Comparison of efficacy of small incision extracapsular excision or phacoemulsification in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effects of small incision extracapsular excision and phacoemulsification on the number of corneal endothelial cells, macular thickness and surgically induced corneal astigmatism in cataract patients.METHODS: Retrospective research. A total of 296 age-related cataract patients(296 eyes)admitted to our hospital from May 2019 to February 2023 were selected. They were divided into a small incision extracapsular excision group(144 eyes)and a phacoemulsification group(152 eyes)according to surgical method. The uncorrected visual acuity, best corrected visual acuity, numbers of corneal endothelial cells, macular thickness, surgically induced corneal astigmatism and postoperative complications between the two groups of patients at 7d, 1 and 3mo after surgery were compared.RESULTS: The uncorrected visual acuity and best corrected visual acuity of patients in the small incision extracapsular excision group after 7d of surgery were better than those of the phacoemulsification group, the number of corneal endothelial cells after 7d and 1, 3mo of surgery were higher than that of the phacoemulsification group, the macular thickness after 7d and 1mo of surgery was lower than that of the phacoemulsification group, and the incidence rate of postoperative corneal edema and incidence rate of total complications were lower than those of the phacoemulsification group(all P<0.05). Furthermore, there was no statistical significance in the values of surgically induced corneal astigmatism after 1, 7d and 1, 3mo of surgery compared with phacoemulsification group(P>0.05).CONCLUSION: Compared with phacoemulsification, the changes in the number of corneal endothelial cells and thickness of the macular area after small incision extracapsular excision are relatively small, visual recovery is faster, and the complications reduced.

Improving the Toric Intraocular Lens Calculation by Considering Posterior Corneal Astigmatism and Surgically-induced Corneal Astigmatism

PURPOSE: To investigate the effect of surgically induced corneal astigmatism (SICA) and total corneal astigmatism (TCA) estimation on the anterior corneal astigmatism (ACA)-based toric intraocular lens (IOL) calculation. METHODS: Data from preoperative and postoperative corneal astigmatism, postoperative visual acuities, and refractive outcomes were collected. The incision was superior in with the rule anterior corneal astigmatism (WTRA) eyes and temporal in against the rule anterior corneal astigmatism eyes. The following five methods of calculating the toric IOL were compared: (1) ACA only and estimated SICA; (2) ACA with a fixed posterior corneal astigmatism (PCA) and estimated SICA; (3) ACA with a fixed PCA value and actual SICA; (4) and (5) TCA derived from the regression equations of ACA and actual SICA. The residual astigmatism was simulated. The Alpins method was used to analyze the astigmatism. RESULTS: Sixty eyes from 46 patients were enrolled. Thirty eyes had WTRA and the other thirty had against the rule anterior corneal astigmatism. The vector and arithmetic means of the difference vector decreased when the information regarding the actual SICA and PCA was added to the calculation (from 0.59 diopters [D] @ 87.5° to 0.15 D @ 48.5°, and from 0.95 ± 0.53 to 0.71 ± 0.63 D, respectively; p < 0.001). The mean difference vector across the whole sample was lowest using model 5. The correction index was significantly closest to 1.0 in the WTRA group. CONCLUSIONS: Researchers may improve the accuracy of post-implantation predictions by calculating toric IOL using exact SICA and TCA, with consideration of the PCA derived from the regression equation of ACA.

A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis

PURPOSE: To compare surgically induced corneal astigmatism following trabeculectomy versus deep sclerectomy and collagen implant (DSCI). METHODS: 37 consecutive eyes of 28 patients having glaucoma surgeries for uncontrolled open-angle glaucoma were retrospectively analyzed. 16 eyes had trabeculectomy and 21 eyes had DSCI. Visual acuity, intraocular pressure (IOP) and autorefractokeratometry of both groups were evaluated preoperatively and 1, 7 days, 1, 3, 6, 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis. RESULTS: Mean age was 51.63 +/- 12.73 years in the trabeculectomy group and 39.95 +/- 15.09 years in the DSCI group and differed between groups (p = 0.015). Visual acuity was significantly decreased after surgery compared with preoperative values and was improved slowly in both groups. Intraocular pressure was lower in the trabeculectomy group than in the DSCI group at postoperatively 1 and 6 months (p = 0.046 and 0.029, respectively). There was no significant difference in surgically induced corneal astigmatisms (SIA) between both surgeries, which decreased over time in the group with stable postoperative IOP. They showed with-the-rule astigmatism immediate postoperatively. The DSCI group with MMC showed less SIA than the group without MMC. CONCLUSIONS: Surgically induced astigmatisms following trabeculectomy and deep sclerectomy with collagen implant were not differ significantly between two surgeries.

The Change of Corneal Astigmatism after Extracapsular CataractExtraction with 7 mmScleral Tunnel Incision

In recent days, cataract surgery has trend to reduce postoperative astig-matism and acquired early visual rehabilitation.Phacoemulsification with small incision and insertion of foldable intraocular lens has been used popularly, but its high cost and intraoperative or postoperative complication especially in old age with dense nucleosclerosis could be detrimental to patients. Postoperative corneal astigmatic changes and visual rehabilitation were evaluated after extracapsular cataract extraction with 7 mmscleral tunnel incision (Group I, 7 mm-ECCE, 28 eyes)by comparing with those after phacoemulsification with 3.5 mmscleral tunnel incision (Group II, 3.5 mm-Phaco, 41eyes).One piece PMMA intraocular lens was inserted in group I, while foldable intraocular lens in group II.Surgically induced corneal astigmatism was calculated by Cravy's vector analysis.There was no statistically signifi-cant difference between group I and group IIfor surgically induced corneal astigmatism (Kt)after postoperative one month (p>0.05).In group I and group II, corneal astigmatism was with-the-rule in early postoperative days, and changed to against-the-rule in postoperative 3 months.There was no statistically significant difference between group I and group IIincorneal astigmatism during all follow-up period (p>0.05). Therefore, 7 mm-ECCE could be an effective method for old patient with high grade nucleosclerosis or when phacoemulsification was unavailable.

Early Result of Corneal Astigmatism in Sutureless Cataract Surgery

Since surgically induced corneal astigmatism was one of important complications after cataract extraction the authors analyzed corneal astigmatism for 3 months after sutureless cataract surgery. Among the patients who were treated with phacoemulsification and PCL implantation by one surgeon (L. E. H.), 40 patients had sutureless cataract surgery by 5mm incision and 51 patients had 10-0 nylon shoelace suture by 7mm incision. Corneal astigmatism was analyzed by algebraic and vector method. Visual acuity was analyzed in patients who were below 60 years age and without posterior segment disorders, whose predictive refractive errors were -0.75D according to SRK/T formula. 0.19D with-the-rule astigmatism induced at 1 day after 5mm sutureless cataract surgery was nearly unchanged until 3 months postoperatively and induced with-the-rule astigmat ism at 1 day after operation was not changed into against-the-rule astigmatism, visual rehabilitation was faster and corrected visual acuity was better.