Visual outcome of manual small-incision cataract surgery: comparison of modified Blumenthal and Ruit techniques / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery (MSICS).METHODS: This was a prospective, non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision, i.e., the Blumenthal technique (group 1, n=64) or a temporal scleral tunnel incision, i.e., the Ruit technique (group 2,n=65). MSICS and intraocular lens implantation were performed through an unsutured 6.5-to 7.0-mm scleral tunnel incision. Uncorrected and corrected visual acuity, intraoperative and postoperative complications, and surgically induced astigmatism calculated by simple subtraction were compared. Patients were examined 1 day, 1 week, 1 month, and 3 months after surgery.RESULTS: Both groups achieved good visual outcomes with minor complications. Three months after surgery, the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group (P=0.29). The average (SD) postoperative astigmatism was 0.87 (0.62) diopter (D) for the Blumenthal group and 0.86 (0.62) D for the Ruit group. The mean (SD) surgically induced astigmatism was 0.55 (0.45) D and 0.50 (0.44) D for the Blumenthal and Ruit groups, respectively (P=0.52). Common complications were minimal hyphema and corneal edema. There was no statistically significant difference in the complication rate between the groups (P>0.05).CONCLUSION: In MSICS, both the Blumenthal and Ruit techniques achieve good visual outcomes, with low complication rates.

Visual outcomes and incidence of vitreous loss among third-year ophthalmology residents performing manual small incision cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine the visual outcome and the incidence of vitreous loss in patients undergoing manual small incision cataract surgery(MSICS)by third-year ophthalmology residents.METHODS:Hospital records of 799 consecutive patients undergoing MSICS at Department of Ophthalmology,Prapokklao Hospital by third-year ophthalmology residents between July 2005 and June 2007 were reviewed.Bestcorrected visual acuity(BCVA)were compared between the eyes operated by residents and those operated by the staffs.For the complication of vitreous loss,the study group(patients with vitreous loss)were compared with the control group(patients without vitreous loss)using analytic case-control study.RESULTS:One month postoperatively,91.0%of patients in resident group and 92.5%in the staff group had visual acuity of 6/18 or better.The difference in visual outcome between the two groups was not statistically significant(P =0.526).The incidence of vitreous loss among residents was 5.01%(20/399)and 1.00%(4/400)among the staff.The overall incidence of vitreous loss was 3.0%.The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 5.22 times,the odds that the eyes in the staff group would have such a complication(P = 0.002,95%confidential interval(Cl)of relative risk =1.769-15.426).CONCLUSION:Good visual acuity can be achieved after resident perfoming MSICS.The vitreous loss rate in this study is high.

Corneal endothelial cell loss between the Kongsap manual phacofragmentation and phacoemulsification.

OBJECTIVE: To compare corneal endothelial cell loss between the Kongsap manual phacofragmentation and phacoemulsification. MATERIAL AND METHOD: One hundred two eyes with age-related cataract were randomized to undergo either the Kongsap manual phacofragmentation (Group 1, 52 eyes) or phacoemulsification surgery (Group 2, 50 eyes) with implantation of a posterior chamber, foldable, acrylic intraocular lens performed by one surgeon. The main parameters were corneal endothelial cell density (ECD), best corrected visual acuity (BCVA), and intraoperative and postoperative complications. Follow-up visits were scheduled at 1, 4, and 12 weeks. RESULTS: Pre-operatively, the mean ECD in Group 1 was 2,350 +/- 229 cells/mm2 and in Group 2 was 2,429 +/- 263 cells/mm2 (p = 0.112). Mean ECD decrease was 7.61% in Group 1 and 7.19% in Group 2 at the end of 12 weeks. The 95% confidence intervals of the mean differences of the endothelial cell loss at 4 weeks and 12 weeks after surgery were -1.87 to 2.04% and -2.77 to 3.63%, respectively. Mean best-corrected visual acuity at the end of 4 weeks was 0.88 +/- 0.22 in Group 1 and 0.82 +/- 0.24 in Group 2 (p = 0.117). There was no statistical difference between the groups in intra-operative and postoperative complications (p > 0.05). CONCLUSION: The corneal endothelial cell loss after cataract surgery with the Kongsap manual phacofragmentation is equivalent to those of phacoemulsification and both surgical techniques allowed excellent visual results.

Manual sutureless cataract surgery with foldable intraocular lens using the Kongsap technique: the results of 95 cases.

OBJECTIVE: To evaluate the visual outcome and complications of the small incision cataract surgery with foldable intraocular lens implantation using the Kongsap technique. STUDY DESIGN: Prospective, non-comparative study. MATERIAL AND METHOD: This prospective study was conducted at Prapokklao Hospital, Chanthaburi between December 2005 and May 2006. The ninety-five eyes of 95 patients underwent cataract surgery using the Kongsap technique. The best-corrected visual acuity, intra-operative and post operative complications, and the corneal endothelial cell loss were then evaluated. Follow-up visits were scheduled at one week, one month, three months, and six months. RESULTS: Best corrected visual acuity (BCVA) was 20/40 or better in 83 eyes (87.37%) at one week postoperatively, in 86 eyes (90.53%) at one month, in 87 eyes (91.58%) at 3 months, and in 85 eyes (89.48%) at 6 months. The most common intra-operative complication was iris prolapse (7.37%). Other intra-operative complications were posterior capsule rupture (2.11%), transient intracameral bleeding (2.11%), and capsulorhexis tear (2.11%). The most significant post operative complication was transient corneal edema located at the corneal wound, which developed in seven eyes (7.37%). No other significant complications were noted during the six-month follow up period. Mean endothelial cell loss was 5.3% at one month and 7.1% at three months post operatively. CONCLUSION: Manual sutureless cataract surgery with foldable intraocular lens using the Kongsap technique when performed by an experienced surgeon was a safe procedure with good visual recovery and no need for a phaco machine.

Corneal injury by bee sting with retained stinger--a case report.

OBJECTIVE: To report a rare case of corneal injury by bee sting with its complication and management. MATERIAL AND METHOD: A 3-year-old boy, who was attacked by a swarm of bees, was referred for the right eye's corneal ulcer evaluation. RESULTS: Two stingers were found and completely removed with jeweler forceps. Corneal epithelial defect, corneal edema, secondary bacterial keratitis, heterochromia iridis, and internal ophthalmoplegia were identified The corneal edema markedly improved 3 days after removing the retained bee stingers and treatment by topical antibiotics and steroids. The patient was evaluated after 1 week and 1 month and was found with permanent central corneal scar particularly at the area corresponding to the retained stinger The patient had subsequently localized traumatic anterior subcapsular cataract corresponding to where the stinger had penetrated the lens. CONCLUSION: Corneal bee sting injury is an uncommon ocular trauma, but can result in severe sight threatening complication. Even though the response of corneal edema is well inclined to topical steroid, awareness in adjusting the clinical treatment for the particular case needs a scrutinized investigation of the infection.

A comparison of patient pain during cataract surgery with topical anesthesia in Prechop Manual Phacofragmentation versus phacoemulsification.

OBJECTIVE: To compare the pain level and complications during cataract surgery with topical anesthesia in Prechop MPF versus phacoemulsification. STUDY DESIGN: Prospective randomized comparative study. MATERIAL AND METHOD: One hundred patients, undergoing small incision cataract surgery under topical anesthesia, were allocated randomly to perform Prechop MPF (n = 50) or phacoemulsification (n = 50). Patients were asked to rate their pain level on a 10-point visual analog pain scale during the administration of the anesthetic, during the surgery and after surgery. The surgeon recorded his subjective assessment of patient cooperation and surgical complications. RESULTS: The mean pain score during surgery was 1.64 +/- 1.48 (SD) in the prechop MPF group and 0.92 +/- 1.34 (SD) in the phacoemulsification group. The difference between groups was statistically significant (p = .001). There was no significant difference in pain scores for delivery of anesthesia (p = .077), or after surgery (p = .221) and no significant difference in patient cooperation (p = .446) and surgical complications in either group. CONCLUSION: Patients having cataract surgery under topical anesthesia in the prechop MPF group had more intraoperative pain than patients in the phacoemulsification group. However there was no significant difference in patient cooperation and surgical complications between the groups.