Intraocular Lens-shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety when Treating Dense Nuclear Cataracts

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 Nov 18

PMID 25401512

Citations 6

Authors

Lixia Luo

Haotian Lin

Weirong Chen

Bo Qu

Xinyu Zhang

Zhuoling Lin

Jingjing Chen

Yizhi Liu

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts.

Methods: Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the "IOL-shell technique", features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out.

Results: The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05).

Conclusions: Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT02138123).

Trial Registration: ClinicalTrials.gov NCT02138123.

Citing Articles

Observations of the efficacy of the artificial lens cushion plate technique in hard-core cataract surgery.

Huang Z, Zheng M, Xu M, Cai L, Song X Front Med (Lausanne). 2024; 11:1406578.

PMID: 39301492 PMC: 11410693. DOI: 10.3389/fmed.2024.1406578.

Corneal Edema after Cataract Surgery.

Briceno-Lopez C, Burguera-Gimenez N, Garcia-Domene M, Diez-Ajenjo M, Peris-Martinez C, Luque M J Clin Med. 2023; 12(21).

PMID: 37959216 PMC: 10647590. DOI: 10.3390/jcm12216751.

Femtosecond laser-assisted cataract surgery in a spherophakic lens: An unusual case report.

Cao D, Wang Y, Lei R, Khan M, Wang L Medicine (Baltimore). 2019; 98(44):e17426.

PMID: 31689746 PMC: 6946445. DOI: 10.1097/MD.0000000000017426.

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification.

Hua X, Dong Y, Wang L, Li Z, Du J, Chi W Int J Ophthalmol. 2019; 12(7):1215-1218.

PMID: 31341816 PMC: 6629814. DOI: 10.18240/ijo.2019.07.25.

"Crack, Reduce, and Implant": A Safe Phaco Technique in a Case with Hard Brown Cataract.

Toprak I, Yaylali V Case Rep Med. 2019; 2019:9043417.

PMID: 30833969 PMC: 6369501. DOI: 10.1155/2019/9043417.

References

Gimbel H, Pereira C . Advances in phacoemulsification equipment. Curr Opin Ophthalmol. 2002; 13(1):30-2. DOI: 10.1097/00055735-200202000-00007. View

Edelhauser H, VAN HORN D, Hyndiuk R, Schultz R . Intraocular irrigating solutions. Their effect on the corneal endothelium. Arch Ophthalmol. 1975; 93(8):648-57. DOI: 10.1001/archopht.1975.01010020614011. View

POLACK F, Sugar A . The phacoemulsification procedure. II. Corneal endothelial changes. Invest Ophthalmol. 1976; 15(6):458-69. View

Olson L, Marshall J, Rice N, Andrews R . Effects of ultrasound on the corneal endothelium: I. The acute lesion. Br J Ophthalmol. 1978; 62(3):134-44. PMC: 1043167. DOI: 10.1136/bjo.62.3.134. View

Koch P, Katzen L . Stop and chop phacoemulsification. J Cataract Refract Surg. 1994; 20(5):566-70. DOI: 10.1016/s0886-3350(13)80239-8. View

Leaming D . Practice styles and preferences of ASCRS members--1998 survey. J Cataract Refract Surg. 1999; 25(6):851-9. View

Luo L, Lin H, He M, Congdon N, Yang Y, Liu Y . Clinical evaluation of three incision size-dependent phacoemulsification systems. Am J Ophthalmol. 2012; 153(5):831-839.e2. DOI: 10.1016/j.ajo.2011.10.034. View

Zeng M, Liu X, Xia Y, Luo L, Yuan Z, Zeng Y . Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol. 2008; 92(8):1092-6. PMC: 2569137. DOI: 10.1136/bjo.2007.128504. View

Sato M, Mizushima Y, Oshika T . Visco-shell technique with sodium hyaluronate 2.3% in phacoemulsification of Morgagnian cataract. J Cataract Refract Surg. 2008; 34(11):1824-7. DOI: 10.1016/j.jcrs.2008.05.064. View

10.

Wang Y, Xia Y, Zeng M, Liu X, Luo L, Chen B . Torsional ultrasound efficiency under different vacuum levels in different degrees of nuclear cataract. J Cataract Refract Surg. 2009; 35(11):1941-5. DOI: 10.1016/j.jcrs.2009.05.055. View

11.

Simanjuntak G, Tan J, Mailangkay H . Double extra sharp chopper increase efficacy of phacoemulsification for hard mature cataract surgery. Semin Ophthalmol. 2010; 25(1-2):8-12. DOI: 10.3109/08820538.2010.482846. View

12.

Hwang H, Kim E, Kim M . Drill-and-crack technique for nuclear disassembly of hard nucleus. J Cataract Refract Surg. 2010; 36(10):1627-30. DOI: 10.1016/j.jcrs.2010.08.003. View

13.

Shah P, Yoo S . Innovations in phacoemulsification technology. Curr Opin Ophthalmol. 2006; 18(1):23-6. DOI: 10.1097/ICU.0b013e328011f9d0. View