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Digital archive of theses discussed at the University of Pisa


Thesis etd-12092019-121942

Thesis type
Tesi di dottorato di ricerca
Thesis title
The impact of new surgical techniques, devices and intraocular lenses on clinical, functional, and refractive results of cataract surgery.
Academic discipline
Course of study
tutor Prof. Nardi, Marco
  • cataract
  • devices
  • IOL
Graduation session start date
Release date
Aims and scopes: the aim of this study is to investigate the impact of new
surgical techniques and devices on surgical and functional results of cataract

Introduction: with more than 19 millions surgeries per year cataract is the
most performed surgical procedure after childbirth and is therefore a high
interest topic for both clinical and industrial world. For this reason cataract
surgery is a highly innovative field with new devices and instruments
emerging every year. The impact of new devices and instruments on clinical
and functional results is nevertheless poorly investigated.

Methods: monocentric, retrospective, non randomized clinical study. In this
study we investigated the impact of two different phacoemulsification
platforms (Alcon Centurion Vision System vs Stellaris® Enhanced Vision
System) and three different Intra-Ocular Lenses (Alcon Clareon IOL, Alcon
Acrysof IQ IOL and Bausch&Lomb enVista IOL) on surgical and clinical
outcomes of cataract surgery. All surgeries have been performed in our clinic
during a 2 years period (1st April 2017 to 31st January 2019) by the same
experienced surgeon. Patients have been subjected to four follow-up visits
(1, 15 days and 3, 6 months after surgery). Intra-operative data such as
surgery duration and ultra sound usage have been registered as well as
postoperative outcomes regarding refraction and IOL performance.

Results: 180 patients participated to the study. Mean US time was equivalent
for both phaco-platforms while irrigation liquid per minute and US
percentage used were significantly lower for Stellaris® platform. Glistening
phenomena were found in Acrysof IOLs only while posterior capsule
opacification was found in one patient implanted with the enVista IOL. No
differences in visual acuity were found among the subgroups.
Conclusions: Different phacoemulsification machines apply distinct
mechanism of vacuum power production and fluidic control. These
mechanism influence intra-operative parameters such as surgery duration,
fluid consumption and ultrasound usage. In our study we found these
differences don’t affect clinical outcomes of cataract surgery but studies with
larger population, different surgeons and prolonged follow-up are needed
to better investigate this topic. Hydrophobic Acrylic IOLs show a significant
higher grade of glistening when compared with newer IOLs. The impact of
this phenomenon on visual acuity is otherwise still controversial. Studies
with larger population and prolonged follow-up are needed to better
investigate this aspect.