Lens decompression technique for prevention of intraoperative complications during phacoemulsification of intumescent cataract.
Ontology highlight
ABSTRACT:
SUBMITTER: Nabil KM
PROVIDER: S-EPMC5742978 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:In this new technique of cataract surgery in patients with iris-fixated phakic intraocular lens with cataract, phakic IOL is explanted at the end of surgery. Phakic IOL remains stable and securely enclaved to the iris during phacoemulsification which is performed through a small 2.2 mm incision. Endothelial protection is provided by viscodispersive OVD above the phakic IOL and space for surgery is created by high molecular weight viscocohesive OVD beneath the phakic IOL. This technique provides significant advantages from the previously described techniques in terms of chamber stability, endothelial protection, iris trauma and surgical ease.
| S-EPMC6213707 | biostudies-literature
Project description:Purpose:To report the effectiveness of an intraoperative posterior chamber irrigation technique to enhance vitreous cavity support during postvitrectomy phacoemulsification cataract surgery. Methods:The irrigation technique was performed during phacoemulsification cataract surgery on 10 postvitrectomy eyes (9 patients) with moderate or hard density cataracts and with low vitreous cavity support. A cohesive viscoelastic tamponade was applied to pressurize the anterior chamber to start the procedure. The vitreous cavity was then irrigated using a 26-gauge flushing cannula injecting balanced salt solution under the iris through the zonules, until the vitreous cavity pressure balanced and exceeded the anterior chamber pressure and viscoelastic flowed out from the corneal incision. Intraoperative performance with the irrigation technique, postoperative visual acuity, and anatomy, and complications were retrospectively evaluated. Results:The irrigation procedure instantly enhanced posterior segment pressure before capsulorhexis in 4 eyes, before phacoemulsification in 4 eyes, after phacoemulsification in 2 eyes, before intraocular lens implantation in 6 eyes, and after implantation in 3 eyes. Phacoemulsification cataract surgery was facilitated by the irrigation technique, with a stabilized anterior chamber and robust vitreous cavity support. No complications occurred intraoperatively and postoperatively. At a 3-month follow-up, favorable visual and anatomic outcomes were achieved in all eyes. Conclusions:The irrigation technique balanced the pressure of anterior and posterior segments. Thus, vitreous cavity support and anterior chamber depth were well stabilized during phacoemulsification cataract surgery in postvitrectomy eyes.
| S-EPMC7048943 | biostudies-literature
Project description:Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.
| S-EPMC6572121 | biostudies-literature
Project description:ImportanceComplications that arise from phacoemulsification procedures can lead to worse visual outcomes. Real-time image processing with artificial intelligence tools can extract data to deliver surgical guidance, potentially enhancing the surgical environment.ObjectiveTo evaluate the ability of a deep neural network to track the pupil, identify the surgical phase, and activate specific computer vision tools to aid the surgeon during phacoemulsification cataract surgery by providing visual feedback in real time.Design, setting, and participantsThis cross-sectional study evaluated deidentified surgical videos of phacoemulsification cataract operations performed by faculty and trainee surgeons in a university-based ophthalmology department between July 1, 2020, and January 1, 2021, in a population-based cohort of patients.ExposuresA region-based convolutional neural network was used to receive frames from the video source and, in real time, locate the pupil and in parallel identify the surgical phase being performed. Computer vision-based algorithms were applied according to the phase identified, providing visual feedback to the surgeon.Main outcomes and measuresOutcomes were area under the receiver operator characteristic curve and area under the precision-recall curve for surgical phase classification and Dice score (harmonic mean of the precision and recall [sensitivity]) for detection of the pupil boundary. Network performance was assessed as video output in frames per second. A usability survey was administered to volunteer cataract surgeons previously unfamiliar with the platform.ResultsThe region-based convolutional neural network model achieved area under the receiver operating characteristic curve values of 0.996 for capsulorhexis, 0.972 for phacoemulsification, 0.997 for cortex removal, and 0.880 for idle phase recognition. The final algorithm reached a Dice score of 90.23% for pupil segmentation and a mean (SD) processing speed of 97 (34) frames per second. Among the 11 cataract surgeons surveyed, 8 (72%) were mostly or extremely likely to use the current platform during surgery for complex cataract.Conclusions and relevanceA computer vision approach using deep neural networks was able to pupil track, identify the surgical phase being executed, and activate surgical guidance tools. These results suggest that an artificial intelligence-based surgical guidance platform has the potential to enhance the surgeon experience in phacoemulsification cataract surgery. This proof-of-concept investigation suggests that a pipeline from a surgical microscope could be integrated with neural networks and computer vision tools to provide surgical guidance in real time.
| S-EPMC8855235 | biostudies-literature
Project description:PurposeTo present the technique and outcomes of a modified manual small incision cataract surgery designed for the phacoemulsification surgeons who are learning to perform manual small incision cataract surgery.MethodsThis was a retrospective, single-centred, comparative study. We included all the patients who underwent the modified manual small incision cataract surgery for visually significant cataract at Singapore National Eye Centre. All surgeries were performed by either a senior phaco-trained surgeon (M.A.) who had performed more than 500 manual small incision cataract surgery or a junior phaco-trained surgeon (D.C.) who had performed around 500 phacoemulsification but never performed any manual small incision cataract surgery. The main modification of this technique lies in the creation of an additional phaco-like main wound at 90° to the scleral tunnel wound, with most surgical steps performed through this additional wound. The outcomes were analysed and compared between the senior and junior surgeons. The main outcome measures were visual outcome and major intraoperative complications such as posterior capsular rupture and zonular dialysis.ResultsA total of 132 cases were included; 102 (77.3%) and 30 (22.7%) cases were performed by the senior and junior surgeons, respectively. Pre-operatively, 85.6% eyes had best-corrected visual acuity of counting fingers or worse. Postoperatively, the visual outcome at 1 month was similar between the senior and junior surgeons, with 68.7% eyes achieving a best-corrected visual acuity of ⩾6/12 (p = 0.17). No posterior capsular rupture, zonular dialysis or endophthalmitis was observed during the study period.ConclusionsThis modified technique may serve as a useful transition technique for the phaco-trained surgeons to develop skills in manual small incision cataract surgery, with demonstrable good visual outcome and safety.
| S-EPMC7727050 | biostudies-literature
Project description:Traditional hydrodissection may cause posterior capsule rupture (PCR) if excessive fluid accumulates. In this study, we describe the successful application of a novel minimal fluid hydrodissection technique in 100 consecutive cataract surgery cases. This technique separates the nucleus from the capsule utilizing low hydrostatic pressure and precise kinetic movement of a small volume (around 0.2 cc) of balanced salt solution. There were no instances of PCR. This technique is suitable for a range of cases, including femtosecond laser-assisted cataract surgery and posterior subcapsular cataract.
| S-EPMC6432847 | biostudies-literature
Project description:Use of the phaco tip technique for lens cleavage and removal does not require manual hydrodissection using a syringe and cannula, or cortical removal using an irrigation/aspiration tip. The phaco tip is the only surgical instrument required for this technique. Its advantages include maintaining a stable intraocular pressure during cortical cleaving hydrodissection and lens removal, which includes the cortex.
| S-EPMC5063489 | biostudies-literature
Project description:PurposeThe aim of this study was to evaluate corneal endothelial cell density and morphology, central corneal thickness, and best visual acuity using ultrasound (US) phacoemulsification or nanosecond laser technique.SettingDepartment of ophthalmology, Nabeul, Tunisia.DesignProspective cohort study.MethodsThis study included eyes with nuclear cataracts with a density grade of 1, 2, 3, or 4 according to LOCS III, divided into two groups; group 1 had conventional US, and group 2 had nanosecond laser. The endothelial cell density (ECD), coefficient of variation (CoV) in cell size, percentage of hexagonal cells, central corneal thickness (CCT) and best visual acuity (VA) were evaluated during 24 months.ResultsSeventy-four eyes had uneventful surgery, 40 in group 1, 34 in group 2. Three procedures in group 2 required conversion to standard phacoemulsification. The mean ECD decreased from 2616.4 ± 194.6 cells/mm2 in group 1 preoperatively to 2088.4 ± 229.9 after 2 years. In group 2, it decreased from 2611.8 ± 186.5 cells/mm2 to 2276.4 ± 163.8 after 2 years. The change was statistically significant in both groups. The decline of the mean ECD in group 2 was significantly less important than in group 1 (p = <10-2). The mean percentage of hexagonal cells was 45.18 ± 4.9 preoperatively and 43.5% ± 6.6 after 2 years in group 1. In group 2, it remained almost stable with 45.6 ± 5.1 and 45.4% ± 6.6 preoperatively and after 2 years, respectively. Preoperatively, the mean CoV was 0.39 ± 0.037 in group 1 and 0.38 ± 0.04 in group 2. After 2 years, it was 0.38 ± 0.04 and 0.37 ± 0.038 in group 1 and group 2, respectively. The changes of the mean CoV and the mean percentage of hexagonal cells were significant in both groups, but the difference between the groups was significant only during the six first months postoperatively. In preoperative, the mean corneal central thickness was 509.7 ± 19.5 in group 1 and 510.3 ± 20.4 in group 2. In both groups, the mean corneal thickness increased on D1 postoperatively to 550.9 in group 1, and 528.2 in group 2. The mean corneal thickness decreased more rapidly after 1 week in group 2, to find the initial values. Visual acuity improved from 0.76 Log Mar ± 0.5 at enrolment to 0.45 Log Mar ± 0.2, and 0.033 Log Mar ± 0.086 in group 1 at 1 day post-operative and after 24 months, respectively and from 0.58 Log Mar ± 0.28 to 0.2 Log Mar ± 0.09 and 0.035 Log Mar ± 0.083, respectively in group 2. There was no significant difference in VA at each follow-up between groups except for day 1.ConclusionOur study showed lower corneal tissue trauma, and lower endothelial cell loss in the laser cataract surgery compared to phacoemulsification.Clinical trial registration: (https://classic.clinicaltrials.gov/ct2/show/NCT05886283), identifier NCT05886283.
| S-EPMC10551626 | biostudies-literature
Project description:BackgroundComplete non-perfusion of the anterior segment vasculature during cataract phacoemulsification surgery is rarely reported.Case presentationWe present two cases of transient ocular surface non-perfusion (TOSN) during cataract phacoemulsification surgery. The TOSN happened during intraocular lens (IOL) implantation with complete vanish of blood flow in the conjunctival, episcleral and limbal vessels. Reperfusion started within 30 s and part of the blood supply of the conjunctiva and episclera was restored within 2 min. However, the blood flow in the limbal vessels was not restored until 5 min later. The postoperative examination of both eyes was normal. These two rare cases are the TOSN during cataract surgery. We speculated that the significantly increased intraocular pressure during IOL implantation might be the cause of this rare phenomenon.ConclusionNon-perfusion of the ocular structures may occur if the IOP peak during IOL injection exceeds the perfusion pressure of the anterior vasculature.
| S-EPMC7393894 | biostudies-literature
Project description:PurposeThe purpose of this study was to compare the efficacy and safety of cataract surgery by the phacoemulsification technique with and without the use of ophthalmic viscosurgical devices (OVDs).SettingThis study was conducted at a tertiary eye care center in a rural area of Central India.DesignThis was a prospective, randomized, observational study.MethodsIn this study, 220 patients underwent phacoemulsification for cataract surgery with OVDs (OVD group) or without OVDs (BSS group) (n = 110 in each group). Patients with operable, nuclear Grade 2-4 cataracts were included in the study. The study was conducted from June 2017 to September 2018. The frequency of intraoperative complications, surgical time, and ease of the surgical procedure (easy, difficult, or very difficult) were recorded.ResultsThere was no statistically significant difference in the nuclear opalescence, axial length, and intraocular lens (IOL) power between the two groups. Capsulorhexis extension was seen in two eyes in the OVD group and none of the eyes in the BSS group. The problems that occurred during IOL implantation included flip (OVD group, 2; BSS group, 1), haptic breakage (OVD group, 1; BSS group, 1), sulcus implantation (OVD group, 0; BSS group, 2), and stuck haptic (OVD group, 1; BSS group, 3). The total surgical time was almost equal in the two groups (OVD group, 9.2 min ± 3; BSS group, 9.5 min ± 3.5; P = 0.521). None of the patients had iris trauma or posterior capsular rupture.ConclusionsOVD-less phacoemulsification surgery is a safe and effective technique for treating age-related cataracts that requires no additional instrumentation and saves the cost of the OVD.
| S-EPMC7276164 | biostudies-literature