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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 -
Indian Journal of Ophthalmology Dec 2017Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through... (Review)
Review
Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through phacoemulsification, most of the patients are able to achieve excellent visual outcome. Corneal edema after phacoemulsification in the immediate postoperative period often leads to patient dissatisfaction and worsening of outcome. Delayed onset corneal edema often warrants endothelial keratoplasty. This review highlights the etiopathogenesis, risk factors, and management of corneal edema in the acute phase including descemet's membrane detachment (DMD) and toxic anterior segment syndrome. Various investigative modalities such as pachymetry, specular microscopy, anterior segment optical coherence tomography, and confocal microscopy have been discussed briefly.
Topics: Corneal Edema; Humans; Phacoemulsification; Postoperative Complications
PubMed: 29208818
DOI: 10.4103/ijo.IJO_871_17 -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Phacoemulsification; Cataract Extraction; Internship and Residency; Teaching
PubMed: 37878952
DOI: 10.5935/0004-2749.2023-1005 -
Asia-Pacific Journal of Ophthalmology... 2017Endothelial keratoplasty (EK) has revolutionized corneal transplant surgery by providing rapid visual recovery and improved visual outcomes. In parts of the world with... (Review)
Review
Endothelial keratoplasty (EK) has revolutionized corneal transplant surgery by providing rapid visual recovery and improved visual outcomes. In parts of the world with Fuchs endothelial dystrophy, many patients may present with both cataracts and corneal degeneration requiring surgery. Other forms of endothelial decompensation may also present with cataracts. The staging or combination of transplant surgery and cataract surgery depend on both the abilities of the surgeon and the surgical techniques being considered. We currently use phacoemulsification to remove cataracts and routinely perform both cataract surgery and EK with topical anesthesia. The decision to perform either combined or staged cataract and transplant surgery depends upon the examination of the eye including assessment of the anterior chamber depth and the status of the anterior surface of the cornea, which affects the ability to reliably assess keratometry. Additional considerations include the type of lens implant to use, the desired refractive outcome, and the patient's preference about whether to undergo 1 or 2 surgical procedures per eye.
Topics: Cataract; Corneal Transplantation; Fuchs' Endothelial Dystrophy; Humans; Phacoemulsification; Visual Acuity
PubMed: 28726355
DOI: 10.22608/APO.2017127 -
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 -
The Pan African Medical Journal 2017Cataract is a total or partial clouding of the lens of the eye. It can be congenital or acquired. Cataract associated with the aging process (senile) is the most common...
Cataract is a total or partial clouding of the lens of the eye. It can be congenital or acquired. Cataract associated with the aging process (senile) is the most common type. Common symptoms include visual impairment which varies based on the type and the density of lens opacity. Cataracts etiology is varied and treatment is based on surgery. In patients with morgagnian cataract cortex liquefies and lens core hardens and becomes cloudy. We here report the case of a 51-year old patient with no notable medical history presenting with progressive decreased visual acuity in the left eye with no pain or redness of the eye associated. Ophthalmologic examination showed visual acuity (the individual can see hand movement), clear cornea, normal anterior chamber depth, an intraocular pressure of 15 mmgh and morgagnian cataract. The patient underwent phacoemulsification cataract surgery with implantation within the capsular bag. Post-operative suites were simple.
Topics: Cataract; Humans; Male; Middle Aged; Phacoemulsification; Visual Acuity
PubMed: 29515742
DOI: 10.11604/pamj.2017.28.124.13213 -
Indian Journal of Ophthalmology Oct 2018
Topics: Cataract; Humans; Infant; Lens, Crystalline; Male; Phacoemulsification; Visual Acuity
PubMed: 30249841
DOI: 10.4103/ijo.IJO_637_18 -
Arquivos Brasileiros de Oftalmologia Jun 2020To describe costs and outcomes of phacoemulsification for cataracts performed by ophthalmology residents.
PURPOSE
To describe costs and outcomes of phacoemulsification for cataracts performed by ophthalmology residents.
METHODS
We obtained medical records from patients operated on in 2011 by third year residents (R3) using phacoemulsification (n=576). Our expenses estimation included professionals' and hospital costs (fees, materials, medications, and equipment). The study outcomes included spectacle-corrected visual acuities before and six months after the operation, rate of intraoperative complications, and total number of postoperative visits. We compared outcome variables with those from extracapsular cataract extraction procedures (n=274) performed by R3 residents in 1997.
RESULTS
The mean total cost for phacoemulsification was US$ 416, while an overall estimation indicated the extracapsular cataract extraction cost at US$ 284 (as of December 30, 2011). The mean preoperative spectacle-corrected visual acuity was worse for eyes scheduled for extracapsular cataract extraction (1.73 ± 0.62), than for eyes scheduled for phacoemulsification (0.74 ± 0.54 logMAR) (p<0.01); the mean postoperative visual acuity was better for phacoemulsification (0.21 ± 0.36 logMAR), than for extracapsular cataract extraction (0.63 ± 0.63 logMAR) (p<0.01). Most patients undergoing phacoemulsification (85%) achieved postoperative spectacle-corrected visual acuities ≥0.30 logMAR, while only 45% of those undergoing extracapsular cataract extractions achieved the same postoperative visual acuity (p<0.01). The rate of intraoperative complications was significantly higher after extracapsular cataract extractions (21%) than it was after phacoemulsifications (7.6%) (p<0.01), and the mean number of postoperative visits was also higher after extracapsular cataract extractions (5.6 ± 2.3) than after phacoemulsifications (4.5 ± 2.4) (p<0.01).
CONCLUSION
These data indicate that cataract surgery performed by in-training ophthalmologists using phacoemulsification is expensive, but compared to extracapsular cataract extraction results, teaching phacoemulsification leads to an approximate three-fold lower complication rate, smaller number of postoperative visits and, most importantly, better visual acuities.
Topics: Cataract; Humans; Intraoperative Complications; Phacoemulsification; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity
PubMed: 32490980
DOI: 10.5935/0004-2749.20200059 -
Eye (London, England) Jan 2022To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE).
OBJECTIVES
To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE).
METHODS
Prospective, single surgeon, multi-year study of consecutive patients undergoing PCE was performed. At the conclusion of each procedure, the surgeon recorded the CCA and perceived surgeon stress score. Patient variables included gender, age, diabetes mellitus, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, and intraocular lens power.
RESULTS
During the 10-year study, 1097 eyes underwent surgery and CCA was diagnosed intraoperatively in 41 eyes. On multi-variable analysis, the following patient characteristics were associated with intraoperative CCA: diabetes mellitus (p = 0.002), age >80 years (p = 0.002), presence of posterior capsular cataract (p = 0.046), severe nuclear sclerosis (p = 0.004), and absence of pseudo-exfoliation (p = 0.043).
CONCLUSION
Diabetes mellitus, advanced age and posterior subcapsular cataract are associated with CCA necessitating generous repetitive hydrodissection.
Topics: Aged, 80 and over; Cataract; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Phacoemulsification; Prospective Studies; Tissue Adhesions
PubMed: 33674725
DOI: 10.1038/s41433-021-01482-5 -
Indian Journal of Ophthalmology Dec 2017
Topics: Aged, 80 and over; Capsule Opacification; Humans; Male; Phacoemulsification; Posterior Capsule of the Lens
PubMed: 29208841
DOI: 10.4103/ijo.IJO_913_17