---

Introduction: Cataract is one of the most important and a major disease in human. The prevalence of cataract in age 65-74 get to 50%, and over 75 it arrives to 70%. Absolute cure for cataract is surgery that can be done by different techniques such as intracapsular, extracapsular, and phacoemulsification. Cataract surgery has different side effects such as hemorrhage, Glaucoma, posterior capsular opacification and astigmatism. This study decides to compare astigmatism after two techniques of cataract surgery phaco and extracapsular. Materials and Methods: This study is a double blind randomized clinical trial, which has been experienced on 112 patients. Patients were divided in two groups (A and B). In group A surgery was done by phaco technique which has a small incision of 3.2 mm and does not need suture. But in group B, (extracapsular group) the incision is bigger about 10 mm and needs suture. Then keratometry was done for each patient before surgery, one week and 2 months after surgery for determining astigmatism. Data was analyzed by independent and paired sample T tests. p< 0.05 was considered meaningful. Results: From 112 patients that had been studied, 56 patients underwent phaco technique and 56 patients underwent extracapsular technique. Mean of astigmatism before surgery in group phaco was 0.79±0.71 D and in extracapsular was 0.90.55 D (p>0.05). Mean of astigmatism 1 week after surgery in phaco group was 1.110.72 D and in extracapsular group was 3.991.46 D (p<0.05) and mean of astigmatism two months after surgery in phaco group was 1.00.71 D and in extracapsular group was 3.281.29 D (p<0.05). Conclusion: Induced astigmatism in phaco group was 0.21 D and in extracapsular was 2.38 D, that has meningful difference. Other criteria such as age, lens number, sex and left or right eye do not have any effect on induced astigmatism.

---

Introduction: Cataract is a type of tarnish observable opacity in different layers constituting the lens and will cause light occlusion or scattering. Necessity for treatment of Cataract via surgery and its close relation with corneal astigmatism, when we applied a new method in cutting and type of cataract surgery, led us to measure the post-operation corneal astigmatism changes in frown incision Phacosection. Materials and Methods: This interventional study has been done on 73 eyes(58 patients). These patients were gone under Cataract surgery via no stitch frown incision scleral tunnel phacosection method. In this study we have 7mm external scleral incision with no suture. They were Keratometerized in four separate periods including pre-operation, one week, one month and three months post- operation. Data was analyzed using independent and paired t-tests. Results: Age, sex and left or right eye had no influence on astigmatism. Mean pre- operation astigmatism was 0.84 ± 0.87D, mean astigmatism 1 week post- operation was 0.27 ± 0.88 D, 1 month post- operation 0.06 ± 0.82 D, and three months post-operation was -0.03 ± 0.85 D (P= 0.0001). Before operation, 80% of the patients did have an astigmatism rate less than 1D that increased to 94.5% in three months period after operation and in 89% of the cases, the ultimate change in astigmatism has been found lower than 1D. The obtained information revealed that there is a meaningful difference between pre-operation astigmatism and the same after one week, one month and three months post-operation(P= 0.0001). Independent sample t and paired t-test were used to analyse data. Conclusion: Our study indicated that the no stitch frown incision scleral tunnel phacosection surgery can reduce pre-op corneal astigmatism, and because of induction of the slight controlled astigmatism we can apply this technique for all cataractic patients

---

Background: Post operative nausea and vomiting (PONV) is a very common and distressing complication after surgeries which may result in more serious problems such as incisional hernia wound dehiscence and aspiration. Cataract surgery following increase in intraocular pressure is sensitive to POVN. This study was designed to evaluate the effect of capsicum ointment on Korean acupressure points in reducing PONV and the amont of anti- emetic medications was used. Methods and Materials: This study is a double-blinded clinical trial which was done on 200 patients who were referred to Amir Kabir hospital for cataract surgery. The patients were randomized assigned to two groups, one who received capsicum ointment and the other placebo (vaseline ointment) at the pressure points (K-K9 and K-KD2). After applying the ointments and during the first 12 hours after the operation the patients were assessed for the incidence and intensity of PONV. Results: The incidence of nausea and vomiting during the first 6 and 12 hours was higher in the placebo group in compare to the capsicum group (p=0.001). Nausea scores were also higher in the 6 and 12 hours in the placebo group (p=0.0005). Uses of metoclopramide was significant higher in the placebo group in compare to the capsicum group (p=0.001). There was no significant difference between the two groups for vomiting during first 12 hours ofter opration. Conclusion: Stimulating of both K-D2 & K-K9 Korean acupressure points simultaneously is a simple, noninvasive, cheap and effective method for reducing PONV.

---

Background: Cataract is the leading cause of blindness and visual impairment. This study was performed to compare effects of two different incision types in cataract surgery on dry eye symptoms and diagnostic test values. Materials and Methods: In this clinical trial, 300 patients with cataract requiring phacoemulsification were studied. The patients were randomly divided into two operative method groups: limbal and clear corneal (anterior to the vascular arcade) incision. A complete set of ophthalmic examinations and tear related tests were done for all of the patients before surgery and one week and one month after surgery. The collected data were analyzed using SPSS and EPI-Info softwares. Results: Overall, 149 men and 151 women were enrolled in this study. On the first postoperative week, the means of symptoms, and TBUT and TMH values in both groups significantly decreased compared with the preoperative values. These values returned to the preoperative levels one month postoperatively which werein contrast to the changes of debri, PEE, corneal and conjnnctival staining. There were statistically significant differences between the results of pre- and post-operative symptoms, PEE, debri, TBUT, conjunctival and corneal staining. Except for TBUT, the results of these tests were not statistically different according to incision location. Conclusion: Phacoemulsification cataract surgery affects dry eye symptoms and diagnostic test values. In addition, except for TBUT, the location of incision had no effect on other test results and symptoms.

---

Background: Endophthalmitis is the most important complication after cataract surgery which its incidence can lead to severe loss of vision or even loss of vision therefore, methods of prevention are very important. This study investigated the influence of vancomycin consumption during cataract surgery on prevention of endophthalmitis.

Materials and Methods: In this experimental study, the study population included patients of cataract surgery that were admitted to Amir Kabir Hospital. The patients were randomly assigned to two groups: with and without receiveing vancomycin in serum. Demographic characteristics of the patients before surgery and incidence of endophthalmitis with the examination until two weeks after surgery were recorded. To compare the frequency (incidence) of infection, endophthalmitis in two groups, Fisher's exact test and X2 test were used.

Results: Of the 1281 patients, 539 were administered vancomycin in serum. The examination after two weeks indicated that 3 (0.23%) patients developed endophthalmitis. Of these, 2 (0.16%) patients belonged to the group without vancomycin and 1(0.07%) patient belonged to the group receiving vancomycin. Fisher's exact test did not show any significant differences between the groups receiving vancomycin and the control group in the prevalence of endophthalmitis.

Conclusion: Although the relative frequency of endophthalmitis in patients without receiving vancomycin was further than control group, the difference was not statistically significant. Thus, adding a drop of vancomycine was not effective in prevention of endophthalmitis and the causes should be sought in other cases.

---

Background: Intraocular pressure (IOP) rise is the most common complication of Nd YAG laser posterior capsulotomy, and the aim of this study was to compare the effect of oral acetazolamide versus topical Co-biosopt in preventing IOP rise following Nd YAG laser posterior capsulotomy.

Materials and Methods: This clinical trial was done on 200 patients who underwent laser Nd: YAG capsulotomy. First group received oral acetazolamide 250 mg q 6h and placebo drops q 8h and second group received Co-biosopt) timolol 0/5% and dorzolamide 2%) drops q 8h and oral placebo capsule q 6h. IOP was measured before and 24 hours after laser capsulotomy.

Results: Mean IOP of right and left eye 24 hours after capsulotomy in the acetazolamide group was significantly decreased as compared to the previous (p=0.001) and in Co-Biosopt group the values 24 hours after capsulotomy was significantly decreased as compared with the previous in right and left eye (p=0.001).

Conclusion: According to oral acetazolamide side effects and desirable IOP reduction with Co-Biosopt that recently entered to Iran’s market and have typical domestic, this medication can be an option for preventing IOP rise after laser capsulotomy in a patient with posterior capsular opacification.

---

Background: Phacoemulsification is a modern cataract surgery that developed surgery from large incisions into smaller incision size and lead to faster wound heal and earlier visual rehabilitation. The purpose of this study was to compare the outcomes and complications of 3.2 and 2.65 mm main Incisions in phacoemulsification .

Materials and Methods: In this clinical study in Amir Kabir Hospital of Arak, 78 patients with senile cataract were divided into two groups. Half of them experienced 3.2 mm main incision (first group) and the others were under main incision with 2.65 mm (group 2). Immediately after operation if patients had a wound leak, the standard stromal hydration was used and a suture was placed. A day after operation, the patients were examined in the light of iris prolapse, if it existed, then a suture would be palced.

Results: The occurrence of anterior chamber wound leak was 7.7% and 2.6% in group 1 and group 2, respectively. Stromal hydration was needed 5.1% and 3.2% in group 1 and group 2 respectively. In fact, suture was needed 2.6% and 0.0% in group 1 and group 2, respectively. There was no iris prolapse in both groups.

Conclusion: There was no statistically significant difference between two groups from the point of view of wound leak and the need for suture and the rate of iris prolapse (p>0.05). Also, in low or intermediate nuclear density grade, the smaller and the more permanent incision with 2.65 mm is preferred.

---

Abstract

Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery.

Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room.

Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15^th and 20^th minutes (heart rate and respiratory rate) after arrival to the recovery room.

Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.

---

---

Background:
 
This study aimed to compare the effect of cold eye irrigation solution (BSS) and viscoelastic gel with their combination in room temperature on the dosage of sedative drugs which we use in Phacoemulsification cataract surgery.
 
Material and methods:
 
190 patients scheduled for cataract surgery under sedation were randomly divided into two equal groups. During surgery we used cold (4c) and warm (room temperature) BSS and viscoelastic gel in the first and second group respectively. For all patients we started sedation with Midazolam and Fentanyl and in case we needed additional drug we used Sodium Thiopental till we reached desired sedation level. Ramsay sedation scores (before, during and after surgery) and total sedative drug consumption   were evaluated   and compared between two groups and at the end of the surgery we checked the satisfaction score of patients and surgeon about the quality of sedation.
 
Results:
The average dosage of Midazolam wasn’t significantly different between the two groups, while the average dosage of Sodium Thiopental was significantly lower in Cold group. Also the average time of which we reached desired Ramsay sedation score and the level of Ramsay score were significantly different between the two groups.
 Conclusion:
Using cold BSS and viscoelastic gel in cataract surgery in comparison of their combination in room temperature will reduce the dosage of sedative drugs which we use during surgery and help us getting a more effective sedation and gaining both a satisfied patient and surgeon.