Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: randomized trial

Wan, Wenjuan; Jiang, Lu; Ji, Yan; Xun, Yan; Xiong, Lei; Xiang, Yongguo; Li, Ruonan; Li, Zhouyu; Wang, Xiaoqin; Stewart, Jay M.; Hu, Ke

doi:10.1016/j.jcrs.2019.07.029

Cited by 7 publications

(17 citation statements)

References 19 publications

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“…In our previous work, similar study of hypothermic perfusion in hard nuclear senile cataract by animal experiments and clinical trials has also been performed [13]. There was a significant difference in the central and incisional corneal thickness, the corneal endothelial cells loss, and the anterior segmental inflammation between the 4°C group and the 24°C group in hard nuclear cataract surgeries.…”

Section: Discussionmentioning

confidence: 79%

“…In cataract surgeries, applying an ice-cold eye mask after operation could increase the comfort level and reduce inflammation with no adverse effects [12]. In our previous study, we found that hypothermic perfusion in the phacoemulsification of senile hard nuclear cataract was safe and could effectively protect the corneal endothelium, decrease corneal edema and reduce anterior chamber inflammation in the early postoperative stage [13]. Therefore, we hypothesized that hypothermia could also protect the cornea during phacoemulsification and reduce the early postoperative anterior chamber inflammation in patients with uveitis.…”

Section: Introductionmentioning

confidence: 98%

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Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial

et al. 2020

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Background: To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. Methods: This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4°C (treatment group) or 24°C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. Results: The aqueous flare score was 0.83 ± 0.76 in the 4°C group, which was lower than that in the 24°C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4°C group (0.17 ± 0.38) than that in the 24°C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4°C group (907.66 ± 85.37 μm) was thinner than that in the 24°C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). Conclusions: Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. Trial registration: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 98%

Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial

et al. 2020

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“…1,21 Surgeons employ various ultrasound power delivery modulations, innovative phaco tips, use deeper plane phacoemulsification of nuclear fragments and coat corneal endothelium with viscodispersive OVDs to protect corneal endothelium. 6,[8][9][10][11]14,18,21 However, the rigid and irregular nuclear fragments do not mold well at the phaco tip leading to a much greater chatter and poor followability. In addition, high fluidic use during phacoemulsification predisposes increased chatter.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13] In order to minimize endothelial cell loss associated with mechanical trauma, maneuvers such as endocapsular or deeper plane phacoemulsification of totally separated small nuclear fragments, hypothermic perfusion, employment of fluidics to provide a stable anterior chamber, anterior chamber maintainer, replenishing anterior chamber with ophthalmic viscosurgical device (OVD), and use of femtosecond laser or manual prechopping techniques have been described. 2,4,11,[14][15][16][17] However, these modalities do not ensure the prevention of hard nuclear fragments from coming into physical contact with the corneal endothelium during surgery, thereby causing focal endothelial cell loss and precipitating corneal edema in the early postoperative period. [18][19][20] We describe a new technique that employs the use of a chopper to shield corneal endothelial cells from damage that can occur due to direct contact with hard nuclear fragments.…”

Section: Introductionmentioning

confidence: 99%

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

Parkash¹,

Parkash²,

Mahajan³

et al. 2021

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Purpose: To describe an innovative technique of using a chopper as a shield for preventing mechanical corneal endothelial trauma that can occur during the phacoemulsification of brunescent cataracts. Methods: This prospective study included patients with hard cataracts (grade nuclear opalescence 4 and above on LOCS III) who underwent phacoemulsification surgery. The chopper shield technique was performed in 48 eyes of 44 patients. The technique entailed placing the chopper horizontally as a shield anterior to the emulsifying nuclear fragment between the phaco tip and corneal endothelium to prevent nucleus fragments from coming into contact with the corneal endothelium. Outcome measures included cumulative dissipated energy (CDE), corneal edema (day one), CCT (assessed at one day, one week, and one month), and endothelial cell density assessed at three months. Results: Of the 48 eyes included in the study, 23 were males and 25 were females (mean age: 70.02±5.98years). Preoperatively, mean central corneal thickness (CCT) was 529.62 ±21.70 microns, and endothelial cell counts were 2258.76±182.22 cells per mm 2 . Postoperatively on day one, CCT increased to 563.93±24.53 microns, a 6.47% increase from preoperative central corneal thickness. CCT became 534.83±22.64 microns on postoperative day seven, a 0.98% increase from preoperative CCT. Endothelial cell loss was 6.77% at three months from the day of surgery. Conclusion:The chopper shield technique offers continuous protection to the corneal endothelium by minimizing endothelial cell loss during phacoemulsification of dense nuclear cataracts.

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“…2 Hypothermia is a protective factor that can increase the body's tolerance to ischemia and hypoxia, indicating that the corneal structure can be more stable in hypothermic perfusion conditions. 9 This study was an in vivo study on white rabbit eyes exposed to ultrasonic phacoemulsification energy and treated with intraocular hypothermia irrigation ORIGINAL ARTICLE at 4 o C and 24 o C at room temperature. The expression of the Na + /K + ATPase was analyzed through anatomical pathology examination with immunohistochemical antibodies.…”

Section: Introductionmentioning

confidence: 99%

Expression of Na+/K+ATPase and changes of corneal endothelium cell density after phacoemulsification with hypothermic perfusion

et al. 2022

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Background: Intraocular hypothermic perfusion can be used as an alternative to reduce corneal endothelial cell damage in phacoemulsification procedures. This study aimed to analyze the effect of hypothermic intraocular perfusion on cell density and expression of the Na+/K+-ATPase on corneal endothelial cells after exposure to ultrasonic phacoemulsification energy. Methods: Sixteen New Zealand white rabbits (n=16 eyes) were randomly divided into two groups and exposed to phacoemulsification ultrasonic energy. The control group received room-temperature Intraocular Balanced Salt Solution (BSS) hyperthermic perfusion (24oC) and the treatment group received low-temperature intraocular BSS hypothermic perfusion (4oC). Corneal endothelial cell density (ECD) was measured before and 1 day after surgery using a specular microscope. On the first postoperative day, the expression of Na+/K+ATPase was examined using immunohistochemical antibody staining. Data were analyzed using SPSS version 26 for Windows. Results: There was no statistically significant difference in the expression of corneal endothelial Na+/K+-ATPase between the control and treatment groups (p=0.053). There was no significant difference in corneal endothelial cell density changes between the control and treatment groups (p=0.115). There was no correlation between changes in cell density and corneal endothelial Na+/K+ATPase expression in the control and treatment groups (p=0.216). Conclusion: The effect of intraocular hypothermic perfusion on phacoemulsification procedures remains controversial. Endothelial cell density decreased in hypothermic perfusion after phacoemulsification and Na+/K+ATPase expression was not significantly affected by hypothermic perfusion.

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Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: randomized trial

Cited by 7 publications

References 19 publications

Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial

Effect of hypothermic perfusion on phacoemulsification in cataract patients complicated with uveitis: a randomised trial

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

Expression of Na+/K+ATPase and changes of corneal endothelium cell density after phacoemulsification with hypothermic perfusion

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