Purpose To compare the loss of corneal endothelial cells after phacoemulsification according to different anterior chamber depths (ACDs) Methods We conducted a prospective study on 135 eyes with senile cataracts Eyes with nuclear density grades of 2 to 4 were divided into three groups according to ACD: ACD I, 15 005) Endothelial cell loss was significantly higher in ACD I than in ACD III in grades 3 and 4 cataract density groups 2 months after phacoemulsification (P < 005) There were also more changes in CCT in all of the cataract density groups in the ACD I group compared to the ACD II and III groups 2 months postoperatively, but the difference was not statistically significant Conclusions Eyes with shallow ACDs, especially those with relatively hard cataract densities, can be vulnerable to more corneal endothelial cell loss in phacoemulsification surgery

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Endothelial Cell Loss after Phacoemulsification according to Different Anterior Chamber Depths

Purpose: To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX) in noncomplicated cataract surgery. Methods: In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories) was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts. Results: The study included 120 cases of age-related cataract whose mean age (standard deviation [SD]) was 59.68 years (9.47). There was a highly statistically significant endothelial cell loss (P , 0.001). The endothelial cell loss ranged 11–1149 cells/mm 2 with a median (interquartile range) of 386 cells/mm 2 (184.5–686 cells/mm 2 ). The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range) of 15.4% (7.2% to 26.8%). A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman’s rank-order correlation coefficient values, rho, (ρ) were as follows: CDE (ρ = 0.425), aspiration time (ρ = 0.176), and volume (ρ = 0.278). Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall’s tau τ = 0.42). Conclusion: Microcoaxial phacoemulsification was efficient in removing noncomplicated cataracts; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness. This endothelial cell loss was mostly related to the increased cumulative dissipated energy (CDE), aspiration time, and volume of balanced salt solution used.

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Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery

Introduced in 2008, the femtosecond laser is a promising new technological advance which plays an ever increasing role in cataract surgery where it automates the three main surgical steps: corneal incision, capsulotomy and lens fragmentation. The proven advantages over manual surgery are: a better quality of incision with reduced induced astigmatism; increased reliability and reproducibility of the capsulotomy with increased stability of the implanted lens; a reduction in the use of ultrasound. Regarding refractive results or safety, however, no prospective randomized study to date has shown significant superiority compared with standard manual technique. The significant extra cost generated by this laser, undertaken by the patient, is a limiting factor for both its use and study. This review outlines the potential benefits of femtosecond-laser-assisted cataract surgery due to the automation of key steps and the safety of this new technology.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.12416

Femtosecond-laser assisted cataract surgery: a review.

Purpose To compare the intraoperative performance and postoperative outcomes of 3 phacoemulsification machines that use different modes. Setting Kensington Eye Institute, Toronto, Ontario, Canada. Design Comparative case series. Methods This chart and video review comprised consecutive eligible patients who had phacoemulsification by the same surgeon using a Whitestar Signature Ellips-FX (transversal), Infiniti-Ozil-IP (torsional), or Stellaris (longitudinal) machine. Results The review included 98 patients. Baseline characteristics in the groups were similar; the mean nuclear sclerosis grade was 2.0 ± 0.8. There were no significant intraoperative complications. The torsional machine averaged less phacoemulsification needle time (83 ± 33 seconds) than the transversal (99 ± 40 seconds; P=.21) or longitudinal (110 ± 45 seconds; P=.02) machines; the difference was accentuated in cases with high-grade nuclear sclerosis. The torsional machine had less chatter and better followability than the transversal or longitudinal machines (P Conclusions All 3 phacoemulsification machines were effective with no significant intraoperative complications. The torsional machine outperformed the transversal and longitudinal machines, with a lower mean needle time, less chatter, and improved followability. This corresponded to less corneal edema 1 day postoperatively and better visual acuity. Financial Disclosure Dr. Braga-Mele was a consultant to Abbott Medical Optics, Alcon Laboratories, Bausch & Lomb, and Allergan at the time the study was performed. Neither author has a financial or proprietary interest in any material or method mentioned.

Intraoperative performance and postoperative outcome comparison of longitudinal, torsional, and transversal phacoemulsification machines.

Three-Year Findings of the HORIZON Trial: A Schlemm Canal Microstent for Pressure Reduction in Primary Open-Angle Glaucoma and Cataract.

Purpose To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Setting Department of Ophthalmology, University of Leipzig, Germany. Design Randomized single-center clinical trial. Methods Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. Results The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P Conclusion The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification

To evaluate the influence of anterior chamber depth (ACD), anterior chamber volume (ACV), lens density (LD), and axial length (AL) as risk factors on endothelial cell loss 3 months after cataract surgery. We enrolled 47 patients with senile cataract who were operated between July 2012 and March 2013 by the same surgeon using torsional phacoemulsification. Preoperatively, we measured ACD, ACV, and LD using the Oculus Pentacam®. The AL was determined using the IOL Master®. Primary outcomes were central endothelial density (ECD) and corrected distance visual acuity (CDVA) 3 months after surgery We evaluated the effect of ACD, ACV, LD, and AL as possible risk factors of postoperative percentage endothelial cell loss (ECL). The median age was 72 years. The median CDVA before surgery was 0.5 improving to 1.0 postoperatively. The median ECL was 5.2 % (range 1.7 %–7.6 %). These results are comparable to our previous study (median ECL 6.9 % after 3 months) [Reuschel et al. (2010) J Cataract Refract Surg]. The median ACD in our study was 2.56 mm (range 2.26 mm–2.8 mm). Median ACV was 144 mm3 (range 121 mm3–158 mm3]. The median LD was 12.4 (range 11.4–13.7). Median AL was 23.1 mm (range 22.7 mm–23.9 mm). Our correlation analysis showed no significant correlation between ACD, ACV, LD, AL, and postoperative ECL. ACD, ACV, AL, and LD were not identified as risk factors of postoperative endothelial cell loss in our analysis.

Influence of anterior chamber depth, anterior chamber volume, axial length, and lens density on postoperative endothelial cell loss.

PURPOSE The objective of this study was to evaluate endothelial changes between torsional and longitudinal phacoemulsification 2 years after cataract surgery. DESIGN This was a prospective, randomized, controlled clinical trial. METHODS We enrolled 200 patients with senile cataract between August 2008 and December 2009 for surgery using either torsional (group A, n = 100) or longitudinal (group B, n = 100) phacoemulsification. Outcomes were central endothelial cell density and corrected distance visual acuity (CDVA) 3 months and in this follow-up 2 years after surgery. Statistical evaluation of endothelial cell loss (ECL) was performed according to statistical guidelines by creating a primary analysis (substitution of missing values by the median) and a secondary analysis (actual data). RESULTS The mean age was 71 (SD, 7.3) years. We were able to reexamine 46 patients in group A and 54 in group B 2 years after surgery. The median CDVA before surgery was 0.3 logMAR in group A and 0.35 logMAR in group B, improving to 0 logMAR postoperatively in both groups. The median ECL in the primary analysis was 6.9% after 3 months and 10.3% 2 years after surgery in group A. In group B, we found a loss of 6.6% after 3 months and 8.6% 2 years postoperatively. In the secondary analysis, the loss was 10.0% in group A and 8.5% in group B after 2 years. The difference was statistically not significant. CONCLUSIONS There is no difference between the ECL between torsional and longitudinal phacoemulsification up to 2 years after cataract surgery.

Anna Reuschel

Papers

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification

Influence of anterior chamber depth, anterior chamber volume, axial length, and lens density on postoperative endothelial cell loss.

Long-Term Comparison of Endothelial Changes Between Torsional and Longitudinal Phacoemulsification.