Automated Precision Pulse Capsulotomy Versus Manual Capsulorhexis In White Cataracts: Reduction In Procedural Time And Resource Utilization

Ifantides, Cristos; Sretavan, David W.

doi:10.1097/j.jcrs.0000000000001109

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…However, even with the latest FLACS technology, consistent capsulorrhexis cannot be guaranteed in the treatment of intumescent cataracts, and there have been several reports of Argentinian ag sign complications related to FLACS in intumescent cataracts [11]. Some scholars have reported the use of nanosecond pulse technology, nitinol rings, and other techniques for anterior capsulotomy, but these techniques require new equipment, increasing nancial burden on patients, and their safety has not been clinically con rmed [12].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Argentinian Flag Sign in Intumescent Cataracts Using Anterior Chamber Air Bubble and Cortical Fluid Release Techniques

Wang,

Zhang,

Hou

et al. 2024

Preprint

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Objective: To effectively avoide the occurrence of the Argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts Methods: Preoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. CDVA and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 month. Intraoperative and postoperative complications were documented and analyzed. Results: Fifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 month postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted. Conclusion: The anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.

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Section: Discussionmentioning

confidence: 99%

Prevention of Argentinian Flag Sign in Intumescent Cataracts Using Anterior Chamber Air Bubble and Cortical Fluid Release Techniques

Wang,

Zhang,

Hou

et al. 2024

Preprint

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“…It has been reported that the incidence of an anterior capsular tear during capsulorhexis was 0.8-5.0% [1][2][3][4]. The incidence of an anterior capsule tear during capsulorhexis increases with an increase in cataract density.…”

Section: Introductionmentioning

confidence: 98%

Femtosecond laser LenSx–assisted phacoemulsification of mature intumescent cataract

Дмитрієв,

Гриценко

2023

Oftalmol Zh

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Background: Phacoemulsification (phaco) of mature intumescent cataract is one of the most difficult to perform anterior eye surgeries. In mature intumescent cataract phaco, the most difficult phase is performing a continuous capsulorhexis which should be as round as possible. The incidence of an anterior capsular tear during capsulorhexis has been reported to range from 0.8 to 5.0% and increases with an increase in cataract density. This is because in dense intumescent cataracts, capsulorhexis tends to extend to the periphery due to high intracapsular pressure. Femtosecond laser–assisted phaco of mature intumescent cataract enables a safe laser-assisted capsulotomy with a substantially reduced risk of intraoperative complications. Because this approach is as yet not widely used in ophthalmology, we aimed to share our experience in the use of femtosecond laser in phacoemulsification of mature and intumescent cataracts. Purpose: To assess the efficacy of femtosecond laser–assisted treatment of mature intumescent cataract. Methods: Sixty-five patients (68 eyes) with mature intumescent senile cataract underwent femtosecond laser-assisted cataract surgery (FLACS) with intraocular lens (IOL) implantation and were involved in this study. Results: In 55 eyes (80.8%), laser capsulotomy of the desired diameter (5.0 mm) was performed completely. In 8 eyes (11.7%), capsular bridges (capsular tissue remnants at the site of laser-assisted cut of the anterior capsule) were seen. In addition, after the laser phase of surgery, 3 eyes (4.4%) showed an irregularly shaped anterior capsular disc due to the failure of the laser to cut through the capsule in several regions. In all study eyes, the IOL was well centered in the bag. Conclusion: In eyes with mature intumescent cataract, it is reasonable to use the femtosecond laser for a safe and accurate anterior capsulorhexis to avoid the severe intraoperative complications (those associated with posterior capsular rapture and vitreous prolapse) that can be seen during manual capsulorhexis.

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“… 28 The near-instantaneous creation of the entire circular capsulotomy opening has led to its proposed utility in difficult cases with intumescent white cataract where uncontrolled capsular extensions can lead to the Argentinian flag sign. 37 Laboratory studies have demonstrated that PPC is associated with an intraocular temperature increase of only 2–3°C lasting for only 1–2 seconds that is unlikely to induce any endothelial cell damage. However, as with any cataract surgery instrument that delivers energy into the eye, endothelial cell safety must be clinically demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Endothelial Cell Loss Following Cataract Surgery Using Continuous Curvilinear Capsulorhexis or Precision Pulse Capsulotomy

Vital¹,

Jong²,

Trinh³

et al. 2023

OPTH

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Purpose To compare endothelial cell density (ECD), percentage of hexagonal cells (%Hex) and coefficient of variation (CV) in cell size following lens cataract surgery with phacoemulsification performed using Continuous Curvilinear Capsulorhexis (CCC) or Precision Pulse Capsulotomy (PPC). Patients and Methods Sixty-seven subjects were randomly assigned to undergo lens cataract removal with the capsulotomy step performed using either CCC or PPC. Specular microscopy images were obtained pre-operatively, 1 month and 3 months after surgery. ECD, %Hex and CV were analyzed in a masked fashion by an independent reading center. Results The mean percentage ECD loss at 1 month was 11.5% in the CCC group and 12.3% in the PPC group (P = 0.818; t -test). At 3 months, the mean percentage ECD loss was 11.7% in the CCC group and 12.4% in the PPC group (P = 0.815; t -test). The mean %Hex at 1 month was 54.3% in the CCC group and 54.7% in the PPC group (P = 0.695; t -test). At 3 months, the mean %Hex was 56.2% in the CCC group and 54.7% in the PPC group (P = 0.278; t -test). The CV at 1 month was 34.4% in the CCC group and 34.3% in the PPC group (P = 0.927; t -test). At 3 months, the CV was 32.7% in the CCC group and 33.4% in the PPC group (P = 0.864; t -test). Conclusion No differences in ECD loss, %Hex and CV were observed between patients who received CCC or PPC. PPC use during cataract surgery does not result in any increased endothelial cell loss beyond that normally associated with this surgery.

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Automated Precision Pulse Capsulotomy Versus Manual Capsulorhexis In White Cataracts: Reduction In Procedural Time And Resource Utilization

Abstract: Precision pulse capsulotomy (PPC) was compared with continuous curvilinear capsulorhexis in white cataracts in a single-surgeon retrospective study. PPC showed advantages in capsulotomy metrics, resource utilization, and surgical flow.

Cited by 4 publications

References 21 publications

Prevention of Argentinian Flag Sign in Intumescent Cataracts Using Anterior Chamber Air Bubble and Cortical Fluid Release Techniques

Prevention of Argentinian Flag Sign in Intumescent Cataracts Using Anterior Chamber Air Bubble and Cortical Fluid Release Techniques

Femtosecond laser LenSx–assisted phacoemulsification of mature intumescent cataract

Endothelial Cell Loss Following Cataract Surgery Using Continuous Curvilinear Capsulorhexis or Precision Pulse Capsulotomy

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