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Phacoemulsification systems.

Our objectives in conducting this evaluation were to present an overview of a basic phacoemulsification system and its components, to describe the phacoemulsification procedure within the context of the operating principles of the system's components, and to compare two manufacturers' products. Specifications for additional phacoemulsification systems are available in the November 1989 edition of ECRI's Hospital Product Comparison System. Both of the evaluated systems enable a surgeon to perform a complete cataract extraction procedure by phacoemulsification. We rated both units Acceptable. In selecting a unit, users should consider performance, safety, human factors design, and manufacturer training and support. Although list prices vary widely among available systems, cost factors should not override clinical performance and safety requirements. While we measured certain engineering parameters, such as stroke length and ultrasound (US) output forces exerted on a medium, we stress that the results of these tests do not provide enough information to predict clinical performance. Clinical performance of phacoemulsification systems can be determined only by the experience of the clinicians who use them. Clinicians should review our evaluation thoroughly before making a purchasing decision. The information we present is useful for purchasing the evaluated or other available models because our criteria will guide users in assessing all components, and our findings and discussion on some aspects are common to many available systems (e.g., type of pump, irrigation and aspiration [I/A] characteristics). The in-depth clinical and technical information will help users to better understand principles, thereby helping them to better define their needs. Although we discovered a number of problems with the evaluated models, users should not assume that similar or other problems do not exist with systems that we did not evaluate. The willingness of manufacturers to cooperate in our studies and the knowledge they gain through participating may lead to the development of better products.

Cataract Extraction↗

Phacoemulsification--a senior surgeon's learning curve.

We sought to prospectively document and evaluate the learning curve of an experienced extracapsular surgeon making a supervised transition from extracapsular cataract extraction (ECCE) to phacoemulsification. Over a period of 2 weeks, 51 phacoemulsification procedures using an endocapsular nucleofractis technique were performed by a single senior surgeon at the Christian Medical College in Vellore, India under the supervision of a visiting US expert with more than 15 years' experience in the technique. Vitreous loss occurred in seven eyes (six prior to the stage of cortical aspiration); failure of capsulorhexis necessitated conversion to standard ECCE in four. Injury to the inferior iris during phacoemulsification was cosmetically significant in three eyes. Two eyes had mild persistent localized corneal edema, but there were no instances of permanent corneal damage. One eye had intraoperative displacement of the nucleus into the vitreous. In one eye with vitreous loss, the implanted intraocular lens dislocated into the vitreous cavity. Two patients had clinically detectable cystoid macular edema at 6 weeks. Eleven patients were lost to follow up after 3 weeks. Six weeks after surgery, 36 of the remaining 40 eyes (90%) had achieved a best-corrected visual acuity of 6/6. We conclude that phacoemulsification requires supervised learning, even for an experienced surgeon. Complications still occurred, but were restricted to the unfamiliar steps of the surgery. Factors identified in the first 2 days of surgery (10 cases) as critical in the smooth transition to phacoemulsification were careful selection of initial cases, a successful capsulorhexis, and hydrodissection with vigorous nucleus mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Astigmatism↗

Corneal endothelial cell loss following phacoemulsification using the Small-Port Phaco.

We studied the extent of corneal endothelial injury after phacoemulsification using the Small-Port Phaco (SPP), a new phacoemulsification instrument that allows linear aspiration during phacoemulsification. Of 72 eyes undergoing phacoemulsification, the SPP was used in 33 (group 1) and a standard phacoemulsification instrument in 39 (group 2). Endothelial cell density was examined by specular microscopy preoperatively and at 1 and 3 months after surgery, and the percentage of endothelial cell loss was evaluated. Operative factors influencing endothelial injury such as the duration of ultrasound emission, the ultrasound power expended, and the amount of irrigating solution used also were measured. The percentages of endothelial cell loss at both 1 and 3 months were significantly less (P < .05) in group 1 than in group 2 (in group 1, 4.3 +/- 3.4% at 1 month, and 5.6 +/- 3.8% at 3 months; in group 2, 6.9 +/- 4.6%, and 8.3 +/- 5.4%, respectively). The duration of emission was shorter and the ultrasound power discharged was smaller in the SPP cases. Since the total ultrasound energy emitted in the SPP cases was less than that in the standard-instrument cases, we conclude that the reduced corneal endothelial damage observed in group 1 was directly related to the smaller total ultrasound power expended in these cases.

Aged↗

Factors predicting intraocular pressure control after phacoemulsification in angle-closure glaucoma.

OBJECTIVES: To investigate whether the presence of glaucomatous optic neuropathy affects the reduction of intraocular pressure (IOP) after phacoemulsification in postiridotomy eyes with primary narrow angles, and to evaluate the preoperative factors associated with postoperative IOP control in primary angle-closure glaucoma (PACG). METHODS: Patients with PACG undergoing phacoemulsification were prospectively enrolled and received a complete ophthalmic examination. Diurnal IOP was measured 1 day before and 3 months after surgery. For comparison, patients with primary angle closure or angle closure suspect (PAC/S) undergoing phacoemulsification were also enrolled. RESULTS: Postoperative reduction of IOP was significant in the PACG group (n = 29; P = .001) and in the PAC/S group (n = 28; P<.001), with no significant difference between the groups. The number of glaucoma medications used decreased in both groups (both, P<.001). Multiple regression analysis for the PACG group showed that there was a positive correlation between postoperative IOP and preoperative factors of mean IOP (P = .001) and the anterior chamber depth (P = .03). CONCLUSIONS: The reduction of IOP 3 months after phacoemulsification is significant and is similar in extent in postiridotomy eyes with and without glaucomatous optic neuropathy. A higher postoperative IOP in PACG is associated with a higher preoperative IOP and with a deeper preoperative anterior chamber depth.

Aged↗

[Phacoemulsification of human lens nucleus with a water jet].

BACKGROUND: Today, phacoemulsification with ultrasound represents the gold standard in cataract surgery. Nevertheless, new technologies for this operation are being developed to reduce the loss of endothelial cells, the heating of the tissue, and the size of the accesses. In addition to bimanual phacoemulsification, laser phacoemulsification, and mechanic phacolysis, the waterjet is discussed as an alternative. MATERIALS AND METHODS: Human soft and hard nuclei of the lens obtained by extracapsular cataract extraction (ECCE) were divided in the water bath with the waterjet, whereby the parameter pressure was varied and the time needed for fragmentation was recorded. RESULTS: In spite of different consistencies, all nuclei could be divided under the direct force of the waterjet. For the emulsification of hard nuclei of the lens, a pressure of no less than 10 bar was necessary. This value was obviously higher than a lens capsule can tolerate. For the fragmentation of soft nuclei of the lens with lower acceptable pressures of 5 bar, comparatively long operating times (in some cases over 5 min) were measured. This means that also in these cases a pressure of 10 bar was required. CONCLUSION: Intraocular use of the waterjet with direct effect of the stream with these pressures is not justifiable. Instruments for waterjet phacoemulsification should be developed which pose no danger to the corneal endothelium and lens capsule.

Culture Techniques↗

Phacoemulsification following treatment of choroidal melanoma.

BACKGROUND: Little is known about the risks, effects and results of phacoemulsification following treatment with different modalities of choroidal melanoma. METHODS: In a retrospective study, records were evaluated of 72 patients who underwent cataract surgery after treatment of choroidal melanoma (35 were treated with iodine-125 plaques, 27 with ruthenium-106 plaques, eight by tumor excision, and two with proton beam irradiation). The data were analyzed with respect to complications, effects on postoperative tumor care and visual outcome. RESULTS: Phacoemulsification was performed at a mean interval of 21.5 months after primary tumor therapy. An intraocular lens (IOL) was implanted in 93% of the cases. The mean postoperative follow-up time was 16.2 months. Preoperative problems were rubeosis iridis (30.5%), secondary glaucoma (34.7%) and posterior synechiae (41.6%). Intraoperatively, defects of the posterior capsule occurred in 12.5%. Visual acuity equal to or better than preoperative vision was found in 95.8% of the patients as the best postoperative measurement and in 72.2% at the last follow-up measurement. A deterioration of more than two lines in visual acuity was observed in 4.2% as the best postoperative vision and in 27.8% at the last documented examination. Phacoemulsification was not the cause of deterioration in any of the cases. After cataract surgery, tumor retreatment was necessary in 19.4%. Treatment of radiation retinopathy was performed for the first time in 13.8%. Metastases developed in six patients (8.3%). CONCLUSION: Phacoemulsification following treatment for choroidal melanoma is both possible and advisable. The majority of patients have enhanced visual acuity. No decrease of vision occurred as a result of cataract extraction. The postoperative care of intraocular tumors and the treatment of radiation retinopathy is improved by timely cataract surgery.

Adult↗

Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract.

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.

Adult↗

Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery.

PURPOSE: To evaluate postoperative corneal swelling as a predictor of corneal endothelial cell loss after phacoemulsification cataract surgery. DESIGN: Prospective observational case series. METHODS: Thirty patients planned for routine phacoemulsification cataract surgery were included. Ultrasonic pachymetry and specular microscope endothelial photography of the central and nasal portions of the cornea and Orbscan II slit-scan tomography were performed preoperatively and the day after surgery. The 30 patients were selected from 41 patients based on their increase in central corneal thickness: the first 10 cases with a <5% increase, the first 10 with a 6% to 20% increase, and the first 10 with a > or =20% increase. The same measurements were repeated after 1, 2, and 3 months. The primary outcome measures were corneal endothelial cell loss and increase in pachymetry. Several other parameters were also registered, including age, degree of cataract, visual acuity, phacoemulsification time and energy, total operation time, and the amount of infusion fluid used. RESULTS: The central corneal swelling at postoperative day 1 was strongly correlated with the central corneal endothelial cell loss at 3 months (R(2) = 0.785, P < .001). CONCLUSIONS: In this series, with large variations in the corneal swelling at the first postoperative day, the degree of permanent corneal endothelial damage was reflected in the degree of early postoperative corneal swelling. Measuring the difference in pachymetry at postoperative day 1 is a useful way to assess the effects on the corneal endothelium exerted by the phacoemulsification procedure.

Aged↗

Posterior capsule opacification after phacoemulsification in patients with postoperative steroidal and nonsteroidal treatment.

PURPOSE: To evaluate the effect of dexamethasone, diclofenac, and a placebo given for 3 weeks after phacoemulsification and intraocular lens (IOL) implantation on the formation of posterior capsule opacification (PCO). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In a 2-year prospective randomized double-blind study, a laser flare meter was used to measure aqueous flare intensity preoperatively and 3 days, 2 weeks, and 2 years after phacoemulsification and IOL implantation. Posterior capsule opacification was evaluated 2 years postoperatively using retroillumination images taken with a Scheimpflug camera. The Evaluation of Posterior Capsule Opacification system was used to score the areas of PCO density. RESULTS: The median rate of PCO 2 years after phacoemulsification was 0.72 (range 0.32 to 1.57) in the dexamethasone group, 0.78 (range 0.19 to 2.14) in the diclofenac group, and 0.70 (range 0.35 to 1.70) in the placebo group. The differences were not statistically significant (P>.05; Kruskal-Wallis analysis of variance, multiple comparisons). The rate of neodymium:YAG laser posterior capsulotomy during the 2 years after surgery was not statistically different between groups (P>.05, chi-square test). There was no correlation (Spearman rank coefficient) between laser flare measurements and PCO formation in any group during the study (P>.05). CONCLUSION: Topical instillation of diclofenac, dexamethasone, or a placebo in the immediate period after phacoemulsification and IOL implantation did not seem to influence the formation of PCO 2 years after cataract surgery.

Administration, Topical↗

Optimizing refractive lens exchange with bimanual microincision phacoemulsification.

Bimanual microincision phacoemulsification entails the removal of the crystalline lens through 2 1.2 mm incisions. Infusion is provided through a separate irrigating handpiece, and phacoemulsification and aspiration are performed through a sleeveless phacoemulsification needle. We describe a technique for refractive lens exchange using bimanual microincision phacoemulsification. Capsulorhexis formation, cortical cleaving hydrodissection, lens extraction in the iris plane, and residual cortex removal are performed through the microincisions. This technique offers improved surgeon control throughout the procedure and added safety by maintaining continuous pressurization of the eye while removing the lens far from the posterior capsule.

Anterior Chamber↗

Human cataractous lens nucleus implanted in a sheep eye lens as a model for phacoemulsification training.

We describe a realistic and inexpensive experimental cataract model for phacoemulsification training. After a capsulorhexis is performed, a deep cavity in the lens of an enucleated sheep eye is formed by phacoemulsification through a lateral incision. An undamaged human cataractous lens nucleus obtained by extracapsular cataract extraction is inserted in the preformed cavity, resting in the center of a cortex cushion. Phacoemulsification training is performed through a corneal tunnel incision. The experimental model is prepared with a human cataractous lens nucleus of the preferred hardness, simulating nuclear phacoemulsification in humans.

Animals↗

Retrocapsular lens fragments after uneventful phacoemulsification cataract surgery.

PURPOSE: To analyze the factors influencing the risk for lens fragments in the retrocapsular space after uneventful phacoemulsification cataract surgery. SETTING: Norfolk and Norwich University Hospital, Norwich, United Kingdom. METHODS: Five hundred six consecutive patients who had uneventful phacoemulsification cataract surgery were examined intraoperatively for lens fragments in the retrocapsular space. Data collected for each patient included site of corneal incision, axial length, cataract nuclear density, phaco power and duration, and equivalent phaco time (EPT, calculated as a product of phaco power and duration). Statistical analysis was performed to determine the effect of each factor on the risk for developing retrocapsular lens fragments. RESULTS: Retrocapsular lens fragments were present in 16.6% of patients. Univariate analysis showed that the duration of phacoemulsification and EPT were significantly longer in patients with retrocapsular lens fragments than in those without. Logistic regression showed that EPT was the only factor statistically significantly associated with the fragments. However, the effect of EPT on the odds ratio of developing fragments was small. CONCLUSIONS: Lens fragments in the retrocapsular space occurred relatively frequently after uneventful phacoemulsification surgery. There was a small but statistically significant relationship between EPT and the risk for lens fragments.

Humans↗

Refractive changes after phacoemulsification combined with deep sclerectomy assisted by corneal topography.

PURPOSE: To evaluate the corneal surgically induced refractive change (SIRC) after phacoemulsification and deep sclerectomy. SETTING: Glaucoma Unit, Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain. METHODS: This prospective study comprised 38 eyes of 35 patients with a mean age of 77 years having phacoemulsification using a right clear corneal approach (temporal approach and nasal approach in the right eye and the left eye, respectively) combined with a deep sclerectomy and placement of a reticulated hyaluronic acid implant in the superior quadrant. Computerized keratography was performed preoperatively and 1 month and 3 months postoperatively. The SIRC was calculated at each follow-up by the Holladay-Cravy-Koch method and was expressed vectorially in 3 Cartesian coordinates to facilitate statistical analysis. RESULTS: The magnitude of the resulting mean SIRC components was very small. No significant change was observed in any vectorial component 1 month and 3 months postoperatively. Overall, 47.4% of patients had an induced with-the-rule astigmatism change at 3 months (range 0.03 to 1.67 diopters [D]); however, the mean change was less than 0.50 D and not statistically significant. The mean spherical postoperative change was greater in left eyes than in right eyes (P = .05). No statistically significant changes between the right eye and left eye were observed in the astigmatism vectorial components. CONCLUSIONS: Overall, the refractive change after phacoemulsification combined with deep sclerectomy was mild and not clinically significant. The greater mean spherical change in left eyes than in right eyes might be related to the phacoemulsification approach.

Aged↗

Microkeratome-assisted phacoemulsification.

This study reports a technique in which phacoemulsification and intraocular lens (IOL) insertion are performed in conjunction with a microkeratome flap in a patient with ocular surface disease. Microkeratome-assisted phacoemulsification was performed in a 72-year-old woman with a history of trachoma during childhood. A 130 microm corneal flap was made using a microkeratome prior to phacoemulsification and IOL insertion. Lifting the flap during surgery allowed a clear view of the anterior chamber through the smooth lamellar interface created by the microkeratome blade. The flap was washed and repositioned without sutures at the end of surgery. There were no complications associated with the microkeratome flap following surgery. Visual acuity improved from hand motion to 20/200. Microkeratome-assisted phacoemulsification is a safe technique for cataract patients with diseases of the ocular surface.

Aged↗

Patient pain during stretching of small pupils in phacoemulsification performed using topical anesthesia.

PURPOSE: To assess the pain experienced by patients with small pupils during pupil stretching in phacoemulsification performed using topical anesthesia. SETTING: Royal Victoria Eye & Ear Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. METHODS: This was a prospective study that included 26 eyes with small pupils requiring mechanical pupil stretching during phacoemulsification cataract surgery performed under topical anesthesia without sedation. RESULTS: The mean pain score for the instillation of anesthetic drops (2.02) was higher than the mean pain score for the pupil stretch (1.63), but this difference was not significant (signed rank test = -32; P = .2738). There was no significant correlation between the duration of surgery and the overall pain score (r = 0.345; P = .08). There was no significant correlation between change in pupil size and either the pupil stretch score (r = -0.069; P = .74) or the overall pain score (r = -0.032; P = .8739). CONCLUSIONS: Pupil stretching during phacoemulsification in patients with small pupils was performed with minimal patient-reported pain using topical anesthesia. Stretching small pupils with a mechanical device during phacoemulsification performed under topical anesthesia was a safe procedure and did not result in significant patient discomfort.

Aged↗

Ultrasonic-generated fluid velocity with Sovereign WhiteStar micropulse and continuous phacoemulsification.

PURPOSE: To evaluate and compare ultrasonic turbulence created by conventional and micropulse ultrasound technology. SETTING: Sonora Medical Systems, Longmont, Colorado, USA. METHODS: A high-resolution digital ultrasound probe imaged the zone around a phacoemulsification tip. Doppler analysis allowed determination of flow. The fluid velocity was measured at 4 levels of ultrasound power at a constant flow, comparing the ultrasonic conditions of continuous energy to WhiteStar micropulses. RESULTS: In addition to the normal baseline irrigation and aspiration, fluid movement was detected directly below the phaco tip, produced by a nonlinear effect known as acoustic streaming. Acoustic streaming increased with increased phacoemulsification power for both conditions. At each of the 4 levels of power, fluid velocity away from the tip was less with micropulse technology than with continuous phacoemulsification. CONCLUSIONS: The demonstrated decrease in acoustic streaming flow away from the phaco tip with Sovereign WhiteStar micropulse technology compared to conventional ultrasound provides an objective explanation for clinical observations of increased stability of nuclear fragments at the tip and less turbulence in the anterior chamber during phacoemulsification. This methodology can be used to examine and compare fluid flow and turbulence under a variety of clinically relevant conditions.

Acetates↗

Thermal effect of microburst and hyperpulse settings during sleeveless bimanual phacoemulsification with advanced power modulations.

PURPOSE: To assess wound temperature during bimanual sleeveless phacoemulsification using customizable power modulations such as hyperpulse and microburst technology. SETTING: In vitro laboratory. METHODS: The Millennium Microsurgical System (Bausch & Lomb) with custom control software (CCS) was used to perform phacoemulsification in 5 porcine eyes with MicroFlow needles (Bausch & Lomb) and with power varied from 20% to 80% in 10% increments. Pulse modes were set for fixed microburst (4 ms on, 4 ms off; and 6 ms on, 12 or 24 ms off) and for hyperpulse (30% duty cycle with 8 or 75 pulses per second [pps]), with and without aspiration-line occlusion. Wound temperatures were measured 3 times per second. RESULTS: Using 80% total power, the wound temperature during 3 minutes of occlusion did not exceed 39.0 degrees C. The maximum temperature with fixed microbursts of 4 ms on, 4 ms off was 29.0 degrees C without occlusion and 37.8 degrees C with occlusion (duration 3 minutes). At 6 ms on, 12 ms off, the maximum temperatures were 28.1 degrees C and 38.7 degrees C, respectively. At 6 ms on, 24 ms off, peak temperatures were 24 degrees C and 23.6 degrees C, respectively. The hyperpulse mode of 30% duty cycle and 8 pps produced maximum temperatures of 25.5 degrees C nonoccluded and 33.4 degrees C occluded. With 30% duty cycle, 75 pps, temperatures were 28 degrees C and 38.0 degrees C, respectively. For all power below 80%, temperatures were lower. CONCLUSIONS: Customizable power modulation with microburst and hyperpulse technology further reduced wound temperatures during bimanual sleeveless phacoemulsification. This enhances the safety and effectiveness of phacoemulsification through a sleeveless needle and a small stab incision.

Animals↗

Phacoemulsification with topical anesthesia: Resident experience.

PURPOSE: To compare the intraoperative and postoperative complications and outcomes of phacoemulsification performed by residents using topical and retrobulbar anesthesia. SETTING: Two university ophthalmology departments. METHODS: One hundred fifty phacoemulsification procedures were performed by 3 residents who used retrobulbar anesthesia (retrobulbar group), and 146 phacoemulsification procedures were performed by another 3 residents who used topical anesthesia and who had no experience with retrobulbar or peribulbar anesthesia (topical group). Case notes were prospectively compared. The data analyzed included the ocular history, intraoperative and postoperative complications, and final best spectacle-corrected visual acuity (BSCVA). RESULTS: There were no differences between the 2 groups in complication rates. Anterior capsule tears occurred in 8 eyes (5.3%) in the retrobulbar group and 7 eyes (4.7%) in topical group. Capsulorhexis was continuous but not curvilinear in 14 eyes (9.3%) and 12 eyes (8.2%), respectively. Capsulorhexis tear or posterior capsule rupture that necessitated conversion to extracapsular cataract extraction occurred in 3 eyes (2.0%) in the retrobulbar group and in 1 eye (0.6%) in the topical group. Posterior capsule rupture with vitreous loss occurred in 10 eyes (6.6%) and 9 eyes (6.1%), respectively. Loss of lens fragments in the vitreous cavity occurred in 3 eyes (2.0%) and 4 eyes (2.7%), respectively. The 63 postoperative complications (41 eyes [27.3%], retrobulbar group; 22 eyes [15.0%], topical group) included cystoid macular edema, intraocular lens decentration, endophthalmitis, bullous keratopathy, transient intraocular pressure elevation, temporary corneal edema, and vitreous hemorrhage. Some cases had more than 1 complication. The BSCVA, including in eyes with preexisting ocular pathology, was 20/40 or better in 86.7% in the retrobulbar group and 84.9% in the topical group. CONCLUSION: When supervised and in selected patients, residents who have no retrobulbar or peribulbar anesthesia experience can safely perform phacoemulsification using topical anesthesia.

Adult↗