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Objective
To evaluate the safety and effectiveness of air bubble-assisted intraocular lens (IOL) implantation and its effect on corneal endothelial cell during phacoemulsification for age-related cataract.
Methods
A non-randomized controlled study was conducted.One hundred and seventy eyes of consecutive 170 patients with age-related cataracts who received phacoemulsification combined with one-stage IOL implantation were included from March 2019 to September 2019 in First Affiliated Hospital of Zhejiang Chinese Medicine University in this study.Among the operative eyes, 92 eyes that underwent phacoemulsification combined with air bubble-assisted IOL implantation served as air bubble-assisted group and 78 eyes that received hyaluronan-assisted IOL implantation served as hyaluronan-assisted group.All the subjects were followed up for successive 12 weeks.The total operative duration and IOL implantation duration, corneal endothelial cell count (ECC) and the proportion of hexagonal cells before and 1, 4, 12 weeks after surgery, and intraocular pressure (IOP) before and 1 day, 1 week and 4 weeks after surgery were compared between the two groups.And the total surgery time and IOL implantation time were compared between the two groups.This study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of First Affiliated Hospital of Zhejiang Chinese Medicine University (No.KL-010-01).
Results
The operation went well in all the eyes and there was no serious intraoperative or postoperative complication in all the operative eyes.There was no significant difference in preoperative and postoperative ECC, the proportion of hexagonal cells and the IOP between the two groups (Fgroup=0.004, P=0.953; Fgroup=0.706, P=0.042; Fgroup=1.896, P=0.170). The postoperative ECC and the proportion of hexagonal cells at different time points were significantly smaller than the preoperative ECC and hexagonal cells proportion in the two groups (all at P<0.05). The IOP was elevated in 2 eyes in the hyaluronan-assisted group one day after operation, which returned to normal after anterior chamber puncture.There was no postoperative high IOP in the air bubble-assisted group.The total surgery time and IOL implantation time were (357.78±36.07) seconds and (50.63±8.37) seconds respectively in the hyaluronan-assisted group, which were significantly longer than (256.95±47.74) seconds and (29.66±6.58) seconds respectively in the air bubble-assisted group, showing significant differences between the two groups (both at P<0.01).
Conclusions
Air bubble-assisted technique can shorten the IOL implantation duration.Both air bubble-assisted and hyaluronan-assisted IOL implantation causes no additional risk to corneal endothelium.
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Contributor Information
Department of Ophthalmology, First Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou 310006, China
Department of Ophthalmology, First Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou 310006, China
Phacoemulsification combined with air bubble-assisted intraocular lens implantation
Hyaluronan (Bausch&Lomb, USA) was filled into the anterior chamber through the 12:00 corneal incision of 1.8 mm and the 2:00 corneal incision of 0.8 mm. Capsule forceps were used to perform 5.0-5.5 mm continuous circular capsulorhexis. Phacoemulsification was carried out with Stellaris system and the residual cortex lentis was removed. IOL was loaded into the IOL injector, which was partially filled with hyaluronan and without hyaluronan in its head. The IOL was injected through 12:00 incision and an air-bubble was formed, which could maintain the shape of anterior chamber in the injection to avoid ocular tissue injury.