低浓度台盼蓝囊膜染色技术在白内障手术中的应用

目的：探讨台盼蓝染色晶状体前囊膜的最低有效浓度,评价白内障手术中应用囊膜染色技术的临床意义。

方法：收集2014-03/2016-12成熟期年龄相关性白内障患者60例60眼,晶状体皮质混浊程度为C4～C5、核混浊程度为N3(以晶状体混浊分类系统Ⅱ为标准),随机分为三组。三组患者术中分别使用0.03%、0.015%和0.0075%三种不同浓度台盼蓝。所有患者均由同一经验丰富手术医生完成手法小切口白内障手术。术中观察前囊膜染色情况以及撕囊难易程度。记录连续环形撕囊术(continuous circular capsulorhexis,CCC)成功、后囊袋破裂以及人工晶状体囊袋内植入情况。观察术后1d,1wk,3mo术眼角膜内皮细胞计数、眼压、前房炎症反应、角膜水肿和眼内结构染色情况。

结果：浓度低至0.015%的台盼蓝仍可对晶状体前囊膜有效染色,顺利完成CCC。0.03%与0.015%两组患者CCC成功率和IOL囊袋内植入率均高于0.0075%组,差异均有统计学意义(P<0.0083)。三组患者后囊破裂发生率和角膜内皮细胞平均损失率两两比较,差异均无统计学意义(P>0.0083)。术后晶状体前囊撕囊口边缘及侧切口的着染均于1wk内消失,未见其他眼内结构蓝染,前房炎症反应轻,未发现超过1wk的角膜水肿和眼压升高。

结论：白内障手术中应用台盼蓝晶状体前囊膜染色技术安全有效,可提高手术成功率,建议使用台盼蓝最低有效浓度为0.015%。     

Trypan-blue- and endoillumination-assisted phacoemulsification in eyes with vitreous hemorrhage during combined cataract and vitreous surgery

PURPOSE: To study the safety and usefulness of trypan blue application and conventional endoillumination for enhancing visualization during phacoemulsification and foldable intraocular lens implantation in cases of cataract with vitreous hemorrhage. METHODS: Ten eyes of 10 patients with cataract and coexisting vitreous hemorrhage underwent combined trypan-blue- and endoillumination-assisted phacoemulsification and foldable intraocular lens implantation with vitrectomy. In a two-step surgery, after staining the anterior capsule with trypan blue, continuous circular capsulorhexis was performed; then, phacoemulsification was performed using conventional endoillumination. Specular microscopy was performed before and 3 months after surgery on eyes that underwent trypan-blue- and endoillumination-assisted phacoemulsification and on control eyes that underwent standard phacoemulsification to evaluate the toxic effect of trypan blue on corneal endothelial cells. RESULTS: Trypan blue application improved visualization of the anterior capsule, and a complete capsulorhexis could be performed in all eyes. In all 10 eyes, endoillumination was required to visualize the lens structure, and phacoemulsification could be accomplished. Specular microscopy revealed that there was no significant difference in the level of corneal endothelial cell loss between the trypan-blue- and endoillumination-assisted phacoemulsification group and the control group. CONCLUSION: The described double visualization technique may assist phacoemulsification in selected cases of cataract with vitreous hemorrhage.     

Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study

PURPOSE: To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month. RESULTS: The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains. CONCLUSION: Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.     

台盼蓝在白色白内障超声乳化术中的应用

目的 探讨台盼蓝对晶状体前囊染色在白色白内障手术中应用效果。方法82例87眼随机分为染色组43例46眼与对照组39例41眼，染色组术中用台盼蓝染色，观察前囊膜着色效果、撕囊成功率、在超声乳化术中囊膜保护的完整率以及术中、术后并发症等，并与对照组进行统计学分析。结果染色组前囊膜均均匀着色，撕囊成功率与术中囊膜完整率均为100％，与对照组比较有明显统计学差异；术后视力、眼压、炎症反应、角膜内皮水肿与对照组比较无统计学差异。结论台盼蓝染色是一种简单安全的晶状体前囊膜染色技术，提高了前囊膜的可见度，有助于白色白内障超声乳化术连续环形撕囊术(continuous curvilinear capsulorhexis,COC)和整个手术的顺利进行。     

Closed-system and open-sky capsulorhexis for combined cataract extraction and corneal transplantation

We describe a triple procedure combining corneal transplantation, cataract extraction, and intraocular lens implantation in which the continuous curvilinear capsulorhexis (CCC) is performed in a closed system when corneal transparency is sufficient or using an open-sky method when corneal transparency is poor. With the closed system, the CCC is performed first followed by trephination and hydroexpulsion of the nucleus. A Caporossi coaxial forceps is used to reduce the corneal incision to 1.2 mm, preventing the need for sutures. Tunnel formation, which could limit the size of trephination, is avoided. In addition, endothelial cell loss at the periphery of the recipient cornea is reduced. This technique was performed in 10 eyes without intraoperative complications. With the open-sky method, the CCC is created while counterpressure is applied to the center of the lens with a large spatula, reducing posterior pressure and thus the risk of capsule tear. This technique was performed in 9 eyes without intraoperative complications.     

台盼蓝在全白或过熟期白内障手术连续环形撕囊前的应用观察

目的:探讨台盼蓝在全白或过熟期白内障手术连续环形撕囊前的应用观察.方法:选取近3a在我院眼科住院手术的全白或过熟期白内障患者42例42眼,术中均于前房内注入0.6mg/mL台盼蓝约0.2mL,使前囊膜着色成淡淡的蓝色,后进行连续环形撕囊.记录术前,术后1wk,1mo不同时段角膜内皮细胞密度及角膜内皮六角形细胞比例,并对其进行重复测定方差分析.结果:台盼蓝染色后,所有术眼均顺利完成连续环形撕囊,为下一步手术鉴定了成功的基础.术前,术后lwk,1 mo不同时段记录的角膜内皮细胞密度和角膜内皮六角形细胞比例差异无统计学意义.结论:对于过熟期及全白等难度较大的白内障手术,用台盼蓝染色前囊膜后,连续环形撕囊更易行、更安全.     

连续环形撕囊在压核排液后白色膨胀白内障术中的应用

目的:评价白内障术中破囊后,撕囊镊下压晶状体核,液化皮质充分流出(压核排液)后,在白色膨胀白内障中完成连续环形撕囊的临床应用效果。方法:对60例60眼皮质液化白色膨胀白内障随机分组。观察组30例患者,撕囊镊直接撕囊;治疗组30例患者,压核排液后进行撕囊。结果:在初步破囊时,有前囊膜自动裂向周边现象,观察组有9例,治疗组有10例,差异无统计学意义(P>0.05)。观察组连续环形撕囊的成功率为26.7%,治疗组撕囊成功率66.7%,差异有显著统计学意义(P<0.01)。观察组2例患者术中后囊自发破裂,治疗组无后囊破裂情况发生。结论:在白色膨胀白内障手术中,应用压核排液处理后,液化皮质的流出可消除晶状体核的上浮对前囊膜撕囊的影响,并可显著提高此类白内障中连续环形撕囊的成功率。     

Endoillumination-assisted cataract surgery in a patient with corneal opacity

We present a technique to better visualize cataracts through corneal opacity. A 70-year-old Japanese woman with retinal detachment, cataract, and corneal opacity in the left eye was treated with phacoemulsification, 3-port vitrectomy, and intraocular lens implantation. To circumvent the difficulty of performing continuous curvilinear capsulorhexis (CCC) and subsequent cataract surgery through a hazy cornea, we used an endoilluminator as a light source outside the cornea for CCC and inside the anterior chamber for phacoemulsification. As a result, CCC and subsequent cataract surgery were successfully and easily performed despite potentially troublesome corneal opacity. The use of an endoilluminator can be an effective supportive measure for cataract surgery in patients with corneal opacity.     

手法小切口白内障术中累及悬韧带区的连续环形撕囊的安全性探讨

目的：探讨在手法小切口白内障术中超出无悬韧带区域的连续环形撕囊的安全性及有效性。方法：采用手法无缝线白内障囊外摘除术对住院1 443例1 965眼白内障患者进行手术,术中采用连续环形撕囊法制作7～8mm直径前囊口,对患者术中撕囊是否成功、后囊破裂、术后角膜水肿及视力等情况进行统计学分析,研究其手术价值。结果：患者1 965眼中,1 942眼（98.83%）连续撕囊成功; 15眼（0.76%）囊膜瓣向周边撕裂不能挽救,留有放射状裂口一个; 8眼（0.41%）因为囊膜钙化机化等原因无法常规撕囊,采用囊膜剪开及截囊等方法完成前囊开口。所有病例,均无后囊破裂发生,并顺利植入人工晶状体。术后一过性角膜水肿36眼（1.83%）。术后1d,视力≥0.5者1 650眼（83.97%）,≥0.3者1 867眼（95.01%）。人工晶状体位置正并且稳定。结论：在手法白内障术中用连续环形撕囊方法制作累及悬韧带区域的大于常规直径的前囊口,并未降低囊袋和人工晶状体的稳定性,使手术安全性提高,值得推广和应用。     

针头抽吸方法在白色膨胀白内障撕囊术中的应用

目的：探讨针头抽吸方法在白色膨胀白内障撕囊术中的临床疗效。

方法：应用针头抽吸方法后连续环形撕囊(CCC)治疗白色膨胀白内障166眼。15°穿刺刀在3：00位作辅助切口,注入带有灭菌空气的台盼蓝染色剂约0.1mL进行前囊膜染色,向前房内注入透明质酸钠,再用3.2mm穿刺刀作上方角膜缘切口,保持主切口偏小,然后用一个1mL带27G针头,斜面朝上,穿刺前囊膜抽吸液化皮质,斜面侧向旋转不扩大前部的穿刺口,轻轻压迫晶状体核,继续将前移的核后部的液化皮质吸走,用足够的黏弹剂填充前房,随后用3.2mm穿刺刀扩大角膜切口,完成CCC。

结果：白色膨胀白内障166眼应用此方法,155眼成功完成了环形撕囊,成功率93.4%。

结论：白色膨胀白内障超声乳化手术撕囊过程中,应用针头抽吸方法,通过吸走足够的液化皮质,清除部分膨胀晶状体,不但减轻了晶状体和囊袋的压力,从而可达到环形撕囊的目的,而且减少了因前囊膜不完整带来的手术操作不便和并发症,是一种安全、简便、有效的操作方法,便于掌握和应用。     

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract

PURPOSE: To assess the feasibility, risks, and postoperative outcomes of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorhexis (CCC) in the absence of a red reflex. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 52 eyes of 52 patients with white cataract that had phacoemulsification through a clear corneal temporal incision with PC IOL implantation. In all the cases, trypan blue was used under air to stain the anterior lens capsule and the karate-chop technique was used to emulsify the nucleus. The mean follow-up was 192.2 days. RESULTS: Trypan blue adequately stained the anterior lens capsule in all cases. The CCC was completed uneventfully in 96.15% eyes; 3.85% of cases had to be converted to a conventional extraction technique because of the loss of the CCC. The mean phacoemulsification time was 2.2 minutes. Intraocular complications included incomplete capsulorhexis (3.85%) and pupillary miosis (3.80%). Postoperatively, 3 eyes (5.77%) had corneal edema (striate keratopathy) and 1 eye (1.9%) had fibrin in the anterior chamber. Five eyes (9.61%) had more than 2+ cells and flare at 2 weeks. All responded well to intensive topical and subconjunctival steroids. There were no cases of endophthalmitis. The mean central endothelial cell loss, measured in 37 eyes, was 8.5%. Of the 4 eyes (7.69%) that had increased intraocular pressure (IOP) postoperatively, all responded well to medications and the IOP was normal by the second postoperative week. Fifty eyes (96.16%) had a final best corrected visual acuity of 20/30 or better. In 2 cases, the final visual acuity was worse than 20/200 because of preexisting posterior segment pathology. CONCLUSION: Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.     

白内障合并真性囊膜剥脱综合征手术方式探讨

目的　探讨手术治疗白内障合并真性囊膜剥脱综合征的安全性。方法　回顾性分析２０１０年３月至２０１５年１月期间在河北省眼科医院白内障科就诊的白内障合并真性囊膜剥脱综合征患者４例（５眼）,其中３眼悬韧带正常,我们在撕囊和正常超声乳化手术过程中未发现任何异常;另外２眼合并晶状体不全脱位,我们使用４个虹膜拉勾固定囊袋,囊袋内预劈技术将晶状体核劈成８块,扭动超声乳化核及吸除皮质后,囊袋内植入张力环及人工晶状体。比较术前及术后最佳矫正视力、超声乳化总时间、灌注液消耗量、角膜中央内皮细胞密度、角膜内皮细胞丢失率,观察囊袋及人工晶状体有无偏心移位以及并发症的发生情况。结果　术后３个月最佳矫正视力０．８者２眼,０．６者１眼,０．５者２眼,术后３个月最佳矫正视力均较术前增加。晶状体超声乳化时间为３０．２～５２．６（４５．４±９．１）ｓ。灌注液消耗量为６３．１８～８０．２６（７１．９７±６．９４）ｍＬ。术前角膜中央内皮细胞密度２１６３～２８９２（２５０５．２±３１７．４）ｍｍ－２,术后３个月为２０７５～３０２３（２４１５．４±３０８．１）ｍｍ－２。角膜内皮细胞丢失率为３．５９％。术后５眼测得人工晶状体偏中心量为０．１２～０．４６（０．３０±０．１５）ｍｍ。５眼人工晶状体均成功植入囊袋内,术中未出现后囊膜破裂、悬韧带损伤或加重,术后第１天角膜均透明,远期未出现囊袋收缩、后囊膜混浊等并发症。结论　采用囊袋内预劈核联合虹膜拉勾囊袋固定和囊袋内植入张力环,可以增加合并真性囊膜剥脱综合征白内障手术的安全性。     

Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: a 10-year analysis.

PURPOSE: To analyze the rate of inadvertent anterior lens capsular tears with vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery between January 1, 1997, and December 31, 2006. METHODS: Retrospective chart review, collecting for each eye: age at cataract surgery, type of anterior capsulotomy, any tearing of the capsule, and if yes, details of the tear. RESULTS: A total of 737 eyes were reviewed. Cases with a ruptured lens capsule that occurred prior to surgery were excluded. Eyes that received an anterior capsulotomy by any other method (n = 27) or eyes that did not receive an IOL (n = 100) were reviewed but excluded from final comparative analysis. Of the remaining 339 eyes, 19 eyes (5.6%) were noted to develop an anterior capsule tear (vitrectorhexis, 12 of 226 eyes, 5.3%; CCC, 7 of 113, 6.2%). These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one, cataract removal in three, and IOL insertion/manipulation in eight. In eyes operated for cataract at or before 72 months of age, the manual CCC technique was more likely to develop a tear (relative risk, 3.09) compared with eyes of older children (>72 months of age), where the vitrectorhexis technique was more likely to develop a tear (relative risk, 3.14). CONCLUSIONS: Vitrectorhexis is well suited for use in children less than 6 years of age due to their highly elastic anterior lens capsule. For children aged 6 years and older, manual CCC is the best technique because, by that age, capsule control and ease of capsulotomy completion has improved.     

辅助技术在治疗白内障合并角膜混浊手术中的应用

目的：评价在白内障手术中应用包括囊膜染色、虹膜拉钩、虹膜切除等辅助技术治疗白内障合并角膜混浊患眼的术后视觉效果,并分析手术安全性和有效性。

方法：回顾收集2014-01/2019-03在新疆军区总医院全军眼科中心接受白内障超声乳化合并人工晶状体植入术的白内障合并角膜混浊患者105例105眼,所有患者接受白内障超声乳化摘除并人工晶状体植入术。术中应用台盼蓝囊膜染色剂,并观察前囊膜染色情况,连续环形撕囊成功率,晶状体后囊破裂及人工晶状体囊袋内植入情况。并于术后1d,1wk,1、3mo对患者进行随访,观察术中撕囊成功率,术前、术后的最佳矫正视力(BCVA,LogMAR),术后并发症等。

结果：患者均接受白内障超声乳化吸除合并人工晶状体植入术。术中通过应用台盼蓝囊膜染色剂(台盼蓝)染色前囊膜辅助成功完成所有连续环形撕囊,并采取了包括应用虹膜拉钩及虹膜切开术等其他措施。将可折叠式人工晶状体植入105眼。术后追踪观察3mo,术眼术后BCVA为0.82±0.10,与术前BCVA(3.12±0.14)比较有差异(t=174.893,P<0.01)。

结论：白内障超声乳化摘除术能使白内障合并角膜混浊患者的视力得到安全有效的提高。辅助技术如囊膜染色、虹膜拉钩、虹膜切除等的应用,能有效降低白内障合并角膜混浊患者的白内障手术风险,提高手术安全性,增加手术成功率。     

高频透热撕囊法在白内障手术中的应用

目的:评价在白内障手术中使用高频透热撕囊仪作连续环形撕囊的效果。方法:在30例(34眼)患者进行白内障囊外摘出联合后房型人工晶体植入术中,先向前房注入透明质酸钠,然后使用高频透热撕囊仪作晶体连续环形撕囊术。结果:有3眼术中出现小的晶体前囊放射状撕裂,所有病例术后角膜无水肿,无其他术后合并症,术后一周31眼矫正视力≥0.5,占91.2％。结论:此法操作简便,易于掌握,是一个安全有效的连续环形撕囊的方法。尤其适用于过熟期白内障,儿童先天性白内障和外伤性白内障的截囊。眼科学报1999;15:121—123。     

Tissue damage at anterior capsule edges after continuous curvilinear capsulorhexis, high-frequency capsulotomy, and erbium:YAG laser capsulotomy

PURPOSE: To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM). SETTING: Department of Ophthalmology, Department of Histology and Embryology II, University of Vienna, Vienna, Austria. METHODS: Five anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Kl?ti. Membranes were processed and examined by LM and TEM according to standard procedures. RESULTS: The edges obtained by ELC showed mild signs of denaturation and mechanical disruption, tears, and micro-tears. Lens capsule edges obtained by CCC were smooth with no irregularities in any specimen; the edges were beveled anteriorly to posteriorly with no evidence of tearing. Edges produced by HFC were considerably wider; the surfaces showed distinct denaturation, preformed tears, and micro-tears. The edges were surrounded by a nonhomogeneous mass, which consisted mainly of denatured lens capsule material. CONCLUSIONS: Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.     

Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery

AIM: To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition (EMT) induced by femtosecond laser in femtosecond laser assisted cataract surgery (FLACS). METHODS: Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly: FLACS1 group (cataract surgery by FLACS with LenSx), FLACS2 group (cataract surgery by FLACS with LensAR) and manual group (cataract surgery by phacoemulsification). Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis (CCC) manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. RESULTS: The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC (P<0.05). Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. CONCLUSION: Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.     

An experimental study of the surgical trauma on the rabbit's lens suspensory apparatus after cataract surgery]

Extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation requires that the posterior capsule and the zonules remain sufficiently intact. To assess the surgical trauma on the lens suspensory apparatus of the enucleated rabbit eye, we developed a new fine pressure gauge that could quantitate its strength. The cornea and the iris of enucleated eyes were removed to allow clear visualization of the anterior surface of the lens to the equator. Afterwards several types of anterior capsulotomy were performed for ECCE and PC-IOL implantation. And then the lens of the pseudophakic eye was vertically pressed with the plastic rod of the fine pressure transducer, and the strength of the lens suspensory apparatus was simultaneously measured. The strength of the lens suspensory apparatus of the pseudophakic eye decreased approximately 35% compared with that of the phakic eye. Moreover the integrity of the lens capsule of animals with circular capsulorhexis with tears or linear capsulotomy decreased approximately 43% compared with that of continuous circular capsulorhexis (CCC) and also zonular rupture and vitreous loss occurred as a result of the expansion of radial tears in the anterior capsule. The present study indicates that the strength of the lens suspensory apparatus decreases with cataract surgery, suggesting that much more attention to cataract surgery is needed if the anterior capsule had radial tears. It is also suggested that CCC is the best type of anterior capsulectomy procedure.     

Chandelier retroillumination-assisted torsional oscillation for cataract surgery in patients with severe corneal opacity

We describe a technique that uses 25-gauge transconjunctival chandelier endoillumination in combination with a torsional oscillation system for cataract surgery in cases with severe bullous keratopathy. Because of the hands-free and self-retaining nature of the chandelier fiber, continuous curvilinear capsulorhexis and subsequent bimanual intraocular manipulation can be performed easily. Torsional oscillation efficiently emulsifies lens particles along with the fluidics, preventing posterior capsule rupture and endothelial cell damage. After the chandelier fiber is removed at the end of surgery, the 25-gauge incision self-seals. This technique is safe and provides excellent visualization during cataract surgery in patients with severe corneal opacities.     

Phacoemulsification of white hypermature cataract.

PURPOSE: To evaluate the safety of phacoemulsification of white hypermature cataract, which is common in developing countries. SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: In a teaching hospital setting, a prospective evaluation of phacoemulsification in 25 eyes of 25 consecutive patients with hypermature cataract was done. Patients with good pupil dilation, optimal endothelial cell count, and disease-free ocular and systemic status were included. High magnification, sodium hyaluronate, and a Utrata capsulorhexis forceps were used to perform continuous curvilinear capsulorhexis (CCC). The stop and chop technique was used for nuclear emulsification. A 5.5 mm optic allpoly(methyl methacrylate) intraocular lens (IOL) was implanted, and wound closure was sutureless. RESULTS: Successful CCC was performed in 23 of 25 cases. In 2 cases, the CCC edge extended toward the periphery and a Vannas scissors was used to achieve an even cut. No complications were seen during nuclear emulsification and IOL implantation. Eighty percent of the patients had a visual acuity of 20/40 or better on the first postoperative day. Five patients had significant corneal edema that resolved within 1 week in all cases. CONCLUSION: Phacoemulsification was successfully and safely performed in appropriately selected patients with white hypermature cataract.