RESUMO
@#BACKGROUND. The study was my doctoral thesis under supervision of Prof. Dr. BenoneCarstocea - Head of Romanian Ophthalmologist Society, Head of Central Military Hospital- Department of Ophthalmology and the Head of the vitreo-retinal surgeon’s society, within 2004-2008 and it was held in October 2010 in Bucharest. The thesis included two parts; theoretical part is comprehensive and major literature review by that time and personal part is analysis of all factors such as surgical methods, techniques, IOLs, OVDs development which have direct impact on final achievement of cataract surgery. MATERIAL AND METHODS. Personal research part is retrospective and cohort study combination, performed between 2004-2008 in the Ophthalmology clinic of Central Military Hospital, Bucharest. In total 12.042 cases were analyzed; 11.548 surgical cases from Central Military Hospital and 494 surgical cases from private eye clinic “Laser Optics”. As surgical methods followings were studied and all aspects compared; using ultrasound is high energy or hot phacoemulsification method and cold methods or modern, low energy phacoemulsification methods such as UltraSonic phacoemulsification, AquaLase, Endolaser Vortex Phacoemulsification and PhacoLaser. Due to lower level of energy it brings some additional advantages on reducing corneal and wound related complications and much safer for posterior capsule. AquaLase is non-ultrasound method where a liquid jet performs the emulsification. There is absolutely no incision heat and no friction, because the tip does not vibrate. The tip is soft and round, friendly instrument for posterior capsule.Therefore it might be the best choice in refractive lens exchange surgery. Catarex is true endocapsular vortex emulsification where uses a rotary impeller to create an endocapsular vortex that emulsifies lens fragments without ultrasound or laser. Advantages are lack of significant heat buildup, wound burn or endothelial damage etc. It is most exciting method for achieving desired result of physiological-like lens implant which can accommodate later with true injectable IOL. RESULTS. According to the comparative study on intra and postoperative complications for each of the above 5 methods, it has been revealed that lower incident of corneal edema belongs to the phaco laser method with 1.2%, by ultrasonic with 12.8% and by ultrasound it increased up to 16%. Posterior capsule rupture unlikely to occur in AquaLase (1%) rather than Ultrasonic emulsification method where it was up to 7.1%. Nevertheless nucleus droplet complication occurred with highest rate only in ultrasound emulsification with 1.3%; lowest rate showed at the laser emulsification with 0.7%. The other complications as endophthalmitis, posterior capsule opacity and retinal detachment met only on ultrasound emulsification method. CONCLUSION. In the case of soft cataract Aqualase, Facolaser, Neosonix, Vortex methods are more efficient and safer than ultrasound. In difficult cases such as subluxated cataract, polar cataract, traumatic cataract, those methods ensure safer surgery for patient avoiding complications. Lens surgery development in the new millennium is moving towards to more non-invasive technology which is performed as an emulsification through almost entire lens bag and implant directly injectable lens material. The study showed that postoperative visual recovery was faster through these methods with reduced incident of complications. One another importance is the cost of intervention is significantly reduced.