Macular photostress and visual experience between microscope and intracameral illumination during cataract surgery

Seo, Hyejin; Nam, Dong Heun; Lee, Jong Yeon; Park, Su Jin; Kim, Yu Jeong; Kim, Seong-Woo; Chung, Tae Young; Inoue, Makoto; Kim, Terry

doi:10.1016/j.jcrs.2017.11.016

Cited by 21 publications

(16 citation statements)

References 18 publications

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“…It suggests that light exposure reaching the patient's and surgeon's retina during cataract surgery is lower in the intracameral illumination than in the microscope illumination [27]. A similar work with the same conclusion was also published by Seo et al e authors summarized that, in view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination [28].…”

Section: Discussionmentioning

confidence: 81%

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Studený

Vranová

Nováček

2021

Journal of Ophthalmology

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Introduction. Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose. To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods. During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results. In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion. SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

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Section: Discussionmentioning

confidence: 81%

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Studený

Vranová

Nováček

2021

Journal of Ophthalmology

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“…It is consistent with previous study. [10] However, this study did not predict the absolute intensity of light that the retina could become exposed to during cataract surgery in real life. This is because our study did not measure the intensity of the light on the macula but at the point of the ocular of an operating microscope.…”

Section: Discussionmentioning

confidence: 92%

“…With concern about the retinal phototoxicity from the microscope coaxial light, this technique using the oblique light focused onto the lens offers the advantage of reduced direct illumination of the macula. [10] There have been no studies to date that show the measurement of illuminance and irradiance reaching patient's or surgeon's retina during cataract surgery. Therefore, we performed a prospective comparative indirect observation to assess light exposure to patient's and surgeon's retina between microscope versus intracameral illuminations during phacoemulsification cataract surgery [Fig.…”

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confidence: 99%

Light exposure from microscope versus intracameral illumination during cataract surgery

Kim

Nam

Kim

et al. 2019

Indian J Ophthalmol

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Purpose:To evaluate light exposure from microscope versus intracameral illuminations to patient's and surgeon's retina during cataract surgery.Methods:Thirty consecutive patients who had cataract surgery using microscope and intracameral illuminations. At the point of the ocular of an operating microscope, optical illuminance and irradiance from the microscope illumination (60, 40, 20% intensity) and the intracameral illumination (60% intensity) were measured using a light meter and a spectrometer at a pause after lens capsule polishing in cataract surgery.Results:Average illuminance (lux) was 1.46, 0.66, 0.27, and 0.1 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination. Average total spectral irradiance (μW/cm2) was 1.25, 0.65, 0.26, and 0.03 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination.Conclusion:Microscope ocular illuminance and irradiance during cataract surgery were higher in the microscope illumination than in the intracameral illumination. It suggests that light exposure reaching patient's and surgeon's retina during cataract surgery is lower in the intracameral illumination than in the microscope illumination.

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“…A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. The advanced cataract surgery using intracameral illumination described in our previous studies [11–15] was used in the treatment group. A review of medical records was performed in which demographic data, medical history, ocular history, best-corrected visual acuity, slit-lamp examination including lens scoring (Lens Opacities Classification System III [18]), dilated fundus examination, and fundus photography were collected and reviewed.…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

Kim

Park

Lee

et al. 2019

Journal of Ophthalmology

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Purpose To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

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Macular photostress and visual experience between microscope and intracameral illumination during cataract surgery

Abstract: In a view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination. Objective findings from the model-eye experiment correlated to the result of visual experience.

Cited by 21 publications

References 18 publications

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Light exposure from microscope versus intracameral illumination during cataract surgery

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

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