Intraocular lens-shell technique: adjustment of the surgical procedure leads to greater safety when treating dense nuclear cataracts

Lixia Luo; Haotian Lin; Weirong Chen; Bo Qu; Xinyu Zhang; Zhuoling Lin; Jingjing Chen; Yizhi Liu

doi:10.1371/journal.pone.0112663

Intraocular lens-shell technique: adjustment of the surgical procedure leads to greater safety when treating dense nuclear cataracts

PLoS One. 2014 Nov 17;9(11):e112663. doi: 10.1371/journal.pone.0112663. eCollection 2014.

Authors

Lixia Luo¹, Haotian Lin¹, Weirong Chen¹, Bo Qu¹, Xinyu Zhang¹, Zhuoling Lin¹, Jingjing Chen¹, Yizhi Liu¹

Affiliation

¹ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Abstract

Objective: To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts.

Methods: Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the "IOL-shell technique", features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out.

Results: The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05).

Conclusions: Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT02138123).

Trial registration: ClinicalTrials.gov NCT02138123.

Publication types

Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cataract / diagnosis
Cataract / therapy*
Corneal Pachymetry
Female
Humans
Lens Implantation, Intraocular / adverse effects
Lens Implantation, Intraocular / methods*
Lenses, Intraocular*
Male
Middle Aged
Severity of Illness Index
Treatment Outcome
Visual Acuity

Associated data

ClinicalTrials.gov/NCT02138123

Grants and funding

This study was funded by the Natural Science Foundation of China (81370994). The sponsors of the study played no role in design of the original study protocol, data collection, data analysis, data interpretation, manuscript preparation, or the decision to submit the manuscript for publication.