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Background: This study aims to determine the incidence of conjunctival chemosis during phacoemulsification and to explore the possible mechanism and treatments. Methods: Patients with or without chemosis during phacoemulsification by the same operator within two years were included. The initial site of chemosis, the chemosis originated time, and the degree of chemosis at the end of the surgery were recorded. The differences in phacoemulsification energy/time and irrigation volume were compared between two groups. Meanwhile, the distance between the clear corneal incision (CCI) and the end of the Bowman's layer, surgically induced astigmatism (SIA), intraocular pressure and central corneal thickness were also compared between the two groups. Results: The incidence of intraoperative chemosis was 9.17% (66/720). The distance between CCI and the end of the Bowman's layer in the chemosis group was significantly longer than that in the non-chemosis group postoperatively (P < 0.0001). The initial sites of chemosis were located on both sides of the external opening of the CCI. The average time from the phacoemulsification probe introducing into the anterior chamber to the originating of chemosis was 30.23 ± 49.23s. Conclusion: Intraoperative chemosis is related to the distance from CCI to the end of Bowmen's layer. The residual conjunctiva around the incision wraps the phacoemulsification probe sleeve to form a passage, the leakage fluid enters the subconjunctiva through this passage, forming chemosis. Conjunctival incision on both sides of CCI can effectively prevent the development of chemosis. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to determine the incidence of conjunctival chemosis during phacoemulsification and to explore the possible mechanism and treatments. Methods Patients with or without chemosis during phacoemulsification by the same operator within two years were included. The initial site of chemosis, the chemosis originated time, and the degree of chemosis at the end of the surgery were recorded. The differences in phacoemulsification energy/time and irrigation volume were compared between two groups. Meanwhile, the distance between the clear corneal incision (CCI) and the end of the Bowman’s layer, surgically induced astigmatism (SIA), intraocular pressure and central corneal thickness were also compared between the two groups. Results The incidence of intraoperative chemosis was 9.17% (66/720). The distance between CCI and the end of the Bowman’s layer in the chemosis group was significantly longer than that in the non-chemosis group postoperatively (P

Cataract surgery is the most commonly performed eye surgical procedure. Many ophthalmologists choose phacoemulsification as a cataract surgery procedure. The phacoemulsification technique has many advantages for both the operator and the patient. The main advantages are the smaller incision size, which minimizes tissue damage, lacks inflammation and postoperative pain, and provides faster refractive stabilization with minimal astigmatism due to surgery. The presence of smaller incised wounds in this phacoemulsification technique allows for faster wound healing. The aim of this study was to determine and obtain an overview of wound healing in clear cornea incisions for cataract patients after phacoemulsification surgery on control days 1, 3, and 7 at Hasanuddin University Makassar State University Hospital in February 2021. This study used a prospective cohort research design by collecting patient data on days 1, 3, and 7 after the phacoemulsification procedure. The sample consisted of six men and four women, with an average age of 48.9 years. The patient's vision is typically at the counting finger level, i.e. 70%, with the remaining 30% at the hand movement level. On day 7, a wound healing image of a clear corneal incision in a patient after phacoemulsification surgery shows significant changes in the anterior segment OCT image. [ABSTRACT FROM AUTHOR]

Xinfang Cao, Jie Shao, Yonggang Zhang, Li Zheng, Jun Zhang Department of Ophthalmology, Hangzhou MSK Eye Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Jun Zhang, Department of Ophthalmology, Hangzhou MSK Eye Hospital, Hangzhou, Zhejiang Province, People’s Republic of China, Tel +86 571 85068587, Email zhangjun@mskyk.onaliyun.comPurpose: To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in femtosecond laser-assisted cataract surgery and compare them between 2 types of CCIs: temporal and superior approach.Patients and Methods: Patients received the temporal CCIs (Group A) or the superior CCIs (Group B). Outcome measures included visual acuity, manifest refraction, corneal astigmatism, SIA, flattening effect, and corneal HOAs. Correlation between postoperative corneal HOA and SIA at each follow-up were analysed.Results: This study assessed data from 106 eyes, of which 64 in Group A and 42 in Group B. The two groups had similar postoperative visual acuity of distance, intermediate and near (all P > 0.05). SIA and corneal HOAs were significantly lower in Group A than Group B in the early postoperative period, while there was no significant difference in the late postoperative period. At 6 months after surgery, the arithmetic mean of SIA over corneal 4mm zone was 0.33 ± 0.19D for temporal incision, and 0.37 ± 0.25D for superior incision. For Group A, the correlations of HOAs and SIA persisted from 1 week to 6 months after surgery. For Group B, the changes in corneal HOAs were significantly related to the SIA at 1 week and 1 month postoperatively.Conclusion: This study suggested the consistency of increasing and recovering process of corneal HOAs and SIA after surgery. Compared to the superior incisions, temporal incisions might induce quicker corneal recovery and less change in SIA and corneal HOAs.Keywords: surgically induced astigmatism, higher-order aberrations, clear corneal incision, femtosecond laser-assisted, cataract surgery

Abstract Background This study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation. Methods A total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z4 0, coma coefficients (Coma RMS) Z3 −1 Z3 1, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam. Results One week after the operation, the corneal back Z3 1 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z4 0 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z3 1, Z4 0, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation. Conclusion Our data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation.

Background: This study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation. Methods: A total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z40, coma coefficients (Coma RMS) Z3−1 Z31, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam. Results: One week after the operation, the corneal back Z31 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z40 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z31, Z40, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation. Conclusion: Our data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively. Methods: Retrospective case report with anterior segment optical coherence tomography. Results: A 77-year-old woman with a history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy and scleral-fixated intraocular lens placement. During pars plana vitrectomy, a large corneal bulla formed at the site of the main corneal incision, confirmed with anterior segment optical coherence tomography. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery. Conclusion: This is the first report of corneal bullae formation during pars plana vitrectomy that is confirmed by anterior segment optical coherence tomography and successfully managed with a bandage contact lens intraoperatively. [ABSTRACT FROM AUTHOR]

There are numerous techniques for dealing with astigmatism both during and after cataract surgery. Good uncorrected post-operative distance visual acuity can be obtained for high percentage of cataract patients with pre-existing corneal astigmatism. The goal of this study is to determine the keratometric change and resultant post-operative refraction of routine cataract patients, after a clear corneal incision of 2.8mm on the steeper meridian. Place and Duration of Study: This was a general free hospital-based prospective study. The study was started from May 2016 and was completed by May 2018. Methodology: A total of 30 cataract patients were included in this study. Pre-operative keratometric readings were compared with post-operative readings, after a clear corneal incision (CCI) of 2.8mm made during phacoemulsification procedure. Results: Patients were monitored for four weeks post-operatively. A total of thirty eyes underwent phacoemulsfication cataract surgery with clear corneal incision on steep axis had mean residual astigmatism of 0.45 D and SD achieved 0.58.

BackgroundPosterior chamber phakic intraocular implantable collamer lens (ICL) implantation is an effective surgical option for the management of myopia. Over the past few years, the number of ICL surgeries has significantly increased. Postoperative inflammation and endophthalmitis are among the most serious complications after successful ICL surgery. Sometimes, when the blepharospasm is removed at the end of surgery, a small amount of the ocular surface fluid will flow into the anterior chamber, which can lead to an increased risk of infection and inflammation. However, little attention has been paid to this phenomenon.PurposeWe conducted a retrospective study to compare the incidence of extraocular fluid inflow into the eye through the clear corneal incision (CCI) at two different positions (superior and temporal sides).MethodsA total of 116 patients with myopia underwent superior CCI ICL implantation (n = 58) or temporal CCI ICL implantation (n = 58) at our hospital from October to December 2021. The incidence of conjunctival sac fluid entering the anterior chamber after eyelid fixative was removed was compared in both groups.ResultsBoth groups were well matched in all parameters. Ocular surface fluid inflow into the anterior chamber was significantly higher in the superior CCI group (25/58, 47.1%) than in the temporal CCI group (1/58, 1.7%) (p

There are numerous techniques for dealing with astigmatism both during and after cataract surgery. Good uncorrected post-operative distance visual acuity can be obtained for high percentage of cataract patients with pre-existing corneal astigmatism. The goal of this study is to determine the keratometric change and resultant post-operative refraction of routine cataract patients, after a clear corneal incision of 2.8mm on the steeper meridian. Place and Duration of Study: This was a general free hospital-based prospective study. The study was started from May 2016 and was completed by May 2018. Methodology: A total of 30 cataract patients were included in this study. Pre-operative keratometric readings were compared with postoperative readings, after a clear corneal incision (CCI) of 2.8mm made during phacoemulsification procedure. Results: Patients were monitored for four weeks post-operatively. A total of thirty eyes underwent phacoemulsfication cataract surgery with clear corneal incision on steep axis had mean residual astigmatism of 0.45 D and SD achieved 0.58. [ABSTRACT FROM AUTHOR]

Introduction: To compare surgical outcomes of 2.2 mm clear corneal incision (CCI) between a three-dimensional (3D) visualization system and traditional binocular microscope (BM) for phacoemulsification and intraocular lens implantation surgery. Methods: In this randomized controlled clinical study, 60 eyes with age-related cataracts were divided into two groups receiving cataract surgery using either a 3D vision system (n = 30 eyes) (3D group) or a binocular microscope (n = 30 eyes) (BM group). We recorded and statistically analyzed surgical parameters and pre- and postoperative ocular parameters. Primary outcomes included the change in endothelial cell density (ECD) and CCI architecture, and secondary outcomes comprised other ocular parameters and surgical parameters. All procedures complied with the tenets of the Declaration of Helsinki. Results: Of the 60 eyes randomly assigned between January 5, 2021, and May 9, 2021, 55 (26 eyes in the 3D group and 29 eyes in the BM group) were analyzed. The ECD loss rate was 8.1% in the 3D group and 12.3% in the BM group, but the difference was not statistically significant. Local detachment of Descemet's membrane was seen in 50% (13 eyes, 3D group) and 51.6% (15 eyes, BM group), wound gaping at the endothelial side in 15.4% (four eyes, 3D group) and 10.3% (four eyes, BM group), gaping at the epithelial side in 11.5% (three eyes, 3D group) and 6.9% (two eyes, BM group), and misalignment of the incision in 3.4% (one eye, BM group) 1 day after surgery. These abnormalities improved with time. There was no difference between the 3D group and BM group in terms of other ocular parameters or surgical parameters before and after surgery. Conclusions: Using the 3D surgical system for phacoemulsification and IOL implantation surgery seems to result in similar ECD and CCI conditions as using a conventional binocular microscope. Trial Registration: The protocol was registered on ClinicalTrials.gov (NCT04839250). [ABSTRACT FROM AUTHOR]

AIM: To investigate the influencing factors of clear corneal incision(CCI)after phacoemulsification by Logistic regression analysis. METHODS: A retrospective cases-control study was performed. 126 patients(138 eyes)who received phacoemulsification combined with implantation of foldable intraocular lens(IOL)were included in Erdos Central Hospital. Postoperative 1d, all of the CCIs were scanned by anterior segment optical coherence tomography(AS-OCT). According to whether there were presence of inner opening CCIs, the patients were divided into two groups. Group 1: inner opening CCIs(84 eyes)were absent. They were stable. Group 2: inner opening CCIs(54 eyes)were present. The factors affecting the stability of CCI were analyzed.RESULT: The incidence of internal opening incisions was 39.1%(54/138). It decreased to 8.7%(12/138)at 1wk. One month postoperative, the internal mouths of the incisions were completely closed. The stability of the incisions was good. But AS-OCT scan found 3 cases with poor healing internal incisions. Binary Logistic regression analysis showed that age, incision length, incision angle, location of the internal incision, incision method and descemet's membrane detachment had statistically significant difference(OR=1.102, 0.994, 27.895, 0.127, 30.269, 6.750, all P

Purpose: To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH). Methods: Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH (n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing. Results: On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups (P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 – 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups (P = 0.42). More eyes in the ASPH required conversion to CH (n = 4, 13%) due to difficulty in localizing the pocket compared to MASH (n = 0, P = 0.03) Conclusion: Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket.

AIM: To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. METHODS: This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. RESULTS: Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P

Purpose: To primarily compare surgically induced astigmatism (SIA), total and posterior corneal curvature, pachymetry, and their stabilization after 2.2 and 2.8 mm clear corneal incision in phacoemulsification.Methods: A randomized, prospective interventional study of 130 patients (130 eyes) of either sex having senile cataract (>40 years) divided randomly into two groups. The patients underwent uncomplicated phacoemulsification surgery with foldable intraocular lens implantation using 2.2 mm (group 1) and 2.8 mm incisions (group 2). The patients were evaluated preoperatively and followed-up at first, third, and sixth weeks.Results: Mean SIA was less in group 1 at all the follow-up visits which was not statistically significant (P value - 0.507 (at week 1), 0.626 (at week 3), and 0.312 (at week 6). Mean SIA decreased from week 1 to week 6 in both the groups. Both the groups showed an increase in SIA with the increase in the hardness of cataract. Posterior keratometry (k1 and k2) showed statistically significant steepening in the first postoperative week, followed by gradual flattening which continued till the sixth week postoperatively. Posterior astigmatism increased in both the groups at week 1 (not statistically significant). Thereafter, it decreases and does not change significantly after 3 weeks. Pachymetry increased significantly (P value < 0.001 in both the groups) in the first week in both the groups and thereafter stabilizing at 3 weeks.Conclusion: Reducing the incision size does not result in any significant reduction in SIA. We observed that the posterior corneal curvature majorly stabilized by 3 weeks, but some stabilization continued till 6 weeks. [ABSTRACT FROM AUTHOR]

Objective: To determine the keratometric change and resultant post-operative refraction of routine cataract patients, after a clear corneal incision of 2.8mm on the steeper meridian. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Kharian, from Jul 2017 to Jun 2018. Methodology: A total of 123 cataract patients were included in this study. Pre-operative keratometric readings were compared with post-operative readings, after a clear corneal incision (CCI) of 2.8mm made during phacoemulsification procedure. Opposite clear corneal incision was made in astigmatism over 1 diopter. Results: Patients were monitored for six weeks post-operatively. It showed that a reduction of cylinder (0.81 ± 0.60 vs. 0.92 ± 0.54, p0.035) was present if the incision was at or near the steeper meridian. In 99 patients (80.4%) the astigmatism remained the same or there was a reduction in the power of preoperative cylinder. The remaining 24 patients had either no preoperative astigmatism in 11 patients, (8.94%), or the power of cylinder increased in 13 patients (10.57%) secondary to surgically induced astigmatism (SIA). Temporal clear corneal incision (CCI) made a lesser impact on the surgically induced astigmatism (SIA) than other quadrants. Conclusion: The results confirmed that steeper axis clear corneal incision (CCI) CCI is effective in reduction of post-operative astigmatism. These incisions in conjunction with surgeon’s surgically induced astigmatism (SIA) play an important role in predicting postoperative visual outcome.

Purpose: To evaluate the influence of 2.2 mm clear corneal incision (CCI) features in surgically induced astigmatism (SIA) and higher‐order aberrations (HOAs) after cataract surgery. Methods: Right eyes of 92 subjects receiving 2.2 mm incision cataract surgery were involved. A total of 38 eyes were categorized as the intact incision group, and 54 eyes were the defective incision group. Pre‐ and postoperative (1 month and 6 months) corneal astigmatism and HOAs on anterior and posterior corneal surfaces, corneal volume, and corneal thickness (CT) were measured using Pentacam. The CCI features including incision length (IL), incision angles, distance from incision to central cornea (Dis‐En/Ex), and CT at incision site were quantified using AS‐OCT. Results: The defective incision group showed shorter IL and larger incision angles [false discovery rate (FDR) – p < 0.05]. Changes in CT at incision site were more pronounced for the defective incision group (FDR – p < 0.05). Some SIA parameters were related to the certain specific CCI features, especially IL (FDR – p < 0.05). Both groups exhibited significant increased 6 mm posterior corneal tHOAs at 1 month (Bonferroni corrected – p < 0.01) and the defective incision group showed increased 6 mm posterior tHOAs at 6 months (Bonferroni corrected – p = 0.023). There were characteristic correlations between Zernike terms and CCI features including IL, CT, Dis‐En/Ex, and incision angles at 1 month, especially over 6 mm zone. Conclusion: The CCI deformities can affect corneal recovery and induce more HOAs at 1 month postoperatively. Such effects became minor, but could persist until 6 months. The IL combined with Angle‐En/Ex was important factor influencing CCI integrity and corneal optical quality. [ABSTRACT FROM AUTHOR]

Background: Phacoemulsification is regarded as a type of refractive surgery by which it is possible to ‎reduce pre-existing corneal stigmatism.‎ This study aimed to evaluate the efficacy and safety of on-axis corneal incision with or without opposite clear corneal incisions (OCCI) to correct preoperative corneal astigmatism during uncomplicated phacoemulsification ‎surgeries.‎ Methods: A randomized, prospective, parallel two-arm interventional study, which included a ‎total 40 eyes from 40 patients, was conducted.‎ Patients were divided into two groups: 20 patients as controls underwent phacoemulsification with on-axis incision (CCI group), and 20 patients underwent phacoemulsification with OCCI (OCCI group). Results: Mean astigmatic correction was significantly higher in the OCCI group (0.665 vs 0.265 diopters, p-value Conclusions: Both incisional methods are useful methods for correction of preoperative corneal ‎astigmatism but OCCIs correct a higher amount of astigmatism than the on-axis clear ‎corneal incision.‎ Registration: ClinicalTrials.gov NCT04418986 (05/06/2020).

Purpose: To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH).Methods: Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH (n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing.Results: On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups (P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 - 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups (P = 0.42). More eyes in the ASPH required conversion to CH (n = 4, 13%) due to difficulty in localizing the pocket compared to MASH (n = 0, P = 0.03).Conclusion: Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket. [ABSTRACT FROM AUTHOR]

AIM: To explore the effect of 3.2mm clear corneal incision cataract phacoemulsification combined with intraocular lens(IOL)implantation.METHODS: Retrospective analysis of 95 cases(107 eyes)cataract patients treated in our hospital, and all patients were given 3.2mm clear corneal incision Phaco combined with IOL implantation. The postoperative visual acuity, corneal curvature, corneal astigmatism, anterior chamber depth and complications were observed.RESULTS: Postoperative 3d, 1wk, 1mo patients with the uncorrected visual acuity(0.16±0.06, 0.15±0.05, 0.14±0.04)were significantly better than preoperative(0.48±0.15). The anterior chamber depth(3.86±1.09, 3.69±1.04, 3.84±1.07mm)was significantly higher than the preoperative(2.71±0.88mm)(PP>0.05).CONCLUSION: 3.2mm clear corneal incision Phaco combined with IOL implantation can effectively improve the recovery of postoperative visual acuity and reduce the corneal astigmatism, and it is a safe and effective surgical treatment of cataract.

Objective: To determine the keratometric change and resultant post-operative refraction of routine cataract patients, after a clear corneal incision of 2.8mm on the steeper meridian. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Kharian, from Jul 2017 to Jun 2018. Methodology: A total of 123 cataract patients were included in this study. Pre-operative keratometric readings were compared with post-operative readings, after a clear corneal incision (CCI) of 2.8mm made during phacoemulsification procedure. Opposite clear corneal incision was made in astigmatism over 1 diopter. Results: Patients were monitored for six weeks post-operatively. It showed that a reduction of cylinder (0.81 ± 0.60 vs. 0.92 ± 0.54, p0.035) was present if the incision was at or near the steeper meridian. In 99 patients (80.4%) the astigmatism remained the same or there was a reduction in the power of preoperative cylinder. The remaining 24 patients had either no preoperative astigmatism in 11 patients, (8.94%), or the power of cylinder increased in 13 patients (10.57%) secondary to surgically induced astigmatism (SIA). Temporal clear corneal incision (CCI) made a lesser impact on the surgically induced astigmatism (SIA) than other quadrants. Conclusion: The results confirmed that steeper axis clear corneal incision (CCI) CCI is effective in reduction of post-operative astigmatism. These incisions in conjunction with surgeon’s surgically induced astigmatism (SIA) play an important role in predicting postoperative visual outcome. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the leakage rates of perilimbal uniplanar and biplanar clear corneal incisions in dogs when subjected to increased intraocular pressure (IOP) both from within the eye and via external pressure. Procedure: Uniplanar clear corneal incisions were created in eight freshly enucleated canine eyes using a 3.2 mm straight slit knife while 8 fellow eyes received a biplanar clear corneal incision consisting of an approximately 300 μm deep groove followed by a 3.2 mm straight slit knife entry into the anterior chamber. Both wounds were reapposed using three simple interrupted 8‐0 polyglactin 910 sutures. Eyes were cannulated with two 25 g needles: One connected to a pressure transducer, and the other connected to a reservoir of isotonic saline. The IOP at which the wound leaked was recorded when the intraocular pressure was increased internally by raising the height of the fluid bag, and again when the cornea was externally compressed. Kaplan‐Meier survival curves compared incision types for each method of increasing IOP and were evaluated using Mantel‐Cox log‐rank analysis. Results: Both wound types resisted leakage at IOP in the physiologically achievable range and no significant differences were observed between clear corneal incisions when pressure was applied externally (P =.353) or was increased from within the globe (P =.615). Conclusion: Ex vivo uniplanar and biplanar clear corneal incisions in dogs are equally strong, with no significant differences in leakage rates when IOP is increased internally or externally. [ABSTRACT FROM AUTHOR]

AIM: To analyze the visual outcomes and the posterior capsule opacification (PCO) with the new Incise® MJ14 intraocular lens (IOL) implanted through a 1.4 mm clear corneal incision (CCI) in patients who underwent bimanual microincision cataract surgery (B-MICS). METHODS: Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study: 40 eyes were implanted with an Incise® MJ14 IOL through a 1.4 mm CCI (group A) without enlargement of the main CCI, while 40 eyes were implanted with an Akreos® MI60 IOL with enlargement of the main CCI to 1.8 mm (group B). Best corrected visual acuity (BCVA), astigmatism and endothelial cell loss were evaluated before and after surgery at 7, 30d and 6mo. Anterior segment-optical coherence tomography (AS-OCT) of CCI was performed at 1, 3, 7, 30d, 6 and 18mo. PCO incidence was evaluated at 18mo using EPCO 2000 Software. RESULTS: Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups; no statistically significant difference in surgically induced astigmatism (SIA) was noticed in the two groups. At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery; no statistically significant alterations were found at 1, 6 and 18mo. PCO score at 18mo was 0.03±0.07 for group A and 0.08±0.18 for group B (P=0.11) with no sign of central optic plate invasion in both groups. CONCLUSION: The implant of the new Incise® MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery. PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

AIM: To compare the changes of surgically induced corneal higher-order aberrations after phacoemulsification with 2.8mm clear corneal incisions at different sites.METHODS: The clinical data of 100 cases(100 eyes)of patients with cataract treated by phacoemulsification with 2.8mm clear corneal incision in our hospital from March 2015 to April 2016 were analyzed retrospectively. According to the site of incision, they were divided into Group A(temporal clear corneal incision, n=55)and Group B(upper clear corneal incision, n=45). Changes of the best corrected visual acuity(BCVA), surgically induced astigmatism(SIA)and corneal topography were compared between the two groups before surgery, at 1d, 1wk, 1 and 3mo after surgery. The corneal wavefront aberrations were measured by wavefront aberration analyzer, and the changes of higher-order aberrations in corneal 6mm range were recorded. RESULTS: The BCVA of two groups decreased at 1d, 1wk, 1 and 3mo after surgery(PPPPPPCONCLUSION: The application of 2.8mm temporal clear corneal incision in phacoemulsification can promote the recovery of visual acuity, reduce the effect of surgery on corneal shape, and reduce corneal higher-order aberrations.

Objectives: To investigate use of the Pentacam® HR for evaluation of surgically induced corneal astigmatism (SIA) in canines undergoing bilateral phacoemulsification and determine differences between dorsonasal and dorsotemporal clear corneal incisions. Animals: Client‐owned canines undergoing bilateral phacoemulsification. Procedures: Patients received anterior segment imaging pre‐operatively, immediately post‐operatively, and 2‐4 months post‐operatively (follow‐up). Total corneal refractive power was used to determine SIA. Surgically induced astigmatism was compared between right and left eyes, representing dorsotemporal and dorsonasal incisions, respectively. Repeated measures analyses were used between time points and paired t test compared SIA between eyes. Results: Complete imaging series were obtained for seven patients. Follow‐up imaging occurred at a median of 112 days (range 60‐132 days) post‐operatively. For repeated measures analyses, significant differences were found between pre‐ and immediate post‐operative values (P < 0.01), and between immediate post‐operative and follow‐up values (P < 0.01). There was no significant difference between pre‐operative and follow‐up values. Surgically induced astigmatism was significantly different between right and left eyes, with values of 2.01 ± 1.24 D and 3.05 ± 1.58 D at 3 mm radius (P < 0.05), and 2.04 ± 1.18 D and 3.06 ± 1.27 D at 4 mm radius (P < 0.05) for dorsotemporal and dorsonasal incisions, respectively. Conclusions: Preliminary investigation revealed improvement of corneal SIA 2‐4 months post‐operatively, but development of significantly more SIA in dorsonasal vs dorsotemporal incisions. This prompts consideration of patient or microscope rotation to create a more dorsotemporal incision when possible. [ABSTRACT FROM AUTHOR]

The purpose of this article is to analyze and understand the mechanism of action, effectiveness, cost and time benefits, advantages and disadvantages of the femtosecond laser (FSL) assisted cataract surgery. A PubMed search was done using the topic and the keywords. Research shows considerable improvements in corneal incisions, anterior capsulotomy, and phacofragmentation using FSL. We will also discuss and compare FSL with conventional cataract extraction techniques in terms of both short-term and long-term advantages and disadvantages. Limitations of the studies reviewed include small sample size and short-term follow-up. The major dilemma is still considered to be its heavy financial feasibility to date.

Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS) with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3%) was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B) than in SICS with clear corneal incision (Group-A).

AIM: To study the effects of different position of clear corneal incision of cataract surgery on visual function and quality of life. METHODS: In this study, 126 cases(126 eyes)in our hospital from April 2013 to April 2014 were selected, who were accepted the transparent corneal incision phacoemulsification and intraocular lens implantation in treatment of senile cataract patients. With digital method were divided into observation group and control group with 63 cases in each group, included the observation group selected the maximum refractive power of the cornea radial axial transparent angle incision, and the control group in the temporal clear corneal incision, compared the two groups of patients with postoperative visual function(VF)and quality of life(QOL), and made statistics of uncorrected visual acuity. RESULTS: In the observation group, postoperative visual function and the scores of quality of life were 80.3±5.63 and 80.9±0.79, was significantly higher than the control group(74.9±5.24)and(76.5±0.76). And the postoperative uncorrected visual acuity of patients in the observation group was less than that of the control group, while ≤1.0 of patients than that in the control group. There was statistically significantdifference(PCONCLUSION: Transparent cornea in cataract surgery to choose the largest cornea diopter longitude as incision can effectively improve the therapeutic effect, especially on the visual function of patients and to improve the quality of life.

AIM: To investigate the effect of endocapsular phacoemulsification cataract extraction and intraocular lens(IOL)implantation with a 1.8mm or 3.0mm clear corneal incision on total root mean square(RMS)value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film.METHODS:In a prospective study, 156 age-related patients(196 eyes)were randomly distributed into two groups. 1.8mm-group comprised 94 eyes that had a silicone IOL inserted through a 1.8mm sutureless clear corneal incision, while, 3.0mm-group comprised 102 eyes through a 3.0mm clear corneal incision. Postoperatively, the changes in the total RMS value of the cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film at 1wk, 1 and 3mo were determined respectively.RESULTS: In both groups, postoperatively at 1wk,there were statistically significant differences(PPP>0.05)between two groups at 3mo postoperative.CONCLUSION:This study confirms that incision size has strong impact on the corneal higher-order aberrations, especially, 3.0mm incision caused significant differences in the total RMS value of cornea, corneal astigmatism, spherical aberration, coma, trefoil and tear film compared with 1.8mm micro-incision, therefore, micro-incision is very beneficial for clinical use in phacoemulsification.

Purpose: To evaluate the effects of two different incision sites on central corneal thickness after pediatric cataract surgery with foldable intraocular lens implantation. Material and Method: This prospective, cohort study was conducted in the Department of Ophthalmology, Liaquat University Eye Hospital, Hyderabad from January to June 2016. A total number of 104 eyes of 84 children with pediatric cataract and age range of 4-16 were randomized into 2 groups according to the incision site: clear corneal incision group (52 eyes) and scleral tunnel incision group (52 eyes). Surgery was performed under general anesthesia. Only the incision site is different and all other steps of surgery were same. After cataract removal, acrylic intra ocular lens (IOL) was implanted with the help of injector. Ultrasound Pachymetry was done to record central corneal thickness (CCT) pre operatively and 1 month and 3months post operatively. The mean of 3 readings was calculated for CCT. Results: Preoperative CCT was 518.5 ±29.4 μm in group -1 and 514 ±25.3 μm in group-2. (P value = 0.8). First month postoperative mean CCT was 527.2 ±28.7μm in group-1 and in group-2 mean CCT was 524.1 ±25 μm. The mean increase in CCT was 8.7 μm in Group 1 and 10.1 μm in Group 2 (p-value 0.6). At 3rd postoperative month the mean CCT was 533.6 ±27.7 μm in group-1 and 527.3 ±24.6 μm in group-2. The mean increase in CCT was 15.1 μm in Group 1 and 13.3 μm in Group 2 (p-value = 0.2). Difference between two means was statistically insignificant at 1 month and 3 months post op. In group-1 the mean percent increase in CCT at first postoperative month was 1.68% and 1.96% in group-2. At 3rd postoperative month the mean percent increase in CCT was2.91% in group-1 and 2.59% in group 2. Conclusion: Clear corneal and scleral tunnel incisions seem to result in no significant increase in central corneal thickness up to 3 months postoperatively if foldable intraocular lens is implanted after cataract surgery in children. Clear corneal incision should be preferred to avoid conjunctival scarring. [ABSTRACT FROM AUTHOR]

Purpose: To compare intraocular pressure (IOP) immediately after cataract surgery, and surgically induced corneal astigmatism (SIA) and corneal shape changes between eyes with transconjunctival single-plane sclerocorneal incisions (TSSIs) and eyes with clear corneal incisions (CCIs). Methods: Bilateral eyes of 64 patients undergoing phacoemulsification were randomized to undergo 2.4-mm temporal TSSI or CCI. IOP was measured preoperatively, and in the immediate postoperative periods. SIA was determined using vector analysis, and corneal shape changes and irregular astigmatism were evaluated using a videokeratography preoperatively, and in the early postoperative periods. Results: Wound hydration was performed in 23 eyes (35.9 %) of the TSSI group and in 60 (93.8 %) of the CCI group ( P < 0.0001). Mean IOP was significantly higher in the TSSI group than in the CCI group at 30, 60, and 120 min postoperatively ( P ≤ 0.0179). SIA tended to be smaller in the TSSI group than the CCI group, but the difference was not significant. The higher order irregular astigmatism was smaller in the TSSI group than in the CCI group at 2 days ( P = 0.0312). The videokeratography revealed a wound-related flattening postoperatively in both groups; this change disappeared within 4 weeks in the TSSI group, whereas it persisted until 12 weeks in the CCI group. Conclusion: IOP was significantly higher immediately after TSSI than after CCI and required less wound hydration, suggesting better stability with TSSI. Higher order irregular astigmatism and wound-related corneal flattening were smaller after TSSI than after CCI in the early periods, suggesting that fewer corneal shape changes with TSSI. [ABSTRACT FROM AUTHOR]

To determine whether there is a difference in surgically induced astigmatism (SIA) after phacoemulsification for unsutured temporal clear corneal incisions of 2.5 mm and 3.5 mm wound sizes. Methods: This study comprised 36 eyes of 18 patients who received cataract surgery from a single surgeon. Patients were randomly assigned to receive a one-piece intraocular lens (IOL; Acrysof SA60AT), through a 2.5 mm incision in one eye, and a three-piece IOL (Tecnis Z9000), through a 3.5 mm incision in the contralateral eye. Corneal topography was performed preoperatively and also postoperatively at 3, 6, and 12 weeks. SIA was calculated by means of vector analysis using the Alpins' method. Results: The mean SIAs of the groups with 2.5 mm and 3.5 mm incisions were 0.57 diopter (D) and 0.86 D respectively (p = 0.04) at 3 weeks postoperatively, 0.60 D and 0.83 D respectively (p > 0.05) at 6 weeks postoperatively, and 0.58 D and 0.58 D respectively (p > 0.05) at 12 weeks postoperatively. At 12 weeks postoperatively, SIAs of 0.5 D at 12 weeks postoperatively. The largest SIA was 1.36 D in the 3.5 mm group. Conclusion: Mean SIA in the 3.5 mm group was larger than that in the 2.5 mm group in the early postoperative period, but there was no significant difference for the entire observational period.