ABSTRACT
@#AIM: To observe the clinical surgical effect of brown hard nuclear cataract, and discuss the surgical skills. <p>METHODS: Totally 80 eyes of 80 patients with level V cataract were randomly stratified, divided into two groups. We operated with sclera tunnel incision phacoemulsification in Group A(40 eyes), combined with manual cataract extraction. Sutureless large-incision-manual cataract extraction(SLIMCE)was used in Group B(40 eyes). All cases were implanted posterior chamber folding intraocular lens. We compared the best corrected visual acuity, corneal astigmatism, operation time, intraoperative complications, corneal edema, intraocular pressure and corneal endothelial cells in two groups of different postoperative time. <p>RESULTS: The postoperative best corrected visual acuity at 3 and 7d of Group A were better than those of Group B(<i>P</i><0.05), and there was no difference in the 1d and 1mo after surgery(<i>P</i>>0.05). The corneal astigmatism of 1mo after surgery was much smaller in Group A, and there was a significant statistical difference between two groups(<i>P</i><0.05). Less intraopretative complications happened in Group A, but there was not statistical difference between two groups(by Fisher's exact test, <i>P</i>=0.36). There was a significant statistical difference in corneal edema of these two groups at 1d after surgery(<i>χ</i><sup>2</sup>=5.70, <i>P</i><0.05). There were no significant differences in operation time, postoperative corneal edema, intraocular pressure and corneal endothelial cells in two groups at 7d(<i>P</i>>0.05). <p>CONCLUSION: Sclera tunnel incision phacoemulsification combined with manual nuclear extraction would be a preferred surgical technique for level V cataract.
ABSTRACT
Phaco surgeons initially train in a four quadrant divide and conquer technique. Subsequently, several surgeons transition to chopping techniques due to the perceived advantages of phaco-chop that include lower ultrasound energy and lesser zonular stress. Stop and chop has conventionally been the technique of choice for making this transition. However, the surgeon has to execute a full-fledged chop after the creation of two hemi-segments by the classical trenching and cracking skills already acquired in divide and conquer techniques. Here we describe a set of intermediate steps during four quadrant divide and conquer that breaks down the skills required for chopping and enables the surgeon to sequentially imbibe the required skill sets to make the transition to chop safer and smoother.
ABSTRACT
PURPOSE: To compare intraoperative parameters and postoperative results between divide-and-conquer and multiple phaco-chop technique. METHODS: Two different techniques were performed by one operator on the patients with bilateral cataract. One eye was phacoemulsified by divide-and-conquer technique (D eye), and the other was performed by multiple phaco-chop technique (M eye). Changes of central corneal thickness during the operation, total phaco-time and phaco-energy were measured. RESULTS: Total 29 patients were included. The change of central corneal thickness were 8.4 +/- 11.8 microm in D eye and 11.5 +/- 16.7 microm in M eye, which showed no significant difference (p = 0.350) and total phaco-time were 70.1 +/- 32.9 seconds in D eye and 71.1 +/- 55.0 seconds in M eye, which also showed no significant difference (p = 0.689). However, phaco-energy were 12.4 +/- 8.3 power x s in D eye and 8.4 +/- 9.9 power x s in M eye, and this result showed significantly larger energy when using divide-and-conquer technique (p < 0.001). CONCLUSIONS: There was no significant difference in change of central corneal thickness and phaco-time between two techniques, divide-and-conquer and multiple phaco-chop technique. However, significantly smaller phaco energy was used by multiple phaco-chop technique compared with divide-and-conquer technique.
Subject(s)
Humans , Cataract , Eye , PhacoemulsificationABSTRACT
OBJETIVO: Valorar la técnica de facoemulsificación de Divide y Vencerás en la cirugía del cristalino en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer. MÉTODOS: Se realizó una investigación aplicada retrospectiva y descriptiva en 102 ojos con diagnóstico de cataratas presenil y senil, de 52 pacientes que se les realizó facoemulsificación por la técnica de Divide y Vencerás en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido entre junio del 2006 a febrero del 2009. RESULTADOS: Se encontró que los mayores de 60 años representaron más de 75 por ciento del total del universo estudiado. La mejor agudeza visual corregida en el posoperatorio mejoró a más de 0,7 en la escala de Snellen en el 85 por ciento de los ojos. La diferencia del astigmatismo preoperatorio y posoperatorio fue 0,13 dioptrías. En la microscopia endotelial los cambios encontrados fueron de un 8,2 por ciento, las complicaciones presentadas fueron de 2,8 por ciento, ocurriendo con mayor frecuencia la rotura de cápsula posterior. CONCLUSIONES: Los mayores de 60 años representaron más de 75 por ciento del total del universo estudiado, la agudeza visual corregida en el posoperatorio mejoró cuatro líneas en la escala de Snellen, el astigmatismo posoperatorio fue mínimo sin repercusión en la calidad visual de los pacientes, en la microscopia endotelial los cambios encontrados fueron mínimos y no tuvieron repercusión clínica para los pacientes, las complicaciones presentadas fueron muy bajas y se produjo con mayor frecuencia la rotura de cápsula posterior
OBJECTIVE:To assess the use of Divide and Conquer phacoemulsification technique in the lens surgery at the Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology. METHODS: Retrospective and descriptive applied research was conducted in 102 eyes diagnosed with presenile and senile cataract from 52 patients who underwent Divide and Conquer phacoemulsification technique at the Ocular Microsurgery Center of Ramón Pando Ferrer from June 2006 to February 2009. RESULTS: It was found that patients over 60 years accounted for 75 percent of the universe of study; the best corrected visual acuity in the postoperative stage improved to more than 0,7 in the Snellen´s chart in 85 percent of the eyes, the difference between the preoperative and the postoperative astigmatism was 0,13 dioptries, the changes found in the endothelial microscopy represented 8,2 percent, the complications were observed in 2,8 percent of cases, being the most frequent the posterior capsule rupture. Ã CONCLUSIONS: The patients aged over 60 years accounted for 75 percent of the whole universe of study, the corrected visual acuity improved by four lines in the Snellen´s chart in the postoperative period, the postoperative astigmatism was minimal without any impact on the visual quality of the patients, there were minimal changes in the endothelial microscopy and no clinical impact was recorded. Complications were very low and the most frequent was the posterior chamber capsule rupture