Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations

Foster, Gary; Allen, Quentin B.; Ayres, Brandon D.; Devgan, Uday; Hoffman, Richard S.; Khandelwal, Sumitra; Snyder, Michael E.; Vasavada, Abhay R.; Yeoh, Ronald

doi:10.1016/j.jcrs.2018.03.038

Cited by 33 publications

(28 citation statements)

References 29 publications

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“…Phacoemulsification is one of the most widely used surgical procedures for removal of cataract 9,10 . The corneal endothelium is known to undergo damage during phacoemulsification due to incision, use of ultrasonic energy, irrigation solutions, visco-elastics, etc 11 . Precise measurements of corneal thickness may therefore serve as a parameter for assessing overall endothelial function.…”

Section: Introductionmentioning

confidence: 99%

Change in Central corneal thickness after Phacoemulsification

Wali¹,

Surhio²,

Talpur³

et al. 2020

pak J Ophthalmol

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Purpose: To determine changes in central corneal thickness after phacoemulsification at first post-operative day, one week and one month. Study Design: Descriptive Observational study. Place and Duration of Study: Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad. From June 2018 to March 2019. Material and Methods: Ninety-two patients with ages between 35 and 72 years presenting with senile and pre-senile cataract were selected by non-probability convenience sampling. Patients with previous ocular surgery, ocular trauma, Glaucoma, Uveitis, Contact lens wear and long-term use of ocular medication were excluded. The patients were subdivided into three groups depending on variability in their corneal thickness. Patients with preoperative central corneal thickness (CCT) from 480 to 529µm were placed in group 1 (Thin), group 2 included patients with CCT ranging between 530 and 569µm (Moderate), patients with CCT from 570-640µm were placed in group 3 (Thick). Preoperative CCT was measured before extraction of cataract via phacoemulsification and then repeated on first post-operative day and then on one week and one month. Results: Preoperative mean central corneal thickness increased by 10.2% on first post-operative day. It reduced to 3.1% on seventh post-operative day. It further reduced to 0.7% on 30th post-operative day. Central corneal thickness reduced to mean value of 548.8µm on 30th post-operative day, which was statistically non-significant as compared with preoperative mean value (544.96µm). Conclusion: There was no statistically significant change in CCT one month after phacoemulsification when compared with the pre-operative CCT.

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Section: Introductionmentioning

confidence: 99%

Change in Central corneal thickness after Phacoemulsification

Wali¹,

Surhio²,

Talpur³

et al. 2020

pak J Ophthalmol

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“…Phacoemulsification surgery in rock hard cataracts is associated with high propensity to corneal endothelial cell damage because of prolonged phaco time, high phaco energy, and mechanical contact by hard nuclear fragments. 1,21 Surgeons employ various ultrasound power delivery modulations, innovative phaco tips, use deeper plane phacoemulsification of nuclear fragments and coat corneal endothelium with viscodispersive OVDs to protect corneal endothelium. 6,[8][9][10][11]14,18,21 However, the rigid and irregular nuclear fragments do not mold well at the phaco tip leading to a much greater chatter and poor followability.…”

Section: Discussionmentioning

confidence: 99%

“…High ultrasound energy and prolonged phacoemulsification time are often associated with predisposition to posterior capsule rupture and increased corneal endothelial trauma. 1 Corneal endothelial cell loss can also occur due to mechanical trauma caused by the rebounding of nuclear fragments, air bubbles, irrigating solution turbulence, instrumentation, and IOL contact. 2,3 Various modalities used to minimize ultrasound energy and reduce damage to surrounding ocular structures during phacoemulsification include direct phaco chop, crater and chop, power modulations in the form of torsional, variable pulse and burst modes, and phaco tips with decreased amplitude near the incision.…”

Section: Introductionmentioning

confidence: 99%

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

Parkash¹,

Parkash²,

Mahajan³

et al. 2021

OPTH

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Purpose: To describe an innovative technique of using a chopper as a shield for preventing mechanical corneal endothelial trauma that can occur during the phacoemulsification of brunescent cataracts. Methods: This prospective study included patients with hard cataracts (grade nuclear opalescence 4 and above on LOCS III) who underwent phacoemulsification surgery. The chopper shield technique was performed in 48 eyes of 44 patients. The technique entailed placing the chopper horizontally as a shield anterior to the emulsifying nuclear fragment between the phaco tip and corneal endothelium to prevent nucleus fragments from coming into contact with the corneal endothelium. Outcome measures included cumulative dissipated energy (CDE), corneal edema (day one), CCT (assessed at one day, one week, and one month), and endothelial cell density assessed at three months. Results: Of the 48 eyes included in the study, 23 were males and 25 were females (mean age: 70.02±5.98years). Preoperatively, mean central corneal thickness (CCT) was 529.62 ±21.70 microns, and endothelial cell counts were 2258.76±182.22 cells per mm 2 . Postoperatively on day one, CCT increased to 563.93±24.53 microns, a 6.47% increase from preoperative central corneal thickness. CCT became 534.83±22.64 microns on postoperative day seven, a 0.98% increase from preoperative CCT. Endothelial cell loss was 6.77% at three months from the day of surgery. Conclusion:The chopper shield technique offers continuous protection to the corneal endothelium by minimizing endothelial cell loss during phacoemulsification of dense nuclear cataracts.

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“…Though there is new evidence supporting phacoemulsification can be performed successfully at any stage of nucleo-sclerosis, even on hard rock nuclei, [29] the surgical experience matters and it would be advisable to avoid hard nucleus for young surgeons.…”

Section: Discussionmentioning

confidence: 99%

Do Africans really need to go overseas for Phaco training? Performance audit of a locally trained phaco surgeon in rural Kenya

Niyonzima¹,

Gichuhi

Sitati

et al. 2019

Preprint

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Purpose: To audit phacoemulsification cataract surgeries performed independently after a short - term training completed in a rural hospital in Kenya, and to benchmark the outcomes against WHO recommendations. Methods: This retrospective case-series study recruited patients who had had phacoemulsification cataract surgery at Sabatia Eye Hospital from January to December 2018. All the surgeries were performed by a single surgeon following a brief training in the same center. Data were collected retrospectively using a detailed questionnaire. Results: Of the one hundred and twenty eyes operated on during this period, one-hundred and sixteen eyes of 86 patients met the inclusion criteria. The mean age was 62 years and the majority of the eyes (83.6%) had vision less than 6/18 preoperatively. Co-morbidities included diabetic retinopathy (3.4%), age-related macular degeneration (2.6%), trauma (1.7%) and glaucoma (0.9%). Surgical complications were not severe enough to affect the final best-corrected visual acuity, unlike the comorbidities that were negatively correlated with visual outcomes (p-value< 0.001). Good outcomes were 81% against a WHO target of 80% for uncorrected visual acuity category, and 96.6% in the best-corrected visual acuity category against a target of 90%. The Royal College of Ophthalmology database of cataract surgery outcomes and the European Registry of Quality Outcomes for cataract and refractive surgery had comparable results. Conclusions: This local training model was based on apprenticeship and skills transfer. It can achieve high-quality visual outcomes meeting WHO recommendations.

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Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations

Cited by 33 publications

References 29 publications

Change in Central corneal thickness after Phacoemulsification

Change in Central corneal thickness after Phacoemulsification

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

Do Africans really need to go overseas for Phaco training? Performance audit of a locally trained phaco surgeon in rural Kenya

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