Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Phacoemulsification”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources
PubMed1997

Phacoemulsification in the presence of pseudoexfoliation: challenges and options.

Phacoemulsification in the presence of pseudoexfoliation of the lens presents surgeons with particular challenges. The frequency of intraoperative and postoperative complications such as zonular dialysis, capsular tears, vitreous loss, and intraocular lens (IOL) decentration may be reduced with careful attention to detail and careful surgical technique. Improvements in phacoemulsification technology, IOLs, and new capsular supporting rings allow surgeons to perform safer surgery in these eyes. We present the challenges of and options for managing cataract extraction in the presence of pseudoexfoliation.

Cataract↗
PubMed1998

Metallic fragment deposits during phacoemulsification.

PURPOSE: To describe the nature and origin of foreign metallic intraocular bodies appearing after phacoemulsification. SETTING: Department of Ophthalmology, University Hospital of San Juan, Alicante, Spain. METHODS: Two metallic particles, 1 extracted during surgery and the other from a patient in whom surgery had been performed, were studied by scanning electronic microscopy and X-ray dispersive energy spectroscopy. Also evaluated were all metallic elements used in phacoemulsification including phaco tips, Sinskey hooks, and handpieces. A morphologic analysis at various magnifications was performed and the composition of the elements studied. RESULTS: Scanning electronic microscopy showed irregularities of the phaco tip and Sinskey hook after their use. Spectrographic analysis found that the phaco tip was mainly aluminum and titanium; the Sinskey hook, iron, chromium, cobalt, and nickel; the handpiece, iron, chromium, and nickel; and the 2 metallic particles, iron, chromium, and nickel, the same as the handpiece. CONCLUSION: The metallic particles extracted corresponded to those of the phaco handpiece. Vibration during prolonged use of the phacoemulsifier probably caused these particles to chip off the handpiece.

Alloys↗
PubMed1998

Aqueous flare intensity after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To prospectively compare the postoperative blood-aqueous barrier breakdown induced by phacoemulsification and implantation of a heparin-surface-modified poly(methyl methacrylate) intraocular lens in the capsular bag in eyes with different stages of diabetic retinopathy (DR) and a control group. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Aqueous flare intensity was measured preoperatively and 1 day, 1 week, and 3 months postoperatively in 21 nondiabetic control patients (Group 1), 20 diabetic patients with no or mild-moderate nonproliferative DR (Group 2), and 19 diabetic patients with advanced DR (moderate-severe, severe nonproliferative, and proliferative DR) who were divided into groups: without clinically significant macular edema (CSME), 7 eyes (Group 3), and with CSME, 12 eyes (Group 4). RESULTS: Before surgery, flare intensity in Group 4 was significantly higher than in Groups 1 and 2 (P < .05). Surgical trauma increased flare values 1 day postoperatively in all groups. One week after surgery, Groups 1 and 4 had flare intensity significantly higher than preoperatively (P < .05). Recovery of flare occurred 3 months postoperatively in all groups except Group 2, in which it occurred 1 week after surgery. One day postoperatively, only Group 4 had significantly higher flare than Group 1 (P < .05). One week and 3 months after surgery, Group 4 had significantly higher flare intensity than Groups 1 and 2 (P < .05). The duration of phacoemulsification in Groups 2 and 4 was significantly longer than in Group 1 (P < .05). Operating time was significantly longer than in Group 1 only in Group 4 (P < .05). CONCLUSION: Eyes with advanced stages of DR and with CSME had the highest flare intensity after cataract surgery.

Aged↗
PubMed1998

Retinal detachment following phacoemulsification in highly myopic cataract patients.

PURPOSE: To assess whether modern, small incision phacoemulsification techniques significantly reduce the retinal detachment (RD) risk in highly myopic patients who have visually significant cataracts. SETTING: University-associated ophthalmology practice. METHODS: This retrospective study included 80 eyes in 61 patients with preoperative myopia of 7.00 diopters (D) or more. Sixty-four eyes had an axial length of 25.0 mm or greater. All surgery was performed superiorly using a frown-shaped, self-sealing, scleral tunnel. The incision size ranged from 3.0 to 5.0 mm. Capsulorhexis was performed and then four-quadrant cracking phacoemulsification. The posterior capsule was routinely polished. A posterior chamber intraocular lens (IOL) was implanted in the capsular bag in all cases. RESULTS: No RDs occurred during the mean follow-up of 43 months (range 9 to 77 months) or the mean follow-up after neodymium:YAG capsulotomy of 20 months. No intraoperative complications occurred. Seventy-one of 80 eyes (89%) achieved best spectacle-corrected visual acuity of 20/25 or better. CONCLUSIONS: Retinal detachments following modern cataract surgery in high myopia are much less common than previously reported. We attribute this to small incision size, continued maintenance of the anterior chamber, posterior chamber IOL implantation, and lack of intraoperative complications.

Adult↗
PubMed1998

Phacoemulsification, intraocular lens implantation, and trabeculotomy to treat pseudoexfoliation syndrome.

PURPOSES: To determine the long-term risk/benefit ratio of phacoemulsification and intraocular lens (IOL) implantation combined with trabeculotomy to manage eyes with pseudoexfoliation syndrome and co-existing cataract. SETTING: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine; Kurihara Eye Clinic; Departments of Ophthalmology, Tenri Hospital, Kumamoto University, and Matsue Red Hospital; Nagata Eye Clinic, Japan. METHODS: This multicenter retrospective study comprised 49 eyes of 36 patients with pseudoexfoliation syndrome and co-existing cataract who had the combined procedure for uncontrolled intraocular pressure (IOP) (> 21 mm Hg) even on antiglaucoma medication. RESULTS: After a mean follow-up of 20.0 months +/- 13.2 (SD), IOP in all 49 eyes was well controlled (< or = 21 mm Hg). Mean IOP at the final examination was 14.6 +/- 2.6 mm Hg on a mean of 0.9 +/- 0.8 glaucoma medications. Complications included an IOP spike in 11 eyes and fibrin exudation in 1 eye. CONCLUSION: Phacoemulsification and IOL implantation combined with trabeculotomy was an effective treatment for patients with pseudoexfoliation syndrome and cataract.

Aged↗
PubMed1998

Prospective, randomized trial comparing Micro Visc Plus and Healon GV in routine phacoemulsification.

PURPOSE: To compare the safety and efficacy of two sodium hyaluronate viscoelastics--MicroVisc Plus and Healon GV--in routine phacoemulsification and evaluate whether these more viscous and cohesive agents offer benefits compared to viscoelastics of standard viscosity and cohesion. SETTING: York Finch Eye Associates and York Finch General Hospital, Toronto, Canada. METHODS: An unmasked, randomized, prospective clinical trial of 100 eyes of 100 patients having routine phacoemulsification with intraocular lens implantation was conducted comparing the safety and efficacy of MicroVisc Plus with those of Healon GV. Preoperative and 6 hour, 1 and 5 days, and 1 and 6 month postoperative assessments included acuity, corneal thickness, intraocular pressure, and surgeon assessment of the task-facilitating efficacy of the viscoelastics. Results were compared with those of a similar trial of MicroVisc and Healon. RESULTS: There were no statistically significant differences between the two treatment groups at any follow-up. The surgeon judged the two viscoelastics to be equivalent, although somewhat different in facilitating surgery. There was significantly less transient postoperative corneal thickening in the Healon GV/MicroVisc Plus group than in the Healon/MicroVisc group. CONCLUSIONS: Healon GV and MicroVisc Plus were safe and provided equal outcomes based on the parameters assessed. MicroVisc Plus' higher zero-shear viscosity caused it to behave slightly differently than Healon GV during surgery. More viscous, cohesive viscoelastics may increase surgical safety.

Adult↗
PubMed1998

Phacoemulsification and lens implantation in rabbit eyes: capsular bag versus ciliary sulcus implantation and 4.0 versus 7.0 mm capsulorhexis.

PURPOSE: To compare the effects of intraocular lens (IOL) implantation in the capsular bag versus the ciliary sulcus and of a 4.0 versus 7.0 mm continuous curvilinear capsulorhexis (CCC) on postoperative inflammation and after-cataract formation. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Trial 1 comprised 40 rabbits that had CCC, endocapsular phacoemulsification, and a poly(methyl methacrylate) IOL implanted in the capsular bag in one eye and the ciliary sulcus in the fellow eye. In Trial 2, 40 rabbits had a 4.0 mm CCC in one eye and a 7.0 mm CCC in the fellow eye followed by phacoemulsification and IOL implantation in the capsular bag. White blood cell (WBC) counts and prostaglandin E2 (PGE2) concentrations in aqueous humor were determined at 1, 3, 7(8), 28, and 56 days postoperatively. Wet mass of the dissected after-cataract was measured at day 56. In Trial 1, wet mass of the iris-ciliary body was measured at each observation. RESULTS: In Trial 1, WBC counts at day 1 were higher with a sulcus-fixated IOL (P = .05). The median wet mass of the dissected after-cataract was 108.5 mg in eyes with a sulcus-fixated IOL and 62.5 mg in eyes with a capsule-fixated IOL (P = .01). In Trial 2, WBC counts at day 8 were significantly higher in eyes with a 7.0 mm CCC than in those with a 4.0 mm CCC (P < .05). There was no significant difference in the amount of after-cataract. CONCLUSIONS: The results indicate that IOL implantation in the capsular bag causes less inflammation and after-cataract formation than sulcus fixation and that using a large CCC does not affect the total amount of after-cataract but may enhance the inflammatory response.

Animals↗
PubMed1998

Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation.

PURPOSE: To investigate the effect on intraocular pressure (IOP) of sutureless scleral and corneal tunnel Kelman phacoemulsification (KPE) with foldable posterior chamber intraocular lens (IOL) implantation. SETTING: Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: Preoperative and postoperative (1 and 6 weeks and 6 to 8 months) IOP measurements of 385 consecutive eyes having uneventful phacoemulsification and foldable posterior chamber IOL implantation were reviewed retrospectively. A subset of 193 eyes for which no IOP measurements were missing at any follow-up were analyzed separately. RESULTS: Mean preoperative IOP was 15.8 mm Hg +/- 0.2 (+/- SE). It dropped postoperatively by 1.3 +/- 0.2 mm Hg at 1 week (P < .001), 2.5 +/- 0.2 mm Hg at 6 weeks (P < .001), and 2.2 +/- 0.2 mm Hg at 6 to 8 months (P < .001). Mean preoperative IOP for the subset without missing data was 16.0 +/- 0.3 mm Hg. It decreased by 1.1 +/- 0.3 mm Hg at 1 week (P < .001), 2.3 +/- 0.2 mm Hg at 6 weeks (P < .001), and 2.2 +/- 0.2 mm Hg at 6 to 8 months (P < .001). Wound construction (scleral versus corneal tunnel), anesthesia type (topical versus posterior orbital injection), the eye operated on, and patient age and sex did not significantly influence the postoperative pressure change. Patients with a preoperative diagnosis of glaucoma had significantly higher 1 week postoperative IOPs; however, the differences were statistically insignificant at 6 weeks and 6 to 8 months. CONCLUSION: Sutureless KPE with foldable posterior chamber IOL implantation lowered IOP by 1.1 to 2.5 mm Hg for the 6 months immediately following surgery. Glaucoma patients had a statistically significant initial rise in IOP at 1 week.

Adult↗
PubMed1998

Phacoemulsification of white mature cataracts.

PURPOSE: To evaluate the intraoperative difficulties associated with phacoemulsification of white mature cataracts and develop a strategy for consistently achieving continuous curvilinear capsulorhexis (CCC) in these cases. SETTING: Raghudeep Eye Clinic, Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective study comprised 60 eyes of 60 patients with senile white mature cataract. Mean follow-up was 7 months. Detailed preoperative and intraoperative notes were made including intraoperative subjective assessment of the intracapsular pressure and cataract hardness. A small capsulorhexis was attempted initially. Endophacoemulsification was performed using the stop, chop, chop, and stuff technique. The capsulorhexis was enlarged before intraocular lens implantation. An initial cut in the capsulorhexis margin was made with a cystotome needle while a spatula supported the anterior capsule. The capsulorhexis was then enlarged with forceps. RESULTS: A CCC was achieved in 57 eyes (95%). Intracapsular pressure was judged to be raised in 24 eyes (40%). Of these, CCC was accomplished in 21 eyes (88%). Statistical analysis confirmed that raised intracapsular pressure was a significant factor. Capsule opacification or plaque was detected at the end of the surgery in 20 eyes (33%); 50% of the nuclei were of grade 5 hardness. CONCLUSION: If a CCC can be achieved, the results of white cataract phacoemulsification are comparable to those of routine cataract surgery. When using the two-stage technique, one should be prepared to deal with a hard cataract through a small capsulorhexis.

Adult↗
PubMed1998

Phacoemulsification and lens implantation in patients treated with aspirin or warfarin.

PURPOSE: To determine the incidence and nature of hemorrhagic complications in patients having phacoemulsification and foldable intraocular lens (IOL) implantation while taking aspirin or warfarin. SETTING: The Jules Stein Eye Institute, University of California at Los Angeles School of Medicine, Los Angeles, California, USA. METHODS: This retrospective study reviewed the charts from the practice of 1 ophthalmic surgeon. The type of medication, dosage, indication for anticoagulant therapy, type of incision, type of anesthesia, and intraoperative and postoperative hemorrhagic complications were recorded. RESULTS: Sixty-two patients (82 eyes) taking aspirin and 25 patients (31 eyes) taking warfarin were identified. Seven eyes in the aspirin group (8.5%) and 3 in the warfarin group (9.7%) experienced subconjunctival hemorrhages. Eight of the 10 subconjunctival hemorrhages occurred in eyes with scleral incisions. The remaining 2 occurred in eyes with corneal incisions. No eye developed lid ecchymosis, retrobulbar hemorrhage, hyphema, or suprachoroidal hemorrhage. CONCLUSIONS: Phacoemulsification with foldable IOL implantation was performed safely in patients taking aspirin or warfarin. Subconjunctival hemorrhage was the most common hemorrhagic complication.

Anticoagulants↗
PubMed1998

Topical anesthesia: Proxymetacaine versus Amethocaine for clear corneal phacoemulsification.

PURPOSE: To evaluate the use of proparacaine (Proxymetacaine) versus tetracaine (Amethocaine) as the topical anesthetic agent for phacoemulsification cataract surgery using a 3.5 mm clear corneal sutureless incision. SETTING: Harold Wood Hospital, Romford, Essex, United Kingdom. METHODS: This prospective study comprised 40 randomly selected patients. Twenty were given Proxymetacaine and 20, Amethocaine. The level of discomfort experienced during delivery of the topical anesthetic agent and during and immediately after surgery was measured using a pain score. During surgery, topical anesthesia was supplemented by intracameral lignocaine 1%. RESULTS: Patients given Proxymetacaine experienced no stinging sensation during its administration; those given Amethocaine reported varying degrees of discomfort. The difference between groups was statistically significant (P < .01). There was no difference between groups in the amount of discomfort experienced intraoperatively or postoperatively. CONCLUSION: Proxymetacaine is the topical analgesic of choice for phacoemulsification because it produced no discomfort on administration yet had the same analgesic properties as Amethocaine.

Analgesia↗
PubMed1998

Visual recovery after phacoemulsification using topical anesthesia.

PURPOSE: To assess the speed of visual function recovery after phacoemulsification using topical anesthesia. SETTING: Department of Ophthalmology, Royal United Hospital, Bath, United Kingdom. METHODS: Twenty consecutive patients having routine sutureless clear corneal phacoemulsification with implantation of a Staar foldable intraocular lens were recruited in a prospective study. Visual acuity was assessed using a LogMAR chart and contrast sensitivity using a Pelli-Robson chart 1, 2, 4, and 16 hours postoperatively. A final examination and refraction were performed at 1 week. RESULTS: Although return of visual acuity was slow during the first 2 hours, the mean LogMAR acuity had improved to 0.425 (Snellen equivalent 6/15) by 4 hours and 0.165 (Snellen equivalent of 6/9.5) by 16 hours. There was no postoperative ptosis or diplopia. CONCLUSION: The absence of diplopia and rapid return of visual function with a mean acuity of 6/15 by 4 hours suggest that early patient discharge is relatively safe.

Aged↗
PubMed1998

Systemic diclofenac sodium to maintain mydriasis during phacoemulsification.

PURPOSE: To determine whether systemic diclofenac sodium affects the maintenance of mydriasis during phacoemulsification and to compare pupil diameter regression rates with those in a control group. SETTING: An ophthalmic unit of a National Health Service Trust Hospital in the United Kingdom. METHOD: A prospective, randomized control study of 100 patients presenting for cataract surgery was undertaken. Both groups were administered an identical mydriatic regime commencing 1 hour before surgery. In addition, the diclofenac group (n = 48) received 50 mg of oral diclofenac sodium 1 hour before surgery. Both the control (n = 52) and diclofenac groups had phacoemulsification by one experienced surgeon using a standard technique. The surgeon was masked as to which group the patient belonged. The irrigating fluid in all cases contained adrenaline. Pupil diameter was measured at five stages during surgery and recorded along with the times relative to the start of the procedure. RESULTS: Mean pupil diameter in the diclofenac group was slightly larger than in the control group, but the difference was not significant. Although mean pupil diameter at the start of surgery was 0.4 mm greater in the diclofenac group, the slopes of regression in pupil diameters were virtually identical between the first three stages of surgery, after which a slight reversal occurred in both groups. The slope of regression of mydriasis was small in both groups. CONCLUSION: Systemic diclofenac sodium 50 mg given orally 1 hour before surgery did not significantly inhibit miosis when compared with a control group. Regression rates of pupil mydriasis were small in both groups.

Administration, Oral↗
PubMed1998

Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification.

PURPOSE: To evaluate the effect of superior and temporal clear corneal incisions on astigmatism after sutureless, small incision phacoemulsification. SETTING: World Eye Hospital, Istanbul, Turkey. METHODS: This prospective study evaluated 40 eyes of 20 patients with cataract having bilateral, sutureless, small incision phacoemulsification by the same surgeon. A superior clear corneal incision was used in all right eyes and a temporal clear corneal incision in all left eyes. Mean preoperative astigmatism was 0.63 diopter (D) +/- 0.21 (SD) and 0.65 +/- 0.20 D, respectively. Mean patient age was 66.45 years. Patients were examined preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: Three months postoperatively, mean astigmatism was 1.60 +/- 0.37 D in the superior incision group and 0.83 +/- 0.19 D in the temporal incision group. Induced astigmatism calculated by vector analysis was 1.44 +/- 0.31 D and 0.62 +/- 0.28 D, respectively. The temporal incision group had significantly lower astigmatism at all follow-ups (P = .000). CONCLUSION: Upper lid pressure on the superior corneal incisions led to fluctuating, against-the-rule astigmatism that was significantly higher than that induced by temporal incisions.

Aged↗
PubMed1998

Simplified anesthesia technique for scleral tunnel phacoemulsification.

A simplified anesthesia technique for sutureless scleral tunnel, small incision, one-port phacoemulsification is described. Step 1: Mild intravenous sedation is achieved with 1 mg of midazolam and 10 mg of propofol. Step 2: A tetracaine- or preservative-free-lidocaine-soaked Weck cell sponge is applied to the superior bulbar conjunctiva and the superior episcleral tissue for localized anesthesia. Step 3: Preservative-free lidocaine 1%, 0.75 cc, is injected into the anterior chamber for intraocular anesthesia. This technique can be used in the presence of all types of cataracts, requires about 10 seconds to complete, and can be used with all phacoemulsification techniques. Results of the technique in a study population are reported.

Adult↗
PubMed1998

Two year follow-up of astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions.

PURPOSE: To evaluate changes in astigmatism 6 months to 2 years after 5.2 mm superior scleral incision phacoemulsification using 3 closures. SETTING: Department of Ophthalmology, Vejle Hospital, Vejle, Denmark. METHODS: This long-term follow-up study included 75 consecutive phacoemulsification patients who were randomly allocated to 1 of 3 incision closures: 1 intraoperatively adjusted cross suture, 1 unadjusted cross suture, no suture. Postoperative astigmatism after 1 and 2 years was evaluated by keratometric cylinder, induced astigmatism (Naeser's polar values), induced cylinder (Jaffe's vector analysis), and vector decomposition (Olsen). The data were compared with 1 week values. RESULTS: In the previous study, median astigmatism after 6 months was similar in all 3 groups, but only the sutureless group showed early stability. Significant against-the-rule (ATR) changes were seen in the sutured cases (P < .01). The 1 and 2 year follow-up showed continued stability in the sutureless cases. The adjusted-suture group exhibited stability after 6 months, while the unadjusted-suture group showed a further tendency to change ATR. At 2 years, median ranges of astigmatism were -0.49 to -0.90 diopter (D) (Naeser), 0.77 to 1.02 D (Jaffe), and 96% to 98% ATR (Olsen). The intergroup differences were not statistically significant. CONCLUSION: Two year follow-up confirmed that sutureless closure led to early astigmatism stability. Using a suture prolonged the postoperative period of astigmatism instability, and if used without intraoperative adjustment, a tendency toward a less predictable outcome persisted after 2 years.

Aged↗
PubMed1999

Severe iridodialysis from phacoemulsification tip suction.

During cataract surgery, the iris of an 83-year-old woman was strongly sucked into the phacoemulsification tip twice, resulting in severe iridodialysis. The dehisced iris was sutured to the sclera using double-armed 10-0 polypropylene on a long curved needle. Intensive suction of the iris by the phacoemulsification tip can lead to severe iridodialysis. Machine setting parameters, particularly flow rate, should be lowered after the first iris suction to avoid further iris damage.

Aged↗
PubMed1999

Complications of phacoemulsification on the first postoperative day: can follow-up be safely changed?

PURPOSE: To establish the rate of complications detected on the first postoperative day and therefore the need for evaluation on that day. SETTING: Hinchingbrooke Hospital, Huntingdon, England. METHODS: Complications detected on the first day after phacoemulsification cataract surgery were retrospectively reviewed over 8 months. Ophthalmic nurse practitioners performed the 1 day postoperative examination and kept a log of patients seen, recording complications detected and whether referral to a physician was required. All patients had had routine phacoemulsification with intraocular lens implantation without anterior vitrectomy or trabeculectomy, as identified from the log book and cross-checked with operating theater records. Notes were reviewed if a complication or referral was recorded. Most cases were performed under local anesthesia as day cases using a temporal corneal approach. Sections were routinely left unsutured unless enlarged or closure was not satisfactory at the conclusion of surgery. RESULTS: The review yielded 392 patients. Six (1.53%) had intraocular pressure (> or = 30 mm Hg) requiring treatment, 1 (0.26%) had painless iris prolapse, 11 (2.81%) had corneal abrasions, and 7 (1.78%) were given a more intensive steroid regime. No cases of fibrinous uveitis were recorded. CONCLUSIONS: Potentially sight-threatening complications present on the first postoperative day, albeit infrequently. With our current practice and case mix, the need for this review persists. It is possible to reduce the demand on physician time by using appropriately trained nonmedical practitioners.

Adult↗