Day care versus in-patient surgery for age-related cataract

METTL3-mediated m6A modification of has_circ_0007905 promotes age-related cataract progression through miR-6749-3p/EIF4EBP1

Many cases of blindness are caused by age-related cataracts (ARCs). N6-methyladenosine (m6A)-modified circRNA widely participates in disease progression. However, the role of m6A modification of circRNA in ARC is unclear. We mined and elucidated the functions and mechanisms of key circRNAs with m6A modification involved in ARC progression. The GSE153722 dataset was used to mine m6A-mediated key circRNA. Loss-of-function assays and rescue assays were used to explore the effect and mechanism of circRNA on ARC cell proliferation and apoptosis. Has_circ_0007905 was a hypermethylated and upregulated expression in the ARC group relative to the control group both in vivo and in vitro. Silencing of has_circ_0007905 promoted proliferation and inhibited the apoptosis of HLE-B3 cells. METTL3 was upregulated in HLE-B3 cells after ARC modeling and had four binding sites with has_circ_0007905 and a mediated m6A modification of has_circ_0007905. Proliferation was significantly inhibited and apoptosis of HLE-B3 cells was facilitated by METTL3 overexpression, whereas these effects were prevented by has_circ_0007905 silencing. Silencing of has_circ_0007905 led to an alteration in the transcriptome landscape. Differentially expressed genes were mainly involved in immune-related processes and pathways. EIF4EBP1 overexpression promoted apoptosis and suppressed proliferation, and also significantly reversed effects of has_circ_0007905 silencing. Moreover, miR-6749-3p significantly decreased the luciferase activities of wild type plasmids with both of has_circ_0007905 and EIF4EBP1. MiR-6749-3p inhibitor blocked elevation in proliferation and reduced EIF4EBP1 expression and apoptosis conferred by has_circ_0007905 silencing. We reveal for the first time that the commitment of ARC progression is guided by METTL3/has_circ_0007905/miR-6749-3p/EIF4EBP1 axis, and the results provide new insights into ARC pathology.

Analysis of pupil size by repeat dilation at shrinkage stage

PURPOSE

To compare the pupil size of the original mydriasis and repeat mydriasis at the pupil shrinkage stage.

METHODS

Randomized prospective study. In total, 60 eyes of 30 patients aged 50-70 with age-related cataracts were included. Pupil sizes were measured by the Sirius system before mydriasis, after the first batch of mydriasis, and after the second batch of mydriasis which was 5 h later. Statistical analysis was performed using MedCalc statistical software version 20.0.3 RESULTS: The pupil size of the second batch of mydriasis 5 h later was smaller than the first batch of mydriasis (3.94 ± 0.88 mm vs 5.12 ± 0.96 mm, P < 0.0001).

CONCLUSIONS

Less efficiency repeat mydriasis several hours later compared with original mydriasis in our study suggests that preparation of mydriasis at an appropriate time is necessary for ophthalmological operations. The effect of repeat mydriasis again by tropicamide at the shrinkage stage still needs to be explored.

The development of one-day surgical care in Hungary between 2010 and 2019

BACKGROUND

The constant increase in the utilization of one-day surgical care could be identified since more than a decade in most of European countries. Initially, according to the international rankings, the exploitation of one-day surgery in Hungary was not really significant. In 2010, the Hungarian policy makers intended to increase one-day surgical care as a priority strategy. The aim of our study was to analyze the evolution of the Hungarian one-day surgical care during the last decade in DRG- based performance financing system in Hungary.

METHODS

The dataset of the research was provided by the National Health Insurance Fund Administration of Hungary. The most important indicators related to the one-day surgical care were compared to inpatient care (market share, number of cases, and DRG cost-weights). To discover the impact of one-day surgical care to the utilization of inpatient treatment, the number of hospitalized days was also analyzed.

RESULTS

Between 2010 and 2019, the market share of one-day surgical cases increased from 42, to 80%. Simultaneously the constant increase of one-day surgical cases, the number of hospitalized days were decreased in inpatient care by 17%. The value of Case Mix Index has also increased, approximately by 140%, which could confirm that more complex interventions are being conducted in one-day surgical care as well.

CONCLUSIONS

Due to the comprehensive health policy strategy related to the dissemination of one-day surgical care in Hungary, several important performance indicators were improved between 2010 and 2019. Given that Hungary belongs to the low- and middle-income countries, the results of the study could be considerable even in an international comparison.

Cataract Surgery in One-Eyed Patients: A Cohort Study of 100 Patients

Purpose

To determine the course and outcomes of cataract surgery in one-eyed patients.

Methods

This retrospective cohort study was conducted at the University Hospital of Nice, France. All one-eyed patients who underwent cataract surgery in their functional eye between January 2014 and December 2018 were included. A one-eyed patient was defined as having a visual acuity (VA) ≤20/200 in the other eye. Data were collected from the medical records and included the sociodemographic factors, the past medical history, data from the preoperative and postoperative clinical examinations, the surgical course, and the visual outcomes.

Results

One hundred one-eyed patients with a mean age of 74.01 years were included (48 men/52 women). The mean preoperative VA was 20/100 (+0.74 logMAR). The VA ranged between 20/200 and 20/40 in 75 (75%) patients, was >20/40 in 8 (8%), and was <20/200 in 17 (17%) patients. Fifty-eight (58%) patients were operated on an outpatient basis. General or locoregional anesthesia was used in 29 (29%) and 9 (9%) patients, respectively. All cataract surgery procedures were performed by phacoemulsification. Five (5%) patients experienced intraoperative complications. Seventy-three (73%) one-eyed patients achieved a final VA ≥20/40. The mean final VA was 20/50 (+0.37 logMAR) (p < 0.001).

Conclusion

A low rate of intraoperative complications was observed in one-eyed patients during cataract surgery. In most cases, a good visual recovery was achieved after cataract surgery, even in patients who experienced a surgical complication.

Comparison of safety and number of post-operative visits of patients in convenient day versus conventional first day follow-up after phacoemulsification

Objectives

To compare safety and number of post-operative visits of patients in convenient day versus conventional first day follow-up after phacoemulsification.

Methods

This observational cohort study was conducted in Department of ophthalmology, Sahiwal Medical College, Sahiwal from November 2019 to August 2020. There were 600 patients who underwent uncomplicated phacoemulsification with intraocular lens implantation. Patients were allocated into two groups. Group-I comprised of patients with convenient day follow-up during the first post-operative week. Group-II comprised of the patients with conventional first day follow-up. Rate of complications, number of visits during the first month and final visual acuity were recorded.

Results

In Group-I post-operative complications were noted in 12.67% cases on first follow up visit and in 2.67% cases on first month follow up visit. In Group-II post-operative complication were noted in 22 % cases on first follow up visit and in 4% cases on first month follow up visit. Common postoperative complications were corneal oedema, anterior segment intraocular inflammation, residual lens matter in anterior chamber and intraocular lens subluxation. There was no difference in presenting and postoperative visual acuity between the two groups. Mean follow-up visits were 2.23 ± 0.42 in Group-I and 3.55 ± 0.50 in Group-II.

Conclusion

Convenient day follow-up is as safe as conventional first day follow-up. Convenient day follow-up significantly reduces the number of post-operative visits. This would translate into cost reduction both for the patients and the health care facility.

Same Day Discharge Versus Overnight Observation Protocols - Similar Outcomes Following Artificial Urinary Sphincter Surgery

OBJECTIVES

To analyze our institutional experience transitioning from overnight observation (OBS) to same day surgery (SDS) for artificial urinary sphincter (AUS) procedures. Prior research has questioned the need for OBS following AUS surgery.

METHODS

We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 01/2020. Patients were grouped based on discharge status: OBS vs SDS. Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients.

RESULTS

We identified 525 AUS cases that met inclusion criteria. Men in the SDS group (n = 318) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier. Men in the OBS group (n = 207) were more likely to suffer an immediate postoperative complication (1% vs 0%, P < .01) and to be readmitted within 90 days of surgery (15% vs 5%, P < .01). The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs none for SDS patients (n = 183).

CONCLUSION

SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary.

Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

Importance

Trustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP).

Objective

To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye.

Design, Setting, and Participants

Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines.

Main Outcomes and Measures

Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings.

Results

From 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines.

Conclusions and Relevance

The partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases

AIM

To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital.

METHODS

The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative best-corrected visual acuities (BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed.

RESULTS

A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73% (2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1d, 1wk, and 1mo post-surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12% (171/4151) had posterior capsule rupture, 0.79% (33/4151) had iris or ciliary body injury, and 0.048% (2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38% (182/4151) had cornea edema, 7.78% (323/4151) had intraocular hypertension, 0.096% (4/4151) had IOL toxicity syndrome, 0.28% (12/4151) had retained lens cortex, and 0.048% (2/4151) had hyphema. The delayed discharge rate was 0.82% (44/4151) and the unplanned re-admission to the hospital was 0 (0/4151). The patient satisfaction rate was 91.42% (3795/4151).

CONCLUSION

Day-case cataract surgery is safe and effective with good prospects for development.

Determinants of inappropriate hospitalization in cataract surgery in the south of Italy: a retrospective study

PURPOSE

To analyze the frequency of inappropriate hospitalization in cataract surgery and the type of related determinants.

METHODS

A nested retrospective case-control study was carried out on 2708 consecutive cataract surgery patients operated between January 2013 and December 2015. All cases with inappropriate hospitalization (day surgery or ordinary hospitalization) were compared with a control group of cases treated in an appropriate (day service) regimen. The predictive value for inappropriate admissions to the hospital was assessed using a logistic regression model. Significant variables from the univariate analysis were included in a multivariate model.

RESULTS

Forty-five cases (< 2%) of inappropriate hospital admissions were recorded. Residence, heart disease, tremors, anticoagulants, intraoperative floppy iris syndrome were not related to appropriateness, while psychotic disorder (OR 12.571, p = 0.018), anxiety-depressive syndrome (OR 7.818, p = 0.010) and use of antipsychotropic drugs (OR 7.724, p = 0.002) were related to the inappropriateness of admission by univariate and multivariate analysis. Previous systemic surgeries were predictors of ordinary hospitalization by logistic regression analysis. A greater presence of hypertension, diabetes mellitus and fellow eye pseudophakia was noticed in appropriate hospitalization cases.

CONCLUSIONS

This study detects the predictive role of psychiatric disorders as determinants of hospitalization inappropriateness in cataract surgery. The negative correlation between inappropriate hospitalization and conditions such as hypertension and diabetes points out that in the elderly population common diseases are effectively addressed, in contrast to the difficult management of psychiatric patients. Prior systemic interventions represent factors inducing transfer from day service to ordinary hospitalization, highlighting communication problems related to difficult coping with an outpatient surgery setting.

The Combination of Ketorolac with Local Anesthesia for Pain Control in Day Care Retinal Detachment Surgery: A Randomized Controlled Trial

This study aims to evaluate the efficacy of ketorolac with local anesthesia compared to local anesthesia alone for perioperative pain control in day care retinal detachment surgery. The randomized controlled trial included 59 eyes of 59 participants for retinal detachment surgery who were randomly assigned (1 : 1) into the ketorolac (K) group and control (C) group. All participants underwent conventional local anesthesia while patients in the K group received an extra administration of preoperative ketorolac. Participants in the K group had a statistically significantly lower intraoperative NRS score (median 1.0 versus 3.0, P = 0.003), lower postoperative NRS score (median 0 versus 1.0, P = 0.035), fewer proportion of rescue analgesic requirement (10% versus 34.5%, P = 0.023), and lower incidence of postoperative nausea and vomiting (13.3% versus 41.4%, P = 0.015) compared to the C group. Intraocular pressure (IOP) changes (△IOP) were significantly reduced in the K group (median 1.9 versus 3.0, P = 0.038) compared to the C group 24 hours postoperatively. In conclusion, the combination of local anesthesia with ketorolac provides better pain control in retinal detachment surgery compared to local anesthesia alone. The beneficial effect of ketorolac with local anesthesia may contribute to a wider-spread adoption of day care retinal detachment surgery. This trial is registered with ClinicalTrials.gov NCT02729285.

The treatment methods for post-stroke visual impairment: A systematic review

AIM

To provide a systematic overview of interventions for stroke related visual impairments.

METHOD

A systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article.

RESULTS

Forty-nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits.

CONCLUSION

Further high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post-stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.

Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac

Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria^®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.