The Ganesh朑rewal cystitome maker � A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26?G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25?G flat?tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.

Management of late-onset flocculent after-cataract with capsular bag lavage and posterior continuous curvilinear capsulorhexis

We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.

Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

PURPOSE: To evaluate the effects of continuous curvilinear capsulorhexis, intraocular lens (IOL) decentration and tilt on postoperative clinical outcomes after cataract surgery. METHODS: We reviewed 62 eyes of 52 patients who underwent cataract surgery and measured the uncorrected visual acuity, best corrected visual acuity and manifest refraction preoperatively and 3 months postoperatively. IOL decentration on anterior segment photography and IOL tilt on anterior optical coherent tomography were analyzed and correlations of postoperative uncorrected visual acuity, best corrected visual acuity, and higher order aberrations were evaluated. In addition, we inspected the relationship of size and decentration of continuous curvilinear capsulorhexis (CCC) intraoperatively with the change in IOL position postoperatively. RESULTS: The average size of CCC was 5.40 ± 0.51 mm (4.12-6.24 mm) and the average decentration of CCC was 0.30 ± 0.19 mm (0.09-1.21 mm) intraoperatively. The average decentration of IOL was 0.23 ± 0.15 mm (0.00-0.71 mm) and the average IOL tilt was 1.43 ± 0.73° (0.00-4.22°) postoperatively. Intraoperative CCC size and decentration were associated with postoperative IOL decentration (p = 0.01, p < 0.001), but not with IOL tilt (p = 0.69, p = 0.52). There were no significant correlations between IOL decentration and tilt with postoperative visual outcomes and higher order aberrations. CONCLUSIONS: The CCC size and decentration can affect the IOL decentration, but IOL decentration and tilt do not have a significant impact on clinical outcomes after cataract surgery.

Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

PURPOSE: To evaluate the effects of continuous curvilinear capsulorhexis, intraocular lens (IOL) decentration and tilt on postoperative clinical outcomes after cataract surgery. METHODS: We reviewed 62 eyes of 52 patients who underwent cataract surgery and measured the uncorrected visual acuity, best corrected visual acuity and manifest refraction preoperatively and 3 months postoperatively. IOL decentration on anterior segment photography and IOL tilt on anterior optical coherent tomography were analyzed and correlations of postoperative uncorrected visual acuity, best corrected visual acuity, and higher order aberrations were evaluated. In addition, we inspected the relationship of size and decentration of continuous curvilinear capsulorhexis (CCC) intraoperatively with the change in IOL position postoperatively. RESULTS: The average size of CCC was 5.40 ± 0.51 mm (4.12-6.24 mm) and the average decentration of CCC was 0.30 ± 0.19 mm (0.09-1.21 mm) intraoperatively. The average decentration of IOL was 0.23 ± 0.15 mm (0.00-0.71 mm) and the average IOL tilt was 1.43 ± 0.73° (0.00-4.22°) postoperatively. Intraoperative CCC size and decentration were associated with postoperative IOL decentration (p = 0.01, p < 0.001), but not with IOL tilt (p = 0.69, p = 0.52). There were no significant correlations between IOL decentration and tilt with postoperative visual outcomes and higher order aberrations. CONCLUSIONS: The CCC size and decentration can affect the IOL decentration, but IOL decentration and tilt do not have a significant impact on clinical outcomes after cataract surgery.

Late Onset Capsular Block Syndrome in a Diabetic Patient: Case Report.

We report a case of capsular block syndrome in a diabetic patient who had undergone phacoemulsification after circular capsulorhexis and intraocular lens (IOL) implantation in the left eye. Five years later, the posterior capsule had vaulted far posteriorly, the capsular opening was apparently sealed by the lens optic, and fluid had accumulated between the posterior capsule and the IOL. The retrolental fluid was emptied from the capsular bag posteriorly into the vitreous using a neodymium-doped yttrium aluminium garnet laser capsulotomy, and the distended capsule lieved.

Clinical effect of anterior vitrectomy for congenital cataract / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the clinical efficacy of posterior continuous curvilinear capsulorhexis ( PCCC ) combined with anterior vitrectomy in preventing posterior capsule opacification of congenital cataract surgery. ?METHODS:Postoperative clinical follow-up data of 82 cases ( 87 eyes ) with congenital cataract treated in Eye Center of our hospital from January 2011 to August 2014 were retrospectively analyzed. The patients were divided into the surgical control group ( 38 cases, 40 eyes, recieved phacoemulsification + PCCC ) and the study group ( 44 cases, 47 eyes, accepted phacoemulsification+ PCCC + anterior vitrectomy). The incidence of central optic axis opaque and postoperative visual acuity distribution were recorded at 1a follow - up. lntraoperative and postoperative complications were observed. ?RESULTS:The rate of central optic axis opaque grade 0 in control group was 37. 5%, compared to 76. 6% in study groups. The opacity distribution ratio of grade 1,2,3 and 4 in study group were lower than that of control group, and the central optic axis opacity distribution ratio in study group was significantly better than that of control group (P0. 5 in control group was lower than the 40 eyes ( 85. 11%) of that in study group. The visual acuity between two groups has statistical significance difference after 1a follow-up ( P ?CONCLUSlON: Combination of phacoemulsification, PCCC and anterior vitrectomy presents reliable clinical effects on postoperative central optic axis opacity distribution ratio and visual acuity, and it should be adopted to prevent the occurrence of posterior capsule opacification.

Application of trypan blue and indocyanine green in mature and hypermature cataracts / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AlM: To assess the efficacy and safety of trypan blue and indocyanine green ( lCG ) for continuous curvilineal capsulorrhexis ( CCC ) in mature or hypermature phacoemulsification.?METHODS: A total of 122 eyes of 122 cases with cataracts in mature and hypermature were randomly divided into three groups, trypan blue staining group was 46 eyes of 46 cases as group A, lCG staining group was 40 eyes of 40 cases as group B, control group was 36 eyes of 36 cases as group C. Staining groups were used to 0. 2mL trypan blue or lCG injected into the anterior chamber during operation, respectively. The success rate of CCC, lens posterior capsule rupture and implanted intraocular lens pouch were observed and compared during operation. Anterior chamber inflammation was observed after operation, and compared with the control group to observe and analysis.? RESULTS: The success rate of CCC, implanted intraocular lens pouch were statistically significant difference in trypan blue staining group ( group A ) than that in control group (group C) (P 0. 05 ) . Anterior chamber inflammation was no significant difference in the postoperative reaction among the three groups.?CONCLUSlON:The application of trypan blue or lCG for lens capsule staining before CCC in lack of red reflective mature and hypermature cataracts is safe and effective, both results are comparable. lt guarantees a complete CCC and improves the success rate of phacoemulsification.

ln-the-bag lOL stability of super high myopic eyes with different size of capculorhexis / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AlM: To compare the in- the- bag lOL stability of different size of continuous curvilinear capsulorhexis ( CCC) in super high myopic eyes with cataract underwent phacoemulsification.?METHODS: A total of fourteen cataract patients with bilateral super high myopia were included, Phaco+lOL implantation were performed on both eyes, one eye was randomly classified into 5mm diameter CCC observation group, the fellow eye was 6mm diameter CCC observation group. Cataract extraction combined with in-the-bag intraocular lens implantation ( lOL ) with the type of hydrophilic acrylic aspheric intraocular lens ( MCX11 ) by well experienced surgeon. The operation was running smoothly, the next day after operation, all patients were confirmed by lmage-pro plus6. 0 image analysis software for the measurement of main meridian sac diameter with target capsulorhexis diameter no more than ±0. 2mm. Slit lamp examination of lOL shape and position, changes of anterior capculorhexis edge, refraction, anterior chamber depth was measured and observed of all eyes after operation 1wk;1, 3, 6mo.? RESULTS: Compared with postoperation 1wk, the former sac diameter of two groups were slightly smaller at postoperation 1mo, with no statistically significant difference between two groups. 5mm diameter CCC observation group had slightly hyperopic shift in follow-up 1-3mo, 6mm diameter CCC observation group had hyperopic shift in follow-up 1mo, and getting stable after 1mo. Refraction change was related to anterior chamber depth changes. 5mm diameter CCC observation group had 3 minor loop folding in follw-up 3mo.?CONCLUSlON:Relatively smaller continuous curvilinear capsulorhexis in super high myopic eyes underwent cataract surgery may cause a tendency of uneven construction or effective lens position change of in-the-bag lOL. Unusual refraction change or shift after operation 1mo could suggest instability of lOL, early noticing or interruption could prevent further complications.

Clinical application of posterior continuous curvilinear capsulorhexis of posterior capsular rupture in the phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract? AlM: To observe the clinical effect of posterior continuous curvilinear capsulorhexis ( PCCC ) in phacoemulsification with posterior capsular rupture.?METHODS: Thrity-eight age-related cataract patients (38 eyes) from March 2013 to October 2013 were selected as experimental group and 50 age - related cataract patients ( 50 eyes ) from March 2013 to October 2013 as control group. ln experimental group, PCCC were used in the intraoperative posterior capsule tears in phacoemulsification. And in control group phacoemulsification was applied. The visual acuity and surgical complications were compared between two groups, the follow-up period was continued to 3mo after operation.?RESULTS: The visual acuity and corneal edema in two groups had statistically significant ( P 0. 05 ). At 1d after operation, the intraocular pressure in two groups was not statistically significant (P>0. 05). Three months after operation, the pupil and cystoid macular edema, retinal detachment in two groups was not statistically significant (P>0. 05).?CONCLUSlON:PCCC can improve the therapeutic effect and prevent surgical complications for phacoemulsification with posterior capsular rupture.

Continuous curvilinear capsulorhexis involving zonular area in manual small incision cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the efficacy and safety of large sized continuous curvilinear capsulorhexis ( CCC ) involving zonular area in manual small incision cataract surgery ( MSICS) . METHODS:Totally 1 443 cataract patients ( 1 965 eyes ) underwent MSICS, in which large CCC up to 7-8mm were performed . The related conditions such as success rate of performing CCC, capsule rupture, corneal edema and visual acuity after surgery were recorded and statistically analyzed. RESULTS:In total of 1 965 eyes, 1 942 eyes ( 98. 83%) had successful CCC, 15 eyes (0. 76%) had a radial tear which could not be saved when performing CCC, 8 eyes (0. 41%) had anterior capsule opened with a cystotome or a scissor due to capsule membrane calcification. No posterior capsule rupture occurred, and intraocular lens was transplanted in all cases. Transient corneal edema was noted in 36 eyes (1. 83%). One day after surgery, 1650 eyes (83. 97%) had visual acuity ≥0. 5, 1867 eyes (95. 01%) ≥0. 3. No unstable intraocular lens was noted in all cases. CONCLUSION:Large CCC technique for MSICS is safe and reliable, not decreasing stability capsular bag and intraocular lens. It is of high originality despite zonular area is involved so that it is worthy of application in basic medical institutions.

A reappraisal of the capsulorhexis:tearing angle in capsulorhexis / 国际眼科杂志(Guoji Yanke Zazhi)

ATM:To determine the tearing angle and tearing force,and effects of associated pressures in tearing of various materials and human lens capsule in continuous curvilinear capsulorhexis(CCC).METHODS:Tearing was done on different materials such as aluminum Iaminated paper,different types of thin transplant plastics and human Iens capsule with blunt tip needle.During the procedure,angle and direction of force were measured.Effects of increased underlying pressure on tearing of tearable materials and effect of anterior chamber depth and vitreous pressure on 24 postmortem hunlan eyes with different ages (range from10 to 75 years),was evaluated.RESULTS:Tearing angle in every material was unique for that material.Angle and force of tearing was decreased reversely with increasing age (from 85 degree in a 10-years-old to 10 degree in older than 50 years).Increasing vitreous pressure and decrease in AC depth causes higher pressure on point of tearing.Safe methods in controlling CCC are discussed jn the context.OONCLUSION:Understanding the physics and vector of forces during CCC is necessary in good performance and avoidance of radial tears.Onange in capsular properties between difierent ages and different type of cataract causes different tearing angle and tearing force that should be considered during CCC.

Surgical Techniques and Postoperative Complications in Pediatric Cataract Surgery

PURPOSE: To evaluate postoperative complications of different surgical techniques in pediatric cataract. METHODS: We retrospectively reviewed 105 eyes of 72 patients who had undergone irrigation and aspiration of cataracts with posterior chamber intraocular lens (IOL) implantation from January 1994 to June 2004. All the eyes were divided into three groups according to the surgical techniques used: group 1 (n=39), IOLs in the bag + intact posterior capsule; group 2 (n=24), IOLs in the bag + posterior continuous curvilinear capsulorhexis (PCCC) + anterior vitrectomy; group 3 (n=42), IOLs in the bag + PCCC + optic capture. Postoperative posterior capsular opacity (PCO), secondary intervention for PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were evaluated. RESULTS: Different from those in the past, current surgical methods for pediatric cataract entail either the optic capture of IOL or anterior vitrectomy through PCCC. PCO is the most frequent postoperative complication. Thirty-five eyes (87.1%) in group 1, 2 eyes (8.3%) in group 2, and no eyes in group 3 developed PCO. Five eyes (33.3%) had recurrence of PCO when PCO was treated by Nd:YAG laser posterior capsulotomy. None had PCO recurrence with secondary optic capture of IOL. Postoperative inflammation and IOL decentration were more common in group 2 than in the other groups. There was no statistically significant difference in the prevalence of postoperative glaucoma between the groups. Neither vitreoretinal complication nor infection was found in our series. CONCLUSIONS: Optic capturing of IOL through PCCC permanently maintains the visual axis with the anterior vitreous face preserved.

The Changes of Anterior Capsular Opening Area according to the Materials of Intraocular Lens

PURPOSE: We examined the extent of anterior capsular constriction after continuous curvilinear capsulorhexis according to the initial area of opening, the postoperative period, and the material of optics of intraocular lens(IOL). PATIENTS AND METHODS: We measured the area of anterior capsular opening 1 day, 1, 2, 3, 6, and 12 months postoperatively. Sixty five eyes of 50 patients with poly "methyl methacrylate "(PMMA), foldable silicone, and foldable acrylic IOLs were included. RESULTS: There was no significant correlation between the initial area and the extent of anterior capsular constriction(r=0.090, p=0.476). There was significant reduction during the postoperative 3 months but, thereafter, the changes of the area was insignificant. The mean reduction size was larger in order of foldable silicone, PMMA, and foldable acrylic IOL. The difference between foldable silicone and acrylic IOLs was statistically significant(p=0.009). Those between foldable silicone and PMMA IOLs(p=0.580) or between PMMA and foldable acrylic IOLs(p=0.135) was not significant. CONCLUSIONS: The appropriate choice of IOL should be considered as the strategy to reduce the contraction of anterior capsular opening after continuous curvilinear capsulorhexis.

Continuous curvilinear capsulorhexis and capsular block syndrome / 眼科新进展

Objective　To analysis the relation of the diameter of continuous curvilinear capsulorhexis and other factors with the capsular block syndrome.Methods　We not only analyzed the etiology and clinical characteristic of six cases in intraoperative,early postoperative and lately postoperative,but also discussed the method of treatment.Results　(1)When the diameter of CCC was smaller than the one of IOL's optic , the CBS easily happened; (2)When the hoops of the hydroview IOL had a smaller anterior angle and larger optic, the CBS easily happened; (3)When the viscoelestic material and cortex were stayed in capsular or anterior chamber, the CBS easily happened.Conclusion　(1)Generaly speaking the size of the CCC should right on the edge of the IOL's optic part; (2)To hydroview IOL, we should choose the one which had a larger anterior angle and a smaller optic; (3)Viscoelastic material which should be cleaned and there was no the rest cortex stayed in the capsular.

The Effect of Capsular Tension Ring on Anterior Capsular Opening and Intraocular Lens in Cataract Surgery

The effect of capsular tension ring[CTR]on prevention of contraction of capsular opening induced by continuous curvilinear capsulorhexis in cataract surgery has been evaluated. In this study, we performed cataract surgery on 15 patients[23 eyes]in Group I[IOL implantation with CTR] and 13 patients[24 eyes]in Group II[IOL implantation without CTR]from September 1998 to November 1998. We compared uncorrected visual acuity[UCVA], spherical equivalent[SE], astigmatism, size of capsular opening, IOL rotation and change of anterior chamber depth between two Groups. We used image analysis system to determine an actual size of capsular opening and measured a depth of anterior chamber than 5 times by using A-scan ultrasound. GroupIand IIshowed a similar pattern of change of UCVA, SE and astigmatism. Contraction rate of capsular opening 2 months after operation was 1.41%in Group Iand 3.95%in Group II. This difference was statistically significant [p<0.001].The anterior chamber depth increased temporarily in both groups, However, it was slightly decreased and maintained in Group I, while steadily decreased in Group II. Rotation of IOL was greater in Group IIthan Group I. However, it was not statistically significant. With these results it would be concluded that CTR might prevent a contraction of capsular opening and enhance a stability of IOL.

Phacoemulsification Combined with Transpupillary Silicone Oil Removal Through Posterior Continuous Curvilinear Capsulorhexis

Silicone oil has been used successfully in vitreoretinal surgery for many years. But complications from the use of silicone oil as a long-acting internal tamponade may develop. They include glaucoma, keratopathy, oil emulsification, and cataract. For patients requiring silicone oil removal and cataract surgery, both operations can be performed in a combined procedure. After phacoemulsification, a posterior continuous curvilinear capsulorhexis(PCCC) is performed, followed by irrigation of balanced salt solution(BSS)into vitreous cavity allowing flow out of silicone oil through the PCCC and intraocular lens(IOL)is implanted into remaining capsular bag. This technique offers faster visual rehabilitation, shorter operation time and reduces the risk of peripheral retinal defect, vitreous hemorrhage that may be caused by traditional oil removal through sclerostomy.

A Case of Liquefied Posterior Capsular Opacification

Among the complications of cataract surgery, the reported frequency of posterior capsular opacification was 20~50 percent. We experienced a case of new type of posterior capsular opacification in the seventy-one year old woman patient, who undertook the cataract operation with phacoemulsification six years ago and visited our hospital with the decreased vision. With biomicroscopic examination, posterior capsular opacification, creating a closed chamber between the lens and the posterior capsule in which a liquefied, milky white substance accumulates was detected. The patient was treated with Nd: YAG laser capsulotomy. To our knowledge, there has been no reported case of liquefied posterior capsular opacification in Korea. Therefore we report this case with literature review.

Postoperative Capsular Bag Distension in Cataract Surgery

We have experienced six cases of postoperative capsular bag distension following continuous curvilinear capsulorhexis(CCC) and phacoemulisification with posterior chamber intraocular lens. Successful CCC, phacoemulsification and in the bag fixation of intraocular lens(IOL) were accomplished, and the optics of the IOL were made of silicone material in 6 cases. We have observed various degree of anterior chamber shallowing, anterior displacement of IOL, bulging of posterior capsule, and myopic shift of refractive error, and these findings improved by YAG laser anterior or posterior capsulotomy. Mean refractive change was +2.6D(diopter) at post-laser 1 day.