SEP 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 77 of 98

September 2013 EW RESIDENTS 75 in conventional compared to femtosecond laser-assisted cataract surgery: Three-month follow-up" From left to right: David R. Shield, MD, Daniel Greene, MD, and Ting Ting Liu, MD Source: David R. Shield, MD In this study, the authors conclude that the relative contributions of these variables were minimal given the significant results with reduction in US energy alone. The authors mention that recovery time for endothelial cells ranges from one to six months.17 Other studies have reported postoperative endothelial cell recovery to occur up to 12 months after phacoemulsification and up to 10 years after intracapsular and extracapsular cataract extraction.18,2,19 The short threemonth duration of follow-up of this study is a significant limitation. In addition, although a decrease in endothelial cell count is the primary indicator of endothelial damage, studies have shown that alterations in endothelial cell size and shape (polymegathism and pleomorphism) may also be a sensitive indicator of endothelial trauma.20 Additional specular microscopy measurements such as the coefficient of variation in cell size and percentage of hexagonality could have been included in the study to further describe the degree of endothelial impact from each type of surgery. The authors reported that dense cataracts (mean NO 3.1±0.8) in the study group had significantly less endothelial cell loss (41%) at three months when compared to equivalent nuclear density in the control group. This result, however, was only reported in the conclusions section, and there was no mention of other cataract density level groups. Furthermore, the authors noted a significant reduction in central corneal thickness in the study group compared to controls, and it would be interesting to clarify whether this effect mainly existed with the complete elimination of ultrasonic energy (EPT of 0.00 in NO1 and NO2 subgroups) or also with the marked decrease in energy utilization in higher-grade cataracts. Similarly, were significant differences found among all LOCS III grades throughout the entire follow-up period? Since the authors reported EPT by LOCS III grade, similar subgroup results and analysis on endothelial cell loss and corneal pachymetry would be especially valuable. In summary, this is an important study of the safety profile of femtosecond-assisted cataract surgery compared with traditional phacoemulsification on endothelial cell loss and corneal thickness. We look forward to reading the authors' results with longer follow-up in this ongoing area of investigation. EW References 1. Bourne W, Waller R, Liesegang T, Brubaker RF. Corneal trauma in intracapsular and extracapsular cataract extraction with lens implan- tation. Arch Ophthalmol 1981; 99:1375–76. 2. Bourne R, Minassian D, Dart J. Effect of cataract surgery on the corneal endothelium, modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 2004; 111:679–85. 3. Davison JA. Endothelial cell loss during the transition from nucleus expression to posterior chamber-iris plane phacoemulsification. J Am Intraocular Implant Soc 1984; 10:40–43. 4. Gierek-Lapinska A, Bolek S, KaminskaOlechnowicz B, Wonjciechowska R. The state of corneal endothelium after cataract extraction as examined by contact endothelial microscopy. Klin Oczna 1992; 94:177–79. 5. Gogate P, Ambardekar P, Kulkarni S, Deshpande R, Joshi S, Deshpande M. Comparison of endothelial cell loss after cataract surgery: phacoemulsification versus manual small-incision cataract surgery: six-week results of a randomized control trial. J Cataract Refract Surg 2010; 26:247–53. 6. Mencucci R, Ponchietti C, Virgili G, Giansanti F, Menchini U. Corneal endothelial damage after cataract surgery: microincision versus standard technique. J Cataract Refract Surg 2006; 32:1351–54. 7. Thakur SK, Dan A, Singh M, Banerjee A, Ghosh A, Bhaduri G. Endothelial cell loss after small incision cataract surgery. Nepal J Ophthalmol 2011; 3:177–80. 8. Park J, Lee SM, Kwon JW, Kim MK, Hyon JY, Wee WR, Lee JH, Han YK. Ultrasound energy in phacoemulsification: a comparative analysis of phaco-chop and stop-and-chop techniques according to the degree of nuclear density. Ophthal Surg Lasers Imaging 2010; 41:236– 41. 9. Storr-Paulsen A, Norregaard JC, Ahmed S, Storr-Paulsen T, Pedersen TH. Endothelial cell damage after cataract surgery: divide-andconquer versus phaco-chop technique. J Cataract Refract Surg 2008; 24:996–1000. 10. Bozkurt E, Baraktar S, Yazgan S, Cakir M, Cekic O, Erdogan H, Yilmaz O. Comparison of conventional and torsional mode (OZil) phacoemulsification: randomized prospective clinical study. Eur J Ophthalmol 2009; 19:984–90. 11. Kim D, Wee WR, Lee JH, Kim MK. The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts. Kor J Ophthalmol 2010; 24:336–40. 12. Abell RG, Kerr NM, Vote BJ. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Ophthalmology 2013; 120:942–48. 13. Conrad-Hengerer I, Juburi MA, Schultz T, Hengerer FH, Dick HB. Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up. J Cataract Refract Surg 2013; 39:1308-14. 14. Baradaran-Rafii A, Rahmati-Kamel M, Eslani M, Kiavash V, Karimian F. Effect of hydrodynamic parameters on corneal endothelial cell loss after phacoemulsification. J Cataract Refract Surg 2009; 35:732–37. 15. Lucena DR, Ribeiro MS, Messias A, Bicas HE, Scott IU, Jorge R. Comparison of corneal changes after phacoemulsification using BSS plus versus lactated ringer's irrigating solution: a prospective randomised trial. Br J Ophthalmol 2011: 485–89. 16. Mahdy MA, Eid MZ, Mohammed MA, Hafez A, Bhatia J. Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery. Clin Ophthalmol 2012; 6:503–510. 17. Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg 1996; 22:1079–84. 18. Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994 Jun;101(6):1014–22. 19. Galin MA, Lin LL, Fetherolf E, Obstbaum SA, Sugar A. Time analysis of corneal endothelial cell density after cataract extraction. Am J Ophthalmol 1979: 88:93–96. 20. Matsuda M, Miyake K, Inaba M. Long-term corneal endothelial changes after intraocular lens implantation. Am J Ophthalmol 1988; 105:248–52. Contact information Huang: john.huang@yale.edu

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