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      Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction

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          Abstract

          Aim:

          To evaluate the efficacy and safety of phacoemulsification using torsional modality with different parameter settings for hard nucleus cataract extraction.

          Design:

          A prospective, randomised clinical study.

          Methods:

          A clinical practice study conducted at the Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, and Guangzhou. One eye each from 198 consecutive patients with cataract density grade IV according to the Emery–Little system classification system, requiring phacoemulsification and intraocular lens implantation, was included. Eyes were randomly assigned to the Linear Torsional combined with Ultrasound power group (Linear Tor+US group, n = 66), 100% Fixed Torsional group (Fixed Tor group, n = 65) and conventional Ultrasound burst group (US group, n = 67). All surgeries were performed by a single experienced surgeon and outcomes evaluated by another surgeon masked to treatment. Intraoperative parameters were Ultrasound Time (UST), Cumulative Dissipated Energy (CDE) and surgical complications. Patients were examined on post-op days 1, 7 and 30. Postoperative outcomes were final best corrected visual acuity (BCVA), average central and incisional corneal thickness and central endothelial cell counts.

          Results:

          The mean UST was lower in the Fixed Tor group than in the US group and in the Lin US+Tor group (p⩽0.0001). The mean CDE was lower in the Lin Tor+US group and in the Fixed Tor group than in the US group (p⩽0.0001). Comparing with the two Tor group, the US group had a lower average BCVA on post-op 1, 7 (p⩽0.0001) and 30 (p>0.01), greater average central corneal and incisional thickness on days 1, 7 (p⩽0.0001) and 30 (p>0.01), and higher average corneal endothelial cell losses on day 7 and 30 days (p⩽0.0001).

          Conclusions:

          Torsional combined with ultrasound power or high fixed torsional amplitude can yield more effective hard nucleus phacoemulsification than conventional ultrasound modality.

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          Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment.

          Viney Gupta, Ramanjit Sihota, Tanuj Dada … (2007)
          To compare anterior segment parameters using quantitative imaging by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Tertiary-care glaucoma research center. Sixty-three eyes of 63 subjects had anterior segment evaluation by AS-OCT (Visante-Zeiss) and UBM (Paradigm). Central corneal thickness (CCT), anterior chamber depth (ACD) (measured from the central corneal endothelium to the anterior lens capsule), and the peripheral iridocorneal angles (temporal and nasal) were assessed and compared. There was an excellent correlation between AS-OCT and UBM measurements for the nasal angle (r = 0.84; P<.0001), temporal angle (r = 0.86; P<.0001), ACD (r = 0.97; P<.0001), and CCT (r = 0.91; P<.0001). There was no significant difference (paired t test) between the mean ACD, CCT, and angle parameters measured by AS-OCT or UBM. The mean values of the parameters measured by AS-OCT and UBM were, respectively, as follows: nasal angle, 26.25 degrees +/- 11.0 (SD) and 28.27 +/- 11.3 degrees (P = .3); temporal angle, 25.1 +/- 11.4 degrees and 28.3 +/- 13.5 degrees (P = .15); ACD, 2.85 +/- 0.5 mm and 2.78 +/- 0.5 mm (P = .2); and CCT, 512 +/- 46 microm and 502 +/- 46 microm (P = .25). The AS-OCT images showed sharper definition of the scleral spur than the UBM images. Anterior segment optical coherence tomography and UBM can both be used for anterior segment measurements and yielded comparable results.
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            Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study.

            Lixia Luo, James M. Zeng, Zhaohui Yuan … (2007)
            To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P .01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P .01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.
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              Corneal thickness and endothelial density before and after cataract surgery.

              M Böhnke, José A. Ventura, R Wälti (2000)
              Deturgescence of the corneal stroma is controlled by the pumping action of the endothelial layer and can be monitored by measurement of central corneal thickness (pachymetry). Loss or damage of endothelial cells leads to an increase in corneal thickness, which may ultimately induce corneal decompensation and loss of vision. Little is known about the effect of moderate reductions in endothelial cell number on the thickness of the corneal stroma. This study aimed to investigate this matter further using patients who had incurred moderate decreases in their endothelial cell counts as a result of cataract surgery. Central corneal thickness was measured 1 day before surgery, 1 day after surgery, and again at 3 months or 1 year. Endothelial cell counts were also performed 1 day before surgery and thereafter at 3 months or 1 year after surgery. The relationship between these two parameters was assessed statistically. Precise measurements of central corneal thickness were made by optical low coherence reflectometry. For comparative purposes, this parameter was also determined by ultrasonic pachymetry. Central corneal endothelial cell numerical density was estimated on photomicrographs taken with a specular microscope. All patients had significant postoperative corneal swelling on the day after surgery; preoperative values were restored by 3 and 12 months, even though significant endothelial cell losses had occurred. No correlation existed between central corneal thickness and central corneal endothelial cell numerical density. Measurements estimated by ultrasonic pachymetry were more variable and significantly higher than those determined by optical low coherence reflectometry. As long as the numerical density of the corneal endothelial cells does not fall below the physiological threshold, a moderate decrease in this parameter does not compromise the pumping activity of the layer as a whole.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Ophthalmol
                Journal ID (publisher-id): bjo
                Title: The British Journal of Ophthalmology
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0007-1161
                ISSN (Electronic): 1468-2079
                Publication date Collection: 2008
                Publication date (Print): August 2008
                Publication date (Electronic): 20 June 2008
                Publication date PMC-release: 20 June 2008
                Volume: 92
                Issue: 8
                Pages: 1092-1096
                Affiliations
                [1 ]Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
                [2 ]The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, People’s Republic of China
                Author notes
                Correspondence to: Professor Y Liu, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou 510060, People’s Republic of China; yzliu666@ 123456126.com
                Article
                Publisher ID: bj128504
                DOI: 10.1136/bjo.2007.128504
                PMC ID: 2569137
                PubMed ID: 18567650
                SO-VID: 76aa72a3-2698-4fad-89d4-6fa8cc50d0af
                Copyright © © Zeng et al 2008
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 2 February 2008
                Categories
                Subject: Original Articles
                Subject: Clinical Science

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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