Development, advantages, and methods of the continuous circular capsulorhexis technique

Gimbel, Howard V.; Neuhann, Thomas

doi:10.1016/s0886-3350(13)80870-x

Cited by 502 publications

(142 citation statements)

References 2 publications

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“…However, an incomplete capsulorhexis undoubtedly increases significantly the risk of posterior capsule rupture and its associated sequelae. 1 Of concern, in all six cases the attending surgical and anaesthetic teams were uncertain of the cause of the ocular deviation. A retrospective review of the anaesthetic charts revealed that all six patients had undergone GA with spontaneous respiration techniques without effective NDMR.…”

Section: Introductionmentioning

confidence: 96%

Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Rossiter

Wood

Lockwood

et al. 2005

Eye

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Purpose To describe and examine the observation that eccentric eye positions may develop under certain general anaesthetic conditions and negatively impact upon operating conditions during ocular surgery. Methods A case series description with historical review followed by a 2-week prospective observational survey examining the general anaesthetic techniques utilized during ocular surgery and the associated development of an eccentric eye position. Results A total of 52 cases were studied, of which four developed eccentric eye positions. 50% of patients received effective muscle relaxation. Without muscle relaxants, the incidence of eccentric eye positioning was 18%. Conclusions Eccentric ocular positions are likely to occur in light planes of general anaesthesia. In the case of ocular surgery, this phenomenon may create surgical difficulty and increase the risk of complication and patient morbidity. Arguments for the planned use of balanced general anaesthesia with non-depolarizing muscle relaxants are presented.

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Section: Introductionmentioning

confidence: 96%

Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Rossiter

Wood

Lockwood

et al. 2005

Eye

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“…An intact complete CCC is critical to minimize the risk of capsular tear and to ensure stable in-the-bag intraocular lens (IOL) implantation. 1 Various dyes include fluorescein, 2-4 indocyanine green, 2,5-8 and trypan blue, 2,9-16 have been used for capsular staining to facilitate CCC. Different staining techniques, including subcapsular injection, staining under an air bubble, and staining under viscoelastic material, have been attempted.…”

Section: Introductionmentioning

confidence: 99%

A prospective study on trypan blue capsule staining under air vs under viscoelastic

Wong

Lai

Lee

et al. 2005

Eye

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Aim To compare the safety and effectiveness of trypan blue capsule staining under air vs under viscoelastic. Methods A total of 52 consecutive patients planned for phacoemulsification of white mature cataract were randomly assigned to trypan blue staining under air or under viscoelastic. Perioperative changes in bestcorrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were compared between the two groups. The differences in operating and phacoemulsification times, staining pattern, and complications between the two groups were also recorded. Results Phacoemulsification of white mature cataract was performed in 50 (96%) eyes. The median preoperative BCVA was hand movement. No significant differences in the baseline characteristics were found between the two groups. At 3 months after phacoemulsification, the median BCVA improved to 0.8. The mean CCT returned to preoperative level by 1 month postoperatively and the mean ECD loss was 11.9% 3 months postoperatively. No significant differences in median BCVA, mean phacoemulsification and operation times, mean CCT, and mean ECD were found between the two groups. Conclusions Trypan blue staining of the anterior lens capsule under air or under viscoelastic were similarly effective and safe methods for the phacoemulsification of white mature cataract.

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“…Successful completion of this step is associated with low complication rates and good surgical outcomes. 2 This has been attributed to the inherent strength and elasticity of the continuous curvilinear capsulorrhexis. 2 Recently, staining of the anterior capsule for difficult capsulorrhexis because of poor visibility from inadequate retro-illuminated red reflexes has become popular with cataract surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…1 The absence of an adequate red reflex makes it difficult to perform continuous curvilinear capsulorrhexis with certainty. 2 Retroillumination created by coaxial light from the operating microscope is reduced in the presence of a dense cataract and in heavily pigmented fundi. Various methods to overcome this problem have been described and recently dye staining of the anterior capsule has been employed.…”

Section: Introductionmentioning

confidence: 99%

A histological analysis of lens capsules stained with trypan blue for capsulorrhexis in phacoemulsification cataract surgery

Singh

Sarodia

Brown

et al. 2003

Eye

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Purpose Staining of anterior lens capsules with dye to facilitate completion of continuous curvilinear capsulorrhexis is now being used more frequently in phacoemulsification of white and mature cataracts with poor red reflexes. This study examined the histological characteristics of anterior lens capsules stained with trypan blue. The layer(s) of the lens capsule that stained with dye and the extent of accumulation of dye in these layers of the lens capsule were determined. To the best of our knowledge this has not been described before. Methods A series of 10 stained lens capsules were analysed histologically. The dye used in this study consisted of a standard sterile, noninflammatory, nonpyrogenic, 2 ml solution containing 0.6 mg/ml of trypan blue. Following capsulorrhexis, samples were sent to the laboratory for histological analysis. Frozen sections (8 lm) were prepared and examined with the light microscope. All 10 capsules were cut by frozen section to preserve trypan blue staining (which would be leached by processing) and then subjected to immunohistochemistry for collagen IV. Immunohistochemical analysis using markers for type IV collagen were done on formalinfixed specimens for morphological comparison with the frozen sections. A counterstain highlighted the epithelium. Results Continuous curvilinear capsulorrhexis was successfully and easily completed in all cases without any complications. Frozen section analysis using light microscopy demonstrated accumulation of trypan blue dye in the basement membrane of the lens capsule. Staining was concentrated in the portion of the membrane adjacent to the lens epithelium. The lens epithelium could not be clearly identified on the frozen sections. Consequently, immunohistochemical analysis with markers for type IV collagen was performed. A counterstain highlighted the epithelium. This confirmed that the layer staining with trypan blue was the basement membrane, a consistent feature on all the specimens. Conclusions Trypan blue selectively stains the basement membrane of the anterior lens capsule. There is a concentration of dye in the basement membrane adjacent to the lens epithelial cell layer. The lens cortex does not appear clinically to stain with trypan blue. This enables surgeons to distinguish the lens capsule from the cortex and provides sufficient contrast for successful completion of continuous curvilinear capsulorrhexis during cataract surgery.

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Development, advantages, and methods of the continuous circular capsulorhexis technique

Cited by 502 publications

References 2 publications

Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

A prospective study on trypan blue capsule staining under air vs under viscoelastic

A histological analysis of lens capsules stained with trypan blue for capsulorrhexis in phacoemulsification cataract surgery

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