Intraoperative performance and ultrastructural integrity of human capsulotomies created by the improved precision pulse capsulotomy device.

PURPOSE: To investigate the intraoperative performance and the ultrastructural features of anterior capsulotomy performed with the improved Zepto precision pulse capsulotomy (PPC) device. SETTING: Launceston Eye Institute, Launceston, Tasmania, Australia. DESIGN: Prospective, consecutive case series. METHODS: Intraoperative observation of performance and complications were made on consecutive eyes having capsulotomies with the improved PPC device. The capsulotomy specimens were examined under scanning electron microscope and compared with manual continuous curvilinear capsulorhexis and femtosecond laser-assisted cataract surgery specimens. RESULTS: The study comprised 52 eyes. Intended capsulotomy occurred in 50 eyes with 2 device failures. Complete free-floating capsulotomies were achieved in 48 eyes (96%). Anterior capsule tears occurred in 2 eyes (4%). CONCLUSIONS: The ability of the PPC device to create complete free-floating capsulotomies improved; however, the radial tear rate remained high. The ultrastructural features in ex vivo human capsulotomy specimens still showed areas of irregular capsule margin with frayed edges.

Intraoperative head drift and eye movement: two under addressed challenges during cataract surgery.

PURPOSE: To objectively measure head drift during cataract surgery, and subjectively simulate eye movements and assess impact on surgical technique. MATERIALS AND METHODS: Twelve consecutively recorded routine cataract operations in the Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, were reviewed. The speculum was used as a fixed point and correlated with a superimposed virtual ruler to measure maximum head drift in each direction throughout the operations. To simulate intraoperative eye movement, we attached string to the cataract surgical simulator (Eyesi) eye and manually induced abduction and adduction. A calibrated scale secured to the Eyesi head ensured 5 mm eye movements were consistently created. Ophthalmology trainees performed the continuous curvilinear capsulorhexis (CCC) exercise without and with sequential eye movements. Movements were induced every three seconds. Scores were compared using a paired Student's T-test. RESULTS: Mean head drift in the surgical recordings was 3.1 mm medially (range 2-7 mm), 2.9 mm laterally (range 2-4 mm), 2.6 mm superiorly (range 1-5 mm), and 1.9 mm inferiorly (range 1-4 mm). In 11 of 12 cases, the operating microscope had to be adjusted for head drift. Six junior trainees completed the CCC module on the Eyesi without then with eye movements. After introducing eye movements the mean Eyesi score reduced from 92.7 to 76.9 (P = 0.014), 'roundness of rhexis' score reduced from 89.4 to 57.5 (P = 0.020), and trainees operated 17 s faster (P = 0.016). CONCLUSION: This study objectively demonstrates the under-reported clinical scenario of head drift during cataract surgery. By manipulating the Eyesi we have shown that eye movements reduce the quality of cataract surgery.

Avaliação da eficácia da facectomia com implante de lente intra-ocular na infância / Efficacy of pediatric cataract extraction with intraocular lens implantation

OBJETIVO: Avaliar eficácia da utilização da lente intra-ocular na correção da afacia na infância, segundo a acuidade visual e alteração refracional no pós-operatório. MÉTODOS: Foram estudados trinta e três olhos de 27 crianças portadores de catarata, unilateral ou bilateral, submetidos à cirurgia de lensectomia via pars plana com implante de lente intra-ocular, associada à capsulectomia posterior primária e vitrectomia anterior. O cálculo da lente intra-ocular foi realizado com o objetivo da emetropia no pós-operatório imediato. As crianças apresentavam idades inferiores a seis anos no momento da cirurgia e foram acompanhadas em média durante 2,9 anos. Foram divididas em três grupos: crianças portadoras de catarata unilateral operadas com idade inferior a três anos (Grupo I) e superior a três anos (Grupo II) e grupo III formado pelas crianças portadoras de cataratas bilaterais. RESULTADOS: Acuidade visual pós-operatória obtida no último controle igual ou superior a 20/40 foi encontrada em 85 por cento dos olhos operados. Equivalente esférico no primeiro mês pós-operatório próximo da emetropia foi obtido em 70 por cento das crianças do grupo III e em apenas 30 por cento do grupo I. Quanto à variação refracional pós-operatória, a miopização foi encontrada em 81,81 por cento dos casos, sendo maior esta alteração refracional quanto menor a idade em que a criança foi submetida à cirurgia. CONCLUSÃO: Apesar da miopização pós-operatória que ocorre com o implante de lente intra-ocular na correção da afacia em crianças com menos de seis anos de idade, o resultado visual é bastante satisfatório e a correção refracional residual de fácil execução. Um seguimento pós-operatório mais prolongado há de ser necessário para o acompanhamento dos resultados a longo prazo.

[The state-of-the-art of surgical treatment of congenital cataract in prematures].

Described in the paper are results of a clinical treatment of 127 children (174 eyes), aged 2 to 15 years, with different-type congenital cataract; the treatment was based on modem technologies including tunnel limbic incision, continuous anterior round capsulorhexis, aspiration-irrigation of the contents of the capsular sac, implantation of soft Acrysof SA30A1 IOLs by forceps or "Monarch" injector and suturing of incision. The anterior continuous capsulotomy was found to be the most complicated surgery stage in removal of congenital cataract in children it could be made without errors in 75.3% of cases. Intracapsular implantation of IOL in different-type cataract in children was possible in 97.7% of cases. The single-unit Acrysof IOL stays stable inside the capsular sac for as long as 24 months. A combination of primary capsulorhexis with "dry" anterior vitrectomy is most effective in the prevention of secondary cataract.

Current trends in cataract surgery in Thailand--2004 survey.

OBJECTIVES: To survey and investigate the current trend of cataract surgery in Thai ophthalmologists in 2004. MATERIAL AND METHOD: Questionnaires were sent to 600 ophthalmologists who were the members of the Ophthalmological Society and Royal Colleges of Ophthalmologists of Thailand. Data received from 248 (41.3%) of the recipients were analyzed and compared with those from the previous survey. RESULTS: The majority of respondents were male (63.3%) while 36.7% were female. In cataract surgery, 99.2% were still doing cataract surgery, the average number of cataract surgery procedures per surgeon per month was 25.6, 89.8% preferred phacoemulsification, and 42.5% preferred acrylic lens. The posterior capsular tear was the most common complication. CONCLUSION: There are trends toward more cataract surgical procedures performed by a surgeon, increasing preference of topical anesthesia, small incision wound and foldable acrylic lenses which reflected the popularity of phacoemulsification.

[Efficacy of pediatric cataract extraction with intraocular lens implantation]. / Avaliação da eficácia da facectomia com implante de lente intra-ocular na infância.

PURPOSE: To evaluate the efficacy of the use of intraocular lenses in the treatment of pediatric aphakia, according to postoperative visual acuity and refraction change. METHODS: A total of 33 eyes in 27 children were studied. Children with either unilateral or bilateral cataracts were submitted to lensectomy surgery via pars plana, with intraocular lens implant, associated with primary posterior capsulectomy and anterior vitrectomy. The intraocular lenses were calculated for emmetropia in the first postoperative month. All children were less than six years old at the time of the surgery and had a 2.9 year average follow-up. They were divided into 3 groups. Group I (10 eyes), children with unilateral cataracts and under three years old at the time of the surgery; group II (11 eyes), children with unilateral cataracts and above three years old; group III (12 eyes), children with bilateral cataracts and above three years old at the time of the surgery. RESULTS: On the last follow-up examination recorded visual acuity was equal to or above 20/40 in 85% of the eyes. A spherical equivalent close to emmetropia in the first postoperative month was obtained in 70% of the children of group III but only in 30% of group I. Regarding postoperative refraction variation, myopic shift was detected in 81.81% of the cases. The younger the children were when undergoing surgery, the greater the refractional alteration. CONCLUSION: Despite the myopic shift that happens with the use of intraocular lenses in the treatment of pediatric aphakia in children under six years old, the visual result is very good and the residual refraction correction is easily performed. A more prolonged postoperative follow-up would be necessary for long-term evaluation of the results.