Phacoemulsification in review: Optimization of cataract removal in an in vitro setting

Boulter, Tyler D.; Bernhisel, Ashlie; Mamalis, Christina; Zaugg, Brian; Barlow, William R.; Olson, Randall J.; Pettey, Jeff H.

doi:10.1016/j.survophthal.2019.06.007

Cited by 19 publications

(14 citation statements)

References 36 publications

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“…It is also important to note that the decrease in incidence over time throughout this study may be due to improvements in phacoemulsification technologies and more efficient phacodynamics. 13 Three out of five surgeons used the Divide-and-Conquer phacoemulsification technique while two out of five used the Horizontal Chop, with no statistically significant difference between the two techniques (p = 0.71). These findings suggest that while some patient-specific biometric characteristics have proven to be significant risk factors, surgeon-specific operative habits (not including phacoemulsification technique) may also be associated with retained lens fragments in the anterior chamber.…”

Section: Discussionmentioning

confidence: 88%

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Moshirfar¹,

Lewis²,

Ellis³

et al. 2021

OPTH

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Introduction Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments. Methods Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group. Results Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years ±6.72 (60–80) compared to 63 ±11.41 (22–86) in the control group (p <0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg ±2.59, 19 mmHg ±8.20, and 11 mmHg ±2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm ±0.37 vs 3.33 mm ±0.39, p = 0.01) and lens thickness (4.77 mm ±0.44 vs 4.35 mm ±0.44, p = <0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 ±40 (1–138). Conclusion Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.

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Section: Discussionmentioning

confidence: 88%

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Moshirfar¹,

Lewis²,

Ellis³

et al. 2021

OPTH

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“…Phacoemulsification devices and technologies have been developing every day. [12][13][14][15][16] Active Sentry handpiece, one of the innovations of the Centurion Vision System, functions with the active fluidics system and carries an integrated sensor. This system has many advantages.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety profile of cataract procedures performed with a sensor-embedded handpiece and a new hybrid phaco tip

Sabur

Ünsal

2022

European Journal of Ophthalmology

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Objective To evaluate the efficacy and safety of the new Intrepid Hybrid tip and Active Sentry handpiece in comparison to the Intrepid Balanced tip and Centurion Ozil handpiece. Methods One hundred sixty-eight eyes were included in the study and randomized into Group 1 (Active Sentry handpiece + Intrepid Hybrid tip, n = 86) and Group 2 (Centurion Ozil handpiece + Intrepid Balanced tip, n = 82). Data were collected from the phaco device, including total U/S time, cumulative dissipated energy (CDE), the total number of active surge mitigation actuations (ASM actuations), torsional amplitude, torsional amplitude on time, estimated fluid of aspirated, and aspiration time. Endothelial cell count (ECC) and central corneal thickness (CCT) were assessed. A correlation analysis was performed between ASM actuations, phaco metrics, and patient characteristics in Group 1. Results The CDE, torsional amplitude measured in Group 1 (8.8 ± 3.9, 51.2 ± 13.3, respectively) were significantly lower than those of Group 2 (10.4 ± 4.2, 65.2 ± 9.3, respectively). While no complications were observed in group 1, there were posterior capsule rupture in 2 eyes and iris damage in 1 eye in group 2. The mean ECC and CCT were similar at 1 month. The ASM actuations were more engaged in the eyes with pseudoexfoliation and small pupils. Conclusion The combination of the new Intrepid Hybrid tip and Active Sentry handpiece enables safer cataract procedures without compromising efficacy due to its surge prevention mechanisms and special tip design. It could be a good option for residents in training.

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“…[ 26 27 ] Other factors that may contribute to the overall reduction in the incidence of RLFs are the improvements in phacoemulsification technologies and more efficient phacodynamics over time. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study

et al. 2022

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Phacoemulsification in review: Optimization of cataract removal in an in vitro setting

Cited by 19 publications

References 36 publications

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

The efficacy and safety profile of cataract procedures performed with a sensor-embedded handpiece and a new hybrid phaco tip

Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study

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