The surgical challenges dense brunescent cataracts present

Crispim, João; Jung, Liang Shih; Paz, Lucila; Allemann, Norma; Schor, Paulo

doi:10.1586/17469899.2015.982097

Cited by 5 publications

(7 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 15 , 18 The initial fragmentation step of a very dense lens can be challenging, particularly in patients with ocular comorbidities and zonular weakness. 10 , 11 , 14 While the rate of AEs in phacoemulsification cataract surgery is quite low, in this large, single-surgeon, non-randomized cohort, the lens fragmentation device was associated with a statistically significant reduction in the frequency of overall intraoperative AEs and complications, Serious intraoperative AEs such as posterior capsule rupture and unplanned anterior vitrectomy are more common with very dense cataracts. Posterior capsule rent, for example, occurs in 0.45‒3.6% of cataract surgeries performed by experienced surgeons, 20 and the incidence of posterior capsule rupture or rent in the current study was similar and within this range in both study groups.…”

Section: Discussionmentioning

confidence: 76%

“…9 Addressing advanced cataracts typically requires modification to the surgical preparation or technique, including the use of additional instrumentation for successful removal. While there are a wide range of different approaches to dense cataract nuclear disassembly, such as divide and conquer, in situ fracture, stop and chop, and phaco chop, 10 nearly all techniques result in increased phacoemulsification time and intensity required to fragment and emulsify the solidified nucleus. Higher levels of ultrasonic phacoemulsification energy inherently expose a greater risk of trauma to the cornea and capsular structures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Study of Safety Outcomes Following Nucleus Disassembly with and without the miLOOP Lens Fragmentation Device During Cataract Surgery

Hu¹,

Buie²,

Jensen³

et al. 2022

OPTH

View full text Add to dashboard Cite

Purpose To determine the effect of a microinterventional lens prefragmentation wire loop device (miLOOP ® ; Carl Zeiss Meditec AG, Oberkochen, Germany), on adverse events (AEs), cumulative dispersed energy (CDE), and vision outcomes when used before phacoemulsification of high-grade mature cataracts. Setting Three ambulatory surgical centers in the Peoria, IL region. Design Retrospective comparative consecutive case series; single-surgeon. Methods Patient outcomes were compared before and after introduction of miLOOP-assisted lens fragmentation prior to phacoemulsification during cataract surgeries performed 2016‒2020. The primary outcome was intraoperative AE rate/type. Secondary outcomes included ultrasound cumulative dispersed energy (CDE) administered during phacoemulsification, postoperative AEs, and best-corrected visual acuity (BCVA). Results Data from 765 subjects (mean age 72.9 years; 1025 eyes) comprised 524 conventional lens disassembly (Control) eyes and 501 Device eyes. One hundred percent of the cataracts in both groups were advanced WHO Grade 3+ nuclei. Significantly fewer intraoperative AEs occurred in the Device group versus Controls (2.2% and 6.3% of eyes, respectively; p=0.0011). Postoperative AE rates were comparable between groups (Controls=2.9%, Device=3.5%). Mean CDE from ultrasound was significantly reduced by 21% when the microfilament loop device was used for nuclear disassembly (9.6±5.2 CDE units) versus Controls (11.6±6.4 CDE units; p<0.0001). Median postoperative BCVA was 20/25 Snellen (0.091 logMAR) in both groups. More than 70% of both Control and Device eyes had postoperative BCVA better than 20/30 Snellen. Conclusion Microinterventional lens fragmentation was associated with lower ultrasound energy use and improved intraoperative safety than traditional unassisted surgery of advanced high-grade cataracts, while maintaining similarly acceptable postoperative complication rates and BCVA functional outcomes.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Comparative Study of Safety Outcomes Following Nucleus Disassembly with and without the miLOOP Lens Fragmentation Device During Cataract Surgery

Hu¹,

Buie²,

Jensen³

et al. 2022

OPTH

View full text Add to dashboard Cite

show abstract

“…The main factor affecting lens change is the wavelength of light absorbed by the lens. Research on normal human lenses in vitro shows that chronic exposure to UV rays causes the lens to turn brunescent [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…In brunescent cataract, the difficulty level of cataract surgery is much more difficult due to the very hard lens nucleus, compared to non-cataracts brunescent (Kim WS and Kim KH, 2016). This condition makes it difficult to perform cataract surgery with phacoemulsification techniques, because the ultrasonic energy used during cataract surgery is bigger and longer, thus increasing the risk of intra and post-operative complications [4].…”

Section: Research Articlementioning

confidence: 99%

“…Chromophore that undergoes this modification will display different fluorescence when exposed to UVA [2]. Kynurenine (kynurenine, N-for-mylkynurenine, 3-hydroxykynurenine [3HK], OBD-Glucoside, and 4-(2-amino-3-hydroxyphenyl)-4oxobutanoic acid OBD-Glucoside, quinoline group (quinaldic acid, kynurenic acid, xanthurenic acid, oxoxanthurenic acid and 4-(hydroxy 3-glycine)-quinoline), Group B-carbolines (2,4,(7)(8)(9)(10)(11), and the argpyrimidine group are components of organic molecules found in all crystalline lens proteins [14,15]. Fluorescent chromophores are formed from tryptophan compounds ("UV filter" compounds) such as GSH-3-OHKG, and 3HK, which form cross-linked derivatives with crystalline proteins.…”

Section: Hidayat Et Almentioning

confidence: 99%

See 1 more Smart Citation

THE ANALYSIS OF a-CRYSTALLINE PROTEIN IN WHITE AND BRUNESCENT CATARACT

Hidayat

Nasrul

Gondhowiharjo

et al. 2021

Asian J Pharm Clin Res

View full text Add to dashboard Cite

Objectives: The objectives of the study were to determine the difference of concentration and expression of α-crystalline protein in white and brunescent cataract lenses. Methods: The design of this study is cross-sectional comparative. The subject was cataract patients who underwent cataract surgery in Puskesmas Pariaman, West Sumatra, Indonesia. Lens examination was carried out at the Microbiology Laboratory of FK Unand from July 2019 to February 2020. The samples consisted of 36 subjects who met the inclusion criteria. ELISA examination was used to determine the concentration of α-crystalline protein and Western Blot examination was performed to see the expression of the α-crystalline protein in all subjects. Results: The difference in the concentration of α-crystalline protein in white cataract and brunescent cataract was not statistically significant, with p=0.129 (p>0.05). The result of Western blot examination was normal expression of α-crystalline protein in white cataract and under expression of α-crystalline protein in brunescent cataracts. Conclusion: The expression of α-crystalline protein appeared to be different between white and brunescent cataract lenses. In brunescent cataract, under expression of α-crystalline proteins was related to the decrease of chaperone activity. This change occurred allegedly because of photochemical reaction that happened inside the lens.

show abstract