Magnification and Refocusing Comparison in Cataract Surgery Using a Heads-Up Three-Dimensional Visualization System versus Conventional Binocular Microscopy.

Purpose: To compare magnification and refocusing during phacoemulsification with the NGENUITY®â€¯3-D Visualization System (3-D) versus the conventional microscope (CM) OPMI LUMERA 700. Setting: This study was performed in the Department of Anterior Segment of the Fundación Hospital Nuestra Señora de la Luz. Design: Prospective, randomized, cross-sectional, multi-surgeon, and comparative study. Methods: This study enrolled 100 patients (eyes) scheduled for phacoemulsification to measure the number of times changes in focusing and magnification were needed during cataract surgery. Results: Our study included 100 patients. From the endpoints evaluated, "zoom-in" showed statistically significant differences for all of the four predefined cataract surgery steps (means: Step 1, 0.38 (CM) vs 0.08 (3-D); Step 2, 0.36 (CM) vs 0.06 (3-D); Step 3, 0.54 (CM) vs 0.22 (3-D); Step 4, 0.56 (CM) vs 0.24 (3-D); all comparisons, p <0.05). In Step 4, there was a statistically significant increased use of "focus-out" for the 3-D system (mean 0.16 (CM) vs 0.58 (3-D); p <0.05). "Focus-in" and "zoom-out" showed no group differences for all steps. The duration of surgery with the 3-D system was longer at each step and overall. The percentage of light intensity did not show a statistically significant difference between both systems, with a mean of 99.45 for CM vs 98.43% for the heads-up system. Conclusion: The heads-up 3-D system is a safe option that offers excellent magnification for anterior segment visualization. The surgical time is longer, but adjusting settings like light intensity and brightness may facilitate some surgical steps early in the learning curve.

[Ultrastructure of the anterior capsule of the lens in different pathologies]. / Ultraestructura de la cápsula anterior del cristalino en diversas patologías.

BACKGROUND: We undertook this study to compare the ultrastructural analysis of capsules of normal lenses (phacorefractive procedures) and those of other types of cataracts also such as senile cataracts, with trans-surgical staining. METHODS: Capsule samples were obtained by circular continuous capsulorhexis during phacoemulsification procedures. All samples were fixed and conventionally processed for light- and transmission-electron microscopy analysis. RESULTS: Seventeen analyzed samples were grouped as follows: a) phacorefractive (n = 2), b) senile cataract (n = 3); c) senile diabetic (n = 3), d) pseudoexfoliation syndrome (n = 3); e) stained with trypan blue (n = 2), f) indocyanine green (n = 2), and g) gentian violet (n = 2). According to morphological analysis, all samples of cataract demonstrated lacunae zones between epithelial cells. Filamentous annular bodies were found near the epithelium in capsule of senile cataracts. Senile diabetic cataract samples showed more abnormalities in epithelial morphology; specifically we found conformation of two or three layers of epithelial cells. Samples stained with trypan blue showed a regular basal membrane and minor loss of epithelial cells than other trans-surgical stain techniques. CONCLUSIONS: After an exhaustive medical literature search, we published the first report about the observation of filamentous annular bodies near the epithelium in capsules of senile cataracts. Additionally, it is important to note the presence of stratification of the epithelium at the anterior pole of capsules from diabetic patients.

Evolución de las lentes intraoculares y los viscoelásticos / Intraocular lenses and viscoelastic evolution review

Se hace una revisión de la literatura y se relata la evolución de las lentes intraoculares, de sus materiales y diseños, así como de los viscoelásticos.