International Ophthalmology

, Volume 39, Issue 9, pp 2015–2021 | Cite as

Investigation of scleral thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration using pig eyes

  • Takaki Sato
  • Toru Yasuhara
  • Masanori Fukumoto
  • Masashi Mimura
  • Takatoshi Kobayashi
  • Teruyo Kida
  • Shota Kojima
  • Hidehiro Oku
  • Tsunehiko IkedaEmail author
Original Paper



The purpose of this study was to investigate the thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration (PPPEA) using pig eyes.


Using a 20-gauge (G) vitrectomy system (Accurus®, Fragmatome; Alcon Laboratories) in both the ‘open-tip’ and ‘closed-tip’ techniques, PPPEA was performed in pig eyes and the subsequent thermal injuries generated around the scleral wound were measured by infrared thermal imaging (thermography). Post surgery, the state of the scleral wound was observed under a microscope, and a tissue slice containing the scleral wound was then prepared and observed under an optical microscope.


Thermography measurements revealed a slight temperature rise around the scleral wound in the open-tip case, yet a marked temperature rise in the closed-tip case. The scleral wound incision produced by the open tip was linear, while that produced by the closed tip was expanded. Histological examination revealed mild degeneration of the sclera around the wound in the open-tip case, yet marked tissue degeneration by thermal injuries in the closed-tip case.


Our findings showed that in PPPEA, the temperature of the tip of a 20G vitrectomy system rapidly increases due to the closed-tip technique, thus producing obvious thermal damage to the scleral wound. In order to prevent thermal injuries to the scleral wound during PPPEA, it is important to shorten the time of ultrasonic oscillation during surgery as much as possible while the tip is occluded with nuclear fragments.


Thermal injury Ultrasonic pars plana phacoemulsification and aspiration (PPPEA) Infrared thermal imaging Scleral wound Histological examination 



The authors wish to thank John Bush for editing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have conflicts of interest.

Ethical approval

This article does not contain any studies with human participants and animals performed by any of the authors.


  1. 1.
    Spirn MJ (2009) Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol 20(3):195–199CrossRefGoogle Scholar
  2. 2.
    von Lany H, Mahmood S, James CR, Cole MD, Charles SJ, Foot B, Gouws P, Shaw S (2008) Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Br J Ophthalmol 92(4):493–495CrossRefGoogle Scholar
  3. 3.
    Ernest P, Rhem M, McDermott M, Lavery K, Sensoli A (2001) Phacoemulsification conditions resulting in thermal wound injury. J Cataract Refract Surg 27(11):1829–1839CrossRefGoogle Scholar
  4. 4.
    Sippel KC, Pineda R Jr (2002) Phacoemulsification and thermal wound injury. Semin Ophthalmol 17(3–4):102–109CrossRefGoogle Scholar
  5. 5.
    Bissen-Miyajima H, Shimmura S, Tsubota K (1999) Thermal effect on corneal incisions with different phacoemulsification ultrasonic tips. J Cataract Refract Surg 25(1):60–64CrossRefGoogle Scholar
  6. 6.
    Bradley MJ, Olson RJ (2006) A survey about phacoemulsification incision thermal contraction incidence and causal relationships. Am J Ophthalmol 141(1):222–224CrossRefGoogle Scholar
  7. 7.
    Chang B, O’Reilly P, Tormey P (2002) Thermal injury in phacoemulsification: a survey of eye surgeons in Ireland. J Cataract Refract Surg 28(11):2061–2062CrossRefGoogle Scholar
  8. 8.
    Fujiwara Y, Inukai T, Aso Y, Takemura Y (2000) Thermographic measurement of skin temperature recovery time of extremities in patients with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 108(7):463469CrossRefGoogle Scholar
  9. 9.
    Sigler EJ, Calzada JI (2014) 25-gauge pars plana lensectomy with vitrectomy. Ophthalmic Surg Lasers Imaging Retina 45(6):570–572CrossRefGoogle Scholar
  10. 10.
    Bhandari R, Ernst BJ, Stafeeva K, Mandava N, Quiroz-Mercado H (2012) 23-gauge vitrectomy for retained lens material. Ophthalmic Surg Lasers Imaging 43(4):351–352CrossRefGoogle Scholar
  11. 11.
    Kongsap P (2010) Combined 20-gauge and 23-gauge pars plana vitrectomy for the management of posteriorly dislocated lens: a case series. Clin Ophthalmol 21(4):625–628CrossRefGoogle Scholar
  12. 12.
    Cho M, Chan RP (2011) 23-gauge pars plana vitrectomy for management of posteriorly dislocated crystalline lens. Clin Ophthalmol 5:1737–1743CrossRefGoogle Scholar
  13. 13.
    Koh KM, Kim HS, Cho HJ, Lew YJ, Choi MJ, Han JI, Cho SW, Kim CG, Lee TG, Kim JW, Yoo SJ (2014) Surgical outcomes of 23-gauge vitrectomy for the management of lens fragments dropped into the vitreous cavity during cataract surgery. Saudi J Ophthalmol 28(4):253–256CrossRefGoogle Scholar
  14. 14.
    Takkar B, Azad R, Azad S, Rathi A (2015) Posterior segment nucleotomy for dislocated sclerotic cataractous lens using chandelier endoilluminator and sharp tipped chopper. Int J Ophthalmol 8(4):833–834Google Scholar
  15. 15.
    Nagpal M, Jain P (2014) Dropped lens fragment, dislocated intraocular lens. Dev Ophthalmol 54:234–242CrossRefGoogle Scholar
  16. 16.
    Tzamalis A, Symeonidis C, Brazitikou IP, Tzetzi D, Chalvatzis N, Androudi S, Brazitikos P (2017) Sutureless clear corneal ultrasonic fragmentation for retained lens fragments: a Pilot Study. Retina 37(3):494–499CrossRefGoogle Scholar
  17. 17.
    Nakasato H, Uemoto R, Kawagoe T, Okada E, Mizuki N (2012) Immediate removal of posteriorly dislocated lens fragments through sclerocorneal incision during cataract surgery. Br J Ophthalmol 96(8):1058–1062CrossRefGoogle Scholar
  18. 18.
    Kumar V, Takkar B (2016) Intravitreal phacoemulsification using torsional handpiece for retained lens fragments. J Ophthalmic Vis Res 11(3):268–270CrossRefGoogle Scholar
  19. 19.
    Simpanya MF, Ansari RR, Suh KI, Leverenz VR, Giblin FJ (2005) Aggregation of lens crystallins in an in vivo hyperbaric oxygen guinea pig model of nuclear cataract: dynamic light-scattering and HPLC analysis. Invest Ophthalmol Vis Sci 46(12):4641–4651CrossRefGoogle Scholar
  20. 20.
    Tsuneoka H, Shiba T, Takahashi Y (2002) Ultrasonic phacoemulsification using a 1.4 mm incision: clinical results. J Cataract Refract Surg 28(1):81–86CrossRefGoogle Scholar
  21. 21.
    Tsuneoka H, Shiba T, Takahashi Y (2001) Feasibility of ultrasound cataract surgery with a 1.4 mm incision. J Cataract Refract Surg 27(6):934–940CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Takaki Sato
    • 1
  • Toru Yasuhara
    • 2
  • Masanori Fukumoto
    • 1
  • Masashi Mimura
    • 1
  • Takatoshi Kobayashi
    • 1
  • Teruyo Kida
    • 1
  • Shota Kojima
    • 1
  • Hidehiro Oku
    • 1
  • Tsunehiko Ikeda
    • 1
    Email author
  1. 1.Department of OphthalmologyOsaka Medical CollegeTakatsuki-CityJapan
  2. 2.Yasuhara Eye ClinicTakashima-CityJapan

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