Endothelial protection: Avoiding air bubble formation at the phacoemulsification tip

Kim, Eung Kweon; Cristol, Stephen M.; Kang, Shin J.; Edelhauser, Henry F.; Yeon, Dong Soo; Lee, Jae Bum

doi:10.1016/s0886-3350(01)01155-5

Cited by 12 publications

(8 citation statements)

References 6 publications

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“…Intraoperative factors known to cause corneal endothelial damage include an excessive amount of ultrasound energy, 4,5 a localized rise in temperature, [6][7][8] air bubbles, 9,10 or collision of lens nucleus fragments with the corneal endothelium. 11 Another harmful factor that can damage the corneal endothelium during phacoemulsification is oxidative stress, which is due to the generation of free radicals.…”

mentioning

confidence: 99%

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial

Igarashi

Ohsawa

Kobayashi

et al. 2019

American Journal of Ophthalmology

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PURPOSE: Hydrogen (H 2 ) has been reported to scavenge free radicals, particularly the hydroxyl radical ($OH). Ultrasound oscillation in an aqueous solution produces $OH. Our recent study demonstrated that H 2 dissolved in an irrigation solution prevented corneal endothelial damage during phacoemulsification in an animal model. We examined the effects of H 2 during clinical phacoemulsification.DESIGN: A single-center, prospective, randomized, double-masked clinical trial.METHODS: Thirty-two patients who had cataracts of similar nucleus hardness in both eyes (age: 75.4±7.68 years; 17 males, 15 females) were recruited. Phacoemulsification was performed using a solution of dissolved H 2 in one eye, and a conventional solution in the contralateral eye. Endothelial cell density (ECD) at the center of the cornea was measured using noncontact specular microscopy preoperatively and at 1 day, 1 week, and 3 weeks postoperatively.RESULTS: Reduction rates of ECD (mean ± standard deviation) were 16.0%±15.7% at 1 day, 15.4%±16.1% at 1 week, and 18.4%±14.9% at 3 weeks in the control group, compared to 6.5%±8.7% at 1 day (P [ .003), 9.3%±11.0% at 1 week (P [ .039), and 8.5%±10.5% at 3 weeks (P [ .004) in the H 2 groups. These rates were significantly smaller in the H 2 group at all time points.CONCLUSIONS: H 2 dissolved in irrigation solution reduced corneal endothelial damage during phacoemulsification. This suggests that a considerable part of the corneal endothelial damage during phacoemulsification is caused by oxidative stress, and that H 2 is useful in clinical phacoemulsification.

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confidence: 99%

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial

Igarashi

Ohsawa

Kobayashi

et al. 2019

American Journal of Ophthalmology

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“…Corneal endothelium maintains hydration of the corneal tissues by acting as a barrier and a draining pump against the aqueous humor; thus, decreases in endothelial cell density can induce irreversible corneal edema (bullous keratopathy; BK), in turn causing permanently blurred vision and pain. With an excessive amount of US energy 1 2 , collision of lens nucleus fragments with the corneal endothelium 3 , air bubbles 4 5 , or a localized temperature rise 6 7 8 have been reported and are well known as factors damaging to the corneal endothelium. The development of free radicals has also been identified as a harmful factor associated with the use of US.…”

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confidence: 99%

Hydrogen prevents corneal endothelial damage in phacoemulsification cataract surgery

Igarashi

Ohsawa

Kobayashi

et al. 2016

Sci Rep

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In phacoemulsification, ultrasound induces hydroxyl radical (·OH) formation, damaging corneal endothelium. Whether H2 can prevent such oxidative damage in phacoemulsification was examined by in vitro and in vivo studies. H2 was dissolved in a commercial irrigating solution. The effects of H2 against ·OH generation were first confirmed in vitro by electron-spin resonance (ESR) and hydroxyphenyl fluorescein (HPF). ESR showed a significantly decreased signal magnitude, and fluorescence intensity by oxidized HPF was significantly less in the H2-dissolved solution. The effects of H2 in phacoemulsification were evaluated in rabbits, comparing H2-dissolved and control solutions. Five hours after the procedure, the whole cornea was excised and subjected to image analysis for corneal edema, real-time semiquantitative PCR (qPCR) for heme oxygenase (HO)-1, catalase (CAT), superoxide dismutase 1 (SOD1), and SOD2 mRNA, and immunohistochemistry. Corneal edema was significantly less and the increases in anti-oxidative HO-1, CAT and SOD2 mRNA expressions were significantly suppressed in the H2 group. In addition, corneal endothelial cell expressions of two oxidative stress markers, 4-HNE and 8-OHdG, were significantly lower in the H2 group. In conclusion, H2 dissolved in the ocular irrigating solution protected corneal endothelial cells from phacoemulsification-induced oxidative stress and damage.

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“…8 Another factor that can increase intraoperative endothelial damage is air bubble formation at the phaco tip during cataract removal, which more likely occurs when high power settings are being used. 10,11 Small-incision phacoemulsification allows the surgeon to reduce intraoperative parameters such as ultrasound power and vacuum because the anterior chamber remains more stable and hermetic as the access incisions are smaller.…”

Section: Discussionmentioning

confidence: 99%

Corneal Endothelium Evaluation After Phacoemulsification With Continuous Anterior Chamber Infusion

Millá

Vergés²,

Cipres³

2005

Cornea

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: The trend in modern cataract surgery is to reduce postoperative ocular trauma, and this can be achieved by small-incision phacoemulsification. But it requires a learning curve that we believe can be softened by using some surgical maneuvers such as continuous anterior chamber infusion, which minimizes the risk for anterior chamber collapse during the intervention. Comparing postoperative pachymetry and EC density between group 1 and 2, we found that the use of CACI does not add any additional damage to corneal structures because the initial statistically significant EC loss at day 7 postoperatively has a prompt recovery in subsequent visits, and then the EC loss remains similar in both groups. Transition from conventional to bimanual phacoemulsification can be simplified by using CACI, and it does not increase postoperative corneal damage.

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Endothelial protection: Avoiding air bubble formation at the phacoemulsification tip

Cited by 12 publications

References 6 publications

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial

Effects of Hydrogen in Prevention of Corneal Endothelial Damage During Phacoemulsification: A Prospective Randomized Clinical Trial

Hydrogen prevents corneal endothelial damage in phacoemulsification cataract surgery

Corneal Endothelium Evaluation After Phacoemulsification With Continuous Anterior Chamber Infusion

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