Cataract/Phacoemulsification

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VCA Eye Clinic for Animals Cataract/Phacoemulsification April 2021 Issue #2 Louie Bear’s Journey Pet of at VCA Eye Clinic for the Animals month: Louie Bear went blind the week of Thanksgiving 2020. Nicole, Louie Bear’s mom, started noticing that he Louie was bumping into the glass door, walls, and furniture around the Bear house. She also observed that his eyes were opaque (cloudy) and since Louie Bear is a 13y 6m he is a diabetic, she was concerned chocolate Labrador. He about cataracts. Louie Bear was first was rescued at the age brought to VCA ECFA on November of one from Labrador 23, 2020 where Dr. Strubbe Rescuers. Louie Bear confirmed cataracts and enjoys lounging in the recommended phacoemulsification garden under his and intraocular lens implantations. favorite lavender bush, and he also loves to go on walk and say hello to his neighbors. Louie Louie Bear’s Post- Bear finds entertainment in playing Operative Life with his life size Panda Dr. Strubbe returned Louie Bear’s and carrying it around eyesight on December 1, 2020 just the house. in time for the holidays. With his eyesight back to normal, Louie Bear is able to enjoys strolling in his neighborhood and seeing his favorite people again. “He is so happy and has a sassy swagger in his steps each day! Thanks to Dr. Strubbe and the team.” – Nicole Wissemann. What is a cataract? A cataract is an opacity of the lens Advanced cataracts are a leading within the eye. The lens’ function is to cause of blindness in dogs and are focus light rays on the retina, and generally recognizable by pet owners cataracts decrease vision by as a decrease in the dog’s vision or by interfering with light reaching the a cloudy, whitish-blue appearance to retina. the eye. What is the complete evaluation of the eyes. At What causes the exam, our doctor will determine if Treatment? cataracts are present and if surgery cataracts? might be an option. After that, the Vision of affected dogs patient will go through preoperative Inherited defects are the most can often be restored to medical testing to see if he/she is the common cause of cataracts in the a normal state by right candidate for the surgery. The dog. Other causes include injuries to surgically removing the first test called an electroretinogram, the eye or diseases such as diabetes abnormal lens and which can determine if the retina is mellitus. substituting an artificial working. The second test is an ocular lens. ultrasound. Here we are looking for retinal detachments, floaters in the The first step is to back of the eye, or anything else that What is the most schedule an would adversely affect the outcome of appointment for a surgery. common question? The most common question that owners have is: “How soon will my pet be able to see again?” In most cases, Please reach out they will walk out of the hospital being able to see much better than when to us if you would they walked in. This vision will improve as the inflammation like your fur decreases and the eyes begin to heal. babies to be VCA Eye Clinic for Animals (858)502-1277 featured in our [email protected] monthly 5610 Kearny Mesa Road, Suite A, San Diego, CA 92111 newsetter! .

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Evaluation of Phacoemulsification Cataract Surgery Outcomes After Penetrating Keratoplasty
Open Access Maced J Med Sci electronic publication ahead of print, published on December 20, 2019 as https://doi.org/10.3889/oamjms.2019.379 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2019.379 eISSN: 1857-9655 Basic and Clinical Medical Researches in Vietnam Evaluation of Phacoemulsification Cataract Surgery Outcomes After Penetrating Keratoplasty Le Xuan Cung1, Do Thi Thuy Hang1, Nguyen Xuan Hiep1, Do Quyet2, Than Van Thai3, Vu Thi Nga4, Nguyen Duy Bac2, Dinh Ngan Nguyen2* 1Vietnam National Institute of Ophthalmology, Hanoi, Vietnam; 2Vietnam Military Medical University (VMMU), Hanoi, Vietnam; 3NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 4Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam Abstract Citation: Cung LX, Hang DTT, Hiep NX, Quyet D, Thai BACKGROUND: Cataract is one of the reasons which causes impaired visual acuity (VA) of the eyes after TV, Nga VT, Bac ND, Nguyen DN. Evaluation of penetrating keratoplasy (PK), which can be treated by cataract surgery after PK or triple procedure. Cataract Phacoemulsification Cataract Surgery Outcomes After Penetrating Keratoplasty. Open Access Maced J Med Sci. surgery after PK has advantages that parameters of the eyes such as axial length, anterior chamber depth (ACD) https://doi.org/10.3889/oamjms.2019.379 as well as corneal curvature are stabilized after removing all sutures postoperatively, and intraocular lens (IOL) Keywords: Complicated Cataract; Corneal graft; power can be calculated correctly. Therefore, postoperative VA will be improved significantly. In Vietnam, there Penetrating Keratoplasty; Phacoemulsification have not been any study about cataract surgery after PK, therefore we conduct this research.
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Changes in macular perfusion after Phacoemulsification surgery Sabah Abd El Azeem Soud, Doaa El Said El Badrawy, Nesma Sayed Mohammed Department of Ophthalmology, Alzahraa University Hospital, AL-Azhar University, Cairo, Egypt [email protected] Abstract: Background: Optical coherence tomography angiography (OCT-A) is a non-invasive, non-dye-based imaging modality that is used worldwide in the daily practice of ophthalmology. OCTA enhances our understanding of retinal diseases and retinal vascular changes. Objective: To evaluate, by means of optical coherence tomography angiography (OCTA) the changes that may occur at the macular vessels after phacoemulsification surgery and if these changes can affect the post-operative visual acuity. Patients and Methods: It was a prospective study carried out at Al Zahraa University Hospital on 30 eyes of 21 Patients with senile cataract were included. Retina vessel density at the macular area was checked by OCT A at 1 week, 1 month, and 3 months after cataract surgery. Results: Thirty eyes (21 patients) were included in the final analysis. There was a significant increase in retinal vessel density at the macular area after the cataract surgery, repeated-measures which extended to the end of the follow-up period. At 3 months postoperatively, Appearance of hyper reflective retinal spots post operatively was also noted. Conclusions: Macular vessel density increased after phacoemulsification surgery. These changes seem not to affect visual acuity. Whether these changes will persist over a longer period of time, that still needs to be studied. [Sabah Abd El Azeem Soud, Doaa El Said El Badrawy, Nesma Sayed Mohammed. Changes in macular perfusion after Phacoemulsification surgery.
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Intraocular Pressure During Phacoemulsification
J CATARACT REFRACT SURG - VOL 32, FEBRUARY 2006 Intraocular pressure during phacoemulsification Christopher Khng, MD, Mark Packer, MD, I. Howard Fine, MD, Richard S. Hoffman, MD, Fernando B. Moreira, MD PURPOSE: To assess changes in intraocular pressure (IOP) during standard coaxial or bimanual micro- incision phacoemulsification. SETTING: Oregon Eye Center, Eugene, Oregon, USA. METHODS: Bimanual microincision phacoemulsification (microphaco) was performed in 3 cadaver eyes, and standard coaxial phacoemulsification was performed in 1 cadaver eye. A pressure transducer placed in the vitreous cavity recorded IOP at 100 readings per second. The phacoemulsification pro- cedure was broken down into 8 stages, and mean IOP was calculated across each stage. Intraocular pressure was measured during bimanual microphaco through 2 different incision sizes and with and without the Cruise Control (Staar Surgical) connected to the aspiration line. RESULTS: Intraocular pressure exceeded 60 mm Hg (retinal perfusion pressure) during both standard coaxial and bimanual microphaco procedures. The highest IOP occurred during hydrodissection, oph- thalmic viscosurgical device injection, and intraocular lens insertion. For the 8 stages of the phaco- emulsification procedure delineated in this study, IOP was lower for at least 1 of the bimanual microphaco eyes compared with the standard coaxial phaco eye in 4 of the stages (hydro steps, nu- clear disassembly, irritation/aspiration, anterior chamber reformation). CONCLUSION: There was no consistent difference in IOP between the bimanual microphaco eyes and the eye that had standard coaxial phacoemulsification. Bimanual microincision phacoemul- sification appears to be as safe as standard small incision phacoemulsification with regard to IOP. J Cataract Refract Surg 2006; 32:301–308 Q 2006 ASCRS and ESCRS Bimanual microincision phacoemulsification, defined as capable of insertion through these microincisions become cataract extraction through 2 incisions of less than 1.5 mm more widely available.
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Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy
Open Access Original Article DOI: 10.7759/cureus.12950 Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy Danny Lam 1 , David Z. Wechsler 1, 2 1. Ophthalmology, University of Sydney, Sydney, AUS 2. Ophthalmology, Macquarie University, Sydney, AUS Corresponding author: Danny Lam, [email protected] Abstract Purpose The purpose of this study is to examine five-year outcomes of trabeculectomy and compare the stand-alone procedure when combined with phacoemulsification. Patients and methods This study included 123 eyes of 109 patients, with 79 patients in the trabeculectomy group and 44 patients in the phacotrabeculectomy group. Non-randomized comparative cohort study with data collected retrospectively from an existing database compiled by a single surgeon operating in Sydney, Australia from 2007 to 2019. The primary outcome measure was intraocular pressure. Secondary outcome measures were a number of glaucoma medications, treatment success rates, best-corrected visual acuity, bleb morphology, post-operative complications, and re-operation rate. Results The mean intraocular pressure was 10.6 ± 2.7 mm Hg in the trabeculectomy group (pre-operative mean intraocular pressure of 28.0 ± 9.8) and 12.0 ± 3.0 mm Hg in the phacotrabeculectomy group (pre-operative mean intraocular pressure of 23.4 ± 7.9) after five years (P = 0.052). The number of glaucoma medications required was 0.3 ± 0.7 in the trabeculectomy group (pre-operative mean of 3.7 ± 1.1) and 1.3 ± 1.2 in the phacotrabeculectomy group (pre-operative mean of 3.1 ± 1.0, P < 0.001). Conclusions Intraocular pressure reduction post-operatively over five years was similar between trabeculectomy and phacotrabeculectomy as determined by mean intraocular pressure, and intraocular pressure reduction from baseline.
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Retinal Microvascular Alterations After Phacoemulsification in Patients With
Retinal microvascular alterations after phacoemulsication in patients with diabetes evaluated using optical coherence tomography angiography Le Feng Shanghai Tenth People's Hospital https://orcid.org/0000-0002-2148-7423 Guliqiwaer Azhati Shanghai Tenth People's Hospital Tingting Li Shanghai Tenth People's Hospital Fang Liu ( [email protected] ) https://orcid.org/0000-0003-2844-2225 Research article Keywords: retinal microvasculature, phacoemulsication, diabetes, OCT angiography Posted Date: August 26th, 2019 DOI: https://doi.org/10.21203/rs.2.13588/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/13 Abstract Purpose: To quantify changes in retinal microvasculature in diabetic patients after phacoemulsicatio by using optical coherence tomography angiography (OCTA). Methods: Macular thickness(MT), supercial capillary plexus (SCP), deep capillary plexuses (DCP) and foveal avascular zone (FAZ) measurements of the 3×3 mm macular images were obtained by OCTA at baseline, 1 day,1 week, 1 month, and 3 months after cataract surgery in diabetic and non- diabetic patients. Results: There was a signicant increase in MT at 1 month and 3 months after surgery in both groups (all P<0.05), but no signicant difference between the two groups (p= 0.217). At 3 months postoperatively, the SCP increase was signicantly higher compared with baseline in diabetic group (P<0.05). The MT and SCP was negatively correlated with logMAR best corrected visual acuity(BCVA), while the FAZ area and perimeter were positively correlated with logMAR BCVA in diabetic group. Conclusions: Cataract surgery can increase macular thickness in both diabetic and non- diabetic patients, and also increase the SCP in diabetic patients.
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IOC Mednick: Challenging Surgical Cases
Top 5 Pearls to Consider When Implanting Advanced Technology IOLs in Patients With Unusual Circumstances Zale D. Mednick, BA Guillermo Rocha, MD, FRCSC ’ Pearl #1: The Use of a Toric Multifocal Intraocular Lens (IOL) in the Management of Hyperopic Astigmatism Background The mainstay of treatment for those with hyperopic astigmatism who wish to bypass the need for glasses or contacts has traditionally been laser treatment. Both hyperopic laser in situ keratomileusis (LASIK) and photorefractive keratotomy (PRK) have been used to correct hyperopic astigmatism. Although LASIK can provide promising results for a portion of patients with hyperopic eyes, it becomes less effective when dealing with more exaggerated degrees of hyperopia. Refractive results are much more successful for low diopter (D) hyperopia, with a drop in efﬁcacy starting at + 4.00 to + 5.00 D.1 Esquenazi and Mendoza2 reported that when LASIK is performed on eyes with >5.00 D of hyperopia, both the safety proﬁle of the procedure and the refractive outcomes dramatically decline, coinciding with decreased corrected distance visual acuity (CDVA). Choi and Wilson3 echoed this notion, citing a 2-line drop in CDVA when LASIK was used to treat hyperopia of 5.00 to 8.75 D. This is in stark contrast to the results achieved by LASIK to improve myopia, where corrections are feasible for a far greater range of refractions. Part of the reason that hyperopia is less amenable to correction of higher diopter errors may owe to the fact that larger ablation zones are needed to achieve better refractive results.4 The optimal size of the ablation zone for hyperopic LASIK is >5.5 mm,1 and as such, more corneal alteration is required.
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Phacoemulsification Article by Penelope L
CONTINUING EDUCATION EXAMINATION PHACOEMULSIFICATION ARTICLE BY PENELOPE L. KUHN, CST In1967, an extraordinary innovation in cataract surgery Instrumentation was introduced by Dr Charles D. Kelman.' Distressed by cataract extraction procedures resulting in wound-related The Machine complications and long recuperative periods, Dr Kelman Several generations of phacoemulsification units have been developed a technique enabling surgeons to remove a cata- introduced since Kelman's early prototype in 1967. While ract from a small, 3.0-mm incision utilizing a sophisticated these models differ with respect to various features, instru- form of machine-assisted extracapsular cataract extraction mentation and mechanics are comparable between units. (ECCE). Kelman's development revolutionized cataract The following information is based upon the Phaco- surgery, which until then had been plagued by large inci- Emulsifier Aspirator (PEA) by Alcon Laboratories. sions and traumatic techniques. To describe his new proce- The PEA is an extremely complex piece of equipment, dure, Kelman coined the term phacoemulsijication. yet its operation is relatively simple. It has three basic This paper provides the surgical technologist with an functions: irrigation, aspiration, and ultrasonic vibration. overview of phacoemulsification mechanics, instrumenta- Later PEA models include vitrectomy capabilities. These tion, and operative procedure. functions are selected by compression of a footswitch. In addition, manual control switches are placed on the PEA Kelman Phacoemulsification unit's front console and consist of varying combinations of The term phacoemulsification implies emulsification of the the following: a main power switch, a footswitch position crystalline lens. In actuality, the lens is not liquified but fragmented into pieces small enough to be aspirated.
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Pars Plana Vitreous Tap for Phacoemulsification in the Crowded Eye
techniques Pars plana vitreous tap for phacoemulsification in the crowded eye David F. Chang, MD ABSTRACT This technique facilitates phacoemulsification and foldable intraocular lens (IOL) im- plantation in eyes with extremely crowded anterior segments. An automated pars plana vitreous tap is used to expand the anterior segment when extremely shallow anterior chambers do not deepen sufficiently with viscoelastic injection alone. This technique permits successful completion of pupilloplasty, capsulorhexis, phacoemulsification, and foldable IOL implantation in these high-risk eyes. J Cataract Refract Surg 2001; 27:1911–1914 © 2001 ASCRS and ESCRS he crowded anterior segment presents one of the scribe the use of an automated pars plana vitreous tap to Tmost challenging situations for the phacoemulsifi- facilitate small incision cataract surgery. cation surgeon. Whether because of a short axial length, a larger lens, or a combination, these eyes present with Surgical Technique narrow angles and shallow anterior chambers. As a re- sult, they carry an increased risk of peripheral capsulo- If a vitreous tap is anticipated, a retrobulbar local rhexis tears, corneal decompensation, and intraoperative anesthetic agent is administered. An attempt is made to suprachoroidal hemorrhage.1 Although injection of a deepen the anterior chamber by injecting a retentive, viscoelastic substance usually provides enough room to dispersive viscoelastic substance through a clear corneal perform phacoemulsification, we occasionally encoun- stab incision. This is stopped once the globe starts to ter eyes with anterior chambers so shallow that they do become firm to prevent iris prolapse. In cases in which not deepen sufficiently with viscoelastic material. I de- the anterior chamber remains virtually flat, a pars plana vitreous tap is performed in the following manner: A small conjunctival incision is created at the intended site.
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Full‐Field Electroretinography in Age‐Related Macular Degeneration
Acta Ophthalmologica 2020 Full-field Electroretinography in Age-related Macular Degeneration: can retinal electrophysiology predict the subjective visual outcome of cataract surgery? Thomas Richard Johansen Forshaw,1,2 Hassan Javed Ahmed,3 Troels Wesenberg Kjær,2,4 Sten Andreasson5 and Torben Lykke Sørensen1,2 1Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark 2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark 3Department of Ophthalmology, Zealand University Hospital, Næstved, Denmark 4Department of Neurophysiology, Zealand University Hospital, Roskilde, Denmark 5Department of Ophthalmology, Lund University, Lund, Sweden ABSTRACT. Purpose: Predicting the visual gain from cataract surgery when the main cause of vision loss is age-related macular degeneration may be difficult and warrants the need for an objective predictor of subjective outcome. Full-field electroretinography is an objective measure of overall retinal function. We therefore wanted to study if full-field electroretinography can predict subjective visual outcome using visual function questionnaire. Methods: Thirty-one patients with age-related macular degeneration operated for bilateral cataract underwent full-field electroretinography preoperatively. Full-field electroretinography was performed according to International Society for the Clinical Electrophysiology of Vision standards using a Ganzfeld bowl (RETI-port/scan 21, Roland, Berlin) and Dawson– Trick–Litzkow fibre electrodes. Vision-related quality of life was measured using the National Eye Institute Visual Function Questionnaire-39 before first-eye surgery and 4.12 Æ 2.11 months after second-eye surgery. Results: Mean change in composite visual function questionnaire score after cataract surgery was 9.2 Æ 11.9. The patients were divided into three groups: visual function questionnaire composite score increase >10 (n = 17); no change (n = 8); and decrease (n = 6).
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Phacoemulsification After Pars Plana Vitrectomy: Pearls for the Cataract Surgeon
Ophthalmic Pearls EXTRA CATARACT CONTENT AVAILABLE Phacoemulsification After Pars Plana Vitrectomy: Pearls for the Cataract Surgeon by robert van der vaart, md, and kenneth l. cohen, md edited by sharon fekrat, md, and ingrid u. scott, md, mph ars plana vitrectomy (PPV) capsulorrhexis more difficult. Because 1A is now a frequently per- of decreased resistance, the surgeon formed vitreoretinal surgery needs to exert more pressure with the that, with improvements cystotome or the point of the capsulor- over the last decade, gen- rhexis forceps. However, occult zonu- Perally provides excellent anatomic, lar instability and/or posterior capsule visual, and safety outcomes. The damage may be present after PPV, and indications for PPV are numerous greater pressure against the capsule and include rhegmatogenous or trac- may exacerbate the situation. tional retinal detachment, proliferative Removal of the nucleus, epinucleus, diabetic retinopathy, macular hole, and cortex is complicated by the lack epiretinal membrane, trauma, vitreous of vitreous support, compromise of the hemorrhage, and endophthalmitis. supporting structures of the lens, and Although patients are commonly large fluctuations in anterior cham- referred to a vitreoretinal specialist for ber depth. These factors also make it PPV, the comprehensive ophthalmolo- more difficult to place the IOL in the 1B gist is likely to participate in the long- capsular bag. The incidence of periop- term care of postvitrectomy patients. erative complications, including iris For example, the ophthalmologist trauma, choroidal hemorrhage, and will probably be faced with making nuclear fragment loss, may be as high decisions about cataract surgery, as as 12.5%.2 cataract develops and progresses in up to 70% of patients within 2 years after Preoperative Considerations PREOPERATIVE DISCOVERY.
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Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
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Refractive Outcomes of Phacoemulsification Cataract Surgery in Glaucoma Patients
348 ARTICLE Refractive outcomes of phacoemulsification cataract surgery in glaucoma patients Niranjan Manoharan, MD, Jennifer L. Patnaik, PhD, Levi N. Bonnell, MPH, Jeffrey R. SooHoo, MD, Mina B. Pantcheva, MD, Malik Y. Kahook, MD, Brandie D. Wagner, PhD, Anne M. Lynch, MD, Leonard K. Seibold, MD Purpose: To evaluate refractive outcomes after phacoemulsifica- (P Z .0061) and 11.2% (P Z .0011) in the glaucoma group. Primary tion cataract surgery in patients with glaucoma. open-angle glaucoma (POAG) (n Z 154 eyes), chronic angle-closure glaucoma (n Z 18 eyes), and pseudoexfoliation glaucoma (n Z 23 Setting: University of Colorado Health Eye Center, Aurora, Colo- eyes) had odds ratios of 1.90 (P Z .1760), 14.54 (P Z .0006), and rado, USA. 7.27 (P Z .0138), respectively, of refractive surprise greater than G1.0 D compared with patients without glaucoma. Refractive Design: Retrospective case series. surprise was noted more often in POAG eyes with axial lengths longer than 25.0 mm (P Z .0298). Glaucoma eyes had worse Methods: The incidence of refractive surprise was evaluated in mean postoperative corrected distance visual acuity than control patients with and without glaucoma after phacoemulsification cata- eyes (glaucoma: 0.1088 logarithm of the minimum angle of ract surgery. Refractive surprise was defined as the difference in resolution [logMAR]; controls: 0.0358 logMAR; P Z .01). spherical equivalent of the refractive target and postoperative refraction in diopters (D). Conclusion: Patients with a diagnosis of glaucoma were more likely to have a refractive surprise and/or worse visual outcome after Results: The study comprised 206 eyes in the glaucoma group phacoemulsification cataract surgery.
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