No abstract available.
Phacoemulsification*

Purpose: To analyse the visual outcomes of cases with posterior capsule rupture (PCR) compared to those without PCR following phacoemulsification. The occurrence of posterior capsule rupture during phacoemulsification surgery for cataract can have serious implications in the visual recovery. However, recognition of PCR and proper management can yield a successful visual outcome. This study analysed the visual outcomes of cases with PCR compared to those without PCR. Methods: This is a case-control study. All patients who underwent cataract surgery from 2011 to 2012 in Hospital Melaka were traced from the National Eye Database (NED) of Malaysia. The visual outcomes were classified as good, borderline and poor as per WHO guidelines. The data was analysed with SPSS version 12 IBM. Results: Out of 80.4% (2519) of eyes that had undergone phacoemulsification (PHACO) type of surgery, 3.06% (77 cases) had posterior capsule rupture complication. There was no significant difference in the visual outcome of borderline between cases with PCR and cases without PCR (Odds Ratio (OR) 0.989; 95% Confidence Interval (CI) 0.382- 2.560). However, cases with PCR were significantly less likely to have good vision compared to those without PCR (OR 0.335; 95% CI 0.157-0.714). Conclusion: The study reveals that a significant number of patients without PCR had good vision, whereas those with PCR did not get good vision. We would like to suggest meticulous care during phacoemulsification surgery to avoid PCR in order to obtain good visual outcomes.
Phacoemulsification

Background: Phacoemulsification is the most important cataract surgical procedure performed by ophthalmology residents. There is an increasing and consistent trend in international studies on decreased complication rates and more efficient surgical techniques with more surgeries performed. The data collected from this study can be used to quantitatively assess the cataract surgery training of Ophthalmology residents in the country and can help to improve the quality of cataract surgeries taught and performed in the training programs. Objectives: To analyze outcomes of phacoemulsification cataract surgeries and to determine the intraoperative complication rates of third-year residents of the University of the Philippines - Philippine General Hospital (UP-PGH). Methods: Retrospective chart review of phacoemulsification cases done by eight third-year ophthalmology residents at the UP-PGH from January 1 to December 31, 2017. Outcomes measured included postoperative best corrected visual acuity (BCVA), intraoperative complications (posterior capsular rent and vitreous loss), and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). Results: Four hundred ninety-two (492) cases were analyzed. Postoperative mean BCVA was 20/25. There were no significant differences in visual acuity outcomes over the course of training. Intraoperative complications occurred in 33 cases, with fewer cases with posterior capsule rent and vitreous loss later in training after the first 50 cases. There was a downward trend of adjusted phacoemulsification time throughout training, with a significant difference between the first 50 and 100 cases. Conclusion Good visual outcomes are achievable throughout the resident’s phacoemulsification learning curve. Surgical competency in phacoemulsification, as measured by complication rates and phacoemulsification efficiency, still improves significantly with an increasing number of cases and experience beyond the first 100 cases.
Phacoemulsification

Objective: To determine the efficacy of the Wong incision in providing wound seal compared to stromal wall hydration in clear cornea phacoemulsification in cadaveric porcine eyes. Method: This was an in vitro comparative experimental study using ten porcine eyes. All eyes were randomly assigned to the stromal wall hydration (control) or the Wong incision group (experimental). A side port was made and the anterior chamber formed with viscoelastic device. The main incision was made 180 degrees away. In the experimental group, a Wong incision was made first anterior to the main incision. Phacoemulsification surgery with IOL insertion was simulated. The main incision was sealed by hydration. The anterior chamber (AC) was infused with balanced salt solution (BSS) through an AC maintainer and leakage of fluid from the main incision was assessed. Samples from the AC were taken before and after tryphan blue drip and were sent for analysis by UV spectrophotometry. Trypan blue was dripped over the main incision and the whole eyeball was sent for histopathology. Results: There was a significant increase in density from the pre-dye to the post-dye AC samples of the control (0.0052 to 0.0074, p=0.01) and the experimental groups (0.0076 to 0.0094, p=0.02), although the final samples showed an optical density comparable to pure BSS, indicating that there was no significant amount of trypan blue detected in both groups. On histology, trypan blue staining was not seen in the incision tracts of both groups. After infusing the AC with BSS, there was outward wound leakage in all eyes of the control group and none in the experimental group. Conclusion The Wong incision was as effective as the lateral stromal wall hydration in preventing fluid influx. Furthermore, the Wong incision showed a more stable wound seal against outward wound leakage in an in-vitro porcine model of clear corneal phacoemulsification.
Phacoemulsification

Objective: To report a case of a suture-related corneal abscess caused by Enterococcus casseliflavus on a phacoemulsification corneal incision. Method: This is a case report. Results: An elderly female underwent complicated phacoemulsification surgery on the left eye requiring sutures to seal the corneal incisions. Suture removal was incomplete at the side port, and a suture abscess developed after 9 weeks. Cultures revealed heavy growth of Enterococcus casseliflavus which was initially treated with an empiric broad-spectrum antibiotic (levofloxacin 1.5%) administered via intrastromal and subconjunctival injections, followed by culture-guided topical and oral medications. The corneal infection resolved but significant corneal thinning led to perforation, requiring a modified Gunderson flap procedure to repair the defect. Conclusion Intrastromal and subconjuctival injection of levofloxacin 1.5% may be a viable empiric treatment option for Enterococcus casseliflavus suture-related corneal abscess.
Phacoemulsification

PURPOSE: To investigate whether there was any difference in anterior capsular opening area between the use of silicone intraocular lens(IOL) and acrylic IOL after continuous curvilinear capsulorhexis(CCC). METHODS: In 42 eyes, acrylic IOL(Acrysof(R), Alcon, U.S.A.) were inserted into the capsular bag during phacoemulsification, and in 36 eyes silicone IOL(Chiroflex II(R) , Chiron, U.S.A.) were inserted. The reduction rate of anterior capsular opening area at first, second, third and sixth postoperative month were compared between the two groups. RESULTS: On the whole, the reduction in anterior capsular opening area was larger by 0.574 mm 2 when silicone IOL was used, but the different was not statistically significant(P= .061). The result was the same at 1 month(P= .149), 2 months(P= .144), 3 months(P= .223), 6 months(P= .163) after surgery. CONCLUSIONS: We concluded that there was little difference in the changes of anterior capsular opening area after CCC between the use of silicone IOL and acylic IOL, and other factors should be considered.
Phacoemulsification ; Silicones

A prospective study was conducted on 56 patients (56 yes) who underwent trabeculectomy to treat glaucoma and had blurred vision due to cataract. Most patients were 70-80 years old (60.7%). Patients with closed-angle glaucoma were 80.4%. Majority of eyes (42 eyes, 74.8%) had bad visual acuity (<1/10). Postoperatively, 23 eyes (41%) achieved visual acuity from 3/10 to 7/10. Between 1 and 6 months postoperative, visual acuity improved significantly and quite stable during follow-up period with 30 eyes (53.5 %) achieved acuity of 5/10 or better. One month after operation, there were 30 eyes (54.2%) with intraocular pressure<18mmHg and 26 eyes (45.8%) with previous inflammation discharged membrane, disengage or cutting the pupil edge, all are mechanic effects which affect to cornea endothelium and iris
Phacoemulsification ; Trabeculectomy

PURPOSE: To compare intraoperative parameters and postoperative results between divide-and-conquer and multiple phaco-chop technique. METHODS: Two different techniques were performed by one operator on the patients with bilateral cataract. One eye was phacoemulsified by divide-and-conquer technique (D eye), and the other was performed by multiple phaco-chop technique (M eye). Changes of central corneal thickness during the operation, total phaco-time and phaco-energy were measured. RESULTS: Total 29 patients were included. The change of central corneal thickness were 8.4 +/- 11.8 microm in D eye and 11.5 +/- 16.7 microm in M eye, which showed no significant difference (p = 0.350) and total phaco-time were 70.1 +/- 32.9 seconds in D eye and 71.1 +/- 55.0 seconds in M eye, which also showed no significant difference (p = 0.689). However, phaco-energy were 12.4 +/- 8.3 power x s in D eye and 8.4 +/- 9.9 power x s in M eye, and this result showed significantly larger energy when using divide-and-conquer technique (p < 0.001). CONCLUSIONS: There was no significant difference in change of central corneal thickness and phaco-time between two techniques, divide-and-conquer and multiple phaco-chop technique. However, significantly smaller phaco energy was used by multiple phaco-chop technique compared with divide-and-conquer technique.
Cataract ; Eye ; Humans ; Phacoemulsification

To investigate the relationship of the density, thickness of lens nucleus and cortex with phacoemulsification time, we measured the preoperative density and length of lens nucleus and cortex of 100 eyes with a Scheimpflug camera. We performed phacoemulsification on the same phacoemulsification technique using a phacoemulsifier aspirator by the same surgeon. The preoperative mean values of the density of lens nucleus and cortex were 127. 09+/-57.44 and 30. 33+/-15. 24, respectively. The mean values of the thickness for both were 3.05+/-0.42mm and 0.65+/-0.17mm, respectively. The mean value of phacoemulsification time was 92.68+/-56.98 seconds. The phacoemulsification time was increased significantly as the density of lens nucleus was increased (P<0.0001). However, the thickness of the lens nucleus and cortex and the density of cortex had no significant effect on the phacoemulsification time (p=0. 235, p=0.811). Preoperative evaluation with a Scheimpflug camera is particularly valuable for cataractous patients with corneal endothelial disease deciding on phacoemulsification.
Cataract ; Humans ; Phacoemulsification*

Postoperative changes of keratometric astigmatism were analysed in 137 cases of phacoemulsification and foldable silicone posterior chamber lens implantation using clear corneal incision. The subjects were divided into two groups; Group 1 comprised 36 eyes which underwent surgery using a superior approach, Group 2 comprised 101 eyes which underwent surgery using a temporal approach. Surgically induced keratometric astigmatism in Group 1 was -1.14+/-1.02 diopter(D) at one day, -0.98+/-1.03 D at one week, -0.58+/-0.94 D at two months after operation, and in Group 2 was 0.69+/-0.97 D at one day, 0.96+/-1.08 at one week, 0.63+/-0.68 at two months after operation. The difference of absolute astigmatism between two groups was statistically significant(p<0.05) at one day after operation. But there was no statistically significant difference at one week and two months after operation. Temporal incision induced less astigmatism than superior incision temporarily in cataract surgery using clear corneal incision.
Astigmatism* ; Cataract* ; Phacoemulsification ; Silicones