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Survey of Ophthalmology 2019Phacoemulsification, initially used in the late 1960s, continues to be the standard of care for cataract removal. An animal model was developed so that, in a controlled... (Review)
Review
Phacoemulsification, initially used in the late 1960s, continues to be the standard of care for cataract removal. An animal model was developed so that, in a controlled research setting, all the various machines, handpieces, tips, and settings could be investigated. As a general rule, the higher power, vacuum, and aspiration settings lead to optimally efficient phacoemulsification. In addition, both new phacoemulsification platforms and newly developed devices have been shown to improve efficiency. As a result, we recommend that the integration of these recent developments should be considered in future investigations.
Topics: Animals; Disease Models, Animal; Humans; Phacoemulsification
PubMed: 31276738
DOI: 10.1016/j.survophthal.2019.06.007 -
Journal of Cataract and Refractive... Jun 2002To examine recent developments in the field of phacoemulsification, a literature review was conducted for each system described. the review included peer- reviewed... (Review)
Review
To examine recent developments in the field of phacoemulsification, a literature review was conducted for each system described. the review included peer- reviewed articles, information from manufacturers, and meeting presentations by surgeons. our personal experience with systems we have used forms the underlying basis of our evaluation. data for erbium: YAG laser phacoemulsification came from an interim summary of the U.S. Food and Drug Administration monitored study. Data for NeoSoniX came from a prospective evaluation of phacoemulsification in 25 eyes performed at the Oregon Eye Surgery Center. The development of new technology has allowed safer, more efficient phacoemulsification. Each surgeon should evaluate new developments to achieve the greatest possible benefit for patients.
Topics: Animals; Humans; Laser Therapy; Phacoemulsification
PubMed: 12036654
DOI: 10.1016/s0886-3350(02)01399-8 -
Journal of Cataract and Refractive... May 2016
Topics: Phacoemulsification
PubMed: 27255238
DOI: 10.1016/j.jcrs.2016.05.001 -
The Cochrane Database of Systematic... Sep 2017Age-related cataract is the principal cause of blindness and visual impairment in the world. Phacoemulsification is the main surgical procedure used to treat cataract.... (Review)
Review
BACKGROUND
Age-related cataract is the principal cause of blindness and visual impairment in the world. Phacoemulsification is the main surgical procedure used to treat cataract. The comparative effectiveness and safety of different-sized incisions for phacoemulsification has not been determined.
OBJECTIVES
The aim of this systematic review was to assess the effectiveness and safety of smaller versus larger incisions for phacoemulsification in age-related cataract. The primary outcome of this review was surgically induced astigmatism at three months after surgery.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 10), MEDLINE Ovid (1946 to 28 October 2016), Embase Ovid (1947 to 28 October 2016), PubMed (1948 to 28 October 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 28 October 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com; last searched 13 May 2013), ClinicalTrials.gov (www.clinicaltrials.gov; searched 28 October 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp; searched 28 October 2016). We did not use any date or language restrictions in the electronic searches for trials.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) comparing different-sized incisions in people with age-related cataract undergoing phacoemulsification.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included 26 RCTs with a total of 2737 participants (3120 eyes). These trials were conducted in Bosnia and Herzegovina, China, France, India, Italy, Korea, Spain, Switzerland, and Turkey. Half of the 26 trials were conducted in China. We judged all trials as mostly at unclear to low risk of bias. The included RCTs compared four different-sized incisions:<= 1.5 mm, 1.8 mm, 2.2 mm, and approximately 3.0 mm. These incisions were performed using three different techniques: coaxial and biaxial microincision phacoemulsification (C-MICS and B-MICS) and standard phacoemulsification. Not all studies provided data in a form that could be included in this review. Five studies had three arms.Fifteen trials compared C-MICS (2.2 mm) with standard phacoemulsification (about 3.0 mm). Very low-certainty evidence suggested less surgically induced astigmatism in the C-MICS group at three months compared with standard phacoemulsification (mean difference (MD) -0.19 diopters (D), 95% confidence interval (CI) -0.30 to -0.09; 996 eyes; 8 RCTs). There was low-certainty evidence that both groups achieved similar best-corrected visual acuity (MD 0.00 logMAR, 95% CI -0.02 to 0.02; 242 eyes; 3 RCTs). There was low-certainty evidence of little or no difference in endothelial cell loss and central corneal thickness comparing C-MICS with standard phacoemulsification (MD -7.23 cells/mm, 95% CI -78.66 to 64.20; 596 eyes; 4 RCTs) and (MD -0.68 μm, 95% CI -3.26 to 1.90; 487 eyes; 5 RCTs).Nine trials compared C-MICS (1.8 mm) with standard phacoemulsification (about 3.0 mm). Very low-certainty evidence suggested less astigmatism at three months in the C-MICS group compared with standard phacoemulsification group (MD -0.23 D, 95% CI -0.34 to -0.13; 561 eyes; 5 RCTs). Low-certainty evidence suggested little or no difference in best-corrected visual acuity, endothelial cell loss, and central corneal thickness in the two groups at three months (MD -0.02 logMAR, 95% CI -0.03 to -0.00; 192 eyes; 3 RCTs), (MD 7.56 cells/mm, 95% CI -67.65 to 82.77; 380 eyes; 5 RCTs), and (MD -1.52 μm, 95% CI -6.29 to 3.25; 245 eyes; 3 RCTs).Six studies compared C-MICS (1.8 mm) with C-MICS (2.2 mm). There was low-certainty evidence that astigmatism, visual acuity, and central corneal thickness were similar in the two groups at three months (MD 0.04 D, 95% CI -0.09 to 0.16; 259 eyes; 3 RCTs), (MD 0.01 logMAR, 95% CI -0.01 to 0.04; 200 eyes; 3 RCTs), and (MD 0.45 μm, 95% CI -2.70 to 3.60; 100 eyes; 1 RCT). Very low-certainty evidence suggested higher endothelial cell loss in the 1.8 mm group (MD 213.00 cells/mm, 95% CI 11.15 to 414.85; 70 eyes; 1 RCT).Four studies compared B-MICS (<= 1.5 mm) with standard phacoemulsification (about 3.0 mm). Astigmatism was similar in the two groups at three months (MD -0.01 D, 95% CI -0.03 to 0.01; 368 eyes; 2 RCTs; moderate-certainty evidence). There was low-certainty evidence on visual acuity, suggesting little or no difference between the two groups (MD -0.02 logMAR, 95% CI -0.04 to -0.00; 464 eyes; 3 RCTs). Low-certainty evidence on endothelial cell loss and central corneal thickness also suggested little or no difference between the two groups (MD 55.83 cells/mm, 95% CI -34.93 to 146.59; 280 eyes; 1 RCT) and (MD 0.10 μm, 95% CI -14.04 to 14.24; 90 eyes; 1 RCT).None of the trials reported on quality of life. One trial reported that no participants experienced endophthalmitis or posterior capsule rupture; they also reported little or no difference between incision groups regarding corneal edema (risk ratio 1.02, 95% CI 0.40 to 2.63; 362 eyes).
AUTHORS' CONCLUSIONS
Phacoemulsification with smaller incisions was not consistently associated with less surgically induced astigmatism compared with phacoemulsification with larger incisions. Coaxial microincision phacoemulsification may be associated with less astigmatism than standard phacoemulsification, but the difference was small, in the order of 0.2 D, and the evidence was uncertain. Safety outcomes and quality of life were not adequately reported; these should be addressed in future studies.
Topics: Astigmatism; Cataract; Corneal Edema; Corneal Pachymetry; Humans; Phacoemulsification; Postoperative Complications; Randomized Controlled Trials as Topic; Surgical Wound; Visual Acuity
PubMed: 28931202
DOI: 10.1002/14651858.CD010510.pub2 -
Current Opinion in Ophthalmology Jan 2017The purpose is to review the current and effective advantages of femtosecond laser-assisted cataract surgery (FLACS). (Review)
Review
PURPOSE OF REVIEW
The purpose is to review the current and effective advantages of femtosecond laser-assisted cataract surgery (FLACS).
RECENT FINDINGS
FLACS has advantages over manual phacoemulsification in its precision, and predictability and may be especially advantageous in difficult situations such as shallow anterior chamber, subluxated cataracts, white cataracts, and so on. However, the femtosecond capsulorhexis may not be as strong as a manual rhexis. Laser-induced miosis is also a potential disadvantage.
SUMMARY
There may be increased surgeon confidence and patient satisfaction with FLACS and it may be friendlier to the internal structures of the eye. However, it is not superior to manual phacoemulsification in terms of primary outcomes such as visual and refractive outcomes or overall complications. Further refinements in technology may be needed to give it distinct advantages over manual phacoemulsification and to make it the norm in cataract surgery.
Topics: Capsulorhexis; Humans; Intraoperative Complications; Laser Therapy; Phacoemulsification; Refraction, Ocular; Visual Acuity
PubMed: 27801688
DOI: 10.1097/ICU.0000000000000333 -
Current Opinion in Ophthalmology Feb 2005Familiarization with each of the manufacturers' latest machines and upgrades assists in understanding the advances made in phacoemulsification technology. (Review)
Review
PURPOSE OF REVIEW
Familiarization with each of the manufacturers' latest machines and upgrades assists in understanding the advances made in phacoemulsification technology.
RECENT FINDINGS
Improvements in the delivery of energy through power modulations, alternative and adjunctive energy sources, and advanced fluidics allow the safe use of bimanual microincision techniques for lens extraction.
SUMMARY
Continual advances in phacoemulsification technology and adjunctive surgical devices allow cataract surgery to be performed more safely and efficiently.
Topics: Humans; Phacoemulsification; Technology Assessment, Biomedical
PubMed: 15650578
DOI: 10.1097/00055735-200502000-00007 -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Phacoemulsification; Cataract Extraction; Internship and Residency; Teaching
PubMed: 37878952
DOI: 10.5935/0004-2749.2023-1005 -
The British Journal of Ophthalmology May 2010BACKGROUND The quality of ophthalmic surgical training is increasingly challenged by an untimely convergence of several factors. This article reviews the tools currently... (Review)
Review
BACKGROUND The quality of ophthalmic surgical training is increasingly challenged by an untimely convergence of several factors. This article reviews the tools currently available for training and assessment in phacoemulsification surgery. METHODS Medline searches were performed to identify articles with combinations of the following words: phacoemulsification, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. RESULTS Thus far phacoemulsification training outside the operating room include wet labs and micro-surgical skills courses. These methods have been criticised for being unrealistic, inaccurate and inconsistent. Virtual reality simulators have the ability to teach phacoemulsification psychomotor skills, as well as to carry out objective assessment. Other ophthalmic surgical skill assessment tools such as Objective Assessment of Skills in Intraocular Surgery (OASIS) and Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) are emerging. Assessor bias is minimised by using video-based assessments, which have been shown to reduce subjectivity. Dexterity analysis technology such as the Imperial College Surgical Assessment Device (ICSAD) and virtual reality simulators can be used as objective assessment devices. CONCLUSION Improvements in technology can be utilised in ophthalmology and will help to address the increasingly limited opportunities for training and assessment during training and throughout a subsequent career (re-training and re-validation). This will inevitably translate into enhanced patient care.
Topics: Clinical Competence; Education, Medical, Graduate; Educational Measurement; Humans; Phacoemulsification; User-Computer Interface
PubMed: 19628497
DOI: 10.1136/bjo.2009.159715 -
The Veterinary Clinics of North... Sep 1997The 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... (Review)
Review
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.
Topics: Animals; Dog Diseases; Dogs; Equipment Design; Phacoemulsification; Surgery, Veterinary
PubMed: 9326970
DOI: 10.1016/s0195-5616(97)50106-9 -
Survey of Ophthalmology 1999The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction... (Review)
Review
The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.
Topics: Anesthesia, Local; Capsulorhexis; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Medieval; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification
PubMed: 10541151
DOI: 10.1016/s0039-6257(99)00085-5