Does the phaco TIp position during clear corneal Phacoemulsification Surgery adversely affect corneal endothelium? TIPS study protocol for a randomised, triple-masked, parallel-group trial of bevel-up versus bevel-down phacoemulsification.

Autor:	Kaup S; Department of Ophthalmology, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, 575018, India., Shivalli S; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK., Ajjinicanda Ganapathi C; Department of Ophthalmology, Netra Jyothi Charitable Trust Hospital, Udupi, Karnataka, 576101, India., Arunachalam C; Department of Ophthalmology, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, 575018, India., Buchan J; International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK., Kumar Pandey S; Department of Ophthalmology, SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, 324005, India., Prasad Kudlu K; Department of Ophthalmology, Netra Jyothi Charitable Trust Hospital, Udupi, Karnataka, 576101, India.
Jazyk:	angličtina
Zdroj:	Wellcome open research [Wellcome Open Res] 2023 Jan 25; Vol. 5, pp. 167. Date of Electronic Publication: 2023 Jan 25 (Print Publication: 2020).
DOI:	10.12688/wellcomeopenres.16098.2
Abstrakt:	Introduction: Globally, at least 30 million cataract surgeries are required annually to prevent cataract-related blindness. Corneal endothelial decompensation is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The increasing ageing population and reduced visual impairment threshold for cataract surgery have resulted in rising cataract surgical rates and hence, an increase in corneal endothelial decompensation is expected. The role of phaco tip position on corneal endothelial damage is ambiguous. Previous studies have reported contradictory results and were also underpowered to detect a significant difference due to small sample sizes. With no consensus regarding the most cornea-friendly phaco tip position (bevel-up versus bevel-down) during phacoemulsification, we propose a randomised clinical trial with a robust design using direct chop phaco-technique. Objective: To compare the effect of phaco tip position (bevel-up vs. bevel-down) on corneal endothelial cell count during phacoemulsification. Methods: A randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio is proposed. By adopting stratified randomisation (according to cataract grade), we will randomly allocate 480 patients aged >18 years with immature cataract into bevel-up and bevel-down groups at two centres. History of significant ocular trauma, previous intraocular surgery, shallow anterior chamber, low endothelial cell count, pseudoexfoliation syndrome, intraocular inflammation, and corneal endothelial dystrophy are the key exclusion criteria. The primary outcome is postoperative endothelial cell count at one month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30, and intraoperative complications. Trial registration: Clinical Trial Registry of India CTRI/2019/02/017464 (05/02/2019). Competing Interests: No competing interests were disclosed. (Copyright: © 2023 Kaup S et al.)
Databáze:	MEDLINE
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