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PubMed2005

Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results.

OBJECTIVE: To compare the efficacy, safety, and refractive errors of astigmatism after cataract surgery by phacoemulsification and manual small-incision cataract surgery techniques. DESIGN: Masked randomized control clinical trial. PARTICIPANTS: Four hundred eyes of 400 patients, 1:1 randomization with half in each arm of the trial. METHODS: A total of 400 eyes was assigned randomly to either phacoemulsification or small-incision groups after informed consent and were operated on by 4 surgeons. They were masked to the technique of surgery before, during, and after cataract surgery and followed up to 1 year after surgery. The intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, and astigmatism were recorded at 1 and 6 weeks postoperatively. MAIN OUTCOME MEASURES: The proportion of patients achieving visual acuity better than or equal to 6/18 with and without spectacles after cataract surgery in the operated eye up to 6 weeks, postoperative astigmatism, and complications during and after surgery. RESULTS: This article reports clinical outcomes up to 6 weeks. Three hundred eighty-three of 400 (95.75%) patients completed the 1-week follow-up, and 372 of 400 (93%) patients completed the 6-week follow-up. One hundred thirty-one of 192 (68.2%) patients in the phacoemulsification group and 117 of 191 (61.25%) patients in the small-incision group had uncorrected visual acuity better than or equal to 6/18 at 1 week (P = 0.153). One hundred fifty of 185 (81.08%) patients of the phacoemulsification group and 133 of 187 (71.1%) patients of the small-incision group (P = 0.038) were better than or equal to 6/18 at the 6-week follow-up for presenting visual activity. Visual acuity improved to > or = 6/18 with best correction in 182 of 185 patients (98.4%) and 184 of 187 (98.4%) patients (P = 0.549), respectively. Poor outcome (postoperative visual acuity < 6/60) was noted in 1 of 185 (0.5%) in the phacoemulsification group and none in the small-incision group. The mode of astigmatism was 0.5 diopters (D) for the phacoemulsification group and 1.5 D for the small-incision group, and the average astigmatism was 1.1 D and 1.2 D, respectively. There was an intra-surgeon variation in astigmatism. The phacoemulsification group had 7 posterior capsular rents compared with 12 in the small-incision group, but the phacoemulsification group had more corneal edema on the first postoperative day. CONCLUSIONS: Both the phacoemulsification and the small-incision techniques are safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gives better uncorrected visual acuity in a larger proportion of patients at 6 weeks.

Astigmatism↗

PubMed2001

Identification of free radicals produced during phacoemulsification.

PURPOSE: To detect, identify, and quantitate free radicals produced during conditions similar to phacoemulsification cataract surgery. SETTING: Research laboratory at the Biotechnology Center, Utah State University, Logan, Utah, USA. METHODS: All experiments were performed using a Series Ten Thousand phacoemulsifier (Alcon Laboratories) modified to make a 10 mL continuous circulation loop (to increase sensitivity). The irrigating solution was passed through a 3 mL chamber in line with the circulation loop, and electron spin resonance spin trapping methods were used to detect, identify, and quantitate free radical production during phacoemulsification. As an additional indication of hydroxyl radical production, the hydroxylation of salicylate and thiocyanate was detected by high-performance liquid chromatography and spectrophotometry, respectively. RESULTS: The hydroxyl radical was formed when phacoemulsification was performed in the presence of solutions containing spin trap in double deionized water or balanced salt solution (BSS). Hydroxyl radical production was linear with respect to phacoemulsification time. Production of the hydroxyl radical was not observed when phacoemulsification was performed with anaerobic solutions, indicating a requirement for oxygen in radical production. The concentration of trapped hydroxyl radical was reduced in the presence of balanced salt solution with bicarbonate, dextrose, and glutathione (BSS Plus). Upon phacoemulsification, both salicylate and thiocyanate underwent hydroxylation when included in the irrigating solution, confirming the generation of the hydroxyl radical. Additional tests discounted the formation of superoxide or hydrogen peroxide during phacoemulsification. CONCLUSIONS: Hydroxyl radical was produced by phacoemulsification in the presence of aerobic solutions. Hydroxyl radical production was dependent on the presence of molecular oxygen and was not generated as a result of the homolytic cleavage of water. The amount of hydroxyl radical detected was directly proportional to phacoemulsification time and was reduced in the presence of BSS Plus. Other reactive oxygen species such as superoxide, hydrogen peroxide, and ozone were not detected during phacoemulsification under these conditions.

Acetates↗

PubMed2002

Phacoemulsification with indocyanine green versus manual expression extracapsular cataract extraction for advanced cataract.

PURPOSE: To compare the outcomes of indocyanine green dye (ICG)-assisted phacoemulsification with manual expression extracapsular cataract extraction (ECCE) in eyes with advanced cataract. SETTING: Parkland Memorial Hospital and Dallas Veterans Affairs Medical Center, Dallas, Texas, USA. METHODS: In this retrospective study, 72 consecutive cases of advanced or mature cataract extractions performed in a 1-year period were reviewed. Fifty-nine eyes met the inclusion and exclusion criteria; 33 had ICG-assisted phacoemulsification and 26, manual expression ECCE. Preoperative and intraoperative findings and the postoperative outcomes up to 6 months were analyzed. RESULTS: Intraoperative complications included posterior capsule tear with vitreous prolapse in 2 eyes (6.6%) and conversion to manual expression ECCE in 1 eye (3.3%) in the ICG phacoemulsification group. There was no intraoperative complication in the manual expression ECCE group. There were significantly more patients with a best corrected visual acuity of 20/30 or better in the ICG phacoemulsification group than in the manual expression ECCE group at all postoperative periods. The mean logMAR visual acuities were significantly better in the ICG phacoemulsification group at all postoperative intervals. The ICG phacoemulsification group had significantly less postoperative astigmatism. There was no significant difference between the groups in the early postoperative intraocular pressure. CONCLUSIONS: Phacoemulsification with ICG led to better postoperative visual acuity and less postoperative astigmatism than manual expression ECCE. Phacoemulsification with ICG was associated with more intraoperative complications than manual expression ECCE; however, the complication rate is comparable to a previously published rate for phacoemulsification performed in a university training program. Phacoemulsification with ICG appears to be a reasonable alternative to manual expression ECCE for advanced cataract.

Adolescent↗

PubMed2005

[The outcome of phacoemulsification in eyes after filtering glaucoma surgery].

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.

Aged↗

PubMed2002

Outcome of phacoemulsification after pars plana vitrectomy.

PURPOSE: To compare the outcome of phacoemulsification surgery in patients with and without prior vitrectomy, adjusted for confounding factors. DESIGN: Retrospective cohort study. PARTICIPANTS AND CONTROLS: Thirty-one consecutive eyes undergoing phacoemulsification after pars plana vitrectomy (PPV) and 116 consecutive eyes undergoing phacoemulsification without previous PPV. METHODS: Office records of the operating surgeons were reviewed for age, gender, type of cataract, vitrectomy status, best-corrected visual acuity (BCVA) before and after phacoemulsification, intraoperative difficulties, and postoperative complications. Bivariate analyses between these predictors and the main outcome, BCVA of 20/40 or better after phacoemulsification, were performed using Pearson's chi-square tests. An adjusted analysis of the relationship between outcome and vitrectomy status was performed with logistic regression. Pearson's chi-square tests were used to compare type of cataract, intraoperative difficulties, and postoperative complications in study and control eyes. MAIN OUTCOME MEASURES: BCVA of 20/40 or better after phacoemulsification, rates of intraoperative difficulties, and postoperative complications. RESULTS: The most common indication for PPV was macular hole. The average interval from PPV to phacoemulsification was 15.4 months. Study eyes were followed for an average of 10 months compared with 6.6 months for controls. Study eyes were more likely than controls to have predominantly nuclear sclerotic cataracts (P = 0.002). After cataract extraction, 24 of 31 study eyes (77.4%) and 110 of 116 control eyes (94.8%), had BCVAs of 20/40 or better. After adjusting for confounders, eyes without previous vitrectomy were 3.44 times more likely to obtain a BCVA of 20/40 or better than eyes with prior PPV, but this difference was not statistically significant (95% CI, 0.72-16.67). Only 3 of 31 (9.7%) study and 11 of 116 (9.4%) control eyes had intraoperative difficulties (P = 0.47). Posterior capsule plaque was the most common intraoperative difficulty in study eyes; small pupil requiring stretching or iris hooks was most common in controls. Only 1 of 31 (3.2%) study eyes had a postoperative complication other than posterior capsule opacification compared with 18 of 116 (15.5%) controls (P = 0.07). CONCLUSIONS: A large proportion of patients with prior PPV obtain good visual acuity after phacoemulsification. We did not find significantly higher rates of intraoperative difficulties or postoperative complications compared with controls. The benefits of phacoemulsification seem to be limited only by retinal comorbidity.

Adolescent↗

PubMed1998

Clinical comparison of the Alcon 20,000 Legacy and 10,000 Master phacoemulsification units.

PURPOSE: To determine whether the use of the Alcon 20,000 Legacy phacoemulsification unit requires less phacoemulsification time and causes fewer intraoperative complications than the Alcon 10,000 Master unit. SETTING: Private practices in Kansas City, Missouri, and Marshalltown, Iowa, USA. METHODS: This prospective study comprised 400 consecutive cases of phacoemulsification with intraocular lens (IOL) implantation performed using the Alcon 20,000 Legacy unit by a high-volume phacoemulsification surgeon (n = 200) and a moderate-volume surgeon (n = 200). Data included age, phacoemulsification time, and surgical complications. The control study was a retrospective review of the same data from the previous 200 cases done by each surgeon with the Alcon 10,000 Master unit. RESULTS: In the combined series of 400 cases done with the 10,000 Master unit, mean age was 72.7 years and mean phacoemulsification (i.e., ultrasound) time, 1.97 minutes. There were 2 cases (0.50%) of vitreous loss and 3 cases (0.75%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 1.25% with the 10,000 Master. In the combined series of 400 cases done with the 20,000 Legacy unit, mean age was 72.5 years and mean phacoemulsification time, 1.50 minutes. There were no cases of vitreous loss and 1 case (0.25%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 0.25% with the 20,000 Legacy. The difference in complication rates between the two machines was not significant. Phacoemulsification time with the 20,000 Legacy unit was significantly less than with the 10,000 Master unit for both surgeons (P < or = .001 and .05, respectively). CONCLUSION: The Alcon series 20,000 Legacy unit proved to be a safe, reliable, and highly effective instrument for modern cataract extraction and IOL implantation that required significantly less phacoemulsification time than the 10,000 Master unit.

Adolescent↗

PubMed1998

Extracapsular cataract extraction to phacoemulsification: why and how?

PURPOSE: To determine what factors influence a decision to move from extracapsular cataract extraction to phacoemulsification as the cataract removal technique of first choice, and to investigate how the transition is managed. METHOD: Questionnaire surveys were carried out in 1996 and 1997 of consultant ophthalmologists in the former Oxford Region. RESULT: 'Evidence of clinical benefit' was the strongest factor influencing a decision to change technique, but 'fear of becoming a dinosaur' and 'peer pressure' were also important factors. Beliefs about advantages of phacoemulsification were little changed with increasing experience, but personal contraindications to phacoemulsification diminished with time. Hard nuclei, mature cataracts and poor zonular support remained relatively strong contraindications to phacoemulsification by the second survey. Only 46% of 14 respondents had performed phacoemulsification under supervision before 'going solo', but 64% felt well or adequately prepared for their first solo phacoemulsification. Influence of non-clinical factors such as equipment availability on the choice of technique did not diminish significantly between surveys. Increasing experience of phacoemulsification appeared to reinforce beliefs about its advantages. CONCLUSIONS: Respondents appear to have adopted phacoemulsification with careful preparation, and enthusiasm for the technique has been reinforced by increasing experience. Courses and wet-labs provide limited preparatory experience, but peer supervision is difficult to arrange for consultants. Respondents generally felt that learning phacoemulsification had been stressful, but not as difficult as feared. Implications for the introduction of new surgical techniques into ophthalmological practice in the future are discussed.

Cataract Extraction↗

PubMed2005

Bimanual microincisional phacoemulsification: the future of cataract surgery?

PURPOSE OF REVIEW: Bimanual microincisional cataract surgery has recently become a procedure of interest among cataract surgeons, and a number of trials have shown its potential as a minimally invasive cataract surgery. The purpose of this review is to examine the studies that have been published to date and to evaluate the potential of bimanual phacoemulsification as a method of cataract extraction. RECENT FINDINGS: Recent studies have reinforced the safety of bimanual phacoemulsification. In particular, recently published studies have focused on evaluating various phacoemulsification technologies and their safety when used in bimanual phacoemulsification. Newly developed rollable hydrophilic acrylic ThinOptX lenses have been shown to be implantable in 2.2-mm incisions safely with good visual outcomes. SUMMARY: Bimanual phacoemulsification has been a potential technique for a number of years, but only recently have the technology, software, and technique advanced sufficiently to make bimanual phacoemulsification a feasible method of cataract extraction. Although the main disadvantage to bimanual phacoemulsification remains the lack of intraocular lenses that can fit through microincisions, necessitating the enlargement of corneal wounds for intraocular lens implantation, bimanual phacoemulsification has a number of advantages over traditional small-incision phacoemulsification. Theses advantages have been a source of interest for cataract surgeons and surgical companies who are now developing technologies that will permit the performance of truly microincisional cataract surgery.

Humans↗

PubMedDate not supplied

Comparison of intraocular pressure profiles during cataract surgery by phacoemulsification and extracapsular cataract extraction.

BACKGROUND AND OBJECTIVE: In view of reports of fluctuations in intraocular pressure (IOP) during phacoemulsification, real-time IOP during small-incision, manual extracapsular cataract extraction (ECCE) and phacoemulsification was measured to determine the effect of anterior chamber maintainer infusion on intraoperative IOP dynamics. PATIENTS AND METHODS: A comparative study of IOP during cataract surgery was conducted by these two methods in 29 patients. An anterior chamber maintainer infused balanced salt solution continuously into the eye throughout ECCE. The anterior chamber maintainer was open in 7 cases throughout phacoemulsification and switched off during phacoemulsification in 7 cases. RESULTS: IOP measurements during small-incision ECCE were physiologic (range, 5 to 20 mm Hg) during most of the operation and coincided with the value of hydrostatic pressure established by the height of the anterior chamber maintainer infusion bottle. During phacoemulsification without concomitant anterior chamber maintainer, IOP was positive (> 2 to 3 mm Hg) as long as the phacoemulsification infusion line was activated (position 1). Moving to position 0 caused hypotony. Occlusion breaks occasionally caused wide fluctuations in IOP. Concomitant anterior chamber maintainer and phacoemulsification infusion did not prevent surges, but may account for the lower range of fluctuation. The anterior chamber maintainer also maintained a positive IOP at position 0 during phacoemulsification. CONCLUSIONS: An anterior chamber maintainer in conjunction with a self-sealing incision can maintain stable physiologic IOP during small-incision ECCE. The IOP fluctuations during phacoemulsification, especially during occlusion breaks, can be attenuated by an anterior chamber maintainer.

Aged↗

PubMed1997

Temporal corneal phacoemulsification in patients with filtered glaucoma.

OBJECTIVE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that underwent prior trabeculectomy. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive patients who underwent temporal clear corneal phacoemulsification subsequent to trabeculectomy (trabeculectomy-phacoemulsification group) were identified, and 40 control patients who underwent trabeculectomy alone (trabeculectomy group) were matched to the case patients for length of follow-up, age, IOP, number of antiglaucoma medications, number of 5-fluorouracil injections, race, sex, and diagnosis. MAIN OUTCOME MEASURES: Intraocular pressure before vs 1 year after phacoemulsification in the trabeculectomy-phacoemulsification group compared with IOP in the trabeculectomy group and survival analysis of IOP control after trabeculectomy in the 2 groups. RESULTS: In the trabeculectomy-phacoemulsification group, IOP 1 year after phacoemulsification was not significantly different from the prephacoemulsification IOP value (P = .65). Kaplan-Meier survival analysis showed that the rates of IOP control 3, 6, and 9 years after trabeculectomy in the trabeculectomy-phacoemulsification group were 80%, 66%, and 44%, respectively; in the trabeculectomy group, these were 79%, 69%, and 55%, respectively. These survival curves were not statistically different (P = .55). CONCLUSION: Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long-term IOP control.

Aged↗

PubMed2006

Intraocular pressure during phacoemulsification.

PURPOSE: To assess changes in intraocular pressure (IOP) during standard coaxial or bimanual microincision phacoemulsification. SETTING: Oregon Eye Center, Eugene, Oregon, USA. METHODS: Bimanual microincision phacoemulsification (microphaco) was performed in 3 cadaver eyes, and standard coaxial phacoemulsification was performed in 1 cadaver eye. A pressure transducer placed in the vitreous cavity recorded IOP at 100 readings per second. The phacoemulsification procedure was broken down into 8 stages, and mean IOP was calculated across each stage. Intraocular pressure was measured during bimanual microphaco through 2 different incision sizes and with and without the Cruise Control (Staar Surgical) connected to the aspiration line. RESULTS: Intraocular pressure exceeded 60 mm Hg (retinal perfusion pressure) during both standard coaxial and bimanual microphaco procedures. The highest IOP occurred during hydrodissection, ophthalmic viscosurgical device injection, and intraocular lens insertion. For the 8 stages of the phacoemulsification procedure delineated in this study, IOP was lower for at least 1 of the bimanual microphaco eyes compared with the standard coaxial phaco eye in 4 of the stages (hydro steps, nuclear disassembly, irritation/aspiration, anterior chamber reformation). CONCLUSION: There was no consistent difference in IOP between the bimanual microphaco eyes and the eye that had standard coaxial phacoemulsification. Bimanual microincision phacoemulsification appears to be as safe as standard small incision phacoemulsification with regard to IOP.

Anterior Chamber↗

PubMed1998

Clinical outcomes and costs of cataract surgery performed by planned ECCE and phacoemulsification.

PURPOSE: To compare clinical outcomes and costs of cataract surgery between patients operated with standard extracapsular extraction (ECCE) and those undergoing phacoemulsification. SETTING: Patients from the Ophthalmology Department of a teaching hospital in Barcelona (Spain) scheduled for cataract surgery, not combined with any other ophthalmic procedure. METHODS: A retrospective analysis has been performed on a database of 1046 patients undergoing ECCE and phacoemulsification. The outcome measures used were: surgical complications, visual acuity and costs of surgery and of follow-up. Overall rate of all complications and postoperative visual acuity were compared between the two groups, adjusting for age, preoperative visual acuity, medical and ocular comorbidity. RESULTS: 31.9% of the patients (334) underwent phacoemulsification, and 68.1% (712) underwent ECCE. Patients undergoing phacoemulsification presented a frequency of intra- and postoperative complications lower than those undergoing ECCE (odds ratio 0.57, 95%CI 0.37-0.87 and 0.66, 95%CI 0.46-0.96, respectively), specifically for intraoperative iris trauma (3.1% vs 0.3%, p = 0.004), residual posterior capsular opacity (2% vs 0.3%, p = 0.035) and postoperative corneal edema (7.4% vs 3.6%, p = 0.016). Costs of intervention and follow-up were lower for phacoemulsification compared with ECCE (23.9% and 14%, respectively). But global costs were slightly higher for phacoemulsification (4.87%), due to supply costs, which were more than twice those of ECCE. CONCLUSIONS: Phacoemulsification, when performed by an experienced surgeon, has better clinical outcomes than planned extracapsular extraction, and costs may be lower since supply costs are expected to decrease as the phacoemulsification technique becomes more widespread.

Aged↗

PubMed2002

Phacoemulsification cataract surgery and unplanned anterior vitrectomy--is it bad news?

PURPOSE: The aim of this study was to determine the final visual outcome of patients who undergo complicated phacoemulsification cataract surgery in which the posterior capsule is compromised and vitrectomy was required. METHODS: Data were collected for patients operated on over an 18-month period from the 1st of January till the 24th of June 1999 at the Department of Ophthalmology, Leicester Royal Infirmary. All grades of surgeons were included and patients were identified from the theatre logbook. A standard proforma was completed and the data evaluated. RESULTS: A total of 2538 phacoemulsification cataract operations were performed over this duration. Of these, 2446 (96.4%) had uncomplicated phacoemulsification cataract surgery while 92 (3.6%) required anterior vitrectomy. In order to allow for a more accurate interpretation of the visual outcome, patients were divided into two groups, depending on whether or not there was pre-existing eye disease at initial listing.Sixty-five patients did not have pre-existing eye disease. From this, notes were available for 57 patients, whereby the best-corrected visual acuity (BCVA) was obtained postoperatively. Vision of 6/12 or better was used to define acceptable postoperative vision. This group consisted of 49 patients (86%): five had visual acuities of 6/12, 26 = 6/9, one = 6/7.5 and 17 = 6/6. There were eight (14%) patients with poor visual outcome, largely represented by patients with cystoid macular oedema (8.8%). The most frequent stage of vitreous loss was during primary phacoemulsification in 46 (50%). Irrigation and aspiration, which resulted in 21 (23%) instances, followed this. The rate of posterior capsule rupture and anterior vitrectomy during phacoemulsification cataract surgery is 2% when performed by consultants, 4% by specialist registrars and staff grades and 10% by senior house officers. CONCLUSION: This study looks at the final visual outcome of patients who underwent unplanned anterior vitrectomy during routine phacoemulsification cataract surgery, in a university teaching hospital in the United Kingdom. It includes all levels of surgeons with varying experience. The rate of vitreous loss in this study for phacoemulsification cataract surgery is 3.6%. Patients who undergo complicated phacoemulsification cataract surgery do comparatively well.

Cataract↗

PubMedDate not supplied

Trypan-blue- and endoillumination-assisted phacoemulsification in eyes with vitreous hemorrhage during combined cataract and vitreous surgery.

PURPOSE: To study the safety and usefulness of trypan blue application and conventional endoillumination for enhancing visualization during phacoemulsification and foldable intraocular lens implantation in cases of cataract with vitreous hemorrhage. METHODS: Ten eyes of 10 patients with cataract and coexisting vitreous hemorrhage underwent combined trypan-blue- and endoillumination-assisted phacoemulsification and foldable intraocular lens implantation with vitrectomy. In a two-step surgery, after staining the anterior capsule with trypan blue, continuous circular capsulorhexis was performed; then, phacoemulsification was performed using conventional endoillumination. Specular microscopy was performed before and 3 months after surgery on eyes that underwent trypan-blue- and endoillumination-assisted phacoemulsification and on control eyes that underwent standard phacoemulsification to evaluate the toxic effect of trypan blue on corneal endothelial cells. RESULTS: Trypan blue application improved visualization of the anterior capsule, and a complete capsulorhexis could be performed in all eyes. In all 10 eyes, endoillumination was required to visualize the lens structure, and phacoemulsification could be accomplished. Specular microscopy revealed that there was no significant difference in the level of corneal endothelial cell loss between the trypan-blue- and endoillumination-assisted phacoemulsification group and the control group. CONCLUSION: The described double visualization technique may assist phacoemulsification in selected cases of cataract with vitreous hemorrhage.

Aged↗

PubMed2000

[Direct measurement of nitric oxide levels in aqueous humor with selective iso-NO electrode under physiologic conditions and after phacoemulsification and artificial acrylic lens implantation in experiments on rabbits].

PURPOSE: Using a direct method, with selective and nitric oxide sensitive electrode Iso-NO, we estimated the level of the Nitric Oxide (NO) in the aqueous humor of the rabbit's eye after phacoemulsification and acrylic foldable lens implantation. We also analysed the NO level during early postoperative days between the 1st and the 5th postoperative day. The current methods of the NO level estimations are also considered. MATERIAL AND METHODS: We examined 30 gray rabbits (weighing 3.0-3.5 kg). Just before surgery, samples of aqueous humor were aspirated. Lens was extracted with phacoemulsification technique. In 15 eyes acrylic foldable IOL was implanted and 15 eyes were left aphacic. The aqueous samples were collected 1, 3, 5 days after surgery. Nitric oxide in each sample was determined with direct, selective nitric oxide sensitive electrode Iso-NO. Because of changing values of the NO concentration and its characteristic course, we expressed the concentration of NO in aqueous humor using field-under-curve method to compare it with control group. The results of our examination are presented in the absolute values. RESULTS: During physiological conditions the mean value of the field under curve of the NO concentration was estimated as 4987.29 +/- 895.89. After phacoemulsification with or without artificial lens implantation the level of the NO was higher as compared to the control group. After phacoemulsification and acrylic foldable lens implantation the highest level of NO was estimated on the 1st postoperative day as 6917.10 +/- 1199.72. During the examinations, the field under curve of NO concentration was estimated as 6246.63 +/- 327.02 and 5172.28 +/- 552.67 (on the 3rd and 5th days respectively). Only on the 1st and the 3rd postoperative day, the value of the field under curve of NO was significantly higher as compared with the control group. In contrast, after phacoemulsification without lens implantation the highest value of NO field under curve, was estimated on the 3rd postoperative days as 5801.44 +/- 344.45. During the examinations, the field under curve of NO concentration was estimated as 5115.30 +/- 796.11 and 4837.12 +/- 205.87 (on the 1st and the 5th days, respectively). Moreover, it was the only one day of examination with significantly higher value of NO field under curve as compared with the control. CONCLUSION: We came to conclusion that the level of nitric oxide in aqueous humor after phacoemulsification with or without artificial lens implantation is higher than in control group. The highest value of the field under curve was estimated on the 1st postoperative day after phacoemulsification and acrylic foldable lens implantation and on the 3rd postoperative day after phacoemulsification without lens implantation.

Animals↗

PubMedDate not supplied

Comparison of phacoemulsification and planned extracapsular cataract extraction in combined pars plana vitrectomy and posterior chamber intraocular lens implantation.

BACKGROUND AND OBJECTIVE: To compare two kinds of cataract removal methods combined with pars plana vitrectomy and posterior chamber intraocular lens (PC-IOL) implantation. PATIENTS AND METHODS: Cataract removal was performed by either phacoemulsification or extracapsular cataract extraction (ECCE) and followed by pars plana vitrectomy and PC-IOL implantation. Between May 1996 and June 2001, 31 and 22 patients with cataract and vitreoretinal disease were treated by phacoemulsification and ECCE, respectively, combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative vision, astigmatism change, and complications were analyzed. RESULTS: The mean age of patients in the phacoemulsification and ECCE groups was 62.5 and 63.4 years, respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 87.1% of the phacoemulsification group and 59.1% of the ECCE group. The change in astigmatism after surgery was 0.92+/-1.08 D (P = .001) in the ECCE group and 0.25+/-0.74 D (P = .087) in the phacoemulsification group. There were fewer postoperative complications, including recurrent vitreous hemorrhage, increased intraocular pressure, and iris changes in the phacoemulsification group than in the ECCE group. CONCLUSION: Phacoemulsification and ECCE combined with pars plana vitrectomy and PC-IOL implantation are both effective surgical methods to achieve better and more rapid visual rehabilitation for patients with combined cataract and vitreoretinal disease. In this study, phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation resulted in greater improvement in vision, less astigmatism change, and fewer postoperative complications.

Aged↗

PubMed2006

Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy.

PURPOSE: To determine the effect of phacoemulsification, aspiration, and intraocular lens (IOL) implantation in eyes with acute angle closure or eyes with prior laser iridotomy for acute angle closure. SETTING: Department of Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes with acute angle closure and 8 eyes with cataracts that had a prior acute angle closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL. A third group that had phacoemulsification, aspiration, and IOL for cataracts only served as controls. The preoperative and postoperative intraocular pressures (IOPs), visual acuities, and number of antiglaucoma medications were compared between these 3 groups. RESULTS: The mean IOPs in the eyes with phacoemulsification, aspiration, and IOL alone and the eyes with prior acute angle closure treated by laser iridotomy were decreased significantly after phacoemulsification, aspiration, and IOL. The mean IOPs in the control group also decreased, but not significantly. There was no significant difference in the postoperative IOP between the 3 groups. The postoperative visual acuities were improved significantly in the 3 groups, and the differences in the final visual acuities were not significant. Postoperatively, the antiglaucoma medication was not needed in the phacoemulsification, aspiration, and IOL-alone group, but medication was necessary in eyes treated previously with laser iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

Acute Disease↗

PubMed2006

Effect of temporal clear corneal phacoemulsification on intraocular pressure in eyes with prior Ahmed glaucoma valve insertion.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes after Ahmed glaucoma valve insertion. SETTING: Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. METHODS: The files of 13 patients who received phacoemulsification after Ahmed glaucoma valve insertion were reviewed in this retrospective case series. Visual acuity, IOP, and the number of glaucoma medications before phacoemulsification were used as a baseline for comparison with the values at various follow-up intervals. RESULTS: The mean IOP before phacoemulsification was 15.1 mm Hg +/- 3.6 (SD). Postoperatively, it was 12.8 +/- 4.5 mm Hg, 13.1 +/- 3.6 mm Hg, 16.4 +/- 5.2 mm Hg, 15.8 +/- 4.0 mm Hg, 16.1 +/- 3.9 mm Hg, 15.3 +/- 4.1 mm Hg, and 15.2 +/- 3.4 mm Hg at 1 day after 1 week, at 1, 2, 6, and 12 months, and at last visits, respectively. The mean IOP did not differ significantly from the prephacoemulsification value at any follow-up. The number of glaucoma medications increased significantly after phacoemulsification (P = .031), and 6 of 13 eyes required additional glaucoma medication because of IOP elevation at approximately 1 month. CONCLUSIONS: Temporal clear corneal phacoemulsification did not increase IOP significantly in eyes with prior Ahmed glaucoma valve insertion. However, some eyes experienced an IOP elevation 1 month after phacoemulsification and required glaucoma medication.

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