SEARCH · PubMed Health

Results for “Phacoemulsification”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources

PubMed2006

Vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes.

OBJECTIVE: To describe vitrectomy-phacoemulsification-vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56-78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery. INTERVENTION: The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to "debulk" the vitreous and soften the eye. Step 2: Phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications. RESULTS: The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage. CONCLUSIONS: The vitrectomy-phacoemulsification-vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.

Aged↗

PubMed2005

Acoustic cavitation in phacoemulsification and the role of antioxidants.

Cataract surgery by phacoemulsification generates acoustic cavitation, resulting in formation of reactive oxygen species. The aim of this study was to establish the mechanism of damage by phacoemulsification in an in vitro setting simulating cataract surgery and to assess the protective effects of water-soluble antioxidants. Electron paramagnetic resonance spectroscopy was used to analyze generation of radicals in an intraocular irrigating solution by phacoemulsification instrumentation, operating at an ultrasonic frequency range of 40--60 kHz. Hydroxyl radicals were generated by phacoemulsification under conditions simulating cataract surgery. The effects of water-soluble antioxidants in the irrigating solution on the amounts of radicals were evaluated by electron paramagnetic resonance spectroscopy. The water-soluble antioxidant glutathione, applied in either oxidized or reduced form, decreased hydroxyl radicals concentration measured in the sonicated medium. The effective concentrations of oxidized and reduced glutathione in irrigating solution that significantly eliminate the hydroxyl radical signal were determined in the range of 10(-3)-10(-2) M. Antioxidants should be applied clinically to reduce damage to the corneal endothelium induced by phacoemulsification, thereby improving biosafety.

Antioxidants↗

PubMed2001

Acute full-thickness macular hole after uncomplicated phacoemulsification cataract surgery.

PURPOSE: To report the occurrence of a full-thickness macular hole in the early postoperative period after uncomplicated phacoemulsification cataract surgery. METHODS: Retrospective analysis of a consecutive series of eyes referred for treatment of a full-thickness macular hole after uncomplicated phacoemulsification cataract surgery. RESULTS: In a 4-year period, five eyes with acute full-thickness macular hole after uncomplicated phacoemulsification cataract surgery were examined. Metamorphopsia and vision loss had occurred 2 to 8 (mean, 4.4) days after phacoemulsification. All eyes had attained normal corrected vision on day 1 postoperatively. A stage 2 full-thickness macular hole was present in four of the five, and a stage 3 full-thickness macular hole in one of the five eyes with acuities of 20/60--20/120 (median, 20/80). All five eyes had successful closure with early primary full-thickness macular hole surgery with visual improvement to 20/20-- 20/60 (median, 20/40). CONCLUSION: Full-thickness macular hole may occur rarely during the early postoperative period after uncomplicated phacoemulsification, and early diagnosis and full-thickness macular hole surgery carries a favorable prognosis. The mechanisms underlying macular hole formation in these eyes are unclear.

Acute Disease↗

PubMed2001

Cataract surgery by phacoemulsification in adults with retinopathy of prematurity.

PURPOSE: To report the preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with retinopathy of prematurity. METHODS: Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and January 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) with retinopathy of prematurity were identified who had undergone phacoemulsification for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative follow-up. RESULTS: Cataract extraction by phacoemulsification was performed on 20 eyes. Follow-up ranged from 6 to 103 months (mean, 32 months). A posterior chamber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the intraocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and remained unchanged in two eyes. Postoperatively, visual acuity was worse than 5/200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegmatogenous retinal detachment 1 month after cataract surgery; the retina was successfully reattached. CONCLUSIONS: Although cataract extraction in eyes with regressed retinopathy of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeon should be aware of the special considerations in this population, alert to potential zonular weakness intraoperatively, and careful of increased postoperative risks, including retinal detachment.

Adolescent↗

PubMed2000

Phacoemulsification and lens implantation after scleral buckling surgery.

PURPOSE: To determine the intraoperative and postoperative complications and best-corrected visual acuity outcomes of eyes undergoing phacoemulsification and intraocular lens implantation after retinal detachment repair by the scleral buckling technique. METHODS: The charts of all patients who underwent phacoemulsification and intraocular lens implantation between July 1991 and May 1998 in two surgical practices were reviewed to identify eyes with a history of retinal detachment repaired by the scleral buckling technique. Eyes with a history of pars plana vitrectomy were excluded. Demographic and surgical data, preoperative and postoperative best-corrected visual acuity, and intraoperative and postoperative complications were recorded. RESULTS: We identified 34 eyes of 32 patients. The mean interval from retinal detachment repair to phacoemulsification was 12.4 years. The mean interval from phacoemulsification to final examination was 20 months. Risk factors for retinal detachment included isolated myopia (82%), myopia with lattice retinal degeneration (5.9%), and myopia with trauma (8.8%). One eye (2.9%) had no identifiable risk factors. Final best-corrected visual acuity of 20/40 or better was attained in 29 (85%) of 34 eyes and 20/20 or better in 18 (53%) of the eyes. Of the five eyes with the lowest best-corrected visual acuity, three had a macula-off retinal detachment; one had a posterior capsule opacity, epiretinal membrane, and corneal edema secondary to ocular ischemia; and one had advanced glaucoma. All five eyes still experienced an improvement in best-corrected visual acuity. With regard to complications, one eye had a posterior capsular tear with vitreous loss and another developed a postoperative retinal tear. Posterior capsule opacification requiring laser capsulotomy developed in 13 eyes (38%). No eye developed a retinal redetachment. CONCLUSION: Phacoemulsification and intraocular lens implantation can be performed safely after scleral buckling surgery and excellent best-corrected visual acuity results can be attained in most eyes. No modification of surgical technique is necessary. No retinal redetachment occurred in this series.

Adult↗

PubMed2000

Phacoemulsification versus extracapsular cataract extraction in patients with diabetes.

OBJECTIVE: To compare phacoemulsification with extracapsular cataract surgery in patients with diabetes and to identify determinants of postoperative visual acuity. DESIGN: Prospective, randomized, paired-eye trial. PARTICIPANTS: Forty-six patients with diabetes and bilateral cataract. INTERVENTION: Patients were allocated to phacoemulsification surgery with silicone intraocular lens to one randomly determined eye, and extracapsular cataract surgery with 7-mm polymethylmethacrylate intraocular lens to the other. MAIN OUTCOME MEASURES: Logarithm of minimum angle of resolution visual acuity (logMAR VA), incidence of clinically significant macular edema (CSME), retinopathy progression, indices of anterior segment inflammation, and incidence of capsulotomy. RESULTS: Compared with eyes undergoing phacoemulsification, eyes managed with extracapsular surgery had more anterior chamber cells (P = 0.0004) and flare (P = 0.007) 1 week after surgery and a higher incidence of posterior synechiae (P = 0.04) and intraocular lens deposits (P < 0.0005) in the first postoperative year. The need for posterior capsulotomy was greater in eyes undergoing extracapsular surgery (16 of 46 vs. 5 of 46, P = 0.01). No difference in incidence of postoperative CSME, progression of retinopathy, or development of high-risk proliferative retinopathy was identified between techniques (P = 1.0, 0.8, and 0.2). Median 1-year logMAR VA was worse in eyes undergoing extracapsular surgery (0.08 vs. 0.06, P = 0.02), especially in those with retinopathy (0.14 vs. 0.08, respectively; P = 0.01). The presence or absence of CSME at the time of surgery was the most significant determinant of 1-year logMAR VA in regression models for both extracapsular (P = 0.0004, R2 = 0.45) and phacoemulsification groups (P < 0.00005, R2 = 0.46). CONCLUSIONS: Phacoemulsification is associated with better postoperative VA, less postoperative inflammation, and less need for capsulotomy than extracapsular cataract surgery in patients with diabetes. However, with both techniques, the principal determinant of postoperative VA appears to be the presence or absence of CSME at the time of surgery. Early intervention, reducing the risk that unrecognized CSME is present at the time of surgery, may be more critical to outcome than choice of surgical technique.

Aged↗

PubMed1997

Phacoemulsification. Technology and fundamentals.

The number one rule of phacoemulsification and aspiration cataract surgery is to know your machine. This chapter is designed to help the surgeon who is currently using phacoemulsification, or those who wish to understand more about technique, learn the basics and technology of the various types of phacoemulsification machines. Fluidics, pump design, handpiece mechanics, phacoemulsification needles, and fundamentals of phacoemulsification of cataracts will be reviewed.

Animals↗

PubMed2002

Phacoemulsification in the anterior chamber.

PURPOSE: To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. RESULTS: The mean nuclear hardness was 2.67 +/- 0.61 (SD) in the stop-and-chop group and 2.65 +/- 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% +/- 4.24% in the stop-and-chop group and 11.20% +/- 5.60% in the phaco-out group. There were no significant differences between groups in any parameter (P >.05, independent-sample t test). CONCLUSION: Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.

Aged↗

PubMed2002

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Aged↗

PubMed2002

Comparison of sonic and ultrasonic phacoemulsification using the Staar Sonic Wave system.

PURPOSE: To compare the performance of sonic phacoemulsification with that of ultrasonic phacoemulsification in regard to 1-day postoperative visual acuity, corneal edema, and procedure efficiency. SETTING: Oregon Eye Institute, Eugene, Oregon, USA. METHODS: This prospective nonrandomized study comprised 86 eyes with mild to moderate nuclear sclerotic cataract. Forty-three eyes had sonic and 43 ultrasonic phacoemulsification using the Staar Sonic Wave phacoemulsification system. The mean age was 76 years in the ultrasonic group and 71 years in the sonic group. The mean nuclear sclerosis was 2.0+ in the sonic group and 1.9+ in the ultrasonic group. Patient age, lens density, postoperative corneal edema, 1-day postoperative uncorrected visual acuity (UCVA), and the percentage of eyes with a visual acuity of 20/40 or better were determined. In addition, the mean ultrasonic and sonic times, mean percentage phaco power, and mean effective phaco time (EPT) were calculated in each group. RESULTS: Both groups had a 5% incidence of trace corneal edema. The mean UCVA was 20/41 in the ultrasonic group and 20/42 in the sonic group. Seventy-nine percent of eyes in the ultrasonic group and 74% in the sonic group had a UCVA of 20/40. The mean percentage phaco power was 7.2% and 7.6% in the ultrasonic group and sonic group, respectively. The mean EPT was low in both groups, 4.0 and 2.9 seconds, respectively. CONCLUSION: Sonic technology yielded outcomes similar to those of ultrasonic phacoemulsification with respect to postoperative visual acuity and corneal edema in patients with average density nuclear sclerotic cataract.

Corneal Edema↗

PubMed2003

Clinical application of the lens opacities classification system III in the performance of phacoemulsification.

PURPOSE: To report the correlation of features of cataracts graded by the Lens Opacities Classification System, version III (LOCS III), with phacoemulsification energy expenditure and the balanced salt solution (BSS) volume used during cataract surgery. SETTING: Wolfe Clinic, Marshalltown, Iowa, USA. METHODS: This was a retrospective review of 2364 cases operated on by a single surgeon from January 1998 to July 2000 in which the cataract had been graded at the slitlamp using the 4 grading scales of the LOCS III: nuclear opalescence (NO), nuclear color (NC), cortical cataract (C), and posterior subcapsular cataract (P). Polynomial best-fit lines were derived using regression analysis correlating the 4 preoperative LOCS III characteristics with 3 intraoperative observations: machine-measured phacoemulsification time, mean power expenditure, and BSS volume. RESULTS: As determined by best-fit lines and their coefficient of determination (R(2)), there were exponential relationships between machine-measured phacoemulsification time and the degree of NC (R(2) = 0.48) and NO (R(2) = 0.40). Trends existed between NC and NO and the amount of BSS used (R(2) = 0.08 and R(2) = 0.07, respectively). No relationships were observed between the LOCS III classes of cataract, C and P, at any intraoperative observation. CONCLUSIONS: Exponentially, greater phacoemulsification energy was required as NC and NO increased. The LOCS III cataract grading system enhanced the ability to estimate ultrasonic energy expenditure and BSS volume use during phacoemulsification. Preoperative LOCS III cataract classification can help to create a more formally organized, integrated, customized operative plan.

Cataract↗

PubMed2003

Efficacy and wound-temperature gradient of whitestar phacoemulsification through a 1.2 mm incision.

PURPOSE: To evaluate the efficacy and wound-temperature gradients of WhiteStar micropulse technology using bimanual phacoemulsification without an irrigation sleeve through a 1.2 mm incision. SETTING: Island Eye Surgicenter, Carle Place, New York, USA. METHODS: Ten patients had bimanual phacoemulsification using micropulse technology without an irrigation sleeve through a 1.2 mm clear corneal incision. A thermocouple consisting of a 30-gauge copper wire was inserted into clear cornea directly adjacent to the wound to digitally record temperature gradients at the wound. Endothelial cell counts were evaluated preoperatively and postoperatively in all patients. RESULTS: All 10 patients maintained corneal clarity with no sign of thermal damage to the wound. The maximum corneal wound temperatures during phacoemulsification ranged from 24 degrees C to 34 degrees C, well below the temperature of collagen shrinkage. The endothelial cell loss at 3 months was 7%. CONCLUSIONS: Because of the decreased thermal effect with WhiteStar technology, an irrigation sleeve over the phacoemulsification needle is superfluous. As a result, bimanual phacoemulsification can be safely performed through a 1.2 mm incision.

Body Temperature↗

PubMed2003

Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes.

PURPOSE: To evaluate the effect on the corneal endothelium of phacoemulsification combined with passive silicone oil removal and intraocular lens (IOL) implantation under topical anesthesia after pars plana vitrectomy. SETTING: Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy. METHODS: This retrospective study evaluated the corneal endothelium in 17 consecutive patients (17 eyes) who had phacoemulsification with transpupillary passive silicone oil washout (1300 centistokes) through a posterior capsulorhexis and single clear corneal incision and foldable acrylic IOL implantation. The findings were compared with those in a control group of 17 patients (17 eyes) who had phacoemulsification with acrylic IOL implantation through a single clear corneal incision. All procedures were performed by the same surgeon using topical anesthesia. The preoperative and postoperative endothelial cell densities, coefficient of variation (CV), and percentage of hexagonal cells at the corneal center and peripheral temporal position, evaluated by noncontact specular microscopy, were compared between the 2 groups. The central corneal thickness and occurrence of keratopathy were also noted. RESULTS: The mean phacoemulsification and total ultrasound times did not differ significantly between the 2 groups. At 6 months, the mean endothelial cell loss was 284.50 cell/mm(2) +/- 462.3 (SD) (11.2%) in the study group and 200.15 +/- 117.9 cell/mm(2) (8.3%) in the control group (P=.87, unpaired t test). There were no significant between-group differences in the increase in the mean CV and the percentage of hexagonal cells. The mean pachymetry remained at preoperative values, with no difference between groups. Keratopathy was not observed in any patient. CONCLUSIONS: Passive silicone oil efflux caused significant endothelial cell loss and changes in endothelial morphology. Nevertheless, these modifications were well tolerated and minimally different from the results of trauma caused by standard phacoemulsification with posterior chamber IOL implantation.

Acrylic Resins↗

PubMed1996

Comparison of viscoelastic substances used in phacoemulsification.

PURPOSE: To evaluate the usefulness of four viscoelastic agents during phacoemulsification: 2% hydroxypropylmethylcellulose (HPMC) (Methocel), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat), 1% sodium hyaluronate (Healon), 1.4% sodium hyaluronate (Healon GV). SETTING: Eye Clinic, Kreiskrankenhaus Bad Hersfeld, Germany. METHODS: Two hundred patients, divided into four groups of 50 patients, received one of the viscoelastic substances during phacoemulsification and posterior chamber intraocular lens implantation. Patients were followed for 1 month. Visual acuity and intraocular pressure (IOP) were measured. The following were subjectively evaluated for each viscoelastic: corneal findings, anterior chamber reaction, visibility of intraocular structures and retention time during phacoemulsification, space maintaining ability, and removability and ease of injection. RESULTS: Postoperative IOP and visual acuity were comparable among the four groups. Viscoat tended to trap nuclear fragments and air bubbles during the phacoemulsification procedure, which decreased visibility during surgery. Space maintenance and injection ease were significantly better with Healon and Healon GV. CONCLUSION: The high molecular weight viscoelastics (Healon and Healon GV) performed better as viscosurgical tool during cataract surgery using phacoemulsification.

Chondroitin Sulfates↗

PubMed1997

Corneal endothelial function after extracapsular cataract extraction and phacoemulsification.

PURPOSE: To compare the morphology and function of the corneal endothelium in the early postoperative period after extracapsular cataract extraction (ECCE) and phacoemulsification. SETTING: University Eye Clinic of Trieste, Italy. METHODS: In this prospective, randomized study of patients scheduled for cataract surgery, 40 patients were divided into two groups of 20 patients each. Group 1 had ECCE and Group 2, phacoemulsification; both had capsular bag intraocular lens (IOL) implantation. Preoperatively and 7 and 30 days postoperatively, a complete ophthalmological examination, endothelial specular microscopy, ultrasonic pachymetry, and anterior segment fluorophotometry were done. Visual acuity, endothelial cell density, cell size variation coefficient, corneal thickness, endothelial permeability coefficient, and endothelial pump function were studied. RESULTS: Visual acuity was better 7 days after phacoemulsification than after ECCE, but no differences were observed after 30 days. No significant differences in postoperative loss of endothelial cells were found between the two groups. Coefficient of variation in size, corneal thickness, and endothelial permeability significantly increased in both groups 7 days postoperatively, but only in the ECCE group 30 days postoperatively; the differences between the two groups were statistically significant. Endothelial pump function significantly increased after 7 days in only the phacoemulsification group. CONCLUSIONS: Functional endothelial failure occurred in the early period after ECCE. Phacoemulsification seemed to minimize postoperative functional damage to the endothelium.

Aged↗

PubMed1998

Phacoemulsification learning curve: experience of two junior trainee ophthalmologists.

PURPOSE: To establish the incidence of complications during surgery performed by junior trainees learning phacoemulsification. SETTING: Eye infirmary in a United Kingdom district general hospital. METHODS: A retrospective review of case notes of the first 102 cases of phacoemulsification procedures performed by two senior house officers was done. Main outcome measures were change in surgical plan, position of implanted lens, posterior capsule tear, vitreous loss, zonule loss, and visual outcome at discharge. Follow-up was 6 weeks. RESULTS: A posterior capsule tear occurred in 6 eyes (5.8%) and vitreous loss in 3 (2.9%). All eyes had a posterior chamber lens, 6 (5.8%) implanted in the sulcus and 96 (94.2%), in the capsular bag. Eleven eyes (10.8%) had a visual acuity of 6/18 or worse at discharge: of these, 10 had pre-existing pathology in keeping with the level of acuity. In the other eye, there was no apparent cause for the 6/18 acuity. CONCLUSIONS: The study indicates that junior trainees can be taught phacoemulsification with acceptable complication rates and visual results. The results compare favorably with reports of senior surgeons converting to phacoemulsification, trainee surgeons learning extracapsular surgery, and recently reported phacoemulsification series.

Aged↗

PubMed1998

Risk of acute suprachoroidal hemorrhage with phacoemulsification.

PURPOSE: To establish whether small incision cataract surgery with phacoemulsification decreases the risk of acute suprachoroidal hemorrhage (ASCH) compared with traditional nucleus expression by extracapsular cataract extraction (ECCE). SETTING: St. Erik Eye Hospital, Stockholm, Sweden. METHODS: A retrospective study was done on the incidence of ASCH in cataract surgery between July 1990 and July 1996. During this period, 37,565 cataract extractions (phacoemulsification and ECCE) were performed at St. Erik Eye Hospital, combined procedures excluded. The criteria for diagnosis were the suspicion of ASCH during surgery and a verified diagnosis via an expulsive hemorrhage into the wound (4 cases), postoperative ultrasonic examination (20 cases), or a choroidal mass on performing ophthalmoscopy together with a postoperative history alluding to the diagnosis (2 cases). RESULTS: Twenty-six eyes were identified with ASCH, including 7 during phacoemulsification and 19 during ECCE. The incidence of ASCH was 0.03% in the 23,213 phacoemulsification cases and 0.13% in the 14,352 ECCE cases. The difference was statistically significant (P = .0003; chi-square test). CONCLUSION: Small incision surgery with phacoemulsification decreased the risk of ASCH in cataract surgery compared with the traditional nucleus expression technique.

Acute Disease↗

PubMed1998

Viscoelastic adherence to corneal endothelium following phacoemulsification.

PURPOSE: To compare the residual adherence of viscoelastics to the corneal endothelium following phacoemulsification in an in vitro rabbit model. SETTING: Departments of Ophthalmology and Anatomy, Wayne State University, Detroit, Michigan, USA. METHODS: Three groups of 10 rabbit eyes each had a lensectomy via phacoemulsification using sodium hyaluronate (Amvisc Plus, Healon GV) or sodium chondroitin sulfate-sodium hyaluronate (Viscoat) as the viscoelastic agent. After phacoemulsification and cortex removal, a central corneal block was excised, cryofixed, and processed for light and electron microscopy. Viscoelastic thickness was determined by a calibrated reticule on the light microscope or a calibrated measuring program in the electron microscope. The nonparametric statistical test, Kruskal-Wallis, was used to compare viscoelastic groups. RESULTS: Median phacoemulsification time between viscoelastic agents was not significantly different. Median viscoelastic thicknesses were 13.0 microns for Amvisc Plus, 0.4 micron for Healon GV, and 375.0 microns for Viscoat. Each was significantly different from the others (Kruskal-Wallis, P < .001). CONCLUSIONS: Median thickness of Amvisc Plus, Healon GV, and Viscoat remaining adherent to the corneal endothelium after phacoemulsification was markedly different. Viscoat provided the greatest amount of viscoelastic material adjacent to the corneal endothelium.

Animals↗