[Effect of duration of phacoemulsification on postoperative inflammation--a retrospective study]

Factors influencing aqueous flare after cataract surgery and its evaluation with laser flare photometry

Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood-aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. It highlights the impact of preoperative pathological states such as uveitis and diabetes, intraoperative techniques, including efficient phacoemulsification and direct comparisons between postoperative anti-inflammatory regimes. There is a large interobserver variation in the subjective flare measurement after cataract surgery and the continued use of LFP amongst other objective, noninvasive measurements of intraocular inflammation, particularly in the further development of cataract surgery, is recommended.

Optimization of Phacoemulsification Tip Gauge on the Oertli CataRhex3 in an in vitro Setting

Purpose

To evaluate the effect of each of the tip sizes available for the Oertli CataRhex3^® phacoemulsification machine on efficiency.

Methods

Porcine lenses were fixed in formalin for 2 hours, then cut into 3.0 mm cubes. We studied three Oertli tips, all of which had a 30-degree bevel: easyTip 2.2 mm (20G), easyTip 2.8 mm (19G), and CO-MICS (21G). For the 19G and 20G tips, vacuum was set at 600 mmHg, irrigation rate at 50 mL/min, continuous power 70%, and bottle height 85 cm. For the 21G tip, vacuum was set at 450 mmHg; irrigation and power settings were identical to those used for the easyTip tips. We measured time to removal and chatter events to determine efficiency.

Results

Results from 20 trials for each tip showed that the larger the gauge size, the more quickly lens fragments were removed. Chatter events demonstrated an increasing trend with smaller tip gauge. The 19G tip used an average time to fragment removal of 2.8 seconds; the 20G, 3.2 seconds; and the 21G, 4.6 seconds. Increasing tip diameter from 21G to 20G decreased emulsification time by 33% (P = 0.02). Increasing the diameter from 21G to 19G further decreased time to emulsification by 42% (P = 0.003). The 21G tip had a mean 1.4 events/cube; 20G, 0.35 events; and 19G, 0.1 events. Differences in mean chatter events for each tip were each statistically significant.

Conclusion

These data suggest that when evaluated by chatter events and emulsification time, the 2.8 mm (19G) easyTip proves to have greatest efficiency.

Laser flare-cell photometer: principle and significance in clinical and basic ophthalmology

A slit-lamp examination is an indispensable and essential clinical evaluation method in ophthalmology, but, it is qualitative subjective. To complement its weaknesses in making a quantitative evaluation of flare intensity and number of cells in the aqueous humor in the eye, we invented the laser flare-cell photometer in 1988. The instrument enables a non-invasive quantitative evaluation of flare intensity and number of cells in the aqueous with good accuracy and repeatability as well as maneuverability equal to slit-lamp microscopy. The instrument can elucidate the pathophysiology in the blood-aqueous barrier (BAB) function in a variety of ocular disorders. The accuracy of the instrument makes it possible to investigate not only the pathophysiology of intraocular disorders but also the effects of various drugs and surgical procedures in BAB. The instrument does not only lighten the burden on patients in clinical examinations and study but it also helps minimize the sacrifice of experimental animals and improves the reliability of the results by minimizing inter-individual variations through its good repeatability. Here I shall relate how the instrument has been applied to clinical and basic studies in ophthalmology and what novel knowledge its application contributed to pathophysiology in ophthalmology.

Intraindividual comparison of surgical trauma after bimanual microincision and conventional small-incision coaxial phacoemulsification

PURPOSE

To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs).

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

METHODS

A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed.

RESULTS

There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08)

CONCLUSIONS

Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.