Evaluation of phacoemulsification (ultrasound) cataract surgery on the dynamics of the anterior segment of primary angle closure by AS-OCT

OBJECTIVE

To explore the changes of anatomical biological parameters and dynamic parameters of the anterior segment (AS) before and after primary angle closure glaucoma (PACG) surgery.

METHODS

The clinical data of 82 patients (82 eyes) who underwent phacoemulsification in our hospital were retrospectively analyzed and divided into group A (angle closure, n = 38) and group B (normal open angle, n = 44). The anatomical biological parameters and dynamic parameters were compared between the two groups before and after surgery.

RESULTS

Compared with group B, group A had smaller anterior chamber depth, higher vaulting, greater iris curvature, and smaller TISA500. Compared with group B, group A had smaller ΔTISA500 and ΔI-area. Compared with group B, the TISA500 was smaller in group A preoperatively, at 1 week, and 1 month after surgery (P < 0.05). The iris curvature was larger in group A (P < 0.05). The ΔI-area was significantly reduced in group B at 1 week and 1 month after surgery. Group B exhibited smaller ΔI-curv than group A at 1 week and 1 month after surgery (P < 0.05).

CONCLUSION

Anterior segment optical coherence tomography (AS-OCT) can effectively monitor the dynamic changes (DC) of the AS caused by phacoemulsification in patients with primary angle closure (PAC). Phacoemulsification can open the primary of PAC patients. However, their iris area does not change significantly. The biological characteristics of the iris itself may be a risk factor leading to PAC.

Ocular Surface Changes Associated with Ophthalmic Surgery

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.

Phacoemulsification and IOL-Implantation without Using Viscoelastics: Combined Modeling of Thermo Fluid Dynamics, Clinical Outcomes, and Endothelial Cell Density

Phacoemulsification is a widely used surgical method in cataract surgery with a high energy ultrasound source. The viscoelastic is considered to be tissue protective. The aim of this study is to investigate during surgery the impact of using viscoelastic versus no viscoelastic on clinical outcomes, potential complications and effect on endothelial cell density. The study group included 64 patients, who were subjected to phacoemulsification using balanced salt solution (BSS). Control group consisted of 62 patients, who underwent phacoemulsification using Hyaloronic acid 1% Healon 1%. Student’s t-test was applied for statistical analysis. The simulations of temperature changes during phacoemulsification were performed by COMSOL Multiphysics software. In the BSS group, a mean endothelial cell loss (ECL) of 4.5% was measured one month postoperatively, while in the Healon group ECL was 5.3%. Data analysis showed no significant difference in ECL between the groups (Student’s t-test, p = 0.8). No significant difference was observed in endothelial cell morphology and IOP between the two groups pre- and postoperatively (all p > 0.05). The modeling of thermo fluid dynamics showed that the heating of the cornea is slightly less when Healon was used as irrigation fluid. The phacoemulsification technique can be performed by an experienced surgeon with viscoelastics or continuous anterior chamber (AC) irrigation on the same level of safety regarding endothelial cell damage, providing equally satisfying clinical outcomes.

Dexamethasone intravitreal implant in patients with cataract and naïve diabetic macular edema

PURPOSE

To assess the feasibility and clinical effectiveness of dexamethasone intravitreal implant 0.7 mg (IDI) administered in diabetic patients to prevent the worsening of macular edema.

METHODS

Forty eyes of 40 consecutive patients with naïve macular edema secondary to diabetes mellitus who were treated with IDI administered preoperative (Group A: 20 patients) or IDI administered immediately after cataract surgery (Group B: 20 patients). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes were evaluated at baseline and at postoperative time points.

RESULTS

Follow-up study was 20 weeks. In Group A and B, mean BCVA improved significantly at all post-surgery time points (p < 0.05). In Group A and B, mean CMT decreased significantly at 16 weeks (p = 0.02 and p = 0.004, respectively). At week 20, CMT failed to reach statistical significance in both groups (p = 0.5, group A and p = 0.15, group B). No statistical differences were noted between groups in term of BCVA (with the exception of week 4 for the presence of cataract in Group A), CMT and IOP.

CONCLUSIONS

The use of intravitreal dexamethasone implant 1 month prior to scheduled cataract extraction or at the time of phacoemulsification appears to be safe and effective for at least 16 weeks after surgery.

Cataracts and phacoemulsification in the Siberian Husky: A retrospective and multicentric study (2008-2018)

PURPOSE

To compare cataract characteristics and complications related to cataracts and phacoemulsification in the Siberian Husky (Huskies) versus other canine breeds (non-Huskies).

ANIMALS

A total of 50 Huskies (92 eyes) and 96 non-Huskies (182 eyes) were evaluated.

METHODS

Medical records of Huskies (at four university veterinary hospitals, 2008-2018) and non-Huskies (Colorado State University, 2017-2018) diagnosed with cataracts were reviewed. Age of dog, cataract stage at presentation, and pre- and post-operative complications were recorded and analyzed.

RESULTS

Mean (±standard deviation) age at presentation was significantly lower in Huskies (3.5 ± 3.3 years) compared to non-Huskies (9.5 ± 2.9 years) (p < .0001). Huskies more commonly presented with hereditary cataracts than non-Huskies (84% versus 52%) and a significantly higher percentage of non-Huskies presented with diabetic cataracts than Huskies (48% versus 16%; p = .0001). Cataract stage at presentation did not differ between Huskies and non-Huskies. Phacoemulsification was performed in 40% (20 out of 50 dogs, 39 out of 92 eyes) of Huskies and 42% (40 out of 96 dogs, 74 out of 182 eyes) of non-Huskies. Pre-operative and post-operative retinal detachment were more common in Huskies than non-Huskies (13% versus 2% and 10% versus 1%, respectively) but the difference was not significant. Other post-operative complications occurred with similar frequency in both groups (p ≥ .17).

CONCLUSIONS

Huskies evaluated for cataracts were younger and less likely to present with diabetic cataracts than other canine breeds and, although not statistically significant, had a clinically important increased risk of retinal detachment pre- and post-phacoemulsification.

Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab

PURPOSE

To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema.

PATIENTS AND METHODS

A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT.

RESULTS

The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group.

CONCLUSION

Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.

Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers

BACKGROUND/OBJECTIVES

To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control).

METHODS

Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant.

RESULTS

A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p < 0.001 for both).

CONCLUSION

This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.

Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery

BACKGROUND

To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery.

METHODS

A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications.

RESULTS

Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection (p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month (p < 0.001).

CONCLUSIONS

The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.

The visual outcomes and complications of manual small incision cataract surgery and phacoemulsification: long term results

Objective: To compare visual outcomes and complications between manual small incision cataract surgery (MSICS) and phacoemulsification.

Methods: A retrospective study was conducted in the tertiary care center. A total of 1281 cases underwent manual small incision cataract surgery and phacoemulsification from January 2014 to December 2016. The postoperative best corrected visual acuity (BCVA) along with the rates of complications were compared between both groups.

Results: Five hundred and twenty-one patients (40.67%) and 760 patients (59.33%) were subjected by staff members and residents, respectively. Altogether, 689 cases (53.79%) were subjected to MSICS technique and 592 cases (46.21%) to phacoemulsification. The MSICS group had significantly harder cataract (cataract grading ≥ 4+ :31.64% vs. 7.77%; p<0.001). One month postoperatively, good visual outcome (BCVA ≥ 6 /18) in the phacoemulsification group was higher than that in the MSICS group (86.33% vs. 72.12%, p<0.001). The risk factor for poor outcome (post-operative BCVA < 6 /60 in both groups) was the presence of associated ocular pathologies. The intraoperative and perioperative complications rates were higher in the MSICS group (16.55% vs. 6.6%, p<0.001). The most common complications were hyphema (4.35%), posterior capsule ruptures (4.21%), and prolapsed iris (3.05%). Long-term postoperative complication rates were higher in the phacoemulsification group (9.29% vs. 21.28%, p<0.001). The most common complication was posterior capsule opacity (8.71% vs. 20.44%, p<0.001). Pseudophakic bullous keratopathy (PBK) was similar in both groups (0.29% vs. 0.17%, p=1.00).

Conclusion: The number of patients who had experienced good visual outcomes was higher in the phacoemulsification group. However, for both groups, no significant differences were found on the long-term complication rate.

Phacoemulsification outcomes and complications in vitrectomised versus non-vitrectomised eyes

Clinical relevance: Pars plana vitrectomy techniques have evolved in the recent years and the number of patients undergoing phacoemulsification for post-vitrectomy cataract has increased. Eye-care practitioners need to be aware of intraoperative complications and post-operative outcomes in previously vitrectomised eyes.Background: The aim of the present study is to compare the outcomes and related complications of phacoemulsification in previously vitrectomised versus non-vitrectomised eyes.Methods: This is a retrospective case-control study. Visual acuity, refractive outcomes, intra- and post-operative complications were analysed in consecutive phacoemulsification patients between January 2015 and August 2017. Patients with no post-operative data were excluded.Results: One hundred and forty-nine previously vitrectomised eyes and 608 non-vitrectomised eyes were included in the analysis. Previous pars plana vitrectomy was associated with worse logMAR visual acuity pre-operatively (0.75 ± 0.54 vs. 0.40 ± 0.33, p < 0.0001) and post-operatively (0.15 ± 0.29 vs. 0.09 ± 0.22, p = 0.014). There were no statistically significant differences between the two groups regarding refractive outcomes (p = 0.393) or posterior capsule rupture rate (p = 0.223). Previous pars plana vitrectomy was associated with a higher risk of post-operative macular oedema (p = 0.046) and posterior capsule opacification (p < 0.0001).Conclusions: Previous pars plana vitrectomy was not associated with a higher risk of intraoperative complications. However, a higher incidence of cystoid macular oedema and posterior capsule opacification were identified in the present study. Further research can provide insight into the mechanisms involved and any appropriate prevention strategies for these conditions.

Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time

Purpose

To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones.

Patients and Methods

A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery.

Results

A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups (P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference (P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (P < 0.0001).

Conclusion

When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.

Efficacy of Nepafenac versus Flurbiprofen in Maintaining Intraoperative Mydriasis During Phacoemulsification: A Comparative Study

Purpose

To compare the efficacy of topical nepafenac (0.1%) with flurbiprofen (0.03%) in maintaining intra-operative mydriasis during phacoemulsification surgery.

Patients and Methods

This study comprised of 160 patients, who were divided into two arms of 80 each (arms A and B) after randomisation. Pre-operatively, all patients received one drop of tropicamide 0.8% and phenylephrine 5% (combination), 4 times, at an interval of 15 minutes on the day of surgery. Thereafter, Nepafenac drop in arm A/Flurbiprofen drop in arm B was administered 4 times, at an interval of 15 minutes keeping a gap of 10 minutes between tropicamide-phenylephrine and any of the experimental drugs. Phacoemulsification was performed one hour after the administration of last drop. Both vertical and horizontal pupillary diameter were measured at three steps; immediately before the surgical incision (baseline), at the end of emulsification of nucleus (before irrigation and aspiration) and at the end of surgery (after stromal hydration).

Results

The difference in pupillary diameter between two groups, was statistically insignificant for vertical diameter (P = 0.08) and horizontal diameter (P = 0.28) at the start of surgery. On the other hand, pupillary diameter difference was statistically significant after emulsification of nucleus and at the end of surgery as well when both vertical (P < 0.05) and horizontal diameter (P < 0.05) were considered. The total reduction in pupillary diameter (both vertically and horizontally) was significantly less in the Nepafenac as compared to Flurbiprofen group (P < 0.05). Analysis of mean cumulative dissipated energy did not document any appreciable difference between the two groups. Phacoemulsification time analysis yielded statistically significant results (P = 0.004) between the Nepafenac and Flurbiprofen group.

Conclusion

In the present study, topical Nepafenac (0.1%) proved to be more efficacious in maintaining intra-operative mydriasis during phacoemulsification surgery as compared to topical Flurbiprofen (0.03%).

Refractive Outcomes and Anterior Chamber Depth after Cataract Surgery in Eyes with and without Previous Pars Plana Vitrectomy

Purpose: To compare the differences in refractive outcome and anterior chamber depth (ACD) after phacoemulsification between eyes with and without previous pars plana vitrectomy (PPV).Materials and Methods: Patients who had significant cataracts after PPV were included in the study group, and patients with a matched axial length (AL) who had cataracts without PPV were selected as the control group. The performance of new generation intraocular lens (IOL) power calculation formulas (Barrett Universal II, Kane, Ladas Super formulas), and the traditional formulas (SRK/T, Holladay 1, Hoffer Q, Haigis) with and without the Wang-Koch (WK) AL adjustment were compared between the two groups. The postoperative ACD was measured using the Scheimpflug imaging system with manual correction at least three months after surgery. Results: In total, there were 193 eyes from 193 patients in each group. The mean prediction errors (MEs) of the new generation formulas had no significant systemic bias in the study group; the hyperopic shift was displayed in the traditional formulas for eyes with AL > 26mm. However, the difference of MEs between the two groups among all the formulas were not significant. The absolute prediction error (MAE) and median prediction error (Med AE) in the study group were larger than those in the control group among all the formulas. The postoperative ACD of the study group was deeper but not significant than that of the control group. Conclusions: There was no refractive shift in vitrectomized eyes compared with non-vitrectomized eyes no matter in new generation formulas or traditional vergence formulas. The prediction error among all the formulas in vitrectomized eyes were significantly higher than those in non-vitrectomized eyes. The ACD after phacoemulsification in vitrectomized eyes was not significantly different from non-vitrectomized eyes.

Changes of the tear film lipid layer thickness after cataract surgery in patients with diabetes mellitus

PURPOSE

To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery.

METHODS

We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer's tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery.

RESULTS

Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer's test results were significantly lower in DC group compared to ARC group (both p < 0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p = 0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10 years) than in those with shorter duration (p < 0.001). One month after surgery, LLT of DC group was significantly thinner than at baseline (pre: 65.7 ± 23.3, post: 51.3 ± 17.1, p = 0.002). While in ARC group, LLT had no significant difference before and after cataract surgery (pre: 67.1 ± 23.4, post: 60.2 ± 21.1, p = 0.078). Compared to baseline data, there was no statistically significant difference between two groups in the partial blink rates, TBUT and Schirmer's test results after cataract surgery (p > 0.05). Ocular Surface Disease Index (OSDI) scores were significantly higher after surgery than at baseline in both ARC (pre: 8.9 ± 8.4, post: 12.4 ± 8.5, p = 0.003) and DC group (pre: 11.4 ± 10.3, post: 18.5 ± 8.5, p = 0.001). Multivariate linear regression analysis showed OSDI scores were associated with LLT either before or after cataract surgery (β = -0.862, p < 0.001 and β = -0.592, p < 0.001, respectively).

CONCLUSION

The tear film LLT is correlated with duration of DM and becomes significantly thinner one month after cataract surgery, leading to the aggravation of dry eye symptoms.

Evaluation of the Cataract Surgery 2018 Survey in Terms of Achieving Refractive Cataract Surgery Targets

Objectives

The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are.

Materials and Methods

A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria.

Results

Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%.

Conclusion

It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery.

12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm's canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery

PURPOSE

To characterize clinical outcomes of combined viscodilation of Schlemm's canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery in eyes with mild to moderate open-angle glaucoma (OAG).

METHODS

In this prospective case series, the OMNI glaucoma surgical platform (Sight Sciences, Menlo Park, CA) was utilized to perform the procedure either combined with phacoemulsification or as a standalone procedure. Changes from baseline in intraocular pressure (IOP) and IOP-lowering medications were evaluated through the first 12 months of a planned 24-month follow-up period.

RESULTS

Among 17 eyes of 15 subjects, mean IOP was reduced from 20.4 mmHg to 12.7-13.7 mmHg through 12 months of follow-up (p < 0.001 at every time point) and mean medications reduced from 2.5 to 0.1-0.6 (p < 0.001 at every time point). IOP reductions in eyes undergoing standalone surgery were approximately 2-4 mmHg greater at each time point compared to eyes undergoing surgery combined with phacoemulsification; this may be related to a higher baseline IOP in the former eyes (22.1 vs 18.5 mmHg). Six eyes developed hyphema, of which three required washout for elevated IOP on the first postoperative day; six additional eyes had IOP elevations that resolved with medical management.

CONCLUSION

Viscodilation of Schlemm's canal and collector channels paired with ab interno trabeculotomy performed with a single integrated instrument (OMNI), whether as standalone or combined with phacoemulsification, effectively lowers both IOP and the need for IOP-lowering medications through 12 months of follow-up.

[Results of hybrid (femtosecond laser-assisted) phacoemulsification of hypermature cataract in patients with lens subluxation]

Studying the use of femtosecond laser in patients with complicated cataracts remains a topical issue in phaco surgery.

PURPOSE

To comparatively analyze the results of using hybrid (femtosecond laser-assisted) phacoemulsification in hypermature cataract in patients with lens subluxation.

MATERIAL AND METHODS

The study included 78 patients (78 eyes) with hypermature cataract in combination with lens subluxation of I-II degree. In the 1^st group (45 eyes) capsulorhexis was performed using a femtosecond laser. In the 2^nd group (33 eyes) manual capsulorhexis was performed.

RESULTS

On the first day after surgery, best corrected visual acuity of 0.8-1.0 was obtained in 57.8% of cases in the 1^st group and 33.3% in the 2^nd group. Transient corneal edema during the first 1-3 days was noted in 4.4% of cases in the 1^st group and in 15.2% - in the 2^nd group of patients. Pachymetry in the center of the cornea showed an increase in its thickness on the 1^st day after surgery from 0.564±0.027 mm to 0.591±0.033 mm in the 1^st group and from 0.561±0.023 mm to 0.637±0.043 mm (p<0.05) in the 2^nd group of patients. The loss of corneal endothelial cells amounted to 10.9±1.8% in the 1^st group and 17.4±2.9% in the 2^nd group (p<0.05). Macular edema with decreased visual acuity confirmed by OCT was detected in the 1^st group of patients in 2.2% of cases, in the 2^nd group - in 9.1% of cases. With a follow-up period of up to 3 years, IOL optics decentration by more than 1 mm was detected in 2.2% of cases in the 1^st group of patients and in 12.1% of cases in the 2^nd group.

CONCLUSION

Femtosecond laser-assisted capsulorhexis significantly improves the results of surgery in patients with hypermature cataract combined with lens subluxation.

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM

To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation (phaco-vitrectomy) in idiopathic macular holes (IMH).

METHODS

A total of 56 eyes with IMH (IMH group) that underwent phaco-vitrectomy and 44 eyes with age-related cataract (ARC group) that underwent cataract surgery were retrospectively reviewed. The best corrective visual acuity (BCVA), predicted refractive error (PRE), actual refractive error (ARE), axial length (AL), were measured in both groups before and 6mo after operation. The power calculation of IOL and the predicted refractive error (PRE) were calculated according to the SRK/T formula. The difference of PRE and ARE between the two groups were compared and analyzed.

RESULTS

In the IMH group, the diameters of macular holes were 271.73±75.85 µm, the closure rate was 100%. The pre- and post-operative BCVA were 0.80±0.35 and 0.40±0.35 logMAR. The PRE of A-ultrasound and IOL Master in the IMH group was -0.27±0.25 and 0.10±0.66 D. The postoperative mean absolute prediction error (MAE) was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound (P=0.758). The PRE and ARE of the IMH group were 0.10±0.66 D and -0.19±0.64 D (P=0.102). The PRE and ARE of the ARC group was -0.43±0.95 and -0.31±0.93 D (P=0.383). The difference between PRE and ARE was -0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups (P=0.021). The proportion of myopic shift was 67.9% in the IMH group and 27.3% in the ARC group (P=0.004).

CONCLUSION

The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery

AIM

To report the effectiveness of intravitreal implantation of dexamethasone implant (Ozurdex) after phacoemulsification and intraocular lens implantation in refractory uveitis patients.

METHODS

This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation. The main outcome measurements were best-corrected visual acuity (BCVA), central retinal thickness (CRT), grade of anterior chamber cell (AAC), intraocular pressure (IOP), and systemic/ocular adverse events.

RESULTS

Ten eyes of 7 patients were included. BCVA showed significant improvement at 1mo (P=0.004), 3mo (P=0.0004), and 6mo (P=0.001) post operation. There were no statistically significant differences in the postoperative CRT among follow-up groups (P>0.05). No significant differences were observed in the baseline IOP when compared to 1, 3, and 6mo (all P>0.05) post operation. One patient developed a transient elevated IOP post injection. Two eyes (20%) developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In six patients (8 eyes, 71.4%), the systemic steroid usage was reduced to below 10 mg/d. The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6mo before operation and 0.7±0.48 in the 6mon post operation. The mean recurrence time was 13±0.58wk (range 12-14wk) post operation. In five of seven patients (7 out of 10 eyes), inflammation relapse was developed postoperatively. Only one patient (2 eyes) needed increased amounts of oral corticosteroids. Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids.

CONCLUSION

Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study. After the disappearance of Ozurdex's anti-inflammatory effects over time, in most cases the recurrent inflammation can be controlled by topical steroids.

Prevalence of Astigmatism in Patients Undergoing Cataract Surgery at a Tertiary Care Center in North India

AIM

To assess the demography, magnitude, and type of corneal astigmatism in patients undergoing cataract surgery in North India.

METHODS

It is a clinic-based, cross-sectional, observational study. Keratometric values and demographic data were collected for eligible patients who had undergone phacoemulsification at a tertiary eye care center between January 2010 and December 2017, using a non contact, optical low coherence reflectometry (OLCR).

RESULTS

A total of 3597 eyes were recruited for the study. There were 1810 (50.3%) females and 1787 (49.7%) males. The mean age was 59.121±15.19 (range 5-100 years). A total of 3559 eyes were qualified for astigmatism analysis. The mean corneal astigmatism among all patients was 1.17±1.15 D (range 0-12.5 D). There was no astigmatism in 99 eyes (2.78%), with-the-rule (WTR) in 1062 eyes (29.83%), against-the-rule (ATR) in 1843 eyes (51.72%) and oblique astigmatism (OA) in 555 eyes (15.59%). The tendency of a gradual change from with the rule (WTR) to against the rule (ATR) astigmatism was noted as the age advanced.

CONCLUSION

In the present study around 56.69% of eyes had corneal astigmatism of <1.0 D that can be managed by simple cost-effective keratorefractive procedures especially in developing countries. However, our 40.49% patients had >1.0 D of corneal astigmatism, which may benefit by toric intraocular lenses.

A-scan biometry, phacoemulsification, and foldable intraocular lens implantation in a young orangutan (Pongo pygmaeus)

Background:

Cataracts are the major cause of visual impairment in animals which can be curable by surgical treatment. Phacoemulsification is the standard technique for cataract treatment that is applied to almost all species with a high success rate.

Case Description:

A 2-year-old intact female orangutan (Pongo pygmaeus) was presented for the study having bilateral opacity of the lenses, for 2 weeks. Ophthalmic examination revealed mature cataract OU. Ocular biometry measurements using A-scan ultrasonography for appropriate intraocular lens (IOL) refractive power calculation were carried out. Electroretinography was applied to ensure retinal function is intact. The orangutan underwent phacoemulsification OU and +24 diopter IOL implantation OS to restore vision. IOL implantation was not carried out OD because of a posterior capsular tear. Retinoscopy after 3 weeks postoperatively revealed +2.0 diopters OS. The outcome of the cataract surgery was successful during 3 years follow-up. The orangutan lived with other orangutans and was alert with normal behavior such as catching food, climbing trees, and swinging hand over hand from one branch to another.

Conclusion:

Cataract surgery with phacoemulsification OU and adjusted IOL implantation OD was successful with few complications in this orangutan. Vision was restored with normal behavior, even though an adjusted IOL was inserted in only one eye.

Effectiveness of Pulmonary Surfactant in the Treatment of Corneal Edema

Purpose: To compare the effectiveness of topical surfactant and 3% sodium chloride (NaCl) in the treatment of corneal edema occurring after cataract surgery. Methods: Ninety eyes of 90 patients with no corneal disease who underwent cataract surgery were included in the study. Thirty eyes without corneal edema comprised group 1. Patients with corneal edema were divided into two groups: those treated with 3% NaCl (group 2, 30 eyes) and those treated with surfactant drop (group 3, 30 eyes). Results: The mean age was 70.8 ± 6.6 years, with no significant age difference between the groups. Preoperatively, there was no significant difference in mean central corneal thickness (CCT) or mean endothelial cell count (ECC) among the groups (P = 0.999). On postoperative day 1, CCT was significantly lower in group 1 (P < 0.001) but did not differ between groups 2 and 3 (P = 0.999). There was no significant difference between groups in terms of ECC (P > 0.05). At postoperative day 7 and 14, CCT differed significantly between groups 1 and 2 (P < 0.001) and between groups 2 and 3 (P = 0.001), with no significant difference between groups 1 and 3 (P = 0.474). ECC was significantly higher in group 1 (P < 0.05), whereas there was no significant difference between groups 2 and 3 (P > 0.05). Conclusion: Topical pulmonary surfactant may be a more effective treatment option than 3% hypertonic NaCl for the treatment of corneal edema that develops after cataract surgery.

Clinical experience of using the NGENUITY three-dimensional surgery system in ophthalmic surgical procedures

PURPOSE

To assess the clinical experience of using a three-dimensional (3D) system for ophthalmic surgical procedures.

METHODS

We retrospectively analysed video recordings of patients who underwent 3D ophthalmic surgery, using the NGENUITY^® 3D visualization system, or traditional microsurgery at our hospital, from August 2017 to February 2018. Patients underwent phacoemulsification or phacoemulsification combined with vitrectomy. Diagnoses, operation type, duration of continuous curvilinear capsulorhexis (CCC), number of forceps nips during CCC and capsulorhexis complications were recorded. Five surgeons and four assistants answered a 3D surgery questionnaire.

RESULTS

Twenty-six of 46 patients who underwent 3D surgery, and 31 of 51 patients who underwent traditional microsurgery (control group) were enrolled. The mean CCC duration in the study and control groups was 31.2 ± 10.8 and 28.7 ± 13.2 seconds (p = 0.071), and the mean number of forceps nips was 5 ± 2 and 5 ± 2 (p = 0.634), respectively. The anterior capsular rupture rate of phacoemulsification under 3D and traditional conditions was 3.85% (1/26 cases) and 3.23% (1/31 cases), respectively. The complication rate was similar between the two groups (p > 0.999). Four of five surgeons and two of four assistants believed the clarity of 3D surgery was similar or better than that of traditional microsurgery. The occurrence of dizziness (p > 0.999), shoulder and neck pain (p = 0.262), backache (p = 0.471) and visual fatigue (p = 0.347) did not differ significantly between the two methods.

CONCLUSION

The 3D surgical system facilitated similar operation speed and stability as the traditional microscope and provided reliable support for ophthalmic surgery.

Aerosolization and Fluid Spillage During Phacoemulsification in Human Subjects

Background

Concerns had been raised for the potential hazard of SARS-CoV-2 transmissions via aerosols and fluid droplets during cataract surgeries amid the COVID-19 pandemic. This study aims to evaluate the rate of visible aerosol generation and fluid spillage from surgical wounds during phacoemulsification in human subjects.

Methods

This is a prospective consecutive interventional case series. High-resolution video captures of 30 consecutive uncomplicated phacoemulsification surgeries, performed by 3 board-certified specialists in ophthalmology, were assessed by 2 independent and masked investigators for intraoperative aerosolization and fluid spillage. Water-contact indicator tape was mounted on the base of the operating microscope, around the objective lens, to detect any fluid contact.

Results

No visible intraoperative aerosolization was detected in any of the cases, irrespective of different surgical practices among the surgeons with regard to wound size and position, lens fragmentation technique, power settings and means of ocular lubrication, or the different densities of cataract encountered. Large droplets spillage was noted from the paracentesis wounds in 70% of the cases. For all cases where fluid spill was detected on video, there was no fluid contact detected on the water-contact indicator tape.

Conclusion

Visible aerosolization was not detected during phacoemulsification in our case series. Although the rate of fluid spillage was high, the lack of detectable contact with the indicator tape suggested that these large droplets posed no significant infectious risks to members of the surgical team.