Results of small incision extracapsular cataract surgery using the anterior chamber maintainer without viscoelastic

Abstract

Aims-To assess the eYcacy of extracapsular cataract surgery using the anterior chamber maintainer (ACM) without the use of viscoelastic. To compare the eVects of this surgical technique on non-diabetic and diabetic patients. Methods-A prospective single armed clinical trial of 46 eyes in 46 patients undergoing cataract surgery using the ACM without viscoelastic. Patients were assessed preoperatively and at 3 weeks, 3 months, and 12 months postoperatively. The main outcome variables included visual acuity, surgically induced astigmatic change (SIAC), changes in endothelial cell density (ECD), and morphology aVecting the central and superior regions of the cornea. Results-Postoperatively, 56% and 70% of patients had unaided visual acuities of 6/12 or better at 3 weeks and 3 months respectively. Even after excluding those patients with pre-existing maculopathy (including diabetic maculopathy), there remains a significant diVerence between the nondiabetic and diabetic groups in terms of the proportion of patients attaining an unaided visual acuity of 6/12 or better at both 3 weeks (p=0.003) and 3 months (p=0.001). Three months postoperatively, the SIAC based upon the keratometric and refractive data was 1.1 dioptres (D) and 1.3 D respectively. There was no statistically significant diVerence in the SIAC when the non-diabetic and diabetic groups were compared. The mean central and superior endothelial cell losses at 3 months postoperatively were 16% and 22% respectively and at 12 months postoperatively were 20% and 25% respectively. The diabetic group demonstrated greater endothelial cell losses and a more marked and protracted deviation of endothelial cell morphology from normality when compared with the non-diabetic group; however, the diVerences did not reach statistical significance. Conclusions-The eYcacy of small incision cataract surgery using the ACM in terms of visual outcome and induced astigmatism is comparable with the results obtained using other techniques that utilise a similar size of incision. However, in view of the magnitude and range of the endothelial cell losses associated with this technique the concurrent use of viscoelastic is suggested. There does not appear to be a statistically or clinically significant diVerence between non-diabetic and diabetic patients in terms of the magnitude of the endothelial cell losses or in the wound healing response in the 12 months after cataract surgery using the ACM. (Br J Ophthalmol 1999;83:71-75)

Comparison of Endothelial Cell Loss and Surgically Induced Astigmatism following Conventional Extracapsular Cataract Surgery, Manual Small-Incision Surgery and Phacoemulsification

“…Wright et al 5 reported significant endothelial cell loss among persons with diabetes who underwent the Blumenthal technique. However, the modified Mininuc, which was used in that series, has since been modified 4 and does not require the entire nucleus to be prolapsed in the anterior chamber.…”

“…There is little data available on the endothelial cell loss and astigmatism induced by the technique of small-incision cataract surgery. 5 This study was designed to compare induced endothelial cell loss and astigmatism between three commonly used cataract surgical techniques in our practice.…”

Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal

“…Endothelial trauma can be reduced further by the use of intracameral viscoelastics before extraction of the nucleus. 19 Eighty (16.0%) of cases had pre-existing central posterior capsule plaques; however, only 10 of the 80 cases had an acuity less than 6/18 at discharge attributable to the plaque. The frequency and location of this type of posterior capsule opacification corresponds with a previous histopathological study on human crystalline lenses from our centre.…”

Manual Small Incision Cataract Surgery

“…Its use was found to increase intraoperative safety, which was later confirmed in other studies as well. 18,19 Irrigating Cannula Nishi 20 described the use of an irrigating cannula for nucleus delivery. It consists of a 20-gauge needle attached with a flat insertion plate at 90 degrees to its axis with a flow outlet.…”