Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges

Abstract

Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann–Whitney U test, Pearson’s Chi-square test, and Fisher’s exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.

Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy

“…1, see Additional le 1, which demonstrated the phaco-chop with illuminated chopper). [16][17][18][19][20] Cataract surgery in phacovitrectomy was performed after 25 gauge 3-port trocar cannula insertion. In cases of increased posterior pressure due to retrobulbar anesthesia, minimal core vitrectomy was performed before cataract surgery.…”

Mechanical pupil dilation, posterior capsule rupture, and cystoid macular oedema in illuminated chopper-assisted cataract surgery

“…1, see Videos, Additional le 1 and 2, which demonstrates the phaco chop with illuminated chopper). [17,18] Sub-Tenon anaesthesia was administered using 0.5-1.0 mL of lidocaine 2.0%. Neither intracameral epinephrine nor lidocaine was administered.…”

“…However, in cataract surgery involving iris challenges, the use of the illuminated chopper could improve surgical eld visibility and reduce the requirement for additional use of a pupil expansion device. [13,17] (2) Creating a capsulorhexis is di cult in eyes without a su cient red re ex. Thus, few staining methods have been used to visualize the anterior capsule.…”

“…Using the illuminated chopper could reduce the use of pupil expansion devices, iris manipulation, operation time, and eventually CME. [5,6,17] This study was limited by its single-surgeon retrospective design, which may have resulted in bias in the outcome analyses. Further prospective studies should be conducted regarding the advantages associated with the illuminated chopper compared to those of the conventional tool.…”

“…1). [17,18] It is a blunt chopper that is ideal for horizontal but not for vertical chopping. In this large sample-based cohort of cataract surgeries using an illuminated chopper, we evaluated the use of mechanical pupil dilation or capsule staining, operative time, complications, and visual outcomes.…”