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OHM. Abhay Vasavada, Vaishali A Vasavada, Devarshi Gajjar, Shetal Raj. Comparative quantification of ingress of trypan blue into anterior chamber following microcoaxial phacoemulsification with torsional or longitudinal ultrasound. Iladevi Cataract and IOL Research Center, Ahmedabad, India. - PowerPoint PPT Presentation
Citation preview
OHM
Comparative quantification of ingress of trypan blue into anterior chamber following
microcoaxial phacoemulsification with torsional or longitudinal ultrasound
The authors have received travel expense reimbursement from Alcon Laboratories, USA
Abhay Vasavada, Vaishali A Vasavada, Devarshi Gajjar,
Shetal Raj
Iladevi Cataract and IOL Research Center, Ahmedabad,
India
Berdahl JP, Jun P, DeStafeno JJ, et al
Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds
J Cataract Refract Surg 2008; 34 (12): 2091-2095
Phacoemulsification using the OZil™ handpiece through a microincision with an Ultrasleeve and a 45-degree miniflared tip showed favorable clinical and intraoperative characteristics such as less total energy use and less endothelial cell loss at 6 months
Introduction
Praveen MR, Vasavada AR, Gajjar D, et al
Comparative quantification of ingress of trypan blue into the anterior chamber after microcoaxial, standard coaxial, and bimanual phacoemulsification: randomized clinical trial
J Cataract Refract Surg 2008 Jun; 34 (6): 1007-12
* Trypan blue ingress into the anterior chamber found in all three groups.
* There was no significant difference between the standard coaxial and microcoaxial phacoemulsification following IOL implantation.
Aim To compare ocular surface fluid ingress into the anterior
chamber during microcoaxial phacoemulsification performed
with the Torsional ultrasound (Ozil™) and Longitudinal
ultrasound using Trypan Blue as the quantifying tracer
Study design: Study design: Prospective, Randomized, Masked studyProspective, Randomized, Masked study
Study population: Study population:
80 consecutive patients undergoing phacoemulsification for 80 consecutive patients undergoing phacoemulsification for uncomplicated age-related cataractsuncomplicated age-related cataracts
80 eyes - Random allocation into 2 groups:80 eyes - Random allocation into 2 groups:
Group ITorsional ultrasound
(n = 40)
Group IILongitudinal ultrasound
(n = 40)
Exclusion Criteria
• Dense cataracts (> grade 4), uveitis, shallow anterior chamber, glaucoma, high myopia (AL > 25mm)
• Intraoperative complications: Wound site thermal injury (WSTI), Posterior capsule rupture, Incisional damage / suture
Materials And MethodsMaterials And Methods
Surgical TechniqueSurgical Technique
•All surgeries performed by a single surgeon (ARV)
•Microcoaxial phacoemulsification performed on the Infiniti
Vision System ™
• 2.2mm temporal single plane clear corneal incision
• Standardized surgical parameters
• 0.9mm miniflared ABS 45 deg Kelman tip used
Surgical Parameters Used
Group II: Longitudinal Ultrasound
•Torsional amplitude : Ozil continuous with linear control, upto 80
•Aspiration flow rate (AFR) : 25cc/min
•Vacuum (mmHg) : upto 650mmHg ( depending on grade cataract )
•Bottle height : 90-110cm
•Preset U/S power (Pulse mode) : 60% preset, 40 pps, 40% on time
•Aspiration flow rate (AFR) : 25cc/min
•Vacuum (mmHg) : upto 650mmHg ( depending on grade cataract )
•Bottle height : 90-110cm
Group I: Torsional Ultrasound (Ozil ™)
Methodology
All incisions were hydrated
Speculum was removed
Trypan blue applied over conjunctiva
Encouraged to blink for 2 min
After IOL implantationAfter IOL implantation
0.1ml aqeous aspirated0.1ml aqeous aspirated
Observation
Quantify the ingress of trypan blue in anterior chamber in the two groups
** Trypan blue was first scanned at different wave lengths (190nm Trypan blue was first scanned at different wave lengths (190nm to 900nm) using a U.V visible spectrophotometerto 900nm) using a U.V visible spectrophotometer
** The maximum optical density of trypan blue was found to be at The maximum optical density of trypan blue was found to be at 595nm595nm
** A standard graph using different dilutions of trypan blue was A standard graph using different dilutions of trypan blue was createdcreated
Quantification of Trypan BlueQuantification of Trypan Blue
Standard GraphSpectrophotometry of Trypan blue
00.5
11.5
22.5
33.5
44.5
0 0.6 1 1.6 2 2.6 3 4 5
Log dilution with Normal saline
Absorb
ance a
t
Comparison of log of denominators of Trypan blue ingress into the anterior chamber between the two groups:
GROUP N MEAN + SD MIN. MAX.
OzilTM 40 3.77 + 0.82* 1.0 4.75
Longitudinal ultrasound 40 3.40 + 0.60 1.6 4.75
Mann Whitney U Test P= 0.007
ResultsResults
* Higher Log value of Trypan blue ingress indicates lesser amount of Trypan blue in the anterior chamber
Conclusion
• Trypan blue ingress was found in both groups
• Trypan Blue ingress was statistically significantly
greater following phacoemulsification with
Longitudinal ultrasound as compared to Torsional
ultrasound (OzilTM)