SPS-112 Cataract Surgery - Techniques | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
Expand each tab below to view the paper abstract for each paper within this session.
New Surgical Procedure for Securing Dislocated Intraocular Lenses with 8-0 Goretex and Outcomes
Author
Huck A. Holz, MD

Purpose
To describe a new technique for lasso suturing dislocated intraocular lenses using 8.0 Gore-Tex suture and clinical outcomes.

Methods
retrospective analysis of 15 patients who had suture fixation using newly described 8-0 Gore-Tex suture fixation procedure. Inclusion criteria to include all patients with capsular bag/IOL subluxation who qualify for surgical correction. Intervention surgical procedure of Gore-Tex suture fixation. outcome measurements to include visual acuity, intraocular pressure, complications, cme rates and vitreous hemorrhage rates.

Results
patient bcva pre bcva 1w bcva 1m final bcva 1 20/200 20//40 20/30 20/40 2 20/80 20/150 20/ 3 20/25 20/20 20/20 20/20 4 20/50 20/40 20/50 5 20/30 20/25 20/25 6 20/50 20/30 20/25 20/30 7 20/25 20/30 20/30 8 20/20 20/25 20/25 9 20/20 20/20 20/20 10 20/20 20/50 20/25 20/25 11 20/20 20/20 20/20 20/20 12 20/200 20/200 20/50 20/50 13 20/50 20/25 20/25 14 20/50 20/100 2 eyes lost one line of BCVA (20/20 to 20/25) 4 eyes gained lines of BCVA No surgical complications All lenses well centered No revisions required

Conclusion
IOL haptic fixation using the 8-0 gore-tex threaded needle is a safe and effective surgical repair modality for the repair of the within the capsule bag dislocated intraocular lens
The Effect of Low Flow Rate on Ovd Thermal Properties Using Phacoemulsification
Authors
Jacob T. Harris
Emilie L. Ungricht
Nathan Jensen
Randall J. Olson, MD

Purpose
Phacoemulsification is a critical element of cataract surgery and has the potential to cause corneal collagen contracture (CCC). This study aims to determine the thermal features of the Centurion (Alcon) phacoemulsification machine with 20 cc/min aspirational flow rate on four ophthalmic viscosurgical devices (OVDs).

Methods
The Alcon Centurion phacoemulsification machine was used with an Omega Temperature Gauge secured to the phaco sleeve. The Centurion was set to 68 cm IOP, 700+ mm/Hg vacuum, 20 cc/min aspiration, and 60% torsional power. Temperature was continuously recorded for 60 seconds. The phacoemulsifier was primed and 0.1 mL of OVD was added to the test chamber. Once the thermistor measured a consistent OVD temperature, the phaco pedal was engaged for 60 seconds and then removed. This procedure was then repeated 10 times for BSS alone and for each OVD. The increase in temperature from time zero was then compared for each OVD with the BSS results with Student-T testing. Significance was set at P<0.05.

Results
BSS demonstrated an average 60 second increase of 2.82±0.45°C. Viscoat showed 2.36±0.93°C. Provisc showed 2.47±1.38°C. Discovisc showed 2.49±0.77°C. Healon 5 showed 3.02±0.94°C. While all OVDs showed higher temperatures at five and ten seconds compared to BSS, only Healon 5 and DisCoVisc were significantly different at five seconds (1.92±0.79 and 1.73±0.66 respectively) and only Healon 5 at ten seconds (1.54±0.43). None of the temperature increases over the control BSS were more than 1.0 degrees C.

Conclusion
With even a small amount of fluid flow, the heat created during ultrasound was minimal and not different than with BSS after just a few seconds. Only DisCoVisc and Healon 5 (highly viscous OVDs) showed an effect that was significantly different than BSS. Therefore, OVD induced wound burns are not a concern if there is any flow through the system.
Chopper Scaffold Technique to Reduce Endothelial Cell Damage and Postoperative Corneal Edema in Hard Cataracts
Authors
Tushya O. Parkash, MS
Rohit Om Parkash, MS
Shruti Mahajan, MS

Purpose
To evaluate the efficacy of Chopper scaffold technique to reduce endothelial cell damage and postoperative corneal edema in hard cataracts

Methods
Randomised prospective study was done in 35 patients undergoing phacoemulsification from July 2018 - June 2019.Patients with NS > grade 4 and ACD > 2 mm were included. Two prototypes of phaco chopper were used, sharp tip for chopping and blunt tip for providing scaffold while emulsification.The postoperative outcome measures were corneal edema(day 1),CCT(day 1,3,7,&30) AC cells and flare (day 1,3,7), and endothelial cell density assessed at 3 months.Corneal oedema was graded clinically on slit lamp bio-microscopic evaluation as diffuse/localised, epithelial/stromal oedema, or the presence of Descemet membrane folds.The CCT was measured using anterior segment optical coherence tomography.

Results
The study comprised 35 eyes out of which 28 eyes had clear cornea , 4 eyes had descemet membrane folds, 3 eyes with focal stromal oedema and 1 eye with diffuse corneal oedema at post-op day 1. The mean pre-op CCT was 530.2 ± 42.5 and mean post-op CCT was 542.40 ± 49.41 at Day 1 which reduced to 536.50 ± 44.32 at Day 7. The mean percentage of endothelial cell loss was 7.62 % (mean endothelial cell count, 2351.8 ± 405.3 cells/mm2 preoperatively and 2157.8 ± 392.8 cells/mm2 3 months postoperatively)

Conclusion
Chopper scaffold technique reduces endothelial cell damage and postoperative corneal edema in hard cataracts without compromising visual outcomes
Directed-Flow Hydrodissection: Take a Step Back to Improve Cortical Cleavage
Author
Steve Dewey, MD

Purpose
While several techniques and instruments are available to remove cortex safely, the author was frustrated by the lack of consistency in standard hydrodissection. This study was undertaken to determine if a directed-flow technique could achieve more complete cortical cleavage, thus improving the efficiency of this vital step.

Methods
In placing the irrigation cannula central to, but not underneath the capsule, the anatomic plane between the capsule and cortex can be more consistently located. Initiating the flow in this fashion achieves a more complete hydrodissection wave. Two subtleties improve the reproducibility of this modification to the standard technique. The first is the initiation of flow just above the capsule, moving down until it is aimed directly at the edge of the capsulotomy. The second is to allow the nucleus to "float" under the restriction of the shaft of the cannula, rather than pressing the nucleus downward.

Results
(Additional cases will be added to the evaluation.) At the time of submission, the original premise of directing flow toward the capsulotomy edge yields a 33% rate of complete cortical separation, with cortical removal rated as easy in 58% of evaluated cases (n=79). The two additional refinements to this technique improves complete cortical separation to 62%, with cortical removal rated as easy in 86% of studied cases (n=67). These results will be compared to a cohort of cases of standard hydrodissection by the same surgeon. The only identified weakness of the directed-flow irrigation is its lack of suitability for a pupil smaller than 4 mm.

Conclusion
Directed-Flow Hydrodissection improves the consistency of achieving an irrigation flow in the proper anatomic plane between the capsule and cortex. This facilitates cortical removal at the conclusion of nuclear removal, improving the efficiency of cataract surgery.
Cortical Removal Facilitated in FLACS: A Simple, Direct Irrigation Technique
Author
Steve Dewey, MD

Purpose
The anatomy of a cataract treated with the femtosecond laser is fundamentally different from a standard cataract. Specifically, the cortex is fused at the capsulotomy, and standard hydrodissection fails due to pneumodissection. This paper will evaluate a technique of direct irrigation to facilitate cortical removal in FLACS cases.

Methods
Lake, et al, described a technique of "second-wave" hydrodissection to facilitate the separation of cortex from the capsule in femtosecond laser-assisted cataract surgeries. Their technique was to direct a jet of irrigating BSS from outside the capsule toward the junction of fused cortex and cut capsule. This author has found that piercing the cortical layer near the junction of the fused cortex and capsule facilitates entry to this plane. The irrigation then has direct access to the cortico-capsular plane. With either technique, any disruption in the cortical layer will disrupt the progression of the wave.

Results
The technique is quite effective in removing cortex nearly completely, but only in specific situations. By utilizing the directed flow of irrigation in several locations around the edge of the capsule, cortical separation can still be facilitated. This paper will review 100 consecutive FLACS procedures for the suitability and efficacy of this technique.

Conclusion
"Second-Wave Hydrodissection" as described by Lake, et al, is a highly effective method of removing cortex in FLACS. Its efficacy is dependent on an intact cortical layer following nuclear removal. By slightly modifying the original technique, the utility of the second-wave is enhanced, and can be used to facilitate cortical removal in FLACS.

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