Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM: To compare perioperative parameters of one-handed rotational phacoemulsification technique (one-handed phaco-roll) with each of other two techniques, “Divide et Conquer” and femtosecond laser-assisted cataract surgery (FLACS) METHODS: In this retrospective and comparative cohort study, eyes with uncomplicated cataract (nuclear density grade 2 to 3) treated routinely with one-handed phaco-roll (n=23; Group 1) or “Divide et Conquer” (n=23; Group 2) or FLACS (n=23; Group 3) were enrolled. Intraoperative parameters including effective phaco-time (EPt), ultrasound time (USt), aspiration time, surgical time, phacoemulsification (phaco)-power, balanced salt solution (BSS) use, cumulative dissipated energy (CDE) were recorded and compared. Clinical outcomes including best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT) and central macular thickness (CMT), were assessed and compared pre-operatively and at 1mo after surgery. RESULTS: Aspiration and surgical time, and BSS used were lower in Group 1 (P<0.01) than other groups. EPt, phaco-power and CDE were lower in Group 1 (P<0.05) than Group 2 but not significantly different from Group 3. In Group 1, USt was lower (P<0.05) than Group 2 but higher (P<0.05) than Group 3. BCVA improved in all groups without significant difference between Group 1 and the other ones. No significant differences regarding all post-operative morphologic outcomes (ECD, ECL, CCT, CMT) were reported. No clinical complications occurred. CONCLUSION: One-handed phaco-roll seems to be less time-consuming than “Divide et Conquer” and FLACS and less energy-consuming than “Divide et Conquer”. Furthermore, one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.     

Femtosecond laser capsulotomy versus manual capsulotomy: a Meta-analysis

AIM: To perform a Meta-analysis on the precision and safety of femtosecond laser (FSL) capsulotomy compared with manual continuous curvilinear capsulotomy (CCC). METHODS: We searched PubMed, EMBASE, Web of Science, the Cochrane Library databases, and Clinical Trials.gov that maintained our inclusion criteria. Reference lists of retrieved articles were also reviewed. The effects of morphology of capsulorhexis and the tears of anterior capsule were calculated by using random-effect models. RESULTS: We identified 4 randomized and 7 nonrandomized studies involving 2941 eyes. The diameter of capsulotomy and the rates of anterior capsule tear showed no statistically difference between FSL group and manual group (MD=0.03; 95%CI, -0.03 to 0.09, P=0.31), and (OR=1.40; 95%CI, 0.28 to 6.97, P=0.68) respectively. In terms of the circularity of capsulotomy, FSL group had a more significant advantage than the manual CCC group (MD=0.09; 95%CI, 0.05 to 0.12, P<0.0001). CONCLUSION: Our Meta-analysis shows that FSL can perform a capsulotomy with more precision and higher reliability than manual CCC. The results in diameter of capsulotomy and the rate of anterior capsule tears was no significant difference between FSL and manual CCC groups. However in terms of circularity, the FSL was superior to the manual procedure.     

Pseudophakic rhegmatogenous retinal detachment in a large Asian tertiary eye centre: a cohort study

Background: To determine the incidence and identify risk factors for the development of rhegmatogenous retinal detachment in patients who had cataract surgery at the Singapore National Eye Centre between 2001 and 2003. Design: Retrospective case–control study. Participants: All patients who had cataract surgery between 2001 and 2003 and subsequently retinal detachment surgery in the same eye, between 2001 and June 2008, at Singapore National Eye Centre. Methods: Review of case records. Main Outcome Measures: Incidence of posterior capsular rupture and retinal detachment. Results: Thirty‐nine eyes, out of 24 846 cataract operations performed between 2001 and 2003, developed rhegmatogenous retinal detachment in the follow‐up period from 2001 to 2008 (cumulative incidence 0.16%, 95% confidence interval 0.11–0.21%). Of the 508 eyes with posterior capsular rupture during cataract surgery, nine developed retinal detachment (cumulative incidence 1.77%, 95% confidence interval 0.87–3.23%). Men were more likely to develop retinal detachment (P < 0.001). On Kaplan–Meier survival analysis, younger patients had a higher probability of retinal detachment in comparison with older subjects (P < 0.001). Similarly, eyes with posterior capsular rupture during surgery had shorter interval duration to retinal detachment, compared with eyes that did not (P = 0.002). When compared with patients more than 70 years of age, younger patients had significantly higher hazard ratios of retinal detachment (hazard ratio 19.7, 95% confidence interval 3.6–107.3, P < 0.05). Conclusion: The incidence of pseudophakic retinal detachment in our institution is low. Posterior capsular rupture during surgery, men and younger age at time of surgery increases the risk of developing retinal detachment, and careful observation for the occurrence of retinal detachment may be warranted in these groups of patients.     

OCTA对飞秒激光辅助白内障超声乳化术后视盘区血管密度和神经纤维层厚度的观察

目的　应用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察飞秒激光辅助白内障超声乳化术后患者视盘区放射状毛细血管密度及神经纤维层厚度的改变。方法　回顾性对照研究。在术前及术后1 d、1个月、3个月,对26眼飞秒激光辅助白内障超声乳化术患者应用OCTA进行视盘区自动化扫描,以获得视盘区放射状毛细血管密度及神经纤维层厚度,同时测量患者最佳矫正视力及眼压。结果　与术前相比,术后1 d、1个月、3个月,飞秒激光辅助白内障超声乳化术患者视盘区放射状毛细血管密度明显减少（F=9.809,P<0.001）;术后1 d、1个月、3个月,视盘上半区和下半区的毛细血管密度较术前也均有所减少（F=7.068,P=0.001;F=6.845,P<0.001）。术后1 d,视盘区神经纤维层厚度较术前并无明显变化（P=0.507）,但在术后1个月、3个月,视盘区神经纤维层厚度均较术前有所增加（P=0.001、0.019）。术后1 d、1个月、3个月,最佳矫正视力较术前明显提高,差异有统计学意义（F=74.779,P<0.001）。结论　飞秒激光辅助白内障超声乳化术后患者视盘区放射状毛细血管的密度有所减少,视盘区神经纤维层厚度呈晚期增加的趋势,但对患者术后视力的改善并无明显影响。     

Posterior capsular opacification in patients with pseudoexfoliation syndrome: a long‐term perspective

Purpose: To compare posterior capsular opacification in patients with and without pseudoexfoliation syndrome 6–7 years following surgery. Methods: Forty‐four eyes of 44 patients with pseudoexfoliation syndrome who underwent cataract surgery with phacoemulsification in 2001 and 2002 were available for follow‐up in 2008. These patients were compared to 86 age‐ and gender‐matched patients (86 eyes) without pseudoexfoliation syndrome who had surgery during the same time period. Posterior capsule opacification was assessed using digital retroillumination photography. The images were analysed with a software program (POCOman ) to determine the extent and severity of the capsular opacification. Results: Percentage and severity of posterior capsular opacification within the central 4.0 and 1.3 mm of the optical zone were compared in eyes with and without pseudoexfoliation syndrome. Neither of these results were statistically significant. Before the re‐examination in 2008, neodymium:yttrium‐aluminium‐garnet laser posterior capsulotomy had been conducted in 16% (n = 7) of eyes with pseudoexfoliation syndrome, as well as in 16% (n = 14) of eyes without pseudoexfoliation syndrome. Conclusion: Our study indicates that, with phacoemulsification, development of long‐term posterior capsular opacification is not increased in patients with pseudoexfoliation syndrome after uncomplicated cataract surgery.     

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD= -0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.     

不同设计人工晶状体植入术后3年后囊膜混浊的研究

目的研究不同材料和不同设计的人工晶状体植入术后3年的后囊膜混浊(posterior capsular opacification,PCO)发生率及PCO形态。方法回顾性研究132眼老年性白内障患者,由同一医生进行超声乳化联合人工晶状体(in-traocular lens,IOL)植入术,根据IOL的不同分为4组:Storz Hydroview H60M组(33眼),Silicone折叠式硅胶IOL组(29眼),AcrySof三片式IOL组(36眼)和聚甲基丙稀酸甲酯(poly-methyl methacrylate,PMMA)组(34眼)。术后3年随访患眼的最佳矫正视力(best corrected visual acuity,BCVA),扩瞳后采集PCO数码图像,分析不同IOL组PCO的形态及PCO发生率。结果各种IOL的PCO形态各异,H60M组和AcrySof组分别有10眼和15眼后囊形成皱折,而Silicone和PMMA组为片状混浊。虽然各组BCVA和BCVA下降率差异没有显著性(P>0.05),但PCO发生率差异有非常显著性,分别是AcySof组5.6%,Silicone组30.3%,H60M组31%和PMMA组55.9%。结论AcrySof疏水丙烯酸酯三片式折叠IOL,有直角边缘设计,术后3年能明显降低PCO的发生。     

白内障术后并发症:现状与对策

近年来,由于手术方式、仪器设备和人工晶状体的改进,白内障术后并发症的发生率已明显下降。晶状体上皮细胞间质转化机制学说和人工晶状体材料及设计研究有了新的突破,为后发性白内障的防治提供了新途径。大量临床研究证实,术毕前房注射抗生素（头孢呋辛或莫西沙星）可显著降低术后眼内炎的发生率,包括术中合并晶状体后囊膜破裂的患者,未来有望在临床广泛推广。体外培养人角膜内皮细胞和促角膜内皮细胞增生药物的研发为白内障术后角膜内皮损伤的治疗带来了曙光。利用光学相干断层扫描、光学相干断层扫描血管成像能在早期准确诊断白内障术后黄斑囊样水肿,且非甾体抗炎药或抗血管内皮生长因子药物玻璃体内注射对此疗效明确。随着研究的深入,进一步认识到先天性白内障手术时机、人工晶状体植入否与术后继发性青光眼的相关性。高度近视眼患者晶状体屈光性手术的提前,增加了这类患者晚期人工晶状体-囊袋复合体脱位的发生率,并让相应治疗面临新的挑战。飞秒激光辅助的白内障手术因其精准性和安全性已在临床逐渐应用,但仍需关注其可能带来的干眼、瞳孔缩小、视网膜光损伤等并发症。另外,由于糖尿病的高发病率,对糖尿病患者的白内障手术应全面、综合、系统地治疗,以防止术后各种眼表、眼底并发症的发生。本文就上述各方面的研究现状和相应对策进行综述,以期帮助眼科医生进行临床诊疗。     

不同类型白内障患者术后晶状体后囊膜混浊发生率的比较

目的 比较不同类型白内障患者术后晶状体后囊膜混浊发生率。设计 回顾性病例系列。研究对象 2007-2008年在石家庄市第一医院同一医师施行的超声乳化白内障吸除及人工晶状体植入术的2069眼。其中,单纯老年性白内障1574眼、糖尿病性白内障305眼、高度近视并发白内障165眼,陈旧性葡萄膜炎并发白内障25眼。方法 于术后2年进行视力、裂隙灯、眼底检查,观察记录晶状体后囊膜混浊程度,并根据Hayashi方法进行混浊分级。主要指标 晶状体后囊膜混浊发生率。结果 单纯老年性白内障组后囊膜混浊128眼（8.13%）,糖尿病性白内障组39眼（12.79 %）,葡萄膜炎并发白内障组4眼（16.00%）,高度近视并发白内障组36眼（21.82%）。4个组比较,后囊膜混浊发生率之差异有统计学意义（χ2=35.377,P=0.000）。1级后囊膜混浊发生率各组相近：单纯老年组60眼（3.81%）,糖尿病组6眼（1.97%）,葡萄膜炎组1眼（4.00%）,高度近视组5眼（3.03%）;2级后囊膜混浊发生率糖尿病组较高,20眼（6.56%）;3级后囊膜混浊发生率高度近视组较高,24眼（14.55%）。4组患者后囊膜混浊程度之间比较有显著差异（χ2=105.55,P=0.000）。结论 单纯老年性白内障术后后囊膜混浊发生率较低,高度近视组后囊膜混浊发生率较高,混浊程度较重。（眼科, 2014, 23： 91-93）     

Clinical outcomes of femtosecond laser–assisted cataract surgery versus conventional phacoemulsification: A retrospective study in a tertiary eye care center in South India

Purpose:To compare the clinical outcomes of femtosecond laser–assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) in terms of refractive outcomes, cumulative dissipated energy, and intraoperative complications.Methods:In this retrospective study performed in a tertiary care ophthalmic hospital, we reviewed 2124 eyes that underwent FLACS or CP. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cumulative dissipated energy (CDE), and intraoperative complications were analyzed in the study.Results:Out of 2124 eyes, 873 underwent FLACS and 1251 underwent CP. The postoperative mean UCVA after one month was 0.05 ± 0.11 logMAR and 0.14 ± 0.23 logMAR for FLACS and CP, respectively (P < 0.00001). Mean CDVA one month post operation was 0.02 ± 0.07 logMAR and 0.06 ± 0.19 logMAR for FLACS and CP, respectively (P < 0.0001). The CDE for the FLACS group was 6.17 ± 3.86 (P < 0.00001) and it was 9.74 ± 6.02 for the CP group. The intraoperative complication for the FLACS group was 1.60% and the CP group was 2.39% (P < 0.00001).Conclusion:The visual outcomes were better in FLACS compared to CP. The CDE was lower for the FLACS group and FLACS had significantly less intraoperative complications.     

Pharmacological attempts to reduce posterior capsule opacification after cataract surgery – a review

Reduction of posterior capsule opacification (PCO) after cataract surgery has been achieved since the general acceptance of posterior chamber intraocular lens implantation 30 years ago. Attention to surgical technique on the one hand and changes in lens design and materials on the other have synergistically reduced the incidence of PCO to less than 5% at 5 years. But lens epithelial cells still proliferate and pharmacological prevention has been largely unsuccessful so far. Any agent must be toxic to these lens epithelial cells without being toxic to the corneal endothelium. This review looks at many substances that have been tried and a few that have been partly successful without yet entering clinical practice. Possibilities for future clinical research are canvassed.     

Incidence of endophthalmitis after phacoemulsification cataract surgery: a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^th,2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.     

2型糖尿病白内障术后后囊混浊的临床研究

目的比较合并2型糖尿病的老年性白内障患者与单纯老年性白内障患者行超声乳化白内障摘出人工晶状体植入术后后囊膜混浊情况。方法2001年3月～2003年3月我院行超声乳化白内障摘出人工晶状体植入术162例245眼，A组为合并2型糖尿病的老年性白内障患者80例120眼，B组为单纯性老年性白内障患者82例125眼。随访3～36个月，比较2组PCO发生率及YAG激光后囊切开百分率、囊膜混浊程度。结果A组、B组后囊膜混浊百分率分别为50．00％、26．04％；YAG激光后囊切开百分率分别为20．00％、6．04％，2种百分率差异均有显著性（P〈0．01）。2组后囊膜混浊程度分级后行秩和检验，差异有显著性（P〈0.01）。结论2型糖尿病是影响白内障术后后囊膜混浊的重要因素之一。     

后囊膜连续环形撕囊联合或不联合前部玻璃体切除对儿童后发性白内障影响的Meta分析

目的:系统评价儿童白内障术中后囊膜连续环形撕囊(PCCC)联合与不联合前部玻璃体切除(AV)对后发性白内障形成的影响,并对术后并发症的发生率进行分析。方法:计算机检索MEDLINE(1990/2007)、西文生物医学期刊文献数据库CMCC(1995/2007)、中国知识资源总库CNKI(1979/2007)的中外文献,结合手工检索方式,回顾所有相关已发表文献。对纳入文献进行质量评估,分析后发性白内障及并发症的发生率。采用RevMan 4.2软件进行统计学分析。应用随机效应模型进行Meta分析。采用比值比(OR)及其95%可信区间(CI)作为效应量。结果:最终纳入文献13篇,病例730例。总体差异有统计学意义[OR=0.17,95%CI(0.11,0.27)],随机组差异有统计学意义[OR=0.15,95%CI(0.05,0.44)],非随机组差异也有统计学意义[OR=0.15,95%CI(0.08,0.27)]。共有6篇文献提及术后黄斑水肿和视网膜脱离的发生情况,所有病例均未发生黄斑水肿或视网膜脱离。结论:儿童白内障术中一期行PCCC AV较单纯PCCC,可以减少或延迟后发性白内障的发生,并具有一定的安全性。但目前高质量的研究较少,使结果的论证强度受到一定程度的限制。     

Rescue of an extending capsulorrhexis by creating a midway tangential anterior capsular flap: a novel technique in 22 eyes

Objective: To show how an extending capsulorrhexis can be rescued by a midway tangential capsular flap in order to achieve an uneventful phacoemulsification.Design: Consecutive case series.Participants: Twenty-two eyes of 22 patients with extending capsulorrhexis treated at the Farabi Eye Hospital, Tehran.Methods: First, a tangential capsular opening was created on the border of the presumed continuous curvilinear capsulorrhexis just midway between the beginning of the capsulorrhexis and the edge of the extending capsulor-rhexis, to make a tangential flap of the anterior capsule. Second, the centre of this new flap was grasped and pulled centripetally until the edges of the new flap joined the edges of the extending flap to complete the capsulorrhexis.Results: The technique was successfully performed in all cases, leading to an uneventful phacoemulsification.Conclusions: Midway tangential capsular flap is a safe and effective technique to rescue an extending capsulorrhexis and leads to an uneventful phacoemulsification.     

后囊环形切除及其联合前段玻璃体切除术对后发性白内障影响的Meta分析

目的 系统评价白内障超声乳化吸除术中选择Ⅰ期后囊环形切除（PCCC）与选择Ⅰ期后囊环形切除联合前段玻璃体切除（PCCC＋AV）对患者后发性白内障的影响。设计 基于文献检索的Meta分析。研究对象 检索MEDLINE数据库、中国期刊网专题全文数据库、中文生物医学文献数据库、维普中文科技期刊数据库、中国医学学术会议论文、中国优秀硕博士论文数据库、超星数字图书馆、书生之家数字图书馆等；手工检索国内外相关教科书、会议论文等；并以所有检出文献的参考文献作为补充。方法 严格按照纳入、排除标准筛选文献，并对纳入文献进行质量评估，提取研究所需信息。数据分析选用Review Manager 4．2．2软件、SPSS10．0软件，检验异质性，根据检验结果选择相应的效应模型进行Meta分析，以优势比（OR）判定PCCC术式和PCCC＋AV术式对患者后发性白内障的影响，并改变选择的效应模型，计算失效安全数（Nfs）进行敏感性分析。主要指标 纳入研究的文献异质性，研究结果的敏感性，95％置信区间（CI）及Nfs。结果 6篇文献共计305例白内障患者。经异质性检验，纳入文献无异质性，选择固定效应模型计算OR值。后发性白内障PCCC组与PCCC＋AV组的合并OR值为0．13（95％CI：0．06～0．25），差异有统计学意义（P〈0．000）。改用随机效应模型计算OR值，进行敏感性分析，差异仍有统计学意义（P〈0．000），且Nfs=76．8，纳入文献稳定性好。结论 白内障超声乳化吸除术中选择Ⅰ期PCCC＋AV术式患者较术中单纯选择I期PCCC术式的患者更能有效抑制后发性白内障的发生。     

白内障术后角膜病变治疗的新进展

白内障患者晶状体超声乳化术后的角膜水肿、干眼、角膜内皮功能失代偿致大泡性角膜病变等严重影响着患者满意度和视觉质量。长期以来,穿透性角膜移植是角膜内皮功能失代偿患者视力恢复的有效方法,但角膜供体缺乏及移植后角膜内皮细胞密度降低等问题仍然无法解决。近年来,角膜内皮移植、局部角膜后弹力层撕除、人工培养角膜内皮细胞植片的移植、Rho激酶抑制剂调节角膜内皮细胞增殖等方面的进展和新手段,为白内障术后角膜内皮功能失代偿患者的治疗带来新思路。     

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens (IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.