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PubMed2004

NeoSoniX ultrasound versus ultrasound alone for phacoemulsification: randomized clinical trial.

PURPOSE: To evaluate the difference in consumption of ultrasound (US) energy required with NeoSoniX (Alcon) in conjunction with US (NeoSonix US) versus US alone. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This prospective randomized study comprised 120 consecutive eyes having phacoemulsification with the Alcon Legacy 20000 series at Iladevi Cataract & IOL Research Centre. Two groups of 60 eyes each were formed based on cataract grade according to the Emery classification: grade 2 and 3 nuclear sclerosis (Group A) and grade 4 and 5 nuclear sclerosis (Group B). In each group, 30 eyes had phacoemulsification using NeoSoniX US and 30 eyes, using US alone. The main parameters were intraoperative US time and mean US power. Effective phaco time (EPT) was calculated by multiplying the US time and mean US power and dividing the product by 100. The unpaired Student t test was used to evaluate the differences between NeoSoniX US and US alone. The corresponding 95% confidence intervals were calculated. RESULTS: In Group A, the mean US time was 106 seconds with NeoSoniX US and 144.30 seconds with US alone (P = .002), the mean US power was 13.50% and 15.83%, respectively (P = .059), and the mean EPT was 15.17 seconds and 22.94 seconds, respectively (P = .006). In Group B, the mean US time was 193.67 seconds with NeoSoniX US and 255.17 seconds with US alone (P = .000), the mean US power was 18.31% and 22.76%, respectively (P = .000), and the mean EPT was 35.67 seconds and 59.15 seconds, respectively (P = .000). The EPT was 33.5% and 39.6% less with NeoSoniX US than with US alone in Group A and Group B, respectively. CONCLUSIONS: Ultrasound energy consumption with NeoSoniX was significantly less than with US alone, indicating the value of NeoSoniX in emulsifying cataracts of optimum density and dense hard cataracts. Combining NeoSoniX and US significantly reduced the consumption of US energy.

Aged↗

PubMed2005

Zonular dialysis and vitreous loss with a J-shaped hydrodissection cannula during phacoemulsification.

We report a complication that occurred during clear corneal phacoemulsification. When saline was injected during hydrodissection with a 27-gauge J-shaped cannula attached to a 2.0 mL luer-lock polypropylene syringe, the cannula dislodged and slipped behind the iris, hooking to the lens equator. Although the cannula was carefully removed, 3 clock hours of zonular dialysis were observed between the 4 o'clock and 7 o'clock meridians. After phacoemulsification, lens aspiration, and in-the-bag intraocular lens implantation, vitreous was noted inferiorly and the anterior vitrectomy was completed.

Aged↗

PubMed2005

Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis.

PURPOSE: To evaluate the visual outcomes and complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation, (PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC). SETTING: Private clinic and an academic hospital. METHODS: In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated. RESULTS: Twenty-four male and 16 female patients aged 12 years to 70 (SD) (mean 35 +/- 12 years) were operated on and followed for 17.8 +/- 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment. CONCLUSION: Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.

Adolescent↗

PubMed2005

Scanning laser polarimetry of nerve fiber layer thickness in normal eyes after cataract phacoemulsification and foldable intraocular lens implantation.

PURPOSE: To assess the effect of cataract phacoemulsification and intraocular lens (IOL) implantation on retinal nerve fiber layer (RNFL) thickness using scanning laser polarimetry (SLP). SETTING: Eye Clinic, Trieste University, Italy. METHODS: Forty-eight eyes were evaluated prospectively the day before and 30 days after cataract phacoemulsification and foldable IOL implantation. In each eye, lens opacity grading according to the Lens Opacities Classification System III (LOCS III), and axial length (AL) measurements were performed. Retinal nerve fiber layer thickness was quantified at baseline by means of SLP and anterior segment birefringence compensation was evaluated acquiring macular retardation map (MRM). Acrylic and silicone IOLs were implanted randomly. After surgery, RNFL thickness was reevaluated, and MRM was reacquired. Macular retardation map pattern variations regarding baseline profile were classified into 3 groups: no variation, bow-tie profile enhancement, or attenuation. Distribution of IOL power, AL, and cataract type in the 3 groups was assessed, as were presurgery and postsurgery SLP parameters with mean values (+/-SD) compared by paired t test. RESULTS: Twenty-two eyes (Group 1, 45.8%) showed no MRM variation, 14 (Group 2, 29.2%) an enhancement, and 12 (Group 3, 25%) an attenuation. In Group 1, no significant RNFL thickness variation occurred. In Group 2, variation 10% to 15% was measured, whereas thickening a 8% to 15% thinning appeared in Group 3. Variations occurred irrespective of IOL material, AL, or cataract type. CONCLUSIONS: Cataract surgery with IOL implantation was associated with an MRM profile change and RNFL thickness variations in 54.2% of eyes. Variations are probably related to opacified lens removal. A new baseline SLP reading is mandatory after cataract surgery.

Acrylic Resins↗

PubMed2005

Phacoemulsification, persistent hypotony, and cyclodialysis clefts.

A retrospective noncomparative case-note analysis of 3 men presenting with persistent hypotony after routine phacoemulsification cataract surgery was performed. All patients had a previous history of significant blunt ocular trauma. All patients had surgical repair of the cyclodialysis clefts, 1 with cleft cryopexy and 2 with formal cleft closure with a limbal-based double scleral flap technique. All patients achieved closure of the cyclodialysis clefts following surgical intervention with complete resolution of hypotony. Mean preoperative intraocular pressures improved from 3, 4 and 3 mm Hg in the 3 cases to 11, 16, and 17 mm Hg postoperatively. Visual acuities improved from preoperative readings of counting fingers, 6/36 and 6/24 in the 3 cases to 6/6, 6/9, and 6/9 postoperatively. Persistent hypotony because of possible activation of a preexisting doormant cyclodialysis cleft following routine atraumatic phacoemulsification cataract surgery in previously traumatized eyes has not been reported.

Adult↗

PubMed2005

Mycobacterium chelonae-Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation.

We report a clear corneal wound infection occurring in a 74-year-old man caused by a member of the Mycobacterium chelonae-Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin and ciprofloxacin. Despite aggressive therapy, a full-thickness corneal perforation developed, requiring emergent cyanoacrylate glue to preserve ocular integrity. Both the difficulty and delays in obtaining a correct diagnosis led to severe ocular morbidity. Infectious lamellar keratitis limited to the clear cornea phacoemulsification incision is rare, but some unusual organisms such as atypical mycobacteria may be encountered.

Aged↗

PubMed2005

Single-piece foldable acrylic intraocular lens implantation in the sulcus in eyes with posterior capsule tear during phacoemulsification.

PURPOSE: To evaluate early and late period results of the implantation of single-piece foldable acrylic intraocular lens (IOL) in the sulcus in eyes developing a posterior capsule tear (PCT) during phacoemulsification (PE). SETTING: S.S.K. Vakif Gureba Training Hospital Eye Clinic, Istanbul, Turkey. METHODS: This prospective and noncomparative study consisted of 89 eyes of 88 patients in which PCT developed, with or without vitreous loss, and that were followed up for at least 1 year. The IOL was implanted in the sulcus in all eyes with sufficient capsule support. Postoperative best corrected visual acuity (BCVA), anterior segment biomicroscopy, intraocular pressure (IOP), IOL centralization, and fundus were analyzed. RESULTS: Temporary corneal edema, the most frequently observed cause of reduced vision in the early period, appeared in 33 eyes; high IOP in 17 eyes; anterior chamber inflammatory reaction in 5 eyes; clinical cystoid macular edema in 7 eyes; and retinal detachment in 1 eye. The IOL was decentered in 4 eyes and dislocated in 1 eye. Repositioning was performed in 2 eyes. No IOL was removed. In the early period, BCVA was 5/10 and above in 41 eyes; the final BCVA was 4/10 and below in 16 eyes and of 5/10 and above in 73 eyes. CONCLUSIONS: The implantation of foldable acrylic IOL in the sulcus in eyes developing posterior capsule tear during phacoemulsification surgery maintains the advantages of a small incision. Postoperative visual results were good, complications were few, and IOLs were centered.

Acrylic Resins↗

PubMed2005

Origin of intraocular metallic foreign bodies during phacoemulsification.

This is the first report of a case of intraocular metallic foreign bodies retained after phacoemulsification in which the source was identified as silver emanating from the brazing of the irrigation tube as it entered the handpiece shell on its inner diameter. Although silver is considered to be inert in the eye and nonmagnetic, manufacturers should evaluate alternate methods of phacoemulsification handpiece design.

Aged↗

PubMed2006

Comparative clinical trial of ultrasound phacoemulsification with and without the WhiteStar system.

PURPOSE: To compare the postoperative outcomes of cataract surgery performed with the Sovereign 4.0 system or the Sovereign system with WhiteStar power modulation. SETTING: Ambulatory surgery centers at 4 sites in the United States. METHODS: This was a 3-month, open-label, randomized, parallel-group comparative clinical trial in patients with visually interfering cataract. Surgeons used the divide-and-conquer phacoemulsification technique for nuclear removal. An intraocular lens was implanted using the recommended insertion system. Primary operative outcome measures were equivalent phaco time (EPT), percentage of phaco power, amount of balanced salt solution used, and surgical complications. Patients were seen 1 day and 3 months after surgery. Postoperative outcome measures were the change in endothelial cell count from the preoperative visit to 3 months, corneal clarity, inflammation, and corneal thickness. RESULTS: The Sovereign with WhiteStar group had 48 patients and the Sovereign 4.0 group, 49 patients. Mean EPT and mean percentage of power were significantly lower in the Sovereign with WhiteStar group. Mean EPT was 6.67 seconds +/- 8.2 (SD) in the Sovereign with WhiteStar group and 8.59 +/- 9.3 seconds (P = .01) in the Sovereign 4.0 group. Mean percentage of phaco power was 6.41% +/- 3.3% in the Sovereign with WhiteStar group and 8.51% +/- 4.9% in the Sovereign 4.0 group (P = .01). The Sovereign with WhiteStar group lost significantly fewer endothelial cells (-319.6 +/- 634.2 cells/mm(2)) than the Sovereign 4.0 group (-430.3 +/- 594.6 cells/mm(2)) (P = .01). Corneal clarity, cells and flare, and pachymetry were comparable with the exception of the 3-month visit. The mean change in baseline central pachymetry showed significantly less corneal thickening in the Sovereign with WhiteStar group. CONCLUSIONS: The Sovereign with WhiteStar power modulation system provides effective lens removal at lower levels of phaco power and ultrasound energy than the Sovereign 4.0 system. Lower ultrasound levels may reduce the risk for endothelial cell loss during phacoemulsification.

Cell Count↗

PubMed2005

Imatinib as a cause of cystoid macular edema following uneventful phacoemulsification surgery.

Cystoid macular edema (CME) is an important cause of visual impairment following phacoemulsification surgery. Imatinib is a new drug that is being used as adjunctive therapy in the management of various malignancies. A reported ocular side effect of this drug is spontaneous retinal edema. We report the case of a patient on imatinib who developed significant premature CME following uneventful phacoemulsification surgery. This resolved soon after cessation of imatinib therapy, and there was an improvement in visual acuity.

Antineoplastic Agents↗

PubMed2006

Capsular stabilization device to preserve lens capsule integrity during phacoemulsification with a weak zonule.

We describe a new capsular stabilization device for suspending a lens with weak zonular support. It is flexible, 10.0 mm in length, and fashioned from 5-0 nylon. The contact portion is bent at 1.25 mm with an end bifurcating to form a T-shape to minimize stress on the capsular equator. After a continuous curvilinear capsulorhexis is created, the capsular stabilization devices to hook the capsulotomy margin are inserted. The T-shaped end is passed around the anterior capsular flap to fit the curvature of the equator. Phacoemulsification and aspiration using this device was performed in 12 eyes of 9 patients, and the usefulness and complications were analyzed. The capsular stabilization devices suspended the capsule and facilitated safe phacoemulsification in all eyes. Posterior capsule rupture occurred in 2 eyes. None of the cases had notable postoperative complications. This device ensures a stable capsule-iris complex and reduces surgical risks.

Adult↗

PubMed2006

Phacoemulsification in anterior megalophthalmos.

This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes.

Adult↗

PubMed2006

Phacoemulsification in a patient with a deep brain stimulator.

We describe a 62-year-old man with a deep brain stimulator who had cataract surgery performed by phacoemulsification. Representatives of Medtronic and Alcon Laboratories would not sanction our proceeding with cataract surgery because of the possible interaction between the ultrasound and the device. Simulated cataract surgery 1 week before the scheduled operation failed to produce any consequences. One week later, the patient had uneventful cataract surgery. Although a single case does not guarantee the lack of interference between the ultrasound used in phacoemulsification and the deep brain stimulator, our safe outcome may warrant a place in the ophthalmic literature.

Deep Brain Stimulation↗

PubMed2006

Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification.

We report surgical removal of a droplet of intraocular chloramphenicol ointment in a 70-year-old man who had routine small-incision phacoemulsification. A spherical droplet of ointment adherent to the intraocular lens was noted 2 months postoperatively. The source was considered to be the immediate postoperative conjunctival fornix chloramphenicol ointment. Gonioscopy revealed tiny droplets adherent to the peripheral iris and angle. The droplet was surgically explanted using a minimally traumatic technique with a lens glide and ophthalmic viscosurgical device through an enlarged clear corneal incision and sent intact for laboratory biochemical analysis. The patient maintained good vision without evidence of uveitis or secondary glaucoma at 1 year of follow-up. This uncommon case also raises issues about the need for immediate postoperative antibiotic ointment for endophthalmitis prophylaxis and phacoemulsification thermal wound effects on the integrity of self-sealing clear corneal incisions.

Aged↗

PubMed2006

Quantification of macular and optic disc hyperfluorescence after phacoemulsification in diabetes mellitus.

PURPOSE: To quantify changes in areas of hyperfluorescence of the macula, perifovea, and optic disc after phacoemulsification in patients with diabetes mellitus and evaluate relationships between hyperfluorescence, macular thickness, diabetic retinopathy (DR), and logMAR best corrected visual acuity (BCVA). SETTING: Ophthalmology Clinic and Operating Room, Ambulatory Care Center, University of North Carolina at Chapel Hill, School of Medicine, and the University of North Carolina Hospitals, Chapel Hill, North Carolina, USA. METHODS: This prospective case-control study comprised 30 eyes of 24 subjects with cataracts and diabetes mellitus with different levels of DR. Preoperatively and 2 months postoperatively, BCVA was recorded, digital retinal photography and fluorescein angiography were performed, macular thickness was measured (optical coherence tomography), and DR and hyperfluorescence of the optic disc, macula, and perifovea were quantified. RESULTS: Postoperatively, BCVA improved in surgical eyes but was unchanged in nonsurgical eyes. Preoperatively, between eyes, there was no difference in hyperfluorescence. Postoperatively, hyperfluorescence of the optic disc, macula, and perifovea increased in surgical eyes and was unchanged in nonsurgical eyes. Macular thickness increased in surgical eyes, although DR was unchanged in surgical and nonsurgical eyes. Although there was no correlation between hyperfluorescence and macular thickness in surgical eyes, increased hyperfluorescence of the perifovea was associated with less improvement in BCVA. CONCLUSIONS: After phacoemulsification, hyperfluorescence and macular thickness increased in the eyes of diabetic subjects. These short-term changes are more likely an effect of the surgery than a worsening of DR.

Adult↗

PubMed2006

Ultrasound biomicroscopy in traumatic aniridia 2 years after phacoemulsification.

A 45-year-old man with retinitis pigmentosa experienced total aniridia in the left eye due to direct blunt trauma 2 years after uneventful bilateral phacoemulsification via a 3.5 mm clear corneal incision. Ultrasound biomicroscopy (UBM) of the left eye revealed no missing or stretched zonular fibers extending from the ciliary body to the anterior capsule, a few iris root remnants, a normal ciliary body, an in-the-bag acrylic intraocular lens, and Descemet's membrane dehiscence at the corneal tunnel through which the iris extruded. The eye recovered 20/25 visual acuity after 1 week. Transient hyphema and a rise in intraocular pressure were recorded. This is the first report of traumatic aniridia 2 years after phacoemulsification with UBM evidence of undamaged zonular apparatus. A UBM examination may be clinically helpful, especially when blood prevents accurate slitlamp examination of the anterior segment.

Anterior Eye Segment↗

PubMed2007

Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy: results of a prospective study.

PURPOSE: To evaluate the factors influencing the refractive outcomes of combined phacoemulsification, foldable intraocular lens (IOL) implantation, and pars plana vitrectomy (PPV). SETTING: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. METHODS: One hundred fifty-four consecutive patients who had combined phacoemulsification, IOL implantation, and PPV between September 2001 and August 2004 were enrolled in a prospective study. Refractive, keratometric, and axial length measurements were performed preoperatively and 4 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. RESULTS: The mean refractive prediction error (ie, actual minus predicted spherical equivalent [SE]) was -0.06 diopters (D) +/- 0.75 (SD). In long eyes (preoperative axial length more than 24.5 mm), the mean predicted SE and actual SE were -0.81 +/- 0.76 D and -1.24 +/- 0.79 D, respectively; the difference was significantly different (P = .001, paired t test). Patients with a preoperative visual acuity worse than 5/200 and those with preoperative foveal detachment had a significant postoperative myopic shift (P = 0.024 and P = 0.002, respectively; paired t test). Postoperative refractive error was not influenced by the intraocular air or gas tamponade during surgery (P = 0.336, paired t test). CONCLUSIONS: The combined surgery included a small biometric error that was within the tolerable range in most cases. However, myopic shifts developed in patients with long axial lengths, poor preoperative visual acuity, and the preoperative presence of foveal detachment.

Adult↗

PubMed2006

Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.

OBJECTIVE: To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). DESIGN: Single-center, retrospective, noncomparative, consecutive case series. PARTICIPANTS: Sixteen patients with a diagnosis of retained nuclear fragments in the AC. METHODS: Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded. MAIN OUTCOME MEASURES: Visual outcome and visual acuity at last follow-up visit. RESULTS: Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30. CONCLUSIONS: Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.

Aged↗