A Comparison of the Cystotome-Assisted Prechop and Phaco-Chop Phacoemulsification Nucleotomy Techniques.

BACKGROUND The aim of this study was to compare the intra-operative parameters and post-operative outcomes of cataract surgery performed using the cystotome-assisted prechop (CAP) and phaco-chop techniques. MATERIAL AND METHODS Fifty-two eyes with age-related cataract in the CAP group, and 63 eyes in the phaco-chop group were enrolled for analysis in this study, and the surgical outcomes were reported 1 day and/or 1 week, and 1 month post-operatively. RESULTS The CAP technique was associated with statistically significantly lower cumulative dissipated energy compared with the phaco-chop technique (P<0.001). The mean endothelial cell loss in the CAP group was statistically significantly lower than that of the phaco-chop group 1 week (5.6±5.9% versus 8.8±8.7%, P=0.020) and 1 month post-operatively (6.3±6.8% versus 9.8±9.9%, P=0.026). The change in the central corneal thickness between the 2 groups was significantly different at 1 day post-operatively (3.3±3.1% versus 4.9±4.6%, P=0.036). The change in the 8.0 mm central corneal volume between the 2 groups was significantly different at 1 day and 1 week post-operatively (6.5±6.1% versus 10.9±7.9%, P=0.001; 3.2±4.7% versus 5.4±5.7%, P=0.029, respectively). CONCLUSIONS The CAP technique showed lower ultrasound energy consumption and less endothelial damage and corneal edema than the phaco-chop technique. It might therefore prove a cost-effective prechop method for cataract surgery.

Cataract surgery in patients with glaucoma drainage implants: the hooked tube technique.

PURPOSE: Cataract surgery has been reported to adversely affect the IOP control in eyes with the glaucoma drainage implant (GDI). One reason might be the flow of lens debris/viscoelastic material through the GDI tube into the bleb. This pilot study was conducted to determine the clinical results of a novel technique for temporary occlusion of the GDI tube with an iris retractor hook during phacoemulsification. METHODS: Retrospective analysis of 15 patients (control group) who underwent phacoemulsification between January 2005 and December 2010 and 17 patients (treatment group) who underwent phacoemulsification with the hooked tube technique between January 2011 and April 2016 with a minimum 1-year follow-up. RESULTS: The IOP remained within 4 mmHg of the preoperative level in all eyes of the treatment group. Three eyes exhibited IOP spikes (≥ 10 mmHg) among controls. The mean postoperative IOP at 1 month was statistically significantly increased in the control group compared with the treatment group (P = 0.040). The number of antiglaucoma medications at 3 and 6 months was significantly increased in the control group (1.4 ± 1.1 vs. 1.7 ± 1.1; P = 0.041, 1.4 ± 1.1 vs. 2.3 ± 1.2; P = 0.017, respectively). After phacoemulsification, there was a significant increase in the mean number of antiglaucoma medications used at 6 months in the control group compared with the treatment group (P = 0.049). In both groups, one eye developed corneal decompensation. CONCLUSIONS: The hooked tube technique seems to provide an effective way to reduce the risk of the IOP spikes after cataract surgery in eyes with GDI.

Can we improve the efficacy of modern cataract surgery by using different tip designs? A comparison of balanced and tapered tip in femtosecond laser-assisted cataract surgery and manual phacoemulsification.

IMPORTANCE: Different tip designs in modern cataract surgery have not been studied between the reported systems. BACKGROUND: Aim of this study is to assess the efficacy of two tip designs, Intrepid® balanced tip (BT) and Kelman tapered tip (TT), in femtosecond laser assisted cataract surgery (FLACS) and the microcoaxial torsional phacoemulsification. DESIGN: Prospective randomized unmasked cohort outcome study (hospital setting). PARTICIPANTS: Threehundert-forty-three eyes of 343 patientes underwent cataract surgery. METHODS: Data of n = 196 FLACS and n = 147 manual phacoemulsification were analysed. Intrepid® balanced tip and Kelman tapered tip, Alcon, USA, were tested in FLACS (LenSx Alcon, USA) und manual phaco (Alcon Centurion System, USA). Four study cohorts were formed; FLACS BT (n = 90, 70.2 years), FLACS TT (n = 106, 68.1years), Manual BT (n = 70, 71.3 years), Manual TT (n = 77, 71.8 years). The nuclei were graded in Lens Opacities Classification System (LOCS) II,III and IV. MAIN OUTCOME MEASURES: Cumulative dissipated energy (CDE%s), balanced salt solution volume (BSSml), total longitudinal energy (%s) and torsional amplitude (%s). RESULTS: Lower CDE values were seen in FLACS compared to manual phacoemulsification (CDE %s median FLACS BT 3.28, FLACS TT 4.07, Manual BT 5.57, Manual TT 6.27). There was a significant difference between CDE FLACS BT and FLACS TT (p = 0.038), and between FLACS BT and Manual TT (p = 0.001). CONCLUSIONS AND RELEVANCE: The right choice of tip designs in advanced phacoemulsification systems is a key factor in increasing efficacy in cataract surgery. The balanced tip showed a considerable energy-saving advantage in FLACS and manual phacoemulsification compared to the tapered tip.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics.

PURPOSE: To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems . METHODS: A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ® phacoemulsification system or the gravity-fluidics Infiniti ® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared. RESULTS: A mean age of 68.3 ± 9.8 years was found (range 57-92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R 2 = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R 2 = 0.112, P = 0.046) and AT values (r = 0.156, R 2 = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P < 0.0001 and P = 0.001). CONCLUSIONS: The active-fluidics Centurion ® phacoemulsification system achieved higher surgical efficiency than the gravity-fluidics Infiniti ® IP system for NII and NIII cataracts.

Comparative clinical study of Whitestar Signature phacoemulsification system with standard and Ellips FX handpieces.

PURPOSE: To compare the intraoperative parameters and postoperative outcomes using two different phaco handpieces with different energy delivery systems of the same phacoemulsification machine. METHODS: One hundred and sixty eyes of 160 cataract patients were randomly assigned to 2.40 mm phacoemulsification using the AMO WhiteStar Signature® phaco system with the standard phaco handpiece (Group 1) or the Ellips FX phaco handpiece (Group 2). According to the lens opacities classification system III, each group was divided into four subgroups of 20 patients each. U/S total time (UST), total phaco time (TPT), mean effective phaco time, cumulative dissipated energy (CDE) and balanced salt solution (BSS) consumption were studied. Visual acuity, corneal endothelium cell count and corneal pachymetry were evaluated before surgery and 1, 7 and 30 days after surgery. RESULTS: No statistically significant difference in terms of visual acuity was observed between the two groups. The postoperative endothelial cell loss and corneal pachymetry were similar between the two groups. In higher density cataracts, Ellips FX showed the lower CDE and the lowest UST. TPT and BSS consumption were significantly lower in the Ellips FX handpiece group. CONCLUSIONS: The two phaco handpieces appeared to be safe. AMO Ellips FX handpiece showed better performances and may be safer in lens removal, especially in hard cataract patients.

Wound temperature profiles of coaxial mini-incision versus sleeveless microincision phacoemulsification.

BACKGROUND: Temperature profiles at the corneal wound of coaxial mini-incision (2.4 mm) cataract surgery and sleeveless microincision (1.1 mm) cataract surgery were compared. DESIGN: Prospective, controlled, paired-eye clinical trial conducted in a tertiary care hospital. PARTICIPANTS: Twenty patients with mild-to-moderate bilateral nuclear sclerotic cataract. METHODS: Twenty patients underwent bilateral cataract surgery within a 1-month period. One eye was operated on by conventional coaxial mini-incision (2.4 mm) phacoemulsification. The second eye underwent microincision surgery by using a naked phacoemulsification tip and a specialized 19-gauge anterior chamber maintainer as the sole fluid source (three-port microincision cataract surgery technique). Patients had moderate bilateral cataracts with no other anterior segment pathology. Temperature at the corneal wound was constantly recorded by using infrared thermal imaging. MAIN OUTCOME MEASURES: Temperatures at the corneal wound. RESULTS: Mean temperatures at the corneal surgical wound were not significantly different between the coaxial and sleeveless groups (31.1 °C ± 2.3 vs. 31.0 °C ± 2. 0; P = 0.89). There was also no difference in maximum temperatures reached during phaco-emulsification. Temperatures did not rise above 40 °C during any surgery, and there were no corneal burns. Final visual acuity and intraoperative and postoperative complication rates were similar between the two groups. CONCLUSIONS: The temperature profile at the surgical wound using a microincisional sleeveless phacoemulsification technique is comparable with that of the conventional coaxial mini-incision method.

Torsional power study using CENTURION phacoemulsification technology.

BACKGROUND: To evaluate the effect of varying levels of power on phacoemulsification efficiency using the CENTURION Vision System. METHODS: Formalin-soaked porcine lenses were divided into 2-mm cubes; 0.9-mm, balanced tips were used. Torsional power levels were tested from 10% to 100% at 10% intervals. Vacuum was set to 550 mmHg, aspiration to 50 ml/min, and intraocular pressure at 50 mmHg. Efficiency (time to lens removal) and chatter (number of lens fragment repulsions from the tip) were determined. RESULTS: Increasing torsional power up to 60% increased efficiency. This effect was linear from 30 to 60% power (R2 = .90; P < 0.05). There were no significant differences in efficiency past 60%. Chatter was highest at 10% power and decreased linearly (R2 = .87; P = 0.007) as power was increased up to 60% power, and chatter did not improve above this power level. CONCLUSIONS: Power improved efficiency only up to a 60% power level, and then was negligible. Chatter correlated well with power up to the 60% level, so that as power was increased, chatter decreased. Because there are no additional benefits in efficiency past 60% power, and because chatter is minimal at 60% power, we recommend torsional ultrasound at 60% as the optimal power setting for using the CENTURION System for phacoemulsification.l.

All about capsular tension rings.

PURPOSE OF REVIEW: To discuss capsular tension devices and recent evidence regarding their use. RECENT FINDINGS: The capsular tension ring, modified capsular tension ring, and capsular tension segment are well established tools for use during phacoemulsification when zonular instability is present. Recent research has provided additional evidence of their benefits in decreasing intraoperative and postoperative complications. SUMMARY: Endocapsular support devices allow for cataract surgery success in the setting of zonular instability.

Fluid dynamics and intraocular pressure using venturi phacoemulsification machine in dogs ex vivo.

OBJECTIVE: To optimize fluid dynamics through measuring intraocular pressure (IOP) in a venturi phacoemulsification machine in dogs. PROCEDURES: In step I, flow and IOP of the test chamber were measured using a pressure transducer with the bottle height (BH) set at 50, 70, 100, and 120 cm and the vacuum from 30 to 450 mmHg. A 19-gauge phaco and a 0.3-mm irrigation/aspiration (I/A) handpiece were used. In step II, flow and IOP were measured in an enucleated canine eye with a 3.0- and a 3.2-mm clear corneal incision (CCI), respectively. IOP was measured using the pressure transducer at a 30-mmHg vacuum to allow corneal deformation, to define the fluidic parameters for preventing surge. RESULTS: Flow was directly proportional to the BH and vacuum, whereas IOP was directly proportional to the BH and inversely to the vacuum. Flow with an I/A handpiece was significantly less than with a phaco handpiece, explaining why IOP with an I/A handpiece was significantly higher than with a phaco handpiece. With the I/A handpiece, vacuum parameters less than 450 mmHg did not result in corneal deformation. IOP with a 3.2-mm CCI was significantly lower than with a 3.0-mm CCI, with the 3.2-mm flow being greater than the 3.0-mm flow. CONCLUSIONS: BH during the I/A stage could be reduced to avoid unnecessary stress on the canine eye when using a venturi system. Although phacoemulsification with a 3.2-mm CCI could induce lower IOP, a 3.0-mm CCI might lessen the irrigation flow stress on the eye.

Safety study of capsular tension ring use in canine phacoemulsification and IOL implantation.

OBJECTIVE: To evaluate and compare surgical outcome and complications in canine eyes with stable, cataractous lenses undergoing routine phacoemulsification and intraocular lens (IOL) implantation with or without implantation of a capsular tension ring device (CTR). PROCEDURES: Dogs undergoing routine bilateral phacoemulsification and IOL implantation had one eye randomly chosen to have a CTR (47 eyes) inserted while the contralateral eye served as a control (47 eyes). The CTR was placed in the capsular bag following phacoemulsification and immediately prior to IOL implantation. All eyes received acrylic foldable IOLs. Patients were evaluated intra- and postoperatively, and complications were compared between eyes with and without a CTR. RESULTS: There were no intra-operative complications associated with implantation of the CTR. Postoperatively, the overall incidences of glaucoma (6%), intraocular hemorrhage (4%), and retinal detachment (2%) were equal between control and CTR eyes at the time of last follow-up. There was no significant difference in overall incidence of immediate postoperative uveitis (35% vs. 38%) or fibrin (19% vs. 15%) between control and CTR eyes. Follow-up time ranged from 2 weeks to 21 months. CONCLUSION: In canine eyes with stable cataractous lenses undergoing routine phacoemulsification and IOL implantation placement of a CTR does not increase the risk of intra- or postoperative complications.

Evaluating the trabecular micro-bypass stent combined with phacoemulsification compared to phacoemulsification alone.

AIM: The aim of this study was to assess the effect of iStent (trabecular micro-bypass stent) implantation in combination with phacoemulsification on IOP and glaucoma medications and to compare this to the outcome of phacoemulsification alone. PATIENTS AND METHODS: A retrospective consecutive comparative review was undertaken. 131 eyes with ocular hypertension and medically controlled glaucoma underwent phacoemulsification alone (n=78 group I) or combined with gonioscopic-guided implantation of one iStent (n=31, group II) or two iStents (n=22, group III). Patients were assessed at postoperative weeks 1, 3 and 6, and months 3 and 6. Pre- and post-operative measures included visual acuity, IOP and glaucoma medications. RESULTS: Post-operatively at 6 months, mean IOP decreased from 16.3 mmHg to 14.2 mmHg in group I (p<0.01), from 16.7 mmHg to 15.1 mmHg in group II (p<0.16) and from 17.0 to 13.8 in group III (p=0.05). Mean glaucoma medication decreased from 1.9 to 1.6 in group I (8%, p=0.12), from 2.5 to 0.8 in group II (27%, p=0.04), and from 2.1 to 1.0 in group III (45%, p<0.01). CONCLUSIONS: iStent implantation resulted in similar IOP reduction to phacoemulsification alone but achieved a significantly greater reduction in glaucoma medications. This may improve compliance and quality of life, and reduce health care costs in patients with early to moderate glaucoma.

Phacoemulsification with implantation of Morcher aniridia capsular rings for postoperative atonic pupil after iridencleisis--case report.

INTRODUCION: Large iris defets, anirdia or wide atonic pupil may cause disturbing photoptic phenomena my require surgical treatment. In acquired iris defects, ophthalmologists have a relatively wide choice of therapeutic strategies, which depend on the size and etiology of the defect and the comorbidities. The goal of treatment is to restore iris diaphragm and to reconstruct the pupil in order to prevent glare and to increase the quality of perceived image. CASE REPORT: We present a case of cataract and unilateral wide, atonic pupil in a patient 39 years after iridencleisis, who complained of intense glare in the left eye and photophobia ever since. The patient was successfully treated by phacoemulsification through a 2.75 mm clear corneal incision with implantation of two black Morcher aniridia capsular rings. The patient experienced a significant improvement in her subjective quality of vision and a constant glare that she had been experiencing for years resolved. CONCLUSION: The presented case indicates that Morcher aniridia capsular rings may be a good tool instrument to assist the surgeon in cases of cataract concomitant with wide and atonic pupil. Using these rings reduces glare and improves the subjective quality of patients' vision.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems.

BACKGROUND: Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. METHODS: Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. RESULTS: The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. CONCLUSIONS: In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.

[State-of-the-art cataract surgery and intraocular optical correction].

The paper provides current knowledge on cataract epidemiology worldwide and in the Russian Federation, including issues of cataractogenesis and prevention. An overview of medical equipment for preoperative and intraoperative diagnostics is provided. Key aspects of the conventional ultrasonic phacoemulsification method as well as the most marked trends in correction of aphakia with intraocular lenses and in design of the latter are presented. Major laser-assisted techniques, including those that imply the use of femtosecond laser systems, and results that they yielded to date are discussed in detail.

The phaco machine: analysing new technology.

PURPOSE OF REVIEW: The phaco machine is frequently overlooked as the crucial surgical instrument it is. Understanding how to set parameters is initiated by understanding fundamental concepts of machine function. RECENT FINDINGS: This study analyses the critical concepts of partial occlusion phaco, occlusion phaco and pump technology. In addition, phaco energy categories as well as variations of phaco energy production are explored. SUMMARY: Contemporary power modulations and pump controls allow for the enhancement of partial occlusion phacoemulsification. These significant changes in the anterior chamber dynamics produce a balanced environment for phaco; less complications; and improved patient outcomes.

Thermal imaging comparison of Signature, Infiniti, and Stellaris phacoemulsification systems.

BACKGROUND: To compare the heat production of 3 different phacoemulsification machines under strict laboratory test conditions. More specifically, the thermal behavior was analyzed between the torsional modality of the Infiniti system and longitudinal modalities of the Abbot WhiteStar Signature Phacoemulsification system and Bausch and Lomb Stellaris system. METHODS: Experiments were performed under in-vitro conditions in this study.Three phacoemulsification handpieces (Infiniti, Signature, and Stellaris) were inserted into balanced salt solution-filled silicone test chambers and were imaged side-by-side by using a thermal camera. Incision compression was simulated by suspending 30.66-gram weights from the silicone chambers. The irrigation flow rate was set at 0, 1, 2, 3, 4, and 5 cc/min and the phacoemulsification power on the instrument consoles was set at 40, 60, 80, and 100%. The highest temperatures generated from each handpiece around the point of compression were measured at 0, 10, 30, and 60 seconds. RESULTS: Under the same displayed phacoemulsification power settings, the peak temperatures measured when using the Infiniti were lower than when using the other two machines, and the Signature was cooler than the Stellaris. At 10 seconds, torsional phacoemulsification with Infiniti at 100% power showed data comparable to that of the Signature at 80% and the Stellaris at 60%. At 30 seconds, the temperature from the Infiniti at 100% power was lower than the Signature at 60% and the Stellaris at 40%. CONCLUSIONS: Torsional phacoemulsification with the Infiniti generates less heat than longitudinal phacoemulsification with the Signature and the Stellaris. Lower operating temperatures indicate lower heat generation within the same fluid volume, which may provide additional thermal protection during cataract surgery.

Heat profiling of phacoemulsification tip using a thermal scanning camera.

An experimental study to measure the heat profile of the phacoemulsification (phaco) tip using standard continuous phaco and hyperpulse phaco with and without waveform power modulation in the Millennium Microsurgical System with Custom Control Software (CCS). The phaco tip was imaged in air using a thermal camera. The highest temperature was measured 15 s after application of phaco power. Continuous, hyperpulse and waveform power modulations of the Millennium Microsurgical System were used with different power settings (20, 50 and 100 %) and duty cycles (40, 60 and 90 %), with the irrigation turned on and off. Using continuous phaco with the irrigation on, the phaco tip temperature remains <28.0 °C. With irrigation off, the temperature is higher compared to irrigation on but still remains <45.0 °C. Comparing the temperatures for all three power modulations when irrigation is on, at each phaco power and duty cycle setting, the temperature of the phaco tip is highest with continuous phaco, followed by hyperpulse with rise time 1, then hyperpulse with rise time 2. When irrigation is off, the highest temperatures are recorded using the hyperpulse with rise time 2, followed by continuous phaco, then hyperpulse with rise time 1. Hyperpulse and waveform modulations reduce heat generation compared to the continuous mode when irrigation is turned on. Lower duty cycles and lower ultrasound power produce less heat at the phaco tip.

Ophthalmic viscoelastic devices as a cleaning challenge.

Common practice when validating the cleaning of medical devices is to employ clinically relevant test soils as a challenge to the cleaning process. During use, medical devices may come into contact with a variety of materials that are difficult to clean. One example of this is the use of ophthalmic viscoelastic devices (OVDs) in cataract surgery. This study evaluated the effectiveness of a procedure for cleaning the lumens of a phacoemulsification handpiece using two different OVDs as test soils. The results of this study demonstrate that effective cleaning of the aspiration and irrigation lumens of a phacoemulsification handpiece may be achieved if the manufacturer's recommended cleaning procedures are followed.

Removal of posterior segment retained lens material using the OZil phacoemulsification handpiece versus Fragmatome during pars plana vitrectomy.

PURPOSE: To assess the utility of the torsional phacoemulsification handpiece compared to the Fragmatome during pars plana vitrectomy for removal of posterior segment retained lens material. DESIGN: : Retrospective comparative case series. METHODS: Thirty-four eyes of 34 patients at 2 centers who underwent pars plana vitrectomy for retained lens material with either torsional phacoemulsification or the Fragmatome were retrospectively reviewed. Lens material was graded by nuclear density and percentage of total nuclear size. The primary outcome measure was mean change in visual acuity. Secondary outcomes included intraoperative or postoperative complications, occurrence of mechanical malfunctions and metric data including the total ultrasound, phacoemulsification, and torsional times. RESULTS: In the torsional ultrasound group (17 eyes), mean nuclear density was 3.6 and mean size was 63%. Mean initial logarithm of minimum angle of resolution visual acuity was 1.58 (20/760) and improved to 0.66 (20/80) at postoperative Month 3, a gain of 0.92 (P = 0.003). One eye developed a self-limited, peripheral, serous, choroidal detachment intraoperatively, whereas two eyes developed postoperative cystoid macular edema. Mean total ultrasound, phacoemulsification, and torsional times were 76.7, 13.4, and 63.3 seconds, respectively. Mean total operative time to remove retained lens material (excluding vitreous gel removal) was 111 seconds. All the patients demonstrated excellent followability based on independent observations by the surgeons. In the Fragmatome group (17 eyes), initial logarithm of minimum angle of resolution visual acuity was 1.51 (20/640) and improved to 0.6 (20/80) at postoperative Month 3, a gain of 0.91 (P < 0.001). One eye developed a retinal detachment at postoperative Week 2, whereas 3 eyes developed postoperative cystoid macular edema. CONCLUSION: The use of torsional phacoemulsification during pars plana vitrectomy for retained lens material is a novel approach with potential advantages over the standard 20-gauge Fragmatome, including improved followability and purchase of lens material attributable to the addition of torsional movement.

The influence of corneal wound size on surgically induced corneal astigmatism after phacoemulsification.

BACKGROUND/PURPOSE: To determine whether there is a difference in surgically induced astigmatism (SIA) after phacoemulsification for unsutured temporal clear corneal incisions of 2.5 mm and 3.5 mm wound sizes. METHODS: This study comprised 36 eyes of 18 patients who received cataract surgery from a single surgeon. Patients were randomly assigned to receive a one-piece intraocular lens (IOL; Acrysof SA60AT), through a 2.5 mm incision in one eye, and a three-piece IOL (Tecnis Z9000), through a 3.5 mm incision in the contralateral eye. Corneal topography was performed preoperatively and also postoperatively at 3, 6, and 12 weeks. SIA was calculated by means of vector analysis using the Alpins' method. RESULTS: The mean SIAs of the groups with 2.5 mm and 3.5 mm incisions were 0.57 diopter (D) and 0.86 D respectively (p = 0.04) at 3 weeks postoperatively, 0.60 D and 0.83 D respectively (p > 0.05) at 6 weeks postoperatively, and 0.58 D and 0.58 D respectively (p > 0.05) at 12 weeks postoperatively. At 12 weeks postoperatively, SIAs of <1.0 D were found in all eyes in the 2.5 mm group and 93% of eyes in the 3.5 mm group. Forty-four percent of eyes in both groups demonstrated SIAs > 0.5 D at 12 weeks postoperatively. The largest SIA was 1.36 D in the 3.5 mm group. CONCLUSION: Mean SIA in the 3.5 mm group was larger than that in the 2.5 mm group in the early postoperative period, but there was no significant difference for the entire observational period.