Cumulative Dissipated Energy (CDE) in Three Phaco-Fragmentation Techniques for Dense Cataract Removal.

Purpose: To determine the energy expenditure in phacoemulsification surgery expressed as cumulative dissipated energy (CDE) among the divide and conquer, ultrachopper-assisted divide and conquer, and phaco-chop techniques for dense cataract removal. Patients and Methods: The clinical data were obtained from the medical charts of dense cataracts patients undergoing routine phacoemulsification employing any of three phaco-fragmentation techniques, including divide and conquer using the Kelman 0.9 mm tip, the ultrachopper tip, and the phaco-chop technique using the Kelman 0.9 mm tip. Cumulated dissipated energy (CDE), longitudinal ultrasound time (UST), and endothelial cell loss were compared among groups at the one-month postoperative. Results: Surgeries from 90 eyes were analyzed, among whom the conventional divide-and-conquer technique group included 30 patients, 32 in the ultrachopper group, and 28 in the phaco-chop technique group. The average CDE in the conventional divide and conquer group was 44.52 ± 23.00, the ultrachopper technique was 43.27 ± 23.18, and 20.11 ± 11.06 in the phaco-chop group. Phaco-fragmentation chop demonstrated significantly lower CDE than the other techniques (p= <0.0001). The phaco-chop technique showed statistically significantly lower CDE when compared to the other two groups (p=<0.0001) with 93.96 ± 39.71 seconds. There were no statistically significant differences in postoperative endothelial cell density between groups (p=0.4916). Conclusion: The use of the phaco-chop technique in hard cataract phacoemulsification represents a lower energy expenditure than divide and conquer and ultrachopper techniques; nevertheless, no differences regarding endothelial density loss were evidenced.

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant.

PURPOSE: To determine the refractive stability of patients with keratoconus and cataracts after the implantation of a toric intraocular lens. METHODS: This is a cross-sectional, retrospectivestudy. Clinical records from patients with non-progressive keratoconus and cataracts that underwent non-complicated phacoemulsification with toric IOL implantation were reviewed. Mean keratometry (Km), refractive cylinder (RC), spherical equivalent (SE), steeper keratometry (K), and axis were evaluated at the 1-month, 6-month, 12-month, and 24-month follow-up visits. RESULTS: Fifty-four eyes from 41 patients were included. Thirty-seven (68.5%) female and 17 (31.5%) male patients, with a mean age of 67.52 ± 8.22. Refractive cylinder at postoperative 30 days was -1.61 ± 1.23, 6-month -1.22 ± 0.80, 12-month -1.10 ± 0.83 and 24-month visit after surgery was -1.37 ± 0.77(p = 0.290). SE at the 30-day visit was -0.82 ± 1.90, 6-month -0.64 ± 1.23, 12-month -0.78 ± 1.91 and at 24-month postoperative visit -1.02 ± 1.87 (p = 0.210). Km value at the 1-month visit was 47.23 ± 1.95, 6-month 47.87 ± 1.61, 12-month 46.39 ± 2.52 and 24-month postoperative visit 46.92 ± 1.26 (p = 0.877). The steeper K axis in the 30-day control was 78.53 ± 30.12, 6-month 77.29± 37.68, 1-year 93.13 ± 62.42, 24-month 67.31 ± 38.49 (p = 0.632). CONCLUSIONS: Our findings suggest a low variation in the refractive outcome for patients with mild and moderate keratoconus and cataracts, without evident progression signals, a demonstrated keratoconus clinical stability. No statistically significant postoperative changes in the refractive cylinder, SE, mean K, and steeper K axis were observed, which suggests good predictability for toric IOL implant.

Endothelial cell density changes in diabetic and nondiabetic eyes undergoing phacoemulsification employing phaco-chop technique.

PURPOSE: To assess endothelial cell density (ECD) changes on diabetic and nondiabetic patients after phacoemulsification surgery employing the phaco-chop technique. METHODS: This is a prospective, experimental and comparative study. We included type-two diabetic (T2DM) patients and nondiabetic patients who underwent phacoemulsification performed by a single surgeon employing the horizontal phaco-chop technique. ECD and central corneal thickness (CCT), the coefficient of variation and percentage of polymegathism were measured and compared. Specular microscopy was used to evaluate the number of endothelial cells in patients during surgical pre-assessment and at the 1- and 3-month follow-up visits. RESULTS: A total of 42 eyes from 42 patients were included: 21 eyes in the T2DM group and 21 eyes in the nondiabetic group. No statistically significant differences were found between groups in terms of age and sex distribution (p = 0.296; p = 0.502, respectively). Mean postoperative (at 1 and 3-month follow-up) endothelial cell count of the T2DM group was not significantly lower than the nondiabetic group (p = 0.341 and p = 0.065, respectively). Postoperative CCT measurements demonstrated no significant variations between groups, showing a mean 557.8 ± 48.0 and 543.3 ± 41.0 µm, respectively (p = 0.472). Nonetheless, significant differences were evidenced for CoV values for both the pre-surgical and the postoperative follow-up visits between groups, as well as ECD values inside each group. CONCLUSIONS: The present study reveals significant differences between pre-surgical and postoperative mean ECD values; however, no statistically significant differences were found when comparing ECD at each follow-up visit between diabetic patients without evidence of high-risk proliferative diabetic retinopathy and nondiabetic patients undergoing phacoemulsification employing phaco-chop technique.