Clinical Sciences
Mini-Rhexis For White Intumescent Cataracts
Newton Kara-Junior, Marcony Rodrigues de Santhiago
, Andrea Kawakami, Pedro Carricondo, Wilson Takashi Hida
Corresponding author
Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
Read
641
Timeswas read the article
248
Total PDF
393
Total HTML
Share statistics
array:24 [ "pii" => "S1807593222026497" "issn" => "18075932" "doi" => "10.1590/S1807-59322009000400007" "estado" => "S300" "fechaPublicacion" => "2009-04-01" "aid" => "2649" "copyright" => "CLINICS" "copyrightAnyo" => "2009" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2009;64:309-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222026503" "issn" => "18075932" "doi" => "10.1590/S1807-59322009000400008" "estado" => "S300" "fechaPublicacion" => "2009-04-01" "aid" => "2650" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2009;64:313-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Sciences</span>" "titulo" => "Influence of Obesity on Bone Mineral Density in Postmenopausal Asthma Patients Undergoing Treatment with Inhaled Corticosteroids" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "318" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Burcu Yanık, Aylin Ayrım, Duygu Ozol, Asli Koktener, Derya Gokmen" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Burcu" "apellidos" => "Yanık" ] 1 => array:2 [ "nombre" => "Aylin" "apellidos" => "Ayrım" ] 2 => array:2 [ "nombre" => "Duygu" "apellidos" => "Ozol" ] 3 => array:2 [ "nombre" => "Asli" "apellidos" => "Koktener" ] 4 => array:2 [ "nombre" => "Derya" "apellidos" => "Gokmen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222026503?idApp=UINPBA00004N" "url" => "/18075932/0000006400000004/v1_202212060657/S1807593222026503/v1_202212060657/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222026485" "issn" => "18075932" "doi" => "10.1590/S1807-59322009000400006" "estado" => "S300" "fechaPublicacion" => "2009-04-01" "aid" => "2648" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2009;64:303-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Sciences</span>" "titulo" => "Results of Monocular Surgery Under Peribulbar Anesthesia for Large-Angle Horizontal Strabismus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "303" "paginaFinal" => "308" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1 -" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 985 "Tamanyo" => 71990 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">ROC Curve</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tatiana Millán, Keila Monteiro de Carvalho, Nilza Minguini" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Tatiana" "apellidos" => "Millán" ] 1 => array:2 [ "nombre" => "Keila Monteiro" "apellidos" => "de Carvalho" ] 2 => array:2 [ "nombre" => "Nilza" "apellidos" => "Minguini" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222026485?idApp=UINPBA00004N" "url" => "/18075932/0000006400000004/v1_202212060657/S1807593222026485/v1_202212060657/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Sciences</span>" "titulo" => "Mini-Rhexis For White Intumescent Cataracts" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Newton Kara-Junior, Marcony Rodrigues de Santhiago, Andrea Kawakami, Pedro Carricondo, Wilson Takashi Hida" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Newton" "apellidos" => "Kara-Junior" ] 1 => array:4 [ "nombre" => "Marcony Rodrigues" "apellidos" => "de Santhiago" "email" => array:1 [ 0 => "marconysanthiago@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "c1" ] ] ] 2 => array:2 [ "nombre" => "Andrea" "apellidos" => "Kawakami" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Carricondo" ] 4 => array:2 [ "nombre" => "Wilson Takashi" "apellidos" => "Hida" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil" "identificador" => "af1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "c1" "etiqueta" => "*" "correspondencia" => "Tel.: 55 11 3069.6000" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Performing phacoemulsification in white cataracts is a challenge for the cataract surgeon that requires skillful technique and experience.<a class="elsevierStyleCrossRefs" href="#bib1">1–4</a> In white cataracts, the capsule is more fragile, and visibility of the red reflex may be obscured. Moreover, leakage of liquefied cortical material may occur, and capsulorhexis tears tend to extend to the periphery because of high intracapsular pressure.<a class="elsevierStyleCrossRefs" href="#bib1">1–5</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Gimbel and associates, in a prospective observational study of intumescent white cataracts, suggested the advantage of a deliberately small continuous curvilinear capsulorhexis, which is secondarily enlarged after aspirating the liquefied milky lens contents (two-stage continuous curvilinear capsulorhexis); it was suggested that this might be a safer approach when compared to one-stage capsulorhexis.<a class="elsevierStyleCrossRef" href="#bib5">5</a> However, the results of that study may have some limitations, since this it was an observational, non-randomized clinical trial with uneven groups; this could lead to selection bias.</p><p id="para30" class="elsevierStylePara elsevierViewall">The aim of this study was to compare intraoperative difficulties between traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis for intumescent white cataracts, the. In addition, this study assessed the safety of both techniques and aimed to develop a strategy for consistently achieving continuous curvilinear capsulorhexis (CCC).</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">PATIENTS AND METHODS</span><p id="para40" class="elsevierStylePara elsevierViewall">This randomized clinical trial included 24 patients (14 women and 10 men); patients with intumescent white cataracts who were over 50 years old were included. The average patient age was 62.5 years (range: 50 to 77 years). The mean patient age in each group was 65 years for group 1 and 60 years for group 2. Random assignment was performed according to <a href="http://www.randomized.com">www.randomized.com</a>. The exclusion criteria were ocular diseases such as corneal opacities or irregularity, dry eye, amblyopia, anisometropia, glaucoma, retinal abnormalities, surgical complications, or lack of follow-up.</p><p id="para50" class="elsevierStylePara elsevierViewall">This study was conducted according to the established ethical standards for clinical research, and the internal review board of our hospital approved the study protocol.</p><p id="para60" class="elsevierStylePara elsevierViewall">The preoperative ocular examinations included the Snellen visual acuity exam, a detailed biomicroscopic examination, crystalline lens measurements using A-scan ultrasonography, Goldmann applanation tonometry and an axial length measurement (AL).</p><p id="para70" class="elsevierStylePara elsevierViewall">In addition, a B-mode ultrasonographic exam was performed with a pseudo-immersion technique. A saline-filled bladder was placed between the tube and the closed palpebra to maximize the image of the anterior ocular chamber; this allowed measurement of the nuclear diameter.<a class="elsevierStyleCrossRef" href="#bib6">6</a></p><p id="para80" class="elsevierStylePara elsevierViewall">The selected patients were randomly divided into two groups: Group 1 received traditional one-stage continuous curvilinear capsulorhexis with 5–6 mm diameter (1-CCC) and Group 2 received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged [two-stage continuous curvilinear capsulorhexis (2-CCC)]. Depending on the liquidity of the lens material, the liquid cortex was aspirated using the I/A tip, through the small capsulorhexis.</p><p id="para90" class="elsevierStylePara elsevierViewall">The following variables were assessed:<ul class="elsevierStyleList" id="celist10"><li class="elsevierStyleListItem" id="celistitem10"><span class="elsevierStyleLabel">1</span><p id="para100" class="elsevierStylePara elsevierViewall">The echographic appearance of the crystalline lenses.</p></li><li class="elsevierStyleListItem" id="celistitem20"><span class="elsevierStyleLabel">2</span><p id="para110" class="elsevierStylePara elsevierViewall">Intraoperative difficulties during CCC including leakage of the liquefied cortex, the surgeon’s perception of high intracapsular pressure, anterior capsule tears, centration of the continuous capsulorhexis, discontinuity of capsulorhexis, and posterior capsular rupture.</p></li></ul></p><p id="para120" class="elsevierStylePara elsevierViewall">All surgeries were performed between March 2005 and July 2006 by the same senior surgeon using the same technique, and all surgeries included peribulbar anesthesia and eye drops (cyclopentolate 1% and phenylephrine 2.5%) for mydriasis, applied three times one hour before the surgery. A three-step clear corneal tunnel self-sealing incision was made with a 2.75 mm disposable metal blade on the steepest axis, and a side port incision was made with a disposable 15-degree metal blade. After the injection of cohesive ophthalmic viscosurgical devices (<span class="elsevierStyleItalic">Provisc, Alcon Labs</span>)<a class="elsevierStyleCrossRef" href="#bib7">7</a> into the anterior chamber of the eye with white cataracts, 0.1 ml of trypan blue 0.1% was slowly injected into the anterior capsule. Utrata forceps were used to grasp the capsule and perform the capsulorhexis. If the capsulorhexis tear was directed toward the periphery, more viscoelastic was given to that part of the anterior capsule. Endocapsular phacoemulsification was performed in all eyes using the <span class="elsevierStyleItalic">Infiniti Vision System (Alcon Labs)</span> phacoemulsification unit. The corneal incision was enlarged to 3.2 mm, and a foldable hydrophobic acrylic MA60AC (Alcon Labs) intraocular lens was implanted intracapsularly; subsequently, the viscoelastic was removed. Starting on postoperative day 0, the patients were given topical fourth generation quinolones (gatifloxacin 0.1%) four times a day for 7 days and steroids (dexamethasone 0.1%) four times a day, with the decreased dosing over a 30 day period. The patients were scheduled for postoperative clinical evaluations on days 1, 3, 7, 30 and 90.</p><p id="para130" class="elsevierStylePara elsevierViewall">Data were analyzed using the Statistical Program for Social Sciences (SPSS), version 10.0 and Statistica version 5.1/97. The statistical analysis was performed using Fisher’s test. Results were expressed as means ± SD. A P value of less than 0.05 was considered statistically significant.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">RESULTS</span><p id="para140" class="elsevierStylePara elsevierViewall">Of the 24 patients in the study, 11 were assigned to the 2-CCC group and 13 to the 1-CCC group. The difference in participant number was due to individual random selection.</p><p id="para150" class="elsevierStylePara elsevierViewall">Biometric study of the white cataracts showed that the anteroposterior diameter of the crystalline lens was greater than or equal to 4 mm in 21 patients (85%) and less than 4 mm in 3 patients (15%) (p = 0.065).</p><p id="para160" class="elsevierStylePara elsevierViewall">The patients were categorized, according to the echographic appearance into three different types, as shown in Table <a class="elsevierStyleCrossRef" href="#tbl1">1</a>. For the type 1 echographic appearance, there was no leakage in four eyes (66.7%); 1-CCC was performed in one eye and 2-CCC in the other three. For the type 2 echographic appearance, there was no leakage in six eyes (40%); both 1-CCC and 2-CCC were performed in three eyes each. For the type 3 echographic appearance, there was no leakage in three eyes (40%); 1-CCC was performed in two eyes and 2-CCC in one eye.</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para170" class="elsevierStylePara elsevierViewall">The results of the comparison between the two different techniques for continuous curvilinear capsulorhexis in white cataracts are shown in Table <a class="elsevierStyleCrossRef" href="#tbl2">2</a>. Successful in-the-bag lens implantation was achieved in all cases.</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="para180" class="elsevierStylePara elsevierViewall">No differences were observed between the two different techniques of continuous capsulorhexis in terms of leakage of the liquefied cortex.</p><p id="para190" class="elsevierStylePara elsevierViewall">No statistical difference was found in any of the intraoperative variables during CCC (Table <a class="elsevierStyleCrossRef" href="#tbl2">2</a>). In approximately 61% of cases, the surgeon noticed high intralenticular pressure during capsulorhexis when performing the one-stage (1-CCC) technique; however, high intralenticular pressure was only noticed in approximately 36% of cases in which two-stage continuous curvilinear capsulorhexis (2-CCC) was performed. A tendency of the capsule to tear towards the periphery was observed in approximately 54% of cases in which 1-CCC was performed, while this tendency was only observed in 27% of cases in the 2-CCC group. In around 30% of cases with one-stage capsulorhexis, there was a discontinuity of the capsulorhexis; this did not occur with two-stage capsulorhexis.</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">DISCUSSION</span><p id="para200" class="elsevierStylePara elsevierViewall">To evaluate the intraoperative difficulties associated with phacoemulsification of white mature cataracts using a two-stage capsulorhexis technique, Vasavada et al. examined 60 eyes (60 patients) with senile white mature cataracts. A small capsulorhexis was attempted initially, and endophacoemulsification was performed. The capsulorhexis was enlarged before intraocular lens implantation. In that series, CCC was achieved in 57 eyes (95%); in addition, the intracapsular pressure rose in 24 eyes (40%). In our study, CCC was achieved in 89.90% of cases, and the intracapsular pressure was judged to be increased in 27.27% of cases when the two-stage capsulorhexis technique was used. These findings were different from the cases in which a one-stage capsulorhexis technique was used, where CCC was achieved in 53.80% of cases and the intracapsular pressure was judged to be increased in 45.16%. The higher success rate achieved for CCC with the two-stage capsulorhexis technique is assumed to result from increased safety when compared to the one-stage technique. We did not find any statistical differences in the leakage of the liquefied cortex, the surgeon’s perception of high intracapsular pressure, anterior capsule tears, centration of the CCC, discontinuity of the capsulorhexis, or posterior capsular rupture. However, we believe there is a clinical difference between the two techniques.</p><p id="para210" class="elsevierStylePara elsevierViewall">Guimbel and associates analyzed 2,967 consecutive cataract cases in a prospective observational study of the incidence of intumescent cataracts and showed that 45.45% and 46.15% of the one- and two-stage groups had leakage of the liquefied cortex, respectively, with no statistically significant differences<a class="elsevierStyleCrossRef" href="#bib5">5</a>; in addition, the surgeon detected high intracapsular pressure in at least 61% of cases in the one-stage group and 36% of the two-stage group. In our study, radialization of the CCC was detected in 54% of cases in the one-stage group and in 27% of cases in the two-stage group. There was no need to convert to a can-opener capsulotomy in our study. Guimbel and associates revealed that 11.7% of intumescent cases had anterior capsule tears during the first capsulotomy and 4% had to be converted to a can-opener capsulotomy.<a class="elsevierStyleCrossRef" href="#bib5">5</a> Some white cataracts are associated with irregular capsular permeability. Damage to the ion pump and metabolic barrier may allow fluids to enter the lens nucleus with cortical hydration, resulting in high intraocular pressure.<a class="elsevierStyleCrossRef" href="#bib2">2</a>,<a class="elsevierStyleCrossRef" href="#bib3">3</a> In such cases, the high intraocular pressure may lead to unexpected radial tears during the initial capsulotomy with sudden capsulorhexis radialization.<a class="elsevierStyleCrossRefs" href="#bib8">8–13</a></p><p id="para220" class="elsevierStylePara elsevierViewall">In a retrospective study of 212 consecutive patients with white cataracts, Chakrabarti et al. showed incomplete capsulorhexis in 28.3% of cases, a posterior capsular tear in 1.9% of cases, and the conversion to a manual non-phacoemulsification technique in 1.9% of cases.<a class="elsevierStyleCrossRef" href="#bib14">14</a> In our study, none of the eyes had posterior capsular rupture or incomplete capsulorhexis, and none of the eyes were converted to conventional extracapsular cataract extraction. General recommendations for the visualization of the anterior capsule in eyes with white mature cataracts include the following: dimming the operation room lights, increasing the magnification of the microscope, using oblique illumination, using an endoilluminator, and using capsule dyes. In our cases, staining the capsule with trypan blue under viscoelastic material enhanced the visualization of the anterior capsule during capsulorhexis.<a class="elsevierStyleCrossRefs" href="#bib15">15–19</a></p><p id="para230" class="elsevierStylePara elsevierViewall">In the present study, capsulorhexis was continuous, curvilinear and centered in 44% of the 1-CCC group and in 95% of the 2-CCC group. Successful in-the-bag lens implantation was achieved in all cases. The same correlation was demonstrated by Guimbel and associates. There are several procedures that can be used to prevent milky liquefied cortical matter from obscuring the view of the anterior chamber as well as radial tearing caused by high intracapsular pressure in eyes with hypermature or intumescent cataracts; these techniques include the use of sealed anterior chambers,<a class="elsevierStyleCrossRef" href="#bib19">19</a> automated irrigation/aspiration to aspirate the liquefied milky lens contents, aspiration of the liquefied milky lens contents before capsulorhexis using a 26 or 30 gauge needle or through a small CCC, preoperative capsulotomy using a YAG laser (Sinskey) and two-stage CCC.<a class="elsevierStyleCrossRef" href="#bib5">5</a>,<a class="elsevierStyleCrossRef" href="#bib15">15</a></p><p id="para240" class="elsevierStylePara elsevierViewall">The two major limitations of our study are the small sample size and the fact that the observer was not masked for a subjective analysis. The study of this surgical treatment is complicated by the fact that intumescent cataracts are a relatively uncommon condition, since the introduction of phacoemulsification has made indication for surgery in early stages more frequent. Additionally, the observer cannot be masked and must be aware of which patient belonged to which group. A strong bias could therefore be introduced, especially because one of the variables (the surgeon’s perception of high intracapsular pressure) was subjective. However, masking was obviously impossible in this trial.</p><p id="para250" class="elsevierStylePara elsevierViewall">This study suggests that the two-stage continuous curvilinear capsulorhexis technique helps to prevent unexpected radial tears of the initial capsulotomy due to high intracapsular pressure, the sudden radialization of the CCC and other intraoperative complications arising from high intracapsular pressure. This method thus provides a safe cataract surgery in cases of white cataracts, and its results were corroborated by ultrasonography.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "xpalclavsec1584624" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:2 [ "identificador" => "cesec20" "titulo" => "PATIENTS AND METHODS" ] 3 => array:2 [ "identificador" => "cesec30" "titulo" => "RESULTS" ] 4 => array:2 [ "identificador" => "cesec40" "titulo" => "DISCUSSION" ] 5 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-10-28" "fechaAceptado" => "2008-12-26" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1584624" "palabras" => array:5 [ 0 => "Cataract" 1 => "Intumescent" 2 => "Capsulorhexis" 3 => "Minirhexis" 4 => "Capsulotomy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">PURPOSE:</span><p id="spara30" class="elsevierStyleSimplePara elsevierViewall">To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis.</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS:</span><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5–6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes.</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS:</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">With the one-stage technique, 46.15% of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53% of cases. Anterior capsule tears occurred in 23.07% of cases, discontinuity of capsulorhexis in 30.79% of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45% of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36% of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3.</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS:</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Two-stage continuous curvilinear capsulorhexis helps prevent unexpected radial tears of the initial capsulotomy from high intracapsular pressure, sudden radialization of the CCC and other intraoperative complications due to high intracapsular pressure, thus providing a safe cataract surgery in cases of white cataracts. These findings were supported by ultrasonography.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "PURPOSE:" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "METHODS:" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "RESULTS:" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "CONCLUSIONS:" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1 -" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">Echographic appearance \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">No leakageN (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">LeakageN (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Type 1<a class="elsevierStyleCrossRef" href="#tfn1">*</a>(n=6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">4 (66.7%)1 (1-CCC) 3 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">2 (33.3%)1 (1-CCC) 1 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.268 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Type 2<a class="elsevierStyleCrossRef" href="#tfn2">**</a>(n=15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">6 (40%)3 (1-CCC) 3 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">9 (60%)6 (1-CCC) 3 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.087 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Type 3<a class="elsevierStyleCrossRef" href="#tfn3">***</a>(n=3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">3 (100%)2 (1-CCC) 1 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0 (0%)0 (1-CCC) 0 (2-CCC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.243 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tfn1" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">Type I included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections.</p>" ] 1 => array:3 [ "identificador" => "tfn2" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="cenpara20">Type II included white cataracts with voluminous nuclei, limited amounts of whitish solid cortex, and few internal acoustic reflections.</p>" ] 2 => array:3 [ "identificador" => "tfn3" "etiqueta" => "***" "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">Type III included white cataracts with a fibrous anterior capsule and few internal echospikes.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Comparison of the echographic appearance of the crystalline lenses and the leakage of liquefied cortex during the continuous curvilinear capsulorhexis stage in white cataracts; the appearance may suggest high intracapsular pressure</p>" ] ] 1 => array:7 [ "identificador" => "tbl2" "etiqueta" => "Table 2 -" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col">One-stage group (N=13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col">Two-stage group (N=11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Leakage of liquefied cortex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">6 (46.15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">5 (45.45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.972 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Surgeon’s perception of high intracapsular pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">8 (61.53%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">4 (36.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.414 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Anterior capsule tears \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">7 (53.84%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">3 (27.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.423 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Discontinuity of capsulorhexis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">4 (30.79%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.185 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Posterior capsular rupture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Centralization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">10 (90.90%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">7 (53.84%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.078 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Comparison of one-stage and two-stage continuous capsulorhexis techniques in white cataracts with presumably high intracapsular pressure</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phacoemulsification in white cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ G Zhang \n \t\t\t\t\t\t\t\t """ 1 => """ Y Bao \n \t\t\t\t\t\t\t\t """ 2 => """ K Qiu \n \t\t\t\t\t\t\t\t """ 3 => """ J Zao \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Yan Ke Xue Bao" "fecha" => "2000" "volumen" => "16" "paginaInicial" => "252" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12579782" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ SS Ermiss \n \t\t\t\t\t\t\t\t """ 1 => """ F Ozturk \n \t\t\t\t\t\t\t\t """ 2 => """ UU Inan \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.87.11.1356" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2003" "volumen" => "87" "paginaInicial" => "1356" "paginaFinal" => "1359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14609833" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capsulorhexis in intumescent cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ K Bhattacharjee \n \t\t\t\t\t\t\t\t """ 1 => """ H Bhattacharjee \n \t\t\t\t\t\t\t\t """ 2 => """ BJ Goswami \n \t\t\t\t\t\t\t\t """ 3 => """ P Sarma \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(99)00123-6" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "1999" "volumen" => "25" "paginaInicial" => "1045" "paginaFinal" => "1047" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10445188" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phacoemulsification of white hypermature cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ RB Vajpayee \n \t\t\t\t\t\t\t\t """ 1 => """ A Bansal \n \t\t\t\t\t\t\t\t """ 2 => """ N Sharma \n \t\t\t\t\t\t\t\t """ 3 => """ T Dada \n \t\t\t\t\t\t\t\t """ 4 => """ VK Dada \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(99)00118-2" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "1999" "volumen" => "25" "paginaInicial" => "1157" "paginaFinal" => "1160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10445205" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What to do with limited view: the intumescent cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ HV Gimbel \n \t\t\t\t\t\t\t\t """ 1 => """ AB Willerscheidt \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(13)80021-1" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "1993" "volumen" => "19" "paginaInicial" => "657" "paginaFinal" => "661" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7980732" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Diagnostic B-scan ultrasound of the lens before cataract surgery with intraocular artificial lens implantation]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ K Zalecki \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Klin Oczna" "fecha" => "1995" "volumen" => "97" "paginaInicial" => "192" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7643563" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dispersive-cohesive viscoelastic soft shell technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ SA Arshinoff \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(99)80121-7" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "1999" "volumen" => "25" "paginaInicial" => "167" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9951659" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A-scan quantitative echography of senile cataracts and correlation with phacoemulsification parameters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ PD Brazitikos \n \t\t\t\t\t\t\t\t """ 1 => """ S Androudi \n \t\t\t\t\t\t\t\t """ 2 => """ NT Papadopoulos \n \t\t\t\t\t\t\t\t """ 3 => """ WG Christen \n \t\t\t\t\t\t\t\t """ 4 => """ NT Stangos \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1076/ceyr.27.3.175.16051" "Revista" => array:6 [ "tituloSerie" => "Curr Eye Res" "fecha" => "2003" "volumen" => "27" "paginaInicial" => "175" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14562183" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonographic classification and phacoemulsification of white senile cataracts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ PD Brazitikos \n \t\t\t\t\t\t\t\t """ 1 => """ IT Tsinopoulos \n \t\t\t\t\t\t\t\t """ 2 => """ NT Papadopoulos \n \t\t\t\t\t\t\t\t """ 3 => """ K Fotiadis \n \t\t\t\t\t\t\t\t """ 4 => """ NT Stangos \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0161-6420(99)90502-X" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "1999" "volumen" => "106" "paginaInicial" => "2178" "paginaFinal" => "2183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10571356" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ S Jacob \n \t\t\t\t\t\t\t\t """ 1 => """ A Agarwal \n \t\t\t\t\t\t\t\t """ 2 => """ S Agarwal \n \t\t\t\t\t\t\t\t """ 3 => """ S Chowdhary \n \t\t\t\t\t\t\t\t """ 4 => """ R Chowdhary \n \t\t\t\t\t\t\t\t """ 5 => """ AA Bagmar \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(01)01316-5" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "1819" "paginaFinal" => "1825" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12388035" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual small incision cataract surgery in eyes with white cataracts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ R Venkatesh \n \t\t\t\t\t\t\t\t """ 1 => """ M Das \n \t\t\t\t\t\t\t\t """ 2 => """ S Prashanth \n \t\t\t\t\t\t\t\t """ 3 => """ R Muralikrishnan \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0301-4738.16675" "Revista" => array:6 [ "tituloSerie" => "Indian J Ophthalmol" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "173" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16137961" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study on trypan blue capsule staining under air vs under viscoelastic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ VW Wong \n \t\t\t\t\t\t\t\t """ 1 => """ TY Lai \n \t\t\t\t\t\t\t\t """ 2 => """ GK Lee \n \t\t\t\t\t\t\t\t """ 3 => """ PT Lam \n \t\t\t\t\t\t\t\t """ 4 => """ DS Lam \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.eye.6702032" "Revista" => array:7 [ "tituloSerie" => "Eye" "fecha" => "2006" "volumen" => "20" "numero" => "7" "paginaInicial" => "820" "paginaFinal" => "825" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16096664" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capsule staining as an adjunct to cataract surgery: a report from the American Academy of Ophthalmology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ DS Jacobs \n \t\t\t\t\t\t\t\t """ 1 => """ TA Cox \n \t\t\t\t\t\t\t\t """ 2 => """ MD Wagoner \n \t\t\t\t\t\t\t\t """ 3 => """ RG Ariyasu \n \t\t\t\t\t\t\t\t """ 4 => """ CL Karp \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2006.01.024" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2006" "volumen" => "113" "paginaInicial" => "707" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16581432" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phacoemulsification in eyes with white cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ A Chakrabarti \n \t\t\t\t\t\t\t\t """ 1 => """ S Singh \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(00)00525-3" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2000" "volumen" => "26" "paginaInicial" => "1041" "paginaFinal" => "1047" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10946197" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Automated irrigation/aspiration before phacoemulsification in eyes with white cataracts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ YJ Chen \n \t\t\t\t\t\t\t\t """ 1 => """ PC Wu \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ophthalmic Surg Lasers Imaging" "fecha" => "2005" "volumen" => "36" "paginaInicial" => "118" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15792312" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staining the Anterior Capsule with Indocyanine Green or Trypan Blue for Capsulorhexis in Eyes with White Cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ Y Xiao \n \t\t\t\t\t\t\t\t """ 1 => """ YH Wang \n \t\t\t\t\t\t\t\t """ 2 => """ ZY Fu \n \t\t\t\t\t\t\t\t """ 3 => """ H Hong \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10792-005-2228-4" "Revista" => array:7 [ "tituloSerie" => "Int Ophthalmol" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "273" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16532289" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109720357351" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ VK Dada \n \t\t\t\t\t\t\t\t """ 1 => """ N Sharma \n \t\t\t\t\t\t\t\t """ 2 => """ R Sudan \n \t\t\t\t\t\t\t\t """ 3 => """ H Sethi \n \t\t\t\t\t\t\t\t """ 4 => """ T Dada \n \t\t\t\t\t\t\t\t """ 5 => """ MS Pangtey \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0886-3350(03)00573-X" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "326" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15030820" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of indocyaine green staining technique for phacoemulsification in white cataract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ YC Liao \n \t\t\t\t\t\t\t\t """ 1 => """ QL Luo \n \t\t\t\t\t\t\t\t """ 2 => """ Y Yang \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhonghua Yan Ke Za Zhi" "fecha" => "2003" "volumen" => "39" "paginaInicial" => "485" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14642170" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous curvilinear capsulorhexis in intumescent or hypermature cataract with liquefied cortex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DD Chan \n \t\t\t\t\t\t\t\t """ 1 => """ AC Ng \n \t\t\t\t\t\t\t\t """ 2 => """ CK Leung \n \t\t\t\t\t\t\t\t """ 3 => """ RK Tse \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(02)01449-9" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2003" "volumen" => "29" "paginaInicial" => "431" "paginaFinal" => "434" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12663001" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006400000004/v1_202212060657/S1807593222026497/v1_202212060657/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006400000004/v1_202212060657/S1807593222026497/v1_202212060657/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222026497?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 26 | 16 | 42 |
| 2024 September | 35 | 18 | 53 |
| 2024 August | 32 | 16 | 48 |
| 2024 July | 30 | 27 | 57 |
| 2024 June | 19 | 15 | 34 |
| 2024 May | 28 | 10 | 38 |
| 2024 April | 31 | 8 | 39 |
| 2024 March | 22 | 13 | 35 |
| 2024 February | 26 | 9 | 35 |
| 2024 January | 15 | 10 | 25 |
| 2023 December | 7 | 15 | 22 |
| 2023 November | 18 | 20 | 38 |
| 2023 October | 13 | 22 | 35 |
| 2023 September | 13 | 10 | 23 |
| 2023 August | 4 | 2 | 6 |
| 2023 July | 4 | 8 | 12 |
| 2023 June | 4 | 3 | 7 |
| 2023 May | 1 | 0 | 1 |
| 2023 April | 2 | 1 | 3 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 1 | 15 | 16 |
| 2023 January | 1 | 0 | 1 |
| 2022 December | 51 | 7 | 58 |
Show all