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Survey of Ophthalmology 2024In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with... (Review)
Review
In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with phacoemulsification and intraocular lens (IOL) implantation (triple procedure). This surgery might cause a refractive shift difficult to predict. Early DMEK and DSAEK results have shown a tendency toward a hyperopic shift. Myopic postoperative refraction is typically intended to correct this postoperative refractive defect and to bring all eyes as close to emmetropia as possible. We sought to understand the mechanism underlying the hyperopization and to identify predictive factors for poorer refractive outcomes, the most suitable target refraction and IOL calculation methods in patients undergoing combined cataract extraction and lamellar endothelial corneal transplantation (DSAEK or DMEK) for endothelial dysfunctions. Of the 407 articles analyzed, only 18 were included in the analysis. A myopic target between -0.50 D and -0.75 was the most common (up to -1.50 for DSAEK triple procedures), even though no optimum target was found. Hyperopic surprises appeared more frequently in corneas that were flatter in the center than in the periphery (oblate posterior profile). Among the numerous IOL calculation formulas, there was no apparent preference.
Topics: Humans; Refraction, Ocular; Descemet Stripping Endothelial Keratoplasty; Lens Implantation, Intraocular; Phacoemulsification; Visual Acuity
PubMed: 38309315
DOI: 10.1016/j.survophthal.2024.01.003 -
Journal of Cataract and Refractive... Jan 2023To evaluate the responsiveness of 3 phacoemulsification and aspiration (PEA) systems and a new handpiece to occlusion break by measuring anterior chamber depth (ACD) and...
PURPOSE
To evaluate the responsiveness of 3 phacoemulsification and aspiration (PEA) systems and a new handpiece to occlusion break by measuring anterior chamber depth (ACD) and intraocular pressure (IOP).
SETTING
Zengyo Suzuki Eye Clinic, Kanagawa, Japan.
DESIGN
Experimental study.
METHODS
ACD change during intentional occlusion breaks was observed and evaluated using the slit side view (SSV) method and IOP measurement with the Centurion Vision System (Group 1), Centurion Vision System with Active Sentry (Group 2), Infiniti Vision System (Group 3), and Constellation Vision System (Group 4). 5 eyes were included per group. Occlusion breaks were triggered at IOP of 30 mm Hg, vacuum limits of 550 mm Hg, and aspiration rate of 40 mL/min. ACD change ratio, surge duration, and surge volume were analyzed from videos of SSV and IOP measurement.
RESULTS
The smallest ACD change was observed in Group 2 with SSV. ACD change ratios in Groups 1 to 4 were 17.5% ± 3.9%, 7.3% ± 1.2%, 35.7% ± 9.5%, and 74.1 ± 7.7%, respectively. Surge duration and surge volume were calculated only for Groups 1 and 2 and were significantly lower in Group 2 than in Group 1 (0.32 ± 0.03 vs 1.17 ± 0.07 seconds; 18.91 ± 4.70 vs 45.70 ± 0.83 μL). In these 2 groups, ACD change ratio correlated with surge volume.
CONCLUSIONS
This study evaluated the responsiveness of 3 PEA systems and a new handpiece to occlusion breaks by measuring IOP and ACD. The Active Sentry system was useful for maintaining the ACD even during occlusion breaks.
Topics: Humans; Phacoemulsification; Anterior Chamber; Intraocular Pressure; Vacuum; Tonometry, Ocular
PubMed: 36201661
DOI: 10.1097/j.jcrs.0000000000001071 -
Asia-Pacific Journal of Ophthalmology...Femtosecond laser can provide precise and customized incision of ocular tissue with excellent accuracy and predictability. Thus, femtosecond laser-assisted cataract... (Review)
Review
Femtosecond laser can provide precise and customized incision of ocular tissue with excellent accuracy and predictability. Thus, femtosecond laser-assisted cataract surgery (FLACS) can theoretically enhance the safety and efficacy of cataract surgery by providing reproducible and reliable clear corneal incision, limbal relaxing incision, anterior capsulotomy, and lens fragmentation. However, thus far, the superiority of the anatomical and visual outcomes of FLACS over those of conventional cataract surgery have been unclear. Nevertheless, studies have indicated that FLACS can potentially be helpful in improving the safety of cataract surgery in challenging situations, such as zonular weakness, preexisting capsular tear, white cataract, shallow anterior chamber, and pediatric cataracts, which may contribute to enhanced visual and anatomical outcomes. In this review, we provide a summary of the application of femtosecond laser in general cataract cases. In addition, we introduce the application of FLACS in the abovementioned challenging situations and discuss the results of studies regarding the safety and outcome of FLACS in these challenging cases.
Topics: Humans; Child; Laser Therapy; Cataract Extraction; Cataract; Lens, Crystalline; Lasers; Phacoemulsification
PubMed: 37844256
DOI: 10.1097/APO.0000000000000627 -
International Ophthalmology May 2023After cataract phacoemulsification surgery, spherical equivalent refraction (SER) may be affected by factors including corneal curvature, effective lens position and... (Observational Study)
Observational Study
PURPOSE
After cataract phacoemulsification surgery, spherical equivalent refraction (SER) may be affected by factors including corneal curvature, effective lens position and axial length. While refractive outcomes have been assessed in the immediate post-operative period, longer-term changes in refraction have not been reported. The purpose of this study was to investigate the timeline changes in refraction after cataract surgery over a period of 3 years.
METHODS
This was a retrospective observational study that included 344 eyes of 204 patients who underwent cataract emulsification surgery between 1 January and 31 December 2018 at two private hospitals. Keratometry, anterior chamber depth (ACD), central corneal thickness (CCT) and axial length were measured at baseline and post-operatively at 1 month, 1 year, 2 years and 3 years. Changes in SER and ocular parameters were assessed at each post-operative timepoint.
RESULTS
Between 1 month and 3 years post-operatively, an overall myopic shift (0.32 ± 0.21 D, p < 0.001) occurred in 33.6% of eyes and a hypermetropic shift in 45.2% of eyes (0.35 ± 0.22 D, p < 0.001). In 21.2% of eyes, there was no reported change in SER between 1 month and 3 years. Significant changes in ACD (p = 0.04) and CCT (p < 0.001) occurred during the first year after surgery.
CONCLUSION
The 3-year timeline changes in SER after cataract surgery were evaluated. As hypermetropic shift was the most common refractive change observed, it may be beneficial to aim for a more myopic post-operative refraction target. Patients should be advised of the potential for refractive changes after surgery.
Topics: Humans; Phacoemulsification; Lens Implantation, Intraocular; Follow-Up Studies; Refraction, Ocular; Myopia; Cornea; Retrospective Studies; Cataract; Lenses, Intraocular
PubMed: 36223001
DOI: 10.1007/s10792-022-02550-9 -
Vestnik Oftalmologii 2022To optimize the technique of intumescent cataract phacoemulsification by involving the use of femtosecond lasers.
PURPOSE
To optimize the technique of intumescent cataract phacoemulsification by involving the use of femtosecond lasers.
MATERIAL AND METHODS
Group 1 included 29 patients (30 eyes) with mature intumescent cataract, who underwent femtolaser-assisted phacoemulsification using a new, optimized technique. Group 2 included 20 patients (20 eyes), in whom the femtolaser stage was performed using the standard technique. Patients of groups 1 and 2 were almost identical in all preoperative parameters. The optimized femto-capsulorhexis technique included: preoperative assessment of intralenticular pressure, staining of the anterior capsule of the swelling lens with trypan blue, introduction of a viscoelastic with high molecular weight into the anterior chamber to balance intraocular and intralenticular pressures, increasing the laser energy when performing anterior capsulorhexis up to 10 mJ.
RESULTS
In group 1, there was a non-penetration of the anterior capsule in 2 eyes, in one of them in the 30° sector, in the second - in the 45° sector. Leakage of lens material into the anterior chamber and the floating anterior capsule were not observed in patients of group 1. In group 2, non-penetration of the anterior capsule was observed in 6 eyes, in the 45-60° sector - in 2 eyes, in the 90° sector - in 3 eyes, in the 180° sector - in 1 eye. Floating anterior capsule was observed in 5 cases. Leakage of lens material into the anterior chamber was observed in 9 eyes.
CONCLUSION
The optimized technique of femtolaser-assisted intumescent cataract phacoemulsification eliminates leakage of lens material into the anterior chamber and allows performing anterior capsulorhexis of given size and shape.
Topics: Capsulorhexis; Cataract; Cataract Extraction; Humans; Lens Capsule, Crystalline; Phacoemulsification
PubMed: 35234416
DOI: 10.17116/oftalma202213801113 -
BMC Ophthalmology Feb 2022A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
BACKGROUND
A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
METHODS
A disposable 27-gauge blunt needle attached to a 5.0-ml syringe containing balanced salt solution (BSS) is introduced through the side port incision into the anterior chamber. The tip of the needle is directed toward the capsule fornix beneath the incision site, and BSS is flushed to disperse the remaining cortex. Thereafter, the coaxial irrigation/aspiration device is used to remove the loosened cortex.
RESULTS
This technique was used in 60 eyes of 60 patients with difficulty of removing cortical remnant in the subincisional space. Subincisional cortical material was successfully removed in 93.3% (56/60 eyes). There were no intraoperative and postoperative complications related to this procedure.
CONCLUSIONS
The hydro-dispersion technique is a simple and safe approach to remove the subincisional cortical material that is difficult to manage with the standard coaxial irrigation/aspiration device.
Topics: Anterior Chamber; Cataract Extraction; Humans; Lens, Crystalline; Phacoemulsification; Postoperative Complications; Therapeutic Irrigation
PubMed: 35177028
DOI: 10.1186/s12886-022-02314-0 -
Journal of Ayub Medical College,... 2023Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are...
BACKGROUND
Cataract surgery has become one of the most common surgeries in the world with one in every four surgeries performed being a cataract extraction and the numbers are expected to increase by 16 percent in the USA alone by 2024 as compared to the current statistics. The aim of the study is to analyze the visual outcomes of intraocular lens implants for various visual ranges.
METHODS
This non-comparative interventional study was conducted at the Ophthalmology department of Al Ehsan Eye Hospital from Jan to Dec 2021. It included patients who underwent uneventful phacoemulsification with an intraocular lens implant and analysis of the visual outcomes for uncorrected distance (UDVA), uncorrected intermediate distance (UIVA), and uncorrected near distance (UNVA).
RESULTS
Independent sample t-test was applied to observe the mean values of recorded far vision on the 1stday, 1 week, and 1 month after the trifocal intraocular lens implantation. It showed a significant difference with a p-value of 0.00 on 1st day, 1 week, and 1 month after was 0.3±0.1, 0.17±0.09, and 0.14±0.08 respectively. Mean improvement in near vision after 1 month was N6 with S.D 1.03 and in intermediate vision was N8±1.4 respectively.
CONCLUSIONS
Trifocal Intraocular lens implantation offers an improved vision for near, intermediate, and distant visual ranges without the need for correction.
Topics: Humans; Lenses, Intraocular; Hospitals; Phacoemulsification
PubMed: 36849381
DOI: 10.55519/JAMC-01-11149 -
Open Veterinary Journal Aug 2023A cataract is one of the underlying causes of blindness in animals. Phacoemulsification is the standard procedure in cataract surgery for humans and animals. This...
BACKGROUND
A cataract is one of the underlying causes of blindness in animals. Phacoemulsification is the standard procedure in cataract surgery for humans and animals. This procedure has been used to restore vision in cataracts in a variety of animals. However, this technique is difficult in very small animals, such as rodents, due to their small eyes.
CASE DESCRIPTION
A 4-year-old male domestic chinchilla was presented with cloudiness in the lenses for 1 month. The ophthalmic examination revealed cataracts (oculus uterque: both eyes). Positive dazzle reflex oculus sinister; left eye (OS) and negative reflex oculus dexter; right eye (OD) were noted. The electroretinography was low amplitude OS whereas a flat waveform presented OD. In this case, cataract surgery was performed using phacoemulsification without intraocular lens implantation OS. Postoperative, the chinchilla was alert and could jump on and jump off the ledge in a house. When the veterinarian approached closely to OS, the chinchilla displayed an erect body posture and open eyes, whereas the chinchilla was ignored when the veterinarian doing the same OD. The chinchilla was alert and had improved vision observe by this chinchilla can jump on and jump off the ledge in his house throughout the follow-up period 18 months later.
CONCLUSION
In this chinchilla, phacoemulsification was successfully performed and resulted in better overall vision. The chinchilla was alert and could jump on and jump off the ledge in a house after cataract surgery throughout the follow-up period of 18 months.
Topics: Animals; Humans; Male; Phacoemulsification; Chinchilla; Cataract; Postoperative Period
PubMed: 37701661
DOI: 10.5455/OVJ.2023.v13.i8.10 -
Journal of Cataract and Refractive... Apr 2022Vitreous loss is one of the adverse complications that can occur during phacoemulsification. Once vitreous loss is identified, procedural guidelines advise that...
Vitreous loss is one of the adverse complications that can occur during phacoemulsification. Once vitreous loss is identified, procedural guidelines advise that phacoemulsification be ceased and the probe carefully withdrawn to minimize traction on the vitreous. Bimanual-bipedal technique described in this study holds the phacoemulsification probe in place and inserts the vitrectomy cutter through the pars plana port with the other hand. After removal of vitreous around the phacoemulsification tip, the vitrectomy cutter is switched to a cutting rate of zero. phacoemulsification can then be resumed with the vitrectomy cutter as a retainer of the lens fragments, similar to the hook of bimanual technique. Lens fragments are synergistically retained through aspiration between the vitrectomy cutter and phacoemulsification probe to prevent displacement. The bimanual-bipedal technique may offer a more streamlined and potentially safer approach for phacoemulsification with vitreous loss.
Topics: Cataract Extraction; Humans; Lens, Crystalline; Microsurgery; Phacoemulsification; Retrospective Studies; Vitrectomy
PubMed: 35027522
DOI: 10.1097/j.jcrs.0000000000000884 -
Indian Journal of Ophthalmology Jun 2021We herein describe a novel device to contain droplets and aerosols during phacoemulsification. We modified the silicon phaco test chamber into an aerosol containment...
We herein describe a novel device to contain droplets and aerosols during phacoemulsification. We modified the silicon phaco test chamber into an aerosol containment chamber (ACC) by shortening the chamber and making a pear-shaped opening at one aspect of its tip. The ACC was fitted over phaco tip such that 4-5 mm of phaco tip and sleeve was exposed. When the phaco tip and irrigation port are inside the anterior chamber during phacoemulsification, the portion of the modified chamber remains around the clear corneal tunnel in an enclosing manner that contains aerosols and droplets.
Topics: Aerosols; Anterior Chamber; Humans; Phacoemulsification
PubMed: 34011751
DOI: 10.4103/ijo.IJO_3478_20