Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification
TL;DR: The torsional mode was as safe as the longitudinal mode in phacoemulsification for age‐related cataract as well as conventional longitudinal mode, according to Conference on Harmonisation‐E9 Guidelines.
Abstract: 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.
Citations
More filters
TL;DR: Eyes with shallow ACDs, especially those with relatively hard cataract densities, can be vulnerable to more corneal endothelial cell loss in phacoemulsification surgery.
Abstract: 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
65 citations
TL;DR: Microcoaxial phacoemulsification was efficient in removing noncomplicated cataract patients with different grades of nuclear hardness; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness.
Abstract: 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.
58 citations
TL;DR: The potential benefits of femtosecond‐laser‐assisted cataract surgery due to the automation of key steps and the safety of this new technology are outlined.
Abstract: 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.
54 citations
Cites background or methods from "Comparison of endothelial changes a..."
...An increase in endothelial cell loss and corneal thickness has been reported with longer phacoemulsification time when using standard cataract surgery (Walkow et al. 2000; Baradaran-Rafii et al. 2009; Reuschel et al. 2010) with a mean overall central endothelial cell loss of 7....
[...]
...…has been reported with longer phacoemulsification time when using standard cataract surgery (Walkow et al. 2000; Baradaran-Rafii et al. 2009; Reuschel et al. 2010) with a mean overall central endothelial cell loss of 7.5% at 6 weeks and 8.5% at 12 months postoperatively (Walkow et al. 2000)....
[...]
TL;DR: The torsional machine outperformed the transversal and longitudinal machines, with a lower mean needle time, less chatter, and improved followability, which corresponded to less corneal edema 1 day postoperatively and better visual acuity.
Abstract: 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.
51 citations
TL;DR: Combined cataract surgery and microstent placement for mild to moderate POAG is safe, more effective in lowering IOP with fewer medications, and less likely to result in further incisional glaucoma filtrations surgery than cataracts surgery alone at 3 years.
42 citations
References
More filters
TL;DR: In this paper, the authors examined the benefits and pitfalls of the intent-to-treat principle in comparative trials and the use of the confidence interval to draw valid conclusions regarding the clinical value of treatments.
Abstract: If a trial is to be well designed, and the conclusions drawn from it valid, a thorough understanding of the benefits and pitfalls of basic statistical principles is required. When setting up a trial, appropriate sample-size calculation is vital. If initial calculations are inaccurate, trial results will be unreliable. The principle of intent-to-treat in comparative trials is examined. Randomization as a method of selecting patients to treatment is essential to ensure that the treatment groups are equalized in terms of avoiding biased allocation in the mix of patients within groups. Once trial results are available the correct calculation and interpretation of the P-value is important. Its limitations are examined, and the use of the confidence interval to help draw valid conclusions regarding the clinical value of treatments is explored.
576 citations
TL;DR: Very good interobserver reproducibility of the clinical gradings at the slit lamp, excellent intraobserver reproducecibility, very good to excellent interob server reproducible of photographic gradings, and good agreement between clinical and photographic grading are obtained.
Abstract: The Lens Opacities Classification System, version II (LOCS II), uses a set of colored slit-lamp and retroillumination transparencies to grade different degrees of nuclear, cortical, and subcapsular cataract. The system uses four nuclear standards for grading nuclear opalescence and color, five cortical standards, and four subcapsular standards. The LOCS II can be used to grade patients' cataracts at the slit lamp or to grade slit-lamp and retroillumination photographs; it is easy to learn and can be applied consistently by different observers. We obtained very good interobserver reproducibility of the clinical gradings at the slit lamp, excellent intraobserver reproducibility, very good to excellent interobserver reproducibility of photographic gradings, and good agreement between clinical and photographic gradings. The LOCS II is potentially useful for both cross-sectional and longitudinal studies of cataract.
559 citations
"Comparison of endothelial changes a..." refers methods in this paper
...Their results are from the second postoperative month in 100 eyes with a nucleus density of grade 2 to grade 5 on theLensOpacities Classification System II.49 In our study, we used slitlamp grading and included cataracts with a grade of 2 to 3 according to the Oxford Clinical Cataract Classification andGradingSystem.16Another difference is that Bozkurt et al. used a stop-and-chop technique for cataract removal and surgery was performed by 3 surgeons....
[...]
...Their results are from the second postoperative month in 100 eyes with a nucleus density of grade 2 to grade 5 on theLensOpacities Classification System II.(49) In our study, we used slitlamp grading and included cataracts with a grade of 2 to 3 according to the Oxford Clinical Cataract Classification andGradingSystem....
[...]
[...]
01 Jan 1975
TL;DR: The “‘bladder-conscious” patient can protect and preserve bladder function but these bludders appear to remain vulnerable to infection and overdistention, perhaps permanently.
Abstract: The purpose of this study was to determine the long-term effect of Schauta hysterectomy on bladder function as determined by seE persistent elevation of the mean resting pressure was sig@cant in the pooled but not in the paired data; th mean residual urine volume of 25 ml. wa.s signa$cantly elevated. The assumption was that maintenance of intrinsic detrusor muscle tone by prevention of overdistention preserved balanced bladder function. Many patients initiated and maintained m&w&ion by voluntary straining or b we of Crede’s maneuver although others voided relatively normally. Presumably these blad&rs are denervated to varying degrees, producing a spectrum of functional disturbance. The “‘bladder-conscious” patient can protect and preserve bkdakr function but these bludders appear to remain vulnerable to infection and overdistention, perhaps permanently.
414 citations
TL;DR: The firmness of the nucleus is identified as the most significant risk factor for endothelial cell loss and mechanical contact with nuclear fragments is considered the principal cause of endothelial injury.
Abstract: Purpose: To determine the principal risk factors for corneal endothelial injury during phacoemulsification. Setting: Hayashi Eye Hospital, Fukuoka, Japan. Methods: We prospectively investigated 859 consecutive eyes of 800 patients who had had phacoemulsification surgery. The percentage of corneal endothelial cell loss at 3 months after surgery was quantitated using specular microscopy. The firmness of the nucleus was graded by Emery's classification prior to surgery. We selected nine variables that could be associated with endothelial injury. The univariate associations between the endothelial cell loss and these variables were evaluated using simple correlation coefficients. A multiple linear regression analysis was performed to identify independent predictors of endothelial cell loss. Results: In the simple regression analysis, older age, small pupil diameter, high nucleus grade, large nucleus, greater infusion volume, type of IOL implanted, and a greater amount of total emitted ultrasound energy were univariately associated with endothelial cell loss. In the multiple linear regression analysis, the best final model (R2 = 0.42) identified high nucleus grade, greater infusion volume, type of IOL implanted, and large nucleus as independent predictors of endothelial cell loss. Conclusion: Both univariate and multivariate analyses identified the firmness of the nucleus as the most significant risk factor for endothelial cell loss. Therefore, mechanical contact with nuclear fragments is considered the principal cause of endothelial injury.
337 citations
TL;DR: The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium.
Abstract: Purpose To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss Setting Department of Ophthalmology, Humboldt-University of Berlin, Berlin, Germany Methods Fifty consecutive patients scheduled for routine cataract surgery were selected prospectively for this clinical trial Preoperatively, the axial length, anterior chamber depth, lens thickness, and astigmatism were measured Phacoemulsification time and relative energy as well as total surgical time were recorded With a specular microscope, endothelial cell counts were determined centrally, superiorly, and temporally preoperatively and 6 weeks and 6 and 12 months postoperatively Results After 12 months, the mean overall central endothelial cell loss in all eyes was 85% The mean endothelial cell loss was 119% in the lateral quadrant and 114% in the superior quadrant There were no significant differences between superior and temporal surgical approaches in intraoperative parameters of phacoemulsification time, relative intensity of phacoemulsification, and surgical time There were no significant differences in central endothelial cell loss or in the area localized in the quadrant of the positions of the corneal surgical site The only risk factors found significant for higher endothelial cell loss were shorter axial length and longer phacoemulsification time Conclusions The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium Shorter eyes have a significantly higher risk for greater endothelial cell loss
313 citations
"Comparison of endothelial changes a..." refers background in this paper
...It has been postulated that longer phaco time and higher US power (cumulative dissipated energy) are associated with endothelial cell loss.11,18,30,39–41 Walkow et al.41 found a significant correlation between phaco time and central endothelial cell loss, but not between phacoenergyandcell loss....
[...]
...Walkow et al.(41) found a significant correlation between phaco time and central endothelial cell loss, but not between phacoenergyandcell loss....
[...]