Pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries under topical anesthesia

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract

BACKGROUND Cataracts pose a significant clinical burden due to their complex pathogenesis.In recent years,an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment.Additionally,symptoms of ocular axis elongation,lens nucleus hardening,and vitreous liquefaction have become more prevalent.While conventional extracapsular cataract extraction is commonly employed,it often yields suboptimal visual outcomes.Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity.AIM To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract.METHODS We selected 110 patients(with 134 eyes)with myopia and cataracts treated.These patients were categorized into two groups:an observation group(57 patients with 70 eyes)and a control group(53 patients with 64 eyes).The control group underwent cataract phacoemulsification and lens implantation,while the observation group received a refined capsular treatment based on the control group’s procedure.We assessed the differences in visual acuity and quality between the two groups before and after surgery.RESULTS At six months post-operation,the observation group exhibited significantly improved far vision,intermediate vision,near vision,lower objective scattering index,higher Modulation transfer function cut-off frequency,and overall vision metrics at different contrast levels(100%,20%and 9%)compared to the control group(P<0.05).The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group(P<0.05).No significant difference in the incidence of adverse reactions was observed between the observation group and control group(P>0.05).CONCLUSION Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts,warranting its clinical application.

Resolution of myopic macular schisis following cataract phacoemulsification

Dear Editor,We write to introduce a case of high myopia who had bilateral macular schisis along with cataracts.During the following-up period from 2014 to 2021,the severity of macular schisis gradually worsened.However,following cataract surgery,there was a gradual improvement in the macular schisis,ultimately leading to near-complete resolution.We obtained the written informed consent from the patient,and this case study adhered to the principles in the Declaration of Helsinki.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in the Treatment of Patients with Primary Angle Closure Disease and Concomitant Cataract at Preah Ang Duong Hospital in Cambodia

Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.

Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography

·AIM:To evaluate optic nerve head(ONH)vessel density(VD)changes after cataract surgery using optical coherence tomography angiography(OCTA).·METHODS:This was a prospective observational study.Thirty-four eyes with mild/moderate cataracts were included.ONH scans were obtained before and 3mo after cataract surgery using OCTA.Radial peripapillary capillary(RPC)density,all VD,large VD and retinal nerve fiber layer thickness(RNFLT)in total disc,inside disc,and different peripapillary sectors were assessed and analyzed.Image quality score(QS),fundus photography grading and bestcorrected visual acuity(BCVA)were also collected,and correlation analyses were performed between VD change and these parameters.·RESULTS:Compared with baseline,both RPC and all VD increased in inside disc area 3mo postoperatively(from 47.5%±5.3%to 50.2%±3.7%,and from 57.87%±4.30%to 60.47%±3.10%,all P<0.001),but no differences were observed in peripapillary area.However,large VD increased from 5.63%±0.77%to 6.47%±0.72%in peripapillary ONH region(P<0.001).RPC decreased in inferior and superior peripapillary ONH parts(P=0.019,<0.001 respectively).There were obvious negative correlations between RPC change and large VD change in inside disc,superior-hemi,and inferior-hemi(r=-0.419,-0.370,and-0.439,P=0.017,0.044,and 0.015,respectively).No correlations were found between VD change and other parameters including QS change,fundus photography grading,postoperative BCVA,and postoperative peripapillary RNFLT.·CONCLUSION:RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract.No obvious VD changes are found in peripapillary area postoperatively.

Comparison of three fundus inspection methods during phacoemulsification in diabetic white cataract

AIM:To investigate whether Wild Field Imaging System(WFIS SW-8000),25G endoilluminator,and intraoperative optical coherence tomography(iOCT)can perform realtime screening and diagnosing in patients with suspicious diabetic retinopathy(DR)during phacoemulsification,especially in cases of white cataract.METHODS:A cross-sectional study was carried out.A total of 204 dense diabetic cataractous eyes of 204 patients with suspected DR treated from April 2020 to March 2021 were included.Phacoemulsification combined with intraocular lens implantation was performed.Following the removal of the lens opacity,the 25G endoilluminator,fundus photography,and iOCT were performed successively.Optical coherence tomography(OCT)and/or fundus fluorescein angiography(FFA)were used to verify the fundus findings postoperatively.Intraoperative and postoperative results were compared to verify the accuracy of intraoperative diagnosis in each group.RESULTS:Intraoperative and postoperative examinations revealed 58 and 62 eyes with DR,respectively(positive rate,28.43%and 30.39%,respectively).During the phacoemulsification,WFIS SW-8000 detected 44 eyes with DR(the detection rate,70.97%);25G endo-illuminator found 56 eyes with DR(the detection rate,90.32%);iOCT found 46 eyes with DR(the detection rate,74.19%);and 58 eyes with DR were found by combining the three methods(the detection rate,93.55%).There were statistically significant differences in the diagnostic sensitivity for DR among the methods(χ^(2)=16.36,P=0.001).CONCLUSION:WFIS SW-8000,25G endo-illuminator,iOCT,and especially their combination can be used to inspect the fundus and detect DR intraoperatively;they are helpful for the timely diagnosis and treatment of DR in patients with dense cataract.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND During anesthesia administration for cataract surgery,low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing,with the use of additional drops intraoperatively increasing the risk of complications.Accordingly,there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study.Patients were divided into the proparacaine surface anesthesia(SA)group(65 cases)and the compound acupuncture-medicine anesthesia group(CAMA group,65 cases).Patients in the CAMA group were provided acupuncture analgesia in addition to SA.Preoperative anxiety[Self-Rating Anxiety Scale(SAS)score and state anxiety inventory(SAI)score],intraoperative stress,vital signs,analgesia,and cooperation,as well as postoperative adverse events,were compared between groups.RESULTS More marked reductions in anxiety were observed among patients in the CAMA group,with corresponding reductions in SAS and SAI scores.During the operation,no change in the secretion of E,NE,or Cor group compared to the preoperative period was observed in the CAMA,which was markedly lower than that in the SA group.Heart rate,blood pressure,and respiratory rate were more stable intraoperatively in the CAMA group.In addition,the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group.Accordingly,patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery.Furthermore,marked reductions in intraoperative adverse effects were observed in the CAMA group,indicating greater overall safety.CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery

Dear Editor,We read with interest the Meta-analysis conducted by Chen et al[1]on the clinical outcomes and complication rates between femtosecond laser-assisted cataract surgery(FLACS)and conventional phacoemulsification cataract surgery(CPCS).The authors reported no statistical difference between both methods for all measured complications except posterior capsular tear,with CPCS displaying a higher rate of posterior capsular tear.Since its inception in 2011[2].

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials

AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM:To assess the early surgical outcomes of quickchop phacoemulsification technique in patients with high myopia.METHODS:The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens(IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk,1mo. Early postoperative best corrected visual acuity(BCVA), preoperative and postoperative corneal endothelial cell density(ECD), central corneal thickness(CCT) and postoperative complications were assessed.Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.· RESULTS:There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.· CONCLUSION:Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.

Blood pressure change during phacoemulsification and femtosecond laser-assisted cataract surgery

AIM： To evaluate blood pressure（BP） changes during phacoemulsification（PC） and femtosecond laser（FSL）-assisted cataract surgery.METHODS： A retrospective chart review was performed for all patients who received traditional phacoemulsification surgery（PC group） and FSL-assisted cataract surgery（FS group） from July 2013 to December 2014. Totally 206 eyes from 133 patients receiving the two types of procedures were included.Patient characteristics（age, gender, and hypertension history）, pre- and post-operative BPs were collected.RESULTS： The pro-operative systolic and diastolic BPs（mm Hg） were 124.89 ±20.48 vs 126.98 ±16.85, and71.88 ±9.81 vs 73.56 ±10.03, in PC and FS groups,respectively. While the post-operative systolic and diastolic BPs（mm Hg） were 130.13 ±22.59 vs 134.77 ±17.52, and 73.41 ±11.62 vs 78.89 ±12.2, in PC and FS groups, respectively. Paired-sample t-tests showed obvious systolic and diastolic BP elevations in FS group after surgery（P =0.001 and 0.007） and no reliability in PC group（P =0.094 and 0.359）. A linear regression model revealed systolic and diastolic BP elevations,which were related to longer surgical times for FS group（P =0.008 and 0.021）. Age, gender, and hypertension history were not correlated with blood pressure elevation in either group.CONCLUSION： BP increases but at a limited level after FSL-assisted cataract surgery compared to traditional phacoemulsification

Supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts

Elevated intraocular pressure(IOP)is a major risk factor for the development or progression of glaucoma.Lowering IOP is the only proven therapeutic approach to the management of glaucoma.IOP can be lowered by medication,laser treatment or surgery(1).Generally,instillation of IOP-

Outcomes of 1.8-3.0 mm incision phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma with cataract

●AIM:To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0 mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.●METHODS:Ninety-six patients(96 eyes)with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017.Group A(3.0 mm incision),B(2.2 mm incision),and C(1.8 mm incision)comprised 30,34 and 32 eyes respectively.All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy.Data including best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell counts(CECC),intraocular pressure(IOP),and complications were collected before the operation,and at postoperative 1 d,1 and 3 mo.●RESULTS:All the patients were successfully treated with surgery.The BCVA of groups B and C were significantly improved as compared to group A at postoperative 1 d,1 and 3 mo(all P<0.05),but there was no difference between groups B and C at each time interval(all P>0.05).The corneal astigmatism of group A was statistically higher than that of group B(P=0.026);corneal astigmatism of group B was statistically higher than that of group C at postoperative 1 d(P=0.006).The corneal astigmatism of group A at postoperative 3 mo was significantly higher than that before operation(P=0.003).At postoperative 1 and 3 mo,corneal astigmatism of groups B and C were significantly lower than that of group A(all P<0.05).The CECC in group B was significantly higher than that of group A(P=0.020),and CECC in group C was significantly higher than that of group B(P=0.034)at postoperative 1 d.At postoperative 1 and 3 mo,CECC of groups B and C were significantly higher than that of group A(all P<0.05).In each group,postoperative mean IOP at each time interval was significantly lower than preoperative IOP(all P<0.05).●CONCLUSION:Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery,and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

Incidence of endophthalmitis after phacoemulsification cataract surgery:a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery

AIM: To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens(IOL) implantation during femtosecond laserassisted cataract surgery(Femto phaco) and conventional phacoemulsification surgery(Conventional phaco).METHODS: In a prospective cohort study, Conventional phaco and Femto phaco(anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), and manifest refraction were assessed during 1 d, 1 wk, and 1 mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1 wk and 1 mo follow-ups.RESULTS: There were no significant differences in UDCA or CDVA between two groups at 1 mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group(P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group.CONCLUSION: The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.