Comparative study between conventional and 4 mm manual small-incision cataract surgery

Purpose: Comparative study of intraoperative and postoperative complications, visual outcomes, and cost?effectiveness between conventional and 4?mm manual small?incision cataract surgery with MVR blade. Methods: In total, 600 patients having nuclear sclerosis grade I朓V were operated under peribulbar anesthesia and were divided into two groups of 300 each. In group A (300), conventional small?incision cataract surgery was done, whereas in group B (300), 4?mm manual small?incision cataract surgery was performed through a 4?mm sclerocorneal tunnel. A wire vectis was passed through the 4?mm incision below the nucleus to stabilize it, and a 20?G MVR blade was introduced from 11o抍lock limbus and nucleus was bisected into two halves, which were removed through main incision. Cortical wash was given, and foldable IOL was implanted. Intraoperative and postoperative complications between the two groups were compared. Postoperative visual outcome and surgically induced astigmatism between the two groups was studied. Results: The most common intraoperative complication was hyphema (11.33%) and irido?dialysis (8.00%), whereas postoperatively, striate keratopathy (36.33%) and hyphema (19.33%) were common. Short?term complications such as striate keratopathy, hyphema, and irido?dialysis were significantly more in group B, and long?term results in terms of visual outcome and surgically induced astigmatism were significantly less in group B. Conclusion: Although intraoperative and short?term postoperative complications were observed more in 4?mm manual small?incision cataract surgery, it was found to be more effective in terms of surgically induced astigmatism and final visual outcome. In addition, it is cost?effective as compared to phacoemulsification.

Assessment of effectiveness of extracapsular cataract extraction versus manual small incision cataract surgery: an observational study

Background: Dilemma of cost effectiveness of manual small incision cataract surgeries (MSICS) in the terms of training and equipment has been widely pondered upon in developing areas. Objective of the study is to compare the manual small incision cataract surgery and extra capsular cataract extraction. Methods: A prospective study was conducted among the IPD patients of the Ophthalmology Department of Khaja Bandanawaz Teaching and General Hospital, Kalaburagi, from June to December 2017. Statistical Analysis was performed using Microsoft Excel 2013, SPSS 23.0 and Chi-square test was performed. Results: Out of the 160 individuals who underwent extra capsular cataract extraction (ECCE), 06 (3.75%), 91 (56.88%) and 63 (39.37%) of the study subjects had poor (5/50), moderate (6/60-6/24) and good (6/18-6/6) visual acuity respectively. Highest incidence was that of lens prolapse (25%) and corneal complications (25%) in ECCE. Among the subjects who underwent MSICS, highest incidence of intra operative complication noticed was that of lens prolapse, iris prolapse and anterior chamber collapse, each at 20%. Conclusions: It was concluded that the restoration of visual acuity was fairly good and uniform in both the procedures. Certain intra operative complications such as lens prolapse, iris prolapse and anterior chamber collapse were noticed in MSICS and capsular flaps and vitreous loss were noticed only in ECCE.

Sequential versus combined glaucoma and cataract procedures in Siriraj Hospital.

Objective: To compare the efficacy of intraocular pressure (IOP) control after combined cataract and trabeculectomy with sequential cataract surgery after trabeculectomy, both with and without antimetabolites. Methods: The retrospective study recruited 96 eyes of 73 patients who underwent cataract and glaucoma surgery, and were classified into two groups. Group I sequential procedures: 72 eyes of 56 patients who had undergone a previous trabeculectomy (with or without antimetabolites) for at least 6 months before planned phacoemulsification or ECCE. Groups II combined procedures: 24 eyes of 17 patients who underwent combined trabeculectomy(with or without antimetabolites) with phacoemulsification or ECCE between January 1998 and May 2003. The effects on IOP, best corrected visual acuity, and number of glaucoma medications taken were compared. Results: Mean postoperative IOP without oral medications was 14.17 mmHg in group I and 17.15 mmHg in group II (p=0.05) at 12 month follow up. The mean IOP remained significantly lower in group I (13.67) than in group II (16.36) (p=0.023) at the last follow up. There was a significant difference in surgical success between the groups (p=0.005). The reduction in the mean number of glaucoma medications was significantly higher in group I (p=0.04). In group I the mean IOP before and after cataract surgery were similar (p=0.787) but the numbers of glaucoma medications used were significantly increased (p=0.000) after cataract surgery. Conclusion: Sequential glaucoma and cataract procedure was associated with better IOP control than combined procedure. Cataract surgery in eyes with functioning bleb might have the adverse effect on IOP control.

Non-phacoemulsiflcation Small Incision Extracapsular Cataract Extraction and Intraocular Lens Implantation / 医学研究杂志

Objective To evaluate the clinical effects and complications of non - phacoemulsification small incision extracapsular cataract extraction(ECCE) and intraocular lens implantation to treat cataract. Methods Through 5.5 -7mm scleral tunnel incisions at 12:00, 212 cases (231 eyes) of cataracts were treated with intraocular lens implantation after continuous circular capsulorhexis and extraction of lens nucleus. Results One week postoperatively, the visual acuity was ≥0.5 in 184 eyes(79.65% ) ; one month postoperatively, the visual acuity was ≥0.5 in 202 eyes(87.45% ). The main complications were corneal edema, anterior chamber inflammation and posterior capsular rupture etc. Conclusion Nnon - phacoemulsification small incision ECCE and intraocular lens implantation is simple and has satisfied effects to treat cataract.

Sutureless Small Incision ECCE with Phaco Prechopper

PURPOSE: The study was done to introduce the new small incision sutureless extracapsular cataract extraction (ECCE) surgical technique and its safety using phaco prechopper. METHODS: After 4.5 mm scleral frown incision from 2 mm surgical limbus, continuous curvilinear capsulorhexis and complete hydrodissection, nucleus was divided into 2 fragments with phaco prechopper which is special forceps for nuclear divider in the bag. One piece of lens was drawn into anterior chamber from capsular bag using Sinskey hook and removed it with Wilder lens loop (size:4 x15 mm) from anterior chamber. The other piece of lens was removed with the same method. To evaluate the safety of new method compared to phacoemulsification (P.E), analysis of the serial changes of the corneal endothelial cell density, hexagonal pattern and mean cell sizes before and 3months after the operation in 40eyes (ECCE group : 20eyes, P.E group : 20eyes) was made. RESULTS: There were no significant complications such as posterior capsular rupture, vitreous loss, capsulorhexis tear but transient corneal edema was found. The mean percentage of corneal endothelial cell loss was 9.05+/-6.5% in ECCE group and 9.80+/-6.7% in the P.E group. CONCLUSIONS: This new method is safe, easy and does not require expensive instrumentation. It can be of great help for the phaco beginners to practice capsulorhexis, hydrodissection and the use of phaco system. We think it is an alternative method for phacoemulsification in cataract surgery.

A Survey of Post -Operative Daily Life Behavior and Degree of Satis faction in Patients Two or More Years after Cataract Surgery

Recently, the number of cataract surgeries has rapidly increased. This study was devised to evaluate the post-operative daily life behavior and degree of satisfaction in the patients who underwent cataract surgery two or more years ago. Of 400 patients who underwent ECCE with IOL implantation, 125 patients[31%]replied to the mail questionnaire consisted of thirty questions. Hospital records were also reviewed. 84%of the patients were satisfied with outcomes of cataract surgery, which was significantly correlated with current visual acuity[p<0.01]. Degree of satisfaction was significantly higher in patients with bilateral surgery compared with those with unilateral surgery[p<0.05]. Age, sex, occupation, economic and general health status were not significantly associated with degree of satisfaction. As for life behavior, discomfort while driving an automobile was the most common complaint, especially in the patients who underwent unilateral surgery. Concerning ocular symptoms, many patients complained of foreign body sense, epiphora, glare, fatigue, and near vision discomfort. We reconfirmed that the decision to perform cataract surgery should be made with careful consideration of long term prognosis and above results.

Cataract Extraction in Vitrectomized Proliferative Diabetic Retinopathy

The cataract extraction in vitrectomized proliferative diabetic retinopathy(PDR) may be different from the ordinary non-vitrectomized patients in several points. We tried to know what`s the problems during the operation, how`s the visual outcomes and the postoperative complications in these eyes. In 18 previously vitrectomized PDR patients(25 eyes), we performed the extracapsular cataract extraction(ECCE) in 7 eyes and the phacoemulsification in 18 eyes. The intraoperative problems were insufficient dilation of pupil, unstability of (anterior and posterior) chamber depth, and difficulty in removal of cortex, which is firmly adherent to the posterior lens capsule. Opacity of posterior lens capsule, elevation of intraocular pressure, exudative pupillary membrane, posterior synechia and corneal edema were the major postoperative complications. In 22 eyes(88%), the visual acuity was increased more than 2 lines, Cataract extraction was easier and less postoperative complications these cases.

Clinical Analysis of Retinal Detachment Following Extracapsular Cataract Extraction

The authors reviewed retrospectively preoperative ocular clinical characteristics, operative methods, postoperative anatomical results and visual rehabilitation for the 24 eyes, retinal detachments following extracapsular cataract extraction (ECCE). The most, common preoperative visual symptom was decreased vision, 19 eyes (79%) and the significant preoperative ocular findings were vitreous opacity 14 eyes (58%) and posterior capsular rupture 14 eyes (58%). The horseshoe tear 11 eyes (46%), atrophic hole 9 eyes (38%) were more comnnonly encountered, and the retinal breaks were principally located in the superotemporal quadrant in 18 eyes (75%), the superonasal quadrant. in 12 eyes (42%). Also, macular detachment 19 eyes (79%) was found most frequently with retinal detachment eyes. The overall anatomic success rate of surgical treatment of retinal detachment after ECCE was 21 eyes (88%). Especially, the visual acuity improved two line or more in II eyes (85%) with posterior chamber intraocular lens (PC-IOL) implantation group. We suggest that the early detection of retinal detachment. after ECCE with complications and proper operations are important to inaprove the postoperative anatomic success rate and the postoperative visual prognosis.

Corneal Sensation after Phacoemulsification Versus Planned Extracapsular Cataract Extraction

In order to compare the corneal sensation after phacoemulsification and the planned extracapsular cataract extraction(p-ECCE), we studied 40 eyes of 31 patients prospetively. A Cochet-Bonnet esthesiometer was used to measure corneal sensitivity preoperatively and at one day, three day, one week, one month, and two months postoperatively, by the same surgeon using the same technique. There was no difference in corneal sensation between phacoemulsification and p-ECCE group preoperatively. The mean corneal sensitivity at 10:00(2:00) o`clock in phacoemulsificantion/p-ECCE was 17.3+/-7.0(18.2+/-6.7)/9.9+/-1.5(10.3+1.9), 22.1+/-6.9 (23.2+/-6.3)/14.1+/-2.3(14.3+/-2.3), 29.4+/-7.7(30.6+/-7.2)/17.7+2.2(18.7+/-2.2), 37.7+/-9.3(37.8+/-9.4)/26.3+/-7.9(27.7+/-8.4), 56.3+/-7.6(56.3+7.9)/59.2+/-3.8(59.4+/-2.7)mm after 1, 3, 7, 30, 60 days, respectively. Corneal sensation at the center and the 3, 6, and 9 o`clock positions was not changed in all eyes. Corenal sensitivity was significantly more recovered in phacoemulsification group than the p-ECCE group at postoperative onemonth(p<0.05). However, there were no statistically significant difference in recovery of corneal sensation between phacoemulsification group and p-ECCE group at postoperative two months. Conclusively corneal sensation returned to peroperative level at two months postoperatively in both groups.

The Effect of Extracapsular Cataract Extraction in Patients with Chronic Angle-Closure Glaucoma combined with Cataract

14 eyes of 11 patients with chronic angle-closure glaucoma(CACG) undergoing extracapsular cataract extraction(ECCE) with posterior chamber intraocular lens(PCIOL) implantation(group 1) and 14 eyes of 12 patients without glaucoma undergoing ECCE/PCIOL(group 2) were studied to assess the effect on anterior chamber depth, anterior chamber angle, and intraocular pressure (IOP). We measured the anterior chamber depth and angle using the EAS-1000 Scheimpflug camera. Following ECCE/PCIOL in group 1, the anterior chamber depth increased 1.00 +/- 0.25mm(p=0.0001), the anterior chamber angle widened 15.36 +/- 5.61 degrees(p=0.0001), and the postoperative IOP drop of 4.7mmHg(23.9%) showed statistical significance. Group 2 showed the increase of anterior chamber depth 0.22 +/- 0.44mm(p=0.0964), the widening of anterior chamber angle 2.51 +/- 2.65 degrees(p=0.0047), and the decrease of IOP 0.9mmHg(6.2%, p=0.0933). The effects on anterior chamber depth, anterior chamber angle, and rap were statistically significant between the two groups. Based on these results, we recommend that eyes with cataract and CACG may be considered for ECCE/PCIOL implantation as a first procedure rather than combined cataract and filtering surgery.

Long-Term Astigmatic Changes in Cataract Surgery

Long term changes in corneal astigmatism after cataract surgery were evaluated. Phamemulsification with 7mm limbal incision(Group 1) was performed in 68 eyes and ECCE with 101mm limbal incision(Group 2) in 73 eyes. Follow up period was up to 5 years (mean 3.3 years), and the astigmatic change was analysed by Algebraic method. In most cases, postoperative astigmatigm was stabilized at 3 months but showed continuing against-the-rule change up to 5 years. Group 2 and above 60 years of age group showed more against-the-rule change at 5 years follw up although there was no significant differences between groups, up to 2 years. Preoperative against-the-rule group and less than 4 diopters of with-the-rule astigmatism group at 1 week postoperatively developed more against-the-rule change. Diabetic patients showed slightly more shift to against-the-rule astigmation than non-diabetic patients. As a conclusion, corneal astigmatism shifted toward against-the-rule up to 5 years after the cataract surgery continuously and affected by incision length, age of the patients, preoperative astigmatism and diabetes. Thus, surgical modifications would be considered by the patients' status.

Long-Term Astigmatic Changes in Cataract Surgery

Long term changes in corneal astigmatism after cataract surgery were evaluated. Phamemulsification with 7mm limbal incision(Group 1) was performed in 68 eyes and ECCE with 101mm limbal incision(Group 2) in 73 eyes. Follow up period was up to 5 years (mean 3.3 years), and the astigmatic change was analysed by Algebraic method. In most cases, postoperative astigmatigm was stabilized at 3 months but showed continuing against-the-rule change up to 5 years. Group 2 and above 60 years of age group showed more against-the-rule change at 5 years follw up although there was no significant differences between groups, up to 2 years. Preoperative against-the-rule group and less than 4 diopters of with-the-rule astigmatism group at 1 week postoperatively developed more against-the-rule change. Diabetic patients showed slightly more shift to against-the-rule astigmation than non-diabetic patients. As a conclusion, corneal astigmatism shifted toward against-the-rule up to 5 years after the cataract surgery continuously and affected by incision length, age of the patients, preoperative astigmatism and diabetes. Thus, surgical modifications would be considered by the patients' status.

Mitomycin C in Trabeculectomy with Cataract Extraction

We evaluated the effectiveness of combined extracapsular cataract extraction(ECCE), posterior chamber intraocullar lens implantation(PCIOL) and trabeculectomy with mitomycin C in patients with coexisting cataract and glaucoma. The charts were reviewed and compared of all patients who underwent combined procedure implantation without mitomycin C(group I) or with mitomycin C(group II) between 1990 and 1994 at Siloam Eye Hospital. A total of 44 eyes were included: 27 eyes in group I and 17 in group II. Intraocular pressure was controlled successfully in 66.6% of eyes in group I (mean IOP 15.9 +/- 6.6mmHg) and in 88.2% of eyes in group II (mean IOP 13.1 +/- 4.0mmHg). Fifteen of 27 eyes(55.6%) had a best corrected visual acuity of 20/40 or better in group I and thirteen of 17 eyes(76.5%) in group n at 6 months follow up. Complications included corneal haziness, posterior capsular opacity and encapsulated or flattened bleb in group I and shallow anterior chamber, hypotony, hyphema and bleb leakage in group II. The combined procedure with adjunctive mitomycin C appears to be a safe and effective in treating patients with coexisting cataract and glaucoma.

The Comparison between Planned Extracapsular Cataract Extraction and Phacoemulsification Lens Removal in Combined Proceducre of Glaucoma with Cataract Patients

Fourty-one glaucoma triple surgeries(Group I: combined trabeculectomy, planned extracapsular cataract extraction(P-ECCE) 27 cases and Group II: phacoemulsification and posterior chamber intraocular lens(PC IOL) implantation 14 cases) were reviewed. Preoperatively, the two groups did not differ significantly in terms of age, sex, or mean intraocular pressure(IOP). As comparaed with Group I, the Group II had earlier visual rehabilitation, and less postoperative IOP spikes(P<0.05), and needed less postoperative antiglaucoma medications. Other postoperative complications occurred more commonly in the Group I: fibrinous iritis, posterior capsular opacity, encapsulated or flattened bleb, uncontrolled IOP etc. Compared to group II, these differences probably are attitutable primarily to the small incision used in phacoemulsification, which is associated with sustained anterior chamber depth during the operation, and to the reduction of tissue dissection, reducing the stimulus to wound healing and filtration failure.

The Effect of Extracapsular Cataract Extraction Using Nucleus Dislocation into Anterior Chamber on Corneal Endothelium

The nucleus delivery method using nucleus dislocation into the anterior chamber is more safe and easier to maintain a intact lens capsule than conventional "push and pull" method when the continous circular capsulorhexis(CCC) has been performed. To investigate the effect on the corneal endothelium of nucleus dislocation method, time analysis on the changes of central corneal endothlial cell density(CECD) in two groups-extracapsular cataract extraction(ECCE) using nucleus dislocation into the anterior chamber group and a conventional ECCE group-was studied for two months. The study was performed on 18 eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and 10 eyes of 10 cataract patients who were operated on with the conventional ECCE method. Central corneal endothelial cell density(CECD) was measured using specular microscopy, preoperatively and at 1 month and 2 months of postoperation. The average postoperative endothelial cell loss at 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at 2 months postoperation was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between the two groups was not statistically significant.

The effect of extracapsular cataract extraction using nucleus dislocation into anterior chamber on the corneal endothelium

When the continuous circular capsulorhexis (CCC) is being performed, the nucleus delivery using nucleus dislocation into the anterior chamber is safer and easier than using conventional "push and pull" method to maintain an intact lens capsule. This method include such procedures that after CCC, the nucleus being freed in the capsular bag by hydrodissection and hydrodelineation, then hooked with a Sinskey hook and drawn out to the anterior chamber by rotation. It may damage the corneal endothelium because of the manipulation in the anterior chamber. To investigate an effect of this method on the corneal endothelium, we performed two months time analysis of changes of the central corneal endothelial cell density (CECD) in two groups--a group with an extracapsular cataract extraction (ECCE) using nucleus dislocation into the anterior chamber and a group with a conventional ECCE. Eighteen eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and ten eyes of 10 cataract patients who were operated on with a conventional ECCE method were included. The CECD was measured by specular microscopy, preoperatively, postoperatively at 1 month and 2 months. The average endothelial cell loss at postoperative 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at postoperative 2 months was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between two groups was not statistically significant.

Influences of Suture Materials on Corneal Astigmatism After Cataract Surgery

While advancements in microsurgical technique and suture material have led to meticulous wound closure in cataract surgery, excessive postoperative corneal astigmatism may delay visual recovery and compromise the ultimate optical outcome. Greater efforts to prevent and control surgically induced astigmatism have been made recently since the introduction and popularized use of intraocular lenses. Control of astigmatism has been attempted with intraoperative variations in the size, location, and type of incision, the selection of suture material, attention to suture depth and technique, the use of preplaced sutures to facilitate wound closure, and most recently, the application of surgical keratometers. We reviewed follow up records to evaluate and compare the influences on corneal astigmatism after extracapsular cataract extraction(ECCE) with intraocular lens implant in 100 cases of polyglactin 9l0(vicryl) group and 50 cases of polydioxanone (PDS) group, and results were as follows; 1. In planned ECCE group, mean corneal refractive power changes was -0.14D +/- 0.47 in vicryI group and -0.17D +/- 0.78 in PDS group, there was no significant correlation between two. In phacoemulsification(KPE) group, mean corneal refractive power changes was 0.05D +/- 0.49 in vicryl group and 0.27D +/- 0.82 in PDS group. There was no significant correlation between two. 2. In total group, mean corneal refractive power changes was 0.02D +/- 0.48 in vicryl group and 0.08D +/- 0.74 in PDS group. There was no significant correlation between two groups. 3. Mean power of cylindrical lens for correction of astigmatism was -0.76D +/- 0.98 in vicry I group and -0.67D +/- 0.71 in PDS group, there was no significant correlation between two.

Clinical Analysis of Glaucoma Triple Procedure of Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined with Trabeculectomy

Glaucoma triple procedure of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy which was undergone in 21 eyes(20 cases) since May 1984, were reviewed. The results as follows. 1. In the distribution of sex and age of 20 patients, 16 patients(75%) were male, and seventies, which were most common, were 9 patients(45.0%); fifties, 5; forties, 1; thirties, 1. The average age was 63.9 years old. 2. In type of glaucoma, chronic open angle glaucoma which was most common, were 14 eyes(66.7%); chronic angle closure glaucoma, 5 eyes(23.8%); aphakic glaucoma, 1 eye(4.8%); secondary glaucoma, 1 eye(4.8%). 3. Visual acuity improved in 20 eyes but unchanged in 1 eye, and 14 eyes(66.7%) achieved visual acuity 0.5 or better. 4. Preoperative mean intraocular pressure(IOP)was 20.9mmHg and postoperative mean IOP was 6.1, 4.5mmHg lower than preoperative level at 2 and 6 months res pectively. 5. 2.1 glaucoma medications was needed preoperatively and 0.7, 0.8 was needed at postoperative 2 and 6 months respectively. 6. There were no serious complications that affected the visual acuity. However minor complications were as follows. Hyphema were 4 eyes(19.0%); mydriasis, 3 eyes(14.3%); flat chamber, 1 eye(14.3%); flat chamber, 1 eye(4.8%); cystoid macular edema, 1 eye(4.8%).