Endothelial Cell Loss Following "Modern" Phacoemulsification by a Senior Resident

Kreisler, Kenneth R.; Mortenson, Steve W; Mamalis, Nick

doi:10.3928/1542-8877-19920301-04

Cited by 15 publications

(5 citation statements)

References 8 publications

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“…Most of the human literature focuses on ocular surface damage and reduced corneal clarity, rather than postoperative sequelae such as glaucoma. Specifically, lower CDE correlates with less corneal endothelial cell damage [9][10][11][12][13][14][15][16][17][18] and less thermal wound injury 19 which were not directly evaluated in this study. To the authors' knowledge, this is the first study on the effect of CDE on canine cataract surgery outcomes.…”

Section: Discussionmentioning

confidence: 93%

“…All eyes also underwent preoperative slit lamp biomicroscopy, 2 indirect ophthalmoscopy 3 if not completely obscured by cataract, ocular ultrasonography 4 and sedated, dark-adapted, electroretinography. 5 The preoperative ophthalmic medication regimen initiated 2 h prior to surgery included as follows: ofloxacin 0.3% ophthalmic solution 6 (4 total drops), diclofenac 0.1% ophthalmic solution 7 or ketorolac 0.5% ophthalmic solution 8 (4 total drops), prednisolone acetate 1% ophthalmic suspension 9 (4 total drops), atropine 1% ophthalmic solution 10 (4 total drops), and phenylephrine 2.5% ophthalmic solution 11 (2 total drops). Ophthalmic medications in the series were administered 1 drop at a time, 5 min apart, at 30-min intervals.…”

Section: Methodsmentioning

confidence: 99%

“…Using less energy has been shown in human studies to decrease corneal endothelial cell loss and may translate to better surgical outcomes. [9][10][11][12][13][14] The purpose of this study was to evaluate the overall success and complication rates of canine cataract surgery and the effect of the intraoperative variable, CDE.…”

Section: Introductionmentioning

confidence: 99%

“…The CDE units are recorded as percent‐seconds. Using less energy has been shown in human studies to decrease corneal endothelial cell loss and may translate to better surgical outcomes 9–14 …”

Section: Introductionmentioning

confidence: 99%

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Retrospective evaluation of phacoemulsification and aspiration in 182 eyes: Visual outcomes and CDE‐predictive value

Edelmann

Mohammed

Ledbetter

2022

Veterinary Ophthalmology

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Objective To determine the effect of cumulative dissipated energy (CDE) on complications and visual outcome following cataract surgery in dogs. Animals studied Records of 182 canine eyes that had undergone cataract surgery. Procedures Retrospective medical record review was conducted on dogs that underwent unilateral or bilateral elective cataract surgery by a single surgeon. Preoperative variables such as age, cataract duration, and pre‐existing conditions were recorded. Intraoperative variables such as intraocular lens (IOL) status, phacoemulsification time, average power, irrigation fluid volume, and CDE were recorded. Postoperative complications and visual status at last follow‐up were compared to these variables. Results Eighty‐six percent of dogs were visual in one or both eyes at last follow‐up (LFU) examination. Median follow‐up time was 186 days postoperatively. Eyes that developed glaucoma had a significantly greater mean CDE (77.73 ± 80.11) than eyes that did not develop glaucoma (49.21 ± 38.93). Eyes that remained visual at the LFU examination had a significantly lower mean CDE (48.31 ± 37.14) than eyes that were blind at LFU (82.05 ± 82.73). Significantly lower mean CDEs were found in diabetic eyes, younger eyes, early‐operated eyes (<1 month duration), and eyes with preoperative lens‐induced uveitis. Conclusions Higher CDE may be associated with an increased risk of postoperative glaucoma and loss of vision in dogs. Cumulative dissipated energy may be a useful prognostic indicator for success of canine cataract surgery.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Retrospective evaluation of phacoemulsification and aspiration in 182 eyes: Visual outcomes and CDE‐predictive value

Edelmann

Mohammed

Ledbetter

2022

Veterinary Ophthalmology

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“…[23][24][25][26][27][28] Extended phacoemulsification time and higher delivered ultrasound power may contribute to corneal endothelial cell damage. 18,[29][30][31][32][33] Thus, endothelial damage depends on several factors, including surgeon's experience and ability, incision type, ophthalmic viscosurgical device (quality and quantity), intraocular lens type, irrigation solution composition, total phaco energy, and location of active phacoemulsification. 25 We conducted a systematic review and meta-analysis of 8 studies and 837 patients to compare the effectiveness and safety of divide and conquer versus phaco chop for cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Phaco-Chop versus Divide-and-Conquer in Patients Who Underwent Cataract Surgery: A Systematic Review and Meta-Analysis

Guedes,

Pereira,

Amaral

et al. 2024

OPTH

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Background: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer. Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I 2 statistics. A random-effects model was used for outcomes with high heterogeneity. Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] −221.67 Cell/mm 2 ; 95% Confidence Interval [CI] −401.68 to −41.66; p < 0.02; I2=73%); a shorter UST (MD −51.16 sec; 95% CI −99.4 to −2.79; p = 0.04; I2=98%); reduced CDE (MD −8.68 units; 95% CI −12.76 to −4.60; p < 0.01; I2=84%); a lower PT (MD −55.09 sec; 95% CI −99.29 to −12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD −3.86 min; 95% CI −9.55 to 1.83; p = 0.18; I2=99%). Conclusion:The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.

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The Effect of Phacoemulsification Energy on the Redox State of Cultured Human Corneal Endothelial Cells

et al. 2009

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To evaluate the effects of phacoemulsification energy on the redox state and mitochondrial distribution of cultured human endothelial cells. Methods: Human corneal endothelial cells from fresh banked human donor tissue not suitable for transplantation were harvested and cultured. Cellular autofluorescence images were obtained using an inverted microscope. The redox fluorometric ratio, which can be related to oxidative stress, was calculated as the net value of fluorescence from the 4,6-diamidino-2-phenylindole channel divided by the net value of fluorescence from the fluorescein isothiocyanate-conjugated channel after subtraction of background. For determining the mitochondrial distribution patterns, the cell area was divided by drawing a line halfway between the nuclear and cell membranes. The average fluorescence in the central area was divided by the average fluorescence in the peripheral area. This ratio was compared. Results: Human corneal endothelial cells exposed to increasing phacoemulsification times and increasing ultrasonic energy levels displayed dose-dependent decreases in measured redox ratios. Lower redox ratios in response to phacoemulsification did not associate with decreases in cell size or altered patterns of mitochondrial localization. Conclusion: Redox fluorometry may serve as a useful indicator for the in vitro study of human corneal endothelial cell physiological response to ultrasonic stressors and potentially other nonoxidative stressors. Clinical Relevance: Redox fluorometry in combination with human corneal endothelial cell morphometric measurements has potential to serve as an indicator of human corneal endothelial cell injury resulting secondary to ultrasound phacoemulsification.

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Endothelial Cell Loss Following "Modern" Phacoemulsification by a Senior Resident

Cited by 15 publications

References 8 publications

Retrospective evaluation of phacoemulsification and aspiration in 182 eyes: Visual outcomes and CDE‐predictive value

Retrospective evaluation of phacoemulsification and aspiration in 182 eyes: Visual outcomes and CDE‐predictive value

Phaco-Chop versus Divide-and-Conquer in Patients Who Underwent Cataract Surgery: A Systematic Review and Meta-Analysis

The Effect of Phacoemulsification Energy on the Redox State of Cultured Human Corneal Endothelial Cells

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