Aqualase for cataract extraction.

PURPOSE: To report our experience of using Aqualase technology for cataract extraction. METHODS: In total, 33 patients (20 females; mean age 71.4 years) underwent cataract surgery using Aqualase through a 3.2-mm corneal incision. Grade of nucleus, nuclear removal technique, and intraoperative complications were noted. Clinical parameters from postoperative visits were collected. RESULTS: Aqualase is capable of removing cataracts up to nuclear sclerosis 2+ (out of 4) with relative ease. Nuclei graded 2+ or greater were technically more difficult and conversion to ultrasound phacoemulsification was required in one case. Two posterior capsule ruptures occurred: one during nucleus removal (contact with the tip while aspirating without Aqualase) and one unrelated to Aqualase during aspiration of cortex. Of 25 patients seen on the first postoperative day, 22 had a clear cornea. A total of 96% patients without preoperative comorbidity achieved 6/9 or better postoperatively. One patient had transient postoperative uveitis. CONCLUSIONS: Removal of softer cataracts with Aqualase has the theoretical advantage over phacoemulsification, by carrying less risk to the posterior capsule, since the handpiece has a smooth polymer tip that has no mechanical motion inside the eye. However, the tip should not be considered entirely capsule-friendly, as rupture is possible with the foot-pedal in position two (aspiration only). Although certain adjustments to the technique are required, the method is similar enough to phacoemulsification to ensure a brief learning curve. With increasingly firm cataracts, Aqualase becomes less effective and ultrasound phacoemulsification is still superior for such cases, in our experience.

Topical versus peribulbar anesthesia, without sedation, for clear corneal phacoemulsification.

PURPOSE: To investigate patient and surgeon acceptance of topical anesthesia as an alternative to peribulbar anesthesia for clear corneal phacoemulsification. SETTING: Department of Ophthalmology, Whipps Cross Hospital, London, England. METHODS: All cataract surgery was performed using a temporal clear corneal approach, bimanual phacoemulsification, and in-the-bag intraocular lens implantation. The results of 51 patients having surgery under topical anesthesia (amethocaine) were compared with those of 30 patients having peribulbar anesthesia (50:50 mixture of lignocaine 2% and bupivacaine 0.5% with hyaluronidase). No sedation was used in either group. Pain perception on administration of the anesthetic, perioperatively (period immediately surrounding and during surgery), and postoperatively was assessed using a visual analog scale from 0 to 10 (0 = no pain: 10 = worst pain imaginable). A questionnaire was used to assess the degree of patient and surgeon satisfaction. RESULTS: Administration of topical amethocaine was significantly less painful than peribulbar bupivacaine (P = .03). Perioperative pain showed a trend toward being worse in the topical anesthesia group but did not reach statistical significance. There was no difference in the postoperative pain scores of the two groups. The surgical experience was rated very satisfactory by 67% in the topical group and 73% in the peribulbar group. The surgeons reported no difficulties or complications. CONCLUSION: Topical anesthesia was safe and effective for clear corneal phacoemulsification and was well tolerated by patients. The slightly greater awareness of ocular discomfort in the topical group perioperatively did not alter patient satisfaction with the surgical experience when compared with the peribulbar group.