The Ganesh朑rewal cystitome maker � A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

Different strokes for anterior capsulorhexis in pediatric cataract

Background: A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. Purpose: This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. Synopsis: The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue?rhexis), or by coaxial illumination (4. Coaxial?rhexis) or by just the sheen of capsule (5. Sheen?rhexis). The anterior chamber can be maintained using ophthalmic visco?elastic device (Visco?rhexis) or by irrigation fluid (6. Hydro?rhexis). A speed?breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque?rhexis) or by a vitrector (vitrectorhexis) or a pair of micro?scissors (8. Scissor rhexis). Above all, the technology of femto?second?laser?assisted (9. Femto?rhexis) and zepto?pulse?precision capsulotomy (10. Zepto?rhexis) is also illustrated. Highlights: This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

Management of partially absorbed white soft cataract post penetrating injury to eye

Background: A measurable burden to the emergency ophthalmology department is represented by ocular trauma in pediatric patients. Traumatic cataracts still result in visual disability despite great advancements in diagnostic and treatment methods. Cataract surgery with intraocular lens (IOL) implantation aids in the improvement of visual acuity in such cases. Duration of trauma is an important prognostic factor for recovery of visual acuity before amblyopia sets in young patients with penetrating ocular injury. Purpose: This video deals with the management of a case of partially absorbed traumatic cataract in a scenario of an old and neglected penetrating injury. This case had a corneal scar, ruptured anterior lens capsule, and posterior synechiae formation between the posterior pigmented epithelium of the iris and the lens capsule. Synopsis: In a case of penetrating ocular injury, one should always suspect violation of posterior lens capsule, weakened or broken zonules and retained intraocular foreign body. In this case, a circular capsulorhexis is difficult to attain. After staining the capsule with trypan blue dye, viscoelastic substance is instilled in the anterior chamber to have good control over the rhexis and to avoid rhexis run out. In case the rhexis runs off to the equator, a pair of Vannas scissors is used to cut the extended flap. The cataract is partially absorbed ,white and soft in nature and is easily mobilized from the bag and eaten up via phacoaspiration. Before implantation of posterior chamber intraocular lens (PCIOL) in the sulcus, posterior synechiae are released by swiping a cyclodialysis spatula in the sulcus area. Visual axis is cleared by giving nicks in the posterior capsule to remove the central dense posterior plaque. Automated anterior vitrectomy is done and a three?piece PCIOL is implanted safely in the ciliarysulcus. Retained viscoelastic substance is washed, intracameral antibiotic is instilled, and the anterior chamber is subsequently formed via stromal wound hydration. Highlights: Through this video, we tried to show how one should proceed with phacoaspiration with intraocular lens implantation in a case of traumatic cataract post penetrating injury in a sequential manner.

Tunnel-floor entry continuous curvilinear capsulorhexis technique: Rhexis in a controlled and stable anterior chamber always

Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma.

Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26?G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25?G flat?tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.

Can virtual reality surgical simulator improve the function of the non-dominant hand in ophthalmic surgeons?

Purpose: Phacoemulsification surgery requires the use of both hands; however, some surgeons may not be comfortable using their non?dominant hand, especially in critical steps such as chopping. This work aims at assessing whether a virtual reality simulator can help cataract surgeons train their non?dominant hand using the capsulorhexis module. Methods: This was a prospective observational study including thirty ophthalmic surgeons; none of them had previous training on the EyeSi surgical simulator. Twenty?three were experienced, and seven were intermediate surgeons. Surgeons were asked to perform capsulorhexis three times using their dominant hand and then using their non?dominant hand. A performance score based on efficiency, target achievement, instrument handling, and tissue treatment was calculated by the simulator. Results: A significant improvement in the score of surgeons using their non?dominant hand from the first trial (69.57 ± 18.9) to the third trial (84.9 ± 9.2) (P < 0.001) was found, whereas such improvement was not noted with the dominant hand (P = 0.12). Twenty?six surgeons managed to reach 90% of the mean score achieved by dominant hand by using their non?dominant hand, 11 (36.7%) from the first trial, seven (23.3%) from the second, and eight (26.7%) from the third. Conclusion: Cataract surgeons showed significant improvement in the scores of their non?dominant hands with simulator training. Thus, it is possible to safely train non?dominant hands for difficult tasks away from the operating room, which would be a fruitful addition to residency training programs

Vitrector-assisted anterior capsulorhexis in adult intumescent cataract

Performing capsulorhexis in white intumescent cataracts during phacoemulsification surgery is challenging for cataract surgeons because of high intralenticular pressure and reduced red reflex. Capsulorhexis extension to the periphery of the lens is a common occurrence due to lens intumescence. We used a vitrectomy cutter to create an initial tear in the anterior capsule and simultaneously remove a part of milky fluid coming out of the intumescent lens. Once the lens was decompressed, capsulorhexis was completed using capsulorhexis forceps. This technique helped in controlling capsulorhexis in eyes with intumescent cataracts by reducing the intralenticular pressure and thereby preventing unexpected radial capsular tear

The effects of functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia / A influência das reações emocionais durante a facoemulsificação com anestesia tópica em pacientes de olho único

ABSTRACT Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia. Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed. Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure. Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.(AU)

RESUMO Objetivo: Avaliar a relação entre a incidência de complicações e reações emocionais durante a cirurgia de catarata sob anestesia tópica em pacientes funcionalmente monoculares. Métodos: Estudo prospectivo, transversal, caso-controle de vinte e dois pacientes monoculares e dezenove controles pareados por idade e sexo . Dados demográficos foram analisados: idade, sexo e escolaridade. As cirurgias foram realizadas pelo mesmo cirurgião e durante o procedimento os sinais vitais dos pacientes (como pressão arterial sistêmica e frequência cardíaca) e eventos cirúrgicos (duração da cirurgia, movimentos corporais, sinais de aumento da pressão vítrea, dificuldade de realização da capsulorrexis e complicações) foram coletados. A acuidade visual pré e pós foi analisada. A distribuição normal dos dados foi confirmada com o teste de Shapiro-Wilk. Os dados foram expressos como média ± DP e porcentagem. A comparação dos diferentes testes clínicos entre os grupos foi realizada utilizando Student's t-test e ANOVA com correção de Bonferroni. O qui-quadrado foi usado para comparar dados demográficos. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Este estudo incluiu vinte e dois olhos de 22 pacientes funcionalmente monoculares (6 homens e 13 mulheres) e dezenove olhos de 19 controles (11 homens e 11 mulheres). A média de idade foi de 73,05 ± 13,31 anos nos indivíduos monoculares e 69,74 ± 16,81 no controle. Considerando-se os sinais vitais não houve diferença significativa entre os grupos (p>0,05). Durante o procedimento, a percepção do cirurgião em relação aos movimentos excessivos de olho, pálpebra ou cabeça em ambos os grupos foi semelhante, assim como sinais de aumento da pressão vítrea (p=0,2 e p=0,1, respectivamente). Conclusão: Este estudo sugere que é seguro realizar a extração de catarata com anestesia tópica em pacientes funcionalmente monoculares. Esses pacientes aparentemente se comportam de maneira semelhante aos pacientes binoculares.(AU)

Effect of fine capsule treatment on the visual quality of diffractive multifocal intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of fine capsule treatment on the visual quality of diffractive multifocal intraocular lens.<p>METHODS: Ninety-eight patients(120 eyes)with DMIOL implanted in cataract Department of Hebei Eye Hospital from March 2017 to April 2018. They were randomly divided into A group and B group. 60 eyes in each group. Group A patients were treated with anterior and posterior capsular polishing and posterior continuous circular capsulorhexis, while in B group the fine capsule treatment was not performed. The UCDVA, UCIVA, UCNVA, visual quality, intraocular lens neutrality and PCO incidence were compared 6mo after operation.<p>RESULTS: At 6mo after operation, UCDVA, UCIVA and UCNVA in group A were superior to those in group B. The difference was statistically significant(<i>P</i><0.05). At 6mo after operation, the amount of eccentric intraocular lens in group A was less than that in group B. The difference was statistically significant(<i>P</i><0.05). PCO incidence: group A: 0 eyes; group B: 5 eyes(8.3%)in gradeⅠ, 3 eyes(5.0%)in grade Ⅱ, 2 eyes(3.3%)in grade Ⅲ.<p>CONCLUSION: In order to enhance the stability of IOL and maintain the long-term transparency of the optic axis, we performed fine polishing of the anterior and posterior capsule and continuous circular capsulorhexis of the posterior capsule. These could improve the visual quality and satisfaction of patients after surgery.

Application of T-hook pre-chopping combined with capsule fine treatment technology in cataract surgery for high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical efficacy of the T-hook pre-chopping combined with capsule fine treatment technology for patients with high myopia and cataract.<p>METHODS: From March 2016 to February 2019, 56 cases(80 eyes)of cataract patients with high myopia were treated in cataract department of Hebei Province Eye Hospital. They were randomly divided into A and B groups, 40 eyes in each group. Group A underwent T-hook pre-chopping combined with fine capsular treatment. Cataract phacoemulsification combined with intraocular lens implantation was purely performed in group B. We compared the cumulative release energy of ultrasound during operation between the two groups. We also observed the best corrected visual acuity(BCVA), the amount of contraction of the anterior capsule, the degree of posterior capsule opacification, intraocular lens neutrality and complications for more than 6mo.<p>RESULTS: The cumulative release energy of ultrasound in group A was less than that in group B(12.23±3.61 <i>vs</i> 20.46±4.61, <i>P</i><0.01). The best corrected visual acuity of group A was better than that of group B at 6mo after operation(<i>Z</i>=5.328, <i>P</i>=0.002). The changes of anterior capsular contraction and intraocular lens decentration(0.18±0.14, 0.02±0.007mm)were less than those of group B(0.82±0.23, 0.65±0.240mm)(<i>P</i><0.05). In group A, there were 3mm round holes in the center of the posterior capsule, and the optic axis area remained transparent, while in group B, 13 eyes(32%)had turbid central area of the posterior capsule. In group A, there was no intraoperative posterior capsule rupture or postoperative retinal detachment. In group B, there were 2 eyes(5%)with intraoperative posterior capsule rupture and 1 eye(2%)with postoperative retinal detachment.<p>CONCLUSION: We used T-hook pre-chopping combined with capsule fine treatment technology to treat cataract with high myopia, which could reduce the use of ultrasound energy during operation, reduce the risk of posterior capsule rupture, effectively avoid the occurrence of posterior cataract, and achieve satisfactory clinical effect.

Techniques of anterior capsulotomy in cataract surgery

Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

Pseudocapsulorrexis: desdoblamiento idiopático de la cápsula anterior del cristalino / Pseudocapsulorhexis: idiopathic split of the anterior lens capsule

Se presenta el caso de una mujer de 81 años que acude para valoración de cirugía de catarata en el ojo derecho. El examen biomicroscópico revela la existencia de una catarata C2N4 (Lens Opacities Classifi cation System, versión III) con una cápsula anterior que en su región central pareciera estar abierta a modo de capsulorrexis, aunque sin trasvase de material lenticular ni signos inflamatorios en cámara anterior Figura 1. Su consistencia y morfología nos hacen pensar en un posible desdoblamiento idiopático de la cristaloides anterior, ya que tanto el reborde pupilar como la gonioscopia son rigurosamente normales. De ahí nuestro título de "pseudocapsulorrexis".

The role of a femtosecond laser in congenital cataract associated with aniridia / O papel do laser de femtosegundo na catarata congênita associada à aniridia

ABSTRACT A patient with bilateral aniridia and progressive congenital cataract was treated at the age of 7 years through phacoaspiration with femtosecond laser capsulotomy, in-the-bag intraocular lens implantation, and pars plana vitrectomy (combined with posterior capsulotomy). The diameter of the planned anterior capsulotomy was 4.7 mm; however, due to elevated tension in the young capsular bag, the capsulotomy diameter increased (to around 6 mm) shortly after release of the tension by the laser. In addition, the patient had a very flat and small cornea, causing the formation of air bubbles in the curved laser interface. This was addressed by filling the gap by using a viscoelastic. A very similar situation was observed in both eyes. Use of the femtosecond laser facilitated a successful outcome in a complex congenital cataract case with a safe capsulotomy that ensured in-the-bag intraocular lens placement.

RESUMO Paciente com aniridia bilateral e catarata congê­nita progressiva foi tratado com a idade de 7 anos através de facoemulsificação com capsulotomia anterior por laser de femtosegundo, implante de lente intra-ocular e vitrectomia via pars plana (combinada com capsulotomia posterior). O diâmetro da capsulotomia anterior prevista foi de 4,7mm, porém, devido à elevada tensão do saco capsular jovem, o diâmetro da capsulotomia aumentou (para cerca de 6mm) logo após a liberação da tensão pelo laser. Além disso, o paciente tinha uma córnea muito plana e pequena, causando a formação de bolhas de ar na interface do laser. Isso foi resolvido preenchendo a lacuna usando um viscoelástico. Uma situação muito semelhante foi observada em ambos os olhos. O uso do laser de femtosegundo facilitou um resultado bem-sucedido em um caso complexo de catarata congênita com uma capsulotomia anterior segura que garantiu a colocação da lente intra-ocular dentro do saco capsular.

Management of late-onset flocculent after-cataract with capsular bag lavage and posterior continuous curvilinear capsulorhexis

We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.

Use of the lower concentration of trypan blue staining technique during cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To determine the lowest concentration of trypan blue(TB)used to stain the anterior capsule satisfactorily and to evaluate the clinical significance of trypan-blue-assisted capsulorhexis in cataract surgery. <p>METHODS:Totally 60 cases(60 eyes)of mature age-related cataract, of which the cortex lentis cloudy degree was C4-C5 and the nucleus of the lens was N3, were randomly divided into three groups. Different concentrations of TB, 0.03%, 0.015%, 0.0075%, were used in staining groups respectively to stain the anterior capsule during cataract surgery. All cases were performed with manual small-incision cataract surgery by the same ophthalmologist. The staining effects, the success rate of continuous circular capsulorrhexis(CCC), the posterior capsule rupture and the state of the intraocular lens(IOL)were studied during the operation. The significant statistics was conducted between the groups. The density of corneal endothelial cells, intraocular pressure(IOP), inflammation in anterior chamber, corneal edema, staining of other intraocular structures were also observed at 1d, 1wk, 3mo postoperatively. <p>RESULTS: Trypan blue in concentrations as low as 0.015% stained the anterior capsule satisfactorily, allowing safe creation of a CCC. At concentrations of 0.03% and 0.015%, the success rate of CCC and the state of the intraocular lens(IOL)was significantly better than 0.0075% group, the difference was statistically significant(<i>P</i><0.0083). The difference of posterior capsule rupture rates and the rate of lost corneal endothelial cells in three groups were not statistically significant(<i>P</i>>0.0083). The staining of CCC margin and side port disappeared in 1wk after surgery. Inflammation in anterior chamber of all cases was slight. There was not any evidence of residual stain in the anterior segment during the postoperative period. There was no corneal edema and intraocular pressure higher after 1wk. <p>CONCLUSION: Trypan blue staining of the anterior capsule is a safe and useful technique in cataract surgery, which can raise the success rate of cataract surgery. The 0.015% trypan blue staining, the lowest effective concentration, is strongly considered.

Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis / Sinal da bandeira argentina- like durante capsulorrexis posterior primária

ABSTRACT We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.

RESUMO Os autores demonstram uma complicação durante a realização de uma capsulo tomia circular contínua posterior (CCCP) em um paciente com megalocórnea programado facoemulsificação com implante de lente intraocular (LIO) tórica multifocal. Após a remoção do núcleo e córtex, o saco capsular foi preenchido por viscoelástico coesivo com finalidade de prepará-lo para realização da CCCP e com isso assegurar o correto alinhamento do implante no eixo desejado. Entretanto, assim que a agulha de 27-gauge foi utilizada para confecção puntura inicial da capsulotomia, imediatamente a cápsula posterior se abriu até periferia de 0-180 graus, similar à lesão capsular vista no sinal da Bandeira Argentina em cataratas hipermaduras, ambos causados por pressão excessiva intracapsular. Manipulação cuidadosa foi realizada para implantação da lente no eixo correto, a qual aconteceu sem intercorrências. No pós-operatório, a paciente apresentou uma excelente acuidade visual sem correção com LIO corretamente alinhada no eixo desejado.

Avaliação da eficácia de um novo marcador cirúrgico para capsulorrexe anterior / Effectiveness evaluation of a new surgical marker for anterior capsulorhexis

RESUMO Objetivo: Avaliar a eficácia de um novo marcador cirúrgico para ajudar na confecção da capsulorrexe anterior analisando o seu dimensionamento e formato, comparando com a capsulorrexe confeccionada manualmente de maneira livre. Métodos: Como experimento, 3 residentes (R3) de Oftalmologia do Hospital Universitário Onofre Lopes (HUOL) e 1 oftalmologista em treinamento, voluntários, realizaram (cada um) 10 capsulorrexes em olhos de porco enucleados. Em 5 olhos foi utilizado o marcador e em outros 5, não. Todos os olhos foram fotografados tendo ao lado uma régua para orientar e calibrar um aplicativo para a avaliação morfométrica do procedimento. O diâmetro alvo foi de 5 mm, cujo perímetro correspondente é 15,7 mm e a área 19,652 mm2. Foram avaliados em cada procedimento: os diâmetros máximo, mínimo e médio, o perímetro, a área e o desvio em relação ao diâmetro e quanto ao aspecto ideal. Resultados: No grupo utilizando o marcador o diâmetro médio foi 5,44mm (±0,89) contra 6,37mm (±0,67) (p=0,001), no grupo no qual não se utilizou o marcador; quanto ao perímetro, 17,52mm (±1,92) no grupo utilizando o marcador contra 20,14mm (±2,09) (p<0,001) sem o marcador e quanto a área, 24,73mm2 (±1,92) com o marcador, contra 32,62mm2 (±6,32) (p<0,001), sem o marcador. Em relação ao aspecto da capsulorrexe 1,26mm (±0,12), contra 1,21mm (±0,7) (p=0,09) e em relação ao desvio de curvatura: 0,87 (±0,05), contra 0,9 (±0,04), (p=0,06) respectivamente. Conclusão: O trabalho mostrou que o marcador avaliado é eficaz para auxiliar a confecção da capsulorrexe conduzindo a resultados melhores que o método a mão livre.

ABSTRACT Purpose: To evaluate the effectiveness of a surgical device that intented to help in the preparation of the anterior capsulorhexis analyzing the design and shape, comparing with capsulorhexis made by free hand. Methods: Three ophthalmology residents(R3) at the HUOL and one surgeon in training, participate in this research as volunteers. Each surgeon perform 5 capsulorhexis in porcine eyes using the device, and five others by free hand as a control. All capsulorhexis were photographed having a ruler as reference to guide and calibrate a computer application for morphometric evaluation (Cambuí Labs, Natal, Brazil). All surgeons aimed to produce a circular continuous capsulorhexis of 5 mm diameter that represents 15,7mm in perimeter and 19,652mm2 in area. Each wet-lab capsulorhexis was evaluated in regard to these criteria: diameter (mean, maximum and minimum), perimeter, area, deviation from the ideal diameter and ideal shape. Results: Compare to control groups, capsulorhexis with the aid of the surgical device showed: 5,44mm ±0,89 vs 6,37mm ±0,67, for capsulorhexis diameter (p=0,001); 17,52mm ±1,92 vs 20,14mm ±2,09 for capsulorhexis perimeter (<0.001); 24,73mm2 ±1,92 vs 32,62mm2 ±6,36 for capsulorhexis area (p<0,001). A tendency for better result with the aid of the surgical device was observed for deviation of an ideal diameter or ideal aspect were appreciated: 0,87mm ±0,05 vs 0,9 ±0,04 for deviation of a curve (p=0,06); 1,26mm ±0,12 vs 1,21mm ±0,7 for the capsulorhexis aspect (p=0,09). Conclusion: Capsulorhexis produced with the aid of the surgical device, significantly improved wet-lab capsulorhexis performance.

Efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in preventing visual axis opacification in pediatric cataract surgery: A randomized controlled trial

Background: Posterior capsule opacification (PCO) is the commonest complication of extracapsular catraract surgery in pediatric patients with an incidence as high as 95%. But there is inadequate evidence on appropriate intervention to prevent PCO. Aim: To compare the efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in Pediatric Cataract surgery. Materials and methods: The current study was a randomized open labeled controlled study, conducted in the department of ophthalmology, All India Institute of Medical Sciences, New Delhi between July 2015 to June 2016. The study population included 32 children in each of < 2 years age, suffering from bilateral cataract and each eye was randomized to different intervention groups consisting of manual posterior capsulorhexis or and posterior capsulotomy using plasma knife. Anterior vitrectomy was performed in all the eyes. Visual acuity, axial length, Intra ocular pressure, and refraction etc. were measured using appropriate methods. The retro-illuminated clinical photograph was taken using NEW CARL ZEISS f340 CANON camera and was analyzed by EPCO software. Prakash S, Giridhar, Harshila Jain. Efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in preventing visual axis opacification in pediatric cataract surgery: A randomized controlled trial. IAIM, 2017; 4(9): 171-177. Page 172 Results: There was no statistically significant difference in any of the ocular parameters at baseline and at 6 months following surgery. The log MAR visual acuity was significantly higher in intervention 1 (0.465±0.143) as compare to intervention 2 (0.397 ± 0.108) at 1 year, which was statistically significant (P value 0.036). There were no statistically significant differences in the proportion of Visual Axis Opacification (VAO) between the intervention groups. Conclusion: Visual axis opacification after pediatric cataract surgery remains comparable in both techniques at one year (plasma knife assisted posterior capsulotomy and manual capsulorhexis). Hence it can be concluded that plasma knife assisted posterior capsulotomy does not have any added advantage over manual posterior capsulorhexis in preventing visual axis opacification.