tip and snip" technique.

Aged↗