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 compare the efficacy of the Intrepid®,Balanced torsional PHACOEMULSIFICATION tip to that of the 30°,Ozil®,and 45°,Kelman®,tips using Centurion Vision System. Methods: This study included 150 eyes that underwent torsional PHACOEMULSIFICATION SURGERY using 30°,Ozil ®, tip (Group 1, 48 eyes), Intrepid ®, Balanced tip (Group 2, 52 eyes), or 45°,Kelman ®, tip (Group 3, 50 eyes). Ultrasound time (UST), cumulative dissipated energy (CDE), average phaco power, average torsional amplitude, balanced salt solution volume, aspiration and operation time, and preoperative, postoperative corrected distance visual acuity, central corneal thickness were recorded. Results: The mean UST, CDE, average phaco power, average torsional amplitude were 49. 9 ±,15. 7 s, 10. 8 ±,4. 5%‑, s, 23. 9 ±,4. 6%, and 51. 4 ±,5. 7% in the Ozil ®, group and 47. 5 ±,10. 6 s, 5. 3 ±,2. 2%‑, s, 12. 5 ±,5. 3%, and 28. 9 ±,7. 2% in the Intrepid®,Balanced group, and 48. 1 ±,12. 7 s, 6. 9 ±,3. 3%‑, s, 18. 9 ±,5. 9%, and 39. 2 ±,7. 9% in the Kelman ®, group, respectively. The CDE, average phaco power, and average torsional amplitude of the Intrepid®,Balanced group were significantly lower than other groups (P ˂,0. 05). There was no statistically significant difference between the three groups in terms of UST and operation time (P > 0. 05). Conclusion: Intrepid ®, Balanced tip, by means of its distinctive “, double bent”,design and balanced energy distribution, offers more effective PHACOEMULSIFICATION compared to conventional 30°,Ozil ®, and 45°,Kelman ®, tips.

Purpose: To report an interesting case of intraoperative opacification of intraocular lens (IOL). Methods: This study is a report of a 61-year-old male patient who suffered from nuclear sclerosis cataract and had undergone PHACOEMULSIFICATION SURGERY. During SURGERY, intraoperative opacification of IOL (Cristal, Cristalens), which was a foldable, 13 mm, one piece, square edge and hydrophilic acrylic IOL, occurred. This phenomenon caused a surprise and a decision to explant the IOL, but the surgeon decided to keep the IOL in place. After a day, it was completely clear. Results: The SURGERY was completed successfully without any complications, and the IOL was completely clear the day after SURGERY. Conclusion: Acute, transient IOL opacification with unproven etiology may occur during cataract SURGERY.

Background: PHACOEMULSIFICATION is the main method of cataract SURGERY in developed countries. Due to the importance of appropriate analgesia and the immobility of the participants throughout the procedure, the study aimed to assess the impact of intranasal ketamine vs. intranasal fentanyl on the quality of sedation and analgesia in PHACOEMULSIFICATION SURGERY. Materials and Methods: This double-blinded study was carried out on participants who underwent cataract SURGERY in Faiz Hospital, Isfahan, Iran. Eighty subjects were randomly assigned to two groups of 40 receiving ketamine at a dosage of 1. 5 mg/kg intranasally (Intranasal Ketamine (INK) group) or fentanyl at 1. 5 μg/kg nasally (Intranasal Fentanyl (INF) group). The drugs were administered through the nasal passage 15 minutes before the operation. The primary outcomes were a difference in the quality of sedation and pain relief between groups during the procedure and recovery unit. Secondary outcomes were cardiovascular parameters, side effects, the need for sedative rescues, and changes in vital signs. Results: During the study, 25 patients (62. 5%) in the INK cohort and 19 patients (47. 5%) in the INF cohort had no pain. In the INK group, 22 (55%) and in the INF group 20 (50. 0%) patients achieved optimal sedation (Ramsay sedation score 4). There was no discernible disparity observed between the two cohorts in terms of the quality of sedation (P=0. 071), receipt of rescue dosage of propofol (P=0. 601), hemodynamic parameters (P>0. 05), and side effects during treatment Operation (P=0. 542) and in recovery (P=0. 104), patient (P=0. 098) and surgeon (P=0. 120) satisfaction, operative time (P=0. 082), and duration of stay in recovery (P=0. 110). Conclusion: Although INK was more effective than INF in reducing pain and achieving optimal sedation in cataract SURGERY, it was not significantly superior to INF.

Purpose: To compare the outcomes of Descemet’, s membrane endothelial keratoplasty (DMEK) combined with PHACOEMULSIFICATION versus DMEK following PHACOEMULSIFICATION. Methods: In this interventional retrospective comparative nonrandomized case series study, patients with Fuchs endothelial corneal dystrophy (FECD) with either cataract or previous cataract SURGERY with intraocular lens (IOL) implantation were assigned to one of the two groups according to lens status. Group 1 included patients who had cataract and FECD and would undergo triple procedure (PHACOEMULSIFICATION with IOL implantation and DMEK), whereas Group 2 included patients who had FECD and had PHACOEMULSIFICATION with IOL implantation earlier and would undergo DMEK only as a sequential procedure. Results: Postoperative best corrected visual acuity (BCVA) in both groups at 1 week, 1 month, 3 months, and 6 months revealed a statistically nonsignificant difference between the two groups with mean logMAR BCVA at 6 months of 0. 07 ±,0. 18 and 0. 07 ±,0. 19 in Group 1 and Group 2, respectively (P > 0. 05). The drop in endothelial cell density by the end of the 6 th postoperative month was by 39. 44% ±, 7. 92 and 38. 73% ±, 8. 10 in the triple-procedure group and DMEK only group, respectively (P = 0. 005). Total postoperative complications rate and the rebubbling rate were statistically similar between both groups with 13. 5% and 12. 5% rebubbling rate in Group 1 and Group 2, respectively (P > 0. 05). Conclusion: Visual outcomes, endothelial cell loss, and rebubbling rate are comparable when DMEK is combined with PHACOEMULSIFICATION or when it is performed as staged procedure, without statistically significant difference in the outcomes.

Purpose: To evaluate the rate of complications in resident-performed PHACOEMULSIFICATION and influencing factors. Methods: In this retrospective cohort study, the outcomes of cataract surgeries performed by 18 ophthalmology residents were analyzed. The outcome of first 80 PHACOEMULSIFICATION cataract surgeries (1440 cataract surgeries) performed by each resident were analyzed. Outcome measures included the rate of intraoperative capsular rupture requiring anterior vitrectomy, nucleus drop, and incomplete attempts at uncomplicated procedures. Changes in the rate of complications over the surgical training course were also assessed. Results: The most common surgical complications were capsular rupture (7. 5%), followed by incomplete attempt(s) (5. 9%), and nucleus drop (1. 1%). Comparing the first 40 and second 40 surgeries, the rate of complications decreased as a function of surgeon experience in all resident cohorts. Greater theoretical skills and younger surgeon age were associated with a lower rate of intraoperative capsular rupture (hazard ratios = 1. 421 and 1. 481, respectively,P = 0. 047 and P = 0. 041, respectively). The use of antianxiety drugs and number of surgeries in the first 6 months demonstrated no predictive value for a lower rate of intraoperative complications (hazard ratios = 0. 929 and 1. 002,P = 0. 711 and P = 0. 745, respectively). Conclusion: The use of antianxiety medication and more surgeries in the first 6 months did not decrease the rate of intraoperative complications of PHACOEMULSIFICATION, while improvement of theoretical skills may have increased the safety of resident-performed cataract SURGERY.

Purpose: To evaluate corneal endothelial health after cataract SURGERY without viscoelastic substance (VS). Methods: A prospective, non‑ randomized, case‑ series study was developed, and PHACOEMULSIFICATION cataract SURGERY without VS was performed on 1324 eyes between September 2015 and September 2018. As main outcomes, mean endothelial cell density (ECD) and mean central corneal thickness (CCT) were assessed before SURGERY and then 6 and 12 months after SURGERY. Data are summarized as mean, standard deviation (SD), and 95% confidence intervals (CI). Results: A total of 1324 eyes were operated, and 31 were excluded by intraoperative complications. The mean ECD baseline was 2506 cells/ mm 2 (SD = 215, CI = 2494– 2518); 6 months after SURGERY, it was 2328 cells/mm 2 (SD = 213, CI = 2316– 2340); and 1 year after SURGERY, it was 2265 cells/mm 2 (SD = 214, CI = 2253– 2277). In terms of percentage differences, the mean ECD decrease was 9. 4% after 1 year. The mean preoperative CCT was 531. 6 µ m (SD = 34. 8, CI = 529. 7– 533. 5); 6 months after SURGERY, it was 537. 7 µ m (SD = 38. 2, CI = 535. 6– 539. 8); and 1 year after SURGERY, it was 537. 9 µ m (SD = 37. 9, CI = 535. 8– 540. 0). The mean CCT increased 1. 2% 1 year after SURGERY. Conclusions: PHACOEMULSIFICATION cataract SURGERY can be completely performed without VS, with very low intraoperative complications. The postoperative ECD and CCT changes occurred primarily during the first 6 months, and the changes decreased during the second semester.

Purpose: To report the outcomes of graft refractive SURGERY (GRS) together with clear-cornea PHACOEMULSIFICATION and intraocular lens (IOL) implantation in post-penetrating keratoplasty (PKP) eyes.Methods: Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea PHACOEMULSIFICATION with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used.Results: Mean patient age and follow-up period were 50.5±14.4 years and 14.6±7.1 months, respectively. A significant increase was observed in best spectacle-corrected visual acuity (from 0.55±0.18 logMAR to 0.33±0.18 logMAR, P=0.001). There was a significant decrease in vector keratometric astigmatism by 6.22 D (P=0.03). Spherical equivalent refraction was reduced from -3.31±3.96 D to -1.69±2.38 D (P=0.02) which did not significantly differ from the target refraction (-0.76±0.14 D, P=0.20). No complications developed and all the grafts remained clear at the final examination.Conclusion: Simultaneous PHACOEMULSIFICATION and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively.

Purpose: To investigate tear film status after PHACOEMULSIFICATION SURGERY with temporal and supratemporal clear corneal incision in a cohort of patients with senile cataract.Methods: We enrolled sixty eight eyes of 68 patients with senile cataract requiring PHACOEMULSIFICATION in a prospective, cohort study. All patients undergone Basic Tear Secretion Test (BTST), Tear Meniscus Height (TMH), Tear Break Up Time Test (TBUT) and Schirmer I test (SIT), preoperatively and three months after SURGERY. Preoperative keratometry was used to determine the steepest meridian and corresponding location of clear corneal incision. Results: The cohort included 46 men (67.6%) and 22 women (32.3%), with an age range of 48 to 82 years (mean 66.9±9.4 years). PHACOEMULSIFICATION was performed with temporal clear corneal incision in 36 eyes (52.9%) and with supratemporal clear corneal incision in 32 eyes (47.1%). There was no statistically significant difference between the results of pre and postoperative SΙT, TMH and BTST. The results of these tests were not statistically different according to incision location. In contrast, TBUT results differed significantly in pre and postoperative examination in both incision location groups (P<0.001); however, there was no statistically significant difference in TBUT results according to incision location. Conclusion: PHACOEMULSIFICATION cataract SURGERY has no significant effect on tear film. In addition the location of clear corneal incision had no effect on tear film tests.