Purpose: To compare the outcomes of microcoaxial PHACOEMULSIFICATION and conventional PHACOEMULSIFICATION techniquesMethods: In this prospective comparative clinical study in the Negah eye center, 69 eyes of 69 patients with senile cataract of grade 3 to 4 on the Lens Opacities Classification System III (LOCSIII) were placed in two groups. Thirty nine eyes were assigned to undergo surgery by the microcoaxial technique (2.4 mm) and 30 eyes by the conventional coaxial technique (3.2 mm). All surgeries were performed by a single surgeon using the same machine (Sovereign WhiteStar, AMO). In all cases, a temporal clear corneal incision (CCI) was constructed and hydrophobic acrylic flexible intraocular lens (Acrysof Natural, SN60AT) were implanted. Intraoperative parameters including mean PHACOEMULSIFICATION time, total PHACOEMULSIFICATION percentage, effective PHACOEMULSIFICATION time (EPT), total volume of balanced salt solution (BSS) used, and the final size of the corneal incision were measured. Postoperative parameters including uncorrected and best spectacle corrected visual acuity (UCVA, BSCVA), keratometric and astigmatism changes by vector analysis, at 1 day, 5 days and 2 months, were checked.Results: Postoperative BCDVA in 5 days and 2 months in conventional and microcoaxial groups were significantly different. At 5 days, BCDVA was 0.04±0.07 logMAR and 0.00±0.02 logMAR respectively (P=0.006). At 2 months BCDVA was 0.02±0.06 logMAR and 0.00±0.02 logMAR respectively (P=0.044). Mean induced keratometric change in 5 days in conventional and microcoaxial groups were 0.39±0.06 and 0.18±0.24 diopter respectively (P=0.035), but long-term keratometric values showed no significant differences. Other measured intraoperative and postoperative variables showed no significant difference between the two groups. There were no intraoperative or postoperative complications.Conclusion: Microcoaxial PHACOEMULSIFICATION showed significantly less induced keratometric changes and also better corrected visual acuity in early postoperative period. Long-term keratometric values showed no significant differences. Both techniques were effective for surgery in cases with senile uncomplicated cataract.

Purpose: To compare the outcomes of coaxial microincision PHACOEMULSIFICATION with that of conventional coaxial PHACOEMULSIFICATIONSETTING: Department of Ophthalmology, Farabi and Noor Eye Hospitals, Tehran, IranMethods: In a prospective study, 74 eyes of 74 patients with cataract were randomly selected to have cataract extraction using 1 of 2 techniques: coaxial microincision PHACOEMULSIFICATION through a 2.2 mm incision (37 eyes) or conventional coaxial PHACOEMULSIFICATION through a 2.8 mm incision (37 eyes) and foldable intraocular lens (IOL) (SA60; Alcon) implantation. Intraoperative parameters were effective PHACOEMULSIFICATION time (EPT), surgical time, and total volume of balanced salt solution (BSS) used. Assessed ocular biometrics included corneal topography, to evaluate surgically induced astigmatism (SIA), as well as corneal thickness and endothelial cell count (ECC).Results: Using vectorial analysis the amount of SIA was 0.04±0.34 diopter (D) at 126.7 degrees in the 2.8 mm group and 0.07±0.49 D at 11.8 degrees in the 2.2 mm group, at one month postoperatively. At 3 months, the SIA was 0.06±0.41 D at 134.7 degrees and 0.10±0.62 at 161.4 degrees in the 2.8 mm and 2.2 mm groups, respectively.Conclusion: Although coaxial microincision cataract surgery (MICS) was a safe and effective technique there were no clinical or statistically significant differences between 2 techniques in minimizing the effect of incision size on SIA.

Purpose: To determine the results of PHACOEMULSIFICATION at Labbafinejad medical center. Methods and materials: This is a non comparative case series and prospective study. 177 patients (95 males, 53.7% and 82 females, 46.3%) had phacocmulsification. The age range of the patients was 40-84 years with mean of 63.26 (±10.17) years. Five anterior segment attending did 106 (59.9%) surgeries and two cornea fellows did 71 (40.1%) surgeries.Results: In 27 (15.3%) patients, foldable acrylic lenses and in 125 (84.3%) patients, PMMA lenses were used. In one patient (0.6%), lens was not implanted due to expulsive choroidal hemorrhage. Intra-operative complications were premature entrance, two cases (1.1%); tunnel extension leading to shallow anterior chamber, two cases (1.1%); incomplete hydrodissection and hydrodelination, two cases (1.1%); zonular rupture, 3 cases (1.7%); trauma to iris with phaco-tip, 3 case (1.7%); vitreouse loss, 11 cases (6.2%); capsulorrhexis complications including decantation, 6 cases (3.4%); anterior capsular tear, 9 cases (5.1%), capsulorrhexis less than 5.0 mm, 5 cases (2.8%); capsulorrhexis more than 7.0 mm, one case (0.6%); and combinations of these complication, in two cases (1.1%). Keratometry difference less than two diopter was 84.9% in the first week and 96.7% in the first month. Astigmatism less than two cylinders were 76.7% in the first week and 97.7% in the first month. In the first post-operative day, 5.7% of patients had uncorrected visual acuity (VA) of 10/10 and 63.6% had uncorrected VA equal or more than 4/10. In the first week after operation, 66.5% had uncorrected VA equal or more than 7/10, which increased to 74.3% in the first month. Ocular pathology leading to decrease in visual acuity was present in 16.4% of patients. With exclusion of these pathologic conditions, the uncorrected visual acuity equal or more than 7/10 increased to 79.54% in the first week and 88.88% in the first month.Conclusion: PHACOEMULSIFICATION is a safe method which results in rapid visual rehabilitation.

Purpose: To evaluate pupil dilation with intracameral injection of preservative-free lidocaine 1% during PHACOEMULSIFICATION. Methods: This interventional case series included 31 consecutive senile cataract patients scheduled for PHACOEMULSIFICATION and intraocular lens (IOL) implantation. Pupil dilation was achieved using intracameral preservative-free lidocaine 1% without any preoperative or intraoperative mydriatics. Pupil diameter was measured by calipers immediately before and 90 seconds after intracameral injection of lidocaine.Results: Patients included 16 male and 15 female subjects with mean age of 67.3±9.9 years. Four patients were diabetic and four cases had pseudoexfoliation. Pupil diameter increased from 2.63±0.3 mm preoperatively to 7.03±0.61 mm 90 seconds after intracameral injection of lidocaine with a mean increase of 4.39±0.53 mm (range 3.4-5.2, P<0.001). Mean post-injection mydriasis was significantly greater in patients without pseudo exfoliation (7.1 mm vs 6.00 mm, independent t test and Mann-Whitney test, P<0.01). There was no significant difference between diabetic and nondiabetic patients regarding of pre- and post-injection diameter of the pupil.Conclusion: Intracameraم preservative-free lidocaine 1% provides rapid and effective mydriasis and can be a safe alternative to other topical and intracameral mydriatics used in PHACOEMULSIFICATION.

The most common and effective surgical technique for cataract extraction is PHACOEMULSIFICATION. One of proposed mechanisms of PHACOEMULSIFICATION is the direct mechanical effect named jackhammer theory. Close mechanical contact between the tip and the nucleus is one of important factors which determine the efficacy of jackhammer effect.Clockwise turning of stainless steel screw, slightly larger than the inside diameter of a standard phaco tip 1 mm behind the tip boarder, causes internal clockwise grooves. On the external surface, one row of counterclockwise grooves with 1 mm in length was made.The designed tip in vitro and immersed in salin solution was examined to evaluate the efficiency of emulsifying chestnut particles and mature human lens. In vitro effective phaco time (EPT) was less for the double-threaded tip compared with internally grooved tip. The anti-directional design of internal and external grooves could improve mechanical adherence. Important consideration with this design is the fact that these grooves create more cavitation.This tip seems useful especially for stony hard nuclei. Future in vivo and clinical studies are needed to better discover features of this design.

Purpose: To compare the safety and efficacy of three methods for correcting pre‑existing astigmatism during PHACOEMULSIFICATION.Methods: This prospective, comparative, non‑randomized study was conducted from March 2010 to January 2011, and included patients with keratometric astigmatism ≥1.25 D undergoing cataract surgery.Astigmatism was corrected using the following approaches: limbal relaxing incisions (LRI) on the steep meridian, extension and suturing of the phaco incision created at the steep meridian (extended‑on‑axis incision, EOAI), and toric intraocular lens (tIOL) implantation. Keratometric and refractive astigmatism were evaluated 1, 8, and 24 weeks postoperatively.Results: Eighty‑three eyes of 72 patients (35 male and 37 female) with mean age of 62.4 ± 14.3 (range, 41‑6) years were enrolled. The astigmatism was corrected by using the LRI, EOAI and tIOL implantation methods in 17, 33 and 33 eyes, respectively. Postoperative uncorrected distance visual acuity (UDVA) was significantly improved in all three groups. The difference in postoperative UDVA was not statistically significant among the study groups throughout follow‑up except at week 24, when UCVA was significantly better in the tIOL group as compared to the EOAI group (P=0.024). There is no statistically significant difference of correction index and index of success between three groups at week 24 (P=0.085 and P=0.085 respectively).Conclusion: There was no significant difference in astigmatism reduction among the three methods of astigmatism correction during PHACOEMULSIFICATION. Each of these methods can be used at the discretion of the surgeon.

Background and Objectives: PHACOEMULSIFICATION is a modern and effective method of cataract surgery. Since its introduction in the late 1960's by Kelman, a number of major advances occurred in this technique. This study was undertaken in Tabriz in year 1999 to assess its results and compare it with conventional technique of cataract extraction. Materials and Methods: We conducted a quasi-experimental study in 50 patients (26 males and 24 females) with mean age of 64 (16-79) years undergoing cataract extraction by phaco technique. Patients were followed for 1-6 months (Dec. 98 - June. 99). Results: Mean preoperative best corrected visual acuity was 20/80 (H.M. to 20/100) that improved to 20/70 (20/100 to 20/25) after one day and 20/25 (SD=1.2) 1 week postoperatively and to 20/25 (20/100 to 20/40) at final examination. Visual acuity of 20/40 or better was achieved in 82% and 99% of all patients after 1 week and in final examination respectively. Conclusion: PHACOEMULSIFICATION technique provides the patients the greatest amount of vision with the least amount of postoperative time and reduces dependency to eye glasses.  

Purpose: To evaluate anterior chamber aspirates at the conclusion of PHACOEMULSIFICATION and intraocular lens implantation (PE+IOL) for bacterial and fungal contamination.Methods: We prospectively evaluated 80 eyes of 80 patients undergoing routine PE+IOL by performing bacterial and fungal culture on aspirates obtained from the anterior chamber at the end of the surgery.Results: Anterior chamber fluid aspirates were positive for bacteria in 5 eyes (6.33%) with coagulase-negative staphylococcus being the most common organism (three eyes).No instance of positive fungus culture was observed. One of the culture-positive eyes developed postoperative uveitis which resolved during a week of treatment with topical corticosteroids and antibiotics. None of the eyes developed endophthalmitis.Conclusion: In the current series, the rate of anterior chamber contamination by bacteria at the end of PHACOEMULSIFICATION was in the lower range reported by previous studies.