Endothelial Cell Loss, Cumulative Dissipated Energy, and Surgically Induced Astigmatism in Sutureless Scleral Tunnel Phaco-Assisted Cataract Extraction in Advanced Cataracts.

Purpose: To evaluate sutureless scleral tunnel phaco-assisted cataract extraction in regards to the cumulative dissipated energy (CDE) used, the resulting endothelial cell loss (ECL), and the surgically induced astigmatism (SIA) in advanced cataracts. Methods: A prospective interventional uncontrolled case series was performed. Patients with advanced cataracts according to the Lens Opacities Classification System III (LOCS III) had sutureless scleral tunnel phaco-assisted cataract extraction. They were followed up one week, one month, and 3 months postoperatively for SIA and ECL. The used CDE was recorded. Results: The study included 198 eyes: 36 eyes (18.2%) with LOCS III grade nuclear opalescence (NO4) cataracts, 102 eyes (51.5%) with LOCS III grade NO5, and 60 eyes (30.3%) with LOCS III grade NO6. Three months postoperatively, the mean SIA was 0.94 ± 0.71D. The endothelial cell density (ECD) was reduced significantly to 2341.31 ± 471 cells/mm2 (p=0.0001) with a mean ECL of 5.39%. The mean CDE and ECL% were 0.174 ± 0.46 U/S (2.07%), 0.859 ± 0.42 U/S (5.01%), and 2.306 ± 0.89 U/S (8.01%) in LOCS III grade NO4, NO5, and NO6, respectively. The overall mean CDE was 1.17 ± 0.99 U/S, which was significantly correlated with the ECL (p=0.0001). Conclusion: Sutureless scleral tunnel phaco-assisted cataract extraction in advanced cataracts enabled reduction in CDE with good preservation of the ECD and acceptable SIA.

Trocar-assisted flanged transconjunctival intrascleral sutureless intraocular lens fixation.

PURPOSE: To study the safety and efficacy of 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation in patients with insufficient posterior capsular support. METHODS: Five aphakic eyes with capsular insufficiency were included in this prospective interventional case series study, at Dar El Oyoun Hospital, Cairo, Egypt. Twenty five-gauge trocar-assisted flanged intrascleral sutureless technique was used for IOL fixation, in which retinal microforceps were used to capture and externalize both haptics through a scleral tunnel. CDVA, IOP measurements and IOL centralization were reported pre- and one day, one & 3 months postoperatively. Any intra- or postoperative complications were recorded. RESULTS: The mean LogMAR CDVA had significantly improved one day, 1 & 3 months postoperatively (0.74 ± 0.1, 0.42 ± 0.07 and 0.26 ± 0.08 respectively, p < 0.001) compared to the preoperative value (1.7 ± 0.17). The mean IOP showed no significant changes along the follow-up period (16.9 ± 0.1; 16.2 ± 1.1; 16.3 ± 0.9 mmHg, p = 0.68, 0.58, 0.89) respectively at 1st day, 1 & 3 months postoperatively) compared to the preoperative measurement (16.4 ± 1.8 mmHg). The IOL was found to be centralized in all cases. No intra- or postoperative complications were encountered. CONCLUSION: 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation is found to be a reliable and effective technique that overcomes Yamane technique's challenges for IOL fixation in cases with posterior capsular insufficiency.

Seven-day storage of pneumatically dissected Descemet's endothelial grafts with and without Dua's layer.

PURPOSE: To evaluate the efficacy of big-bubble (BB) technique in separating Dua's layer together with the Descemet's membrane endothelial (DE) graft and the effect of 7-day storage of the prepared tissues on the endothelial cells. METHOD: This is an experimental study in which 21 human corneo-scleral tissues unsuitable for transplantation were used. Grafts were mounted on artificial chamber; epithelial side-up with BB technique was used to detach the DE graft. The resultant tissues were stored in tissue culture medium for 7 days. Dua's layer presence, endothelial cell density (ECD), endothelial cell loss and viability were assessed after the dissection and at 7 days after storage. RESULTS: Complete detachment of DE grafts was achieved in 20 cases (95.24%). Histological analysis revealed Dua's layer presence in 14 cases (70%). The mean ECD for the corneas before dissection was 2375 ± 338 cells/mm(2) with significant reduction to 2200 ± 319 cells/mm(2) (p < 0.00001) with endothelial cell loss of 7.3 ± 3.5% and non-viable cells of 6.5 ± 2.5% at the end of the 7-day storage. On comparing the dissected DE grafts with Dua's layer versus those without at 1 day after dissection and at 7 days after storage, we found no statistically significant changes in endothelial cell loss (p = 0.387; p = 0.836 respectively) and non-viable cells percentage (p = 0.180; p = 0.260, respectively). CONCLUSION: Big-bubble technique is reproducible in dissecting DE grafts with minimal damage to the endothelial cells. The percentage of endothelial cell loss and non-viable cells is similar in the DE grafts with/without Dua's layer after 7-day storage.