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Vestnik Oftalmologii 2024The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of...
UNLABELLED
The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of phacoemulsification remains insufficiently studied.
PURPOSE
This study evaluates the influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy, hydrodynamic parameters of phacoemulsification, and the degree of corneal endothelial cell loss.
MATERIAL AND METHODS
Hybrid phacoemulsification was performed in 336 patients (336 eyes) with grade IV immature cataract according to the Buratto classification in three age-matched groups. Group 1 included 103 patients (103 eyes) who underwent hybrid phacoemulsification with preliminary femtosecond laser-assisted fragmentation of the nucleus with a «pizza» pattern (division of the nucleus with 10 radial cuts). Group 2 included 112 patients (112 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «cylinders» pattern (division of the nucleus with 8 radial cuts in combination with 5 circular cuts). Group 3 included 121 patients (121 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «grid» pattern (division of the nucleus with 8 radial cuts in combination with multiple mutually perpendicular cuts in the central zone in the form of a grid with a 0.5 mm cell). Effective ultrasound time and the volume of irrigation solution for emulsification of the lens nucleus fragments were determined during the operation. The loss of corneal endothelial cells was assessed 3 months after surgery.
RESULTS
The minimum effective ultrasound time was noted after using the "grid" pattern - 4.05 (2.88; 4.74) s, which was significantly less than with the "cylinders" pattern - 4.97 (3.78; 5.88) s and the "pizza" pattern - 6.15 (4.52; 7.75) s (<0.05). The effective ultrasound time when using the "cylinders" pattern was significantly less than with the "pizza" pattern (<0.05). The volume of irrigation solution used for emulsification of the lens nucleus fragments was significantly less in the "grid" pattern - 41.5 (33.5; 49.5) ml compared to the "cylinders" patterns 58.5 (51.0; 66.0), <0.05 and "pizza" pattern 75.0 (66.0; 83.5), <0.01. The volume of irrigation solution when using the "cylinders" pattern was significantly less than when using the "pizza" pattern (<0.05). The loss of corneal endothelial cells after using the "grid" pattern was 8.82 (7.59; 9.87)%, which was significantly less than after the "cylinders" patterns - 9.97 (8.81; 10.83)%, <0.05 and "pizza" - 11.70 (10.62; 12.97)%, <0.05. At the same time, the loss of endothelial cells after using the "cylinders" pattern was significantly less than after the "pizza" pattern (<0.05).
CONCLUSIONS
The choice of the optimal pattern of preliminary femtosecond laser-assisted fragmentation of the lens nucleus provides a significant decrease in the energy and hydrodynamic parameters of phacoemulsification and, accordingly, the loss of corneal endothelial cells.
Topics: Humans; Phacoemulsification; Male; Female; Middle Aged; Lens Nucleus, Crystalline; Hydrodynamics; Cataract; Laser Therapy; Treatment Outcome; Aged; Visual Acuity
PubMed: 38739142
DOI: 10.17116/oftalma2024140022129 -
Vestnik Oftalmologii 2024Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus.
UNLABELLED
Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus.
PURPOSE
This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus.
MATERIAL AND METHODS
Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed.
RESULTS
The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification.
CONCLUSIONS
The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.
Topics: Humans; Male; Female; Phacoemulsification; Middle Aged; Cataract; Treatment Outcome; Lens Nucleus, Crystalline; Postoperative Complications; Aged
PubMed: 38739141
DOI: 10.17116/oftalma2024140022123 -
Vestnik Oftalmologii 2024Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a...
UNLABELLED
Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser.
PURPOSE
This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation.
MATERIAL AND METHODS
The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed.
RESULTS
The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density.
CONCLUSIONS
Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.
Topics: Humans; Adult; Male; Female; Phacoemulsification; Laser Therapy; Cataract; Treatment Outcome; Lens Nucleus, Crystalline; Suction; Visual Acuity
PubMed: 38739139
DOI: 10.17116/oftalma2024140022109 -
Maedica Mar 2024Corneal guttata is a non-inflammatory progressive decline of endothelial cell density (ECD) which represents an early clinical feature of Fuch's dystrophy. In patients...
Corneal guttata is a non-inflammatory progressive decline of endothelial cell density (ECD) which represents an early clinical feature of Fuch's dystrophy. In patients with corneal guttata, the relative risk for corneal transplantation after phacoemulsification has been found to be 68.2 times higher than in those without it. In the present study, five patients with corneal guttata underwent 25G pars plana vitrectomy (PPV) with concurrent lensectomy and intraocular lens (IOL) implantation in the sulcus. The aim of the present study is to investigate whether this technique has a less damaging effect on endothelial cells as compared to standard phacoemulsification. This retrospective case series study was conducted at "My Retina" Athens Eye Centre, Greece. Five patients with moderate to dense cataract and clinical signs of corneal guttata were included. All patients had ECD measurement prior to and after surgery. The operation included 25-gauge pars plana vitrectomy (PPV) with subsequent lensectomy and a three-piece IOL implanted in the sulcus with intact anterior capsule. The mean value of ECD was 1157.8±237.51 cells/mm² preoperatively and 1118.2±227.42 cells/mm² postoperatively, indicating a 3.4% reduction from initial values. Retinal detachment was not observed on any of the operated patients after surgery. The IOL was well centered to the sulcus in all patients. Iatrogenic retinal tears were identified in one patient and were treated with laser retinopexy and SF6 gas tamponade. Our results show that PPV along with lensectomy through fragmatome may cause less corneal decompensation than femtosecond laser-assisted cataract surgery (FLACS) or phacoemulsification, especially in patients with corneal guttata. Therefore, reducing the risk for possible future corneal transplantation.
PubMed: 38736935
DOI: 10.26574/maedica.2024.19.11.42 -
Ophthalmology and Therapy Jul 2024The aim of this work is to compare 20 intraocular lens (IOL) power calculation formulas in medium-long eyes (24.50-25.99 mm) in terms of root mean square absolute error...
INTRODUCTION
The aim of this work is to compare 20 intraocular lens (IOL) power calculation formulas in medium-long eyes (24.50-25.99 mm) in terms of root mean square absolute error (RMSAE), median absolute error (MedAE), and percentage of eyes with prediction error (PE) within ± 0.50 D.
METHODS
The data of patients who underwent uneventful phacoemulsification between January 2017 and September 2023 were reviewed. Pre-surgery IOL power was calculated using Holladay1, SRK/T, Hoffer Q, Holladay 2, and Haigis. Three months after phacoemulsification, refraction was measured. Post-surgery IOL power calculations were performed utilizing the following formulas: Barrett Universal II, Kane, K6, Olsen (OLCR), Olsen (standalone), PEARL-DGS, Ladas Super Formula AI (LSF AI), T2, EVO, VRF, Hoffer QST, Castrop, VRF-G, Karmona, and Naeser 2. RMSAE, MedAE, and percentage of eyes with PE within ± 0.25 D, ± 0.50 D, ± 0.75 D and ± 1.00 were calculated.
RESULTS
One hundred twenty-four eyes with axial length ranges between 24.52 and 25.97 mm were studied. The SRK/T formula yielded the lowest RMSAE (0.206) just before Holladay 1 (0.260) and T2 (0.261). In terms of MedAE, the best outcome was obtained by SRK/T (0.12) followed by Barrett Universal II (0.15) and LSF AI (0.15). The highest percentage of eyes with prediction error within ± 0.50 D was achieved by SRK/T, T2, and Holladay 1 (97.58, 93.55, and 93.55%, respectively).
CONCLUSIONS
Third-generation formulas (SRK/T, Holladay 1) provided highly accurate outcomes in medium-long eyes and still can be wildly used to calculate IOL power.
PubMed: 38734806
DOI: 10.1007/s40123-024-00954-7 -
International Journal of Ophthalmology 2024To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training.
AIM
To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training.
METHODS
A total of 10 ophthalmology residents of the first-year postgraduate were included. All the residents were novices to cataract surgery. Real-time cataract surgical observations were performed using a custom-built 3D visualization system. The training lasted 4wk (32h) in all. A modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) containing 4 specific steps of cataract surgery was applied. The self-assessment (self) and expert-assessment (expert) were performed through the microsurgical attempts in the wet lab for each participant.
RESULTS
Compared with pre-training assessments (self 3.2±0.8, expert 2.5±0.6), the overall mean scores of post-training (self 5.2±0.4, expert 4.7±0.6) were significantly improved after real-time observation training of 3D visualization system (<0.05). Scores of 4 surgical items were significantly improved both self and expert assessment after training (<0.05).
CONCLUSION
The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques. It is a useful tool to improve teaching efficiency of surgical education.
PubMed: 38721510
DOI: 10.18240/ijo.2024.03.22 -
Asia-Pacific Journal of Ophthalmology... 2024
Topics: Humans; Glaucoma, Angle-Closure; Phacoemulsification; Trabeculectomy; Cataract; Randomized Controlled Trials as Topic; Intraocular Pressure
PubMed: 38718872
DOI: 10.1016/j.apjo.2024.100066 -
Journal of Refractive Surgery... May 2024To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
PURPOSE
To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based fluidics.
METHODS
In this prospective randomized trial, 200 eyes were randomized to the traditional and Active Sentry groups (n = 80 eyes each) where the Centurion Vision System was used with traditional or Active Sentry (Alcon Laboratories, Inc) hand-pieces, respectively, or the Infinit group (n = 40 eyes) where the Infiniti Vision System (Alcon Laboratories, Inc) was used. Within the traditional and Active Sentry groups, there were two subgroups with low (30 mm Hg) or high (55 mm Hg) intraocular pressure (IOP) used. Outcome measures compared were: cumulative dissipated energy (CDE), percentage change in central corneal thickness (CCT) at 1 day, 1 week, and 1 month, anterior chamber cells at 1 day and 1 week, rate of rise and fall of IOP following occlusion break, corneal endothelial cell density (ECD), and macular thickness 6 months postoperatively.
RESULTS
CDE was significantly lower in group II compared to the traditional group (2.96 ± 1.4 vs 4.14 ± 2.2, = .001). With 30 mm Hg IOP, the Active Sentry group had significantly less percentage change in CCT at 1 week postoperatively compared to the traditional handpiece group (0.01% vs 0.02%, = .008). Incidence of anterior chamber cells less than grade 2 on day 1 was significantly higher in the Active Sentry group (82.9% vs 52%, = .03). Percentage change in ECD was significantly lower in the Active Sentry group (-0.957 vs -0.98%, = .005). Significantly faster rise of IOP to baseline following occlusion break was seen in the Active Sentry group.
CONCLUSIONS
The use of Active Sentry handpiece was associated with lower CDE, less postoperative increase in CCT, fewer anterior chamber cells, and faster rise of IOP following occlusion break. .
Topics: Humans; Phacoemulsification; Prospective Studies; Intraocular Pressure; Male; Female; Aged; Visual Acuity; Lens Implantation, Intraocular; Middle Aged; Endothelium, Corneal; Cell Count; Postoperative Period; Tomography, Optical Coherence; Hydrodynamics; Anterior Chamber; Intraoperative Period
PubMed: 38717085
DOI: 10.3928/1081597X-20240314-02 -
Journal of Cataract and Refractive... May 2024To evaluate the efficacy and safety of Bio-Hyalur LVD compared to Viscoat® ophthalmic viscosurgical device (OVD) in patients undergoing routine cataract surgery.
PURPOSE
To evaluate the efficacy and safety of Bio-Hyalur LVD compared to Viscoat® ophthalmic viscosurgical device (OVD) in patients undergoing routine cataract surgery.
SETTING
Two tertiary eye care hospitals in Italy.
DESIGN
Prospective randomized clinical trial.
METHODS
This study compared the outcomes of Bio-Hyalur LVD versus Viscoat® ophthalmic viscosurgical device in patients undergoing standard cataract surgery with phacoemulsification and intraocular lens implantation from January 2021 to April 2022. The primary outcome was mean change in IOP at 6 hours. Secondary outcomes included 1-, 7-, 30- and 90-day mean intraocular pressure (IOP), 7-, 30- and 90-day best corrected visual acuity, endothelial cell density (ECD), change in central corneal thickness (CCT) and complications including intraocular inflammation.
RESULTS
A total of 84 eyes of 84 patients (n = 41 in the Bio-Hyalur LVD group and n = 43 in the Viscoat group) were screened, enrolled, randomized, and included in the analysis. Mean change in IOP was significantly higher in the Viscoat group than in the Bio-Hyalur LVD group 6 hours (p = 0.034), 7 days (p < 0.001), 30 days (p < 0.001) and 90 days (p = 0.003) postoperatively. Mean change in UDVA and CDVA was significantly higher in the Bio-Hyalur LVD group 30 and 90 after surgery. No significant differences in ECD, CCT and complication rates were observed between groups at any time point.
CONCLUSION
Bio-Hyalur LVD OVD is safe and effective for use in patients undergoing routine cataract surgery. Bio-Hyalur LVD OVD did not confer a higher risk of postoperative increase in IOP.
PubMed: 38711224
DOI: 10.1097/j.jcrs.0000000000001473 -
Journal of Cataract and Refractive... May 2024To compare changes in corneal endothelial parameters following femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CPS) in...
PURPOSE
To compare changes in corneal endothelial parameters following femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CPS) in different corneal regions.
SETTING
Chang Gung Memorial Hospital, Linkou, Taiwan, 2018- 2022.
DESIGN
Single-center, retrospective.
METHODS
Before and 1, 3, and 6 months post-op, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, Position 2 was nearest to the main wound, and Position 3 was at the peripheral zone diagonal to the main wound.
RESULTS
This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, Position 1 had lower ECD and CoV and higher Hex compared to the peripheral regions. FLACS patients had a significantly less phaco time and cumulative dissipated energy. At one month, FLACS patients showed a significantly smaller increase in corneal thickness at Positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at Positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at Position 2 in both groups and was progressive up to 6 months.
CONCLUSIONS
Following phacoemulcification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region.
PubMed: 38711211
DOI: 10.1097/j.jcrs.0000000000001474