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OHM

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.

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OHM

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  1. 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 The authors have received travel expense reimbursement from Alcon Laboratories, USA

  2. Introduction 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

  3. 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.

  4. 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: Prospective, Randomized, Masked study Study population: 80 consecutive patients undergoing phacoemulsification for uncomplicated age-related cataracts

  5. Materials And Methods 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 80 eyes - Random allocation into 2 groups: Group II Longitudinal ultrasound (n = 40) Group I Torsional ultrasound (n = 40)

  6. Surgical 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

  7. Surgical Parameters Used Group I: Torsional Ultrasound (Ozil ™) • 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 Group II: Longitudinal Ultrasound • 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

  8. Methodology After IOL implantation All incisions were hydrated Speculum was removed Trypan blue applied over conjunctiva Encouraged to blink for 2 min 0.1ml aqeous aspirated

  9. Observation Quantify the ingress of trypan blue in anterior chamber in the two groups Quantification of Trypan Blue * Trypan blue was first scanned at different wave lengths (190nm to 900nm) using a U.V visible spectrophotometer * The maximum optical density of trypan blue was found to be at 595nm * A standard graph using different dilutions of trypan blue was created

  10. Standard Graph

  11. Results Comparison of log of denominators of Trypan blue ingress into the anterior chamber between the two groups: * Higher Log value of Trypan blue ingress indicates lesser amount of Trypan blue in the anterior chamber

  12. 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)

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