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Zhang Y, Zhang H, Song X, Liu M, Wang N, Qiao C. Proportion and risk factors of zonulopathy in patients with age-related cataract. Heliyon 2024; 10:e28644. [PMID: 38586387 PMCID: PMC10998138 DOI: 10.1016/j.heliyon.2024.e28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose To investigate the proportion of zonulopathy in patients with age-related cataract, and further explore demographics and ocular characteristics, as well as potential risk factors. Methods Hospital-based, observational, cross-sectional study. We enrolled consecutive patients who were 45 years or older and diagnosed with age-related cataract and underwent surgery between October 2022 and April 2023 at the Division of Cataract, Beijing Tongren Hospital. Zonulopathy was diagnosed based on intraoperative signs. We calculated the total proportion, age, and gender specific proportions of zonulopathy. We compared the demographic and ocular characteristics between the cases with and without zonulopathy. Univariate and multivariate logistic regression analyses were employed to determine the risk factors associated with the presence of zonulopathy in patients with age-related cataract. Results A total of 640 age-related cataract patients with a median age of 70.0 (64.0-77.0) were enrolled. Zonulopathy was diagnosed intraoperatively in 70 patients (10.9%). Compared with the patients having no zonulopathy, those with zonulopathy were likely to be older (P < 0.001), have a shallower central ACD (P < 0.001), a thicker lens (P < 0.001) and a shorter AL (P = 0.010). Logistic regression analyses showed that the risk predictors associated with the presence of zonulopathy in patients with age-related cataract were older age (OR, 1.042; P = 0.035) and shallower central ACD (OR, 0.834; P < 0.001). Conclusion Zonulopathy in age-related cataract patients is not an uncommon finding. Clinicians should be mindful of zonulopathy in patient population with advanced age and shallower ACD.
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Affiliation(s)
- Ye Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xudong Song
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mugen Liu
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Chunyan Qiao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Aiello F, Rampat R, Gallo Afflitto G, Din N, Mandal N, Maurino V. Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:67-72. [PMID: 36627103 DOI: 10.1016/j.jcjo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
| | - Radhika Rampat
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Niraj Mandal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Maurino
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Aggarwal S, Wisely CE, Pepin MJ, Bryan W, Raghunathan K, Challa P. Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience. J Cataract Refract Surg 2023; 49:259-265. [PMID: 36378266 DOI: 10.1097/j.jcrs.0000000000001092] [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: 07/04/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To characterize intraoperative complications, case complexity, and changes in complication rates with surgical experience for cataract surgeries involving residents at the Veterans Health Administration (VHA). SETTING All VHA facilities where cataract surgery was performed. DESIGN Multicenter, retrospective cohort study. METHODS A retrospective review of all cataract surgeries within the VHA between July 2010 and June 2021 was conducted. Several parameters, including resident involvement, intraoperative complications, and case complexity as determined by Current Procedural Terminology codes, and use of pupil expansion or capsular support devices, were collected. Complication rates were compared between residents and attendings. RESULTS Of 392 428 cataract surgeries completed across 108 VHA facilities, 90 504 were performed by attendings alone, while 301 924 involved a resident. Of these, 10 244 (11.3%) of attending cases were complex compared with 32 446 (10.7%) of resident cases. Pupil expansion devices were required in 8191 of attending cases (9.05%) and 31 659 (10.5%) of cases involving residents ( P < .001). Similarly, cases involving residents were more likely than attending-only cases to require a capsular support device (0.835% vs 0.586%, P < .001). Cases involving residents were more likely to have posterior capsular rupture (4.75% vs 2.58%, P < .001) and dropped nucleus (0.338% vs 0.198%, P < .001). Higher resident case volumes were associated with significantly lower complication rates for posterior capsular rupture, dropped nucleus, zonular loss, and suprachoroidal hemorrhage. CONCLUSIONS Although residents had higher intraoperative complication rates than attendings, these rates were reduced with surgical experience. Residents were involved in a similar number of complex surgical cases as attendings.
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Affiliation(s)
- Sahil Aggarwal
- From the Duke Eye Center, Durham, North Carolina (Aggarwal, Wisely, Challa); Durham Veterans Affairs Medical Center, Durham, North Carolina (Pepin, Bryan, Raghunathan, Challa); Duke Anesthesiology, Durham, North Carolina (Raghunathan)
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Nguyen XTA, Thiadens AAHJ, Fiocco M, Tan W, McKibbin M, Klaver CCW, Meester-Smoor MA, Van Cauwenbergh C, Strubbe I, Vergaro A, Pott JWR, Hoyng CB, Leroy BP, Zemaitiene R, Khan KN, Boon CJF. Outcome of Cataract Surgery in Patients With Retinitis Pigmentosa. Am J Ophthalmol 2023; 246:1-9. [PMID: 36252678 DOI: 10.1016/j.ajo.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To assess the visual outcome of cataract surgery in patients with retinitis pigmentosa (RP). DESIGN Retrospective, noncomparative clinical study. METHODS Preoperative, intraoperative, and postoperative data of patients with RP who were undergoing cataract surgery were collected from several expertise centers across Europe. RESULTS In total, 295 eyes of 226 patients were included in the study. The mean age at surgery of the first eye was 56.1 ± 17.9 years. Following surgery, best-corrected visual acuity (BCVA) improved significantly from 1.03 to 0.81 logMAR (ie, 20/214 to 20/129 Snellen) in the first treated eye (-0.22 logMAR; 95% CI = -0.31 to -0.13; P < .001) and from 0.80 to 0.56 logMAR (ie, 20/126 to 20/73 Snellen) in the second treated eye (-0.24 logMAR; 95% CI = -0.32 to -0.15; P < .001). Marked BCVA improvements (postoperative change in BCVA of ≥0.3 logMAR) were observed in 87 of 226 patients (39%). Greater odds for marked visual improvements were observed in patients with moderate visual impairment or worse. The most common complications were zonular dialysis (n = 15; 5%) and (exacerbation of) cystoid macular edema (n = 14; 5%), respectively. Postoperative posterior capsular opacifications were present in 111 of 295 eyes (38%). CONCLUSION Significant improvements in BCVA are observed in most patients with RP following cataract surgery. Baseline BCVA is a predictor of visual outcome. Preoperative evaluation should include the assessment of potential zonular insufficiency and the presence of CME, as they are relatively common and may increase the risk of complications.
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Affiliation(s)
- Xuan-Thanh-An Nguyen
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands
| | - Alberta A H J Thiadens
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Mathematical Institute (M.F.), Leiden University, Leiden, the Netherlands; Department of Biomedical Data Sciences (M.F.), Leiden University Medical Center, Leiden, Netherlands
| | - Weijen Tan
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Martin McKibbin
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Caroline C W Klaver
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands; Institute of Molecular and Clinical Ophthalmology (C.C.W.K.), University of Basel, Basel, Switzerland
| | - Magda A Meester-Smoor
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Ine Strubbe
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium
| | - Andrea Vergaro
- Department of Pediatrics and Inherited Metabolic Disorders (A.V.), Charles University and General University Hospital, Prague, Czech Republic
| | - Jan-Willem R Pott
- Department of Ophthalmology (J.R.P.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart P Leroy
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium; Division of Ophthalmology (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Centre for Cellular & Molecular Therapeutics (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Reda Zemaitiene
- Department of Ophthalmology (R.Z.), Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kamron N Khan
- Novartis Institute of BioMedical Research (K.N.K.), Cambridge, Massachusetts, USA; Department of Ophthalmology (K.N.K.), Harvard Medical School, Boston, Massachusetts, USA
| | - Camiel J F Boon
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands; Department of Ophthalmology (C.J.F.B.), Amsterdam University Medical Centers, Amsterdam, Netherlands.
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Reply: Outcomes of manual small incision cataract surgery in hypermature morgagnian cataract. J Cataract Refract Surg 2022; 48:1481-1482. [DOI: 10.1097/j.jcrs.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Ahn H, Jun I, Seo KY, Kim EK, Kim TI. Femtosecond laser-assisted cataract surgery after corneal refractive surgery. Sci Rep 2022; 12:4263. [PMID: 35277568 PMCID: PMC8917192 DOI: 10.1038/s41598-022-08297-8] [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: 09/02/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Cataract is the leading cause of blindness worldwide, and advanced cataract techniques such as femtosecond laser-assisted cataract surgery (FLACS) have been commercially available. Corneal refractive surgery (CRS) is one of the most popular surgeries for the correction of refractive errors. CRS changes the cornea not only anatomically but also pathophysiologically. However, there has been no clinical research analyzing the refractive and safety outcomes of FLACS after CRS. The aim of this retrospective chart review and comparative study is to evaluate the effect and safety of FLACS after CRS comparing with conventional PCS. Participants with a previous CRS history who underwent FLACS or conventional PCS were included in this study. The visual outcomes and the refractive outcomes including refractive, corneal, and ocular residual astigmatism were compared. The safety outcomes were then studied intraoperatively and postoperatively. A total of 102 patients with age-related cataract were enrolled. At 3 months postoperatively, UCVA, BCVA, and predictive error were not significantly different between the FLACS and conventional PCS groups. Reduction of refractive astigmatism was higher in FLACS. Postoperative ORA was significant lower in FLACS. Reduction of ORA was higher in FLACS. The intraoperative and postoperative complications were also not significantly different between the two groups. FLACS could effectively change refractive astigmatism and ORA; without more complications than conventional PCS. FLACS’ competitive edge in postoperative ORA may provide better visual quality than conventional PCS in patients with a previous history of CRS.
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Affiliation(s)
- Hyunmin Ahn
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Saevit Eye Hospital, Goyang, Gyunggi-do, Korea
| | - Tae-Im Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. .,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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7
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Salimi A, Fanous A, Watt H, Abu-Nada M, Wang A, Harasymowycz P. Prevalence of zonulopathy in primary angle closure disease. Clin Exp Ophthalmol 2021; 49:1018-1026. [PMID: 34382734 PMCID: PMC9293109 DOI: 10.1111/ceo.13983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Background To determine the prevalence of zonulopathy in a large cohort of eyes with primary angle closure disease (PACD) that underwent cataract surgery. Methods Retrospective consecutive case series of PACD eyes (including primary angle closure suspect, primary angle closure, and primary angle closure glaucoma) that underwent phacoemulsification cataract surgery or clear lens extraction between 2009 and 2020 at a single ophthalmology centre. Those with risk factors for zonulopathy such as history of trauma, pseudoexfoliation syndrome, intraocular surgery, retinitis pigmentosa or connective tissue disorders were excluded. The primary outcomes included the prevalence of zonulopathy assessed intraoperatively and secondary pigment dispersion syndrome. Results In our cohort of 806 consecutive PACD eyes, the prevalence of zonulopathy was 7.3% (59 of 806 eyes) – significantly greater than the 0.46%–2.6% range reported for the general population (p < 0.001). Intraoperative signs of zonular weakness included floppy capsular bag (29 eyes, 3.6%), zonular laxity (25 eyes, 3.1%) and zonular dehiscence (11 eyes, 1.4%). Among these eyes, capsular tension ring was used in 23 eyes (39.0%), six eyes (10.2%) experienced vitreous prolapse intraoperatively and underwent anterior vitrectomy, and two eyes (3.4%) experienced posterior capsular rupture, one of which required a scleral‐fixated intraocular lens. Secondary pigment dispersion syndrome was observed in 141 eyes (17.5%). Conclusions This study evidenced a high prevalence of zonulopathy among a large cohort of PACD eyes and suggests zonulopathy as a possible under‐recognised cause of angle closure. Until more sophisticated imaging modalities become available, awareness about the prevalence of zonulopathy in angle closure disease coupled with careful preoperative examinations can help minimise or prevent the complications of zonulopathy.
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Affiliation(s)
- Ali Salimi
- Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada
| | - Anthony Fanous
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Harrison Watt
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mohamed Abu-Nada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anna Wang
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Paul Harasymowycz
- Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Bhatt V, Bhatt D, Barot R, Sheth J. Ultrasound Biomicroscopy for Zonular Evaluation in Eyes with Ocular Trauma. Clin Ophthalmol 2021; 15:3285-3291. [PMID: 34393478 PMCID: PMC8357616 DOI: 10.2147/opth.s323349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of ultrasound biomicroscopy (UBM) in detecting zonular abnormalities in eyes with ocular trauma. Patients and Methods Prospective study of 143 eyes of 143 patients with ocular trauma and having opaque media was evaluated using a UBM. The presence or absence of zonular damage (zonular tears and/or zonular stretching) was examined and the clock-hour involvement was noted. Results One-hundred and one eyes had blunt trauma (70.63%; group 1), while 42 eyes had penetrating trauma (29.37%; group 2) The mean age of the patient population was 48.01±17.93 years with a male:female ratio of 2.11:1. Group 1 had significantly greater visual acuity than group 2 (p = 0.03). Zonular damage was present in 79 (55.2%) eyes, including zonular tears (48 eyes; 33.6%) and zonular stretching (31 eyes; 21.7%). Zonular damage was seen significantly more in eyes with blunt trauma (64.28%) as compared to penetrating trauma (25.74%) (p = 0.015). On quantitative analysis, zonular damage between 3 and 6 clock hours was most frequent, both in eyes having zonular tears (70.83%) and zonular stretching (96.77%). Additionally, 3–6 clock hours of zonular stretching was seen significantly more in blunt trauma as compared to penetrating trauma (p = 0.015). Conclusion UBM is an effective imaging modality to diagnose zonular abnormalities in patients with ocular trauma having opaque media. The ability to detect the presence of zonular weakness and their quantification by performing a UBM is critical to formulate the optimal surgical approach and avoid any untoward surgical complications.
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Affiliation(s)
- Vaidehi Bhatt
- Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Memorial Hospital, Thane, Maharashtra, India
| | - Deepak Bhatt
- Department of Imaging, UBM Institute, Mumbai, Maharashtra, India
| | - Rakesh Barot
- Department of Ophthalmology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Memorial Hospital, Thane, Maharashtra, India
| | - Jay Sheth
- Department of Vitreoretinal, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
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Management of Cataract in Patients with Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10122538. [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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Yang S, Jiang H, Nie K, Feng L, Fan W. Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules. BMC Ophthalmol 2021; 21:19. [PMID: 33413210 PMCID: PMC7792360 DOI: 10.1186/s12886-020-01772-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. METHODS A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. RESULTS Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. CONCLUSION CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.
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Affiliation(s)
- Shangfei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Effect of microinterventional endocapsular nucleus disassembly using centripetal loop fragmentation on refractive outcomes after cataract surgery. J Cataract Refract Surg 2020; 46:1515-1521. [DOI: 10.1097/j.jcrs.0000000000000320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Evaluation of the Utility of Capsular Stabilization Devices in a Zonular Fiber Defect Model with the Slit Side View System. J Ophthalmol 2020; 2020:5921965. [PMID: 32832137 PMCID: PMC7429767 DOI: 10.1155/2020/5921965] [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: 05/21/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
Capsular stabilization devices were evaluated in a zonular fiber defect model using the slit side view (SSV) system to confirm their utility for capsular stabilization during phacoemulsification. A zonular fiber defect model was made by cutting Zinn’s zonule under observation with a slit lamp microscope in a porcine eye. Phacoemulsification was performed, and the movement of the lens capsule and the depth of the anterior chamber were observed using the SSV in three groups: control group: no surgical instruments used, CE group: a capsule expander was inserted, and CTR group: a capsular tension ring was inserted. In the control group, the equator of the lens was unstable and was easily suctioned to the port of the ultrasound handpiece. The lens capsule was stable in both in the CE and CTR groups. In the CTR group, the equator responsible for the zonular rupture also returned and closed true to its original position. The utility of the capsular stabilization devices in this zonular fiber defect model was confirmed with the SSV system.
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Om Parkash R, Mahajan S, Om Parkash T, Om Parkash T, Rai M. Nuclear scaffold: Three-dimensional indigenous capsular bag support combined with IOL scaffold and capsular tension ring to prevent posterior capsule rupture in zonulopathy. J Cataract Refract Surg 2019; 45:1696-1700. [PMID: 31856977 DOI: 10.1016/j.jcrs.2019.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
We describe a technique for performing phacoemulsification in eyes with zonular fiber dehiscence of less than 90 degrees using hard nuclear fragments as a scaffold. In conjunction with a capsular tension ring (CTR), hard nuclear fragments and the intraocular lens (IOL) are used as scaffolds during different steps of nuclear emulsification to prevent posterior capsule rupture and aggravation of zonulopathy. Devices such as capsular hooks, CTRs, and IOLs are used to support the capsular bag associated with zonulopathy. The mass of hard nuclear fragments provides support toward the anteroposterior and the horizontal planes, thereby providing 3-dimensional capsular bag support.
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Affiliation(s)
| | | | | | - Tushar Om Parkash
- Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Milan Rai
- Dr. Om Parkash Eye Institute, Amritsar, India
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Yip H, Akkach S, Meusemann R. Reintervention rate and visual outcomes following zonular dehiscence. Clin Exp Ophthalmol 2019; 47:1223-1224. [PMID: 31412163 DOI: 10.1111/ceo.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/20/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Harry Yip
- Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia
| | - Sarmad Akkach
- Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Robin Meusemann
- Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia
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