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PubMed1986

The effects of prolonged phacoemulsification time on the corneal endothelium.

The question of whether or not phacoemulsification causes significant corneal endothelial damage has been studied in many ways. In this study, we used videotaped specular microscopy and nitroblue tetrazolium (NBT) staining to assess cell damage under conditions in which the two most commonly blamed sources of damage--probe tip trauma and lens fragments--cannot be implicated. After 15 minutes of irrigation, aspiration, and ultrasound in a modified corneal viewing and storage (CVS) chamber, the four test corneas showed less than 5% cell damage as assessed by NBT staining, which was no more than in the control. In one case, an unexpected air bubble on the endothelium caused a loss of endothelial cells. Because small air bubbles are common during phacoemulsification, and because such air bubbles may represent a cause of endothelial cell loss, the endothelial damage caused by air bubbles during phacoemulsification merits further study.

Adult↗
PubMed1979

The effect of phacoemulsification on the corneal endothelium.

Endothelial cell densities were measured following intracapsular cataract extraction and phacoemulsification in the same patients. Phacoemulsification caused 29 percent more endothelial cell loss than intracapsular cataract extraction (p less than .001). The degree of endothelial damage with phacoemulsification appeared to be age related and was minimal in the younger patients.

Adult↗
PubMed1983

Effects of phacoemulsification and extracapsular lens removal on corneal thickness and endothelial cell density in the dog.

Twenty-one dogs were used to study the effects of phacoemulsification and extracapsular lens removal on corneal endothelium and corneal thickness. Specular microscopy revealed preoperative cell morphology and cell densities similar to man. After surgery endothelial cell counts significantly decreased 22% (central) and 13% (periphery) with phacoemulsification and 34% (central) and 31% (periphery) with extracapsular lens removal. Corneal thickness increased with both procedures. Endothelial cell pathology included cellular enlargement, increased pleomorphism, and focal cellular degeneration. Phacoemulsification time did not correlate with the degree of cell loss. Dog corneal endothelium responds to surgical trauma in a manner similar to man and maintains a functional monolayer via cellular enlargement and migration. The dog, therefore, represents a good animal model for the study of corneal endothelial disease in man.

Animals↗
PubMed1980

[Phacoemulsification and corneal endothelium: experimental study by scanning microscopy (author's transl)].

The various traumatic lesions occurring in the corneal endothelium during phacoemulsification were studied in the eyes of anesthetized rabbits. A comparison was made between the effects of massive perfusion of the anterior chamber with simple isotonic saline or Earle's solution, ultrasound emission, total phacoemulsification, and classical extracapsular extraction. The endothelium was examined by electronic scanning microscopy to cover large areas of the endothelium. Simple perfusion with Earle's solution does not alter the appearance of the endothelium, though some modifications in apical digitations may be observed. Perfusion with isotonic saline solution for 15 minutes modifies the appearance of the endothelial surface, with early necrosis in several cells. Ultrasounds provoke complete necrosis of a few isolated cells but do not cause major changes in most of them. Phacoemulsification produces endothelial ulcerations, probably from the trauma from lens debris. Extracapsular extraction, difficult in the rabbit, is the cause of much larger lesions with cell necrosis and vast areas of ulceration.

Animals↗
PubMedDate not supplied

Posterior lens dislocation during attempted phacoemulsification.

Mechanisms of posterior lens dislocation during phacoemulsification have been suggested, but the actual mechanism involved has not been demonstrated. Chart reviews of cataract surgeries performed at Indiana University from 1991 until the present identified nine cases of posterior lens dislocation that occurred during phacoemulsification. In four, the procedure was converted early to a can-opener capsulotomy. Cadaver eye studies showed the role of an imperfect capsulorhexis in extending tears while a "trap door" was being formed for posterior nuclear dislocation during phacoemulsification.

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PubMedDate not supplied

Results of trabeculectomy combined with phacoemulsification versus trabeculectomy combined with extracapsular cataract extraction in patients with advanced glaucoma.

We compared the results of trabeculectomy combined with phacoemulsification (n = 16) with those of trabeculectomy combined with extracapsular cataract extraction (n = 18). There was no significant difference between the two groups in terms of early or chronic postoperative intraocular pressure (IOP) control or in terms of the number of glaucoma medications prescribed postoperatively. However, by 12 weeks postoperatively, bleb height and extent were significantly greater in the phacoemulsification group. There was no significant difference between the groups in terms of postoperative spheroequivalent, astigmatism, or cylindrical axis. The mean final visual acuity, however, was less in the extracapsular group. We conclude that phacoemulsification combined with trabeculectomy offers a safe and effective technique to control postoperative IOP in patients with glaucoma.

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PubMed1993

5-FU-supplemented phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy.

I reviewed the charts of 129 consecutive patients: 38 of whom underwent 5-fluorouracil (5-FU)-supplemented, combined phacoemulsification, posterior chamber lens implantation, and trabeculectomy (phaco/5-FU group); 55 of whom underwent the same combined procedure without 5-FU (phaco group); and 36 of whom underwent a similar combined procedure in which extracapsular cataract surgery was performed instead of phacoemulsification, again without 5-FU (ECCE group). I evaluated and compared the surgical results in these three groups at several points, up to and including 1 year postoperatively, in terms of intraocular pressure (IOP), number of antiglaucoma medications being used, presence or absence of a visible filtering bleb, visual field, anterior chamber cell and flare, visual acuity, postoperative induced astigmatism, and incidence of cystoid macular edema. At 3 months and beyond, there were more blebs in the phaco/5-FU group than in the phaco or ECCE groups. IOPs were generally lowest in the phaco/5-FU group, as were the number of antiglaucoma medications being used. There was no significant difference in the distribution of the amount of visual field loss among the three groups. Inflammation was generally least in the phaco/5-FU group, but there was no significant difference among the groups in terms of postoperative-induced astigmatism and visual acuity. I conclude that 5-FU-supplemented phacoemulsification combined surgery is safe and probably produces better filtering results than those achieved without the adjunctive use of 5-FU.

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PubMedDate not supplied

Long-term endothelial cell loss following phacoemulsification: model for evaluating endothelial damage after intraocular surgery.

BACKGROUND: Newer concepts of phakic intraocular lens (IOL) surgery present concerns as to their long-term deleterious effect on the endothelium. We examine the behavior of the endothelium for up to 6 years following uneventful phacoemulsification surgery, to establish a baseline for what might be an acceptable level of endothelial cell loss due to intraocular surgical trauma. METHODS: Ninety-three eyes undergoing phacoemulsification surgery who had multiple endothelial specular microscopy examinations for up to 6 years were examined. Central endothelial specular photomicrographs were analyzed in all cases and the percent of endothelial cell loss as a function of time was calculated. Cell density calculations were corrected for the normal endothelial cell loss as a function of age. RESULTS: Routine uncomplicated phacoemulsification surgery demonstrated a 9% endothelial cell loss 1 year postoperatively. This is in marked contrast to the 16% average endothelial cell loss cited in the literature after phakic AC-IOL surgery. In general, anterior chamber IOL surgery following cataract removal compares unfavorably to posterior chamber IOL insertion long term (20% cell loss versus 12% cell loss). CONCLUSIONS: A model is proposed to look at the rate of endothelial cell loss that would be significant enough to create the threat for corneal edema long term following refractive intraocular surgery in young patients. Suggestions for critical comparisons between the observed endothelial aging seen with phakic IOLs and values for more routine IOL surgery are proposed to predict the long-term threat for endothelial cell loss and corneal decompensation, which might result many years after phakic refractive IOL surgery.

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PubMedDate not supplied

Phacoemulsification--why?

When a new operation replaces an old, it must be better, not just equally good. The Kelman method of cataract extraction has given impressive results in patients under the age of 30 years. However, for senile cataracts it is not better, the hospital stay is not shortened, and the recovery time is directly proportional to the age of the patient and to the preoperative condition of the eye, not to the type of extraction. Phacoemulsification is a cataract extraction and, therefore, should receive exactly the same monetary reward. No comparative series of cases done by the same surgeon or surgeons of equal skill has demonstrated that the Kelman phacoemulsification procedure is accompanied by fewer retinal detachments, Irvine-Gass syndromes, or other postoperative complications. The Kelman phacoemulsification method should be an adjunct to, and not a replacement for, the current intracapsular cataract extraction.

Adult↗
PubMed1976

The phacoemulsification procedure. II. Corneal endothelial changes.

The effect of phacoemulsification, with the Cavitron-Kelman instrument, on the corneal endothelium of rabbit and cats was studied by scanning electron microscopy and nitroblue tetrazolium staining. The various steps of the procedure were examined separately. Irrigation of the anterior chamber of the eye with balanced salt solution (Plasma-Lyte) for ten minutes caused no cell damage. Ultrasound and irrigation alone for four to six minutes caused increased permeability to NBT. Edema of endothelial cells and cell junction disruption occurred after eight minutes of anterior chamber irrigation with Plasma-Lyte. Uncomplicated phacoemulsification produced moderate cellular edema with scattered loss of endothelial cells. Destruction of endothelial cells was frequent after phacoemulsification, it appeared to be due to lens nucleus manipulation in the anterior chamber, instrumentation, and needle contact. From two to five days postoperatively, intercellular edema, altered cell morphology, and mosaic pattern were seen. However, it gradually recovered and seven to ten days later the endothelium appeared normal.

Animals↗
PubMed1999

Quantification of aqueous flare after phacoemulsification with intraocular lens implantation in eyes with pseudoexfoliation syndrome.

BACKGROUND: Impairment of the blood-aqueous barrier is a frequent finding in eyes with pseudoexfoliation syndrome (PEX). OBJECTIVE: To perform noninvasive quantification of aqueous flare using the laser flare-cell meter to analyze blood-aqueous barrier breakdown following phacoemulsification with intraocular lens implantation in eyes with and without PEX. METHODS: After other conditions that might account for impairment of the blood-aqueous barrier were excluded, 11 eyes with PEX and 11 eyes with senile cataract without PEX were included in the study. Aqueous flare was quantitatively determined using a laser flare-cell meter preoperatively as well as 1, 3, and 5 days postoperatively. Phacoemulsification with posterior chamber intraocular lens implantation was performed by one surgeon. RESULTS: On the first postoperative day, flare values (calculated as mean+/-SD photon counts per millisecond) in eyes with PEX were higher (42.2+/-21.3) than in eyes without PEX (30.6+/-15.1) (P>.05). On days 3 and 5, postoperative flare values decreased slowly in eyes with PEX (23.9+/-7.4 and 21.2+/-5.7 photon counts per millisecond, respectively) and were significantly higher than in eyes without PEX (14.8+/-5.4 and 10.5+/-1.4 photon counts per millisecond, respectively) (P<.05). CONCLUSIONS: Breakdown of the blood-aqueous barrier is significantly more extensive in eyes with PEX and may be an important risk factor for early postoperative complications. The altered response to surgery should be considered in eyes with PEX.

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PubMed1997

Postoperative contamination after using vancomycin and gentamicin during phacoemulsification.

OBJECTIVE: To investigate if the addition of vancomycin and gentamicin to the irrigating solutions during phacoemulsification with lens implantation reduces the incidence of positive postoperative intraocular cultures. DESIGN: Two-part double-masked, placebo-controlled, randomized clinical trial. PATIENTS: In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 10 eyes) and 2 hours after surgery (in 10 eyes) in patients treated with antibiotics. In the primary study, 120 eyes underwent uncomplicated surgery. The treatment group and the placebo group were composed of 60 eyes each. INTERVENTION: The treatment group received vancomycin, 20 micrograms/mL, and gentamicin, 8 micrograms/mL, in the irrigating fluid. The placebo group received only irrigating fluid. All patients in the primary study underwent anterior chamber aspiration following surgery, and culturing was performed 2 hours later. MAIN OUTCOME MEASURE: Identification and quantification of positive cultures in thioglycolate broth and chocolate agar. RESULTS: In the preliminary study, the half-life of both intraocular antibiotics was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in 3 specimens (5.0%) in the antibiotic-treated group and in 7 specimens (12.0%) in the placebo group. CONCLUSIONS: Although we found a higher rate of positive postoperative cultures in the placebo group (odds ratio = 2.51), 2 hours of contact between the antibiotic solution and bacteria did not produce results that reached statistical significance (P =.18) to support adding vancomycin and gentamicin to the irrigating solutions during phacoemulsification. Further studies are needed to evaluate the clinical implications of using antibiotics in irrigating solutions.

Adult↗
PubMed2004

Corneal relaxing incision combined with phacoemulsification and IOL implantation.

OBJECTIVE: To analyze the effectiveness and safety of corneal relaxing incisions (CRI) in correcting keratometric astigmatism during cataract surgery. METHODS: A prospective study of two groups: control group and treatment group. A treatment group included 25 eyes of 25 patients who had combined clear corneal phacoemulsification, IOL implantation and CRI. A control group included 25 eyes of 25 patients who had clear corneal phacoemulsification and IOL implantation. Postoperative keratometric astigmatism was measured at 1 week, 1 month, 3 months and 6 months. RESULTS: CRI significantly decreased keratometric astigmatism in patients with preexisting astigmatism compared with astigmatic changes in the control group. In eyes with CRI, the mean keratometric astigmatism was 0.29+/-0.17 D (range 0 to 0.5 D) at 1 week, 0.41+/-0.21 D (range 0 to 0.82 D) at 1 month, respectively reduced by 2.42 D and 2.30 D at 1 week and 1 month postoperatively (P=0.000, P=0.000), and postoperative astigmatism was stable until 6 months follow-up. The keratometric astigmatism of all patients decreased to less than 1.00 D postoperatively. CONCLUSIONS: CRI is a practical, simple, safe and effective method to reduce preexisting astigmatism during cataract surgery. A modified nomogram is proposed. The long-term effect of CRI should be investigated.

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PubMed2005

[Primary phacoemulsification following acute primary angle closure glaucoma].

Recent developments and clinical studies indicate that primary phacoemulsification and intraocular lens implantation are safe and effective for the surgical treatment of primary angle closure glaucoma (ACG) compared to conventional iridectomy or laser-iridotomy. When compared to control eyes treated using standard peripheral iridectomy, the outcome in terms of intraocular pressure control, adjunct anti-glaucoma medication, visual acuity, and the necessity for successive surgical interventions favored primary phacoemulsification and intraocular lens implantation. Earlier biometric data underline the importance of the "lens factor" in the pathogenesis of relative pupillary block in ACG obtained by Scheimflug image processing and ultrasound biomicroscopy. The vast improvements in modern cataract surgery combined with our current understanding of the pathogenesis of relative pupillary block in ACG indicate that lens extraction is a better procedure in uncontrolled angle closure glaucoma than conventional iridectomy.

Germany↗
PubMed1997

[Minor effect of anti-inflammatory therapy on intraocular inflammation after minimally invasive phacoemulsification].

UNLABELLED: In a prospective study, we examined the influence of different anti-inflammatory treatments on intraocular inflammation after minimally invasive cataract surgery. PATIENTS AND METHODS: A total of 150 patients (39-88 years of age) underwent phacoemulsification using a temporal clear-corneal tunnel incision and implantation of a 5-mm PMMA posterior chamber. Each patient was randomly assigned to one of the following 5 treatment groups, each consisting of 30 patients: (1) diclofenac 0.1% unconserved eyedrops (DICun) pre- and postoperatively; (2) diclofenac 0.1% conserved eyedrops (DICco) pre- and postoperatively; (3) DICun postoperatively; (4) DICun pre- and postoperatively, plus dexamethasone-21-dihydrogenphosphate 0.1% eyedrops (DEXA) postoperatively; (5) DEXA postoperatively. The aqueous flare was measured pre- and postoperatively using the laser flare-cell meter. RESULTS: In group 1, the flare (in photon counts/ms) increased from 10.8 +/- 1.7 preoperatively to only 14.7 +/- 3.1 in the afternoon of the day of surgery. Even on day 1 postoperatively, the flare decreased to 9.3 +/- 0.9 and remained relatively constant on days 3 and 7 after surgery. There were no significant differences among the groups concerning flare means (P = 0.35) or time courses (P = 0.51). DISCUSSION: Anti-inflammatory treatment had no significant influence on the amount of postoperative aqueous flare. This is because of the fact that clear corneal phacoemulsification per se leads to an extremely low intraocular inflammation and thus makes the importance of anti-inflammatory pharmacotherapy relative.

Administration, Topical↗
PubMed1997

[Early postoperative endothelial cell loss after corneoscleral tunnel incision and phacoemulsification in pseudoexfoliation syndrome].

INTRODUCTION: Corneal endothelial involvement can be found in pseudoexfoliation syndrome (PEX). Evaluation of possible differences in endothelial cell loss following cataract extraction was compared to normal eyes. PATIENTS AND METHODS: In a controlled clinical study we prospectively studied 20 patients with PEX and compared them with an age-matched control group with senile cataract. All patients were treated with a standardized self-sealing 7-mm corneoscleral tunnel incision, phacoemulsification and posterior intraocular lens implantation using sodium hyaluronate. In addition to a complete ophthalmological examination, quantitative and qualitative endothelial cell analysis of the central and peripheral cornea was performed preoperatively, at the first postoperative day and after 4 weeks using non-contact specular microscopy (Konan Noncon Robo-ca SP 8000, Konan, Japan). RESULTS: In eyes with PEX (2394 +/- 271 cells/mm2) endothelial cell counts were 10.5% (P < 0.05) lower than in the control group (2674 + 341 cells/mm2). Intraoperatively, ultrasound time (90 +/- 51 s) and power (38 +/- 17%) did not differ between the two groups. After 4 weeks the mean endothelial cell loss in the two groups was 10.4% and 9.8%, respectively (P < 0.001). The mean cell area increased by 55 and 48 microns2 (P < 0.001), respectively. Polymegethism increased postoperatively in both groups and stabilized at 4 weeks at preoperative values. Pleomorphism increased significantly only in the PEX group. CONCLUSIONS: In eyes with PEX no increased cell loss was found in the early postoperative period compared to normal eyes following corneoscleral tunnel incision and phacoemulsification. Due to preoperative reduced endothelial cell densities, endothelium-protecting measures are recommended in eyes with PEX.

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PubMed1999

[Late dislocation of the capsular bag after phacoemulsification with endocapsular IOL in pseudoexfoliation syndrome].

UNLABELLED: PES has been associated with weakness of zonular attachments to the ciliary body and with late dislocation of the IOL following cataract extraction with in-the-bag IOL implantation. We evaluated the frequency of PES in patients with IOL dislocation following phacoemulsification cataract surgery. PATIENTS AND METHODS: We retrospectively reviewed the records of five patients who had undergone phacoemulsification, followed by implantation of a posterior chamber IOL in the capsular bag during the years 1992 through 1996 and who showed IOL dislocation during follow-up. We looked for clinical signs of PES that had been noted prior to or after IOL dislocation. RESULTS: Detailed review of the records of these patients identified PES as a coexistent condition in all five. The most impressive clinical feature was shrinkage of the capsular bag to conform to the size and contour of the implanted IOL. CONCLUSIONS: In accordance with many histopathological and clinical studies supporting our findings, we suggest that shrinkage of the capsular bag can be reduced by not using foldable IOL, by early anterior YAG capsulotomy or by the use of an IOL with a larger optic.

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PubMed1999

[Combined phacoemulsification and goniotrepanation in primary chronic open angle glaucoma and classical pseudoexfoliation glaucoma].

BACKGROUND: Combined glaucoma and cataract operation has been demonstrated to be effective in controlling IOP and increasing visual acuity. Because of the differences between patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXEG), for cataract and glaucoma surgery alone we evaluated the effects and complications for simultanous surgical management. PATIENTS AND METHODS: In a retrospective study 103 patients were examined who underwent a combined phacoemulsification and goniotrephination between January 1993 and January 1997 and had no surgery before (110 eyes with POWG, 22 eyes with PXEG). RESULTS: The average age in the POAG group (75.1 +/- 8.7 years) was significantly less than in the PXEG group (79.3 +/- 5.9 years) (P < 0.05). The mean preoperative IOP in PXEG (31.8 +/- 10.3 mmHG) was significantly higher than in POAG (25.0 +/- 6.4 mmHg) (P < 0.0005). Due to the combined surgery the mean intraocular pressure decreased in both groups < 10 mmHg (days 1 and 7). PXEG had a significantly higher IOP at day 3 than POAG (12.3 +/- 8.4 mmHg versus 8.5 +/- 5.7 mmHg) (P < 0.05) and developed after combined operation IOP peaks > 25 mmHg into a significantly higher level (P < 0.05). Moreover, zonulolysis, rupture of the posterior capsule, vitreous loss and persistence of inflammatory response occurred more often in PXEG, but there was no significant difference compared to POAG. CONCLUSION: PXEG has an higher incidence of typical problems of phacoemulsification, a temporary increase of IOP and prolonged inflammation after combined cataract and glaucoma surgery than POAG, but there is a similar risk compared to a single procedure.

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