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Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification
摘要： Purpose: To compare the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris?, Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil?, Alcon, Fort Worth, TX, USA) ultrasound. Methods: The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively. Results: In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 ± 17.77 sec vs. 97.08 ± 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 ± 15.50% vs. 38.71 ± 26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities. Conclusions: In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endothelial cell loss than torsional phaco.
关键词： Longitudinal,Cataract surgery,Phacoemulsification,Nuclear density,Torsional
更新于2025-09-23 15:22:29
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Simulateur de chirurgie de cataracte EyeSi?: validité de construction des modules capsulorhexis, phacoémulsification et aspiration des masses cristalliniennes
摘要： Introduction. — Le but de notre étude est de tester la capacité du simulateur EyeSi à discriminer les chirurgiens novices des chirurgiens expérimentés lors de la réalisation des exercices de 3 modules de formation à la chirurgie de cataracte, afin de confirmer sa validité de construction pour ceux-ci. Matériels et méthode. — Nous avons inclus 18 chirurgiens répartis en 3 groupes : les ? novices ? (6 internes n’ayant jamais opéré de cataracte), les ? intermédiaires ? (6 internes ayant opéré entre 1 et 10 cataractes) et les ? experts ? (6 chirurgiens ayant opéré plus de 500 cataractes). Nous avons sélectionné 3 modules d’entra?nement du simulateur, le capsulorhexis, la phacoémulsification-cracking et l’aspiration des masses cristalliniennes résiduelles. Douze exercices de difficulté croissante ont été réalisés 2 fois de suite par chaque participant. Nous avons comparé les résultats du 2ème essai en stratifiant sur l’expérience du chirurgien. Résultats. — Pour le module capsulorhexis, dans l’exercice 1, les experts obtiennent des scores plus élevés que les 2 autres groupes (p = 0,0102). Pour le module phacoémulsification-cracking, les experts ont des scores significativement supérieurs dans l’exercice 8 (p = 0,0495) et il existe une tendance à la significativité dans les exercices 3 (p = 0,0934) et 5 (p = 0,0938). Le temps de réalisation de l’exercice décro?t également en fonction du niveau d’expérience dans les exercices 1 (p = 0,0444), 4 (p = 0,06) et 5 (p = 0,0189). Conclusion. — Nos résultats mettent en évidence de meilleurs résultats du groupe experts pour 4 exercices des modules capsulorhexis et phacoémulsification-cracking. Ceci confirme la validité de construction du simulateur EyeSi pour la chirurgie de cataracte déjà mise en évidence par d’autres travaux. Notre étude permettra de contribuer à la réalisation de programmes de formation pertinents sur simulateur pour les internes en ophtalmologie.
关键词： Irrigation and aspiration,Capsulorhexis,Cataract surgery,EyeSi cataract surgery simulator,Construct validity,Phacoemulsification,Systematic training program
更新于2025-09-23 15:22:29
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Experimental and clinical study of simultaneous dual-wavelength laser action in energetic cataract surgery
摘要： A new technique of energy cataract surgery with the simultaneous use of two wave-length of laser emission acting as high-intensity laser—endodissector (Nd:YAG, wave-length λ = 1.44? μm) and a low-intensity laser—endobiostimulator (He–Ne, wavelength λ = 0.632? μm) is represented. The surgical technique is bimanual. The radiation of high-intensity laser ensures the destruction of cataract lens of any density level without addi-tional assistance of ultrasound and without manual fragmentation. The laser tip, which contacts the eye tissues, does not heat up. In the process of high-intensity laser action split-ting and spalling of the eye lens core occurs. Laser energy does not go beyond the lens capsule as it is almost completely absorbed by the liquid of the anterior chamber (water) at less than 1?mm from the distal end of the laser tip. Simultaneous exposure to radiation of high-intensity and low-intensity lasers delivered to the eye lens via one laser tip provide to prevent the progression of posttraumatic inflammatory process in the eye at the initial stage of the start of pathophysiological intracellular changes. This ensures high efficiency and safety of simultaneous dual-wavelength laser cataract extraction (DW LCE).
关键词： 0.632?μm He–Ne laser,Phacoemulsification,1.44?μm Nd:YAG laser,Dual-wavelength laser cataract extraction,Intraoperative endoocular bio-stimulation
更新于2025-09-23 15:21:01
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A Comparison of Intraoperative Metrics between the Infiniti with and the Centurion without Intelligent Phacoemulsification Systems
摘要： Purpose: To compare the efficiency and safety of two phacoemulsification systems, the Infiniti with intelligent phacoemulsification (IP) and the Centurion without IP, in terms of intraoperative metrics of phacoemulsification and the occurrences of adverse events and intraoperative tip obstruction. Design: Comparative case series. Methods: A consecutive series of 340 eyes (151 eyes with the Infiniti, 189 eyes with the Centurion) was evaluated. A 2.4 mm sclerocorneal incision was used with the Infiniti, and a 2.0 mm incision was used with the Centurion. Phacoemulsification of the nucleus was performed using the phaco chop technique, with the IP function of the Infiniti turned on and the IP mode of the Centurion turned off. From among the parameters displayed on the panels of both devices, ultrasound (US) time, cumulative dissipated energy (CDE), aspiration time, and estimated balanced salt solution (BSS) aspiration volume were investigated and compared between the devices. Results: A comparison of all subjects found significant differences between the two devices in mean CDE (p=0.02) and mean aspiration time (p=0.003), but not in mean US time (p=0.43) or mean estimated BSS aspiration volume (p=0.07). For grade 3 nuclei, all parameters of mean US time (p=0.0044), mean CDE (p ≤ 0.001), mean aspiration time (p<0.001), and mean estimated BSS aspiration volume (p=0.001) showed significant differences favoring the Centurion. Conclusions: Compared to the Infiniti with IP mode, cataract surgery with the Centurion without IP mode is likely to be performed with less phacoemulsification energy and higher efficiency.
关键词： Centurion,Intelligent Phacoemulsification Mode,Cumulative dissipated energy,Infiniti,Ultrasound time
更新于2025-09-23 15:21:01
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Comparison of optical quality and distinct macular thickness in femtosecond laser-assisted versus phacoemulsification cataract surgery
摘要： Background: Optical quality and macular thickness changing optical quality is rarely reported after femtosecond laser-assisted cataract surgery (FLACS). In current research, we evaluated optical quality recovery and distinct macular thickness changes after FLACS and phacoemulsification cataract surgery (PCS). Methods: A total of 100 cataract patients (100 eyes) were included (50 eyes for the FLACS group and 50 eyes for the PCS group). Modulation transfer function (MTF), point spread function (PSF) and dysfunctional lens index (DLI) were measured by a ray-tracing aberrometer (iTrace). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also assessed pre-operation,1 week and 1 month after surgery. The MTF values at spatial frequencies of 5, 10, 15, 20, 25 and 30 cycles/degree (c/d) were selected. We used optical coherence tomography (OCT) to assess the macular thickness of different regions pre-operatively and1month after the surgery. Results: In PCS group, we found the statistically significant differences between pre-operation and post-operation in DLI (p < 0.0001), PSF (strehl ratio, SR) (p = 0.027) and MTF (p = 0.028), but not intraocular pressure (IOP) (p = 0.857). The differences between pre-operation and post-operation for DLI (p = 0.031), SR (p = 0.01) and IOP (p = 0.03), but not MTF (p = 0.128) were also found in FLACS group. The differences were statistically significant when the spatial frequencies were at 5, 10 and 25 (p = 0.013, 0.031 and 0.048) between pre-operation and post-operation in PCS group but not FLACS group at 1 month. In PCS group, we found the differences between pre-operation and post-operation in nasal inter macular ring thickness (NIMRT) (p = 0.03), foveal volume (FV) (p = 0.034) and average retinal thickness (ART) (p = 0.025) but not FLACS group at 1 month. Conclusion: FLACS is safe that did not cause significant increase of macular thickness in current study. However, it also cannot produce better optical quality. In contrast, PCS can produce macular thickness changes, but better optical quality recovery. The slightly retinal change may not affect optical quality.
关键词： Macular thickness,Femtosecond laser-assisted cataract surgery (FLACS),Point spread function (PSF),Modulation transfer function (MTF),Phacoemulsification cataract surgery (PCS),Dysfunctional lens index (DLI),Optical quality
更新于2025-09-19 17:13:59
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Femtosecond laser-integrated anterior segment optical coherence tomography to detect preexisting posterior capsular dehiscence and increase safety in posterior polar cataracts
摘要： To determine the efficacy of the femtosecond laser with integrated anterior segment optical coherence tomography (AS-OCT) for the detection of posterior capsular dehiscence in posterior polar cataracts (PPCs). To evaluate the safety of phacoemulsification in these eyes undergoing femtosecond laser–assisted cataract surgery (FLACS).
关键词： posterior polar cataracts,anterior segment optical coherence tomography,femtosecond laser,posterior capsular dehiscence,phacoemulsification
更新于2025-09-19 17:13:59
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Effectiveness of intraoperative intraocular lens use on improving surgical safety for dense cataract phacoemulsification: a randomized controlled trial
摘要： We designed this study to assess if surgical safety can be improved by intraoperative use of intraocular lens (IOL) for cataract phacoemulsification. We performed phacoemulsification cataract removal on 401 patients. We randomly assigned these patients into three groups: the standard setting (Group I, n = 134), with reduced vacuum and flow rate (Group II, n = 137), and with IOL insertion before the last quadrant was emulsified with standard setting (Group III, n = 130). The primary outcomes included the risk of posterior capsular rupture (PCR), ultrasound time, energy, and complications. The secondary outcomes included central corneal thickness (CCT), CCT changes, endothelial cells (ETC) counting, ETC loss, and the best corrected distance visual acuity (BCVA) measured on day 1, day 7 and day 30. If PCR occurred, we emulsified the residual lens materials after insertion of IOL and clean of the prolapsed vitreous. We found that the risk of PCR in Group III (0/130) was lower than Group I (9/134, corrected relative risk (RR) = 18.44, 95% CI: 1.08–313.56) and Group II (3/137, corrected RR = 6.64, 95% CI: 0.35–27.41). Group III showed better BCVA on day 1 and 7, less ECC loss on day 7 and 30, and less CCT increase on day 1 and 7. No cases converted to extracapsular cataract extraction. No residual lens materials misdirected into vitreous cavity. Intraoperative use of IOL can improve surgical safety for dense cataract phacoemulsification.
关键词： cataract phacoemulsification,intraocular lens,surgical safety,posterior capsular rupture,ultrasound time,endothelial cells loss,central corneal thickness
更新于2025-09-19 17:13:59
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CO2 Laser-assisted Deep Sclerectomy Combined With Phacoemulsification in Patients With Primary Open-angle Glaucoma and Cataract
摘要： To assess the safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) combined with phacoemulsification in patients with primary open-angle glaucoma (POAG) and visually significant cataracts. This was a prospective, uncontrolled, interventional case series. Seventeen patients (17 eyes) diagnosed with POAG and cataracts were enrolled starting from November 2015. All subjects underwent CLASS combined with phacoemulsification surgery by the same surgeon. After the surgery, all patients were followed for 12 months. The preoperative to postoperative changes in intraocular pressure (IOP), glaucoma medication requirements, best-corrected visual acuity and adverse events were recorded. The results of 17 eyes of 17 patients were included in the statistical analysis. The baseline mean IOP was 23.94 ± 8.57 mm Hg (mean ± SD), and patients used 2.18 ± 0.88 types of antiglaucoma medication. At 12 months postsurgery, the mean IOP was 14.67 ± 2.97 mm Hg, and patients used 0.59 ± 0.87 types of antiglaucoma medication (both P < 0.001). The logarithm of the minimal angle of resolution of the best-corrected visual acuity improved from 0.77 ± 0.42 preoperatively to 0.33 ± 0.47 postoperatively (P < 0.05). Two patients experienced intraoperative perforation accompanied by iris prolapse. One patient exhibited postoperative choroidal detachment. CLASS with phacoemulsification may become a safe and effective intervention for patients with POAG and visually significant cataracts.
关键词： cataract,primary open-angle glaucoma,phacoemulsification,CLASS,laser surgery
更新于2025-09-16 10:30:52
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Femtosecond laser–assisted cataract surgery: A review
摘要： Purpose: Review scientific literature concerning femtosecond laser–assisted cataract surgery. Methods: Following databases were searched: CENTRAL (Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 2 of 12, June 2019), Ovid MEDLINE? without Revisions (1996 to June 2019), Ovid MEDLINE? (1946 to June 2019), Ovid MEDLINE? Daily Update June 2019, MEDLINE and MEDLINE Non-Indexed Items, Embase (1980–2019), Embase (1974 to June 2019), Ovid MEDLINE? and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to June 2019), Web of Science (all years), the metaRegister of Controlled Trials (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms/keywords included ‘Femtosecond laser’ combined with ‘cataract’, ‘cataract surgery’. Results: Based on quality of their methodology and their originality, 121 articles were reviewed, including randomised controlled trials, cohort studies, case-controlled studies, case series, case reports and laboratory studies. Each step of the femtosecond laser–assisted cataract surgery procedure (corneal incisions, arcuate keratotomies, capsulotomy and lens fragmentation) has been discussed with relevance to published outcomes, as well as complication rates of femtosecond laser–assisted cataract surgery, and what we can learn from the larger studies/meta-analyses and the economics of femtosecond laser–assisted cataract surgery within different healthcare settings. Conclusion: Studies suggest that the current clinical outcomes of femtosecond laser–assisted cataract surgery are not different to conventional phacoemulsification surgery and it is not cost effective when compared with conventional phacoemulsification surgery. In its current technological form, it is a useful surgical tool in specific complex cataract scenarios, but its usage has not been shown to translate into better clinical outcomes.
关键词： Cataract,phacoemulsification,femtosecond laser–assisted cataract surgery
更新于2025-09-11 14:15:04
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The Effect of Eye Patching on Clear Corneal Incision Architecture in Phacoemulsification: A Randomized Controlled Trial
摘要： To investigate the effects of postoperative eye patching on clear corneal incision architecture in phacoemulsification. Design: A single?center, randomized controlled trial. Methods: A total of 132 patients with uncomplicated phacoemulsification were randomly allocated to the intervention or control group. The intervention group received postoperative eye patching for approximately 18 hours, whereas the control group received eye shield. The clear corneal incision architecture was examined postoperatively at 2 hours, 1 day, and 7 days after surgery using optical coherence tomography. Results: Epithelial gaping was significantly reduced on postoperative day 1 in the intervention group (52.4%) compared with control (74.2%) (P = 0.01). No differences were found for other architectural defects. Descemet membrane detachment was associated with lower intraocular pressure on postoperative day 7 (P = 0.02). Presence of underlying diabetes mellitus did not seem to influence architectural defects. Conclusions: Postoperative eye patching facilitated epithelial healing and reduced the occurrence of epithelial gaping on postoperative day 1. It may play a role in protecting and improving corneal wounds during the critical immediate postoperative period.
关键词： epithelial gaping,clear corneal incision,architecture,eye patching,phacoemulsification
更新于2025-09-11 14:15:04