Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial.

PURPOSE: To compare the impact of varying fluidic parameters on intraoperative intraocular pressure (IOP) fluctuations and postoperative outcomes. METHODS: Prospective randomized study of 80 eyes undergoing cataract surgery that were randomly assigned to low (aspiration flow rate: 20 cc/min; bottle height: 90 cm; vacuum: 400 mm Hg) and high (aspiration flow rate: 40 cc/min; bottle height: 110 cm; vacuum: 400 mm Hg) fluidic parameter groups. Real-time dynamic intraoperative IOP was measured during nuclear fragment removal. Mean maximum and minimum IOP and percentage reduction in IOP from maximum were compared between groups. Postoperatively, the rate of change in central corneal thickness and anterior chamber inflammation at days 1 and 7, endothelial cell density at 3 months, and corneal clarity on day 1 were compared. RESULTS: Minimum IOP in the low and high parameters groups was 35 ± 4.0 and 34.5 ± 6.8 mm Hg, respectively. Maximum IOP in the low and high parameters groups was 69 ± 3.0 and 85 ± 1.2 mm Hg, respectively (P < .002). Mean percent reduction from maximum was 59% in the high parameters group compared to 41% in the low parameters group, with the difference being statistically significant (P < .002). Rate of change in central corneal thickness was greater in the high parameters group at postoperative days 1 and 7 (P < .001). Anterior chamber inflammation and corneal clarity on the first postoperative day were significantly better in the low parameters group. CONCLUSIONS: Higher aspiration flow rate and bottle heights are associated with high intraoperative IOPs of up to 85 mm Hg. Prolonged elevated IOP during cataract surgery was found to have more anterior segment inflammation and more edematous corneas.

Outcomes of pediatric cataract surgery in anterior persistent fetal vasculature.

PURPOSE: To report the intraoperative performance and postoperative outcomes in eyes with anterior persistent fetal vasculature (PFV). SETTING: Iladevi Cataract & IOL Research Centre, India, and Filatov Institute Odessa, Ukraine. DESIGN: Prospective interventional case series. METHODS: Eyes with anterior PFV had surgery using a standardized surgical technique. Plaque peeling was used for small plaques and partial excision for larger plaques. In eyes in which the entire lens converted into a fibrovascular tissue, extensive capsulectomy with anterior 2-port limbal vitrectomy was performed. Microphthalmic eyes had no intraocular lens implantation. RESULTS: This study comprised 33 eyes. The mean age at surgery was 6.30 months ± 5.16 (SD). Microcornea was observed in 10 eyes (30.3%). Within the morphology of cataract, 10 eyes (30.3%) had the lens converted into fibrovascular mass, of which 4 had associated prominent ciliary process. Anterior continuous curvilinear capsulorhexis (CCC) and manual posterior CCC were performed in 23 eyes (69.7%) and 3 eyes (9.1%), respectively. Intraoperatively, posterior capsule plaque was seen in 20 eyes (60.6%). In 31 eyes (93.9%), 2-port limbal anterior vitrectomy was performed and in 2 eyes (6.1%), pars plana vitrectomy was performed. Intraocular lens implantation was performed in 16 eyes (48.5%); 17 eyes (51.5%) were left aphakic. Visual axis obscuration was observed in 6 eyes (18.2%). At the 3-year follow-up, visual acuity remained stable in 11 eyes (33.3%) and improved in 22 eyes (66.6%). CONCLUSION: The results suggest that good visual outcomes can be obtained in PFV eyes after surgical intervention, with an acceptable rate of serious postoperative complications. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Approaches to a posterior polar cataract.

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection - instead performing 'inside-out' hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.

Multilevel chop technique.

It is difficult to completely divide a hard nucleus. Excessive force is required, which may inadvertently lead to capsular bag distortion and cause stress to the zonules. We describe a chop technique that enables the surgeon to consistently achieve complete division of brunescent and black cataracts.

Comparison of posterior capsule opacification with hydrophobic acrylic and hydrophilic acrylic intraocular lenses.

PURPOSE: To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single-piece hydrophobic acrylic and 1 of 2 single-piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. SETTING: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. DESIGN: Prospective randomized clinical trial. METHODS: A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C-flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. RESULTS: The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P = .00) and hydrophilic group A (P = .000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P = .000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P = .04 and P = .02, respectively). CONCLUSION: Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Retrospective ultrasound biomicroscopic analysis of single-piece sulcus-fixated acrylic intraocular lenses.

PURPOSE: To evaluate the anatomic location of the haptic and optic of single-piece sulcus-fixated intraocular lenses (IOLs) and their proximity to the iris and ciliary body using ultrasound biomicroscopy (UBM). SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This retrospective study comprised eyes that had primary sulcus implantation of a single-piece IOL. Eyes had an intact anterior capsulorhexis that could provide uniform IOL support and a preoperative anterior chamber depth (ACD) greater than 2.7 mm. The fixation site of the haptics, distance between the optic edge and iris, optic tilt, anterior chamber angle (ACA), central ACD, and ciliary body edema were evaluated by UBM. RESULTS: The time from surgery to UBM examination was 7 to 85 months. Both haptics were in the sulcus in 7 of the 10 eyes, 1 haptic was abutting the iris and the other was in the sulcus in 2 eyes, and both haptics were embedded in ciliary body in 1 eye. The mean distance between the optic edge and iris was 0.16 mm +/- 0.07 (SD), 0.15 +/- 0.03 mm, and 0.38 mm, respectively. The mean ACA was 40.2 +/- 4.5 degrees (range 30.9 to 45.2 degrees), 34.1 +/- 4.5 degrees, and 44.1 degrees, respectively. The mean ACD was 3.47 +/- 0.24 mm, 3.50 +/- 0.23 mm, and 3.57 mm, respectively. No eye had optic tilt or ciliary body edema. CONCLUSIONS: Implantation of both haptics in the sulcus was not achieved in all eyes. The haptics and optics remained in close proximity to the posterior iris surface.

Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: randomized clinical trial.

PURPOSE: To compare the effects of fluidic parameters on the central corneal thickness (CCT), corneal endothelium, and anterior segment inflammation after phacoemulsification with longitudinal ultrasound. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: In this prospective randomized patient- and examiner-masked study, consecutive patients with age-related cataract were randomly assigned to Group 1 (low fluidic parameters: aspiration flow rate 25 cc/min; bottle height 70 cm and 90 cm; vacuum

Comparison of torsional and microburst longitudinal phacoemulsification: a prospective, randomized, masked clinical trial.

BACKGROUND AND OBJECTIVE: To compare intraoperative performance and postoperative outcome of three phacoemulsification technologies in patients undergoing microcoaxial phacoemulsification through 2.2-mm corneal incisions. PATIENTS AND METHODS: The prospective, randomized, single-masked study included 360 eyes randomly assigned to torsional (Infiniti Vision System; Alcon Laboratories, Fort Worth, TX), microburst with longitudinal (Infiniti), or microburst with longitudinal (Legacy Everest, Alcon Laboratories) ultrasound. Assessments included surgical clock time, fluid volume, and intraoperative complications, central corneal thickness on day 1 and months 1 and 3 postoperatively, and endothelial cell density at 3 months postoperatively. Comparisons among groups were conducted. RESULTS: Torsional ultrasound required significantly less surgical clock time and fluid volume than the other groups. There were no intraoperative complications. Change in central corneal thickness and endothelial cell loss was significantly lower in the torsional ultrasound group at all postoperative visits (P < .001, Kruskal-Wallis test) compared to microburst longitudinal ultrasound modalities. CONCLUSION: Torsional ultrasound demonstrated quantitatively superior intraoperative performance and showed less increase in corneal thickness and less endothelial cell loss compared to microburst longitudinal ultrasound.

Prospective evaluation of posterior capsule opacification in myopic eyes 4 years after implantation of a single-piece acrylic IOL.

PURPOSE: To determine whether axial myopia affects posterior capsule opacification (PCO) in eyes with high myopia (axial length [AL] > or = 26.00 mm) 4 years after implantation of an AcrySof single-piece intraocular lens (IOL). SETTING: Clinical practice, Ahmedabad, India. METHODS: In a prospective masked trial, consecutive eyes with high axial myopia (myopia group) and age-matched eyes with a normal AL (21.00 to 23.99 mm) (control group) had phacoemulsification and in-the-bag IOL implantation. Postoperatively, PCO was documented by standardized digital retroillumination images. The PCO area behind the IOL optic was scored (scale 0% to 100%) using the POCO software system. The presence of PCO within the central 3.0 mm of the optic was assessed with the Evaluation of Posterior Capsule Opacification software system. The incidence of neodymium:YAG (Nd:YAG) capsulotomy was determined. RESULTS: The median PCO in the myopia group and control group, respectively, was 3.2% and 5.6% at 1 month (P = .2), 2.2% and 1.6% at 12 months (P = .079), 7.0% and 2.3% at 24 months (P = .079), 3.7% and 3.6% at 36 months (P = .78), and 10.0% and 2.3% at 48 months (P = .61). By 4 years, PCO had encroached onto the central 3.0 mm of the optic in 38% in the myopia group and 20% in the control group (P = .04). One eye (2%) in each group had an Nd:YAG capsulotomy, at 3.2 years and 3.9 years, respectively. CONCLUSION: Axial myopia did not significantly increase the area or incidence of PCO at 4 years.

Comparison between Ringer's lactate and balanced salt solution on postoperative outcomes after phacoemulsfication: a randomized clinical trial.

AIM: To compare the effects of balanced salt solution (BSS) and Ringer's lactate (RL) on corneal thickness, endothelial morphology, and postoperative anterior chamber inflammation in eyes undergoing phacoemulsification. SETTING: Iladevi cataract and IOL research center, Ahmedabad, India. MATERIALS AND METHODS: This prospective randomized study comprised 90 consecutive patients with age-related cataract who were randomly assigned to either Group 1 (n = 45) with BSS or Group 2 (n = 45) with RL. Observations made included measurement of central corneal thickness (CCT), presence of anterior chamber flare and cells, endothelial cell loss, and change in coefficient of variation (CV). Data was analyzed using Mann Whitney test and test of proportion. RESULTS: Mean increase in CCT on postoperative Day 1 was 58microm and 97microm in Groups 1 and 2 respectively ( P = 0.01). Increase in CCT at one month was 10microm and 11microm in Groups 1 and 2 respectively ( P = 0.99); increase in CCT at three months was 3microm and 6microm in Groups 1 and 2 respectively ( P = 0.86). Number of eyes with flare grades in a range of 0 to 3 was statistically higher in Group 2 on postoperative Day 1 ( P = 0.004, 0.016, < 0.001, 0.047 for Grade 0, 1, 2 and 3 respectively). Number of eyes with cells of Grade 3 on first postoperative day was significantly higher in Group 2 as compared to Group 1 ( P = 0.004). Three months postoperatively, endothelial cell loss was 5.5% and 7.8% in Groups 1 and 2 ( P = 0.21) and change in CV was 3 and 5.4 in Groups 1 and 2 ( P = 0.20) respectively. CONCLUSION: BSS offers a significant advantage over RL in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification.

Comparison of 2 moxifloxacin regimens for preoperative prophylaxis: prospective randomized triple-masked trial. Part 1: aqueous concentration of moxifloxacin.

PURPOSE: To evaluate the aqueous concentration of moxifloxacin following 2 dosing regimens of topically administered moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: In this prospective randomized triple-masked clinical trial, 156 patients having cataract surgery were randomly assigned to 1 of 2 regimens of preoperative prophylaxis. In Group A (n = 76), Vigamox was instilled 4 times a day 1 day before surgery plus 1 drop 2 hours before surgery (total of 5 drops). In Group B (n = 76), Vigamox was first instilled 2 hours before surgery and then every 15 minutes for 1 hour (total of 5 drops). In both groups, aqueous samples (0.1 mL) were collected within 2 hours of the first instillation on the day of surgery and stored at -80 degrees C. The antibiotic concentration in all aqueous aspirates was determined using high-performance liquid chromatography. Data were analyzed using the Kolmogorov-Smirnov t test; 95% confidence intervals (CIs) were calculated. RESULTS: The mean aqueous humor concentration of moxifloxacin was 1.58 microg/mL +/- 0.80 (SD) in Group A and 2.05 +/- 0.72 microg/mL in Group B (P<.0001; 95% CI, -0.72 to -0.22). CONCLUSIONS: Both dosing regimens produced substantially higher aqueous concentrations than the known minimum inhibitory concentration for Staphylococcus epidermidis. Topical moxifloxacin administered 2 hours before surgery achieved significantly higher aqueous concentrations than topical moxifloxacin administered 1 day before surgery with 1 drop given on the day of surgery.

Comparison of 2 moxifloxacin regimens for preoperative prophylaxis: prospective randomized triple-masked trial. Part 2: residual conjunctival flora.

PURPOSE: To determine whether a regimen of topical moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox) administered on the day of cataract surgery reduces conjunctival bacterial flora. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: Seventy-four patients were prospectively randomized to receive Vigamox 4 times 1 day before surgery plus 1 drop 2 hours preoperatively (Group 1) and 74 patients, to receive Vigamox 2 hours before surgery and every 15 minutes in the first hour only (Group 2). Conjunctival swabs from the upper and lower lid margins and lower fornix were taken before and after Vigamox instillation. Aliquots were spread on chocolate blood, anaerobic basal, and nutrient agars. The number of bacterial colony-forming units (CFU) on the plates was counted with a grid technique and expressed as log values. The total number of CFU per eye and mean percentage reduction in CFU after instillation were calculated. Bacterial species were identified using biochemical and biophysical reactions. Wilcoxon signed ranked and Mann-Whitney tests and multiple linear regression were applied. RESULTS: In Group 1, the median colony count decreased from 1284.00 CFU +/- 643.18 (SD) before Vigamox instillation to 65.00 +/- 72.61 CFU after instillation (93.12% reduction) (P<.001) and in Group 2, from 1634.00 +/- 769.27 CFU to 75.00 +/- 81.23 CFU (93.28% reduction) (P<.001). The percentage reduction after instillation was similar between the 2 groups (P = .09). CONCLUSION: Both Vigamox regimens reduced the number of CFU of conjunctival flora, indicating that instillation beginning on the day of surgery is effective.

Comparative quantification of ingress of trypan blue into the anterior chamber after microcoaxial, standard coaxial, and bimanual phacoemulsification: randomized clinical trial.

PURPOSE: To compare ocular surface fluid ingress into the anterior chamber at the end of microcoaxial, standard coaxial, and bimanual phacoemulsification using trypan blue as the quantifying tracer. SETTING: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. METHODS: This prospective randomized observational study comprised 180 consecutive patients who had microcoaxial, standard coaxial, or bimanual phacoemulsification. Trypan blue was applied over the conjunctival surface, and the amount of ingress was assessed after cortex removal (time point 1) and at the end of the surgery after intraocular lens insertion and stromal hydration (time point 2). Logs of dilution were used for statistical analysis. RESULTS: At time point 1, a statistically significant difference was observed in the ingress of trypan blue in the aqueous aspirate. The bimanual group had the highest ingress and the microcoaxial group, the lowest. The amount of ingress in the standard coaxial group fell between the other 2 groups (P< .001). At time point 2, there was no statistically significant difference between the microcoaxial group and the standard coaxial group (P = 1.00); however, in the bimanual group, trypan blue ingress was statistically significantly higher than in the other 2 groups (P< .001). CONCLUSION: At both time points, trypan blue ingress was statistically significantly higher in the bimanual group than in the standard coaxial and microcoaxial groups. At time point 2, there was no statistically significant difference between the standard coaxial and microcoaxial groups.

The probable associations for corticocapsular adhesions in patients undergoing cataract surgery: a clinic-based observational study.

BACKGROUND: Corticocapsular adhesions (CCA) are frequently seen between lens capsule and adjacent cortical layer. During cataract surgery, in the presence of CCA, excessive efforts to rotate the nucleus can result in zonular damage. To reduce morbidity, identification of associations with CCA can be helpful in appropriately modifying the surgical procedure. AIM: To investigate probable associations with CCA in patients undergoing cataract surgery. SETTING AND DESIGN: Iladevi Cataract and IOL research center. Case-control study. MATERIALS AND METHODS: A single eye of 600 patients, 200 patients with CCA (cases) and 400 patients without CCA (controls) were considered. A CCA diagnosis was based on: (i) preoperative presence of CCA on slit-lamp examination with visualization of furry surface of cortex during surgery; (ii) preoperative absence of CCA on slit-lamp examination but intraoperative visualization of furry surface of cortex. Variables such as age, gender, type of cataract, grade of cataract, high myopia, diabetes mellitus and hypertension were studied. STATISTICAL ANALYSIS: Multivariate logistic regression was done. Results were presented as odds ratio (OR) with 95% CI. RESULTS: Mean age was 64.71 +/- 9.10 years in cases and 59.27 +/- 8.79 years in controls. Presence of CCA increased with age from 22% (n = 59) in 45 to 49 years to 70% (n = 110) in 70 to 79 years. An increase in age was associated with CCA by 3.3% (OR = 3.3%, P = 0.028). The odds of CCA for females were 83% higher ( P = 0.027). Presence of anterior cortical cataract increased odds of CCA by 9.5 times ( P = 0.001), while posterior cortical cataract increased odds by 3.3 times ( P = 0.001). CONCLUSION: Corticocapsular adhesions were strongly associated with cortical cataracts, increased age and female gender.

Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study.

PURPOSE: To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: A prospective observational case series comprised 84 eyes with age-related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single-piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1-sample t test with 95% confidence intervals (CIs). RESULTS: The mean follow up was 3 months +/- 0.3 (SD). The mean incision size at the end of surgery was 2.3 +/- .09 mm; mean surgical time, 4.5 +/- 1.5 minutes; and mean CDE, 2.3 +/- 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 microm at 1 day (95% CI, 8-25; P = .66;) and by a mean of 3.14 microm at 1 month (95% CI, 2.26-4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8-3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5-2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. CONCLUSION: Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens: prospective randomized masked clinical trial.

PURPOSE: To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: One hundred twenty consecutive patients who had phacoemulsification in a prospective triple-masked trial were randomized to receive an AcrySof SA60AT IOL (40 eyes), AcrySof Natural SN60AT IOL (40 eyes), or AcrySof IQ SN60WF IOL (40 eyes). At 3 months, contrast sensitivity was measured using the CSV-1000E contrast sensitivity chart test face (Vector Vision) at 3, 6, 12, and 18 cycles per degrees (cpd) under photopic conditions (85 cd/m(2)) and mesopic conditions (2.7 cd/m(2)) with 4.0 mm and 6.0 mm fixed central apertures, with and without glare. The Kruskal-Wallis test was used and a pair-wise comparison performed. The main outcome measure was the difference in contrast sensitivity between IOLs at each spatial frequency. RESULTS: The best corrected visual acuity was similar between the 3 IOL groups (P = .6). The AcrySof IQ group had significantly higher contrast sensitivity at 18 cpd under photopic conditions (P = .008); at 3, 6, 12, and 18 cpd during mesopic testing with a 4.0 mm aperture without glare (P = .018, P = .011, P = .007, and P = .0001, respectively) and with glare (P = .003, P = .006, P = .005, and P = .004, respectively); and at all spatial frequencies during mesopic testing with a 6.0 mm aperture without glare (P = .018, P = .006, P = .009, and P = .0001, respectively) and with glare (P = .019, P = .002, P = .01, and P = .017, respectively). CONCLUSION: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil.

Effect of stromal hydration of clear corneal incisions: quantifying ingress of trypan blue into the anterior chamber after phacoemulsification.

PURPOSE: To use trypan blue as a quantifiable ingress tracer to determine whether stromal hydration reduces ocular surface fluid ingress at the end of phacoemulsification. SETTING: Iladevi Cataract and IOL Research Centre, Memnagar, Ahmedabad, India. METHODS: A prospective randomized study included 80 eyes having phacoemulsification through 2.2 mm incisions. These eyes were divided into 2 equal groups: 1 had stromal hydration (surgery completed by injecting fortified balanced salt solution [BSS Plus] to hydrate the lateral walls and internal entry of incision) and the other had no stromal hydration. One half milliliter of 0.0125% sterile trypan blue was instilled on the ocular surface and allowed to remain for 2 minutes. One-tenth milliliter of aqueous fluid was aspirated from the anterior chamber, and its optical density was measured using ultraviolet spectrophotometry. Logs of dilution of trypan blue were used for statistical analysis using the nonparametric Mann-Whitney U test. RESULTS: There was a statistically significant decrease and difference between groups in mean dilution of trypan blue in the aqueous aspirate (P<.001). The mean was 1:11,337 in the stromal hydration group and 1:220 in the no stromal hydration group. Logs of mean dilution of trypan blue had statistically significant lower values in the stromal hydration group than in the no stromal hydration group (3.21 and 2.14, respectively) (P<.001). CONCLUSIONS: Stromal hydration of clear corneal incisions reduced ingress into the anterior chamber of the trypan blue instilled on the ocular surface. Clinically, these findings may have a beneficial effect in reducing the risk for postoperative endophthalmitis.

Post-operative capsular opacification: a review.

Post-operative capsular opacification is a multifactorial physiological consequence of cataract surgery. Opacification involving the central posterior capsule has a significant impact on high and low contrast acuity and low contrast sensitivity. The assessment of Posterior Capsule Opacification (PCO) on cadaver eyes, experimental studies, culture models and in clinical studies has provided an understanding of its pathogenesis. The proliferation, migration and abnormal differentiation of residual lens epithelial cells and fibers in the capsular bag have been implicated in the pathogenesis of PCO. The incidence and severity of PCO correlates to the meticulous use of surgical techniques, IOL optic edge designs and IOL materials. This article summarizes the clinical studies with recommendations for retarding the development of central PCO. It discusses experiments with pharmacological agents broadly categorized as anti-inflammatory, immuno-modulating, antiproliferative, antiadhering, antitransdifferentiating agents for the prevention of PCO. These studies will remain critical for future endeavors undertaken for eradication of PCO.

Analysis of patients with good uncorrected distance and near vision after monofocal intraocular lens implantation.

PURPOSE: To analyze factors contributing to uncorrected visual acuity of at least 6/12 for distance and at least J4 for near (pseudoaccommodation) after monofocal intraocular lens (IOL) implantation. SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS: In a case-controlled study of 30 eyes (30 patients) that had phacoemulsification, those with pseudoaccommodation were assigned to cases and 30 eyes (30 patients) without pseudoaccommodation were designated as controls. Controls were matched by identical best corrected visual acuity, age, and postoperative duration. Subjective refraction was done with retinoscopy. Factors analyzed included corneal astigmatism, pupil size, axial IOL movement, amplitude of accommodation, axial length (AL), and age. Corneal astigmatism was noted on topography and interpreted as against the rule (ATR) (180 +/- 15 degrees), with the rule (WTR) (90 +/- 15 degrees), and oblique (OB) (45/135 +/- 30 degrees). Pupil size was noted on topographic display and AL and anterior chamber depth (ACD) on immersion A-scan. The axial IOL movement was calculated as the difference in ACD after instillation of cyclopentolate 1% (Cyclopent) and subsequently pilocarpine nitrate 2% (Carpinol) at separate visits, and amplitude of accommodation was measured with static and dynamic retinoscopy. Multivariate logistic regression and odds ratio with 95% confidence intervals were determined. RESULTS: Mean spherical equivalent was -0.45 +/- 0.63 diopter (D) in cases and -0.35 +/- 0.83 D (P = .61) in controls. Multivariate logistic regression in cases versus controls: corneal astigmatism (ATR versus WTR and OB collectively): 10.19 [1.8,57.44], P = .009; pupil size: 0.45 [0.07,2.71], P = .38; axial IOL movement: 1.39 [0.51,0.77], P = .514; amplitude of accommodation: 2.95 [0.93,9.3], P = .065; AL: 0.55 [0.29,1.02], P = .058; and age: 0.98 [0.5,1.95], P = .963. CONCLUSION: The study suggests a significant role of ATR corneal astigmatism in good uncorrected distance and near vision after monofocal IOL implantation.

Effect of cortical cleaving hydrodissection on posterior capsule opacification in age-related nuclear cataract.

PURPOSE: To evaluate the effect of multiquadrant cortical cleaving hydrodissection on the development of posterior capsule opacification (PCO) after phacoemulsification. SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS: A prospective randomized triple blind clinical trial was conducted in 86 eyes (86 patients) having phacoemulsification. Eyes were assigned randomly to Group 1, multiquadrant cortical cleaving hydrodissection and hydrodelineation (n = 48 eyes), or Group 2, no multiquadrant cortical cleaving hydrodissection, only hydrodelineation (n = 38 eyes). Age-related nuclear sclerosis (grading system of 1 to 5) and age greater than 50 years were included. Diabetes mellitus and associated eye diseases were excluded. Standard phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was done in both groups. High-resolution digital retroillumination images of the posterior capsule were analyzed at 4 years using POCOman software. Seven patients dropped out (8.1%). Outcome measures were incidence and percentage area of PCO. Test of proportions, independent sample t test, and 95% confidence intervals (CIs) were noted. RESULTS: In Groups 1 and 2, the mean age was 58 years +/- 4 (SD) and 57 +/- 5 years, respectively (P = .702; 95% CI, 1.90-2.81); mean follow-up was 48.4 +/- 2.5 months and 49.3 +/- 1.9 months, respectively (P = .687; 95% CI, 1.186-0.7856); incidence of PCO was 11 of 44 (25%) and 12 of 35 (34.3%), respectively (P = .317; 95% CI, 0.359-0.0889); percentage area of PCO was 14.3% and 25.6%, respectively (P = .006; 95% CI, -19.19 to -3.44). One of 44 eyes (2.27%) and 2 of 35 eyes (5.7%) in the groups, respectively, had a neodymium:YAG capsulotomy. CONCLUSION: Although no difference was noted in the incidence of PCO, in eyes that had PCO, the percentage of the area of the central posterior capsule involved by PCO was significantly lower in eyes that had multiquadrant cortical cleaving hydrodissection than in those that did not.