A Randomised Controlled Trial Comparing the Outcomes of Different Irrigation-Aspiration Techniques for Viscoelastic Removal in Cataract Surgery

Study Title

A Randomized Controlled Trial Comparing the Outcomes of Different Irrigation-Aspiration Techniques for Viscoelastic Removal in Cataract Surgery

Introduction

Ophthalmic viscoelastic devices (OVDs) are essential in cataract surgery to maintain anterior chamber depth, protect intraocular structures, and facilitate intraocular lens (IOL) implantation. Incomplete OVD removal, especially behind the IOL in the retrolental space, may cause postoperative complications like intraocular pressure (IOP) spikes, capsular block syndrome (CBS), and unintended refractive shifts.

Techniques Compared

• *Technique A:* Aspiration from the anterior chamber with IOL tapping.

• *Technique B:* Active aspiration behind the IOL using an irrigation and aspiration (IA) probe while maintaining capsular integrity.

Aim

To compare the efficiency and outcomes of these two IA techniques in OVD removal during phacoemulsification cataract surgery.

Study Design

• Prospective, double-blinded, randomized controlled trial.

• Total sample size: 126 patients (63 in each group).

• Single experienced surgeon performing all surgeries under standardized conditions.

• Follow-up at Day 1, Week 1, and Week 6 postoperatively.

• Outcomes measured: IOP, IOL position (anterior segment imaging), spherical equivalent refractive outcomes, anterior chamber depth changes.

Inclusion Criteria

• Age 50–80 years.

• Nuclear sclerosis grade II–III (LOCS III classification).

• Normal axial length 21.5–24.5 mm.

• No prior ocular surgery.

• Willingness to follow up.

Exclusion Criteria

• Glaucoma or ocular hypertension.

• Pseudoexfoliation syndrome or zonular instability.

• Corneal dystrophies or opacities.

• Poor pupil dilation <6 mm.

• History of uveitis or ocular trauma.

• Patients lost to follow-up.

Ethics

• Institutional ethical approval obtained.

• Adherence to Declaration of Helsinki.

• Informed consent obtained from all participants.

This trial aims to provide evidence-based guidance on the best irrigation-aspiration technique to reduce postoperative complications and improve visual outcomes after cataract surgery