Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial

Abstract

Background: To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. Methods: This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4°C (treatment group) or 24°C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. Results: The aqueous flare score was 0.83 ± 0.76 in the 4°C group, which was lower than that in the 24°C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4°C group (0.17 ± 0.38) than that in the 24°C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4°C group (907.66 ± 85.37 μm) was thinner than that in the 24°C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). Conclusions: Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. Trial registration: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).

Combination of cataract surgery with intravitreal injection of dexamethasone intravitreal implant (Ozurdex) for uveitis-induced cataract

“…As one of the diseases causing blindness, uveitis has hundreds of causes, but the associated etiological mechanism remains undefined, making treatment challenging; cataract is its most common complication [1] . Patients with anterior uveitis or intermediate uveitis experience repeated recurrence and longterm inflammatory response that leads to inflammatory cell infiltration to the lens capsule, affecting its permeability, with altered composition of aqueous fluids affecting lens metabolism that causes the cataract complication; meanwhile, patients with posterior uveitis develop cataract as a result of long-term intake of glucocorticoid drugs in addition to inflammatory causes [9] . The preferred surgical method for uveitis-induced cataract is phacoemulsification in conjunction with IOL implantation.…”

Expression of Superoxide Dismutase-1 (SOD-1) and changes of corneal endothelial morphology after phacoemulsification with hypothermic perfusion

“…4 Jiang et al observed the effect of hypothermia perfusion in the phacoemulsification of uveitis-associated cataracts and found that the mean percentage of hexagonality was higher in the 4 0 C group than the 24 0 C group at 7 days postoperatively but not statistically significant between the two groups. 10 Our results showed that intraocular hypothermic perfusion had no significant effect on changes in CV and hexagonality. This result does not follow our hypothesis, where the change in CV and hexagonality is lower in hypothermic conditions.…”

“…4 Jiang et al reported hypothermic perfusion in uveitisassociated cataracts could inhibit anterior segment inflammation and reduce corneal edema. 10 The present study aims to assess the effect of hypothermic perfusion on the corneal endothelium during the phacoemulsification process by evaluating SOD1 expression and morphological changes in corneal endothelial cells.…”

Corneal Edema after Cataract Surgery

“…Epithelial edema can occur if excessive local anesthetics or ultrasound vibration is used during phacoemulsification. The integrity of both the epithelial and endothelial layers is critical to keeping corneal deturgescence and a balanced stroma hydration [1,10,21,23,30,45,68,69].…”

“…Precautions must be taken during phacoemulsification to avoid corneal edema caused by trauma phacoemulsifiers, lens hardness, short anterior chamber depths, retained viscoelastic fragments of the lens, irrigating solutions and their temperature, phacoemulsification time and energy, IOL insertion, and the surgeon's expertise, which is especially important in patients with pseudoexfoliation or previous endothelial damage (guttae) [6,9,12,17,34,44,45,47,50,65,98,99].…”