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Background: Phacoemulsification surgery is the standard treatment for cataract. However, excessive ultrasound (US) energy may cause injury to the corneal endothelium and other ocular tissues. Recently, a new prechop technique assisted with the reverse chopper is showed to be more efficient and safe, by splitting the nuclei in situ without using any US energy. However, it is verified only in treating some kinds of complex cataracts such as grade IV hard nuclei cataract, small-pupil cataract, and ultra-high myopia cataract. Since grade III nuclei cataract is the most common type of cataract, it is necessary to evaluate the efficacy and safety of prechop technique with reverse chopper in routine cataract surgery. Methods: This prospective, two-parallel, randomized controlled trial was conducted in Beijing Tongren Hospital from January 2022 to September 2022. A total of 89 cataract patients (89 eyes) were enrolled and then randomly assigned to either the reverse chopper-assisted prechop group (n=45) or the phaco-chop group (n=44). The patients were followed for 3 months postoperatively. The best-corrected visual acuity (BCVA), cumulative dissipated energy (CDE), corneal endothelial cell loss (ECL), and degree of corneal edema were evaluated and compared between these 2 groups. Data were analyzed using SPSS 23.0 and GraphPad Prism 8.0. Results: The CDE of the reverse chopper-assisted prechop group was significantly less than that of the phaco-chop group (P=0.011). Compared with the phaco-chop group, the corneal edema in the reverse chopper-assisted prechop group was milder (P=0.026) and the BCVA was better (P=0.0012) at 1 day after surgery. No significant difference was found in the count or rate of corneal ECL between the 2 groups at 1 month after surgery (corneal ECL count: P=0.090; corneal ECL rate: P=0.053). The BCVA of the 2 groups at 1 week, 1 month, and 3 months after surgery was equivalent (P=0.052, 0.26, and 0.41, respectively). Conclusions: The prechop technique assisted with the reverse chopper in treating cataract with grade III nuclei enables less phaco energy consumption, milder ocular structural damage, and faster recovery of vision, compared with traditional phaco-chop technique.
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AIM: To analyze the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique in hard cataract phacoemulsification.METHODS: Prospective study. A total of 100 cases(100 eyes)with age-related grade IV hard cataract were included and randomly divided into 2 groups according to random number table, with 50 patients(50 eyes)in CCFP technique group(group A)and 50 cases(50 eyes)in stop-and-chop technique group(group B). The corneal endothelial cell count before and after operation, intraoperative US time, postoperative corneal endothelial cell loss rate, corneal edema grade at 1 and 7d and best corrected visual acuity(BCVA)were compared and statistically analyzed.RESULTS: The mean US time of group A was lower than that of group B [26.66(16, 40)s vs. 36.12(23, 46)s; Z=-5.56, P<0.01]. The mean corneal endothelial cell count in group A was higher than that in group B at 3mo after operation(2308.12±368.18cell/mm2 vs. 2104.06±379.87cell/mm2; t=2.728, P=0.008), and the loss rate of corneal endothelial cells in group A was lower than that in group B at 3mo after operation [10%(8%, 12%)vs. 17%(14%, 20%); Z=13.231, P<0.01]. The number of eyes with corneal edema of grade 0, 1, 2, 3 and 4 on 1d after surgery was 0, 23, 21, 6 and 0 in group A, respectively, while it was 0, 9, 26, 15 and 0 respectively in group B. Corneal edema in group A was less than that in group B(Z=10.514, P=0.005). The BCVA of group A was better than that of group B at 1d after operation, and there was significant difference in the number of eyes with different BCVA grades between the two groups(Z=7.176, P=0.029). There was no significant difference in the number of eyes with different grades of BCVA between the two groups at 3mo after surgery(Z=2.377, P=0.372).CONCLUSION: Compared with the stop-and-chop technique, CCFP technique uses less ultrasonic energy, has less damage to corneal endothelial cells and is suitable for hard cataract surgery.
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BACKGROUND: There are some techniques for disassembly of hard nuclear. It is challenging in hard cataract surgery through microincision. The classic chop or prechop techniques often do not succeed,resulting in incomplete nuclear segmentation. The authors describe a new chop technique for removing hard nucleus cataracts in coaxial microincisional cataract surgery. METHODS: We create a deep hole (drill) in the central nucleus with the phaco tip and divide the nucleus (prechop) with the Nagahara chopper and the modified capsulorhexis forceps inside the hole. The chopper and the modified capsulorhexis forceps are spread apart laterally after they approach at the center of the nucleus, to create a complete fracture across the entire nucleus. Since January 2022, we have completed 27 eyes of 25 patients with hard nucleus cataract using this technique. RESULTS: Complete segmentation of the hard nuclear into two hemispheres was implemented with this drill and prechop technique in all cases. The effective phaco time and ultrasound energy decreased. No intraoperative complication such as iris injury, anterior capsule tears, zonulysis, or posterior capsule rupture with vitreous loss occurred during surgery. CONCLUSIONS: This technique simplifies the previous prechop techniques especially for hard nucleus in microincisional cataract surgery. The technique is efficient, safe and simple.
Subject(s)
Cataract Extraction , Cataract , Ophthalmology , Humans , Capsulorhexis , IrisABSTRACT
BACKGROUND: To evaluate the safety and efficacy of the pre-chop technique using a novel reverse chopper vs. the classic stop-and-chop technique in phacoemulsification for patients with high myopia and associated grade III-IV nuclear cataracts. METHODS: In this prospective cohort study, a total of 44 consecutive patients (44 eyes) with grade III-IV nuclear cataracts who were admitted to our hospital for cataract surgery between March 2018 and September 2018 were enrolled. All patients had ocular axial length > 27 mm and myopic refraction more than -10 diopters. Patients were randomly divided into a pre-chop group and stop-and-chop group using a randomization table. Nucleus splitting was performed surgically in both groups using either the pre-chop technique with reverse chopper or the classic stop-and-chop technique. RESULTS: Postoperative visual acuity was significantly improved in both groups compared with preoperative values. Significantly better visual acuity, lower degree of corneal edema and lower rates of corneal endothelial cell loss were observed in the pre-chop group compared to those in the classic stop-and-chop group. No complications were reported in either group. CONCLUSIONS: In treating patients with high myopia associated with grade III-IV cataracts, the pre-chop technique using a reverse chopper reduces damage to corneal endothelial cells and improves visual acuity better than the classic stop-and-chop technique.
Subject(s)
Cataract , Myopia , Cataract/complications , Endothelial Cells , Humans , Myopia/complications , Myopia/surgery , Prospective StudiesABSTRACT
BACKGROUND: Phacoemulsification using phaco-chop technique has many challenging features in cataract patients with highly liquefied vitreous. This study aimed to compare the intraoperative parameters and safety between prechop technique and traditional phaco-chop in phacoemulsification for these patients. METHODS: A total of 54 eyes of 54 patients with high myopia-related or post-vitrectomy cataract that underwent phacoemulsification combined with intraocular lens implantation were included in this retrospective study. Of them, 25 eyes that received manual prechop were included in the prechop group, and 29 eyes with best match of age, axial length and nuclear opalescence (NO) that received standardized phaco-chop were included as the control group. The intraoperative complications and surgery parameters were compared between groups. RESULTS: No surgical complications were observed in the prechop group, while 2 eyes with posterior capsular rupture and 1 eye with a broken ciliary zonule (10.3%) were found in the control group. There was no significant difference in phaco time, average energy, and cumulative dissipated energy (CDE) between groups (all P > 0.05), but for hard nuclear cataracts with NO grading ≥ 5, prechop group required less phaco time (P = 0.008) and CDE (P = 0.029). There were significant correlations between phaco time vs. NO (r = 0.762 vs. 0.581, both P < 0.005) and CDE vs. NO (r = 0.717 vs. 0.668, both P < 0.001) in the prechop group and control group, respectively. CONCLUSIONS: The prechop technique which seemed to have less intraoperative complications, reduced phaco time and CDE compared to standardized phaco-chop might be a good alternative for cataract patients with highly liquefied or vitrectomized vitreous, especially those with hard nuclear cataracts.
Subject(s)
Cataract , Phacoemulsification , Cataract/complications , Humans , Intraoperative Complications , Phacoemulsification/methods , Retrospective Studies , Vitrectomy/methodsABSTRACT
PURPOSE: To introduce an alternative prechop technique without or with the use of a modified universal chopper (AE-2591, HI Kim chopper, ASICO, Inc. USA). METHODS: Patients who underwent cataract surgery using the phaco-chop technique and the modified prechop technique have been grouped and reviewed retrospectively. Endothelial cell count (ECC) and central corneal thickness (CCT) measured 7 days pre-operatively, and 1 month and 3 months post-operatively, were compared between the two groups. In modified prechop technique, a narrow 1.7 mm neck prechopper (AE-4298, HI Kim-Inamura chopper, ASICO, Inc., USA) was used with universal chopper (AE-2591, HI Kim chopper, ASICO, Inc., USA) as an additional device for grade 4 and above cataracts or without it for grade 2 to 3 cataracts. Details of the surgical technique is further described in the Method section. RESULTS: A total of 104 eyes in the modified prechop group and 97 eyes in the phaco-chop group were enrolled in the study. Pre-operative nuclear opacity, ECC, and CCT as well as post-operative ECC (absolute value and the loss) and CCT (absolute value and the change) throughout the follow-up between the two groups did not show statistically significant differences. CONCLUSION: Counter prechop technique using the modified prechopper and universal chopper is a safe, easy, and versatile surgical technique that can be applied broadly in a wide range of cases with various complexities, including LOCS lll N1 to N6 nuclei, hypermature cataracts, small pupils, and fragile suspensory zonular ligaments, with post-operative result not inferior to that of the conventional technique.
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Objective:To study the therapeutic effect of 1.8 mm micro incision prechop phacoemulsification (PE) in patients with nuclear cataract.Methods:The clinical data of 120 patients with nuclear cataract from June to December 2018 in Ningbo Medical Center Lihuili Hospital were retrospectively analyzed. Among them, 60 patients were treated with 1.8 mm micro incision prechop PE (prechop group), and 60 patients were treated with 1.8 mm micro incision PE (non-prechop group). The effective ultrasonic time and ultrasonic energy were recorded. The changes of optimum corrected vision, astigmatism degree and related indexes of corneal endothelial cells 1 d before operation and 1 d, 1 week, 1 month, 3 months, 6 months, 12 months after operation were compared between 2 groups.Results:The effective ultrasonic time and ultrasonic energy in prechop group were significantly lower than those in non-prechop group: (44.04 ± 8.93) s vs. (59.03 ± 9.98) s and (11.29 ± 1.08)% vs. (14.15 ± 1.16)%, and there were statistical differences ( t = 4.139 and 5.289, <0.05). No serious complications occurred in both groups. There was no statistical difference in optimum corrected vision 1d before operation and 1 d after operation between 2 groups ( P>0.05); the optimum corrected vision 1 week, 1 month, 3 months, 6 months, and 12 months after operation in prechop group was significantly better than that in non-prechop group, and there was statistical difference ( P<0.05). There was no statistical difference in astigmatism degree before and after operation ( P>0.05). The density of corneal endothelial cells and the proportion of hexagonal cells after operation in prechop group were significantly higher than those in non-prechop group, the area of corneal endothelial cells and variation coefficient were significantly lower than those in non-prechop group, and there were statistical differences ( P<0.05). Conclusions:The 1.8 mm micro incision prechop PE to treat nuclear cataract can effectively reduce astigmatism degree after operation and damage corneal endothelial cells in lower degree. And it is better to patients′ postoperative visual recovery.
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PURPOSE: To describe a manual prechop technique for splitting the nucleus of the lens using a recently developed reverse chopper. METHODS: During the process, the reverse chopper and the Nagahara chopper are placed diagonally in the peripheral area of the nucleus of the lens after capsulorhexis. The reverse chopper and the Nagahara chopper then are pushed horizontally toward each other so they meet at the center of the lens to split the nucleus of lens into 2 parts. RESULTS: In all cases, the reverse chopper was effective during the prechop procedure for hard nuclei, the nucleus of the lens remained in situ during the chopping process, and the reverse chopper did not retract the suspensory ligament in patients in whom the ligament was fragile. During the prechop procedure, no capsule breakage occurred, and the time and energy required for effective phacoemulsification were reduced significantly. CONCLUSIONS: The prechop technique using the reverse chopper can be applied for cases with grade III-V nuclei, overripe nuclei, and fragile suspensory ligaments. The procedure is simple, and the learning curve is not steep.
Subject(s)
Capsulorhexis/instrumentation , Cataract/complications , Exfoliation Syndrome/surgery , Capsulorhexis/methods , Exfoliation Syndrome/etiology , HumansABSTRACT
@#AIM: To discuss the effect of the cystotome-assisted prechop technique performed in hard nuclear cataract phacoemulsification. <p>METHODS: One hundred and twenty-six patients(158 eyes)of age-related cataracts with nucleus density at grade Ⅲ-Ⅳ were randomly divided into two groups. Group A was performed a manual prechop technique using a surgeon-bent cystotome after the capsulorhexis, while group B was performed traditional phaco-chop without prechop technique. The average power(AP), actual ultrasonic time(U/S time), accumulated energy complex parameter(AECP)of machine, average density of endothelial cells, endothelial cells loss, uncorrected visual acuity(UCVA), corneal edema and intraoperative complications were compared between groups. <p>RESULTS: The AP, U/S time and AECP of Group A were significantly lower than that of Group B(<i>P</i><0.05). At postoperative day 1, the corneal edema of Group A was slighter than the control with significant difference(<i>P</i><0.05), so was the UCVA. While there was no significant difference of UCVA between groups at postoperative 1wk. The average corneal endothelium density of Group B was significantly lower than that of Group A at postoperative 1wk, and the average cell loss was higher than that of Group A. Two eyes of group A had posterior capsular rupture compared to 4 eyes of Group B.<p>CONCLUSION: Compared with traditional phaco-chop, the cystotome-assisted prechop technique presents shorter intraoperative ultrasound time and lower energy, while contributes to less corneal endothelial cell loss and better early postoperative UCVA.
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@#AIM:To compare the two techniques of pre-chop and non-pre-chop, and discuss the technical advantages of the capsulorhexis forceps assisted pre-chop.METHODS:Totally 149 cases of age-related cataract were randomly divided into using pre-chop (Group A) and non-pre-chop (Group B) techniques groups, for Group A patients received phacoemulsification after pre-chop by using capsulorhexis forceps.The ultrasonic energy, average phacoemulsification time, intraoperative complications, 1d, 1wk uncorrected visual acuity (UCVA) and 1d, 3d,1wk postoperative corneal edema were recorded and compared.RESULTS:The subgroups of the same group of nuclei were compared in the two groups.The ultrasonic time in Group A was lower than that of Group B, and the difference was significant(P<0.01).Also the corneal edema in the former was lighter than that of the latter(P<0.05).There was difference in uncorrected visual acuity(UCVA) between groups(P<0.05).CONCLUSION:Compared with non-pre-chop, the time of ultrasound in pre-chop group was shorter, the degree of corneal edema was lighter and early postoperative UCVA was better.
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Background Pseudoexfoliation syndrome (PEX) has a high incidence in Uygur population and usually leads to secondary glaucoma and complicated cataract.The abnormal change of lens tissue and degeneration of zonular fibers bring a lot of difficulties for phacoemulsification (phaco) with intraocular lens implantation,especially stop-and-chop phaco technique.Prechop technique is a new choping technology,but its application in PEX with cataract is less.Objective This study was to compare the efficacy and safety of pre chop phaco technique and stop-and-chop phaco technique for PEX combined cataract.Methods A randomized controlled Clinical trial was designed.Forty-one eyes of 41 patients with PEX combined cataract of Ⅲ degree of nucleus were enrolled in People's Hospital of Hetian District from March 2015 to January 2016.The patients were randomized into the prechop group and stop-and-chop group according to random nubmer table,and cystotome-assisted prechop phaco surgery and stop-and-chop phaco surgery were performed in different groups,respectively.The effective phaco duration,corneal endothelium loss rate,cornea edema eye number after operation,vision outcomes and complications were compared between the two groups.Results The mean effective phaco duration was 14.0 (13.0,16.5) minutes and 18.5 (16.5,24.0) minutes in the prechop group and stop-and-chop group,with a significant difference between them (Z =17.354,P ＜ 0.01).The corneal endothelial cells were (2 101.90 ± 209.08)/mm in the prechop group,and the number was similar to (2 002.30 ± 207.04)/mm of the stop-and-chop group (t =-1.530,P =0.134).Corneal endothelial cell lossing rate was (8.27±2.23)％ in the prechop group,which was lower than (13.09±4.26)％ in the stop-and-chop group (t =3.810,P =0.001).The BCVA was better in the prechop group than that in the stop-and-chop group in postoperative day 3 (P =0.044),and the corneal edema degree was not signigicantly different in postoperative day 1 and day 3 between the two groups (P=0.221,0.446).Intraoperative complication was rapture of zonule and occurred in 1 eye and 2 eyes in the prechop group and stop-and-chop group,respectively.Conclusions Compared with the stop-and-chop phaco technique,the prechop phaco tequnique can decrease intraoperative complication,lighten the postoperative damage of corneal endothelial cells and accelerate visual rehabilitation in PEX combined with cataract patients.
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Objetivo: determinar la repercusión sobre el endotelio corneal, con la aplicación de las técnicas de prechop vs. phacochop en la cirugía de catarata por facoemulsificación. Métodos: se realizó un estudio prospectivo analítico de casos y controles, en el Servicio de Catarata adjunto al Centro de Microcirugía Ocular del Hospital Oftalmológico Docente Ramón Pando Ferrer, con el diagnóstico de catarata unilateral o bilateral, desde enero de 2013 hasta enero de 2014. A cincuenta pacientes se les aplicó el procedimiento prechop y a otros cincuenta phacochop. Las variables bajo estudio fueron la edad, el sexo, la dureza del núcleo del cristalino y el tiempo de aplicación del ultrasonido; y tanto en el preoperatorio como en el posoperatorio se tuvieron en cuenta la densidad celular, la hexagonalidad y el coeficiente de variabilidad. Resultados: al comparar los resultados posoperatorios en el grupo en que se aplicó prechop con los obtenidos por phacochop, hubo diferencias en la pérdida de densidad celular y de la hexagonalidad. Estas fueron mayores en el grupo phacochop. También hubo diferencias en el coeficiente de variabilidad y en el tiempo efectivo de facoemulsificación, los cuales fueron mayores en el grupo phacochop. Conclusiones: los resultados posoperatorios corroboran que los pacientes a quienes se les aplica prechop presentan mejor conservación del endotelio corneal que los que reciben phacochop(AU)
Objective: to determine the impact of the application of the techniques of prechop vs phacochop techniques on the corneal endothelium in the cataract surgery using phacoemulsification. Methods: a prospective, analytical case-control study in the cataract service of the Center of Ocular Microsurgery Ocular in Ramón Pando Ferrer teaching ophthalmological hospital, with the diagnosis of unilateral or bilateral cataract, and conducted from January 2013 to January 2014. Fifty patients underwent the prechop procedure and 50 were applied the phacochop method. The variables under study were age, sex, crystalline lens hardness and length of time of ultrasound application; both in the preoperative and postoperative phase, the cell density, hexagonality and the coefficient of variability were took into account. Results: when comparing the postoperative results in the prechop group with those of the phacochop one, there were differences in the loss of cell density and hexagonality, being greater in the phacochop group. There were also differences in the coefficient of variability, and the effective time of phacoemulsificación, which were greater in the phacochop group. Conclusions: the postoperative results corroborate that the group of patients under prechop procedure has better preservation of their corneal endothelium than those in the phacochop group(AU)
Subject(s)
Humans , Cataract Extraction/methods , Endothelium, Corneal/surgery , Phacoemulsification/adverse effects , Case-Control Studies , Prospective StudiesABSTRACT
Objetivo: determinar la repercusión sobre el endotelio corneal, con la aplicación de las técnicas de prechop vs. phacochop en la cirugía de catarata por facoemulsificación. Métodos: se realizó un estudio prospectivo analítico de casos y controles, en el Servicio de Catarata adjunto al Centro de Microcirugía Ocular del Hospital Oftalmológico Docente Ramón Pando Ferrer, con el diagnóstico de catarata unilateral o bilateral, desde enero de 2013 hasta enero de 2014. A cincuenta pacientes se les aplicó el procedimiento prechop y a otros cincuenta phacochop. Las variables bajo estudio fueron la edad, el sexo, la dureza del núcleo del cristalino y el tiempo de aplicación del ultrasonido; y tanto en el preoperatorio como en el posoperatorio se tuvieron en cuenta la densidad celular, la hexagonalidad y el coeficiente de variabilidad. Resultados: al comparar los resultados posoperatorios en el grupo en que se aplicó prechop con los obtenidos por phacochop, hubo diferencias en la pérdida de densidad celular y de la hexagonalidad. Estas fueron mayores en el grupo phacochop. También hubo diferencias en el coeficiente de variabilidad y en el tiempo efectivo de facoemulsificación, los cuales fueron mayores en el grupo phacochop. Conclusiones: los resultados posoperatorios corroboran que los pacientes a quienes se les aplica prechop presentan mejor conservación del endotelio corneal que los que reciben phacochop(AU)
Objective: to determine the impact of the application of the techniques of prechop vs phacochop techniques on the corneal endothelium in the cataract surgery using phacoemulsification. Methods: a prospective, analytical case-control study in the cataract service of the Center of Ocular Microsurgery Ocular in "Ramón Pando Ferrer" teaching ophthalmological hospital, with the diagnosis of unilateral or bilateral cataract, and conducted from January 2013 to January 2014. Fifty patients underwent the prechop procedure and 50 were applied the phacochop method. The variables under study were age, sex, crystalline lens hardness and length of time of ultrasound application; both in the preoperative and postoperative phase, the cell density, hexagonality and the coefficient of variability were took into account. Results: when comparing the postoperative results in the prechop group with those of the phacochop one, there were differences in the loss of cell density and hexagonality, being greater in the phacochop group. There were also differences in the coefficient of variability, and the effective time of phacoemulsificación, which were greater in the phacochop group. Conclusions: the postoperative results corroborate that the group of patients under prechop procedure has better preservation of their corneal endothelium than those in the phacochop group(AU)
Subject(s)
Humans , Endothelium, Corneal/surgery , Cataract/diagnosis , Phacoemulsification/adverse effects , Case-Control Studies , Prospective StudiesABSTRACT
Objetivos: aplicar la técnica de prechop en la cirugía de catarata por facoemulsificación y describir sus resultados. Métodos: estudio descriptivo y prospectivo en 295 pacientes (ojos) con diagnóstico de catarata senil atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre enero y diciembre de 2010. Se analizaronlas variables: mejor agudeza visual corregida y sin corregir, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo resultante, tiempo efectivo de ultrasonido y complicaciones. Resultados: la pérdida celular endotelial fue de 14,2 porciento. La hexagonalidad promedio posoperatoria, de 50,99 porciento. El coeficiente de variabilidad promedio preoperatorio fue de 32,37 por ciento y cambió a 30,43 por ciento en el posoperatorio. El astigmatismo posoperatorio promedio fue de 1,48 dioptría con una inducción de 0,51 dioptría. El tiempo efectivo de ultrasonido estuvo por debajo de los 2 minutos en el 80 por ciento de los casos. La mejor agudeza visual sin corregir preoperatoria fue de 0,14 como promedio y mejoró a 0,43 en el posoperatorio, mientras que la mejor agudeza visual corregida, de 0,29 en el preoperatorio mejoró a 0,82. La complicación transquirúrgica más frecuente fue la rotura de la cápsula posterior y la posquirúrgica, el edema corneal. Conclusiones: la opción de realizar la técnica de prechop para emulsificar el cristalino representa una ventaja para la cirugía de cataratas, sobre todo en pacientes con cristalinos duros por la poca repercusión para el endotelio corneal. Existe una mejoría importante de la agudeza visual sin corregir y con corrección después de la cirugía
Objective: to use the prechop technique in the phacoemulsification cataract surgery and to describe the final results. Methods: descriptive and prospective study of 295 patients (eyes) with senile cataract diagnosis, who were seen at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to December 2010. The analyzed variables were best corrected and uncorrected visual acuity and endothelial cell count, hexagonality, variability coefficient, refractive astigmatism, effective ultrasound time and complications.Results: the endothelial cell loss was 14.2 percent. The postoperative average hexagonality was 50.99 percent. The preoperative variability coefficient averaged 32.37 but changed to 30.43 percent after surgery. Postoperative average astigmatism was 1.48 D, with induction of 1.51 D. The effective ultrasound time was less than 2 minutes in 80 percent of cases. Best uncorrected visual acuity preoperatively was 0.14 and improved to 0.43 in the postoperative phase, but the best corrected visual acuity was 0.29 before surgery and rose to 0.82. The most frequent transurgical complication was rupture of the posterior capsule corneal whereas the corneal edema prevailed after surgery. Conclusions: phacoemulsification using prechop technique is an advantage for the cataract surgery, with an important improvement of final uncorrected and corrected visual acuity, and a very good choice in patients with hard cataract because of the lower impact on the corneal endothelium
Subject(s)
Humans , Male , Female , Cataract Extraction , Phacoemulsification/methods , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Objetivos: aplicar la técnica de prechop en la cirugía de catarata por facoemulsificación y describir sus resultados. Métodos: estudio descriptivo y prospectivo en 295 pacientes (ojos) con diagnóstico de catarata senil atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre enero y diciembre de 2010. Se analizaronlas variables: mejor agudeza visual corregida y sin corregir, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo resultante, tiempo efectivo de ultrasonido y complicaciones. Resultados: la pérdida celular endotelial fue de 14,2 porciento. La hexagonalidad promedio posoperatoria, de 50,99 porciento. El coeficiente de variabilidad promedio preoperatorio fue de 32,37 por ciento y cambió a 30,43 por ciento en el posoperatorio. El astigmatismo posoperatorio promedio fue de 1,48 dioptría con una inducción de 0,51 dioptría. El tiempo efectivo de ultrasonido estuvo por debajo de los 2 minutos en el 80 por ciento de los casos. La mejor agudeza visual sin corregir preoperatoria fue de 0,14 como promedio y mejoró a 0,43 en el posoperatorio, mientras que la mejor agudeza visual corregida, de 0,29 en el preoperatorio mejoró a 0,82. La complicación transquirúrgica más frecuente fue la rotura de la cápsula posterior y la posquirúrgica, el edema corneal. Conclusiones: la opción de realizar la técnica de prechop para emulsificar el cristalino representa una ventaja para la cirugía de cataratas, sobre todo en pacientes con cristalinos duros por la poca repercusión para el endotelio corneal. Existe una mejoría importante de la agudeza visual sin corregir y con corrección después de la cirugía(AU)
Objective: to use the prechop technique in the phacoemulsification cataract surgery and to describe the final results. Methods: descriptive and prospective study of 295 patients (eyes) with senile cataract diagnosis, who were seen at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to December 2010. The analyzed variables were best corrected and uncorrected visual acuity and endothelial cell count, hexagonality, variability coefficient, refractive astigmatism, effective ultrasound time and complications.Results: the endothelial cell loss was 14.2 percent. The postoperative average hexagonality was 50.99 percent. The preoperative variability coefficient averaged 32.37 but changed to 30.43 percent after surgery. Postoperative average astigmatism was 1.48 D, with induction of 1.51 D. The effective ultrasound time was less than 2 minutes in 80 percent of cases. Best uncorrected visual acuity preoperatively was 0.14 and improved to 0.43 in the postoperative phase, but the best corrected visual acuity was 0.29 before surgery and rose to 0.82. The most frequent transurgical complication was rupture of the posterior capsule corneal whereas the corneal edema prevailed after surgery. Conclusions: phacoemulsification using prechop technique is an advantage for the cataract surgery, with an important improvement of final uncorrected and corrected visual acuity, and a very good choice in patients with hard cataract because of the lower impact on the corneal endothelium(AU)
Subject(s)
Humans , Male , Female , Cataract Extraction , Phacoemulsification/methods , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Objetivo: evaluar los cambios endoteliales y resultados visuales en los ojos de pacientes con diagnóstico de catarata senil, operados por técnica de facoemulsificación por pre chop o extracción extracapsular del cristalino por túnel esclerocorneal.Métodos: se realizó un estudio descriptivo y prospectivo de 100 pacientes (ojos) atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, de septiembre a diciembre de 2010. La mitad fueron operados por facoemulsificación y el resto por túnel esclerocorneal. Se analizaron las variables: mejor agudeza visual corregida y sin corrección, dureza del cristalino, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo medio inducido y tiempo efectivo de ultrasonido...
Objective: to evaluate the endothelial changes occurred and the visual results achieved in the eyes of patients diagnosed with senile cataract, who were operated on either by the prechop phacoemulsification technique or by the extracapsular extraction of the crystalline through the scleracorneal tunnel.Methods: a prospective and descriptive study of 100 patients (eyes) seen at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September to December 2010 was conducted. One half was operated on by phacoemulsification whereas the other underwent scleracorneal tunnelized extraction. The analyzed variables were: best uncorrected and corrected visual acuity, endothelial cellular count, hexagonality, variability coefficient, mean induced astigmatism and effective phaco time...
Subject(s)
Humans , Male , Female , Cataract Extraction/adverse effects , Cataract Extraction/methods , Phacoemulsification/methods , Limbus Corneae/surgery , Endothelium, Corneal/physiopathology , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Objetivo: evaluar los cambios endoteliales y resultados visuales en los ojos de pacientes con diagnóstico de catarata senil, operados por técnica de facoemulsificación por pre chop o extracción extracapsular del cristalino por túnel esclerocorneal.Métodos: se realizó un estudio descriptivo y prospectivo de 100 pacientes (ojos) atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, de septiembre a diciembre de 2010. La mitad fueron operados por facoemulsificación y el resto por túnel esclerocorneal. Se analizaron las variables: mejor agudeza visual corregida y sin corrección, dureza del cristalino, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo medio inducido y tiempo efectivo de ultrasonido...
Objective: to evaluate the endothelial changes occurred and the visual results achieved in the eyes of patients diagnosed with senile cataract, who were operated on either by the prechop phacoemulsification technique or by the extracapsular extraction of the crystalline through the scleracorneal tunnel.Methods: a prospective and descriptive study of 100 patients (eyes) seen at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September to December 2010 was conducted. One half was operated on by phacoemulsification whereas the other underwent scleracorneal tunnelized extraction. The analyzed variables were: best uncorrected and corrected visual acuity, endothelial cellular count, hexagonality, variability coefficient, mean induced astigmatism and effective phaco time...
Subject(s)
Humans , Male , Female , Endothelium, Corneal/physiopathology , Cataract Extraction/adverse effects , Cataract Extraction/methods , Phacoemulsification/methods , Limbus Corneae/surgery , Epidemiology, Descriptive , Prospective StudiesABSTRACT
OBJETIVO: Describir los resultados encontrados en pacientes operados de catarata por faco-prechop con el uso de la anestesia tópica. MÉTODOS: Se realizó un estudio observacional descriptivo prospectivo, de 30 ojos (19 pacientes) atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer operados de catarata mediante Facoemulsificación por técnica de prechop, en los cuales se utilizó anestesia tópica durante la cirugía en el período comprendido de julio a septiembre de 2009. A los mismos se les realizó microscopía endotelial antes y después de la cirugía con el objetivo de determinar las modificaciones en la densidad celular. Se evaluó la presencia de dolor, así como el confort del cirujano en una escala de satisfacción. Se analizaron las variables edad, promedio celular, dolor, confort del cirujano y mejor agudeza visual corregida pre y posoperatoria. La información se procesó a través de frecuencias absolutas, relativas, media y prueba T de Student. RESULTADOS: La edad media de los pacientes fue de 62 años con un mínimo de 46 y un máximo de 94. La pérdida celular fue mínima. Un escaso número de pacientes manifestó dolor en algún momento de la cirugía, por lo que el confort del cirujano no se afectó de manera significativa durante el acto quirúrgico. Se encontró una ganancia visual de cinco líneas en la escala de Snellen. CONCLUSIONES: Los anestésicos tópicos en la cirugía de catarata evidenciaron ser de muy buena utilidad en nuestra técnica, lo cual no nos llevó al uso de otras vías anestésicas más invasivas para los pacientes
OBJECTIVE: To describe the results found in patients operated from cataract by the Phaco-Prechop technique using the topical anesthesia. METHODS: A prospective, observational and descriptive study was performed in 30 eyes (19 patients), seen at the Center of Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology and operated from cataract by phacoemulsification using the prechop technique and the topical anesthesia, was in the period of July to September 2009. These patients underwent endothelial microscopy before and after the surgery with the objective of determining any change in the cellular density. The pain and the surgeon's comfort measured in a satisfaction scale were evaluated. Variables such as age, cellular average, pain, the surgeon's comfort and the best pre and postoperative corrected visual acuity were analyzed. The information was processed through the absolute and relative frequencies, the mean and Student´s t test. RESULTS: The average age of the patients was 62 years -minimum 46 and a maximum 94 years. The cellular loss was minimal. A small number of patients felt pain at certain moment of the surgery; therefore the surgeon's comfort was not affected in a significant way during the surgery. The visual gain was found to be five lines in the Snellen´s chart. CONCLUSIONS: The topical anesthetics turned to be very useful in the cataract surgery using the phaco-prechop technique, thus avoiding other more invasive anesthestic paths for the patients
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Anesthetics, Local/therapeutic use , Cataract Extraction/statistics & numerical data , Phacoemulsification/methods , Epidemiology, Descriptive , Observational Studies as Topic , Prospective StudiesABSTRACT
OBJETIVO: Comparar la pérdida celular endotelial en los pacientes operados de catarata mediante facoemulsificación por ultrachop y prechop. MÉTODOS: Se realizó un estudio observacional descriptivo prospectivo de 120 pacientes (ojos) atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer operados de catarata mediante facoemulsificación por ultrachop y prechop en el período comprendido de noviembre 2006 a julio 2008 a los que se les realizó microscopia endotelial antes y después de la cirugía con el objetivo de determinar las alteraciones del endotelio corneal ocasionadas por ella. Se analizaron las variables edad, alteraciones endoteliales, tiempo efectivo de facoemulsificación y agudeza visual. La informaci¾n se procesó a través de frecuencias absolutas, relativas, media y prueba T de Student. RESULTADOS: Se encontró que predominaron los pacientes entre 60 y 87 años; existió pérdida celular proporcional al aumento de la edad y al tiempo efectivo de facoemulsificación. Se produjo aumento del polimegatismo en relación con el tiempo efectivo de facoemulsificación en el grupo operado mediante ultrachop y no fue significativa la modificación del pleomorfismo en ambos grupos. La agudeza visual con corrección mejoró en más de cuatro líneas en la escala de Snellen equivalente a 25 VAR en la escala de Logmar. La presencia de alteraciones endoteliales no influyó en el resultado visual posoperatorio. CONCLUSIONES: Este estudio permite al cirujano del segmento anterior establecer un pronóstico antes de efectuar la cirugía, por lo que su realización en el preoperatorio constituye un pilar fundamental antes de su ejecución
OBJECTIVE: To compare the endothelial cell loss in patients operated on from cataracts through ultrachop and prechop phacoemulsification. METHOD: A prospective observational study of 120 patients (eyes) treated at the Ocular Microsurgery Center in Ramón Pando Ferrer Cuban Institute of Ophthalmology and operated on from cataract through prechop and ultrachop phacoemulsification techniques in the period from November 2006 to July 2008. They were performed endothelial microscopy before and after surgery in order to determine the corneal endothelial disorders caused by it. Variables such as age, endothelial problems, effective phacoemulsification time (PET) and visual acuity were analyzed. The Information was processed through absolute, relative, mean frequencies and Student´s T test RESULTS: The patients aged 60 - 87 years predominated, the cell loss was proportional to increased age and the PET. Polymegatism increased in relation to PET in the group operated on by the ultrachop whereas the change of pleomorphism in both groups was not significant. Corrected visual acuity improved by more than four lines on the Snellen´s chart, which is equivalent to 25 VAR in the Logmar scale. The endothelial alterations did not influence the postoperative visual outcome. CONCLUSIONS: This study allows the surgeon operating the anterior segment to set prognosis prior to the surgery, and this is an important pillar before the surgical procedure
Subject(s)
Humans , Male , Female , Middle Aged , Endothelium, Corneal/physiopathology , Cataract Extraction/methods , Phacoemulsification/adverse effects , Epidemiology, Descriptive , Observational Studies as Topic , Prospective StudiesABSTRACT
OBJETIVO: Describir los resultados encontrados en pacientes operados de catarata por faco-prechop con el uso de la anestesia tópica. MÉTODOS: Se realizó un estudio observacional descriptivo prospectivo, de 30 ojos (19 pacientes) atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer operados de catarata mediante Facoemulsificación por técnica de prechop, en los cuales se utilizó anestesia tópica durante la cirugía en el período comprendido de julio a septiembre de 2009. A los mismos se les realizó microscopía endotelial antes y después de la cirugía con el objetivo de determinar las modificaciones en la densidad celular. Se evaluó la presencia de dolor, así como el confort del cirujano en una escala de satisfacción. Se analizaron las variables edad, promedio celular, dolor, confort del cirujano y mejor agudeza visual corregida pre y posoperatoria. La información se procesó a través de frecuencias absolutas, relativas, media y prueba T de Student. RESULTADOS: La edad media de los pacientes fue de 62 años con un mínimo de 46 y un máximo de 94. La pérdida celular fue mínima. Un escaso número de pacientes manifestó dolor en algún momento de la cirugía, por lo que el confort del cirujano no se afectó de manera significativa durante el acto quirúrgico. Se encontró una ganancia visual de cinco líneas en la escala de Snellen. CONCLUSIONES: Los anestésicos tópicos en la cirugía de catarata evidenciaron ser de muy buena utilidad en nuestra técnica, lo cual no nos llevó al uso de otras vías anestésicas más invasivas para los pacientes(AU)
OBJECTIVE: To describe the results found in patients operated from cataract by the Phaco-Prechop technique using the topical anesthesia. METHODS: A prospective, observational and descriptive study was performed in 30 eyes (19 patients), seen at the Center of Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology and operated from cataract by phacoemulsification using the prechop technique and the topical anesthesia, was in the period of July to September 2009. These patients underwent endothelial microscopy before and after the surgery with the objective of determining any change in the cellular density. The pain and the surgeon's comfort measured in a satisfaction scale were evaluated. Variables such as age, cellular average, pain, the surgeon's comfort and the best pre and postoperative corrected visual acuity were analyzed. The information was processed through the absolute and relative frequencies, the mean and Student´s t test. RESULTS: The average age of the patients was 62 years -minimum 46 and a maximum 94 years. The cellular loss was minimal. A small number of patients felt pain at certain moment of the surgery; therefore the surgeon's comfort was not affected in a significant way during the surgery. The visual gain was found to be five lines in the Snellen´s chart. CONCLUSIONS: The topical anesthetics turned to be very useful in the cataract surgery using the phaco-prechop technique, thus avoiding other more invasive anesthestic paths for the patients(AU)
