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Zhao L, Tan M, Zhang J, Hao M, Liang S, Ji M, Guan H. Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia. J Cataract Refract Surg 2024; 50:624-630. [PMID: 38350159 PMCID: PMC11146191 DOI: 10.1097/j.jcrs.0000000000001425] [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: 12/07/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To compare the short-term changes in cornea, retina, and choroid of femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract. SETTING Affiliated Hospital of Nantong University, Jiangsu Province, China. DESIGN Prospective single-center study. METHODS Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded. RESULTS 97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group ( P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month ( P < .05). CDVA and IOP were similar in both groups at the final visit ( P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group. CONCLUSIONS FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.
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Affiliation(s)
- Lijuan Zhao
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Mengjia Tan
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Junfang Zhang
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Mengyao Hao
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Shu Liang
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Min Ji
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
| | - Huaijin Guan
- From the Eye Institute, Affiliated Hospital of Nantong University, Nantong, China (Zhao, Tan, Zhang, Liang, Ji, Guan); Yixing People's Hospital, Wuxi, China (Hao)
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Pellegrini F, Barosco G, Trento B, Rapizzi E, Zemella N. Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole. JOURNAL OF VITREORETINAL DISEASES 2024; 8:312-316. [PMID: 38770064 PMCID: PMC11102733 DOI: 10.1177/24741264241238910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). Methods: This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. Results: The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. Conclusions: An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.
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Affiliation(s)
| | - Guido Barosco
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Barbara Trento
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Emilio Rapizzi
- Department of Ophthalmology, AULLS3 Serenissima, Ospedale dell’Angelo di Mestre, Italy
| | - Nicola Zemella
- Department of Ophthalmology, AULSS2 Marca Trevigiana, Conegliano, Italy
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Patterson T, Reid G, Stewart S, Earley O. Immediate sequential bilateral cataract surgery (ISBCS): A single-site experience of 41 patients during the COVID-19 pandemic. THE ULSTER MEDICAL JOURNAL 2024; 93:12-17. [PMID: 38707980 PMCID: PMC11067315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical capacity and the risk of nosocomial infection. This study reports on a single site experience of ISBCS in Northern Ireland. Methods Data was collected prospectively between 17th November 2020 and 30th November 2021. The ISBCS surgical protocol, recommended by RCOphth and UKISCRS, was followed. Primary outcomes measures were: postoperative visual acuity (VA), refractive prediction accuracy, intraoperative and postoperative complications. Results Of 41 patients scheduled, 39 patients completed ISBCS and two patients underwent unilateral surgery (n=80 eyes). Mean age at the time of surgery was 71.6 years (standard deviation (SD) ±11.8 years). Median preoperative VA was 0.8 logMAR (range: PL to 0.2 logMAR). Seventeen (20.9%) eyes were highly myopic and 9 (11.1%) eyes were highly hypermetropic. Median cumulative dissipated phacoemulsification energy was 15.7 sec (range: 1.8 sec to 83.4 sec). Median case time was 10.4 min (range: 4.3 min to 37.1 min).One eye (1.3%) developed iritis secondary to a retained tiny cortical fragment. Four eyes (5.0%, n=3 patients) developed cystoid macular oedema, with full resolution. On wide field imaging, an asymptomatic unilateral peripheral suprachoroidal haemorrhage was noted in two highly myopic patients (axial lengths of 27.01mm and 25.05mm respectively). The posterior pole was spared, and both resolved spontaneously without any visual impairment. Conclusions In our initial experience, ISBCS was found to be a safe approach to cataract surgery. Our patient cohort included eyes with dense cataracts and high ametropia. Further studies are required to assess patient reported outcome measures and the possible economic benefits of ISBCS in our local population.
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Affiliation(s)
- Tim Patterson
- Department of Ophthalmology, Belfast Health and Social Care Trust
- Downe Hospital, South Eastern Health and Social Care Trust
| | - Gerard Reid
- Department of Ophthalmology, Belfast Health and Social Care Trust
- Downe Hospital, South Eastern Health and Social Care Trust
| | - Stephen Stewart
- Department of Ophthalmology, Belfast Health and Social Care Trust
- Downe Hospital, South Eastern Health and Social Care Trust
| | - Olivia Earley
- Department of Ophthalmology, Belfast Health and Social Care Trust
- Downe Hospital, South Eastern Health and Social Care Trust
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Ahmadyar G, Carlson JJ, Kimura A, Alobaidi A, Hallak J, Hansen RN. Real-world treatment patterns and economic burden of post-cataract macular edema. BMC Ophthalmol 2023; 23:380. [PMID: 37723463 PMCID: PMC10506304 DOI: 10.1186/s12886-023-03113-x] [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: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Post-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME. METHODS This retrospective claims analysis identified patients from the IBM® MarketScan® Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models. RESULTS Treatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 [30%]), topical nonsteroidal anti-inflammatory drug drops (321 [27%]), and intraocular or periocular injectable steroids (189 [15%]). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7-6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8-3.2), adding $371 in total cost (95% CI: $332 - $410). CONCLUSIONS PCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.
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Affiliation(s)
- Gina Ahmadyar
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA.
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA.
| | - Josh J Carlson
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
| | - Alan Kimura
- Colorado Retina Associates, 255 S. Routt St., Suite 200, 80228, Lakewood, CO, USA
| | - Ali Alobaidi
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Joelle Hallak
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Ryan N Hansen
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
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Management of inflammation after the cataract surgery. Curr Opin Ophthalmol 2023; 34:9-20. [PMID: 36305352 DOI: 10.1097/icu.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery. RECENT FINDINGS FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most cost-effective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drug-loaded IOLs. SUMMARY Inflammation after the cataract surgery can be prevented, and these methods are one of the most essential topics with growing phacoemulsification rate. Topical NSAIDs are cost-effective not only for patients with risk factors for PCME but also for healthy subjects. New dropless techniques are being successfully introduced in the clinical practice.
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Lockington D, Bloom P. Survey of UKISCRS consultant members regarding preferred practice management of persistent Cystoid Macular Oedema. Eye (Lond) 2022; 36:881-882. [PMID: 33767406 PMCID: PMC8956789 DOI: 10.1038/s41433-021-01513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- David Lockington
- grid.415302.10000 0000 8948 5526Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Philip Bloom
- grid.439733.90000 0004 0449 9216The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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GLCM and statistical features extraction technique with Extra-Tree Classifier in Macular Oedema risk diagnosis. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Seth I, Bulloch G, Tan A, Thornell E, Agarwal S. Incidence of Pseudophakic Cystoid Macular Oedema Post-Cataract Surgery in Illawarra Shoalhaven Local Health District, Australia. Biomed Hub 2022; 7:1-10. [PMID: 35223872 PMCID: PMC8832185 DOI: 10.1159/000521053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Post-operatively, cataract surgery is associated with pseudophakic cystoid macular oedema (PCMO) causing vision disturbances. The presence of comorbidities may increase the incidence of PCMO post-cataract surgery. OBJECTIVE This observational study aimed to assess the incidence of PCMO in Australia (Illawarra region) and identify risk factors for developing PCMO. METHODS Retrospective analysis was performed on data from patients who underwent uncomplicated phacoemulsification and intraocular lens implantation between 1st March and June 30, 2016. Demographics, comorbidities, central subfield thickness (CST), visual acuity, and intraocular pressure (IOP) were collected preoperatively, day 1, and weeks 2, 4, and 6 post-operatively. Statistical analysis was performed using SPSS v.27.0 and GraphPad Prism v.9.0. The median and 95% confidence intervals were used to describe data. Logistic regression and χ2 tests were used to describe the associations. We followed the Declaration of Helsinki guidelines. RESULTS Fifty right and 35 left cataract eyes were operated on (58.8% were females; average age 72.8 ± 8.146 years). Total PCMO incidence was 10.6%, and true PCMO incidence (removing PCMO risk factors) was 4.2% at week 6 post-operatively. CST was slightly increased between pre- and post-cataract surgery at week 4 (p = 0.002) and week 6 (p < 0.0001; median = 259 μm, 264 μm, and 263 μm, respectively). IOP was found to be decreased (p < 0.0001) compared to day 1 (median = 17 mm Hg) and week 6 (median = 13 mm Hg). The probability of developing PCMO (odds ratio [OR] = 3) and vitreomacular traction (OR = 2.9) was higher in diabetic patients compared to non-diabetic patients and in patients >65 years old (OR = 1.5). CONCLUSION The true incidence of PCMO was found to be the greatest at 2-4 weeks post-operatively. Patients with diabetes or advanced age (>65 years) are at an elevated risk of developing PCMO after cataract surgery. The treatment regimens for the comorbid populations, especially diabetic patients, remain limited, and future efforts should target pharmaceutical management for these groups.
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Affiliation(s)
- Ishith Seth
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alvin Tan
- Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Erin Thornell
- Wollongong Eye Specialists, Wollongong, New South Wales, Australia
| | - Smita Agarwal
- Wollongong Eye Specialists, Wollongong, New South Wales, Australia
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Jiang Z, Chen J, Gao C, Tan M, Zhang W, Xie Y. Effects of PICCO in the guidance of goal-directed fluid therapy for gastrointestinal function after cytoreductive surgery for ovarian cancer. Am J Transl Res 2021; 13:4852-4859. [PMID: 34150067 PMCID: PMC8205791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effects of PICCO on the Guidance of Goal-Directed Fluid Therapy for gastrointestinal function after cytoreductive surgery for ovarian cancer. METHODS A total of 98 patients who received cytoreductive surgery for ovarian cancer under general anesthesia in our hospital were stochastically divided into the observation group and control group, with 49 cases in each group. The observation group received PICCO guided goal-directed fluid therapy, while patients in the control group were treated with conventional fluid therapy. At last, the total amount of infusion, the time required for postoperative gastrointestinal function recovery and related recovery rating, the first time to get out of bed after the surgery and the total hospitalization time were observed and compared between the two groups. RESULTS The observation group had less time for gastrointestinal function recovery and had better functional recovery rating as well as other indicators than the control group. Besides, the observation group had less volume of infusion, needed shorter time to get out of bed and had a shorter length of hospital stay than the control group (all P<0.05). CONCLUSION PICCO guided goal-directed liquid therapy can effectively improve the recovery of gastrointestinal function and reduce the length of stay in patients with ovarian cancer after cytoreductive surgery.
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Affiliation(s)
- Zhen Jiang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
| | - Jiaqi Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
| | - Chen Gao
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
| | - Mengyuan Tan
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
| | - Yanhu Xie
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China Hefei, Anhui Province, China
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