Supra-ampullary duodenectomy in a patient with positive distal resection margin after subtotal gastrectomy for gastric cancer: a case report

Resection margin involvement after curative intent resection for gastric cancer results in a poor prognosis and deprives the patient of the chance for a cure. Reoperation to achieve an R0 status should guarantee tolerable morbidity and achievement of negative margins. We performed laparoscopic distal gastrectomy with extracorporeal Billroth II reconstruction in a 56-year-old woman with gastric cancer following neoadjuvant chemotherapy. Scattered cancer cells were observed in the proximal and distal resection margins on immunohistochemical staining for cytokeratin. Two weeks postoperatively, remnant total gastrectomy and supra-ampullary duodenectomy were performed. Before reoperation, percutaneous transhepatic gallbladder drainage and angiocatheter placement outside the ampulla of Vater (AoV) via the cystic duct were performed to avoid pancreaticoduodenectomy and to obtain the maximal distal margin. Duodenal transection was performed 1 cm above the AoV. The resected duodenum was 4 cm in length. The patient had no postoperative complications and received adjuvant chemotherapy 1 month after the reoperation.

The Difference in Intraocular Pressure before and after Visual Field Test Measured by Rebound Tonometer

PURPOSE: To investigate the effect of a visual field (VF) test on intraocular pressure (IOP) and relevant parameters in a normal group and an open-angle glaucoma group, and to determine the appropriate time of IOP measurements.METHODS: The IOP was measured by a rebound tonometer before and after a VF test for the normal, normal-tension glaucoma, and high-tension glaucoma groups, and IOP differences after the VF tests were compared among groups. Parameters including age, sex, axial length, central corneal thickness, IOP before the VF test, the VF index, mean deviation, VF test duration, and usage of IOP lowering medications were investigated, and the correlations of these parameters with IOP changes after VF tests were determined using linear regression analyses.RESULTS: A total of 232 participants (232 eyes) included 55 normal subjects, 131 normal-tension glaucoma patients, and 46 high-tension glaucoma patients. The IOP differences after VF tests were not statistically significant in the normal and high-tension glaucoma groups, and the difference was 0.31 mmHg in the normal-tension glaucoma group (p = 0.013). Multivariate regression analyses revealed that axial length (p = 0.005) and IOP before the VF test (p < 0.001) were relevant factors in the total number of patients, and the axial length (p = 0.017), IOP before the VF test (p = 0.001), and duration (p = 0.029) were found to be significantly associated with IOP differences in the normal-tension glaucoma group.CONCLUSIONS: The IOP changes after VF tests using the rebound tonometer were significant in the normal-tension glaucoma group, but were within an acceptable range. The IOP value measured after a VF test is clinically valid in clinical practice.

Comparison of Clinical Outcomes between Swept-source Optical Coherence Tomography Biometer and Partial Coherence Interferometer

Purpose@#To compare the ocular biometry and postoperative refractive outcomes using two devices; the swept-source opticalcoherence tomography biometer (Argos) versus the partial coherence interferometer (IOL Master®500, Carl Zeiss Meditec AG,Jena, Germany). @*Methods@#The axial length (AL), anterior chamber depth (ACD) and keratometry (K) in 221 cataract eyes were measured withArgos and IOL Master®500. One month after surgery, refraction of the respective eyes was conducted and the mean absoluteerror (MAE) calculated for analysis of the refractive outcomes. @*Results@#Measurement was not possible in 13 eyes with the IOL Master®500 but was possible with Argos. Measurement was notpossible in one eye with either biometer. Agreement in measured ocular biometry between the two devices by intraclass correlationcoefficient (ICC) and Bland-Altman plot (ICC AXL = 0.999, ACD = 0.975, K = 0.978) was excellent. The AL and ACD measuredwith Argos were significantly longer than measured with IOL Master®500 (p= 0.005, p= 0.000). The MAE showed no significantdifference between the Argos and IOL Master®500 (p= 0.087). @*Conclusions@#The measurement of ocular biometry was better in Argos than in IOL Master®500. The accuracy of the intraocularlens power calculations of Argos was clinically acceptable and compatible with a conventional device.

A Case of Toxic Keratoconjunctivitis by Self-application of Human Breast Milk

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.

The Effect of Epiretinal Membrane on Dexamethasone Implant for Branch Retinal Vein Occlusion Macular Edema

PURPOSE: To evaluate the effect of epiretinal membrane (ERM) on the outcomes of intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Thirty eyes of 30 patients who received Ozurdex treatment for ME secondary to BRVO, and were followed-up for at least 6 months were retrospectively reviewed. Patients were divided into two groups based on the presence (ERM [+] or absence ERM [−]) of ERM at baseline. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), recurrence of ME, and retreatment rate were evaluated at baseline, 1, 3, and 6 months after Ozurdex injection. RESULTS: Ten eyes of 30 eyes (33%) showed ERM at baseline. While the mean CFT was significantly reduced at 1 month after Ozurdex injection, it began to increase gradually thereafter in both groups. The ERM (+) group showed a significantly higher mean CFT than the corresponding values of the ERM (−) group at 1 (p = 0.022) and 6 months (p = 0.001) after Ozurdex injection. However, no significant difference was found in the BCVA between the two groups at every visit. The proportion of eyes with ME was significantly higher in the ERM (+) group (90%) than that in the ERM (−) group (35%) at 6 months after Ozurdex injection (p = 0.009). There were no significant differences between the two groups in the percentage of retreatment, time to retreatment, and type of materials used for retreatment. CONCLUSIONS: In patients with ME secondary to BRVO, the treatment effect of Ozurdex was low and the duration of treatment was short when ERM was concurrently present. However, the presence of ERM did not significantly affect visual outcomes after treatment with Ozurdex.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty / 고신대학교의과대학학술지

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

Ischemic Stroke in a Patient with Heterozygote Fabry's Disease

It is uncommon for Fabry's disease (FD) patient to present with an isolated ischemic stroke without other typical symptoms or signs of FD. A 48-year-old woman presented with recurrent limb weakness and her brain magnetic resonance imaging revealed multiple ischemic brain lesions. Ten years ago, the patient had been diagnosed with heterozygote FD by the genetic test, but she had not shown any typical symptoms or sign of FD so far. Isolated organ involvement could occur in heterozygote FD.

The Clinical Characteristics of Ocular Toxocariasis in Jeju Island Using Ultra-wide-field Fundus Photography

PURPOSE: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. METHODS: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. RESULTS: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). CONCLUSIONS: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.

Ophthalmologic manifestations in patients with inflammatory bowel disease

BACKGROUND/AIMS: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea. METHODS: Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations. RESULTS: Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (P=0.002). CONCLUSIONS: Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.

Acute Care Surgery Model for Emergency Cholecystectomy

PURPOSE: Acute care surgery (ACS) models have evolved worldwide over the last decade. However, South Korea has an established trauma system and does not consider the ACS model. This study compares the management and outcome of emergency cholecystectomy in the ACS model to those of traditional on-call attending surgeon model for emergency surgery. METHODS: Retrospectively collected data for patients who underwent emergency cholecystectomy from May 2013 to January 2015 was analyzed to compare data from a traditional on-call system (OCS) and ACS. RESULTS: One hundred and twenty-four patients were enrolled in the study (62 patients ACS vs. 62 patients OCS). Hospital stay (days) (ACS=4.29±2.49 vs. OCS=4.82±4.48, p=0.46) and stay in emergency room (minutes) (ACS=213.10±113.99 vs. OCS=241.10±150.73, p=0.20) did not differ significantly between groups. Operation time (minutes) was significantly shorter in the ACS than OCS group (389.97±215.21 vs. 566.35±290.14, p<0.001). Other clinical variables (sex, open-conversion rate, whether the operation was performed at night/holiday, intensive care unit admission rate) did not differ between groups. There was no mortality and readmission. CONCLUSION: The implementation of the ACS led to shorter operation time and no increase of postoperative mortality and complication.

Two Cases of Macular Edema Associated with Extramacular Branch Retinal Vein Occlusion

PURPOSE: To report two cases of patients treated for macular edema associated with extramacular branch retinal vein occlusion (BRVO). CASE SUMMARY: (Case 1) A 64-year-old female presented with macular edema (ME) associated with superotemporal extra-macular BRVO. The ME was resolved but hard exudate (HE) deposited after combined therapy of intravitreal bevacizumab injection and laser photocoagulation of the BRVO area. Best corrected visual acuity (BCVA) improved from 0.2 to 0.5 following absorption of HE. (Case 2) A 53-year-old male presented with ME associated with extramacular BRVO outside the superior vascular arcade. ME was treated with 2 monthly injections of bevacizumab and laser photocoagulation in the BRVO area. Although HE deposited after resolution of ME, it was absorbed and BCVA improved from 0.1 to 0.4. The ME did not recur in either patient. CONCLUSIONS: We report 2 cases managed with combined therapy of intravitreal bevacizumab injection and laser photocoagulation for ME associated with extramacular BRVO.

The Comparison of Post-Operative Pain between Topical Anesthesia and Monitored Anesthesia Care in Cataract Surgery

PURPOSE: To compare pain levels in cataract surgery under topical anesthesia only and topical anesthesia under monitored anesthesia care. METHODS: We recruited 243 patients who were scheduled to undergo cataract surgery under topical anesthesia only or topical anesthesia with monitored anesthesia care (MAC) using fentanyl and midazolam. Anesthesia methods were selected based on the patient's preference. All patients completed an anxiety and information scale survey preoperatively. Vital signs during the operations were recorded. A 0-to-10 visual analog scale pain score survey was conducted immediately and at 2 hours, 6 hours, and 1 day after surgery. RESULTS: Of the 237 patients who completed the study, 183 patients selected topical anesthesia, and 54 patients selected MAC. Mean pain scores according to the aforementioned time points after surgery were 0.50, 0.58, 0.29, and 0.12 in the topical anesthesia group, and 0.22, 0.16, 0.06, and 0.09 in the MAC group, respectively. The differences in pain score between the two groups was statistically significant at 2 hours (p = 0.019) and 6 hours (p = 0.040) after surgery. The mean patient anxiety score for anesthesia was 10.50 in the topical anesthesia group and 11.41 in the MAC group (p = 0.280). Mean systolic blood pressure at the start of surgery was 140.6 mm Hg in the topical anesthesia group, and 158.2 mmHg in the MAC group. CONCLUSIONS: Monitored anesthesia care consistently resulted in less pain throughout the post-operative period. However, transient systolic blood pressure should be carefully monitored for a rise related to intravenous anesthetics.

Bitemporal Hemianopsia in Ethambutol-Induced Optic Neuropathy

PURPOSE: To report three cases with bitemporal hemianopsia after using ethambutol to treat tuberculosis. CASE SUMMARY: A 50-year-old male with chronic renal failure and tuberculous pleurisy, a 57-year-old male with diabetic retinopathy and pulmonary tuberculosis, and a 59-year-old male with diabetes and pulmonary tuberculosis were referred for evaluation due to decreased visual acuity for several months after taking ethambutol to treat tuberculosis. All 3 patients had abnormal color vision and visual evoked potential in both eyes. Visual field showed bitemporal hemianopsia with or without central scotoma. Brain imaging tests were normal. Although ethambutol was discontinued in all three patients, one patient with renal disease showed further decrease in visual acuity and visual field worsened to total field defect. CONCLUSIONS: Ethambutol-induced optic neuropathy is a wide spectrum disorder and based on our cases, can present as bitemporal hemianopsia mimicking compressive chiasmal lesions. A thorough history should be taken and immediate discontinuation of ethambutol is recommended in cases when bitemporal hemianopia occurs.

Conservative Management of Adult Small Bowel Intussusception Detected at Abdominal Computed Tomography / 대한소화기학회지

BACKGROUND/AIMS: The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. METHODS: There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. RESULTS: Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). CONCLUSIONS: Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.

A Case of Ocular Syphilis Presenting as Bilateral Optic Neuritis

PURPOSE: To report a case of ocular syphilis presenting as bilateral optic neuritis. CASE SUMMARY: A 25-year-old man presented with visual difficulty in both eyes that had begun 2 weeks previously. Best corrected visual acuity was 0.7 in the right eye and 0.1 in the left eye. Anterior segment was normal. On fundoscopic examination, optic disc swelling was found in both eyes. Color vision was abnormal in the left eye. The visual field (VF) showed peripheral constriction in the right eye and generalized reduction in the left eye. Fluorescein angiography revealed early, bilateral leakage of dye from the optic disc with multiple hot spots in the chorioretinal level. Serology was positive for fluorescent treponemal antibody absorbance (FTA-ABS) IgM, IgG and rapid plasma reagin test. A test of the cerebrospinal fluid was positive for venereal diseases research laboratory and FTA-ABS IgG. A diagnosis of syphilitic optic neuritis was made and the patient was treated with antibiotics. Six months later, visual acuity was 1.0 in the right eye and 0.8 in the left eye. There was no disc swelling on both fundoscopy and optical coherence tomographs. VF also improved after treatment, with the restoration of central vision. CONCLUSIONS: Syphilis can present as optic neuritis. Clinicians should consider serologic examination for syphilis and then initiate appropriate antibiotic treatment.

A Case of Long Anterior Lens Zonule and Pigment Dispersion Syndrome

PURPOSE: To report a case of long anterior lens zonule and pigment dispersion syndrome. CASE SUMMARY: A 67-year-old female visited our clinic with complaint of visual disturbance in the left eye. She had no history of nyctalopia. Visual acuity was 0.6 in the right eye and 0.4 in the left eye. Intraocular pressure was 12 mm Hg in the right eye and 16 mm Hg in the left eye. Nuclear sclerosis was observed in the left lens. There was no pseudoexfoliative material observed. In the left eye, long anterior zonules with brown pigmented lens striae were spotted irregularly in every direction of the anterior lens. On gonioscopy, the angle was open, and dense, uniform, trabecular meshwork pigmentations were observed at the interior 120 degrees. On fundus examination, cup-to-disc ratio was 0.4 in the right eye, 0.3 in the left eye, and multiple hard exudates were observed in both retinas. Axial length was 22.03 mm in the right eye and 21.84 in the left eye. Anterior chamber depth was 2.71 mm in the right eye and 2.47 mm in the left eye. Defects in the retinal nerve fiber or visual field examination were not observed and pigment dispersion syndrome was diagnosed. The patient showed no significant change at the 9-month follow-up. CONCLUSIONS: We diagnosed atypical pigment dispersion syndrome associated with long anterior zonules and pigmented lens striae. Late onset retinal degeneration should be ruled out with chromosomal analysis if patients show nyctalopia, retinal pigment epithelium atrophy, or family history.

Theoretical and Clinical Comparison of the Hoffer Q and SRK/T Formulas

PURPOSE: To evaluate the biometric conditions causing increased disparity in the calculation of intraocular lens (IOL) power between the Hoffer Q and SRK/T formulas. METHODS: A prospective comparative study was conducted on 365 uneventful, cataract surgeries performed at a tertiary care center by one surgeon. The IOL power was calculated using both the Hoffer Q and SRK/T formulas with A-scan biometry. For a selected IOL power, the expected disparity between the 2 formulas (EDF) was measured and the EDF value was used to categorize the cases. The resultant error associated with each formula was determined at postoperative 6 weeks. KAL was defined as the product of mean corneal power (K) and axial length (AL). Postoperative errors of both formulas were calculated and their association with preoperative biometry measurements analyzed. RESULTS: In 17.8% of the cases, the EDF was larger than 0.4 D, possibly leading to different IOL diopter recommendations. The EDF value and the product of corneal curvature and axial length were significantly correlated (R2 = 0.855, p < 0.001). Multiple regression analysis of causative preoperative biometric factors on the postoperative formula errors showed that astigmatism, anterior chamber depth (ACD), and lens thickness (LT) were significantly associated with Hoffer Q error and SRK/T error. CONCLUSIONS: Overall, both formulas performed very well when recommending the correct IOL power. The cause of disparity between the predicted refraction for the 2 formulas was more associated with KAL than K or AL alone. Astigmatism, ACD, and LT were the causative factors for the postoperative errors in both formulas.

Complete enumeration for the prevalence of allergic disease in Udo Isle's inhabitants

PURPOSE: This study is to estimate the prevalence of allergic disease for the entire inhabitants living in Udo Isle, one of the islands of Jeju. METHODS: The complete enumeration using International Study of Asthma and Allergies in Childhood group was applied to the 1,090 people residing in the Isle. This survey was performed for 2 months from June to July, 2012. For children, their parents' responses were collected, and for adults, their self-reports and interview were performed simultaneously. Of the 1,003 questionnaires (92.0%) were collected, 925 questionnaires were finally analyzed, excluding those of insufficient responses for questionnaires and inhabitants residing in Udo Isle less than one year. RESULTS: For asthma, the prevalence of "wheeze, last 12 months" was 6.6%. The prevalence of "allergic rhinitis, last 12 months" was 17.9%. The prevalence of "itchy eczema, last 12 months" was 8.1%. The prevalence of "allergic conjunctivitis, last 12 months" was 8.1%. The prevalence of "food allergy, last 12 months" was 2.3%. The prevalence of "drug allergy, last 12 months" was 0.8%. CONCLUSION: The inhabitants of Udo Isle had lower prevalence of atopic dermatitis than that of in the entire Jeju Island. However, compared with other regions, it showed higher prevalence, and it tended to be decreased with aging. The prevalence of asthma, allergic rhinitis, allergic conjunctivitis, food allergy and drug allergy, presented no difference by age.

Presumed Ocular Toxoplasmosis Presenting as Isolated Unilateral Papillitis

PURPOSE: To report an atypical case of ocular toxoplasmosis presenting as isolated unilateral papillitis. CASE SUMMARY: A 53-year-old female presented with visual difficulty in her right eye that had begun 1 week previously. Best corrected visual acuity was 0.8 in the right eye and 1.0 in the left eye. On fundoscopic examination, optic disc swelling and focal edema with hard exudates in the nasal parapapillary retina were found in her right eye. Fluorescein angiography revealed marked leakage of dye from the swollen optic disc. There was no evidence of vasculitis and chorioretinitis. Pupillary light reflex and color vision were normal. Visual field (VF) showed generalized reduction in the right eye, and was normal in the left eye. Optical coherence tomography (OCT) revealed right optic disc swelling. Serology was positive for toxoplasma IgM and IgG. The patient was treated with oral steroids and antitoxoplasma antibiotics. Two months later, visual acuity was 1.0 in the right eye. There was no disc swelling on fundoscopy or OCT and VF was normal. CONCLUSIONS: Ocular toxoplasmosis can present atypically as isolated papillitis without chorioretinitis and mimic idiopathic optic neuritis. A thorough serologic examination for toxoplasmosis along with proper treatment should be performed.

Comparison of Phacodynamic Effects on Postoperative Corneal Edema Between 2.8 mm and 2.2 mm Microcoaxial Torsional Phacoemulsification

PURPOSE: To compare the effects of phacodynamic parameters on postoperative corneal edema between 2.8 mm and 2.2 mm microincisional coaxial cataract surgery. METHODS: A prospective randomized study design was conducted and included 144 cases randomly divided into 2 coaxial cataract surgery groups based on incision size, a 2.8 mm incision (n = 72) or a 2.2 mm microincision (n = 72). The cataract was graded using the lens opacity classification system (LOCS III). The total ultrasound time (TUT), cumulative dispersed energy (CDE), average torsional amplitude (ATA), fluid amount, and case time were measured for each surgery. Central corneal thickness (CCT) was measured preoperatively, and 1 day and 1 month postoperatively. Intraoperative parameters were correlated with postoperative corneal edema. RESULTS: The average nuclear opacity, intraoperative parameters, and postoperative corneal edema did not differ significantly between the 2 surgical groups. Regression analysis showed corneal edema to be significant in ATA (p = 0.028) in the standard (2.8-mm incision) coaxial group, whereas edema was significantly different with TUT (p = 0.001), CDE (p = 0.001), fluid amount (p = 0.021), and case time (p = 0.027) in the microcoaxial (2.2-mm microincision) group. CCT returned to baseline with an increase of 1.8% at 1 month. CONCLUSIONS: In the microcoaxial group, sustained ultrasound exposure and prolonged case time caused moderate postoperative corneal edema, while ATA was a significant factor in the standard coaxial group. These data can be used to devise an effective surgical strategy for cataract treatment.