Eyeworld

22 | EYEWORLD | DECEMBER 2019 ASCRS NEWS EYEWORLD JOURNAL CLUB Contact information Challa: pratap.challa@duke.edu applications of this technique should evaluate the patient experience. Conclusion The authors of this study present an interesting and thoughtful idea by which surgeons may be able to reduce postoperative inflammation in cataract patients. While the impact of tissue hypothermia has certainly proven to be effective in a number of disease states and procedures, there is still work to be done to understand its impact on phacoemulsification. We agree that additional studies with larger sample sizes and longer follow-up periods are needed to under- stand the long-term impact of this technique. Furthermore, understanding how intraocular hypothermia may impact the patient's subjective intraoperative and postoperative experience is an important perspective to be explored. We appreciate this unique contribution to the liter- ature and look forward to the development of improved phacoemulsification techniques for the benefit of our cataract patients. position, thereby altering refractive outcomes. Prolonged unfolding may also lengthen surgical times, which could impact postoperative in- flammation. Furthermore, it is unclear whether ophthalmic viscosurgical devices (OVDs) were utilized and, if so, whether it was cohesive or dispersive. OVDs have been shown to protect the corneal endothelium from temperature fluctuations associated with phacoemulsifica- tion. 8 Interpreting the data in the setting of a specific OVD would add context and value to the analysis. Finally, it would have been interesting to learn whether there was a difference in pa- tient comfort intraoperatively and during the early postoperative period. A study in patients undergoing photorefractive keratectomy (PRK) found a trend toward increased pain amongst patients receiving chilled versus room tempera- ture saline, but this was not found to be statis- tically significant. 9 It is unclear what the effect of hypothermic perfusion on patient comfort would be during cataract surgery and future continued from page 21 6. Fundamental of Ultrasonic Phacoemulsification Power 2019. American Academy of Ophthal- mology 2019. 7. Jung GB, et al. Physicochem- ical and surface properties of acrylic intraocular lenses and their clinical significance. J Phar- ma Investig. 2017;47(5):453–460. 8. Suzuki H, et al. Efficacy of Ophthalmic viscosurgical devices in preventing temperature rise at the corneal endothelium during phacoemulsification. Cur Eye Res. 2016;41(12):1548–1552. 9. Neuffer MC, et al. Prospective comparison of chilled versus room temperature saline irrigation in alcohol-assisted photore- fractive keratectomy. Nepal J Ophthalmol. 2013;5(2):154–160. Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: a randomised trial Wenjuan Wan, MD, Lu Jiang, Yan Ji, MD, Yan Xun, Liang Xiong, MD, Yongguo Xiang, Ruonan Li, Zhouyu Li, Xiaoqin Wang, MD, Jay M. Stewart, MD, Ke Hu, MD, PhD n Results: In animal models, the central cornea thickness of the 4°C group (370.4±45.5μm) was thinner than that of the 24°C group (496.7±121.5μm) on the first day postoperatively (P<0.001). The AC inflammation reaction grade of 4°C group (1.1±0.9) was lower than that of 24°C group (2.2±0.8, P=0.0333). In clinical trials, the central and incisional cornea thickness in 4°C group (600.7±51.8μm and 859.2±177.8μm) were thinner than those in 24°C group (655.3±85.0μm and 955.9±196.7μm, P<0.001). The endothelial cell density (P=0.036) and hexagonality (P=0.001) were higher in 4°C group. The AC inflammation reaction grade of 4°C group (0.6±0.6) was lower than that of 24 °C group (1.3±1.0, P=0.004) on the first day postoperatively. n Conclusions: Hypothermic perfusion in phacoemulsification of hard nuclear cataract is safe and it can effectively protect corneal endothelium, decrease corneal edema and reduce AC inflammation in the early postoperative stage. n Purpose: To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of hard nuclear cataract. n Setting: In a tertiary center of ophthalmology in China. n Design: An animal study and a prospective randomised clinical trial. n Methods: A total of 40 rabbits and 80 patients with hard nuclear cataract underwent phacoemulsification with perfusion temperatures at 4°C or 24°C. Anterior segment optical coherence tomography (OCT), corneal endothelial cell count and cornea sections were observed before rabbits' operation and on the 1st and 7th day postoperatively. Anterior segment OCT, corneal endothelial cell count and anterior chamber (AC) inflammation were observed before patients' operation and on the 1st, 7th and 30th day postoperatively.

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