Prospective Evaluation of Standalone XEN Gel Implant and Combined Phacoemulsification-XEN Gel Implant Surgery: 1-Year Results
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To evaluate the safety and efficacy of XEN gel implant (Allergan Inc., Irvine) as a standalone versus combined XEN-Phacoemulsification surgery (XEN+cataract) in glaucoma patients.Prospective, interventional study. One-hundred forty-nine eyes (113 patients) with open-angle glaucoma and uncontrolled intraocular pressure (IOP) despite medical treatment were enrolled at a tertiary glaucoma center and followed up for a minimum of 1 year. Approximately two-thirds of patients underwent combined XEN+cataract surgery, while the remainder had XEN alone surgery. Primary outcome was a 20% or more decrease in IOP from medicated baseline at 1 year. Mean IOP, mean number of medications at last follow-up, and incidence of adverse effects were analyzed.Of 149 enrolled eyes, data of 87 (58%) were available at 1 year. A total of 109 (73.2%) eyes underwent XEN+cataract surgery and 40 (26.8%) XEN alone surgery. Mean medicated IOP was 20.0±7.1 at baseline and 13.9±4.3 mm Hg at 1 year (P<0.01), a 31% IOP reduction. Mean medications dropped from 1.9±1.3 preoperatively to 0.5±0.8 at 1 year (P<0.001). In total, 62.1% of patients achieved a ≥20% IOP reduction; this proportion was higher in the XEN alone group. 57.7% of eyes achieved complete success (without any antiglaucoma medications) and 71.1% qualified success (with or without medications) when IOP<16 mm Hg was considered as the definition of success. In all, 37% of patients required needling intervention. Adverse effects included bleb revision in 5 eyes, choroidal detachment in 2 eyes, and second glaucoma surgery in 9 eyes.The XEN gel implant as a standalone procedure or combined with cataract surgery demonstrated safe and sustained IOP reduction after 1 year.Background: The method of phacoemulsification for cataract surgery is preferred by surgeons, but it is not an affordable method. On the other hand, small-incision cataract surgery performed manually is economically affordable. This is a comparative study conducted prospectively to analyze the visual ability of the patients who had cataract extraction surgery by either of the methods Method: 50 patients had cataract extraction by phacoemulsification and another 50 patients who underwent manual incision cataract surgery were included in the prospective comparative study. The refractive errors and the visual acuity of the subjects were evaluated in the follow-ups conducted after a day, three days, a week, three weeks, for weeks, six weeks, and 12 weeks after the surgery. The results obtained were statistically compared. Result: The observations of the refractive errors after the surgery were comparable in both methods. The difference in the refractive errors was significant with phacoemulsification and manual small-incision cataract surgery. However, the visual acuity was better than the preoperative baseline visual acuity Conclusion: Phacoemulsification is a superior method for cataract surgery when compared to the manual incision method in terms of the occurrence of refractive errors after the surgery.
Cataract extraction
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Astigmatism
Surgical incision
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Abstract Purpose: To compare the surgical waste generated by two different cataract surgery techniques, phacoemulsification versus manual small incision cataract surgery (MSICS). Methods: The amount of disposable waste was assessed by weighing the plastic and glass items used during a single uncomplicated cataract surgery for two cataract surgery techniques, phacoemulsification and manual small-incision cataract surgery (MSICS), including the packaging for each item. Results: We found that in a typical phacoemulsification case, the weight of the single-use disposable waste totaled 252.4 g, compared to a typical MSICS case, which totaled 125.5 g. Materials that are used in both procedures (e.g. drapes and prep materials, balanced saline solution, viscoelastic, lens, etc.) were considered “neutral” and not individually weighed. Conclusions: The waste generated by a standard phacoemulsification cataract surgery is roughly twice that of that generated by MSICS, revealing a striking difference between the two techniques. A major contributor is the cartridges, wiring, and tubing required for phacoemulsification and irrigation/aspiration. In addition to producing more waste, particularly plastic waste, phacoemulsification also generates more energy via the phacoemulsification machine. These data suggest that MSICS may be a more environmentally sustainable technique for cataract surgery. More research is needed to better describe the carbon footprint of various ophthalmic practices, particularly pertaining to cataract surgery.
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Cataract surgery begins and ends with the incision. Incision has evolved also after the advent of facoemulsification, as the current trend is to smaller safer, less astigmatogen and fast healing incisions.
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We describe a 62-year-old man with a deep brain stimulator who had cataract surgery performed by phacoemulsification. Representatives of Medtronic and Alcon Laboratories would not sanction our proceeding with cataract surgery because of the possible interaction between the ultrasound and the device. Simulated cataract surgery 1 week before the scheduled operation failed to produce any consequences. One week later, the patient had uneventful cataract surgery. Although a single case does not guarantee the lack of interference between the ultrasound used in phacoemulsification and the deep brain stimulator, our safe outcome may warrant a place in the ophthalmic literature.
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Elevated intraocular pressure
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Purpose: To analyse the effect of phacoemulsification on the control of intraocular pressure in primary open angle glaucoma in patients having phacoemulsification after previous trabeculectomy and compare them with a control group who had trabeculectomy alone. Patients and Methods: Twenty one patients (one eye from each) who had phacoemulsification subsequent to trabeculectomy were identified, and compared with 41 controls. Intraocular pressure, bleb appearance, glaucoma medications, iris manipulation and complications were recorded. Each patient was followed for full 12 months. Failure of control was defined as follows: 1) intraocular pressure >21 mm Hg on medication, or 2) a greater number of glaucoma medications than before phacoemulsification. Results: The post operative change in intraocular pressure in the case group at 12 months was much less than that in the control (p = 0.001). The mean intraocular pressure had changed from 15.3 mm Hg to 14.7 mm Hg. The control group showed an average intraocular pressure reduction of 6 mm Hg at the last visit (p > 0.001). In phacoemulsification group, 19% required 1 or 2 glaucoma medications at one year follow-up vs 19.5% in the control group. In phacoemulsification group, 9.5% showed flattening of a previously formed bleb at the last visit (P < 0.001), compared with 9.7% of controls. Conclusions: The stability of glaucoma control in the first year after phacoemulsification in previously filtered eyes with primary open angle glaucoma is comparable to that of the natural course after trabeculectomy. The study is limited by the small number of cases available.
Bleb (medicine)
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Achievement of target intraocular pressure is the goal of every efficient antiglaucoma therapy. Target intraocular pressure is the level of intraocular pressure which is associated with minimal likelihood of visual field or optic nerve lesion, or an existing lesion progression due to elevated intraocular pressure. Results of large clinical studies which have offered some new concepts on target intraocular pressure in the management of glaucoma are reviewed. An association between the curve of intraocular pressure decrease and glaucoma progression was demonstrated in these studies. Generally, a lower value of target intraocular pressure implies better protection from the loss of vision and visual field impairment in glaucoma patients. In advanced glaucoma, the greatest possible reduction from the initial intraocular pressure should be attempted. A 20% reduction from the initial intraocular pressure or decrease to < 18 mmHg in advanced glaucoma has been recognized as a favorable strategy to reach target intraocular pressure. In normal tension glaucoma, a lower value of target intraocular pressure is associated with a slower disease progression. In patients with initial glaucoma, 25% reduction from the initial intraocular pressure will slow down the disease progression by 45%. The value of target intraocular pressure depends on the pretreatment level of intraocular pressure, optic nerve condition, glaucoma disease state, rate of glaucoma progression, patient's age, and other risk factors for the development of glaucoma.
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Objective: To assess any association between the cooperation of patients during biometry and cataract surgery by phacoemulsification in order to predict the type of anesthesia for the subject surgery.
Study Design: Cross-sectional study.
Place and Duration of Study: Eye Department, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2019.
Methodology: A total of 332 patients requiring cataract surgery by phacoemulsification were recruited from the Eye department of Combined Military Hospital Multan. Patient cooperation level was measured during A-scan biometry. The cooperation level of same patient, assessed during biometry was used to plan the type of anesthesia to be administered during cataract surgery by phacoemulsification.
Results: There were 209 male and 122 female patients with the mean age of 65.14 ± 0.57 years. A significant association was found between the cooperation of patient during biometry and cataract surgery by phacoemulsification appointments (p=0.02). A significant proportion of the patients 162 (81.4%) maintained their good cooperation during surgery. Out of the 133 patients, exhibiting poor cooperation during biometry procedure, 88 (66.3%) showed an improvement in their status by having good cooperation in surgery procedure.
Conclusion: In the light of favorable clinical observation, the cooperation of the patients at the biometry procedure may be considered as a significant predictor of the type of anesthesia to be administered during cataract surgery by phacoemulsification.
Out patient department
Topical anesthesia
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