Effectiveness assessment of surgical simulator-based small-incision extracapsular cataract extraction training for young ophthalmologists / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the effectiveness of surgical simulator-based small-incision extracapsular cataract extraction training for young ophthalmologists.METHODS:Prospective and controlled study. A total of 48 young participants who had completed at least 3a standardized residency training or had obtained the attending certificate in the He Eye Specialist Hospital from 2020 to 2022 were enrolled. All the participants were randomly divided into simulator surgical operation training group(experimental group, n=24)and real animal eye operation training group(control group, n=24)after passing the theoretical training and assessment of small incision extracapsular cataract extraction. The participants in the experimental group and control group were trained with the surgical simulator and pig eyes respectively. After training, the overall effectiveness of training in both groups was rated using the simulator and pig eye operation was evaluated.RESULTS: The participants in the experimental group used less time than the participants in the control group on simulator assessment(all P<0.05). The scores of injecting viscoelastics during keratonyxis, nucleus delivery and hydrate the paracentesis site steps were not different on simulator assessment between the two groups(P>0.05). For the rest of the steps, the scores of experimental group were higher than those of the control group(all P<0.05). Participants in the experimental group had significantly higher scores than control group on pig eye operation assessment(all P<0.05). In the experimental group, the scores of the scleral groove dissection, tunnel dissection, continuous circular capsulorhexis, hydrodissection and hydro-prolapse and nucleus delivery steps had no significant difference between the surgical simulator and pig eye operation(P=0.068, 0.126, 0.960, 0.520, 0.206). The scores of injecting viscoelastics during keratonyxis, tunnel puncture into anterior chamber and hydrate the paracentesis site steps were significantly lower on simulator assessment than pig eye operation(P=0.007, 0.014, <0.01). The scores of the cortex removal and intraocular lens(IOL)implantation were significantly higher on simulator assessment than eye of real animal(P=0.035, <0.01).CONCLUSION:The application of surgical simulator on training small incision extracapsular cataract extraction skills for young ophthalmologists could significantly improve their skills in cataract surgery operation, providing a new mode and idea for the establishment of standardized cataract surgery training for young ophthalmologists.

Clinical-ophthalmological profile of patients undergoing cataract surgery following their identification in screening eye camps

Background: Senile cataract constitutes about 50–70% of preventable blindness in the year 2000 in India. >3/4th of Indian populations live in rural areas which are away from medical facilities. Conducting of outreach camps forms an integral part in decreasing the visual morbidity due to cataract, etc., in rural areas, thus the unrecognized rural and poor population is benefited. Objective: The objective of this study was to see demographic and clinical-ophthalmological profile of patients undergoing cataract surgery. Materials and Methods: The present cross-sectional observational study which was conducted in a tertiary care hospital involved 72 cataract patients who were assigned to undergo extra capsular cataract extraction surgery (SICS with PC-IOL) following their identification in various screening eye camps of Jammu province. Results: The maximum prevalence was seen in the age group of >60 years, i.e., 76.39%. Males outnumbered females, i.e., 63.89%. Housewives comprised 36.11% followed by farmers who were 34.72%. About 37.5% among studied subjects were smokers and 38.89% were hypertensives while 19.44% had blood sugar level above normal value. Mature cataract was the most common seen in 72.22%. Majority of the patients, i.e., 59.72% had visual acuity of <1/60. Conclusion: Increasing age, housewives, and smoking were the most important risk factors, whereas mature type of cataract was more commonly seen in camp patients.

A comparison of vision outcome and safety between small incision non-phacoemulsification and phacoemulsification surgery for cataract in Tibet / 中华实验眼科杂志

Objective To compare and analyze the visual outcome and safety of phacoemulsification with small incision non-phacoemulsification for cataract and provide a reference for the selection of surgery methods in Tibet.Methods A prospective cohort study was performed.Eighty eyes of 80 consecutive patients with age-related cataract were included in Titet Autonomous Region Tibetan Tradition Medicine Hospital from July to August 2016.The eyes were assigned to non-phacoemulsification extracapsular cataract extraction with small incision combined with intraocular lens (IOL) implantation group (small incision group) and phacoemulsification extracapsular cataract extraction combined with IOL implantation group (phacoemulsification group),with 40 eyes for each group.The uncorrected visual outcome and complications were compared between the two groups after surgery.Results There were no significant differences in gender,age,preoperative visual acuity,and lens nuclear hardness between the two groups (all at P＞0.05).The eyes in various post-operative uncorrected visual acuity outcome was not significantly different 1 day and 5 days after surgery between the two groups (both at P＞0.05).In the fifth day after surgery,the eye number in various post-operative uncorrected visual acuity outcome was not significantly different in the eyes with grade Ⅱ and Ⅲ nuclei between the two groups (Z =0.503,P =0.478;Z =0.952,P =0.329).The eye number of acuity ≥0.5 in the small incision group was significantly more than that in the phacoemulsification group in the eyes with grade Ⅳ nuclei (Z =4.501,P =0.034).The eye number with post-operative transiently ocular hypertension was increased in small incision group compared with phacoemulsification group.Conclusions Non-phacoemulsification surgery with small incision has comparable visual outcome with phacoemulsification surgery,and small incision nonphacoemulsification surgery combined with IOL implantation can serve as the preferred surgical method in basic level medical institutions of Tibet.

Clinical observation of a triple procedure of stimultaneous penetrating keratoplasty combined with extracapsular cataract extraction and intraocular lens implantation / 眼科新进展

Objective To evaluate the operative outcomes of a triple procedure including simultaneous penetration keratoplasty (PKP),extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation,and to investigate the relationship between postoperative corneal refractive power and preoperative lens diopter.Methods This retrospective analysis study involved 15 patients who had undergone a triple procedure surgery in Beijing You'an hospital from April to October 2016.Outcomes including the best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal refractive power,axial length,postoperative complications,corneal endothelial cell counts and the survival of corneal graft were determined one year after surgery.Results All corneal grafts were transparent and corneal endothelium were (1974.20 ±472.82) cell · mm-2.The mean postoperative LogMAR visual acuity (0.80 ±0.27) had a significant improvement compared with the mean preoperative LogMAR visual acuity (2.63 ±0.62) (t =13.042,P ＜0.001).There were no statistically significant differences in preoperative IOP (15.27 ± 2.37) mmHg (1 kPa =7.5 mmHg) and postoperative data (14.53 ± 3.04) mmHg (t =0.685,P =0.505),preoperative axial length (23.69 ±2.01) mm and postoperative data (23.62 ±2.12)mm (t =-0.138,P=0.893)and preoperative keratometry (45.01 ± 1.66) D of the control eye and postoperative data (42.56 ± 5.48) D (t =1.202,P =0.260).The postoperative spherical equivalent refractive was (0.40 ±4.65) D,and the target refraction was (0.58 ±0.25)D.Conclusion The triple procedures are safe and effective for the treatment of patients with coexisting corneal pathologies and cataracts.Selection of emmetropia lens diopter may result in the satisfactory postoperative visual acuity.However,unpredictable postoperative corneal curvature changes will still affect the final refractive state.

Clinical observation of Descemet's membrane detachment after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the causes and effective diagnosis and treatment of Descemet's membrane detachment in the patients received phacoemulsification combined with intraocular lens implantation and extracapsular cataract extraction combined with intraocular lens implantation. <p>METHODS: A retrospective analysis was applied for 2 069 eyes in 2006 patients which had received one of above-mentioned surgeries from January 2015 to December 2017. The treatment and prognosis of 26 patients(26 eyes)who had the complication of Descemet's membrane detachment during or after the surgery were observed. <p>RESULTS:After the appropriate treatment, no corneal endothelial decompensation happened in the 26 patients, and the visual acuity was improved to different extent. UBM confirmed that the Descemet's membrane was reset. <p>CONCLUSION: Early detection and appropriate treatment of Descemet's membrane detachment is important for the visual acuity recovery.

Results and safety profile of trainee cataract surgeons in a community setting in East Africa.

Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO‑O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO‑Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. Results: Four hundred and fourteen patients were included in the study. Two hundred and twenty‑five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t‑test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t‑test, P < 0.001). Mean logMAR best‑corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow‑up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). Conclusion: AMO‑O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.

Resultados de tres alternativas quirúrgicas para la remoción del cristalino en el cierre angular primario agudo / Results of three surgical alternatives for the crystalline lens extraction in the acute primary angle- closure

Objetivo: evaluar la efectividad de la remoción del cristalino en el tratamiento del cierre angular primario agudo. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo de serie de casos en 27 ojos de igual número de pacientes con cierre angular primario agudo, distribuidos en tres alternativas: facoemulsificación (faco n= 7), túnel esclerocorneal (túnel n= 12) y túnel postrabeculectomía (túnel pos-TBT n= 8).Se analizaron las variables presión intraocular y número de colirios hipotensores en preoperatorio y posoperatorio a la semana, al mes, a los tres y a los seis meses, al año y a los dos años, así como las variables esfera, cilindro y agudeza visual mejor corregida en preoperatorio y a los dos años posoperatorios. Resultados: la presión intraocular posoperatoria fue estable en el tiempo en los 3 grupos (12-14 mmHg). A los dos años hubo reducción significativa de presión intraocular media en grupo túnel (3,83 ± 5,27 mmHg; p= 0,032); del número de colirios hipotensores en grupo faco (1,29 a 0,14; p= 0,038) y del grupo túnel (1,33 a 0,25; p= 0,006). Se indujo miopía en grupo túnel pos-TBT (-1,16 ± 1,12 D; p= 0,028) y astigmatismo en grupo túnel (1,00 ± 1,05 D; p= 0,016). La agudeza visual mejor corregida promedio se incrementó en los tres grupos, con significación en los grupos túnel y túnel pos-TBT (p= 0,003 y p= 0,012 respectivamente). Conclusiones: en pacientes con cierre angular primario agudo, la facoemulsificación y el túnel esclerocorneal reducen la presión intraocular y el número de colirios hipotensores en el mediano plazo de dos años, a la vez que se mantiene el poder hipotensor de una filtrante previa. Las tres variantes recuperan de manera efectiva la agudeza visual, mientras se induce el error miópico de 1 dioptría en pacientes con trabeculectomía previa y astigmatismo de 1 dioptría mediante túnel esclerocorneal(AU)

Objective: to evaluate the effectiveness of the crystalline lens extraction in the treatment of the acute primary angle-closure. Methods: prospective, longitudinal and descriptive study of a case series of 27 eyes from the same number of patients suffering acute primary angle-closure, distributed according to three alternatives: phacoemulsification (n=7, phaco), sclerocorneal tunnel (n=12, tunnel)and postrabeculectomy tunnel ( n=8, post-TBT tunnel). The variables intraocular pressure and number of hypotensive eyedrops used in the preoperative and postoperative period were analyzed a week, a month, three months, six months, one year and two years after the surgery as well as sphere, cylinder and best corrected visual acuity in the preoperative phase and two years after surgery. Results: postoperative intraocular pressure was steady in the course of time in the three groups (12-14 mmHg). Two years later, there had been a significant reduction of average intraocular pressure in the tunnel group (3.83 ± 5.27 mmHg; p= 0.032), of the number of hypotensive eyedrops used in the phaco group (1.29 to 0.14; p= 0.038) and the tunnel group (1.33 to 0.25; p= 0.006). Myopia in the post-TBT tunnel group(-1.16 ± 1.12 D; p= 0,028) and astigmatism in the tunnel group(1.00 ± 1.05 D; p= 0.016) were both induced. The best average corrected visual acuity increased in the three groups, being significant in the tunnel and the post-TBT tunnel groups (p= 0.003 and p= 0.012, respectively. Conclusions: in those patients with acute primary angle-closure, phacoemultification and sclerocorneal tunnel reduce the intraocular pressure and the number of hypotensive eyedrops to be used in 2 years-term and the hypotensive power of a previous filtering bleb. The three variants can effectively recover the visual acuity whereas the myopic error of one diopter is induced in patients with previous trabeculectomy and one diopter astigmatism through the sclerocorneal tunnel(AU)

Cataract Surgery in Asian Countries – An Overview.

Cataract, the leading cause of blindness in the world, is treated with surgery, and is the most common eye surgery performed. A PubMed search was done to review the spectrum of practice of cataract surgeries in Asian countries. Coverage for surgeries varied in different countries which depends mainly on the surgical facilities available in the region or country. Outreach programs, free surgeries and reimbursement of transport influence this. The cost of cataract surgery depends on type of cataract operation, government/private hospital, and facilities provided in the hospital, day care/in patient surgery, and economic status of people in the region/country. Phaco surgery was more expensive than extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (SICS). Intracapsular cataract extraction (ICCE) was cheaper than ECCE in India. Local anaesthesia (retrobulbar, peribulbar, subtenon and topical) is used compared to general anaesthesia. Pain was more in topical compared to regional anaesthesia though no pain was reported for phacoemulsification under topical. Several manouveres have been utilised in difficult cases to optimise the outcomes. These include invention and modification of instruments, phacodynamic settings and surgical techniques. Specific regimes for pupillary dilatation have been recommended. In Diabetics, trenching was difficult. Elimination of cotton balls reduced fibres in the anterior chamber. Innovations in intraocular lenses (IOL) are glued IOL, Artisan iris fixated IOL, intrascleral fixation of IOL with Y sutures. Visual outcomes varied based on techniques of surgeries and types of IOLs used. The advancement of techniques and instrumentation has benefited patients with cataracts by improving outcomes.

Comparison of outcomes between phacoemulsification-trabeculectomy and ECCE-trabeculectomy for cataract combined with glaucoma / 中华实验眼科杂志

Background Phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) with trabeculectomy are primary approachs for cataract combined with glaucoma.To compare the efficiency and safety between the two methods is important for the choice of surgeries.Objective This study was to compare the clinical outcomes between ECCE combined with trabeculectomy and Phaco combined with trabeculectomy.Methods A randomized controlled study was designed.Sixty-three eyes of 63 patients with cataract and glaucoma were included from January 2013 to February 2014 in Xinjiang Autonomous District Traditional Chinese Medicine Hospital under the informed consent.The patients were assigned to parallel two groups according to random number table.ECCE+intraocular lens (IOL) implantation with trabeculectomy was performed in 33 eyes of 33 patients in the ECCEteabelectomy group,and Phaco+IOL implantation with trabeculetomy was carried out in 30 eyes of 30 patients in the Phaco-trabeculectomy group.The patients were followed-up for six months.Visual acuity,intraocular pressure (IOP),astigmatic degree and complication after surgery were compared between the two groups.Results The visual acuity was obviously improved after surgery in both groups.The distribution of eyes in different vision acuities was significantly different after operation between the two groups (H =0.125,P =0.032).The IOP was (14.13 ±5.19) mmHg in the Phaco-trabeculectomy group and (15.18 ± 6.04) mmHg in the ECCE-trabeculectomy group,without significantly interclass difference among the two groups (F=3.762,P ＞ 0.05),however,the IOP were lower after surgery (Ftime =14.991,P ＜ 0.05).The postoperative astigmatic power was (1.02-± 0.44) D in the Phacotrabeculectomy group and (3.76 ± 1.53) D in the ECCE-trabeculectomy group,showing a significant reduce in the Phaco-trabeculectomy group (t =3.089,P =0.034).The incidence rates of postoperative complications were 6.67％ and 18.18％ in the Phaco-trabeculectomy group and ECCE-trabeculectomy group,respectively,with a significant difference between them (x2 =6.112,P＜0.05).Conclusions Compared to the ECCE+IOL implantation with trabeculectomy,Phaco + IOL implantation with trabeculectomy for cataract combined with glaucoma shows better clinical effectiveness,less complications and lower astigmatic power.

Comparison of the clinical effect of phacoemulsification and middle incision extracapsular cataract extraction / 国际眼科杂志(Guoji Yanke Zazhi)

To compare the clinical effect of phacoemulsification and middle incision extracapsular cataract extraction ( Ml-ECCE) . METHODS: One hundred and eighty - five eyes of phacoemulsification (137 cases) and 185 eyes of 139 cases for Ml-ECCE from January 2011 to May 2013 were involved in this study. And the ratio posterior capsular rupture during surgery, visual acuity, corneal edema, corneal astigmatism and intraocular pressure post operation were followed up.RESULTS: On 1d after surgery, uncorrected visual acuity in the group of Ml-ECCE was better than that of phacoemulsification group, while from 3d; 1 and 3mo after surgery, no significant difference was found from the above two groups. On 1d postoperation, corneal edema ratio in phacoemulsification group ( 45 eyes ) was higher than that in Ml-ECCE group(20 eyes) ( X2=11. 665, P=0. 0006 ) . No significant difference was found for the ratio of posterior capsule rupture during surgery in these two surgical technique groups(X2=0. 094,P=0. 759). On 1wk;1 and 3mo after surgery, significant difference was found for the average of surgical induced corneal astigmatism between two groups (u=6. 661, 6. 880, 4. 187, P = 0. 00, respectively ). During following up, no significant difference was found for the intraocular pressure between two groups ( u=1. 858, 0. 963, 0. 471, 1. 349, 1. 388; P= 0. 063, 0. 335, 0. 638, 0. 177, 0. 165). lntraocular pressure on 1d postoperation in phacoemulsification and Ml-ECCE groups was higher than before operation ( u = 19. 86, 19. 39, P = 0. 00, respectively). And on 1wk; 1 and 3mo postoperation, intraocular pressure in the operated eyes in both groups was lower than before operation for 2~3mmHg.CONCLUSlON: Although phacoemulsification and Ml-ECCE could both get good visual rehabilitation, with similar visual outcome, no significant effect for intraocular pressure, and no severe complications, the latter one owns the advantage that easier maneuver, quicker recovery, and cheaper instruments needed, which is suitable for the hard nuclei cataract in local hospitals. Ml-ECCE is a safe, effective and easy manipulation for local hospital for large batch of cataract surgeries.

AppIication of smaII incision extracapsuIar cataract extraction combined with intraocuIar Iens impIantation in bIindness prevention and treatment / 国际眼科杂志(Guoji Yanke Zazhi)

· AlM: To investigate clinical therapeutic effect and safety of small incision extracapsular cataract extraction combined with intraocular lens implantation in blindness prevention and treatment. · METHODS: Clinical data of 425 patients with cataract (425 eyes) were analyzed retrospectively, who received small incision extracapsular cataract extraction combined with intraocular lens implantation in the No.413 Hospital of Chinese PLA, with the help from “handicapped rehabilitation engineering in Dinghai District of Zhoushan City” from September 2013 to August 2014.Visual acuity before and after operation, average corneal curvature, corneal astigmatism and intraoperative and postoperative complications were compared statistically and analyzed emphatically. ·RESULTS: ln all of the 425 patients with cataract (425 eyes) , the preoperative best corrected visual acuity of 99 patients were less than 0.05, and the other 326 patients were 0.05 to 0.3.Classification of lens nucleus hardness:level Ⅲ, 63 cases; level Ⅳ, 257 cases; and level Ⅴ, 105 cases.The preoperative average corneal curvature and corneal astigmatism of all patients were 44.6 ±1.52D and 1.35±0.96D.All the 425 patients underwent small incision extracapsular cataract extraction combined with intraocular lens implantation.Postoperative follow-up of 3mo results: the best corrected visual acuity: 5 cases were less than 0.05 (blindness-free rate 98.8%);8 cases were 0.05 to · CONCLUSlON: lt is effective and safe to apply small incisionextracapsular cataract extraction combined with intraocular lens implantation in blindness prevention and treatment, and it gives excellent visual rehabilitation to cataract patients.Especially in those areas and hospitals having no condition of phacoemulsification, it’s a safe and effective alternative when carrying out the program of blindness prevention and treatment.

Application on small incision extracapsular cataract extraction in large - scale vision recovery action in Shaanxi Province / 国际眼科杂志(Guoji Yanke Zazhi)

To investigate the characteristics of scale cataract operations and the effects and experiences of small incision extracapsular cataract extraction with intraocular lens ( lOL) implantation in large - scale vision recovery action. ●METHODS: Four thousand eight hundred ninety - two cases ( 4892 eyes ) of cataract were treated by small incision non-phacoemulcification cataract extraction from March 2010 to November 2011 in our hospital ( Fuming No. 1 surgery car of Shaanxi Province ) which were retrospectively analyzed. Visual acuity, intraoperative and postoperative complications, the recovery of postoperative inflammation were observed. ●RESULTS: Visual acuity reached 0. 3 or more in 4521 eyes (92. 42%) at 1d after the operation, at 3d after the operation in 4571 eyes (93. 44%), there were 4887 eyes with lOL implantation, implantation rate was 99. 90%. All the cases had lesser intraoperative and postoperative complications, and the postoperative inflammation recovered quickly. ●CONCLUSlON: Small incision extracapsular cataract extraction with lOL implantation is simple, effective, economical, safe and adapting for large - scale vision recovery action.

The temerloh hospital cataract complications study:factors associated with, types and outcomes of cataract surgery complications / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the prevalence of complications of cataract surgery and any association between the occurrence of complications and experience of surgeon, type of surgery, type of anaesthesia and visual outcome.METHODS: This was a retrospective study of patients who underwent cataract surgery over a period of two years in a district hospital in Malaysia. The demographic details of patients, type of surgery done, as well as type of anaesthesia used and experience of the surgeon were noted. The types of intraoperative and postoperative complications were recorded. The final best corrected visual outcome was recorded. RESULTS:Complications occurred in 11. 1% of the total 1007 patients operated. Posterior capsule rupture (3. 6%) was the most common complication. The experience of the surgeon and the type of anaesthesia used did not affect complications during surgery. Intracapsular cataract extraction ( ICCE ) and phacoemulsification converted to extracapsular cataract extraction ( ECCE ) were significantly associated with more complications ( P CONCLUSION: The occurrence of complications during cataract surgery significantly affected the visual outcome. The type of surgery done was associated by the occurrence of complications. However, the experience of the surgeon and the type of anaesthesia used did not affect the occurrence of complications. We recommend that particular attention be given to ICCE and phacoemulsification converted to ECCE to minimise the complications and thereby reducing the chances of poor vision postoperatively.

Application on improved small incision extracapsular cataract extraction in the sight-regaining program / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinic efficacy and operation safety of improved small incision extracapsular cataract extraction in the sight-regaining program. METHODS: Totally 82 cases ( 82 eyes ) included in the sight-regaining program of the cataract patients were underwent small incision extracapsular cataract extraction conbined with improved technology ( anterior capsule staining, continuous curvilinear capsulorhexis, auxiliary incision ) , postoperative visual recovery and operative complications were observed. RESULTS: Postoperative visual acuity: uncorrected visual acuity when out of hospital: ≥0. 3 were 67 cases (82%);1wk after dismissed from hospital:≥0. 3 were 76 cases (93%), admist which ≥0. 8 were 45 cases (55%). There is no serious complication such as posterior capsule rupture, zonular dialysis, etc. in the operation.CONCLUSION: Combined use of improved technology can increase operation safety of small incision extracapsular cataract extraction.

A Case of Corneal Burn During Phacoemulsification

PURPOSE: To report a case of severe corneal burn during phacoemulsification that was successfully managed with a second operation and medical treatment. CASE SUMMARY: An 89-year-old female had phacoemulsification of a mature cataract in her right eye, and was transferred to our outpatient clinic after development of a thermal burn at the corneal incision site. On initial examination, visual acuity was light perception and slit-lamp examination revealed diffuse, severe corneal edema, and a 3.0 x 3.0 mm-sized epithelial defect with severe stromal opacity around the incision site. Extracapsular cataract extraction through superior scleral incision was performed with posterior chamber implantation of a 3-piece hydrophobic acrylic intraocular lens (IOL). Topical steroids as well as hypertonic saline were used to manage corneal edema postoperatively. One month postoperatively, her best corrected visual acuity was 0.06 and slit-lamp examination showed markedly decreased corneal edema and epithelial defect. Three months postoperatively, her best corrected visual acuity was 0.2, the IOL was centered in the capsular bag, and corneal edema nearly disappeared with remnant moderate corneal opacities. CONCLUSIONS: We report successful treatment of severe corneal burn during phacoemulsification managed with extracapsular cataract extraction through scleral incision and medical treatment.

Clinical research of small incision extracapsular cataract extraction / 中国医师进修杂志

Objective To explore the clinical effect of small incision extracapsular cataract extraction combined with implantation of artificial lens and phacoemulsification combined with implantation of artificial lens for patients with cataract.Methods One hundred and ten patients (142 eyes) with cataract were selected,55 patients (69 eyes) were treated with small incision extracapsular cataract extraction combined with implantation of artificial lens (observation group),and 55 patients (73 eyes) were treated with phacoemulsification combined with implantation of artificial lens (control group).After treatment,the corrected vision and quality of life were observed 1-week,1-and 3-month after operation,and the complications were recorded.Results The vision 0.6-1.0 of 1-week,1-and 3-month in observation group were 34 eyes (49.3％,34/69),61 eyes (88.4％,61/69) and 63 eyes (91.3％,63/69) respectively,in control group were 37 eyes (50.7％,37/73),64 eyes (87.7％,64/73) and 65 eyes (89.0％,65/73) respectively,there were no statistical differences (P ＞0.05).The quality of life score 1-week,1-and 3-month in observation group were (87.5 ± 10.7),(91.2 ± 5.3),(94.3 ± 5.8) scores respectively,in control group were (85.9 ± 11.5),(90.6 ± 6.7),(94.5 ± 6.0) scores respectively,there were nostatistical differences (P ＞ 0.05).The rate of complications in observation group was 23.2％ (16/69),in control group was 37.0％ (27/73),there was statistical difference (P ＜ 0.05).Conclusions The vision recovery and quality of life in cataract patients treated with small incision extracapsular cataract extraction combined with implantation of artificial lens are similar to treated with phacoemulsification combined with implantation of artificial lens.However,with fewer complications,small incision extracapsular cataract extraction combined with implantation of artificial lens is a more safe and reliable treatment method.

Late-Onset Bleb-Related Endophthalmitis Following Extracapsular Cataract Extraction

Bleb-related infective endophthalmitis is an uncommon but serious complication more commonly associated with glaucoma-filtering surgery. However, blebs can also result from other intraocular surgery, including extracapsular cataract extraction (ECCE) surgery. This report illustrates a case of infective endophthalmitis from an extracapsular cataract extraction bleb. Immediate treatment with intravitreal antibiotics is essential, but may still result in a poor visual outcome.

Effect of kistrin on expression of collagen type IV in lens posterior capsule / 中华实验眼科杂志

BackgroundThe proliferation of lens epithelial cellsLECs) following extracapsular cataract extraction is the biological basis of posterior capsular collagen and cataract formation.Disintegrin is certified to competitively bind the integrin with extracellular matrix and therefore prevent the posterior capsular opacification (PCO).But,its molecular mechanism is below understand.ObjectiveThe present study was to investigative the effects of disintegrin (kistrin) on the expression of collagen in lens posterior capsular.MethodsThe right eyes of 24 New Zealand white rabbits received transparent lens extracapsular enudeation and were randomly divided into two groups using random number table,0.2 ml of kistrin ( 80 mg/L) was intracapsularly injected at end of the operation in 12 eyes ( kistrin group) and the same volume of normal saline solution was used at the same way in other 12 operative eyes ( normal saline group).The PCO was graded in postoperative 1,3,5,7,14 days on Odrich' s criteria under the slit lamp.The lens section was prepared at 14 days and 3 months after operation.Haematoxylin and eosin stain was used to examine the proliferation of LECs in posterior capsule; Masson stain was used to observe the collagenous fiber formation in capsule bag,and the expression of collagen type Ⅳ was detected by immunochemistry.Results No significant difference in the number PCO eye was found in postoperative 14 days between normal saline group and kistrin group ( P =0.093 ).However,the eye numbers of 2-3 grades of PCO were significant increased in normal saline group compared with kistrin group in 1,2,3 months after operation( P=0.041,0.014,0.022).In the operative 14 days,staining and adhesion of LECs in posterior capsule were more in normal saline group than kistrin group,and the fibrocytes in capsule were evidently increased in normal saline group in 3 months.Masson stain certified that the blue stain was seen to be stronger and more in posterior capsule in normal saline group in comparison with kistrin group in 3 months after operation,and the immunochemistry showed that the gray values of collagen type Ⅳ in posterior capsule were significant lower in normal saline group compared with kistrin group in both 14 days and 3 months after operation (P=0.000,0.001 ).ConclusionsKistrin can suppresses the proliferation of LECs and collagen type Ⅳ on rabbit lens posterior capsular after transparent lens extracapsular enudeation.

Phacoemulsification versus extracapsular extraction: governmental costs

PURPOSE: To evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country. METHODS: A prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques. RESULTS: Of the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated. CONCLUSION: Under the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

Cost-effectiveness analysis of cataract surgery with intraocular lens implantation: extracapsular cataract extraction versus phacoemulsification.

A randomized single blinded clinical trial to compare the cost-effectiveness of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) from March 2000 until August 2001. The cost of a cataract surgery incurred by hospital, patients and households were calculated preoperatively, one week, two months (for both techniques) and six months (for ECCE only). Effectiveness of cataract surgery was assessed using Visual Function 14 (VF-14), quality of life measurement specifically for vision. The cost analysis results from each 50 subjects of ECCE and PEA group showed that average cost for one ECCE after six months post-operation is USD 458 (± USD 72) and for PEA is USD 528 (± USD 125). VF-14 score showed a significant increased after a week, two months and six months post-operation compared to the score before operation for both techniques (p<0.001). However, there was no significant difference between them (p = 0.225). This study indicated that ECCE is more cost effective compared to PEA with cost per one unit increment of VF-14 score of USD 14 compared to USD 20 for PEA.