Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial.

PURPOSE: To compare the impact of varying fluidic parameters on intraoperative intraocular pressure (IOP) fluctuations and postoperative outcomes. METHODS: Prospective randomized study of 80 eyes undergoing cataract surgery that were randomly assigned to low (aspiration flow rate: 20 cc/min; bottle height: 90 cm; vacuum: 400 mm Hg) and high (aspiration flow rate: 40 cc/min; bottle height: 110 cm; vacuum: 400 mm Hg) fluidic parameter groups. Real-time dynamic intraoperative IOP was measured during nuclear fragment removal. Mean maximum and minimum IOP and percentage reduction in IOP from maximum were compared between groups. Postoperatively, the rate of change in central corneal thickness and anterior chamber inflammation at days 1 and 7, endothelial cell density at 3 months, and corneal clarity on day 1 were compared. RESULTS: Minimum IOP in the low and high parameters groups was 35 ± 4.0 and 34.5 ± 6.8 mm Hg, respectively. Maximum IOP in the low and high parameters groups was 69 ± 3.0 and 85 ± 1.2 mm Hg, respectively (P < .002). Mean percent reduction from maximum was 59% in the high parameters group compared to 41% in the low parameters group, with the difference being statistically significant (P < .002). Rate of change in central corneal thickness was greater in the high parameters group at postoperative days 1 and 7 (P < .001). Anterior chamber inflammation and corneal clarity on the first postoperative day were significantly better in the low parameters group. CONCLUSIONS: Higher aspiration flow rate and bottle heights are associated with high intraoperative IOPs of up to 85 mm Hg. Prolonged elevated IOP during cataract surgery was found to have more anterior segment inflammation and more edematous corneas.

Incidence, management, and postoperative outcomes in pediatric eyes with coexisting posterior capsule plaque and cataract.

PURPOSE: To determine the incidence and evaluate the management and postoperative outcomes of posterior capsule plaque in pediatric eyes with cataract. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Cohort study. METHODS: This study evaluated consecutive eyes of children aged 1 month to 15 years having cataract surgery. In cases of posterior capsule plaque, plaque peeling (smaller plaque) or posterior vitrectorhexis (larger plaque) was performed. Intraocular lenses (IOLs) were implanted in all except microphthalmic eyes. The postoperative observations included visual axis obscuration and IOL decentration. RESULTS: Posterior capsule plaque was observed in 90 (13.4%) of 670 eyes (63 [13.2%] of 475 children). Of eyes with posterior capsule plaque, 70 had total white mature cataract and 20 had posterior subcapsular cataract. Plaque peeling was performed in 41 eyes (45.5%) and partial excision of the plaque with a vitrectome in 49 eyes (54.4%). The mean follow-up was 24.03 months ± 2.68 (SD). Of the 60 eyes that had an IOL, 54 (90%) had in-the-bag implantation and 6 (10%) had ciliary sulcus implantation. Postoperatively, there was no IOL decentration. Visual axis obscuration developed in 6 eyes (6.7%). CONCLUSIONS: Posterior capsule plaque was frequently observed in pediatric cataractous eyes, especially in eyes with total cataract. After plaque peeling or plaque removal with a vitrectome, the IOL was stable in the capsular bag and the visual axis was clear.

Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: randomized clinical trial.

PURPOSE: To compare the effects of fluidic parameters on the central corneal thickness (CCT), corneal endothelium, and anterior segment inflammation after phacoemulsification with longitudinal ultrasound. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: In this prospective randomized patient- and examiner-masked study, consecutive patients with age-related cataract were randomly assigned to Group 1 (low fluidic parameters: aspiration flow rate 25 cc/min; bottle height 70 cm and 90 cm; vacuum

Software-based assessment of postoperative rotation of toric intraocular lens.

A specially designed grid and software used to assess the postoperative rotation of a toric intraocular lens (IOL) are described. Postoperatively, a digital retroillumination image of the patient is taken and this image is superimposed on the grid. The software determines the center of the IOL. A prominent episcleral vessel is identified, and the axis of the toric IOL and the episcleral vessel are documented using the grid. These values act as references for aligning the images taken during the follow-up period.

Anterior dislocation of a sulcus fixated posterior chamber intraocular lens in a high myope.

A 31-year-old man with high axial myopia and strabismus fixus convergens underwent bilateral refractive lens exchange followed by a squint surgery (bilateral superior partial Jensen's procedure and medial rectus recession). After one year he presented with traumatic anterior dislocation of the sulcus fixated posterior chamber polymethyl methacrylate lens. The lens was dialed back into the ciliary sulcus without any complications. This case highlights the importance of implanting an intraocular lens (IOL) in-the-bag. If the IOL needs to be implanted in the sulcus, a larger diameter of the IOL with larger optic size and overall length is desirable, especially in highly myopic eyes.