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.

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.

Características del endotelio corneal en pacientes sometidos a cirugía del cristalino por la técnica de prechop vs. facochop / Characteristics of the corneal endothelium in patients undergoing lens crystalline surgery with the prechop vs. facochop technique

Objetivo: determinar la repercusión sobre el endotelio corneal, con la aplicación de las técnicas de prechop vs. phacochop en la cirugía de catarata por facoemulsificación. Métodos: se realizó un estudio prospectivo analítico de casos y controles, en el Servicio de Catarata adjunto al Centro de Microcirugía Ocular del Hospital Oftalmológico Docente Ramón Pando Ferrer, con el diagnóstico de catarata unilateral o bilateral, desde enero de 2013 hasta enero de 2014. A cincuenta pacientes se les aplicó el procedimiento prechop y a otros cincuenta phacochop. Las variables bajo estudio fueron la edad, el sexo, la dureza del núcleo del cristalino y el tiempo de aplicación del ultrasonido; y tanto en el preoperatorio como en el posoperatorio se tuvieron en cuenta la densidad celular, la hexagonalidad y el coeficiente de variabilidad. Resultados: al comparar los resultados posoperatorios en el grupo en que se aplicó prechop con los obtenidos por phacochop, hubo diferencias en la pérdida de densidad celular y de la hexagonalidad. Estas fueron mayores en el grupo phacochop. También hubo diferencias en el coeficiente de variabilidad y en el tiempo efectivo de facoemulsificación, los cuales fueron mayores en el grupo phacochop. Conclusiones: los resultados posoperatorios corroboran que los pacientes a quienes se les aplica prechop presentan mejor conservación del endotelio corneal que los que reciben phacochop(AU)

Objective: to determine the impact of the application of the techniques of prechop vs phacochop techniques on the corneal endothelium in the cataract surgery using phacoemulsification. Methods: a prospective, analytical case-control study in the cataract service of the Center of Ocular Microsurgery Ocular in Ramón Pando Ferrer teaching ophthalmological hospital, with the diagnosis of unilateral or bilateral cataract, and conducted from January 2013 to January 2014. Fifty patients underwent the prechop procedure and 50 were applied the phacochop method. The variables under study were age, sex, crystalline lens hardness and length of time of ultrasound application; both in the preoperative and postoperative phase, the cell density, hexagonality and the coefficient of variability were took into account. Results: when comparing the postoperative results in the prechop group with those of the phacochop one, there were differences in the loss of cell density and hexagonality, being greater in the phacochop group. There were also differences in the coefficient of variability, and the effective time of phacoemulsificación, which were greater in the phacochop group. Conclusions: the postoperative results corroborate that the group of patients under prechop procedure has better preservation of their corneal endothelium than those in the phacochop group(AU)

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.

Resultados funcionales y anatómicos en la facoemulsificación coaxial estándar mediante la técnica de multichop / Functional and anatomical results of standard coaxial phacoemulsification based on the multichop technique

OBJETIVOS: Describir los resultados funcionales y anatómicos obtenidos con la facoemulsificación coaxial estándar por la técnica de multichop en la cirugía de catarata. MÉTODOS: Estudio descriptivo, longitudinal y prospectivo en el período comprendido entre septiembre de 2005 y mayo de 2007, de pacientes operados de catarata en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". RESULTADOS: El poder del ultrasonido promedio fue de 20,7 por ciento, el tiempo de ultrasonido medio fue de 46 segundos y el tiempo efectivo de facoemulsificación promedio fue de 10,2 s; existió relación significativa entre la dureza del núcleo y el tiempo de ultrasonido empleado (p < 0,05). La agudeza visual media mejor corregida posoperatoria fue de 0,8 con relación significativa (p = 0,00) al igual que el astigmatismo inducido que fue de 0,37 dioptrías. Existió una relación significativa entre la pérdida de células endoteliales y la dureza del núcleo (p < 0,05). CONCLUSIONES: Los parámetros facodinámicos empleados fueron bajos, la agudeza visual posoperatoria mejoró y el astigmatismo inducido fue poco.

OBJECTIVES: To describe the functional and anatomical results achieved in standard coaxial phacoemulsification using multichop technique in the cataract surgery. METHODS: Prospective longitudinal and descriptive study of patients operated on from cataract at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology, conducted from September 2005 to May 2007. RESULTS: The average ultrasound power was 20,7 percent, the average ultrasound time was 46 seconds and the average effective phaco time was 10,3 seconds; there was significant relation between nucleus hardness and time of ultrasound (p < 0.05). Postoperative best corrected average visual acuity was 0,8 with significant relation (p = 0.00) as well as induced astigmatism of 0,37 dioptres. Significant relation was observed between loss of endothelial cells and nucleus hardness (p < 0.05). CONCLUSIONS: The used phacodynamic parameters were low, postoperative visual acuity improved and induced astigmatism was also low.