No abstract

Life expectancy of the population increase and cataract development will affect all the people with aging. Cataract surgery, a worldwide performed procedure, evolves and progresses. However, different techniques exist, which could be selected for different cases. Any ideal technique should be safe, simple, fast, and easy to learn with good clinical outcome. This chapter will describe one technique to operate cataracts with those characteristics and to perform phacoemulsification cataract surgery without viscoelastic substance. Some advantages of this technique are related to avoiding viscoelastic potential problems, as postoperative intraocular pressure elevation or anterior chamber inflammation associated with viscoelastic. Moreover, a fundamental factor to remark is the difference between work into the anterior chamber with negative pressure or positive pressure. Because the anterior chamber is maintained by the balanced salt solution with the continuous irrigation without viscoelastic. Performing the capsulorhexis is easier. Other advantages are shorten surgical time, fewer economical cost, and potentially fewer complications. Some limitations are as follows: intraocular lens must be one piece foldable, and principally, patients with corneal endothelial pathology must be excluded. Tips, step-by-step surgery, recommendations, and evolution of the technique will be described, with the wish that many surgeons will try to perform Bianchi's method (bimanual, microincision phacoemulsification cataract surgery without viscoelastic substance) for your next patient.

Purpose: To evaluate the safety, visual performance, and patient satisfaction of a new presbyopic pseudophakic intraocular lens (IOL). Methods: A prospective non-randomized case-series study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed Femtosecond laser assisted cataract surgery (FLACS), performed between October and December 2020, with a 6-month follow-up period. The Intensity (Hanita Lenses) IOL was bilaterally implanted. Spherical equivalent (SE) refraction, uncorrected distance and near visual acuity (UDVA/UNVA), defocus curve, endothelial cell density (ECD), central corneal thickness (CCT), and a satisfaction questionnaire were evaluated. Results: A total of 56 patients (112 eyes), aged 65 ± 6.12 years were included. The mean ± SD of preoperative SE was 1.85 ± 2.24 D (range; −4.50 to 4.75), which had decreased 6 months after surgery to −0.08 ±0.32 D (range; −0.75 to 0.63). No eyes experienced a loss of lines of vision, and 94% obtained SE values between ± 0.50 D. Defocus curve for different additions was 0.03 LogMAR (logarithm of the minimum angle of resolution) for −3.0 D, −0.005 LogMAR for −1.5 D, and −0.07 LogMAR for 0 D. The ECD, CCT remained stable ( P : 0.09 and 0.58, respectively) and all patients achieved their preoperative expectations, with a 6-month follow-up period. Conclusion: Patients who underwent a safe bilateral implantation with Intensity IOL achieved a high degree of spectacle independence and satisfaction, 6 months after surgery.

Purpose: To evaluate corneal endothelial health after cataract surgery without viscoelastic substance (VS). Methods: A prospective, non-randomized, case-series study was developed, and phacoemulsification cataract surgery without VS was performed on 1324 eyes between September 2015 and September 2018. As main outcomes, mean endothelial cell density (ECD) and mean central corneal thickness (CCT) were assessed before surgery and then 6 and 12 months after surgery. Data are summarized as mean, standard deviation (SD), and 95% confidence intervals (CI). Results: A total of 1324 eyes were operated, and 31 were excluded by intraoperative complications. The mean ECD baseline was 2506 cells/mm2 (SD = 215, CI = 2494–2518); 6 months after surgery, it was 2328 cells/mm2 (SD = 213, CI = 2316–2340); and 1 year after surgery, it was 2265 cells/mm2 (SD = 214, CI = 2253–2277). In terms of percentage differences, the mean ECD decrease was 9.4% after 1 year. The mean preoperative CCT was 531.6 μm (SD = 34.8, CI = 529.7–533.5); 6 months after surgery, it was 537.7 μm (SD = 38.2, CI = 535.6–539.8); and 1 year after surgery, it was 537.9 μm (SD = 37.9, CI = 535.8–540.0). The mean CCT increased 1.2% 1 year after surgery. Conclusions: Phacoemulsification cataract surgery can be completely performed without VS, with very low intraoperative complications. The postoperative ECD and CCT changes occurred primarily during the first 6 months, and the changes decreased during the second semester.