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European Journal of Ophthalmology Jan 2020We describe a technique for performing hydrodissection in which the cannula tip is not advanced beyond the capsulorhexis edge, nor embedded into the cortex, but instead...
We describe a technique for performing hydrodissection in which the cannula tip is not advanced beyond the capsulorhexis edge, nor embedded into the cortex, but instead is placed within the capsulorhexis boundaries, pointing to the capsulorhexis edge, and angled slightly posterior to it. The fluid stream squirted from the cannula creates a cleavage plane between the capsule and cortex (hydrodissection), with a distinct wave dissecting the posterior capsule off the overlying cortex. By later rotating the angle slightly more posteriorly, hydrodelineation occurs, with the resultant "golden ring," and often, multiple "golden rings." The cleavage planes obtained using this technique may be more precise than when embedding the cannula tip under and beyond the capsulorhexis edge. This "remote hydrodissection" technique is easy and reproducible with soft and medium lenses, becoming more difficult to perform with harder cataracts. Hence, we recommend that this modification should initially be learned/tried on softer lenses.
Topics: Capsulorhexis; Catheterization; Humans; Phacoemulsification; Robotic Surgical Procedures
PubMed: 30722695
DOI: 10.1177/1120672119827774 -
Ophthalmic Research 2023The iStent (Glaukos Corporation; Laguna Hills, CA, USA) is one of the minimally invasive glaucoma devices. It can be inserted at the time of phacoemulsification or as a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The iStent (Glaukos Corporation; Laguna Hills, CA, USA) is one of the minimally invasive glaucoma devices. It can be inserted at the time of phacoemulsification or as a stand-alone procedure to lower the intraocular pressure (IOP).
OBJECTIVE
Our aim was to conduct a systematic review and meta-analysis comparing the effect of iStent insertion at the time of phacoemulsification with phacoemulsification alone in patients with ocular hypertension or open-angle glaucoma.
METHODS
We searched EMBASE, MEDLINE (OVID and PubMed), CINAHL, and Cochrane Library for articles published between 2008 and June 2022 (PRISMA 2020 for the checklist). Studies comparing the IOP-lowering effect of iStent with phacoemulsification versus phacoemulsification alone were included. The endpoints were IOP reduction (IOPR) and the mean reduction in the number of glaucoma drops. A quality-effects model was used to compare both surgical groups.
RESULTS
Ten studies were included, reporting on 1,453 eyes. Eight hundred fifty three eyes had the combined iStent and phacoemulsification, and 600 eyes underwent phacoemulsification alone. IOPR was higher in the combined surgery at of 4.7 ± 2 mm Hg compared to 2.8 ± 1.9 mm Hg in phacoemulsification alone. A greater decrease in postoperative eye drops was noted in the combined group having a decrease of 1.2 ± 0.3 eye drops versus of 0.6 ± 0.6 drops in isolated phacoemulsification. The quality effect model showed an IOPR weighted mean difference (WMD) of 1.22 mm Hg (confidence interval [CI]: [-0.43, 2.87]; Q = 315.64; p < 0.01; I2 = 97%) and decreased eye drops WMD 0.42 drops (CI: [0.22, 0.62]; Q = 42.6; p < 0.01; I2 = 84%) between both surgical groups. Subgroup analysis shows that the new generation iStent may be more effective in reducing IOP.
CONCLUSION
iStent has a synergetic effect with phacoemulsification. The reduction of IOP and glaucoma eye drops was higher when iStent is combined with phacoemulsification compared with isolated phacoemulsification.
Topics: Humans; Phacoemulsification; Glaucoma, Open-Angle; Glaucoma Drainage Implants; Glaucoma; Intraocular Pressure; Trabecular Meshwork; Ophthalmic Solutions
PubMed: 37245507
DOI: 10.1159/000531077 -
Current Opinion in Ophthalmology Jan 2024The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. (Review)
Review
PURPOSE OF REVIEW
The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery.
RECENT FINDINGS
With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism.
SUMMARY
Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
Topics: Humans; Lens Implantation, Intraocular; Refraction, Ocular; Lenses, Intraocular; Cataract Extraction; Cataract; Astigmatism; Biometry; Phacoemulsification
PubMed: 37962881
DOI: 10.1097/ICU.0000000000001005 -
Journal of Cataract and Refractive... Jun 2023
Topics: Humans; Phacoemulsification; Intraocular Pressure
PubMed: 37257173
DOI: 10.1097/j.jcrs.0000000000001149 -
Ophthalmology Jul 2022To present the 5-year results of the HORIZON trial comparing cataract surgery (CS) combined with an intracanalicular microstent with CS alone. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To present the 5-year results of the HORIZON trial comparing cataract surgery (CS) combined with an intracanalicular microstent with CS alone.
DESIGN
Prospective, multicenter, controlled randomized clinical trial.
PARTICIPANTS
Patients with cataract and primary open-angle glaucoma treated with 1 or more glaucoma medications, washed-out diurnal intraocular pressure (DIOP) of 22 to 34 mmHg, and no prior incisional glaucoma surgery.
METHODS
Eyes were randomized 2:1 to receive a Hydrus Microstent (HMS; Ivantis, Inc) or no stent after successful CS.
MAIN OUTCOME MEASURES
Intraocular pressure (IOP), glaucoma medication use, repeat glaucoma surgery, visual acuity, visual field, procedure-related adverse events, and corneal endothelial cell counts.
RESULTS
Three hundred sixty-nine eyes were randomized to HMS treatment, and 187 eyes were randomized to CS only. Study groups were well matched for preoperative IOP, medication use, washed-out DIOP, and glaucoma severity. Five-year follow-up was completed in 80% of patients. At 5 years, the HMS group included a higher proportion of eyes with IOP of 18 mmHg or less without medications than the CS group (49.5% vs. 33.8%; P = 0.003), as well as a greater likelihood of IOP reduction of 20% or more without medications than the CS group (54.2% vs. 32.8%; P < 0.001). The number of glaucoma medications was 0.5 ± 0.9 in the HMS group and 0.9 ± 0.9 in the CS group (P < 0.001), and 66% of eyes in the HMS group were medication free compared with 46% in the CS group (P < 0.001). The cumulative risk of incisional glaucoma surgery was lower in the HMS group (2.4% vs. 6.2%; P = 0.027, log-rank test). No clinical or statistically significant differences were found in the rate of endothelial cell loss from 3 to 60 months between the HMS and CS alone groups (P = 0.261).
CONCLUSIONS
The addition of a Schlemm's canal microstent in conjunction with CS was safe, resulted in lowered IOP and medication use, and reduced the need for postoperative incisional glaucoma filtration surgery compared with CS after 5 years. Long-term presence of the implant did not affect the corneal endothelium adversely.
Topics: Cataract; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Phacoemulsification; Prospective Studies; Stents
PubMed: 35218867
DOI: 10.1016/j.ophtha.2022.02.021 -
Current Opinion in Ophthalmology Jan 2022Modern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is... (Review)
Review
PURPOSE OF REVIEW
Modern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is critical for both reducing surgical times and improving postoperative outcomes. The present article reviews recent findings in phacodynamics to explore the optimum use of ultrasound in cataract surgery.
RECENT FINDINGS
In studies seeking to determine the optimum parameters in both fluidics and power, increased power and aspiration does not necessarily equate to more efficiency. New developments, such as torsional ultrasound, micropulse, and burst mode have shown increased efficiency in randomized control trials and in-vitro compared with conventional ultrasound. Regarding vacuums, the venturi pump has demonstrated greater efficiency compared with the peristaltic pump. We also explore other parameters, such as chamber pressure and tip selection. Meta-analyses on femtosecond-laser assisted cataract surgery (FLACS) have shown similar long-term visual outcomes compared to conventional cataract surgery.
SUMMARY
Though conventional cataract surgery remains highly effective, surgeons have increasing options for customizing their ultrasound settings and phacoemulsification techniques.
Topics: Cataract; Cataract Extraction; Humans; Laser Therapy; Ophthalmology; Phacoemulsification
PubMed: 34854827
DOI: 10.1097/ICU.0000000000000821 -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Phacoemulsification; Cataract Extraction; Internship and Residency; Teaching
PubMed: 37878952
DOI: 10.5935/0004-2749.2023-1005 -
Indian Journal of Ophthalmology Jan 2020
Topics: Adult; Cataract; Humans; Lens, Crystalline; Male; Phacoemulsification; Visual Acuity
PubMed: 31856523
DOI: 10.4103/ijo.IJO_1214_19 -
European Journal of Ophthalmology Jul 2023Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following... (Review)
Review
Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31 January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.
Topics: Adult; Humans; Child; Lens Implantation, Intraocular; Visual Acuity; Lenses, Intraocular; Cataract Extraction; Multifocal Intraocular Lenses; Refraction, Ocular; Astigmatism; Phacoemulsification
PubMed: 36124376
DOI: 10.1177/11206721221126301 -
Journal of Cataract and Refractive... Oct 2020
Topics: Aerosols; Cataract Extraction; Phacoemulsification
PubMed: 33060485
DOI: 10.1097/j.jcrs.0000000000000382