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      Phacoemulsification in the anterior chamber: An alternative surgical technique in post-vitrectomy cataract

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          Abstract

          Objective:

          To evaluate the characteristics, safety and effectiveness of a modified technique of phacoemulsification in post-vitrectomy cataracts.

          Methods:

          This retrospective clinical trial comprised 31 patients (31 eyes) with post-vitrectomy cataract, who had undergone phacoemulsification combined with intraocular lens implantation. An alternative surgical technique known as phacoemulsification in the anterior chamber was used for nucleus management in those cases. The following parameters were evaluated: best corrected visual acuity (BCVA), ocular inflammation, intraocular pressure, endothelial cell count and surgical complications.

          Results:

          Three months after surgery, the BCVA improved significantly compared with that before surgery ( Z=-10.547; p<0.05). There were no significant differences in IOP before and after surgery ( Z=-0.474; p>0.05). There was a statistically significant postoperative decrease in endothelial cell densities ( Z=-3.916; p<0.05). The mean endothelial cell loss was -8.71%. A little inflammatory response in the anterior chamber in 11 eyes and mild corneal edema in 8 eyes were observed on the first day after surgery, which subsided after a week. The posterior capsular opacification were observed in three eyes, two of which were denser, and the YAG laser was performed for posterior capsular incision. No obvious surgical complications occurred.

          Conclusion:

          The modified technique of phacoemulsification, with phacoemulsification in the anterior chamber, is safe and effective to deal with post-vitrectomy cataracts.

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          Most cited references17

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          Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique.

          To compare endothelial cell damage during cataract surgery performed using the divide-and-conquer or phaco-chop nuclear fracturing technique. Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, Denmark. In a prospective study, 60 eyes of 60 patients were randomly assigned to 1 of 2 groups (30 eyes each group) based on the phacoemulsification technique used: phaco chop or divide and conquer. During surgery, phaco time, phaco power, irrigation volume, and grade of nuclear firmness were recorded. The endothelial cell density, variation in endothelial cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were recorded at baseline and 3 and 12 months postoperatively. Sample size was based on a power calculation (power 0.90, P = .05, clinically important difference = 300 cells/mm2). Significantly less phaco power was used during phaco-chop surgery than during divide-and-conquer surgery. Postoperatively, both groups had a significant but equal decrease in cell density. There were no statistically significant changes in variation in endothelial cell size, percentage of hexagonal cells, or CCT. Visual acuity increased significantly and equally in the 2 groups. Higher endothelial cell loss was significantly correlated with shorter axial length. It has been suggested that the phaco-chop technique is less harmful to the corneal endothelium than the divide-and-conquer technique because it uses less phaco power. The findings did not support this hypothesis as similar and low cell loss was observed in the 2 groups.
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            Cataract surgery after pars plana vitrectomy.

            To review recent studies and advances and their possible implications in the care of patients undergoing cataract surgery after pars plana vitrectomy.
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              Surgery for post-vitrectomy cataract.

              Cataract formation or acceleration can occur after intraocular surgery, especially following vitrectomy, a surgical technique for removing the vitreous which is used in the treatment of disorders that affect the posterior segment of the eye. The underlying problem that led to vitrectomy may limit the benefit from cataract surgery.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Nov-Dec 2018
                : 34
                : 6
                : 1512-1516
                Affiliations
                [1 ] Tao Yu, Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, Shandong, China
                [2 ] Xu-Guang Han, Jinan Aier Ophthalmology Hospital, Aier Eye Hospital Group, Jinan 250014, Shandong, China
                [3 ] Ying-Mei Li, Jinan Second People’s Hospital, Jinan Eye Hospital, Jinan Eye Institute, Jinan 250012, Shandong, China
                [4 ] Yu-Guang Zhang, Jinan Second People’s Hospital, Jinan Eye Hospital, Jinan Eye Institute, Jinan 250012, Shandong, China
                Author notes
                Correspondence: Tao Yu. Qianfoshan Hospital Affiliated to Shandong University, No.16766 Jingshi Road, Jinan, 250014, Shandong, China. E-mail: rcyutao@ 123456163.com
                Article
                PJMS-34-1512
                10.12669/pjms.346.15962
                6290232
                30559814
                ba98a318-25e5-47bb-9028-f2e46f6a6992
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 June 2018
                : 22 September 2018
                Categories
                Original Article

                anterior chamber,cataract,phacoemulsification,post-vitrectomy

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