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Sim PY, Donachie PHJ, Day AC, Buchan JC. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture. Eye (Lond) 2024:10.1038/s41433-024-03344-2. [PMID: 39294232 DOI: 10.1038/s41433-024-03344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 08/09/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND/OBJECTIVES To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery. SUBJECTS/METHODS Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients' gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR. RESULTS This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33-4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05-3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23-4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24-2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate. CONCLUSION Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity.
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Affiliation(s)
- Peng Yong Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Paul H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Database, London, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Alexander C Day
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Database, London, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Bjerager J, Hajari J, Klefter ON, Subhi Y, Schneider M. Systemic adverse events and all-cause mortality following same-session bilateral intravitreal anti-VEGF injections: a systematic review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2355-2364. [PMID: 38194112 DOI: 10.1007/s00417-023-06368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To review the risk of systemic adverse events and all-cause mortality following same-day bilateral anti-VEGF injections. METHODS Twelve literature databases were searched for studies on same-session bilateral intravitreal anti-VEGF injections. Studies reporting on systemic adverse events and mortality were included. Data extraction was made independently by two authors and discussed afterwards until consensus was reached. RESULTS Seven studies were included with a total of 13,406 intravitreal anti-VEGF injections (6703 bilateral injections sessions) given to 689 patients. Across all studies, mean age of patients ranged from 55.7 to 82.5 years, and mean follow-up times ranged from 1.3 to 41 months. Six studies reported on systemic adverse events: Two cases of non-fatal cardiac adverse events were reported after 12,964 injections (6482 bilateral injection sessions) in 626 patients. Four studies reported on death: 12 deaths were recorded after 6233 bilateral injection sessions in a total population of 554 subjects. CONCLUSIONS We suggest that the risk of non-fatal systemic adverse events and death after same-session bilateral anti-VEGF injection is reasonably low, but larger studies with follow-ups of several years are needed to quantify the exact risk. STUDY REGISTRATION Prospectively registered in PROSPERO, registration ID: CRD42023428254, registration date: 20/05/2023.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Mackenbrock LHB, Auffarth GU, Albrecht M, Naujokaitis T, Kessler LJ, Mayer CS, Khoramnia R. Anterior Segment Complications Following Intravitreal Injection. Klin Monbl Augenheilkd 2024; 241:917-922. [PMID: 39146576 DOI: 10.1055/a-2349-2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Intravitreal injections (IVI s) have gained increased popularity in the past decades and are used to treat a multitude of ailments. In 2010, the total number of IVI s surpassed the number of cataract surgeries performed, making it the most common procedure in ophthalmology. As the number of injections increases, so does the number of injected-related complications. While complications in the posterior segment, such as retinal detachment or endophthalmitis, are detrimental to visual function and have therefore been well documented, IVI s can also lead to complications in the anterior segment. These include hyphema, inflammation of the sterile anterior segment (incidence rate of 0.05 to 1.1% depending on the drug), implant migration with corneal decompensation (incidence rate of 0.43%), iatrogenic lens damage (incidence rate of 0.07%), accelerated cataract formation (up to 50% for steroids and 10.9% for anti-VEGF), and an increased complication rate during subsequent cataract surgery (up to 4% per IVI). Most of these complications occur immediately and have a good prognosis if treated correctly. However, the increased risk of complications during subsequent surgery demonstrates that IVI s can also have long-term complications, a topic that needs to be explored further in future research projects.
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Affiliation(s)
| | - Gerd U Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Michael Albrecht
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Tadas Naujokaitis
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Lucy J Kessler
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Christian S Mayer
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, Germany
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Falb T, Singer C, Holter M, Eder L, Grosspötzl M, Weger M, Lindner E, Berghold A, Mayer-Xanthaki C, Haas A, Wedrich A. Evaluation of intravitreal injections as a risk factor for capsular rupture during cataract surgery. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00155-8. [PMID: 38834170 DOI: 10.1016/j.jcjo.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/16/2024] [Accepted: 05/12/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To determine whether previous intravitreal injections are an independent risk factor for posterior capsular rupture (PCR) during cataract surgery after adjusting for known risk factors. DESIGN Single-centre medical records analysis of a population-based cohort at a university-based referral centre. A retrospective cohort study has been conducted with inclusion of cataract surgeries done from January 1, 2005 to December 31, 2020 at the Department of Ophthalmology, Medical University of Graz, Austria. PARTICIPANTS All consecutive cataract surgeries done in patients of at least 18 years of age from January 1, 2005 to December 31, 2020 have been included. METHODS Association between previous intravitreal injections and PCR rates has been analysed through univariable and multivariable generalized estimating equations (GEE). Other investigated risk factors were age, combined surgery, pseudoexfoliation, surgeon's experience, and type of cataract surgery. RESULTS A statistically significant higher rate of posterior capsular rupture during cataract surgery has been found in patients with previous intravitreal therapy compared with patients with no history of intravitreal therapy (OR 1.27, 95% CI 1.10-1.46, p = 0.008). However, after adjusting for confounding risk factors, no statistically significant effect was seen (OR 1.04, 95% CI 0.89-1.21, p = 0.664). CONCLUSION We found no association between history of intravitreal injections and PCR during cataract surgery after adjusting for known risk factors. Further studies upon interactions between history of intravitreal injections and known risk factors for PCR, especially pseudoexfoliation, are needed.
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Affiliation(s)
- Thomas Falb
- Department of Ophthalmology, Medical University of Graz, Graz, Austria.
| | - Christoph Singer
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Lisa Eder
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Manuel Grosspötzl
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Martin Weger
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Ewald Lindner
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Anton Haas
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
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Bjerager J, Hajari J, Klefter ON, Subhi Y, Schneider M. Endophthalmitis following same-day bilateral anti-VEGF injections: a systematic review. Int Ophthalmol 2024; 44:37. [PMID: 38332399 DOI: 10.1007/s10792-024-02983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/29/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To review the risk of endophthalmitis in same-day bilateral anti-VEGF injections. METHODS We searched 12 literature databases for studies on the risk of endophthalmitis after same-day bilateral intravitreal anti-VEGF injections. Data extraction was made independently by two authors and discussed afterward until reaching consensus. RESULTS Seventeen studies were included with a total of 138,478 intravitreal anti-VEGF injections (69,239 bilateral injections sessions) given in at least 7579 patients. In total, 33 cases of endophthalmitis had occurred, and no cases were bilateral. The incidence of endophthalmitis ranged from 0 to 0.53% per intravitreal injection across studies. CONCLUSIONS We suggest that clinicians can consider same-day treatment of both eyes of patients in need of bilateral intravitreal anti-VEGF injection therapy, but larger studies are needed to quantify the exact risk of endophthalmitis.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Siddiqui MZ, Elhusseiny AM, Soliman MK, Chauhan MZ, Neuhouser AJ, Yang YC, Sallam AB. Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration. J Cataract Refract Surg 2024; 50:140-145. [PMID: 38259133 DOI: 10.1097/j.jcrs.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/21/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE To compare the rate of intraoperative complications and visual outcomes in patients with neovascular age-related macular degeneration (NvAMD) and control eyes without NvAMD undergoing phacoemulsification. SETTING Multicenter study. DESIGN Retrospective, nonrandomized comparative study. METHODS Eyes were classified based on the presence or absence of an NvAMD diagnosis. The main outcomes were (1) the rate of intraoperative complications, (2) the logMAR visual acuity (VA) at 4 to 12 weeks postoperatively in both groups, and (3) the reinjection rate of intravitreal antivascular endothelial growth factor after phacoemulsification. RESULTS Preoperative VA was worse in the NvAMD group (0.9 ± 0.5) compared with the reference group (0.6 ± 0.5). We observed no difference in the rate of posterior capsule rupture (PCR) (2.90% vs 2.77%; P = .889), dropped lens fragments (0.46% vs 0.29%; P = .618), or zonular dialysis (0.46% vs 0.58%, P = .749) between the 2 groups. Receiving ≥10 intravitreal injections before cataract surgery predicted the likelihood of PCR with an odds ratio of 2.86 (P = .027). Proportions of eyes achieving a visual gain of ≥0.3 logMAR (∼3 Snellen lines equivalent) was lower in NvAMD eyes (39.2% vs 63.7%; P < .0001). We observed 203 eyes (73%) in the active treatment group and 139 eyes (36%) in the inactive treatment group received >1 intravitreal injection after phacoemulsification (P < .0001). CONCLUSIONS The risk for PCR was higher for eyes receiving ≥10 intravitreal injections before phacoemulsification. Only 39% of eyes with NvAMD had visual improvement by ≥3 Snellen lines.
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Affiliation(s)
- Mohammad Z Siddiqui
- From the Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Siddiqui, Elhusseiny, Chauhan, Neuhouser, Sallam); Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt (Soliman); Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio (Soliman); Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom (Yang)
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Alkharki L, Yusef SN, Al-Makhdar YM, Andreeva IV, Matyuschenko AG, Gerasimov AN, Budzinskaya MV. [Application of optical coherence tomography in the assessment of the posterior lens capsule during anti-angiogenic therapy]. Vestn Oftalmol 2024; 140:28-33. [PMID: 38739128 DOI: 10.17116/oftalma202414002228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Intravitreal injection (IVI) of anti-angiogenic drugs is one of the most common therapeutic procedures in ophthalmology. In recent years, a new non-contact study method has been developed - anterior segment optical coherence tomography (AS-OCT), which allows the formation of three-dimensional images of the lens and provides more detailed information about its structure and morphology. PURPOSE This study uses optical coherence tomography method to analyze the risks of developing changes in the posterior lens capsule in patients after IVI of an anti-angiogenic drug. MATERIAL AND METHODS The study involved 100 people (14 men and 86 women) with a natural lens and neovascular age-related macular degeneration (nAMD). The average age was 70.57±7.98 years. During the study (12 months), all patients underwent IVI of an anti-angiogenic drug aflibercept in the treat-and-extend (T&E) mode. All subjects were divided into 2 groups: with a total number of IVI less than 10 - group 1 (50 patients), and more than 10 IVI - group 2 (50 patients, of which 49 were included in the study). All patients underwent OCT using the Optopol REVO NX device (Poland) with the Anterior B-scan Wide protocol before inclusion in the study, as well as after 3, 6 and 12 months. RESULTS It was found that the risk of developing a posterior lens capsule rupture, visualized using OCT, depends on the total number of IVI (correlation coefficient 0.473 p=0.001): the more IVI, the higher the probability that damage to the posterior capsule will occur after the next IVI, and after the 15th injection the risk of developing damage to the posterior capsule increases sharply. CONCLUSION The astudy analyzed the risk factors for the development of posterior lens capsule damage that can be detected using OCT, and presented three risk groups for the development of rupture (or damage) of the posterior lens capsule depending on the number of intravitreal injections performed.
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Affiliation(s)
- L Alkharki
- Krasnov Research Institute Of Eye Diseases, Moscow, Russia
| | - S N Yusef
- Krasnov Research Institute Of Eye Diseases, Moscow, Russia
| | | | - I V Andreeva
- Krasnov Research Institute Of Eye Diseases, Moscow, Russia
| | | | - A N Gerasimov
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russia
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Aiello F, Gallo Afflitto G, Leviste K, Swaminathan SS, Yoo SH, Findl O, Maurino V, Nucci C. Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 2023; 49:1168-1179. [PMID: 37276258 DOI: 10.1097/j.jcrs.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
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Affiliation(s)
- Francesco Aiello
- From the Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (Aiello, Gallo Afflitto, Nucci); Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Gallo Afflitto, Leviste, Swaminathan, Yoo); Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Maurino); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl)
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Arad T, Engel X, Ackermann H, Schmack I, Kohnen T. Association between anterior chamber biometry and posterior capsular defects. J Cataract Refract Surg 2023; 49:1086-1091. [PMID: 37532253 DOI: 10.1097/j.jcrs.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction. SETTING University Eye Hospital, Goethe University Frankfurt, Germany. DESIGN Population-based study. PATIENTS AND METHODS Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values. RESULTS A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences ( P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 μm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT ( P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29). CONCLUSIONS In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.
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Affiliation(s)
- Tschingis Arad
- From the Department of Ophthalmology, Goethe University, Frankfurt, Germany (Arad, Engel, Schmack, Kohnen); Institute for Biostatistics, Goethe University, Frankfurt, Germany (Ackermann)
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10
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Darian-Smith E, Safran SG, Coroneo MT. Zonular and capsular bag disorders: a hypothetical perspective based on recent pathophysiological insights. J Cataract Refract Surg 2023; 49:207-212. [PMID: 36700888 DOI: 10.1097/j.jcrs.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/13/2022] [Indexed: 01/27/2023]
Abstract
The purpose of this article was to look at the pathophysiology behind and devise a classification system for the causes of zonular apparatus-capsular bag (ZACB) insufficiency. Also discussed is dystrophic bag syndrome, including clinical cases and addressing where it lies on the ZACB spectrum. There has been interest in the emergence of in-the-bag intraocular lens (IOL) subluxation, the prevalence of which is increasing. There has also been a recent report of dead bag syndrome, which the authors believe is part of the same disease spectrum. The authors put these phenomena into perspective and provide a classification system based on the possible causes of what they have termed ZACB insufficiency. The basic aspects of capsular bag-IOL ocular pathophysiology are summarized with a focus on functional aspects and the consequences for IOL fastening. Within this framework, dystrophic bag syndrome is a form of primary capsular ZACB insufficiency. The contribution of factors such as intraocular drugs may suggest a reconsideration of agents used and their mode of application.
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Affiliation(s)
- Erica Darian-Smith
- From the Department of Ophthalmology, Prince of Wales Hospital at University of New South Wales, Sydney, Australia (Darian-Smith, Safran, Coroneo); Sydney University Medical School, Sydney, Australia (Darian-Smith); Capital Health System, New Jersey Surgery Centre, Pennington, New Jersey
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11
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Chandra S, McKibbin M, Mahmood S, Downey L, Barnes B, Sivaprasad S. The Royal College of Ophthalmologists Commissioning guidelines on age macular degeneration: executive summary. Eye (Lond) 2022; 36:2078-2083. [PMID: 35624304 PMCID: PMC9582190 DOI: 10.1038/s41433-022-02095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/16/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shruti Chandra
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | | | - Sajjad Mahmood
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Beth Barnes
- The Royal College of Ophthalmologists, London, UK
| | - Sobha Sivaprasad
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
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12
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Abstract
PURPOSE OF REVIEW This review highlights the complications of both intravitreal injection procedure as well as different intravitreal medications including antivascular endothelial growth factors, antibiotics, antivirals, antifungals, methotrexate, and steroids. Techniques for reducing rates of endophthalmitis will also be discussed. RECENT FINDINGS Intravitreal vancomycin can cause hemorrhagic occlusive retinal vasculitis resulting in severe vision loss. Intravitreal brolucizumab is associated with intraocular inflammation and retinal vasculitis resulting in significant vision loss. Face mask use by both patient and physician is not associated with increased risk of endophthalmitis and may decrease culture positive endophthalmitis. SUMMARY Intravitreal injections continue to be one of the most commonly performed procedures by ophthalmologists. Although the injections are generally well tolerated, sight-threatening complications can occur including endophthalmitis, retinal detachment, and/or retinal vasculitis. Adverse events associated with specific medications are outlined below. Several safety measures have been shown to reduce rates of endophthalmitis, the most concerning complication of this procedure.
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Affiliation(s)
- Dillan Patel
- Department of Ophthalmology, Temple University Hospital
| | - Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Varun Chaudhary
- Department of Health Research Methods, Evidence and Impact
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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13
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Dawson VJ, Patnaik JL, Wildes M, Bonnell LN, Miller DC, Taravella MJ, Lynch AM, Christopher KL. Risk of posterior capsule rupture in patients with type 2 diabetes mellitus and diabetic retinopathy during phacoemulsification cataract surgery. Acta Ophthalmol 2022; 100:813-818. [PMID: 35253993 DOI: 10.1111/aos.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/19/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie J. Dawson
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Michael Wildes
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Levi N. Bonnell
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - D. Claire Miller
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Michael J. Taravella
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Anne M. Lynch
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Karen L. Christopher
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
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Mudie LI, Patnaik JL, Lynch AM, Wise RE. Prior pars plana vitrectomy and its association with adverse intraoperative events during cataract surgery. Acta Ophthalmol 2022; 100:e423-e429. [PMID: 34137180 DOI: 10.1111/aos.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the risk of intraoperative complications during cataract surgery in eyes with a prior vitrectomy. METHODS A retrospective review of data from our cataract surgery registry of all patients undergoing cataract surgery between 2014 and 2018 at the University of Colorado Hospital. Univariate and multivariate analyses were conducted, accounting for intra-patient correlation in subjects who underwent two cataract surgeries. The three main outcomes of interest, zonulopathy, posterior capsule (PC) tears and dropped lens fragments, were analysed for their association with prior pars plana vitrectomy (PPV) and clinical characteristics of patients such as history of prior intravitreal injection and surgeon level of experience. RESULTS 10 540 eyes of 6447 patients were included in the analysis. 371 (3.5%) eyes had a prior PPV. Eyes with a prior PPV experienced more zonulopathy during cataract surgery (adjusted OR 2.2, 95% confidence interval: 1.3-3.7, p = 0.002). Combined phacoemulsification/PPV were significantly more likely to experience all 3 complications, and this effect was even greater for eyes with a prior PPV. CONCLUSIONS All complications were rare; however, there was a significant association with prior PPV and intraoperative zonulopathy. Cataract surgeons must be aware of a patient's prior vitrectomy and plan accordingly for the increased risk of intraoperative complications.
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Affiliation(s)
- Lucy I. Mudie
- Sue Anschutz‐Rodgers UCHealth Eye Centers Department of Ophthalmology University of Colorado School of Medicine Denver CO USA
| | - Jennifer L. Patnaik
- Sue Anschutz‐Rodgers UCHealth Eye Centers Department of Ophthalmology University of Colorado School of Medicine Denver CO USA
| | - Anne M. Lynch
- Sue Anschutz‐Rodgers UCHealth Eye Centers Department of Ophthalmology University of Colorado School of Medicine Denver CO USA
| | - Ronald E. Wise
- Sue Anschutz‐Rodgers UCHealth Eye Centers Department of Ophthalmology University of Colorado School of Medicine Denver CO USA
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15
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Bjerager J, Dijk EHC, Holm LM, Singh A, Subhi Y. Previous intravitreal injection as a risk factor of posterior capsule rupture in cataract surgery: a systematic review and meta-analysis. Acta Ophthalmol 2022; 100:614-623. [PMID: 35060678 DOI: 10.1111/aos.15089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta-analyses to provide pooled summary risk estimates. METHODS We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta-analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. RESULTS Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti-VEGF). Our meta-analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39-3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01-1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. CONCLUSIONS Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
| | - Elon H. C. Dijk
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
| | - Lars Morten Holm
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Amardeep Singh
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
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Segers MHM, Behndig A, van den Biggelaar FJHM, Brocato L, Henry YP, Nuijts RMMA, Rosen P, Tassignon MJ, Young D, Stenevi U, Lundström M, Dickman MM. Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg 2022; 48:51-55. [PMID: 34074994 DOI: 10.1097/j.jcrs.0000000000000708] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery. SETTING European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN Retrospective cross-sectional register-based study. METHODS Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs). RESULTS We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001). CONCLUSIONS Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.
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Affiliation(s)
- Maartje H M Segers
- From the University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands (Segers, van den Biggelaar, Nuijts, Dickman); Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden (Behndig); ESCRS, Dublin, Ireland (Brocato); Department of Ophthalmology, Amsterdam UMC, Amsterdam, the Netherlands (Henry); Department of Ophthalmology, Oxford Eye Hospital, Oxford, United Kingdom (Rosen); Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium (Tassignon); Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom (Young); Department of Ophthalmology, Sahgrenska University Hospital, Mölndal, Sweden (Stenevi); Department of Clinical Sciences, Ophthalmology, Lund University, Lund, Sweden (Lundström)
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Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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Risk of Posterior Capsular Rupture during Phacoemulsification in Patients with the History of Anti-VEGF Intravitreal Injections: Results from the Pan-American Collaborative Retina Study (PACORES) Group. J Ophthalmol 2021; 2021:5591865. [PMID: 34671489 PMCID: PMC8523249 DOI: 10.1155/2021/5591865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the risk for capsular rupture during routine phacoemulsification in patients with a history of anti-VEGF injections and other possible risk modifiers such as treatment patterns, type of anti-VEGF agent, and experience of the surgeon, among others. Methods This study reviewed the medical records of 11,129 patients from 7 different hospitals in 5 countries. The study included 939 patients that underwent routine phacoemulsification and had a history of anti-VEGF therapy. We excluded patients with known risk factors for capsular rupture, as well as patients with a history of other retinal procedures. The study extracted data regarding general demographics, the number of previous injections, type of anti-VEGF agent, details of cataract surgery, and anti-VEGF treatment patterns. Results Overall prevalence of posterior capsular rupture: 7.45% (95% CI: 5.9–9.32%). The mean number of injections per patient was 3.37 ± 2.8. More than 50% of the patients received their last anti-VEGF injection within three months before cataract surgery. The complication rate during intravitreal injections was 1.07%. In the univariate analysis, the experience of the cataract surgeon (inexperience surgeons; OR: 2.93) and the history of prior anti-VEGF therapy (OR: 1.77) were significant risk indicators for PCR (p < 0.05). However, after controlling for age in the multivariate analysis, the trend did not reach a statistical significance. Conclusion The risk for capsular rupture is higher in patients with a history of intravitreal anti-VEGF injections.
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Sivaprasad S, Banister K, Azuara-Blanco A, Goulao B, Cook JA, Hogg R, Scotland G, Heimann H, Lotery A, Ghanchi F, Gale R, Menon G, Downey L, Hopkins N, Scanlon P, Burton B, Ramsay C, Chakravarthy U. Diagnostic accuracy of monitoring tests of fellow eyes in patients with unilateral neovascular age related macular degeneration (EDNA study). Ophthalmology 2021; 128:1736-1747. [PMID: 34329651 PMCID: PMC8639888 DOI: 10.1016/j.ophtha.2021.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the diagnostic accuracy of routinely used tests of visual function and retinal morphology compared with fundus fluorescein angiography (FFA) to detect onset of active macular neovascularization in unaffected fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD). Design Prospective diagnostic accuracy cohort study conducted in 24 eye clinics in the United Kingdom over 3 years. Participants Older adults (>50 years) with recently diagnosed unilateral nAMD with a fellow (study) eye free of nAMD. Methods Self-reported vision, Amsler, clinic-measured visual acuity (VA), fundus assessment, and spectral domain OCT. The reference standard is FFA. Main Outcome Measures Sensitivity and specificity of the 5 index tests. Results Of 552 participants monitored for up to 3 years, 145 (26.3%) developed active nAMD in the study eye, of whom 120 had an FFA at detection and constituted the primary analysis cohort. Index test positives at nAMD detection in those confirmed by FFA were self-reported vision much worse (5), distortion on Amsler (33), 10-letter decrease in acuity from baseline (36), fundus examination (64), and OCT (110). Percentage index test sensitivities were: self-reported vision 4.2 (95% confidence interval [CI], 1.6–9.8); Amsler 33.7 (95% CI, 25.1–43.5); VA 30.0 (95% CI, 22.5–38.7); fundus examination 53.8 (95% CI, 44.8–62.5); and OCT 91.7 (95% CI, 85.2–95.6). All 5 index test specificities were high at 97.0 (95% CI, 94.6–98.5), 81.4 (95% CI, 76.4–85.5), 66.3 (95% CI, 61.0–71.1), 97.6 (95% CI, 95.3–98.9), and 87.8 (95% CI, 83.8–90.9), respectively. The combination of OCT with one other index test that was a secondary outcome measure increased sensitivity marginally and decreased specificity for all combinations except fundus examination. Conclusions Tests of self-reported change in vision, unmasking of new distortion, measurements of acuity, and fundus checks to diagnose active nAMD performed poorly in contrast to OCT. Our findings support a change to guidelines in clinical practice to monitor for onset of nAMD.
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Affiliation(s)
- Sobha Sivaprasad
- Moorfields National Institute of Health Research Biomedical Research Centre, London, EC1V 2PD
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK AB25 2ZD
| | | | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK AB25 2ZD
| | - Jonathan A Cook
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF
| | - Ruth Hogg
- Centre for Public Health, Queen's University Belfast, Belfast BT12 6BA
| | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, AB25 2LD
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, L7 8XP
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, S016 6YD
| | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ
| | - Richard Gale
- York Teaching Hospital NHS Foundation Trust, York, YO31 8HE
| | - Geeta Menon
- Frimley Health NHS Foundation Trust, Surrey, GU16 7UJ
| | - Louise Downey
- Hull and East Yorkshire NHS Trust, Anlaby Rd, Hull HU3 2JZ
| | | | - Peter Scanlon
- Gloucestershire Hospitals NHSFT, Cheltenham GL53 7AN
| | - Ben Burton
- James Paget University Hospital, Lowestoft Road, Gorleston NR31 6LA
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK AB25 2ZD
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University Belfast, Belfast BT12 6BA.
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20
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Mehta H. Management of Cataract in Patients with Age-Related Macular Degeneration. J Clin Med 2021; 10:2538. [PMID: 34201114 PMCID: PMC8228734 DOI: 10.3390/jcm10122538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Cataract and age-related macular degeneration (AMD) are two of the most common eye diseases of aging. This review addresses the pre-operative, intra-operative, and post-operative considerations in managing cataract in patients with age-related macular degeneration. Surgery for visually significant cataracts in patients with AMD can substantially improve the quality of life and reduce the risk of falls. Pre-operative optical coherence tomography is now recommended where possible to identify pre-existing macula disease. Careful counselling of patients is required before cataract surgery, especially with respect to the expected visual outcome, intraocular lens choice and potential risks of surgery. Real-world data has suggested 6 months of intravitreal anti-VEGF therapy for neovascular AMD before cataract surgery is compatible with optimum long-term visual outcomes. Patients receiving intravitreal therapy for neovascular AMD should be advised of the slightly higher risk of intraoperative complications and the surgeon should be prepared to manage these during the operation. During cataract surgery, unnecessary light exposure should be avoided to reduce phototoxicity. Careful planning of intravitreal therapy for neovascular AMD just before cataract surgery allows the eye greater recovery time in the post-operative period before further planned intravitreal therapy.
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Affiliation(s)
- Hemal Mehta
- Save Sight Registries, University of Sydney, Sydney, NSW 2000, Australia;
- Strathfield Retina Clinic, Strathfield, Sydney, NSW 2135, Australia
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
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21
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Chancellor J, Soliman MK, Shoults CC, Faramawi MF, Al-Hindi H, Kirkland K, Chu CJ, Yang YC, Sallam AB. Intraoperative Complications and Visual Outcomes of Cataract Surgery in Diabetes Mellitus: A Multicenter Database Study. Am J Ophthalmol 2021; 225:47-56. [PMID: 33422465 DOI: 10.1016/j.ajo.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the visual outcome and the rate of intraoperative complications in eyes of diabetic and nondiabetic patients undergoing phacoemulsification over 15 years. DESIGN Retrospective clinical cohort study. METHODS Data of 179,159 eyes that underwent phacoemulsification at 8 centers were classified based on the presence or absence of diabetes mellitus. Visual acuity (VA) was defined as the best value of uncorrected or corrected distance measure available. For the VA analysis, eyes with co-pathologies or combined surgical procedures were further excluded, leaving a subset of 90,729 eyes. Main outcome measures were logarithm of the minimum angle of resolution (logMAR) VA at 4-12 weeks postoperatively, and rate of intraoperative complications. RESULTS Cataract surgery in eyes of diabetic patients was associated with an improvement in mean VA of 0.48 logMAR (5 Snellen lines). Mean postoperative VA was slightly worse in diabetic compared to nondiabetic group (logMAR 0.23 vs 0.13; Snellen 20/30 vs 20/25; P < .0001) and the proportions of eyes achieving a visual gain of ≥3 Snellen lines (≥0.3 logMAR) was lower in the diabetic group (56.6% vs 63.5%; P < .0001). There was a linear relationship between diabetic retinopathy severity and worse postoperative visual acuity (β coefficient 0.098 to 0.288; P < .0001). We observed higher rates of posterior capsule rupture (2.3% vs 1.6%; P < .001) and dropped nuclear fragments (0.3% vs 0.2%; P < .001) in the diabetic group. CONCLUSIONS Postoperative VA negatively correlated with diabetes and diabetic retinopathy severity. Eyes of diabetic subjects had higher risks of posterior capsule rupture.
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22
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Hård Af Segerstad P. Risk model for intraoperative complication during cataract surgery based on data from 900 000 eyes: previous intravitreal injection is a risk factor. Br J Ophthalmol 2021; 106:1373-1379. [PMID: 33888463 DOI: 10.1136/bjophthalmol-2020-318645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to develop a risk model for intraoperative complication (IC) during cataract surgery, defined as posterior capsule rupture and/or zonular dehiscence, and to include previous intravitreal therapy (pIVT) in the model. METHODS This retrospective register-based study covered patients reported to the Swedish National Cataract Register (SNCR) between 1 January 2010 and 30 June 2018. Odds ratios (ORs) were used to quantify association strength of each variable with IC. Data from the SNCR were cross referenced with the Swedish Macula Register to include data on pIVT. Variables statistically significant in the univariate analyses (p<0.05) were included in a multivariate logistic regression model. RESULTS The inclusion criteria were met by 907 499 eyes. The overall rate of IC was 0.86%. Variables significantly associated with IC were best corrected visual acuity ≥1.0 LogMAR (OR (adjusted): 1.75, p<0.001), age ≥90 years (OR: 1.25, p<0.001), male sex (OR: 1.09, p<0.01), pseudoexfoliation (OR: 1.33, p<0.001), glaucoma (OR: 1.11, p<0.05), diabetic retinopathy (OR: 1.35, p<0.001), pIVT (OR: 1.45, p<0.05), surgeon's experience <600 surgeries (OR: 2.77, p<0.001), use of rhexis hooks (OR: 6.14, p<0.001), blue staining (OR: 1.87, p<0.001) and mechanical pupil dilation (OR: 1.52, p<0.001). CONCLUSION The risk model can be used in the preoperative setting to predict the probability of IC, to facilitate planning of surgery and improving patient communication. Patients who have undergone intravitreal therapy prior to cataract surgery have an increased risk of IC during cataract surgery.
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Affiliation(s)
- Poya Hård Af Segerstad
- Dept of Clinical Sciences Lund, Ophthalmology, Lund University, Skåne University Hospital, Lund, Sweden
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23
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Kaur M, Bhai N, Titiyal JS. Risk factors for complications during phacoemulsification cataract surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1806715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Manpreet Kaur
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nithya Bhai
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S. Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Miller DC, Christopher KL, Patnaik JL, Lynch AM, Seibold LK, Mandava N, Taravella MJ. Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections. Curr Eye Res 2020; 46:179-184. [PMID: 32657614 DOI: 10.1080/02713683.2020.1795884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery. METHODS A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rodgers UCHealth Eye Center from January 1, 2014, through December 31, 2018. The primary outcome was the occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regression with generalized estimating equations to account for correlation between patient eyes. Additional sub-analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes. RESULTS In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8-12.7, p < .0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1-10.4, p-value = 0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with the anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR. CONCLUSIONS History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.
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Affiliation(s)
- D Claire Miller
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Michael J Taravella
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
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25
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Using the slitlamp to perform cataract surgery on upright patients. J Cataract Refract Surg 2020; 46:655-656. [PMID: 32271308 DOI: 10.1097/j.jcrs.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nagar AM, Luis J, Kainth N, Panos GD, Mckechnie CJ, Patra S. Risk of posterior capsular rupture during phacoemulsification cataract surgery in eyes with previous intravitreal antivascular endothelial growth factor injections. J Cataract Refract Surg 2020; 46:204-208. [DOI: 10.1016/j.jcrs.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Campbell RJ, El-Defrawy SR, Gill SS, Whitehead M, Campbell EDLP, Hooper PL, Bell CM, Ten Hove MW. Association of Cataract Surgical Outcomes With Late Surgeon Career Stages: A Population-Based Cohort Study. JAMA Ophthalmol 2019; 137:58-64. [PMID: 30326021 DOI: 10.1001/jamaophthalmol.2018.4886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Evidence suggests that the quality of some aspects of care provided by physicians may decrease during their late career stage. However, to our knowledge, data regarding the association of advancing surgeon career phase with cataract surgical outcomes have been lacking. Objective To investigate whether an increase in cataract surgical adverse events occurs during later surgeon career stages. Design, Setting, and Participants This population-based study of 499 650 cataract operations performed in Ontario, Canada, between January 1, 2009, and December 31, 2013, investigated the association between late surgeon career stage and the risk of surgical adverse events. Linked health care databases were used to study cataract surgical complications while controlling for patient-, surgeon-, and institution-level covariates. All ophthalmologists who performed cataract surgery in Ontario within the study period were included in the analysis. Exposures Isolated cataract surgery performed by surgeons at early, mid, and late career stages. Main Outcomes and Measures Four serious adverse events were evaluated: dropped lens fragments, posterior capsule rupture, suspected endophthalmitis, and retinal detachment. Results Of 416 502 participants, 244 670 (58.7%) were women, 90 429 (21.7%) were age 66 to 70 years, 111 530 (26.8%) were age 71 to 75 years, 90 809 (21.8%) were age 76 to 80 years, and 123 734 (29.7%) were 81 years or older. Late-career surgeons performed 143 108 of 499 650 cataract operations (28.6%) during the study period. Late surgeon career stage was not associated with an increased overall risk of surgical adverse events (odds ratio [OR] vs midcareer, 1.06; 95% CI, 0.85-1.32). In a sensitivity analysis with surgeon volume removed from the model, late career stage was still not associated with overall adverse surgical events (OR, 1.10; 95% CI, 0.88-1.38). Among individual complications, late surgeon career stage was associated with an increased risk of dropped lens fragment (OR, 2.30; 95% CI, 1.50-3.54) and suspected endophthalmitis (OR, 1.41; 95% CI, 1.01-1.98). These corresponded with small absolute risk differences of 0.11% (95% CI, 0.085%-0.130%) and 0.045% (95% CI, 0.028%-0.063%) for dropped lens fragment and suspected endophthalmitis, respectively. Conclusions and Relevance These findings suggest that later-career surgeons are performing a substantial proportion of cataract operations with overall low surgical adverse event rates. Future studies might extend evaluations to the frequency of secondary surgical interventions as additional measures of surgical care quality.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.,Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Queen's University and University of Toronto sites, Kingston and Toronto, Ontario, Canada
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Queen's University and University of Toronto sites, Kingston and Toronto, Ontario, Canada.,Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada.,Division of Geriatric Medicine, Providence Care Hospital, Kingston, Ontario, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Queen's University and University of Toronto sites, Kingston and Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Erica de L P Campbell
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.,Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ontario, Canada
| | - Philip L Hooper
- Department of Ophthalmology, University of Western Ontario, London, Ontario, Canada.,Department of Ophthalmology, St Joseph's Hospital, London, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Martin W Ten Hove
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.,Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Ontario, Canada
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Vanathi M, Kumawat D, Singh R, Chandra P. Iatrogenic Crystalline Lens Injury in Pediatric Eyes Following Intravitreal Injection for Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2019; 56:162-167. [PMID: 31116863 DOI: 10.3928/01913913-20190211-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the occurrence of lens injury during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in infants with retinopathy of prematurity (ROP). METHODS ROP cases presenting to a tertiary care center with cataract following intravitreal injection were retrospectively studied from June 2017 to May 2018. The indication, setting, and method of injection were noted. Ultrasound biomicroscopy (UBM) details were recorded. The main measures were morphology of cataract, posterior capsular defect, and intraocular lens (IOL) placement. RESULTS Three children (mean age: 14 ± 8.6 months, two male and one female) received injection elsewhere under topical anesthesia in the neonatal intensive care unit (NICU) for type 1 ROP (stage 3 in zone I or II with significant plus disease) 9 to 18 months earlier. All cases developed cataract caused by intravitreal needle damaging the posterior capsule. In one case, a dense zonular cataract was present and peripheral dehiscence of the posterior capsule became evident only during lens aspiration. The second and third cases had a central posterior subcapsular cataract. Preexisting central dehiscence of the posterior capsule was noted on UBM and confirmed during surgery. A multi-piece IOL was securely placed in all cases. At last follow-up (median: 6 months; range: 3 to 6 months), the IOL was stable and centered in all cases with a clear visual axis. CONCLUSIONS The increasing occurrence of cataract in treatment-requiring ROP following intravitreal anti-VEGF injections being given by practitioners in the NICU setting under topical anesthesia that hinders optimal visualization and technique is a significant concern. [J Pediatr Ophthalmol Strabismus. 2019;56(3):162-167.].
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Levitz L, Reich J, Hodge C. Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review. Clin Ophthalmol 2018; 12:1701-1706. [PMID: 30233133 PMCID: PMC6134952 DOI: 10.2147/opth.s173089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon. Patients and methods We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented. Results Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure. Conclusion This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
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Affiliation(s)
- Lewis Levitz
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Joseph Reich
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Chris Hodge
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia, .,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Mehta H, Tufail A, Daien V, Lee AY, Nguyen V, Ozturk M, Barthelmes D, Gillies MC. Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res 2018; 65:127-146. [DOI: 10.1016/j.preteyeres.2017.12.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022]
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Kohnen S, Lotfipour S. [Capsule rupture and vitrectomy during phacoemulsification]. Ophthalmologe 2018. [PMID: 29516160 DOI: 10.1007/s00347-018-0684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rupture of the posterior capsule can occur as one of the complications during phacoemulsification. OBJECTIVE The aim of this study was to determine whether the risk of capsule rupture depends on the surgeon's concentration or experience, time of day and season, the side to be operated on and anatomy of the eye as well as the frequency with which it can be expected. MATERIAL AND METHODS The patient collective was derived from patients who underwent cataract surgery by phacoemulsification between 2004 and 2014. All surgeries were performed by the same surgeon and constituted no primarily combined operations. Thereby, it was determined how many capsule ruptures occurred, with and without vitrectomy. RESULTS There were so significant differences between the left or right eye, weekday or month. During the various surgical steps of cataract surgery, the occurrence of capsule rupture was only significantly more frequent at the time of capsule polishing. CONCLUSION Compared to the results of other studies, the risk of complications was lower in the operation collective investigated in this study.
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Affiliation(s)
- S Kohnen
- Augencentrum Dreiländereck, Brüsseler Ring 5a, 52074, Aachen, Deutschland.
| | - S Lotfipour
- Augencentrum Dreiländereck, Brüsseler Ring 5a, 52074, Aachen, Deutschland
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Lee CS, Lee AY, Holland GN, Van Gelder RN, Tufail A. Big Data and Uveitis. Ophthalmology 2018; 123:2273-2275. [PMID: 27772646 DOI: 10.1016/j.ophtha.2016.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 01/27/2023] Open
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Goyal S, Hardin J, Uwaydat SH, Ellabban AA, Warner DB, Sallam AB. Review and update of cataract surgery in the diabetic eye. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1351296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sunali Goyal
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua Hardin
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sami H. Uwaydat
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - David B. Warner
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Shalchi Z, Okada M, Whiting C, Hamilton R. Risk of Posterior Capsule Rupture During Cataract Surgery in Eyes With Previous Intravitreal Injections. Am J Ophthalmol 2017; 177:77-80. [PMID: 28212876 DOI: 10.1016/j.ajo.2017.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the risk of posterior capsular rupture (PCR) during cataract surgery in eyes with previous intravitreal injection (IVI). DESIGN Retrospective cohort study. METHODS The Moorfields Patient Administrative System and OpenEyes electronic databases were used to study all cataract surgery procedures undertaken between January 1, 2012 and August 31, 2015 in the Moorfields main and satellite sites. Clinical data were anonymized and extracted, including prior occurrence and number of intravitreal injections. Logistic regression was performed with the Hosmer-Lemeshow test for goodness of fit to generate odds ratios for possible risk factors. RESULTS In total, 62 994 cataract surgery procedures were undertaken over the study period, of which 1035 (1.64%) were in eyes with previous intravitreal injection(s). PCR occurred in 650 (1.04%) eyes. After logistic regression, prior intravitreal injection was associated with an increased risk of PCR (P = .037), with an odds ratio of 1.66. The number of prior injections, indication for injections, and service undertaking the surgery were not associated with increased risk of PCR (P > .1). CONCLUSIONS Eyes with previous IVI have a higher risk of PCR. This is not affected by number of previous injections, indication for injections, or the specialty undertaking the surgery.
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