Clinical outcomes and safety of intra-capsular bag soft-shell technique during phacoemulsification for hard nuclear cataract / 中华实验眼科杂志

Background Phacoemulsification for hard nuclear cataract is easy to cause corneal edema and posterior capsular rupture.Researches determined that soft-shell technique phacoemulsification can effectively reduce corneal edema,but the risk of posterior capsular rupture during the surgery is still existed.Whether intra-capsular bag soft-shell technique can protect the posterior capsular of lens from rupture is still unclear.Objective This study was to observe the effect of intra-capsular bag soft-shell technique phacoemulsification on hard nuclear cataract.Methods A prospective cohort study was designed.One hundred and sixty-eight eyes of 160 patients with age-related cataract and Ⅳ-Ⅴ grade of nucleus were enrolled in Affiliated Second Hospital of Zhengzhou University from November 2013 to May 2015 under the approval of Ethic Commission and informed consent of the patients.The eyes were randomized into the intra-capsular soft-shell technique group and conventional soft-shell technique group with the matched age,gender and nuclear hardness in a manner of randomized block design.A 3.0 mm incision of cataract phacoemulsification with soft-shell technique in capsular bag was performed on 80 eyes of 78 patients in the intracapsular soft-shell technique group,and conventional soft-shell technique phacoemulsification was performed on 88 eyes of 82 patients in the conventional soft-shell technique group.Intraoperative records including the cumulative dissipated energy,effective phacoemulsification time and posterior capsular changes were recorded during the surgery.Postoperative follow-up indexes included corneal edema,endothelial cell density,BCVA and intraocular pressure changes.Results The mean cumulative dissipated energy and operation duration were (20.13 ± 8.34) ％ and (14.28-±2.17) minutes in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were (19.67±5.24)％ and (15.36±3.49) minutes,showing significant differences between them (t =0.216,P =0.376;t =0.403,P-=0.518).Posterior capsular rupture occurred in 1 eye in the intra-capsular softshell technique group and 7 eyes in the conventional soft-shell technique group.The percentages of eyes with BCVA ≥ 0.5 were 78％,83％ and 92％ in postoperative 1 day,1 week and 1 month in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were 56％,71％ and 89％,with a significant increase in postoperative 1 day,1 week in the intra-capsular soft-shell technique group (x2 =5.130,P =0.027;x2 =4.361,P =0.032).The corneal endothelial cell loss rates were 6.97％ and 7.19％ in the intra-capsular soft-shell technique group and conventional soft-shell technique group respectively in postoperative 3 months,with no significant difference between them (P＞0.05).The intraocular pressure was (20.16±4.23) mmHg (1 mmHg =0.133 kPa) in postoperative 1 day in the intra-capsular soft-shell technique group,which was significantly higher than (17.38± 5.21) mmHg in the conventional soft-shell technique group (t =1.241,P =0.037).Conclusions Intra-capsular bag soft-shell technique phacoemulsification for hard nuclear cataract can decrease the intraoperative and postoperative complications and quicken the visual recovery after surgery.

Evaluation on the clinical effects of the soft-shell technique with domestic materials during the cataract phacoemulsification / 中国医师进修杂志

Objective To evaluate the efficacy of the soft-shell technique with domestic materials during the cataract phacoemulsification. Methods Eighty-two eyes of 76 patients with the mature cataract phacoemulsification were divided into 3 groups randomly, including 28 eyes using the soft-shell technique with sodium tvlose and sodium hyaluronate (the domestic group),and 28 eyes using DuoVisc (Viscoat+ProVisc) (the import group), and 26 eyes using sodium hyaluronate (the common group). Results The average naked vision was 0.50 ± 0.22,0.51 ± 0.27,0.27 ± 0.21 respectively on the first day after operation.There was no signiticant difference between the domestic group and the import group (P＞0.05 ), while the first two groups and the common group had significant difference (P ＜ 0.05). The average naked vision was 0.61 ± 0.17,0.63 ± 0.18,0.58 ± 0.18 respectively 7 days after operation. There was no statistical difference among the three groups (P ＞ 0.05 ). The rate of corneal endothelial cells 1 month after operation was 7.1% in the domestic group,7.0% in the import group and 15.9% in the common group. It was clear that the rate in the domestic group and the import group was much lower than that in the common group. Meanwhile, the difference existed statistically between the two groups and the common group (P ＜ 0.01 ). However, the difference between the domestic group and the import group had no statistical significance. Conclusion The soft-shell technique with domestic materials is as safe and effective as that with the import materials in protecting the corneal endothelial cells during the cataract surgery in patients with the mature cataract.

Clinical Outcomes of Cataract Surgery Using Torsional Mode Phacoemulsification and Soft Shell Technique

PURPOSE: To evaluate the additional protective effect of the soft shell technique on corneal endothelial cells in torsional mode phacoemulsification. METHODS: Torsional mode phacoemulsification was performed on 60 eyes in 38 patients who were diagnosed with moderate cataracts. Thirty eyes were assigned to the soft shell technique group, and a control group with 30 eyes using only cohesive viscoelastics was created to evaluate ultrasound (US) time, mean US intensity, cumulative dissipated energy (CDE), and amount of used balanced salt solution. Corneal endothelium and corneal thickness were measured before and after the procedure. RESULTS: There were no statistically significant differences in US time, mean US intensity, cumulative dissipated energy, and dosage of the balanced salt solution between the two groups. There were no statistically significant differences between the two groups in postoperative central corneal thickness. Corneal endothelial cell densities decreased significantly after surgery in both groups, but there were no statistically significant differences between the two groups. CONCLUSIONS: There are no significant differences in the intensity of ultrasound, the density of corneal endothelial cells or the thickness of the cornea between the two groups. Therefore, the soft shell technique is not needed under torsional mode phacoemulsification.

The Corneal Endothelial Protective Effect of Soft Shell Technique in Cataract Surgery

PURPOSE: To evaluate the efficacy and safety of soft shell technique (SST) to reduce corneal endothelial damage during cataract surgery. METHODS: Cataract surgery was performed in thirty five eyes using SST with Healon and Viscoat , and in thirty five eyes with Healon alone as a control group. The corneal parameters such as corneal thickness, cell density, hexagonality, and the coefficient of variance were evaluated. RESULTS: The mean central corneal thickness in the control group was 533.1 +/- 34.9micrometer before surgery and 549.1 +/- 34.3micrometer at one week after surgery. The difference in corneal thickness was statistically significant (p<0.01). However, in the SST group, the change in corneal thickness before and after surgery was not statistically significant (529.5 +/- 36.3micrometer, 536.0 +/- 36.9micrometer, respectively). There were statistically significant changes in cell density after surgery in both groups. The results for the control group were 2478.5 +/- 319.7/mm2 before surgery and 1861.9 +/- 109.1/mm2 at 3 months after surgery. The result for the SST group were 2571.2 +/- 256.5/mm2 before surgery and 2107.2 +/- 374.1/mm2 at 3 months after surgery. The rate of endothelial cell loss at 3 months after surgery was smaller in the SST group (19%) than in the control group (25%). The coefficient of variance and hexagonality were normalized at one week after surgery in SST group. CONCLUSIONS: These results suggest that SST is effective in protecting corneal endothelial cells during cataract surgery, providing better results in the early postoperative period.