Intraoperative complications of phacoemulsification in pseudoexfoliation: Metaanalysis

Vázquez-Ferreiro, Pedro; Carrera-Hueso, Francisco Javier; Jornet, Jaime E. Poquet; Fikri-Benbrahim, Narjis; Diaz-Rey, Marta; Sanjuán-Cerveró, Rafael

doi:10.1016/j.jcrs.2016.09.010

Cited by 29 publications

(20 citation statements)

References 15 publications

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“…The diagnosis of PXF is of paramount importance as this disease is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. 17 Intraoperative and postoperative complications may arise from the weakened capsule and zonular apparatus (zonulopathy) secondary to the progressive proteolytic disintegration of the suspensory ligament, responsible for the instability of the crystalline lens during surgery, capsular rupture, zonular dialysis, vitreous loss, nuclear luxation, decentration or dislocation of the intraocular lens (IOL) with time. Further difficulties during surgery result from poor or inadequate pupil dilation (iridopathy), secondary to atrophic changes of the iris sphincter and stroma characterized by transillumination defects.…”

Section: Introductionmentioning

confidence: 99%

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Fontana¹,

Coassin²,

Iovieno³

et al. 2017

OPTH

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Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated.

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Section: Introductionmentioning

confidence: 99%

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Fontana¹,

Coassin²,

Iovieno³

et al. 2017

OPTH

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“…14 No complications that have been previously reported in FLACS, like incomplete capsulotomy, tears in anterior capsule or posterior capsule ruptures were recorded during any of the surgeries in our study. 15,16,17 BCVA was signi cantly improved in both groups. No changes in VF were recorded, but longer follow up is necessary to evaluate the real impact of this procedure in glaucoma progression.…”

Section: Discussionmentioning

confidence: 86%

Femtosecond Laser-Assisted Cataract Surgery in Glaucoma Patients, Case Series.

Alvarez-Ascencio

Prado-Larrea

Jiménez-Román

et al. 2020

Preprint

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BackgroundWe aim to describe the short-term effect of femtosecond laser-assisted cataract surgery (FLACS) in intraocular pressure (IOP), visual acuity (VA), number of hypotensive medications, and visual fields (VF) in glaucomatous eyes.MethodsSingle-center consecutive case series study included patients with a previous glaucoma diagnosis that needed cataract surgery alone or combined with incisional glaucoma procedure. IOP was measured during surgery immediately before and after pretreatment docking with an indentation tonometer. Changes in visual acuity (VA), IOP, number of medications, and VF were evaluated with a 90 day follow up.ResultsTwenty-seven eyes of 27 patients were included. Mean patient age was 70 years, 70% (n = 19) were female. Glaucoma diagnoses were: twelve patients with primary open-angle glaucoma, 13 with angle-closure glaucoma, and 2 with pseudoexfoliation glaucoma. Twenty-one patients underwent cataract surgery alone and 6 combined with an incisional glaucoma procedure (trabeculectomy or glaucoma drainage device implantation). We found no significant differences between pre-docking IOP (17.59 mmHg ± 6.25 SD) and post-docking IOP (17.23 mmHg ± 7.74 SD) p = 0.7. No surgical complications were recorded. The 90-day postoperative follow up revealed no changes from baseline regarding VF mean deviation, mean IOP, and the number of glaucoma medications decreased in both groups.ConclusionFLACS appears to perform well in the short-term in eyes with glaucoma undergoing cataract surgery alone or with an incisional glaucoma procedure. Comparable outcomes to manual phacoemulsification were obtained regarding IOP, VA, and postoperative period evolution.Clinical SignificanceSafety and efficacy of FLACS have not been properly studied in the glaucoma population, we present a case series with different glaucoma diagnoses who underwent FLACS alone or with an incisional glaucoma procedure.

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“…Failure to achieve this increases the risks of leakage, infection, or vitreous traction that may lead to cystoid macular edema or retinal detachment. Risk of PCR increases in difficult cases, including small pupil, pseudoexfoliation (PXF), intraoperative floppy iris syndrome (IFIS), and dense cataract such as mature, white, intumescent, or black cataract 8,9 . PCR commonly occurs towards the end of the surgery when removing the last quadrant of the nucleus.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intraoperative intraocular lens use on improving surgical safety for dense cataract phacoemulsification: a randomized controlled trial

Zeng

Wang

Cheng

et al. 2020

Sci Rep

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We designed this study to assess if surgical safety can be improved by intraoperative use of intraocular lens (IOL) for cataract phacoemulsification. We performed phacoemulsification cataract removal on 401 patients. We randomly assigned these patients into three groups: the standard setting (Group I, n = 134), with reduced vacuum and flow rate (Group II, n = 137), and with IOL insertion before the last quadrant was emulsified with standard setting (Group III, n = 130). The primary outcomes included the risk of posterior capsular rupture (PCR), ultrasound time, energy, and complications. The secondary outcomes included central corneal thickness (CCT), CCT changes, endothelial cells (ETC) counting, ETC loss, and the best corrected distance visual acuity (BCVA) measured on day 1, day 7 and day 30. If PCR occurred, we emulsified the residual lens materials after insertion of IOL and clean of the prolapsed vitreous. We found that the risk of PCR in Group III (0/130) was lower than Group I (9/134, corrected relative risk (RR) = 18.44, 95% CI: 1.08-313.56) and Group II (3/137, corrected RR = 6.64, 95% CI: 0.35-27.41). Group III showed better BCVA on day 1 and 7, less ECC loss on day 7 and 30, and less CCT increase on day 1 and 7. No cases converted to extracapsular cataract extraction. No residual lens materials misdirected into vitreous cavity. Intraoperative use of IOL can improve surgical safety for dense cataract phacoemulsification.After decades of development, phacoemulsification for cataract extraction has become safer, faster, and more efficient than ever. It has become one of the most extensive and effective treatments for cataract surgeries. Developments of phacoemulsification technology include energy release model innovation, fluidics systems upgrading, and surgical techniques improvement 1 , among others. In particular, improved fluidics system has greatly enhanced the anterior chamber stability.However, post-occlusion surge (POS) caused by anterior chamber instability is still an undesirable and inevitable consequence after occlusion break 2,3 . POS tends to occur in proportion to vacuum. For soft nucleus fragments emulsification, the phaco tip is often not totally occluded. Therefore, it can be emulsified with less energy and vacuum. After the core nucleus is emulsified, epinucleus is often in situ. This supports and protects the capsule from rupturing due to POS. But for dense nucleus, epinucleus rarely left after the nucleus was emulsified. Thus, the protective effect of epinucleus is lost. The last dense quadrant usually needs the highest preset energy and vacuum to be emulsified. This will inevitably cause POS. Without the protection of epinucleus, PCR occurs very often. Even worse, vitreous can lose or nuclear fragments can descend into the vitreous cavity. Emulsifying the last quadrant is still challenging and critical for complete removal of dense cataract, although there are some protective factors of POS and PCR. These factors include improved fluidics system, low-compliance tubing, aspiration b...

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Intraoperative complications of phacoemulsification in pseudoexfoliation: Metaanalysis

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 29 publications

References 15 publications

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Femtosecond Laser-Assisted Cataract Surgery in Glaucoma Patients, Case Series.

Effectiveness of intraoperative intraocular lens use on improving surgical safety for dense cataract phacoemulsification: a randomized controlled trial

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