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PubMed1992

Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.

Eighteen eyes with coexisting cataract and vitreoretinal disease underwent combined phacoemulsification, pars plana vitrectomy, and posterior chamber lens implantation. Preoperative vitreoretinal disease included nonclearing vitreous hemorrhage (eight eyes), vitreous hemorrhage and tractional retinal detachment (three eyes), tractional retinal detachment (one eye), epiretinal membranes (three eyes), peripheral uveitis (two eyes), and a retained intraocular metallic foreign body (one eye). Postoperative visual acuity improved in each case; 14 eyes achieved visual acuity between 20/20 and 20/80 during an average postoperative period of 11 months (range, 3 to 39 months). Perioperative complications included an iatrogenic retinal break (one eye) and pupillary block glaucoma (one eye). Four eyes required YAG laser capsulotomy postoperatively. Phacoemulsification did not interfere with corneal clarity, allowed water-tight wound closure during vitrectomy, and preserved the capsular bag, allowing endocapsular fixation of the posterior chamber lens. Combining phacoemulsification, posterior chamber lens implantation, and pars plana vitrectomy allows rapid visual rehabilitation and functional unaided vision in these eyes.

Adult↗
PubMed1976

Corneal endothelial damage associated with phacoemulsification.

Twenty-one cats underwent standard Kelman phacoemulsification procedures in their right eyes. The left eyes of the same amimals underwent a planned extracapsular cataract extraction or irrigation and aspiration for 15 minutes using the Kelman phacoemulsification unit. The corneal endothelium was evaluated at various times postoperatively using a stain for endothelial cell viability and scanning electron microscopy. The results suggested that the irrigation procedure alone is deleterious to the cat endothelium as is the rubbing of nuclear material against the endothelial cells. These two procedures caused additonal damage when combined in a routine phacoemulsification procedure.

Animals↗
PubMed1987

Nd:YAG laser photodisruption of the lens nucleus before phacoemulsification.

We studied the use of Q-switched Nd:YAG laser pulses to soften sclerotic lens nuclei before phacoemulsification. We obtained 105 lens nuclei from extracapsular cataract extractions, graded them for degree of sclerosis, and randomized them into laser treatment (53 lenses) or control groups (52 lenses). The treated lenses received laser pulses until confluent pits and clefts were visible. All lenses were phacoemulsified and the times recorded. Nd:YAG laser pretreatment decreased phacoemulsification time in all grades. In moderately sclerotic nuclei, average phacoemulsification time was reduced from 40.1 to 23.9 seconds (40.4%). The nuclei of ten lenses obtained from intracapsular cataract extractions were treated intracapsularly, and the posterior capsule was inadvertently ruptured in five.

Cataract Extraction↗
PubMed1981

Endothelial cell loss following phacoemulsification in the pupillary plane.

Endothelial cell loss following posterior chamber phacoemulsification with and without posterior chamber lens implantation was studied. Postoperative cell counts were taken four months after surgery. Three surgeons participated in this study. Posterior chamber phacoemulsification alone (30 patients) resulted in a mean cell loss of 9%, with a maximum cell loss of 22% in one patient. Posterior chamber phacoemulsification with posterior chamber lens implantation (30 patients) resulted in a mean cell loss of 8% with a maximum cell loss of 26% in one patient. Statistical analysis shows no difference in postoperative cell loss between these two groups.

Aged↗
PubMed1983

Phacoemulsification with the Heslin/Mackool Ocusystem: results of a retrospective study.

One surgeon's experience with phacoemulsification and the Heslin/Mackool Ocusystem is reported. The visual results and intraoperative and postoperative complications are comparable to those reported by surgeons using other phacoemulsification instruments. The authors conclude that the Heslin/Mackool Ocusystem is an efficient instrument for phacoemulsification.

Adolescent↗
PubMed1985

Recent advance in intracapsular phacoemulsification and complete in-the-bag intraocular lens implantation.

We have modified our technique of subcapsular phacoemulsification and aspiration in two ways: (1) Intracapsular phacoemulsification is performed without an anterior capsulotomy. Because the inner wall of the anterior capsule can be cleaned completely by the irrigation/aspiration tip through a small opening in the anterior lens capsule, the clean capsular bag is retained. (2) An intraocular lens (IOL) is inserted completely into the bag. If desired, the central part of the anterior capsule can be removed before or after IOL implantation. We propose changing the name of this technique to intracapsular phacoemulsification and aspiration and complete in-the-bag IOL fixation.

Anterior Chamber↗
PubMed1992

Incidence of vitreous loss among third-year residents performing phacoemulsification.

The incidence of vitreous loss among third-year residents learning phacoemulsification was retrospectively evaluated. One hundred thirty-six cases of phacoemulsification were performed by six different third-year residents with the same attending physician supervising all cases. The incidence of vitreous loss was 14.7%. This study demonstrates that the rate of vitreous loss among residents learning phacoemulsification is higher than the reported incidence of vitreous loss for residents learning planned extracapsular cataract surgery with expression of the lens nucleus.

Cataract Extraction↗
PubMed1990

Comparison of the protective effects of methylcellulose and sodium hyaluronate on corneal swelling following phacoemulsification of senile cataracts.

The protective effects of two viscoelastic substances (hydroxypropyl methylcellulose and sodium hyaluronate) on the cornea during phacoemulsification of senile cataracts were investigated in a prospective, randomized, clinical study. The viscoelastic substances were placed in the anterior chamber before and during phacoemulsification. The mean increase in central corneal thickness (measured by ultrasonic pachymetry) on the first postoperative day was statistically significantly higher (P less than .05) in the methylcellulose group (35 eyes) than in the sodium hyaluronate group (35 eyes). Five weeks postoperatively the difference in mean central corneal thickness between the two groups was not statistically significant. However, one eye in the methylcellulose group developed bullous keratopathy. The present study indicates that methylcellulose does not protect the corneal endothelium as effectively as sodium hyaluronate during phacoemulsification procedures.

Aged↗
PubMed1991

Divide and conquer nucleofractis phacoemulsification: development and variations.

Cataract extraction by phacoemulsification of the lens in situ can be accomplished by a technique incorporating continuous curvilinear capsulorhexis (CCC), deep central sculpting of the nucleus, and manual cracking ("nucleofractis") and subsequent fragmentation and emulsification of the remaining nucleus. This "divide and conquer" nucleofractis technique of phacoemulsification is uniquely suited to the constraints that CCC, which provides excellent conditions for well-centered in-the-bag placement of intraocular lenses, imposes upon cataract extraction. The cracking and fragmentation maneuvers allow phacoemulsification to be extended to patients with hypermature and brunescent lenses, as well as small pupils, who are not normally considered good candidates for the technique.

Cataract Extraction↗
PubMed1993

Conversion to small-incision phacoemulsification: experience with the first 50 eyes.

Conversion from extracapsular cataract surgery to small-incision phacoemulsification is inevitably associated with a learning curve. Retrospective analysis of one surgeon's learning curve was carried out on the first 50 consecutive operations using small-incision phacoemulsification. Parameters were evaluated, including postoperative acuity and astigmatism at eight days, three weeks, three months, and six months. A comparison of the results of the first 25 operations and the subsequent 25 showed statistically significant differences only in acuity at eight days and cylinder at three months. The most frequent complication was corneal edema lasting at least one week. With careful preparation, proper patient selection, and meticulous technique, the learning curve for converting from extracapsular surgery to small-incision phacoemulsification does not necessarily increase the complication rate.

Aged↗
PubMed1986

Fate of the capsular bag in endocapsular phacoemulsification and complete in-the-bag intraocular lens fixation.

We performed endocapsular phacoemulsification on 17 eyes of 15 patients between November 1984 and February 1985. Phacoemulsification was performed intracapsularly through a small incision in the anterior capsule. The inner wall of the bag was cleaned with the Cavitron handpiece. Posterior chamber intraocular lens implantation was performed completely in the bag. A clear capsular bag was present in 15 eyes with an average follow-up of six months. Central anterior lens capsule opacity occurred in two eyes. Sixteen eyes had visual acuity better than 20/40 and nine eyes had visual acuity better than 20/20. We have changed the name of this procedure from intracapsular to endocapsular phacoemulsification to prevent confusion.

Aged↗
PubMed1995

[Phacoemulsification of the dislocated lens nucleus in the vitreous body].

BACKGROUND: one of the most intriguing complications in phacoemulsification is the rupturing of the posterior capsule with los of the nucleus into the vitreous. As severe inflammation will follow, the removal of the nucleus is mandatory. Several methods have been described. Our approach has the advantage to minimize some of the imminent risks. PATIENTS AND METHOD: On 15 eyes phacoemulsification in the vitreous cavity following vitrectomy has been carried out. Supporting liquids like viscoelastic substances or fluordecalin were not necessary. RESULTS: There was no indication of retinal damage caused by this procedure. The early postoperative vision, however, was compromised by a longer lasting corneal edema. The long term visual prognosis was good. CONCLUSIONS: Phacoemulsification in the central vitreous cavity proved to be safe and fairly easy procedure without adverse effects on retina and sclera. It helps to reduce intraoperative risks of alternative methods, avoiding a large opening of the anterior chamber and hypotony of the eye globe.

Cataract Extraction↗
PubMed1990

[Phacoemulsification. Why?].

Improved by both technology and new surgical procedures, phacoemulsification of the nucleus has become increasingly important in extracapsular cataract surgery. Phacoemulsification within the capsular bag has proved to be a valuable surgical technique, yielding predominantly good results. In the hands of a carefully trained, critical surgeon, this procedure results in safe in-the-bag fixation of an intraocular lens. In intravitreal surgery it is almost indispensable. In special cases, such as congenital coloboma, hydrophthalmia in adults, pseudoexfoliation syndrome, risk of expulsive hemorrhage, or in cataract surgery following penetrating keratoplasty, phacoemulsification of the nucleus may be surgically safer than expression of the nucleus through a large corneoscleral incision.

Cataract Extraction↗
PubMed2002

[Topical anesthesia for cataract surgery with phacoemulsification: lidocaine 2% vs ropivacaine 1%. Preliminary results].

BACKGROUND: The safety, tolerability and efficacy of ropivacaine 1% vs lidocaine 2% for phacoemulsification using topical anesthesia during cataract surgery, are compared. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anesthesia is reported. ENVIRONMENT: Operative Unit of Ophthalmology, general Hospital. 1893 consecutively patients were studied (ASA 1-3, 738 males, 1155 females, age 71.8+/-9.7 years, range 35-90 years) undergoing routine phacoemulsification under topical 2% lidocaine (group I) and 1% ropivacaine (group II). The mains outcome measures of the study were: - the total dose of local anesthetic for obtaining a reduction of corneal sensation measured with the Cochet-Bonnet esthesiometer (value>3); - the pain recorded with visual analogic scale and verbal scale at: T1 = the first injection of local anesthetic; T2 = corneal incision; T3 = the end of surgery; T4 = 1h after surgery; T5 = the first postoperative day; - any requirement for additional intraoperative injection anesthesia and systemic sedation when needed; - surgeon assessments of operative conditions and patient cooperation; - patients' subjective level of comfort; - complications. RESULTS: Topical anesthesia using lidocaine 2% was significantly more painful than the ropivacaine 1%. The onset of anesthesia adequate for surgery was similar in all two groups. There were differences between the groups with respect to perioperative analgesia because the VAS was significantly higher in lidocaine group than in ropivacaine group. There were no statistically differences between the two groups at the follow-up. Inadequate anesthesia was seen in 8.05% (74/919 patients) cases of group I vs 0.9% (22/974 patients) of group II. Sedation was needed only in 10 patients and 6 patients of group I and II respectively. The surgeon assessment showed more patient cooperation in the ropivacaine group (83%). Satisfactory comfort (level 1) was reported by 60.4% in the lidocaine group and 86.8% in the ropivacaine group. In both groups there were cases of postoperative epithelial edema (29 patients in group I vs 36 patients in group II) although it decreased after the first postoperative day. No other significant side-effects were observed with the use of either formulations. CONCLUSIONS: Lidocaine 2% and ropivacaine 1% were safe and effective agents in patients having phacoemulsification with IOL implantation. However, ropivacaine provides more good operative conditions than lidocaine for the surgeon and comfortable surgical circumstances for the patient.

Administration, Topical↗
PubMed1992

A prospective study of the transition to phacoemulsification and small incision cataract surgery.

Phacoemulsification is an increasingly popular method of performing cataract surgery. The procedure remains controversial. Opponents of phacoemulsification maintain the procedure has an unacceptably high complication rate during transition to the technique. This prospective study found that the many advantages of phacoemulsification were safely introduced into a moderate sized community practice. The surgical complication rate was very low and visual acuity statistics excellent.

Cataract Extraction↗
PubMed1992

[Phacoemulsification. The method of choice in cataract surgery].

Complications and problems in the first 300 patients operated on by phacoemulsification technique are described. In the first 100 cases the procedure began with the creation of the corneoscleral incision and the anterior capsule was opened in a "can opener" fashion. In the second group of 200 patients we preferred the scleral incision, and the anterior capsule was opened mainly by capsulorhexis. The phacoemulsification was predominantly performed in the capsular bag or in the iris plane. The wound was closed with interrupted sutures. The most common and the most serious complication as well in the first 100 cases was posterior capsule rupture (11%). Then the percentage of this most common complication was diminished significantly with increasing experience of the surgeon (2.5% in 200 cases). The same problems which the authors had in their first operations appeared again, though in a smaller amount as soon as they started to work with phacoemulsification as a method of choice of cataract surgery.

Cataract Extraction↗
PubMed1992

Endothelial cell loss following "modern" phacoemulsification by a senior resident.

Historically, extracapsular cataract extraction (ECCE) has been shown to cause less endothelial cell loss than phacoemulsification. To further evaluate endothelial cell loss following phacoemulsification, we prospectively studied 60 patients who underwent cataract extraction with "in situ" phacoemulsification within the capsular bag following a continuous-tear circular capsulotomy, with placement of a posterior chamber intraocular lens (PC-IOL) in the capsular bag. All procedures were performed by a single senior ophthalmology resident. The average preoperative endothelial count was 2318 +/- 36 cells/mm2; the average postoperative count (at 8.5 weeks) was 2167 +/- 41 cells/mm2. The average endothelial cell loss, then, was 6.4 +/- 1.2%. This level of cell loss with a capsular-bag-fixed PC-IOL is comparable to that reported for ECCE.

Aged↗
PubMed1990

[Lens position following planned capsular sac fixation: results of 200 consecutively surgically treated phacoemulsifications].

A total of 200 phacoemulsifications with planned in-the-bag fixation of one piece PMMA posterior chamber lenses implanted consecutively by one surgeon were examined on postoperative days 3-7. Special attention was given to both position of the haptics and centering of the lens. No sodium hyaluronate or other viscoelastic materials were used in any of the operated eyes. After capsulorhexis and phacoemulsification inside the bag we were able to confirm in-the-bag fixation in 190 implants (95%). In 197 of the 200 patients centering of the IOL was excellent. The capsular rim of the circular capsulorhexis was preserved in all cases due to phacoemulsification within the capsular bag. This procedure meets the best conditions for a secure in-the-bag insertion of the posterior chamber lens. Expression of the lens nucleus after capsulorhexis or through the so-called letter-box technique leads to a remarkably lower percentage of proven bag-bag fixation of the haptics.

Cataract Extraction↗