Temperature in the anterior chamber during phacoemulsification

Suzuki, Hajime; Oki, Kotaro; Igarashi, Tsutomu; Shiwa, Toshihiko; Takahashi, Hiroshi

doi:10.1016/j.jcrs.2013.08.063

Cited by 18 publications

(11 citation statements)

References 12 publications

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“…DMEK) or even penetrating keratoplasty (Dick et al 1996;D ıaz-Valle et al 1998;Walkow et al 2000;Morikubo et al 2004;Storr-Paulsen et al 2008;Gonen et al 2012;Keenan et al 2012;Shimazaki et al 2014). Numerous studies investigated factors with an impact on the corneal endothelium during cataract surgery, such as ultrasound time and energy, temperature increase, nuclear fragments colliding with the corneal endothelium, firmness of the lens, turbulent flow during irrigation, fluctuating or increased intraocular pressure due to the bottle height of the irrigation solution, surgical instruments and techniques, as well as the formation of free radicals and the use of ophthalmic viscoelastic devices (OVDs) (Svensson & Mellerio 1994;Dick et al 1996;Hayashi et al 1996;Pirazzoli et al 1996;Cameron et al 2001;Miyata et al 2002;Takahashi et al 2002Takahashi et al , 2006Bourne et al 2004;Storr-Paulsen et al 2007Murano et al 2008;Suzuki et al 2009Suzuki et al , 2014Suzuki et al , 2016Ho & Afshari 2015).…”

Section: Introductionmentioning

confidence: 99%

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Kunzmann

Wenzel

Bartz‐Schmidt

et al. 2019

Acta Ophthalmologica

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Purpose The purpose of this study was to establish a standardized in vitro phacoemulsification damage model for future investigations of the effects of phacoemulsification, surgical devices, protective ophthalmic viscoelastic devices (OVDs), irrigation solutions and other aspects related to cataract phacoemulsification surgery on the corneal endothelium using porcine eyes. Methods Thirty‐four porcine eyes were randomly assigned to three groups (phacoemulsification (n = 13), irrigation (n = 9), control (n = 12)). A total of 5 min of ultrasound energy with intermittent irrigation/aspiration was applied in the eyes of the phacoemulsification group. The eyes of the irrigation group received the identical treatment, but without the application of ultrasound energy. The control group was left untreated. All eyes were then prepared to split corneal buttons followed by 15 days of cultivation. Endothelial cell density (ECD) was assessed blinded on day 15. Results Endothelial cell density declined significantly more until day 15 in the phacoemulsification group (2567 ± 317/267 cells/mm² (median ± 25%/75%‐quartiles), −32.5 ± 7.0/6.4%) compared to the irrigation (3450 ± 350/383 cells/mm², −11.8 ± 5.3/2.6%; p < 0.001) and the control group (3650 ± 288/258 cells/mm², −10.2 ± 3.2/4.6%; p < 0.001). Conclusion The phacoemulsification damage model presented in this study is sensitive to phacoemulsification energy and may reliably be used to investigate various factors involved in phacoemulsification with regard to their influence on corneal endothelial cells. This method is able to replace animal experiments or in vitro cell culture experiments that often do not translate well to the in vivo situation in humans.

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Section: Introductionmentioning

confidence: 99%

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Kunzmann

Wenzel

Bartz‐Schmidt

et al. 2019

Acta Ophthalmologica

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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.…”

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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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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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“…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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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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Temperature in the anterior chamber during phacoemulsification

Abstract: Because differences in the phacoemulsification settings can lead to temperature elevations in the anterior chamber, surgeons must carefully monitor these settings to prevent corneal tissue damage.

Cited by 18 publications

References 12 publications

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

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

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