Comparison of clinical outcomes of Eyecryl toric and Alcon toric intra-ocular lenses – A real world study

Purpose: To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra?ocular lenses (IOLs). Methods: This retrospective, observational study included 143 eyes of 141 patients who underwent phaco?emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post?op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed. Results: The mean pre?op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post?op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post?op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post?op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02). Conclusion: Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post?operative outcomes in terms of UCVA and residual astigmatism. The post?op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group

Phaco-handpiece used as a Fragmatome for managing nucleus drop

Background: Nucleus drop during cataract surgery is a dreaded complication and requires urgent vitreo?retinal intervention which is managed commonly using a fragmatome. However, a fragmatome is not readily available in routine ophthalmology set?ups because its use is very limited. On the other hand, a phaco?probe is commonly available with all surgeons and makes it cost?effective. Purpose: The purpose is to demonstrate the utility of a phaco?probe as an alternative to a fragmatome in managing nucleus drop during cataract surgery, making it cost?effective and less time?consuming and simple. Synopsis: The video shows two cases of complicated cataract surgery in which a nucleus is dropped in the vitreous cavity. The sleeve of the phaco?probe was removed, and infusion was disconnected to make it function as a fragmatome. We noted reduced lenticular repulsion from the phaco?handpiece tip as compared to the fragmatome, and no scleral burns were observed. The cases were completed by secondary placement of an intra?ocular lens in the sulcus in the same sitting. Thus, the phaco?probe can be considered to manage nucleus drop in the absence of a fragmatome. Highlights: A phaco?probe can be used as an alternative to a framgamtome, which is a cost?effective and simple technique.

A comparative analysis of surgical outcome in uveitic and non-uveitic steroid–induced glaucoma in children

Purpose: To compare outcomes of surgical management of uveitic glaucoma (UG) and steroid?induced glaucoma (SIG) in children in terms of intraocular pressure (IOP) control, visual acuity, and associations for failure. Methods: This was a retrospective case–control study of consecutive UG (cases) and non?uveitic SIG (controls) in children <18 years of age who underwent surgery between January 2005 and December 2017. Results: Primary trabeculectomy with mitomycin C (MMC) was performed in 12 cases (mean age: 9.2 ± 4.3 years) and 40 controls (mean age: 10.4 ± 3.7 years) (P = 0.33). Primary phaco?trabeculectomy with MMC was performed in 11 cases (mean age: 11.4 ± 4.7 years) and 16 controls (mean age: 10.4 ± 3.4 years) (P = 0.57). IOP control (P = 0.26), visual acuity (P = 0.97), number of glaucoma medications (P = 0.06), and survival rates (49% cases vs. 68% controls at 5 years; P = 0.22) were similar between the two groups following trabeculectomy. Survival rates in the phaco?trabeculectomy group at 5 years were 68% cases vs. 69% controls (P = 0.71). IOP was higher (P = 0.008) and visual acuity was worse (P = 0.02) in cases at the last visit. Associations for failure (univariate analysis) were younger age (OR: 6.29, 95% CL: 1.43, 27.67; P = 0.03) and male gender (OR: 4.79, 95% CL: 1.09, 20.97; P = 0.04). On multivariate analysis, younger age (OR: 11.985, 95% CL: 1.071, 134.153; P = 0.04) remained significant. Preoperative number of uveitic attacks was protective on univariate (OR: 0.75, 95% CL: 0.48, 1.15; P = 0.1) and multivariate analyses (OR: 0.49, 95% CL: 0.24, 0.09; P = 0.04). Conclusion: Outcomes of trabeculectomy between cases and controls were similar in our series. However, phaco?trabeculectomy in pediatric uveitic eye group fared worse than eyes with SIG.

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Ologen implant versus mitomycin C in combined trabeculectomy and phacoemulsification

Purpose: To comparatively evaluate in Indian eyes with coexisting cataract and primary open?angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy. Methods: Eyes with primary open?angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty?four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology. Results: In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 � 2.89 mm Hg with MMC and 14.56 � 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed. Conclusion: MMC and Ologen are both effective adjunctives in combined phaco?trabeculectomy. However, the Ologen implant provides better bleb health and safety

Clinical study of posterior capsular opacification after cataract surgery in diabetic patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the incidence and risk factors of posterior capsular opacification(PCO)after cataract surgery in diabetic patients.<p>METHODS: Clinical data of 182 cases(203 eyes)who underwent cataract phacoemulsification combined with intracellular lens implantation in our hospital from April 2016 to August were collected. The patients were divided into diabetic group(DM group, 98 eyes)and non-diabetic group(non-DM group, 105 eyes)according to whether they had diabetes before operation. DM group were divided into groups according to whether PCO occurred 30mo after cataract surgery, 26 eyes in the PCO group, and 72 eyes in non-PCO group. The incidence and grading of PCO in the DM group and the non-DM group were compared. The effects of preoperative diabetic course, HbA1c level and the presence of diabetic retinopathy on PCO in DM group were tested.<p>RESULTS: The incidence of PCO was 10.2%, 14.3%, 22.4%, 26.5% at 12, 18, 24 and 30mo in the DM group and 2.8%, 4.8%, 10.5%, and 14.3% in the non-DM group. Two groups of patients with the degree of PCO are gradually increasing, and the degree of each point in time the PCO patients with DM group were heavier than patients without DM group(all P<0.05). There were differences in the preoperative course of diabetes and the presence of DR between PCO and non-PCO groups(P<0.05), but there was no difference in the preoperative level of HbA1c(P>0.05).<p>CONCLUSION: The incidence of PCO in diabetic patients after cataract surgery was higher than that in non-diabetic patients, and the degree of opacity was more severe. Preoperative course of diabetes and the presence of DR were risk factors for PCO.

Cirugía facorrefractiva en la alta miopía y sus complicaciones / Phaco-refractive surgery in high myopia and its complications

La miopía es un grave problema de salud pública por su alta y creciente prevalencia en distintas áreas geográficas. La cirugía facorrefractiva consiste en la extracción del contenido transparente o esclerosado del cristalino y el implante de una lente intraocular, con el objetivo posoperatorio de alcanzar o acercarse a la emetropía. Ha demostrado un resultado predecible y estable en el tiempo, pero no está exenta de complicaciones. Se presenta un paciente de 44 años de edad con antecedentes de oftalmológicos de miopía elevada, glaucoma secundario y cirugía facorrefractiva en ambos ojos, refracción dinámica de -3,50-100 x 200 con agudeza visual mejor corregida de 0,8 por cartilla de Snellen en el ojo derecho y -5,25 -1,25 x 1600 con agudeza visual mejor corregida de 0,6 en el ojo izquierdo. En el examen biomicroscópico se observó afaquia quirúrgica, opacidad de la cápsula posterior con capsulotomía láser central amplia y presencia de vítreo en la cámara anterior en ambos ojos con cifras de tensión ocular elevadas. Se realizó implante secundario de lente intraocular en ambos ojos. La refracción dinámica a los 3 meses fue para el ojo derecho de: -0,50 -0,50 x 400 con agudeza visual mejor corregida de 0,9 por cartilla de Snellen y para el ojo izquierdo de: -1,00 -0,75 x 1600 con agudeza visual mejor corregida de 0,6 por cartilla de Snellen. A los dos años presentó desprendimiento de retina subclínico en el ojo derecho, que fue tratado con terapia láser, y daño glaucomatoso en el ojo izquierdo. Se le realizó trabeculectomía, trabeculoplastia selectiva láser y posteriormente implante de drenaje valvulado en el ojo izquierdo(AU)

Myopia is a serious public health problem, due to its high and increasing prevalence in various geographic regions. Phaco-refractive surgery consists in extraction of the clear or sclerosed content of the crystalline lens and implantation of an intraocular lens with the postoperative objective of achieving or approaching emmetropia. The procedure has shown to obtain predictable results stable in time, but it is not exempt from complications. A case is presented of a male 44-year-old patient with an ophthalmologic history of high myopia, secondary glaucoma and phaco-refractive surgery in both eyes, dynamic refraction of -3.50-100 x 200 with best corrected visual acuity of 0.8 on the Snellen chart in the right eye and -5.25 -1.25 x 1600 with best corrected visual acuity of 0.6 in the left eye. Biomicroscopic examination found surgical aphakia, posterior capsule opacity with large central laser capsulotomy, presence of vitreous in the anterior chamber of both eyes and high ocular pressure values. Secondary intraocular lens implantation was performed in both eyes. Dynamic refraction at three months was -0.50 -0.50 x 400 for the right eye with best corrected visual acuity of 0.9 on the Snellen chart, and -1.00 -0.75 x 1600 for the left eye with best corrected visual acuity of 0.6 on the Snellen chart. At two years the patient experienced subclinical retinal detachment in the right eye, which was treated with laser therapy, and glaucomatous damage in the left eye, for which the treatment indicated was trabeculectomy, selective laser trabeculoplasty, and then valved drainage implantation in the left eye(AU)

Complicaciones posoperatorias inmediatas en pacientes diabéticos tipo 2 operados de catarata por la técnica de facochop / Immediate postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery

Objetivo: Describir la posible presencia de complicaciones posoperatorias en pacientes diabéticos tipo 2, operados de catarata por la técnica de facochop. Métodos: Se realizó un estudio observacional, descriptivo, y longitudinal prospectivo, con 128 pacientes diabéticos (168 ojos) operados de catarata en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre septiembre del año 2017 y diciembre de 2018. Las variables clínicas y epidemiológicas objeto del estudio fueron la edad, el sexo, el color de la piel, la queratometría, la profundidad de la cámara, la longitud axial, la dureza del cristalino, la presión intraocular pre- y posoperatoria y las complicaciones posoperatorias en las primeras 72 horas. Resultados: En el estudio predominaron las mujeres (63,3 por ciento), de piel blanca (74,2 por ciento), quienes presentaron ojos biométricamente normales, con una diferencia estadísticamente significativa. La presión intraocular aumentó a las 24 horas de la cirugía. De los 128 pacientes diabéticos tipo 2 operados de catarata senil por la técnica de facochop, se pudo determinar que el promedio y la desviación estándar de la edad se ubicaron en los 69,49 ± 8,96 años, y osciló entre los 50 y 88 años. Conclusiones: Las complicaciones posoperatorias más frecuentes son el edema corneal y la uveítis. Es significativamente más probable encontrar la uveítis posquirúrgica en pacientes menores de 70 años, y el edema corneal en quienes sobrepasan esta edad(AU)

Objective: Describe the possible presence of postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery. Methods: An observational prospective longitudinal descriptive study was conducted of 128 diabetic patients (168 eyes) undergoing cataract surgery at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2017 to December 2018. The clinical and epidemiological variables analyzed were age, sex, skin color, keratometry, chamber depth, axial length, crystalline hardness, pre- and postoperative intraocular pressure, and postoperative complications in the first 72 hours. Results: A predominance was found of women (63.3 percent) of white skin color (74.2 percent) and biometrically normal eyes, with a statistically significant difference. Intraocular pressure rose 24 hours after surgery. Mean age and standard deviation were 69.49 ± 8.96 years, range of 50-88 years, in the 128 type 2 diabetic patients undergoing senile cataract surgery by the phaco chop technique. Conclusions: The most common postoperative complications are corneal edema and uveitis. It is significantly more probable to find postsurgical uveitis in patients aged under 70 years and corneal edema in patients aged over 70 years(AU)

Application of different phacoemulsification and chopping techniques in hard nuclear cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy of bevel-up phaco chop versus bevel-down phaco drill in the treatment of hard nuclear cataract and the influence on corneal endothelium.<p>METHODS: Between August 2018 and April 2020, 94 patients(104 eyes)with hard(grade Ⅳ-Ⅴ)nuclear cataract treated with phacoemulsification were enrolled in this retrospective study. Among them, 50 eyes treated by bevel-up phaco chop were included in the control group, while 54 eyes treated by phaco drill technique were included in the observation group. The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter in the two groups were recorded. The best corrected visual acuity(BCVA)in 7d, corneal endothelial cell count in 2mo, the proportions of normal hexagonal cells and the degree of corneal edema in 7d were compared between the two groups.<p>RESULTS: The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter of the observation group were shorter and lower than those of the control group(<i>P</i><0.05). The BCVA of both groups increased after operation, and the observation group had higher BCVA than the control group at the same time(<i>P</i><0.05). In 1 and 2mo, the corneal endothelial cell counts and the proportions of normal hexagonal cells in both groups were lower than those before operation. Meanwhile, the corneal endothelial cell count and the proportions of normal hexagonal cells in the observation group were higher than those in the control group(<i>P</i><0.05). Besides, corneal edema was milder in the observation group than in the control group at 24h and 7d after operation(<i>P</i><0.05).<p>CONCLUSION: Compared with bevel-up phaco chop, phaco drill can significantly shorten the time of using ultrasound, reduce ultrasound energy, promote visual recovery, and reduce corneal endothelial cell damage.

Comparison of press-and-chop and Nagahara phaco-chop phacoemulsification nucleotomy techniques / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.<p>METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.<p>RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s <i>vs</i> 22.87(18.36, 27.38)s, <i>P</i><0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm² <i>vs</i> 1957.94±280.54/mm², <i>P</i><0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)<i>vs</i> 0.22(0.16, 0.28), <i>P</i><0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(<i>Z</i>=13.195, <i>P</i>=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(<i>Z</i>=-0.48, <i>P</i>=0.63).<p>CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.

Influencing factors of curative effect of PHACO combined with intraocular lens implantation in the treatment of high myopia with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze influencing factors of the curative effect of phacoemulsification(PHACO)combined with intraocular lens implantation in the treatment of high myopia with cataract.<p>METHODS: The clinical data of 80 cases patients(91 affected eyes)with cataract and high myopia who underwent phacoemulsification and intraocular lens implantation in the hospital from February 2016 to March 2019 were analyzed retrospectively. According to the best corrected visual acuity(BCVA)at 3mo after operation, the patients were divided into low vision group(BCVA<0.3)and normal group(BCVA≥0.3). The preoperative clinical data of the two groups were compared, and the factors affecting visual recovery were analyzed.<p>RESULTS: All patients completed surgery successfully, and there were statistically significant differences in BCVA before and after surgery(<i>P</i><0.001). No serious complications such as corneal decompensation, secondary glaucoma and intraocular lens displacement were found. There were significant differences in age, myopia time, axial length, preoperative intraocular pressure, corneal astigmatism, anterior capsular opening area, central anterior chamber depth, grade of lens nucleus and incidence rates of diabetic retinopathy, posterior scleral staphyloma, macular degeneration and postoperative macular edema between the low vision group and the normal group(<i>P</i><0.05). Multivariate Logistic regression analysis showed that axial length >30 mm, preoperative intraocular pressure ≥21mmHg, corneal astigmatism ≥1.30D, grade Ⅲ-Ⅳ lens nucleus, preoperative diabetic retinopathy and macular degeneration were the independent risk factors for postoperative visual recovery in patients with high myopia and cataract(<i>P</i><0.05).<p>CONCLUSION: PHACO combined with intraocular lens implantation is markedly effective in the treatment of high myopia with cataract. However, the curative effect is affected by axial length, preoperative intraocular pressure, corneal astigmatism, grade of lens nucleus, preoperative diabetic retinopathy and macular degeneration, which deserves attention.

Clinical Evaluation of Patients Undergoing Phacoemulsification for Dry Eye

Background: “Dry eye” is a multifactorial disease of tears and ocular surface that can be result from aqueous deficiency ormay be evaporative in nature. Dry eye affects individuals worldwide. Long-term epidemiological studies have shown that theincidence rates among the population between ages 43 and 86 years at 5 and 10 years of follow-up to be 13.3% and 21.6%,respectively.Aim of the Study: The aim of the study was to assess the incidence and severity pattern of dry eye among patients who haveundergone phacoemulsification.Materials and Methods: A total of 152 patients undergoing phacoemulsification for matured cataracts in the Department ofOphthalmology of KMCT Hospital were included in this study. The incidence of dry eye on day 7 after phacoemulsificationwas assessed using the ocular surface disease index (OSDI) questionnaire. Tear breakup time (TBUT), fluorescein stainingwith Oxford Schema, and Schirmer I test without anesthesia were performed after the questionnaire. The TBUT measures theinterval between the last complete blink and the first appearance of a dry spot or disruption of the tear film.Observations and Results: Among 152 subjects, there were 97 male patients (63.81%) and 55 (36.18%) female patientswith a male to female ratio 1.76:1. The mean age was 57.13 ± 9.50 years. The eldest patient was aged 78 years. On day 7postoperatively, the mean scores of OSDI questionnaire (preoperatively vs. postoperatively was 12.57 vs. 35.10, respectively),TBUT (preoperatively vs. postoperatively was 15.85 ± 1.25 s vs. 13.9 ± 0.70 s), Oxford Schema (preoperatively vs. postoperativelywas Grades 1 vs. 2), and Schirmer I without anesthesia (preoperatively vs. postoperatively was 22.10 ± 5.44 mm at 5 min[15–35 mm] vs. 7.50 ± 2.20 in 55.30% [6.10–9.05], respectively) showed a trend toward dry eye syndrome during the 1st week.Conclusions: Dry eye symptoms can develop immediately after phacoemulsification and the severity can peak on day 7. Bothsymptoms and signs of dry eye can improve over time. However, it is important that ophthalmologists assess dry eye beforeand after phacoemulsification to ensure proper treatment, quality of vision, and quality of life for their patients

Phaco-EX-PRESS for refractory open-angle glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the effect of phaco-EX-PRESS for refractory open-angle glaucoma with cataract.<p>METHODS: Totally 66 patients(67 eyes)with refractory open-angle glaucoma and cataract were selected.There were 34 eyes in the phaco-EX-PRESS and 33 eyes in the phacotrabeculectomy. Preoperative best corrected visual acuity(BCVA)and intraocular pressure(IOP), intraoperative complications, operation time, postoperative BCVA and IOP, postoperative complications were observed. The follow-up time were 1d, 1wk, 1mo, 6mo and 1a.<p>RESULTS: The operation time in experimental group was 23.26±2.00min, while the control group was 31.73±2.17min. The difference between the two groups was statistically significant(<i>t</i>=16.68, <i>P</i><0.01). In the experimental group, superficial anterior chamber and filtering bubble scar occurred in 1 eye each. In the control group, low IOP occurred in 3 eyes, anterior chamber hemorrhage and choroid detachment in 1 eye and filtering bubble scar in 5 eyes.There was no statistically significant difference in follicular Kronfeld classification(<i>Z</i>=-0.775, <i>P</i>=0.438). Intervention factors and time in both groups had an effect on postoperative IOP. Intervention factors had no effect on postoperative visual acuity, and the difference in postoperative visual acuity between the two groups was statistically significant.<p>CONCLUSION: Phaco-EX-PRESS for the refractory open-angle glaucoma combined with cataract is safe and effective, and the operation time is shorter, so it can be used as a conventional combination surgery.

Combined cataract extraction with a new nonvalved glaucoma drainage device in adult eyes with cataract and refractory glaucoma

Purpose: The purpose of the study is to report the outcomes of simultaneous cataract extraction (CE) and a new nonvalved glaucoma drainage device (GDD), Aurolab Aqueous Drainage Implant (AADI), in eyes with cataract and refractory glaucoma. Methods: This was a non-comparative, interventional, retrospective study. Consecutive patients who underwent AADI together with phacoemulsification from June-2015 to January-2017 by a single fellowship trained glaucoma surgeon with documented 3-months of follow-up were included. The main outcomes were intraocular pressure (IOP), antiglaucoma medication (AGM), visual acuity, and complications. Results: We included 19 eyes of 17 patients with average follow-up of 14.4 ± 8.4 months. IOP and AGM reduced from 36.9 ± 11.1 mmHg and 4 ± 0.8 preoperatively to 12 ± 4.5 mmHg and 0.8 ± 1.2, respectively (P < 0.001). Complications were seen in seven eyes (36.8%). Total success was seen in 17 eyes (89.5%). None of the patients lost vision. Conclusion: Combining cataract extraction with the new non-valved Aurolab Aqueous Drainage Implant, appears to be an effective and safe technique in eyes with refractory glaucoma and cataract. Larger studies and further follow-up is recommended for such patients.

Comparison of endolaser or cryotherapy on capsule contraction syndrome after phaco - vitrectomy surgery for rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the influence of endolaser or cryotherapy on capsule contraction syndrome (CCS) following phaco - vitrectomy and intraocular lens implantation in patients with rhegmatogenous retinal detachment. ·METHODS: A total of 244 eyes were enrolled in this retrospective analysis. The surgical approach was standard vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation simultaneously. There were 198 eyes underwent endolaser and 46 eyes underwent cryotherapy during the surgery. The main outcome measures were postoperative clinical outcomes including anatomical position of retina, the capsules and the position of IOLs and best corrected visual acuity (BCVA) at 1d,1wk,1,2,3,6mo and 1a. ·RESULTS: There were 6 eyes (3.0%) of CCS occurred in endolaser group and 5 eyes (10.9%) of CCS occurred in cryotherapy group. The different procedures during the surgery were significantly associated with the incidence of CCS (odds ratio:0.256,P=0.021,95% Cl:0.075-0.880). ·CONCLUSION: Different procedures during phaco -vitrectomy surgery are significantly associated with the incidence of CCS. Endolaser is more beneficial than cryotherapy in preventing CCS following phaco -vitrectomy and intraocular lens implantation.

LENS SURGERY IN THE NEW MILLENNIUM / Шинэ санаа Шинэ нээлт

@#BACKGROUND. The study was my doctoral thesis under supervision of Prof. Dr. BenoneCarstocea - Head of Romanian Ophthalmologist Society, Head of Central Military Hospital- Department of Ophthalmology and the Head of the vitreo-retinal surgeon’s society, within 2004-2008 and it was held in October 2010 in Bucharest. The thesis included two parts; theoretical part is comprehensive and major literature review by that time and personal part is analysis of all factors such as surgical methods, techniques, IOLs, OVDs development which have direct impact on final achievement of cataract surgery. MATERIAL AND METHODS. Personal research part is retrospective and cohort study combination, performed between 2004-2008 in the Ophthalmology clinic of Central Military Hospital, Bucharest. In total 12.042 cases were analyzed; 11.548 surgical cases from Central Military Hospital and 494 surgical cases from private eye clinic “Laser Optics”. As surgical methods followings were studied and all aspects compared; using ultrasound is high energy or hot phacoemulsification method and cold methods or modern, low energy phacoemulsification methods such as UltraSonic phacoemulsification, AquaLase, Endolaser Vortex Phacoemulsification and PhacoLaser. Due to lower level of energy it brings some additional advantages on reducing corneal and wound related complications and much safer for posterior capsule. AquaLase is non-ultrasound method where a liquid jet performs the emulsification. There is absolutely no incision heat and no friction, because the tip does not vibrate. The tip is soft and round, friendly instrument for posterior capsule.Therefore it might be the best choice in refractive lens exchange surgery. Catarex is true endocapsular vortex emulsification where uses a rotary impeller to create an endocapsular vortex that emulsifies lens fragments without ultrasound or laser. Advantages are lack of significant heat buildup, wound burn or endothelial damage etc. It is most exciting method for achieving desired result of physiological-like lens implant which can accommodate later with true injectable IOL. RESULTS. According to the comparative study on intra and postoperative complications for each of the above 5 methods, it has been revealed that lower incident of corneal edema belongs to the phaco laser method with 1.2%, by ultrasonic with 12.8% and by ultrasound it increased up to 16%. Posterior capsule rupture unlikely to occur in AquaLase (1%) rather than Ultrasonic emulsification method where it was up to 7.1%. Nevertheless nucleus droplet complication occurred with highest rate only in ultrasound emulsification with 1.3%; lowest rate showed at the laser emulsification with 0.7%. The other complications as endophthalmitis, posterior capsule opacity and retinal detachment met only on ultrasound emulsification method. CONCLUSION. In the case of soft cataract Aqualase, Facolaser, Neosonix, Vortex methods are more efficient and safer than ultrasound. In difficult cases such as subluxated cataract, polar cataract, traumatic cataract, those methods ensure safer surgery for patient avoiding complications. Lens surgery development in the new millennium is moving towards to more non-invasive technology which is performed as an emulsification through almost entire lens bag and implant directly injectable lens material. The study showed that postoperative visual recovery was faster through these methods with reduced incident of complications. One another importance is the cost of intervention is significantly reduced.

A randomized controlled clinical study on reverse-chopper prechop technique with phaco-and-chop technique for high myopia associated with hard nucleus cataract / 中华实验眼科杂志

Background The innovation of pre-chop technique lies in shortening surgery duration,reducing ultrasound power,and deseasing the loss of corneal endothelial cells (CECs).Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse-chopper and phaco-and-chop phaco technique to super high myopia associated with hard nucleus cataract.Methods A prospective randomized-controlled-clinical interventional study was performed.Fourty eyes of 40 high myopia associated with cataract patients with Ⅲ-ⅣV degree of nucleus were enrolled in Beijing Tongren Hospital from March to September 2016.The patients were randomized into the pre-chop group and matched phaco-and-chop group according to random number table,and the self-made reverse chopper-assisted pre-chop phacoemulsification (phaco) surgery and phaco-and-chop phaco surgery were performed on the eyes of different groups,respectively.The phaco power,effective phaco duration and best corrected visual acuity (BCVA) were recorded and compared between the two groups to evaluate the efficacy,and the loss rate of corneal endothelial cells and eyes in different grades of cornea edema after operation were compared between the two groups to assess the safety of surgery procedure.Written informed consent from each patient was obtained prior to relevant examination and surgery.Results The surgery was finished smoothly in the eyes.The mean effective phaco duration was (47.30±11.29) seconds and (57.70± 14.51) seconds in the pre-chop group and phaco-andchop group,respectively,with a significant difference between them (t =-2.530,P =0.016).The BCVA was better at the seventh day after surgery in the pre-ehop group than that in the phaco-and-chop group (4.75t0.11 vs.4.67± 0.14),showing a significant difference between the two groups (t=2.147,P=0.038).In 1 month after surgery,the CECs loss rate was (10.82±3.77)％ in the pre-chop group,which was lower than (16.11±6.47)％ in the phacoand-chop group (t=-3.758,P=0.001).The number of the eyes with grade 2-3 of corneal edema in the pre-chop group was significantly decreased in comparison with the phaco-and-chop group 7 days after surgery (Z =11.822,P=0.008).Conclusions Compared with the conventional phaco-and-chop technique,reverse-chopper prechop technique appears to have a better efficacy and safety in phaco surgery for high-myopia associated with hard nuclear cataractous eyes.

Phaco-emulsification in completely vitrectomized eyes: Intraoperative analysis of modified phaco sleeve.

Purpose: The purpose was to evaluate the results of modified sleeve in phacoemulsification of cataract in completely vitrectomised eyes, Materials and Methods: Twenty-five previously completely vitrectomized eyes of 23 patients having visually significant cataract were included. After through evaluation they underwent phaco-emulsification by phaco chop with a modified sleeve via temporal clear corneal incision. The modified sleeve was made by creating a small round port of approximate 1 × 1 mm size at the proximate end of the sleeve in line with the already existing ports. This port faced the posterior capsule while performing phacoemulsification. Patients were observed for any intraoperative complications. Result: The most common indication for pars plana vitrectomy in our study group was vitreous hemorrhage due to diabetic retinopathy [13 out of 25 eyes (52%)]. Intraoperative findings included miosis [seen in 3 (12%) eyes] and posterior capsular plaque [seen in 2(8%) eyes]. No other significant intraoperative complications (posterior capsular tear, dropped nucleus) were observed. Average effective phaco time was 33 sec. (±15.11). Conclusion: Though cataract surgery in postvitrectomized eyes is a challenging situation, modified sleeve prevents anterior chamber fluctuation and avoids complications arising out of it, making the surgery safe.

Comparison of Surgical Parameters and Outcomes According to the Phacoemulsification Technique

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.

Extracción de cristalino transparente en pacientes hipermétropes / Extraction of transparent crystalline lens in hypermetrope patients

OBJETIVOS: Describir los resultados obtenidos en la extracción de cristalino transparente de pacientes hipermétropes. MÉTODOS: Se efectuó un estudio descriptivo, prospectivo y longitudinal, en el período de septiembre de 2009 a febrero de 2010. Fueron estudiados 60 ojos de 30 pacientes con hipermetropía, quienes acudieron al Instituto Cubano de Oftalmología Ramón Pando Ferrer y no cumplieron los criterios establecidos para cirugía refractiva corneal. Se aplicó la fórmula Hoffer Q por IOL máster para el cálculo del lente intraocular, técnica quirúrgica estándar, facoemulsificación (facoaspiración), poder ultrasónico: 10 por ciento (pulsado), vacío: 350 mmHg, flujo: 25 cc/min; túnel corneal, capsulorrexis amplia e implante de lente intraocular monofocal en saco capsular. Se realizó el análisis estadístico por promedio asociado a prueba T para datos pareados. RESULTADOS: La edad promedio fue de 39 ± 2,6 años. La longitud axil promedio fue de 21 ± 2 mm. La mejor agudeza visual sin correcci¾n ascendi¾ de 0,08 en el preoperatorio a 0,72 en el posoperatorio. La mejor agudeza visual con corrección varió de 0,92 a 0,98. El valor de la esfera se redujo de 5,25 a - 0,50 y el cilindro de 0,75 a - 0,25 dioptrías; en consecuencia, el equivalente esférico disminuyó de 4,75 en el preoperatorio a -1,00 dioptrías en el período posoperatorio, específicamente en el ojo dominante a 0,46 y en el no dominante a -0,97 dioptrías. CONCLUSIONES: La monovisión resulta efectiva en los pacientes. La extracción de cristalino transparente en pacientes hipermétropes es una opción útil cuando estos no son candidatos a cirugía refractiva corneal

OBJECTIVES: To describe the results obtained in the extraction of the transparent crystalline lens in hypermetrope patients. METHODS: A longitudinal, prospective and descriptive study was conducted from September, 2009 to February, 2010. Sixty eyes was studied from 30 patients presenting with hypermetropy who came to Ramón Pando Ferrer Cuban Institute of Ophthalmology due to they not fulfilled the criteria established for corneal refractory surgery. Hoffer W by IOL master formula was applied for estimation of intraocular lens, standard surgical technique, phacoemulsification (phacoaspiration), ultrasonic power: 10 percent (pulsed), empty: 350 mm Hg, flow: 25 cc/min; corneal tunnel, wide capsulorrhesis and implant of monofocal intraocular lens in capsular sac. For paired data a statistical analysis by t-test associated average was carried out. RESULTS: Mean age was of 39 ± 2,6 years. The mean axial length was of 21 ± 2 mm. The better visual acuity without correction rise of 0,08 in the preoperative period to 0.72 in the postoperative one. The better visual acuity with correction varied from 0.92 to 0.98. The value of sphere decreased from 5.25 to 0.50 and the cylinder from 0.75 to 0.25 dioptres; consequently, the spherical equivalent decreased from 4.75 in preoperative period to 1,00 dioptres in the postoperative one, specifically in the dominant eye to 0.46 and in the non-dominant one to -0.97 dioptres. CONCLUSIONS: Monovision is effective in the patients. The extraction of transparent crystalline lens in patients with hypermetropy is a useful option when they are not candidates to corneal refractive surgery