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Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper?assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty?three eyes of 433 consecutive patients who underwent illuminated chopper?assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann–Whitney U test, Pearson’s Chi?square test, and Fisher’s exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.
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Background The innovation of pre-chop technique lies in shortening surgery duration,reducing ultrasound power,and deseasing the loss of corneal endothelial cells (CECs).Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse-chopper and phaco-and-chop phaco technique to super high myopia associated with hard nucleus cataract.Methods A prospective randomized-controlled-clinical interventional study was performed.Fourty eyes of 40 high myopia associated with cataract patients with Ⅲ-ⅣV degree of nucleus were enrolled in Beijing Tongren Hospital from March to September 2016.The patients were randomized into the pre-chop group and matched phaco-and-chop group according to random number table,and the self-made reverse chopper-assisted pre-chop phacoemulsification (phaco) surgery and phaco-and-chop phaco surgery were performed on the eyes of different groups,respectively.The phaco power,effective phaco duration and best corrected visual acuity (BCVA) were recorded and compared between the two groups to evaluate the efficacy,and the loss rate of corneal endothelial cells and eyes in different grades of cornea edema after operation were compared between the two groups to assess the safety of surgery procedure.Written informed consent from each patient was obtained prior to relevant examination and surgery.Results The surgery was finished smoothly in the eyes.The mean effective phaco duration was (47.30±11.29) seconds and (57.70± 14.51) seconds in the pre-chop group and phaco-andchop group,respectively,with a significant difference between them (t =-2.530,P =0.016).The BCVA was better at the seventh day after surgery in the pre-ehop group than that in the phaco-and-chop group (4.75t0.11 vs.4.67± 0.14),showing a significant difference between the two groups (t=2.147,P=0.038).In 1 month after surgery,the CECs loss rate was (10.82±3.77)％ in the pre-chop group,which was lower than (16.11±6.47)％ in the phacoand-chop group (t=-3.758,P=0.001).The number of the eyes with grade 2-3 of corneal edema in the pre-chop group was significantly decreased in comparison with the phaco-and-chop group 7 days after surgery (Z =11.822,P=0.008).Conclusions Compared with the conventional phaco-and-chop technique,reverse-chopper prechop technique appears to have a better efficacy and safety in phaco surgery for high-myopia associated with hard nuclear cataractous eyes.
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Background The pre-chop technique can decrease the use of ultrasound power,and thus reducing the loss of corneal endothelial cells (CECs) and injuries of other intraocular structures.Many currently developed manual pre-chop techniques restrict the wide application of the pre-chop technique because of their intrinsic disadvantages.The present study describes a manual pre-chop technique for pre-slicing the lens nucleus by using a novel reverse chopper,which has not been reported yet.Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse chopper and stop-and-chop phacoemulsification technique on Ⅳ degree hard nucleus cataract.Methods A prospective clinical-controlled interventional study was performed.Thirty-two eyes of 32 cataract patients with Ⅳ degree of nucles were enrolled in People's Hospital of Hetian District from March 2015 to January 2016.The patients were randomized into the prechop group and matched stop-and-chop group according to random number table.The self-made reverse chopper-assisted pre-chop phacoemulsification surgery and stop-and-chop phaco surgery were performed on the eyes of corresponding groups,respectively.The ultrasound power,effective phaco duration,corneal endothelium loss rate,the eye number of different grade of cornea edema after operation and vision outcome were compared between the two groups.Written informed consent was obtained prior to relevant examination and surgery.Results The mean effective Phaco durations were 42.56 (39.31,45.81) seconds and 78.63 (73.85,83.40) seconds in the prechop group and stop-and-chop group,with a significant difference between them (Z =-4.937,P =0.000).The eye number with different degree of best corrected visual acuity (BCVA) was significantly different between the two groups,at postoperative day 1 and day 3 (P =0.013,0.033).The number of corneal endothelial cells (CECs) 1 month after surgery was (2 026.05 ± 154.03)/mm2 in the prechop group,and the number was (1 866.50-± 117.16)/mm2 in the stop-and-chop group,with a significant difference between them (t =3.298,P=0.003).The CECs loss rate was (13.36±2.85) ％ in the prechop group,which was lower than (25.77±3.81) ％ in the stop-and-chop group (t=-6.996,P=0.000).The eye number with different degree of corneal edema was significantly decreased in the prechop group compared with the stop-and-chop group at postoperative day 1 and day 3 (P =0.001,0.002).Conclusions Compared with the stop-and-chop phaco technique,a reverse chopper-assisted pre-chopping technique can decrease the intraoperative complication,lighten the postoperative damage of CECs and accelerate visual rehabilitation in hard nucleus cataract eyes.
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El propósito de este estudio fue determinar los resultados obtenidos con la técnica de prechop (PCh) y su combinación con la microincision cataract surgery MICS (por sus siglas en inglés) (PChMICS) en la cirugía de catarata por facoemulsificación con el uso de el chopper de irrigación oblicua en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer desde septiembre de 2006 hasta enero de 2007. El universo de trabajo estuvo constituido por 120 pacientes (ojos) con diagnóstico de catarata presenil y senil, que recibieron tratamiento quirúrgico. Se analizaron como variables: edad, sexo, agudeza visual con corrección, microscopia endotelial y cilindro refractivo, todos en el preoperatorio y posoperatorio, así como el tiempo de ultrasonido y complicaciones más frecuentes. Estos datos se analizaron a través de tablas de contingencia con frecuencias absolutas y relativas, medias y se utilizó la prueba t de Student para su comparación. Se encontró que la catarata predominó en pacientes menores de 60 años; la agudeza visual con corrección mejoró 5 líneas en la cartilla de Sellen, el cilindro refractivo apenas se modificó; el tiempo de ultrasonido aplicado estuvo dentro de valores normales; la pérdida de células endoteliales no fue importante, y la complicación transoperatoria más frecuente fue rotura de cápsula posterior con salida de vítreo.
The objective of this study was to present the results of the prechop technique (PCh) combined with microincision cataract surgery (MICS) that was used in cataract surgery by phacoemulsification with the oblique irrigation chopper in the Center of Eye Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from September, 2006 to January, 2007. The universe of study was made up of 120 patients (eyes) diagnosed with pre-senile and senile cataract and surgically treated. The analyzed variables were age, sex, visual acuity with correction, endothelial microscopy and refractive cylinder during the preoperative and postoperative periods, as well as ultrasound time and most common complications. For this analysis, contingency tables with absolute and relative frequencies and medians, and also Student´s t test for comparing data were used. It was found that cataract prevailed in patients under 60 years; visual acuity with correction improved 5 lines in Sellen chart, the refractive cylinder slightly changed, the time of ultrasound application was within the normal values; loss of endothelial cells was not significant and the most frequent transoperative complication was rupture of posterior capsule with vitreous detachment.