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Results for “Phacoemulsification”

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PubMed2006

[Phacoemulsification of first and second eye: indication criteria and results].

PURPOSE: To compare indication criteria, intra- and postoperative complications, visual outcomes and time interval between the first and second eye surgery (phacoemulsification). METHODS: Prospective study was done in 96 eyes of patients who underwent bilateral consecutive phacoemulsification surgery, performed by a third-year ophthalmology resident. An established protocol was filled out before, during and after the surgery. The same surgical technique was used. Chi-squared, Mann-Whitney, Kruskal-Wallis, Dunn multiple comparison and Student's t tests were used for statistical analysis. Bicaudal tests were used in all situations. p<0.05 rejected the null hypothesis. RESULTS: The indication for the second eye surgery was done earlier and with best correct visual acuity when compared with the first eye (p=0.016). The mean phacoemulsification ultrasound time (US time) of the first eye was significantly higher (p=0.026). There were no statistically significant differences between the two groups in relation to type of cataract, previous intraocular diseases, final visual acuity and mean spherical equivalent. The incidence of intra- and postoperative complications was smaller in the second eye, but was not statistically significant (p=0.07). Time interval between the first and second eye surgery was significantly lower along the trimesters. CONCLUSION: The patients underwent the second eye phacoemulsification surgery earlier (with better visual acuity and shorter time interval), had a shorter phacoemulsification time and tendency to be followed by less intra- and postoperative complications.

Chi-Square Distribution↗

PubMed2004

[Phacoemulsification cataract surgery in vitrectomized eyes].

OBJECTIVE: This study focuses on determining the intra- and post-operative complications stemming from technical difficulties, anatomical aspects, intraoperatory management and visual outcome of post-vitrectomized patients that undergo phacoemulsification. METHOD: In this prospective, longitudinal, observational and descriptive study phacoemulsification was performed in 25 post-vitrectomized eyes that required cataract surgery. Pre-surgical variables: sex, age, affected eye, visual accuity, underlying vitreoretinal disease, anterior segment morphological findings such as: cataract density and pupil alterations. Intrasurgical variables: characteristic of anterior chamber and pupil, phacoemulsification technique and time and the presence of complications. Post-surgical variables were also registered: visual capacity and the presence of complications. Minimum six-month follow-up period. RESULTS: The average interval between pars plana vitrectomy and phacoemulsification was 18.5 months. Silicone oil was the most frequent tamponade used in our serie (44%). Biomicroscopical findings were miosis 28% and posterior synechies 24%. The average interval of phaco time was 2.26 minutes. The intraoperative findings were fluctuations in the anterior chamber depth (24%) and anterior capsular tears (12%). The postoperative complications most frequently seen were posterior capsular plaque (28%) and corneal edema (16%). CONCLUSIONS: Phacoemulsification is a safe and effective technique in eyes after pars plana vitrectomy that require cataract surgery. The surgeon must be aware of the morphological and anatomical findings of these eyes. Visual rehabilitation will generally be determined by the presence of an underlying vitreo-retinal pathology.

Adolescent↗

PubMed2001

[Effect of high-vaccum-manual-chop technique in phacoemulsification].

OBJECTIVE: To study the effect of high-vaccum-manual-chop technique to reduce complications related to phacoemulsification. METHODS: The correlation between the relative energy complex parameter (RECP) and the postoperative corneal edema rate (CER) in manual-chop and phaco-divide groups was statistically studied. RESULTS: The intraoperative mean relative ultrasound power and the mean time of ultrasound phacoemulsification were increased with the increase of the lens nucleus hardness. A significant difference existed between the mean time of the ultrasound phacoemulsification of the two groups (t = 3.1467, P < 0.01). The comparison between the mean relative ultrasound power of the two groups has no significant difference (t = 0.1874, P > 0.05). Positive correlation was observed between RECP and CER (r = 0.97, P < 0.01). CONCLUSION: High-vaccum-manual-chop technique may reduce the postoperative complications related to phacoemulsification, and RECP can be taken as a reliable index to evaluate the safety of phacoemulsification.

Adult↗

PubMedDate not supplied

Phacoemulsification and foldable intraocular lens implantation in eyes filled with silicone oil.

BACKGROUND AND OBJECTIVE: To evaluate the visual outcome of phacoemulsification and foldable intraocular lens (IOL) implantation in eyes already filled with silicone oil. PATIENTS AND METHODS: Following vitrectomy and silicone oil injection, 16 eyes of 16 consecutive patients undergoing phacoemulsification and IOL implantation were included in the study. RESULTS: The mean age of patients was 58.3 +/- 9.2 years (range, 38 to 71 years). The time interval between the cataract surgery and silicone oil injection was 5.8 +/- 1.7 months (range, 4 to 9 months). The mean number of previous surgeries was 2.0 +/- 0.8 (range, 1 to 4). Trypan blue (0.4%) was used for anterior capsule staining in 3 eyes with white cataract. Dispersive viscoelastic material was used during all steps of phacoemulsification. A capsular tension ring was inserted after capsulorhexis and hydrodissection in all cases. An IOL with a 6.0-mm optic was implanted in all eyes. The preoperative best-corrected visual acuity ranged from hand motions to 0.3. The mean postoperative best-corrected visual acuity was 0.3 +/- 0.1 (range, 0.1 to 0.6); best-corrected visual acuity increased in all eyes. A small amount of silicone oil moved into the anterior chamber during phacoemulsification in 1 eye and was evacuated. In all eyes, no silicone oil was present in the anterior chamber postoperatively. CONCLUSION: The use of dispersive viscoelastic and a capsular tension ring provides safer phacoemulsification and foldable IOL implantation in eyes already filled with silicone oil.

Adult↗

PubMed2004

Results of combined surgery by phacoemulsification and vitrectomy.

BACKGROUND: Eyes scheduled for posterior segment surgery may have cataract, which obscures the visualization of the retina. Surgery may be carried out either by a two-step procedure: i.e., removal of the cataract followed later by posterior segment surgery; or it may be done in a single session: i.e., combined surgery of both the anterior and posterior segments. OBJECTIVE: To evaluate the outcomes of combined surgery by phacoemulsification and vitrectomy. METHODS: We retrospectively reviewed the records of 42 patients with coexisting cataract and vitreoretinal disease who underwent combined surgery by phacoemulsification and pars plana vitrectomy at one session. RESULTS: Indications for surgery were vitreous hemorrhage in 71.4%, retinal detachment in 11.9%, macular hole in 11.9%, and epiretinal membrane in 4.8%. There were no significant intraoperative complications. The main early postsurgical complications were fibrinous formation in 11.9%, elevated intraocular pressure in 23.8%, and recurrent vitreous hemorrhage in 9.5%. There were a few late complications related to phacoemulsification: posterior synechia in 9.5%, posterior capsular opacification in 7.1%, and dislocating intraocular lens in 4.8%. Recurrent retinal detachment occurred in five eyes and rubeoisis iridis in one. Visual acuity was improved in 85.8%, stable in 7.1% and worse in 7.1%. CONCLUSIONS: Phacoemulsification performed at the time of posterior segment surgery enables good visualization during the vitrectomy, facilitates surgery, and is associated with only minor complications. In cases with cataract and vitreoretinal diseases, combined surgery by phacoemulsification and vitrectomy in one session may be considered.

Aged↗

PubMed2005

[Phacoemulsification with Advan-Tec system and Neosonix handpiece].

PURPOSE: The comparative analyses of the standard Legacy 20000 efficiency and the AdvanTec Legacy efficiency take into consideration the effective phacoemulsification time, power, and the postoperative clinical outcomes. MATERIAL AND METHODS: Retrospective clinical study which comprises 2 groups of patients operated on with phacoemulsification: 200 eyes were operated on using the classic handpiece of the Legacy 20000 system; 200 eyes were operated on using the AdvanTec Legacy system and the NeoSoniX handpiece. RESULTS: The effective phacoemulsification time in the standard Legacy group was under 0.4 min in 40 cases (20%), between 0.4-1.2 min in 120 cases (60%), and more than 1.2 min in 40 cases (20%). The effective phaco time in the AdvanTec-NeoSoniX group was under 0.4 min in 118 cases (59%), between 0.4-1.2 min in 72 cases (36%) and more than 1.2 min in 10 cases (5%). The mean phacoemulsification power varied between 19-38% in the first group and 14-22% in the second group. Descemetic striae and corneal edema on the first postoperative day were observed in 38 eyes (19%) in the Legacy standard group, and 18 eyes (9%) in the AvanTec-NeoSonix group. CONCLUSIONS: The progression from the standard Legacy to the AdvanTec Legacy system with NeoSoniX handpiece led to the reduction in phacoemulsification power by two mechanisms, oscillation, which breaks the nucleus, and vacuum, which removes and evacuates the nuclear material.

Aged↗

PubMedDate not supplied

Combined pars plana vitrectomy and cataract surgery: outcome of phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel.

BACKGROUND AND OBJECTIVE: To compare the results of combined pars plana vitrectomy and cataract extraction with intraocular lens implantation by phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel. PATIENTS AND METHODS: Retrospective chart review of all patients who underwent combined pars plana vitrectomy with intraocular lens implantation and phacoemulsification or extracapsular cataract extraction through a sclerocorneal tunnel between March 1992 and July 2002. RESULTS: Fifty-four eyes of 51 patients were evaluated. Mean age was 69.68 +/- 9.11 years, and mean follow-up was 9 months. Phacoemulsification was performed in 35 cases (64%) and manual extraction in 19 cases (36%). Visual acuity improved from mean logarithm of the minimal angle of resolution 1.69 +/- 0.54 before surgery to 1.22 +/- 0.76 after surgery. There was a greater improvement of visual acuity in the phacoemulsification group (0.59 +/- 0.67) than in the extracapsular cataract extraction group (0.22 +/- 0.68) (P = .06). Final visual acuity was correlated to the vitreoretinal pathology. Ultrasound biomicroscopy showed well-positioned foldable or rigid intraocular lens in the bag or in the sulcus. CONCLUSION: Combined cataract extraction by phacoemulsification or extracapsular cataract extraction through sclerocorneal tunnel and pars plana vitrectomy are safe and effective procedures.

Adult↗

PubMed2005

Vitreous loss during phacoemulsification learning curve performed by third-year residents.

OBJECTIVES: To assess the resident's phacoemulsification learning curve as a risk factor for vitreous loss and to determine the incidence of vitreous loss among the residents performing phacoemulsification. DESIGN: Retrospective matched case-control study MATERIAL AND METHOD: A case-control study comparing all consecutive cases of attempted phacoemulsification with intraocular lens (IOL) implantation from January 1st, 1998 to December 31st, 1999. The surgeon variable will be categorized into two groups, the third year ophthalmology residents, representing resident's phacoemulsification learning curve, and faculty staffs. The study group consisted of eyes that had had intraoperative complication of vitreous loss. The control group consisted of eyes that had not had vitreous loss. Continuous variables were compared with the 2-sided unpaired t-test. Categorical variables were compared between groups using analytical matched case-control study with relative risk or odd ratio, Mc Nemar's (Marginal) o 2 test and 95% confident interval of relative risk. RESULTS: The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 4 times the odds that the eyes in the faculty staff group would have such complication (P = 0.0052, 95% confidential interval (CI) of relative risk (RR) = 1.516-10.556). The incidence of vitreous loss among residents was 6.93% (28/404) and 2.06% (28/1358) among the faculty staffs. The overall incidence of vitreous loss was 3.18% (56/1762). CONCLUSION: The incidence of intraoperative complication of vitreous loss, the relative risk of such complication performed by the learning curve surgeon in the present study serve as benchmarks for residents-in-training, beginning and surgeon-in-practice converting to phacoemulsification.

Case-Control Studies↗

PubMed2006

Cool phaco in combined phacoemulsification and vitrectomy surgery.

PURPOSE: The aim of this paper is to present the use of bimanual phacoemulsification technique in combined phacoemulsification and vitrectomy surgery. MATERIAL AND METHODS: Combined phacoemulsification and vitrectomy procedure was performed in 20 eyes. Phacoemulsification was performed through two paracenteses. Soft acrylic intraocular lenses were implanted into the capsular bag through a paracentesis 1.8 mm wide. Standard three-port pars plana vitrectomy followed. Indications for vitrectomy were diabetic retinopathy, retina detachment, uveitis, macula hole. All surgeries were performed as one-day surgeries. Follow-up lasted six months. RESULTS: Visual acuity improved in 19/20 eyes (95%). The achieved functional results were similar to that achieved in standard phacoemulsification combined with vitreoretinal surgery. Surgery time did not differ significantly from time needed to perform a standard procedure. The bimanual technique allowed the stablization of the anterior chamber during vitreoretinal surgery. No serious postoperative complications occurred. CONCLUSIONS: The presented method improves the quality of combined surgery, ensures stability of the anterior chamber, reduces postoperative astigmatism, lowers the risk of inflammation.

Adolescent↗

PubMed1997

Phacoemulsification for cataract following pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To determine if the technical aspects of phacoemulsification for removal of cataract following pars plana vitrectomy differ from those of phacoemulsification for removal of cataract in nonvitrectomized eyes. PATIENTS AND METHODS: Twenty-two eyes that had undergone prior vitrectomy were identified through a retrospective review of chart notes and operative records of 1039 consecutive cataract extractions performed by one surgeon. RESULTS: Complications of proliferative diabetic retinopathy was the most common indication for prior vitrectomy. The predominant lens change was nuclear sclerosis. Deep anterior chambers with large anterior to posterior excursions of the iris lens diaphragm with simultaneous fluctuation in pupil size occurred during phacoemulsification. The posterior capsule was flaccid and mobile during lens cortex removal. No posterior capsules ruptured. Postoperative visual acuity improved in 91% of the patients. CONCLUSIONS: Prior vitrectomy was associated with diabetes and nuclear sclerotic cataract. Phacoemulsification in this patient population was associated with inadequate pupillary mydriasis, superior conjunctival scarring, intraoperative anterior chamber depth, pupil size, and iris lens excursions that hindered phacoemulsification tip placement. Posterior capsules were excessively flaccid, prone to rapid anterior and posterior excursions, and may have plaques that are resistant to intraoperative removal.

Anterior Chamber↗

PubMed1997

The initial complication rate of phacoemulsification in India.

PURPOSE: This study was designed to investigate the feasibility of teaching experienced surgeons to perform phacoemulsification in India, a cataract-endemic area. Complications occurring during surgery and the first postoperative day were documented and evaluated. METHODS: During a 1-month period, at the Aravind Eye Hospital in Madurai, India, the first 100 consecutive cataract operations performed by each of three experienced surgeons (a total of 300 cases), using phacoemulsification were prospectively evaluated. Multiple logistic regression was used to identify factors associated with intraoperative and postoperative complications. RESULTS: The mean age of patients was 57.4+/-9.3 years. The median best corrected preoperative visual acuity was 20/80. Mean surgical and phacoemulsification times were 15.8+/-3.7 minutes and 2.2+/-1.5 minutes, respectively. Complications occurred in 65 (21.7%) eyes. The most common was a rent in the posterior capsule, occurring in 40 (13.3%) eyes. There were significant variations in complication rate and in surgical time among the surgeons. The risk of experiencing a complication decreased as the number of phacoemulsifications performed increased. An increased risk of complications was associated with worse preoperative visual acuity and increasing patient age. CONCLUSIONS: With each successive case, the chances of experiencing a complication decreased 1%. Acceptable results were obtained within 1 month of performing the first phacoemulsification.

Adult↗

PubMed1998

Early intraocular pressure after phacoemulsification combined with trabeculectomy.

BACKGROUND AND OBJECTIVE: To determine the efficacy of combined phacoemulsification--trabeculectomy in preventing early postoperative increases in intraocular pressure (IOP). PATIENTS AND METHODS: Eighty patients were enrolled in a prospective cohort study. Thirty-six patients with cataracts and uncontrolled glaucoma underwent combined phacoemulsification--trabeculectomy, and 44 patients with cataracts underwent phacoemulsification alone. The operations were performed in a standardized manner by one surgeon. IOP was measured at 4 hours, 1 day, and 7 days after surgery. The need for intervention (digital massage, medications) and the presence of complications were documented. RESULTS: Four hours after surgery, 5.5% of patients undergoing the combined procedure had IOPs greater than 30 mm Hg, compared with 22.7% of phacoemulsification patients (P < .05). No significant difference in IOP was found between the groups at postoperative day 1 or day 7. CONCLUSION: These results suggest that combined phacoemulsification-trabeculectomy protects against early postoperative elevations in IOP. This finding may influence the surgical management of cataracts in patients with poorly controlled glaucoma and significant compromise of visual field or optic nerve.

Adrenergic beta-Antagonists↗

PubMed1998

[Surgery of intravitreous nuclear luxations post-phacoemulsification].

PURPOSE: To evaluate anatomical and functional results after surgery of retained nucleus or nuclear lens fragments into the vitreous cavity after phacoemulsification. METHODS: Files of 46 patients that underwent vitrectomy for posterior retained nuclear fragments between July 92 and June 96 were studied retrospectively. Minimum follow-up was 6 months. Patients having only cortical material were excluded. In 34 cases the nucleus or nuclear fragments were removed posteriorly during a pars plana vitrectomy using either fragmentation with fragmatome (13 cases) or cutting with the vitreotome tip (21 cases). Anterior removal after pars plana vitrectomy was performed in 12 cases. 20 patients were operated on the first week, 12 during the second week and 14 after the second week following phacoemulsification. RESULTS: Forty-one per cent of the patients reached 20/40 or better. 28% had less than 20/200. 8 (17%) patients presented a retinal detachment, 6 a cystoid macular edema, 6 a bullous dystrophy, and 9 an elevated intraocular pressure. At the end of follow-up 89% have been implanted (50% had been implanted at the end of the cataract surgery). We found no correlation between visual acuity and timing of surgery, anterior or posterior site removal of nuclear fragments or lens implantation during phacoemulsification. CONCLUSION: Dislocation of the nucleus into the vitreous cavity is a serious event during phacoemulsification because of its inflammatory and retinal complications. Vitreoretinal surgery allows good visual recovery in about half of the patients. Technical handling depends primarily on the nucleus density. An IOL may be placed at the end of phacoemulsification if the nucleus is not too hard and if the anterior segment has been cleaned carefully.

Aged↗

PubMed1983

A comparison of the effects of phacoemulsification and nucleus expression on endothelial cell density.

A series of patients undergoing extracapsular cataract extraction by phacoemulsification (1,126) or nucleus expression (632) were studied to evaluate the relative effects of emulsification time, irrigating volume, and surgical technique on endothelial cell density. The collective data revealed a higher cell loss with phacoemulsification (15%) than with nucleus expression (12%). Patients over 69.5 years appeared to be more vulnerable to the effects of phacoemulsification than those below 69.5 years. Although the data were subjected to combinations and permutations of age, sex, time, and volume, no direct correlation between emulsification time and/or irrigating volume and endothelial cell loss was shown. When data sets for individual surgeons were analyzed, the most striking difference was between the endothelial effect of anterior chamber phacoemulsification (26% average reduction) and that of posterior chamber phacoemulsification (13% average reduction).

Age Factors↗

PubMed1994

Corneal endothelial cell loss after phacoemulsification using nuclear cracking procedures.

This study assessed corneal endothelial damage in endocapsular phacoemulsification surgery using a nuclear cracking procedure in which the nucleus was divided into four quadrants and emulsified. Forty-five eyes had phacoemulsification using this technique, and 33 eyes had phacoemulsification using undivided sculpting techniques (without cracking). We examined the extent of endothelial cell loss at one and three months after surgery using specular microscopy. We also measured ultrasound time, time spent for phacoemulsification, and infusion volume during surgery. Endothelial cell loss was significantly less in the nuclear cracking group than in the undivided sculpting group. Ultrasound time in surgery with cracking was significantly shorter than that in surgery without cracking. The time for the phacoemulsification maneuvers and the infusion volume were the same for both procedures. These findings indicate that the ultrasound time was shortened using the nuclear cracking technique and resulted in less corneal injury.

Aged↗

PubMed1991

Eccentric capsulorhexis and bidirectional endocapsular phacoemulsification.

The advantages of continuous circular capsulorhexis and endocapsular (endolenticular, posterior chamber, in situ) phacoemulsification are well recognized. Perhaps the only disadvantage of the phacoemulsification technique is the increased operative time. This report presents a new method for endocapsular phacoemulsification which includes a superiorly decentered circular or oval capsulorhexis and more rapid endocapsular phacoemulsification using a combination of one- and two-handed techniques. The procedure may also be safer since most of the phacoemulsification is performed within the central "safe zone" of the posterior chamber.

Cataract Extraction↗

PubMed1991

Nucleus-splitting phacoemulsification technique.

A technique for phacoemulsification that can be used with or without capsulorhexis and that allows surgery to be performed at the 12 o'clock position is described. Following central sculpting, the nucleus is tipped superiorly to the level of the iris plane with a second instrument and the phacoemulsification tip. The hard nucleus is split from the soft nucleus, leaving two bowl-shaped pieces. The nucleus is rotated and the hard nucleus is removed with a phacoemulsification tip while the softer nucleus or epinucleus is ignored. Once the hard nucleus has been removed, the epinucleus follows easily into the phacoemulsification tip. The technique is advantageous for beginning phacoemulsification surgeons and offers an alternative for very hard nuclei with small pupils.

Cataract Extraction↗

PubMedDate not supplied

Cataract extraction by the intracapsular methods and by phacoemulsification: the results of surgeons in training.

The results of 63 phacoemulsifications performed by 14 resident ophthalmologists (surgeons in training) were compared to their first 112 intracapsular cataract procedures. Although the number of complications was greater in the eyes undergoing intracapsular operations, the final visual acuities obtained by either procedurewere similar: visual acuities in the range of 20/20 to 20/30 were found in 80.7% of intracapsular cataract operations and in 83.3% of phacoemulsification procedures. Visual acuities of 20/50 or better were found in 90.3% of intracapsular cataract extractions andin 88.8% of phacoemulsification procedures. Cylindric correction of higher power was required to correct astigmatism associated with intracapsular cataract surgery as compared to phacoemulsification. The results of irrigation-aspiration of soft or traumatic cataracts performed in 20 eyes with needle and syringe were compared to results of 19 eyes operated on by use of the Cavitron-Kelman irrigation-aspiration handpiece. The incidence of postoperative secondary membrane requiring discussion was similar for both procedures. The basis for setting up a successful program for resident training in phacoemulsification is discussed.

Cataract Extraction↗