Comparison of Ocular Pain during Cataract Surgery Using a Scleral Pocket Incision under Pinpoint versus Intracameral Anesthesia

We compared the pain produced during different phases of phacoemulsification cataract surgery using a scleral pocket incision under pinpoint anesthesia with that under intracameral anesthesia. This prospective study comprised each 100 cataract patients who had no complications influencing the degree of pain during surgery. Patients were asked about pain immediately after each phase and pain occurring during each phase was measured using 4 step verbal scale(from 0 to 4). In both anesthesia,conjunctival reposition was the most painful.Pinpoint injection was statistically significantly more painful than induction of intracameral anesthesia.The pain score during conjunctival reposition and at 1hr after surgery were significantly higher under intracameral anesthesia than under pinpoint, but during most of phases under both anesthesia,the pain score was relatively low. Intracameral anesthesia is easy,safety and dose not require additional ocular damage during induction of anesthesia,so if combined with topical anesthesia,it is very effective during cataract surgery using scleral pocket incision.

The Location of Scleral Incision for Decrease of corneal Astigmatism in Sutureless Cataract Surgery

We analysed postoperative corneal astigmatic changes to know that preoperative astigmatism was able to decreased according to the location of incision in sutureless cataract surgeries. We divided 70 patients, 81 eyes that scleral pocket incision, phacoemulsification, and posterior chamber intraocular lens implantation was performed into two groups. The one is the preoperative with-the-rule(WTR)astigmatism more than 1 diopter(D) with superior incision, and the other is the preoperative WTR less than 1D or against-the-rule (ATR) astigmatism with temporal incision. We followed up the corneal astigmatic chnges until six months postoperatively. According to the results of algebraic analysis, in the superior incision group, postoperative astigmatic changes showed WTR decrease of 0.43D immediately, which advanced toward ATR decrease of 0.41D immediately, which keep up ATR decrease and showed ATR decrease of 0.44D at 6 months. According to the results of vector analysis, surgical inducced corneal astigmatism was o.69D in superior incision group and 0.50D in temporal incision group at postoperative 1day. It was 0.98D in superior incision group and 0.57D in temporal incision group at postoperative 6 months. We could decrease preoperative corneal astigmatism with performing incision at the position of greater corneal curvature. Temporal incision group showed less surgical induced astigamatic changes than superior incision.

Mid Limbal Incision vs Scleral Pocket Incision in Cataract Surgery

Recent cataract surgery has a trend to use clear corneal incision that does not require conjunctival peritomy and has fewer complications such as hyphema and ciliary body damage etc. Clear corneal incision also provides less corneal astigmatism and thereby better naked visual acuity. However the side effects of clear corneal incision such as includes wound leakage and associated endophthalmitis, endothelisal cell damage, irregular corneal astigmatism and instability of wounds have been reported continuously. Thus, we have introduced the 3.5mm sized mid limbal incision technique which may compensate the above complications and have rapid visual rehabilitation. Postoperative corneal astigmatism and uncorrected visual acuity of patients with clear corneal incision were compared with the results of scleral pocket incision. The corneal astigmatic changes of both group showed trivial against- the-rule change(0.44-0.12D) in early post operative period. Mid limbal incision group presented a little highter against-the-rule change at post operative 1 wee, but no significiant diffeence was noted sice postoperative 1 month. Uncorrected visual acuity showed no difference between two groups. From these results, we conclude mid limbal incision is an effective procedure that can compensate the disadvantage of both clear corenal incision and scleral pocket incision.

Clinical Results of Phacoemulsification with Scleral Pocket Incision in Diabetic Patients

We compared the visual outcome after phacoemulsification through the scleral pocket incision between non-diabetic patients and diabetic patients, and studied the factors influencing the visual outcome and postoperative complications in diabetic patients. retrospectively. The subjects operated by one of the authors were composed of 277 non-diabetic patients (277 eyes) and 90 diabetic patients (113 eyes). An average of the best corrected visual acuities at postoperative 8 weeks was lower in diabetic patients than that in non-diabetic patients, but there was no statistically significant difference between diabetic patients who had no or background diabetic retinopathy and non-diabetic patients. In diabetic patients the visual outcome was significantly related with severity of diabetic retinopathy, duration of the diabetes, and insulin dependency, but not related with the rupture of posterior capsule during surgery. Among the complications there were posterior capsule rupture (10.6%), hyphema (7.8%), posterior capsular opacity (4.9%), and posterior synechiae (4.9%).

Extracapsular Cataract Extraction Using Scleral Pocket Incision

We analyzed corneal astigmatism 2 months after extracapsular cataract extraction with posterior chamber intraocular lens implantation using scleral pocket incision to minimize postoperative corneal astigmatism. Among the patients who were operated between July 1993 and April 1994, 25 eyes of 20 patients could be followed up over 2 months. Keratometric and refractive measurements were obtained before and at every week after operation. The mean postoperative refractive astigmatism was +1.42D at 1 week, +0.02D at 8 weeks and mean postoperative keratometric astigmatism was +1.58D at 1 week, -0.17D at 8 weeks. Our results suggest that extracapsular cataract extraction using scleral pocket incision has the advantage of decreasing early postoperative astigmatic change.

Cataract Surgery Using a Sleral Pocket Incision of 7 mm in Length

During a eight-month period from june 1993, cataract surgery using a scleral pocket of 7 mm in length was performed on 30 eyes of 26 patients. In order to evaluate the effect of chamber entry length and closure technique on astigmatic changes and visual recovary, three different surgical procedures were carried out and compared retrospectively. The visual acuity, refraction and keratometry were assessed at every week. The H group(15 eyes) had a single horizontal suture after phacoemulsification followed by implantation of a one piece of PMMA lens through 7 mm chamber entry. The F group(6 eyes) had a single horizontal suture followed by implantation of a foldable lens through 4 mm chamber entry. The R group(9 eyes) had a single radial suture followed by implantation of one piece of PMMA lens through 7 mm chamber entry. Overall uncorrected visual acuity of 20/40 or better was 67% at 1 week, 93% at 8 weeks postoperatively and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean refractive astigmatism from 1 to 8 weeks postoperatively was 0.69D and there was no statistically significant difference among the three groups(p>0.05). The overall change of mean keratometric astigmatism method from 1 to 8 weeks postoperatively was 0.12D and there was no statistically significant difference among the three groups(p>0.05). Early clinical observations indicate that cataract surgery using a scleral pocket of 7 mm in length shows early visual recovery and minimizes surgically induced astigmatism without serious complications.

Surgically Induced Astigmatism According to Corneoscleral Incision Length and Suture Methods After Cataract Surgery

We analyzed corneal astigmatic change on patients after phacoemulsification with scleral pocket incision, according to incision length and suture methods. The patients were divided into 4 groups and followed up at least for 2 months. The four groups were 5.5 mm incision length with horizontal suture technique group, 5.5 mm incision length with sutureless technique group, 6.5 mm - 7.0 mm incision length with horizontal suture technique group and 6.5 mm - 7.0 mm incision length withsutureless technique group. Inall groups, there was slightly increasing tendency of against the rule astigmatism, but less than 0.54 D(average). Among the patients with 5.5 mm incision length, horizontal suture group had almost the same astigmatic change as sutureless group(p=0.44, t-test), and with horizontal suture technique, 5.5 mm group had a tendency of less astigmatic change than 6.5 - 7.0 mm group(p=0.087, t-test), but without statistical significance.

The Evaluation of Incidence of Hyphema as Early Complication following Sutureless Cataract Surgery

Postoperative hyphema following cataract extraction surgery is not usually a serious complication and clears quickly in the most cases. Sutureless cataract surgery was reported to have less incidence of postoperative hyphema than conventional cataract surgery. We analyzed the incidence of postoperative hyphema in each group according to the depth and the length of scleral pocket incision in 500 eyes with the sutureless cataract surgery via superior incision during two years. One day after surgery, 90 cases(18.0%) had hyphema and most of them(74.4%) showed grade 1 severity. The incidence of hyphema was 23.0% in the deep incision group and only 11.9% in the superficial incision group(p<0.01). The percentage of grade 1 hyphema was 66.6% in the deep group and 92.6% in the superficial group, then severity was greatly reduced in the superficial incision group(p<0.01). The incidence of hyphema in the group of 7.0 mm in length was highest among the 6.0, 6.5, 7.0 mm groups(p<0.01), and the shorter the incision length, the milder the serverity of hyphema(p<0.01). The incidence of hyphuma was the lowest(6.2%) in the group of 6.0 mm in length and superficial incision, and it was the highest(28.5%) in the 7.0 mm in length and deep incisional group(p<0.01).

Evaluation of 82 Cases of Oval Optic Intraocular Lens Implanted in the Bag

The postoperative results of 77 paients:(82 eyes) who had undergone phacoemulsification with implantation of oval optic poly methylmethacrylate (PMMA) introoular intraowlar lens (IOL) (5 X 6mm) were evaluated retrospectively. Scleral pocket incision was done tangentially at the point 2mm. apart from the surgical limbus and 5mm in length. No suture in the group 1 (30 eyes), single horizontal suture in the group 2 (31 eyes) and single X suture in the group 3 (21 eyes) were used for the closure method. Average uncorrected visual acuity at postoperative one week was 0.5 or better in each group and there was no statistically significant difference among three groups (p>0.05). The change in mean keratometric astigmatism from postoperative one to eight weeks turned out to be less than 1 diopter (D) in each group and there was no statistically significant difference among three groups (p>0.05). When the diameter of continuous cirular capsulorhexis (CCC) was greater than 5mm or the position of CCC was decentered, it was found that optic was partially escaped form the bag due to adhesion between the remained anterior and posterior capsular structure. It could be suggested that oval optic PMMA IOL showes early visual recovery with less astigmatism regardless of the suture method and in order to place the optic of IOL properly in the bag postoperatively, the diameter of CCC should be less than 5mm and the position of CCC should be centered.

Comparison of the Corneal Astigmatism Between Suture Methods After 7mm Scleral Pocket Incision Catartact Surgery

Most of cataract surgeons have made a great effort to minimize or nullify corneal 'astigmatism resulted from the incision and closure, but a completely ideal wound system still eludes us. The scleral pocket incision and continuous single knotted shoelace suture of it has been known as one of the technique for reducing postoperative astigmatism. Recently, horizontal suture closure of scleral pocket incisior has been introduced because it doesn't cause suture induced wound compression. We implanted standard PMMA intraocular lenses in the bag of 400 patients through 7mm scleral pocket incision following CCC (continuous circular capsulorhexis) and bimanual phacoemulsification. The incision was closed with either the shoelace or horizontal suture. The keratometric measurement was maded at postoperative 1 day, 1 week, 1 month, 2 month, 3 month and 6 month. In shoelace suture group, the preoperative corneal astigmatism appeared -0.14 +/- 0.15D of with the rule astigmatism (WTR); at one day postoperatively -2.75 +/- 1.61 of WTR, at 3 month 0.18 +/- 1.14D of against the rule astigmatism (ATR), 6 month 0.3 +/- 1.22D of ATR. In horizontal suture group, the preoperative corneal astigmatism appeared -0.22 +/- 1.22D of WTR; at one day postoperatively -1.05 +/- 1.28 of WTR, at 2 month 0.57 +/- 1.0 of ATR, at 6 month 0.72 +/- 1.91 of ATR. The difference between two suture methods was statistically significant (p<0.01 until 3 month, p<0.05 until 3-6 month).