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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)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Postoperative Complications/therapy , Uveitis/complications , Cataract Extraction/methods , Diabetes Mellitus, Type 2/etiology , Microsurgery/methods , Corneal Edema/complications , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Observational Studies as TopicABSTRACT
@#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.
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@#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/mm<sup>2</sup> <i>vs</i> 1957.94±280.54/mm<sup>2</sup>, <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.
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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.
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PURPOSE: To compare intraoperative parameters and postoperative results between divide-and-conquer and multiple phaco-chop technique. METHODS: Two different techniques were performed by one operator on the patients with bilateral cataract. One eye was phacoemulsified by divide-and-conquer technique (D eye), and the other was performed by multiple phaco-chop technique (M eye). Changes of central corneal thickness during the operation, total phaco-time and phaco-energy were measured. RESULTS: Total 29 patients were included. The change of central corneal thickness were 8.4 +/- 11.8 microm in D eye and 11.5 +/- 16.7 microm in M eye, which showed no significant difference (p = 0.350) and total phaco-time were 70.1 +/- 32.9 seconds in D eye and 71.1 +/- 55.0 seconds in M eye, which also showed no significant difference (p = 0.689). However, phaco-energy were 12.4 +/- 8.3 power x s in D eye and 8.4 +/- 9.9 power x s in M eye, and this result showed significantly larger energy when using divide-and-conquer technique (p < 0.001). CONCLUSIONS: There was no significant difference in change of central corneal thickness and phaco-time between two techniques, divide-and-conquer and multiple phaco-chop technique. However, significantly smaller phaco energy was used by multiple phaco-chop technique compared with divide-and-conquer technique.
Subject(s)
Humans , Cataract , Eye , PhacoemulsificationABSTRACT
@#ObjectiveTo observe the effect of high vacuum phaco chop technique for hard nucleolus cataract.Methods51 cases (65 eyes) of hard nucleolus cataract were performed by high vacuum phaco chop.ResultsThe best corrected visual acuity (BCVA) ≥ 0.3 was in 56 eyes (86%) one day after operation. The best corrected visual acuity (BCVA) ≥ 0.3 was in 61 eyes (94%) one month after operation. 3 eyes had posterior capsule rupture in operation.ConclusionHigh vacuum phaco chop technique is safe and effective for hard nucleolus cataract.
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Phacoemulsification of cataracts with small pupils would induce serious complications in some instance, but we could perform phacoemulsification and IOL implantation in the posterior chamber without any serious complications.We did not need any iris retractors or adjacent iris surgery.Thirty-one eyes of 28 patients with a pupil diameter equal to or less than 4 mm at the beginning of the procedure were reviewed.We analyzed them in the preoperative ocular problems, the size of pupil and the method of enlargement, the technique of nucleus removal, complications, and vision after six months follow-up.Preoperative pupillary diameter was less than 3 mm in 26 cases (83.9%), the most frequent preoperative ocular problem was uveitis with 19 eyes (61.36%).Removing pupillary membrane, releasing of synechiae and mechanical pupillary stretch followed by viscoelastic injection were effective in pupillary expansion.Central phaco chop technique was effective in small pupil cases.In complications, focal corneal edema in 7 eyes and mild iris damage in 6 eyes during surgery.Postoperatively, fibrinous reaction developed in 8 eyes.Postoperative corrected vision of 0.5 or better was in 15 eyes (48.4%), and 22 eyes (71%)had visual increment by 2 lines or more in the Hann's vision chart.In conclusion, phacoemulsification of cataracts with small pupils could be performed safely without serious complications, even with no iris retractor or iris surgery).