Results of the First Year's Experience by Phaco-Emulsification

Hiles, David A.; Hurite, Francis G.

doi:10.1016/0002-9394(73)91159-8

Cited by 35 publications

(5 citation statements)

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“…The procedure is now used by many surgeons. The technique requires advanced microsurgical skills and there is a high incidence of complications during the period when a surgeon is inexperienced in the method (Cleasby et al, 1974;Hiles and Hurite, 1973). However, over a larger number of operations the complications are comparable to those with conventional cataract procedures (Kelman, 1973).…”

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Effects of ultrasound on the corneal endothelium: I. The acute lesion.

Olson¹,

Marshall²,

Rice³

et al. 1978

British Journal of Ophthalmology

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SUMMARY The ultrasonic radiation utilised in phacoemulsification procedures for the removal of cataractous lenses results in the widespread production of discrete lesions in the corneal endothelium. The morphology of this induced damage has been examined in rabbit and man using both scanning and transmission electron microscopy. The illustrated results are related to both the duration of the ultrasonic exposure and to the mechanisms of damage.Phacoemulsification was introduced as a new technique for the surgical treatment of cataract by Kelman (1967). The principle of the technique is to fragment the lens nucleus by ultrasonic vibration, thereby allowing aspiration of the cataractous lens. The procedure is now used by many surgeons. The technique requires advanced microsurgical skills and there is a high incidence of complications during the period when a surgeon is inexperienced in the method (Cleasby et al., 1974;Hiles and Hurite, 1973). However, over a larger number of operations the complications are comparable to those with conventional cataract procedures (Kelman, 1973).Reports of the incidences of postoperative corneal oedema vary between zero (Kelman, 1974) and 18 % (Cleasby et al., 1974). Recently endothelial cell destruction has been shown to occur during the phacoemulsification procedure (Polack and Sugar, 1976;Binder et al., 1976). These lesions have been attributed to a number of mechanisms which include the effects of irrigation, lens manipulation, and lens fragments in the anterior chamber, instrument contact with the endothelium, and ultrasound. This paper investigates the effect of radiating ultrasound on corneal endothelium resulting from the application geometry and dosage commonly used during phacoemulsification. Materials and methodsAdult Dutch rabbits weighing 2 to 3 kg were killed with intravenous pentobarbitone prior to enucleation. The pair of isolated eyes was transported to the Address for reprints: Mr Noel S. C. Rice, FRCS, Moorfields Eye Hospital, City Road, London ECIV 2PD. phacoemulsifier in a constant temperature container maintained at room temperature. An average journey time was 45 minutes. On arrival the eyes were placed in a holder and a 3 mm incision was made at the limbus with the aid of a surgical microscope. The tip of a Cavitron-Kelman phacoemulsifier (Model 7007) was inserted into the anterior chamber parallel to the iris and at a depth approaching the edge of the pupil. Care was taken to avoid either the endothelium or lens capsule. The tip direction and location were noted and recorded. To one eye of each pair irrigation, aspiration, and ultrasound were given continuously for times ranging from 10 seconds to 5 minutes. Fresh glutathionebicarbonate-Ringer (GBR) solution maintained at room temperature was used for irrigation in all procedures. The ultrasonic transducer of the phacoemulsifier was fully tuned with a power setting of 8. The other eye of each pair was used as a control and was therefore exposed only to irrigation and aspiration. In some control eyes air...

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confidence: 99%

Effects of ultrasound on the corneal endothelium: I. The acute lesion.

Olson¹,

Marshall²,

Rice³

et al. 1978

British Journal of Ophthalmology

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“…Indeed, it is not clear that Kelman did other than fit contact lenses to his patients. The professional literature soon carried papers by other surgeons who reported outcomes similar to those achieved with the ECCE technique (Hiles and Hurite 1973;Cleasby et al 1974). Thus was born the technique that transformed cataract surgery.…”

Section: The Trigger Invention: Phakoemulsificationmentioning

confidence: 96%

Medical Innovation

Consoli¹,

Mina²,

Nelson³

et al. 2015

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This book brings together a collection of empirical case studies featuring a wide spectrum of medical innovation. While there is no unique pathway to successful medical innovation, recurring and distinctive features can be observed across different areas of clinical practice. Drawing on a broad body of research on Innovation, Science and Technology, this book examines why medical practice develops so unevenly across and within areas of disease, and how this relates to the underlying conditions of innovation across areas of practice.The contributions contained in this volume adopt a dynamic perspective on medical innovation based on the notion that scientific understanding, technology and clinical practice co-evolve along the coordinated search for solutions to medical problems. The chapters follow an historical approach to emphasise that the advancement of medical know-how is a contested, nuanced process, and that it involves a variety of knowledge bases whose evolutionary paths are rooted in the contexts in which they emerge. This book will be of interest to researchers and practitioners concerned with medical innovation, management studies and the economics of innovation.

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“…These reports found that the degree of endothelial damage was related to the duration of the operative procedure and suggest that corneal oedema should be a common postoperative complication of this technique. Reported results indicate that transient induced oedema decreases with increasing experience, with incidence as high as 18 % during early use of the instrument (Hiles and Hurite, 1973) and zero when the surgeon is proficient (Kelman, 1974). The occurrence of persistent oedema is far less common, with figures varying between zero (Kelman, 1974) and 2% (Cleasby et al, 1974).…”

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Effects of ultrasound on the corneal endothelium: II. The endothelial repair process.

Olson¹,

Marshall²,

Rice³

et al. 1978

British Journal of Ophthalmology

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SUMMARY The responses of corneal endothelium to a 2-minute exposure of ultrasound from a clinical phacoemulsification device have been studied by specular microscopy and both scanning and transmission electron microscope. Healing of lesions occurred in two ways, and these were related to lesion size. Small lesions healed by a process of rosette formation, and large lesions were repaired by a process of endothelial dedifferentiation and migration. All damaged areas were re-covered with endothelial cells within 24 hours of exposure, and at this time corneal thickness had returned to control levels. The implications are discussed in relation to the phacoemulsification procedure.The physiological processes which maintain the transparency of the cornea are ultimately dependent on the ability of the corneal endothelium to pump fluids out of the corneal stroma and into the aqueous (Hodson and Miller, 1976). Any agent which damages this system reduces the efficiency of the pumping mechanism and results in corneal swelling or oedema.Endothelial damage has been reported following the completion of phacoemulsification for cataract removal (Polack and Sugar, 1976;Binder et al., 1976) and recently in response to the isolated ultrasonic radiation component of this procedure (Olson et al., 1978). These reports found that the degree of endothelial damage was related to the duration of the operative procedure and suggest that corneal oedema should be a common postoperative complication of this technique. Reported results indicate that transient induced oedema decreases with increasing experience, with incidence as high as 18 % during early use of the instrument (Hiles and Hurite, 1973) and zero when the surgeon is proficient (Kelman, 1974). The occurrence of persistent oedema is far less common, with figures varying between zero (Kelman, 1974) and 2% (Cleasby et al., 1974).The apparent lack of correlation between the morphological damage seen in the corneal endothelium and the clinical observations on corneal oedema suggests a rapid healing process in response to this type of injury. The present paper investigates the behaviour of the corneal endothelium during the first week after exposure to ultrasonic radiation. Materials and methods IN VIVO EXPERIMENTSAdult Dutch rabbits weighing between 2 and 3 kg were anaesthetised with intravenous pentobarbitone before being given a retrobulbar injection of 0 5 ml of 1% lignocaine. With the aid of an operating microscope a 3-mm incision was made at the limbus and the tip of a Cavitron-Kelman phacoemulsifier (Model 7007) was introduced into the anterior chamber parallel to the iris and at a depth approaching the edge of the pupil. Care was taken to avoid contact with endothelium and the lens capsule. All corneas were exposed to 2 minutes of ultrasound, with the generator fully tuned and a power setting of 8. Glutathione-bicarbonate-Ringer (GBR) solution was used for irrigation thoughout these experiments. After exposure, the tip was withdrawn and the limbal wound was sutured with 8-0 silk....

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Results of the First Year's Experience by Phaco-Emulsification

Cited by 35 publications

References 5 publications

Effects of ultrasound on the corneal endothelium: I. The acute lesion.

Effects of ultrasound on the corneal endothelium: I. The acute lesion.

Medical Innovation

Effects of ultrasound on the corneal endothelium: II. The endothelial repair process.

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