Central corneal thickness assessment after phacoemulsification: Subluxation versus Divide-and-Conquer

Jeancolas, Anne-Laure; Lhuillier, Louis; Renaudin, Laurie; Boiché, Mathilde; Ghetemme, Cedric; Goetz, Christophe; Ouamara, Nadia; Perone, Jean‐Marc

doi:10.1016/j.jfo.2017.02.013

Cited by 14 publications

(16 citation statements)

References 25 publications

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“…17 It is distinguished by gentle and precise double-wave hydrodissection that is performed in the microcoaxial mode and achieves tilting of the nucleus in a vertical/oblique position. 11,16 Several studies have shown that compared with endocapsular techniques, subluxation techniques, such as tilt-andtumble, Garde-à-vous, and others, decrease total procedural time, pain, and energy. 11,14,[18][19][20][21] However, it has been suggested that the supracapsular methods may be limited by the fact that the ultrasound is used closer to the endothelial cells, which could increase damage to the corneal endothelium.…”

mentioning

confidence: 99%

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial

Perone

Ghetemme

Zevering

et al. 2021

Cornea

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Purpose: Subluxation techniques are superior to divide-andconquer in procedure duration, pain, and ultrasound quantity, but their safety in endothelial cell loss (ECL) is unclear. This randomized single-blind noninferiority clinical trial aimed to determine whether subluxation supracapsular phacoemulsification techniques are inferior to a reference endocapsular technique (divide-andconquer) regarding postoperative corneal ECL.Methods: Patients (aged18 years or older) with greater than +0.2 logarithm of the minimum angle of resolution best spectacle-corrected visual acuity and normal to severe density cataract were randomized to subluxation or divide-and-conquer phacoemulsification in 2015 to 2016. Follow-up with ophthalmic tests was conducted on day 4 and months 1, 3, and 12. The primary study outcome was ECL at all time points. Secondary study end points were operative variables, including effective phaco time and procedure duration. A clinically relevant noninferiority ECL limit was established on the basis of the literature.Results: In total, 292 patients (mean age, 73 yrs; 59% female) were randomized and underwent subluxation (n = 148) or divide-andconquer (n = 144). Day 4 and month 1, 3, and 12 data were available for 243, 270, 275, and 198 patients, respectively. The unexpectedly high dropout at 12 months meant that the 12-month ECL data could only be assessed qualitatively. Surgery was successful in all patients. Subluxation was noninferior to divide-and-conquer in ECL. Effective phaco times were similar, but subluxation associated with shorter procedure duration. Conclusions:The subluxation technique was noninferior to divideand-conquer regarding postoperative ECL, at least in the first 3 months, and associated with reduced intervention time. Subluxation techniques may be suitable alternatives to endocapsular techniques.

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mentioning

confidence: 99%

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial

Perone

Ghetemme

Zevering

et al. 2021

Cornea

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“…Recent studies have revealed that anterior chamber phacoemulsification or supracapsular techniques can be used safely and have certain advantages [4,15,[17][18][19]. Hwang et al [4] compared the retro-chop and stop-and-chop techniques according to the postoperative ECL and CCT increase.…”

Section: Discussionmentioning

confidence: 99%

“…Koch et al [14] have also found that iris plane phacoemulsification causes more ECL than the posterior chamber phacoemulsification even if OVD is used. In contrast, there is no considerable difference in postoperative central corneal thickness (CCT) between the pure posterior chamber techniques and some supracapsular techniques that involve more maneuvers and phacoemulsification in the anterior chamber [4,15]. The surgical technique during the phacoemulsification procedure may require modification owing to several factors such as patient compliance, surgeon comfort, intraoperative pupil changes, anterior chamber dynamics, diameter of the capsulorhexis, prolapses of the lens to the anterior chamber during hydrodissection, catch of the nuclear fragments by OVD in the anterior chamber, avoiding posterior capsule rupture, and surgeon experience.…”

Section: Original Articlementioning

confidence: 99%

The association between postoperative corneal edema and phacoemulsification level

Uyar¹

2022

j-ebr

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To evaluate the effect of phacoemulsification level on postoperative central corneal thickness (CCT) differences and to assess the effects of demographic characteristics, biometric values and surgical parameters of patients on postoperative corneal edema. Methods: This prospective study included 232 eyes of 232 patients who underwent phacoemulsification surgery. Biometric values, phacoemulsification time, phacoemulsification power and effective phacoemulsification time (EPT) were evaluated. CCT measurements were repeated at follow-ups on days 1, 7 and 30 after surgery. Phaco-chop technique was performed in all patients and phacoemulsification level changes that occurred during surgery were recorded. Patients were grouped as Group 1: >75% of lens nucleus emulsified in capsular bag; Group 2: >75% of lens nucleus emulsified in iris plane; and Group 3: >50% of lens nucleus emulsified in anterior chamber. Results: Increase in the mean CCT values on the first day (incCCT1) and at the first week after surgery were more pronounced in Group 3 as compared with both Groups 1 and 2 (p < 0.05 for all). In addition, incCCT1 was higher in Group 2 than Group 1 (p=0.040). In the final model of multiple linear regression (R 2 =0.31), it was determined that EPT, aqueous depth (AD) and phacoemulsification level significantly affected incCCT1 (p range: <0.001 to 0.009). Conclusions: The present study showed that more anterior phacoemulsification levels than the capsular bag caused higher CCT increase postoperatively. In addition, AD, EPT and phacoemulsification level were found as the most significant factors that influence postoperative corneal edema.

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“…2 These results are comparable to those of other studies, concerning phaco chop technique, which also find values of EPT clearly higher than those described in the article studied, with mean observed value between 5 and 10 s. [5][6][7][8][9] It would also be interesting in the present case, to judge the reliability of the technique described, to test this technique for interventions on harder cataracts and to compare it with a traditional "cracking" mode technique like other authors have already done. 5,6,10,11 Finally, it would also be wise to calculate the immediate post-operative corneal edema and even more precisely the endothelial cell loss observed with this technique and to compare these data with those obtained with "cracking" or phaco chop techniques. These measurements would demonstrate the safety of the technique for the corneal endothelium.…”

Section: Dear Editormentioning

confidence: 99%

Considerations regarding the tilt-and-crush phacoemulsification technique

Perone¹

2020

European Journal of Ophthalmology

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Central corneal thickness assessment after phacoemulsification: Subluxation versus Divide-and-Conquer

Cited by 14 publications

References 25 publications

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial

The association between postoperative corneal edema and phacoemulsification level

Considerations regarding the tilt-and-crush phacoemulsification technique

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