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Sella R, Bu JJ, Lian RR, Hu JQ, Gali HE, Walker EH, Livny E, Afshari NA. Axial length and pharmacologic pupillary dilation in highly myopic patients. Graefes Arch Clin Exp Ophthalmol 2024; 262:1531-1538. [PMID: 37999774 DOI: 10.1007/s00417-023-06296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To determine how high myopia impacts pharmacological pupillary dilation, and to evaluate the relationship between the extent of pharmacologic pupillary dilation and axial length. METHODS Patients were grouped into high myopes, defined as one or both eyes having a refractive error greater than - 6 diopters, and controls (between - 2 and + 2 diopters). Dilation was achieved with 1 drop each of tropicamide 1% and phenylephrine 2.5%. Pupil size was measured at full and dim light prior to dilation, then 15 and 30 min after dilation. Biometry was measured for each patient. Statistical analyses were performed using the Mann-Whitney-Wilcoxon tests, two-sample Welch's t-tests, and linear mixed effect models and generalized estimating equations models accounting for inter-eye correlation. RESULTS Forty patients (20 high myopes and 20 controls, 80 eyes total) participated in the study. High myopes had larger pupils at baseline and achieved significantly greater pupillary size (7.08 mm, 95% CI: 6.97 to 7.19 mm) than controls (6.23 mm, 95% CI: 5.94 to 6.52 mm) after 30 min of dilation (P < .0005). Fully dilated pupil size at 30 min was significantly correlated with both refractive error (r = - 0.57, P < .0005) and axial length (r = 0.47, P < .0005). Generalized estimating equations and linear mixed effect models identified other predictive variables of pupil size after dilation including age and white-to-white diameter. CONCLUSIONS Highly myopic patients dilate to a larger pupillary size compared to other patients. Predicting dilation based on extent of myopia could facilitate intraocular surgery planning and reduce clinic wait times for myopic patients.
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Affiliation(s)
- Ruti Sella
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jennifer J Bu
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Rebecca R Lian
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Jenny Q Hu
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Helena E Gali
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Evan H Walker
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie A Afshari
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Dr, La Jolla, CA, 92093, USA.
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Yahalomi T, Elhaddad O, Avadhanam V, Tole D, Darcy K, Levinger E, Tuuminen R, Achiron A. Complications of pupil expansion devices: a large real-world study. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1283378. [PMID: 38983009 PMCID: PMC11182085 DOI: 10.3389/fopht.2023.1283378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/27/2023] [Indexed: 07/11/2024]
Abstract
Purpose To assess the risk for uveitis, pseudophakic cystoid macular edema (PCME), and posterior capsular opacification (PCO) associated with the use of pupil expansion devices in cataract surgery. Design A retrospective comparative cohort study. Participants Patients who underwent routine cataract surgery with and without pupil expansion devices at the Department of Ophthalmology, Bristol Eye Hospital, UK, between January 2008 and December 2017. Methods This study included 39,460 eyes operated without a pupil expansion device and 699 eyes operated with the device. Odds ratios for uveitis and PCME when using a pupil expansion device were calculated using univariate and multivariate regression analysis, having age, gender, diabetes, pseudoexfoliation, and pupil expansion device as independent variables. Multivariate Cox regression controlling for age and gender was used to estimate hazard ratios (HR) for Nd : YAG laser capsulotomies. Results Postoperative uveitis and PCME were reported in 3.9% and 2.7% of the eyes operated with a pupil expansion device compared to 2.3% and 1.3% operated without the device (p=0.005 and p=0.002, respectively). In univariate regression analysis, eyes with pupil expansion devices showed a higher risk of postoperative uveitis or PMCE after cataract surgery (OR 1.88, 95%CI 1.39-2.55, p<0.001). In multivariate regression analysis, the risk for PMCE was greater among diabetic patients and in eyes with a pupil expansion device than in those without (OR 1.50, 95%CI 1.24-1.83, P<0.001; OR 1.90, 95%CI 1.16-3.11, P=0.01). In Cox regression analysis adjusted for the patient's age and gender, the use of a pupil expansion device was associated with higher Nd : YAG laser capsulotomy rates (HR 1.316, 95%CI 1.011-1.714, P=0.041). Conclusion In our large cohort study, the use of pupil expansion devices in cataract surgery was associated with an increased risk of major postoperative complications. Effective anti-inflammatory treatment and follow-up are warranted in eyes operated with a pupil expansion device.
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Affiliation(s)
- Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Eliya Levinger
- Ophthalmology Department, Soraski Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Asaf Achiron
- Ophthalmology Department, Soraski Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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He Y, Wang C, Zhou X, Peng J, Zhang X, Wang Y, Rui Y, Zhang C, Zhang W, Feng L, Dai S, Xia X, Song W. Comparison of clinical outcomes between cystotome-assisted prechop phacoemulsification surgery and femtosecond laser-assisted cataract surgery for hard nucleus cataracts. Eye (Lond) 2023; 37:235-241. [PMID: 35091707 PMCID: PMC9873648 DOI: 10.1038/s41433-021-01900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/11/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES To compare the safety and efficacy of cystotome-assisted prechop phacoemulsification surgery (CAPPS) and femtosecond laser-assisted cataract surgery (FLACS) in patients with hard nucleus cataract. SUBJECTS/METHODS Ninety-six eyes of 64 patients with grade IV hard nucleus cataract were assigned to 1 of the 2 groups (49 CAPPS and 47 FLACS). Follow-up visits were performed at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, and the outcome measures comprised ultrasound power, effective phacoemulsification time (EPT), corrected distance visual acuity (CDVA), endothelial cell density (ECD), corneal endothelium cell loss rate (ECL), central corneal thickness (CCT), and intraoperative and postoperative complications. RESULTS The ultrasound power and EPT were lower in the CAPPS group (p = 0.03 and <0.0001, respectively). Patients in both groups gained better CDVA postoperatively. The ECD value decreased at each follow-up visit and did not return to the preoperative level; FLACS resulted in greater endothelial cell loss compared to CAPPS. CCT increased immediately after the surgery and decreased thereafter. The mean CCT value returned to the preoperative level 3 months postoperatively in the CAPPS group, while in the FLACS group, CCT value took 6 months to return to the preoperative level. Miosis was more likely to occur in the FLACS group. CONCLUSIONS Due to its efficacy and cost-effectiveness, CAPPS is worth promoting and applying to clinical work in the future.
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Affiliation(s)
- Ye He
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Chao Wang
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Xuezhi Zhou
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Jingjie Peng
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Xuan Zhang
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yujue Wang
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yuhua Rui
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Cheng Zhang
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Wulong Zhang
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Lemeng Feng
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Shirui Dai
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Xiaobo Xia
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China.
- Eye Center of Xiangya Hospital, Central South University, Hunan, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China.
| | - Weitao Song
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Hunan, China.
- Eye Center of Xiangya Hospital, Central South University, Hunan, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China.
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Salgado R, Torres PF, Marinho A. Pupil Status with Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification: An Intraindividual Comparative Study. Clin Ophthalmol 2023; 17:331-339. [PMID: 36718349 PMCID: PMC9883999 DOI: 10.2147/opth.s399788] [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: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Purpose To compare the pupil changes in low-energy femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CP) intraindividually. Patients and Methods A retrospective review of registered surgical data from patients that undergone uncomplicated cataract surgery in a single centre, with randomly assigned femtosecond laser-assisted cataract surgery (FLACS) to one eye and conventional phacoemulsification (CP) to the other, was performed. The recorded pupil images were evaluated at pre and post laser treatment (after suction release) and at several surgical timepoints for both techniques (FLACS and CP). Pupil areas were calculated and compared in the same eye undergone FLACS (pre vs post laser treatment), between eyes (CP vs FLACS) in the same patient and between groups. Subgroups were built regarding age and ocular comorbidity. Results This study involved a total of 164 eyes of 82 patients (55 female, 27 male). No statistical differences regarding the total duration of surgery (p=0.805) between FLACS and CP. Pupil measurements between pre and post laser treatment in the FLACS group showed no statistically significant differences (p=0.107). The mean change in pupil area from the beginning until the end of surgery (total variation) was 6.59±2.08 mm2 in the FLACS group and 6.67±2.13 mm2 in the CP group, associated to less narrowing of pupil area with FLACS, although not statistically significant (p=0.080). Comorbidity group analysis revealed less, but not significant, pupil narrowing with the FLACS technique (p=0.071). No statistically significant differences between FLACS and CP concerning age subgroups were registered. Conclusion This study shows no significant pupil changes, namely myosis, after low-energy FLACS pre-treatment. Comparison between techniques showed less pupil variation in FLACS as compared to CP, more markedly in eyes with comorbidities (particularly with shallow anterior chamber), although non-statistically significant.
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Affiliation(s)
- Ramiro Salgado
- Departamento de Oftalmologia do Hospital da Arrábida, Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Vila Nova de Gaia, Porto, Portugal,Correspondence: Ramiro Salgado, Departamento de Oftalmologia do Hospital da Arrábida, Praceta Henrique Moreira 150, Vila Nova de Gaia, 4400-346, Portugal, Tel +351 915677244, Fax +351 224003046, Email
| | - Paulo F Torres
- Departamento de Oftalmologia do Hospital da Prelada, Universidade do Porto, Porto, Portugal
| | - Antonio Marinho
- Departamento de Oftalmologia do Hospital da Luz Arrábida, Universidade do Porto, Porto, Portugal
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Visco DM. Comparison of postcataract surgery anti-inflammatory regimens on the incidence of cystoid macular edema, iritis, pain, and photophobia. J Cataract Refract Surg 2023; 49:44-49. [PMID: 35862832 DOI: 10.1097/j.jcrs.0000000000001022] [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: 11/02/2021] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare postcataract surgery anti-inflammatory regimens of intracanalicular dexamethasone insert and topical bromfenac on the incidence of cystoid macular edema (CME), iritis, pain, and photophobia. SETTING Eyes of York Cataract & Laser Center, York, Pennsylvania. DESIGN Retrospective chart review. METHODS Case records of 647 consecutive patients (1001 eyes) who underwent cataract surgery and received dexamethasone intracanalicular insert 0.4 mg (Group 1; 482 eyes) or topical nonsteroidal anti-inflammatory drug (NSAID) (bromfenac 0.075% 2 times a day) for 4 weeks postoperatively (Group 2; 519 eyes) were included. Both groups received intracameral moxifloxacin and phenylephrine/ketorolac. Patients with prior CME, vitreomacular traction, combined cataract/glaucoma surgery, and medication protocols different from those examined in this study were excluded. RESULTS Compared with the dexamethasone insert group, the topical NSAID group had a significantly lower incidence of CME (0.4% [2/519] vs 3.9% [19/482], P < .001) and photophobia (1.9% [10/519] vs 4.8% [23/482], P = .012). The incidence of breakthrough iritis (3.5% [18/519] vs 5.6% [27/482], P = .104) and pain also trended lower (4.0% [21/519] vs 5.4% [26/482], P = .314) in the topical NSAID group. CONCLUSIONS Topical NSAIDs were found to be more effective in controlling CME, pain, iritis, and photophobia after cataract surgery compared with the intracanalicular dexamethasone insert in the presence of intracameral phenylephrine/ketorolac.
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Affiliation(s)
- Denise M Visco
- From the Eyes of York Cataract & Laser Center, York, Pennsylvania
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Zaluski S, Amzallag T, Bouchut P, Pinsard L, Theron JP, Tellouck-Morincomme J, Baffert S. Perioperative time and economic impact of an intracameral combination of mydriatics and anaesthetics in routine cataract surgery. Eur J Ophthalmol 2023; 33:239-246. [PMID: 35570572 DOI: 10.1177/11206721221101359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to compare the perioperative time and economic impact of a licensed intracameral anaesthetic/mydriatic combination (Mydrane) during routine cataract surgery. METHODS A real-life, prospective, comparative study was performed in 3 clinical centres in France. Preoperative, surgical, and post-operative times were determined for two mydriasis strategies using conventional preoperative mydriatics/anaesthetics eye drops (control regimen) or Mydrane administered at time of surgery. Staff, surgery schedules and drugs utilisation were collected over 12 surgery half-days. The total cost of each strategy was estimated based on treatment cost and nursing costs. RESULTS The analysis included 112 routine cataract surgeries (57 surgeries using Mydrane and 55 using the topical regimen) without protocol deviations or complicated surgery. Overall, the mean time between administration of the first mydriatic eye drops or Mydrane and the end of the surgery was 27.4 ± 21.1 min in the Mydrane group vs. 90.3 ± 30.4 min in the control group (P < 0.0001). The total time of the procedure (from admission to discharge) was not significantly different between groups (P = 0.1611). On average, the extra cost of drugs per patient in the Mydrane group (€5.81) was almost balanced by the reduced nursing time (€5.57) with some variations between centres, due to different organisation including staff resource and consumable. CONCLUSIONS The Mydrane strategy produced perioperative nursing time saving and cost reduction provided that adaptation and reorganisation of routine cataract surgery are implemented.
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Affiliation(s)
- Serge Zaluski
- Polyclinique St Roch, Cabestany, France.,VISIS ophthalmological centre, Perpignan, France
| | | | | | - Loïc Pinsard
- Polyclinique St Roch, Cabestany, France.,VISIS ophthalmological centre, Perpignan, France
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Zhang W, Guo Y, Chen Y, Wu W, Li J. Analysis of pupil size by repeat dilation at shrinkage stage. Int Ophthalmol 2022; 42:2645-2649. [PMID: 35947252 DOI: 10.1007/s10792-022-02235-3] [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: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the pupil size of the original mydriasis and repeat mydriasis at the pupil shrinkage stage. METHODS Randomized prospective study. In total, 60 eyes of 30 patients aged 50-70 with age-related cataracts were included. Pupil sizes were measured by the Sirius system before mydriasis, after the first batch of mydriasis, and after the second batch of mydriasis which was 5 h later. Statistical analysis was performed using MedCalc statistical software version 20.0.3 RESULTS: The pupil size of the second batch of mydriasis 5 h later was smaller than the first batch of mydriasis (3.94 ± 0.88 mm vs 5.12 ± 0.96 mm, P < 0.0001). CONCLUSIONS Less efficiency repeat mydriasis several hours later compared with original mydriasis in our study suggests that preparation of mydriasis at an appropriate time is necessary for ophthalmological operations. The effect of repeat mydriasis again by tropicamide at the shrinkage stage still needs to be explored.
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Affiliation(s)
- Weili Zhang
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yanjiang Guo
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yile Chen
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Wencan Wu
- Department of Ophthalmology, Zhejiang Eye Hospital, Wenzhou, 325000, Zhejiang, China
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
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Kwak J, Han JY, Moon SY, Nam S, Kim JY, Tchah H, Lee H. Relationship Between Tamsulosin Use and Surgical Complications of Cataract Surgery in Elderly Patients: Population-Based Cohort Study. Front Med (Lausanne) 2022; 9:882131. [PMID: 35665322 PMCID: PMC9160597 DOI: 10.3389/fmed.2022.882131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Although several previous studies have investigated the relationship between tamsulosin use and surgical complications of cataract surgery, no population-based cohort study has been conducted for the Asian population. We aimed to investigate the relationship between tamsulosin use and surgical complications of cataract surgery in the Korean elderly population. Methods This nationwide population-based retrospective cohort study included elderly patients (≥60 years) who had undergone cataract surgery in the period from 2003 to 2015. Baseline characteristics were age, sex, income, residence, and systemic, and ocular comorbidities (glaucoma, myopia, eye trauma, diabetes mellitus with ophthalmic manifestations, severe cataract, age-related macular degeneration). The exposure of interest was tamsulosin use within 1 year before cataract surgery. Logistic regression model was used to evaluate the relationship of tamsulosin use with surgical complications of cataract surgery. Results The rate of surgical complications of cataract surgery was 0.88% (375/42,539) in the non-tamsulosin group and 0.83% (71/8,510) in the tamsulosin group. The groups showed no significant difference in the risk of surgical complications of cataract surgery in the unadjusted model [odds ratio (OR) = 0.946; 95% confidence interval (CI):0.733–1.220; P = 0.669]. Additionally, tamsulosin use was not significantly associated with surgical complications of cataract surgery in the fully adjusted model accounting for age, income, residence, and systemic and ocular comorbidities (OR = 0.997; 95% CI: 0.749–1.325; P = 0.981). Conclusions The rate or risk of surgical complications of cataract surgery does not change with tamsulosin use. We suggest that better surgical techniques and surgeons' cognizance of the patient's tamsulosin use could improve surgical outcomes, without increasing surgical complications.
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Chung HS, Lee J, Lee H, Kim JY, Tchah H. Evaluation of the Optical Aspects of the Ophthalmic Viscosurgical Device During Femtosecond Laser-Assisted Cataract Surgery. Transl Vis Sci Technol 2022; 11:2. [PMID: 35506930 PMCID: PMC9078068 DOI: 10.1167/tvst.11.5.2] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose In femtosecond laser-assisted cataract surgery (FLACS), capsulorhexis can be performed with an ophthalmic viscosurgical device (OVD) filled in the anterior chamber. We aimed to investigate changes in the laser properties in various optical aspects, such as focal shifting, reflection, and absorption associated with OVD. Methods Simulation was achieved by calculating the laser power attenuation due to reflection and spot size change using the Gullstrand eye model. Additionally, we calculated the absorption coefficient by measuring the laser power passing through the OVD with a laser meter and evaluated the effect of absorption by the OVD. Results In our simulation, power attenuation due to reflection was a maximum of 0.07%, and power attenuation was 0.08% even when considering the change according to the incident angle. Power attenuation due to the change of the spot size at the focus was 0.005%. Owing to the absorption of the OVD, a power increase of up to 13.5% was required for an anterior chamber depth of 3.0 mm to obtain the same effect as the aqueous humor. Conclusions The main reason for laser power attenuation associated with OVD was laser absorption through the OVD, and could also be caused by laser cavitation bubbles. To complete a safe capsulotomy during FLACS, the laser power should be increased appropriately, considering the absorption by the OVD in the anterior chamber. Translational Relevance The study results can be applied to calculate the optimal femtosecond laser energy to achieve complete capsulotomy during FLACS in the presence of anterior chamber OVD.
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Affiliation(s)
- Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jinho Lee
- The Research Institute of Natural Science and Department of Physics Education, Gyeongsang National University, Jinju, Korea
| | - Hun Lee
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Wang JD, Zhang JS, Li M, Mao YY, Mayinuer Y, Wan XH. Comparison of different pupil dilatation methods for phacoemulsification in eyes with a small pupil. BMC Ophthalmol 2022; 22:173. [PMID: 35436870 PMCID: PMC9016963 DOI: 10.1186/s12886-022-02402-1] [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: 10/17/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification. METHODS This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared. RESULTS One same doctor finished all cataract surgeries successfully. The eyes' condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm2, 1961/mm2. PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (Padjusted < 0.05). CONCLUSIONS All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn't affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially.
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Affiliation(s)
- Jin Da Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Jing Shang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Meng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Ying Yan Mao
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Yusufu Mayinuer
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Xiu Hua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China.
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11
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Visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov79105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: To date, there is a number of debatable aspects of cataract phacoemulsification in the literature, one of which is the investigation of features of the surgery in patients with visually stressful work.
AIM: The aim is to investigate the dynamics of the best corrected distance visual acuity and quality of life in heavy visual workload patients with bilateral cataract before and after phacoemulsification.
MATERIALS AND METHODS: We observed 32 heavy visual workload patients with binocular cataracts. All patients underwent standard phacoemulsification using Infiniti (Alcon, USA) or Constellation (Alcon, USA) devices according to the standard technique. The quality of life was assessed using the tested in refractive surgery QOL-25 questionnaire.
RESULTS: The high efficiency of phacoemulsification surgery was established, which is confirmed (14 days after the second procedure) by an increase in best corrected distance visual acuity to an average value of 0.920.95 relative units. Along with this, a certain quality of life dynamics of was revealed, which is manifested by a statistically significant deterioration (by 2.34.7%, p = 0.020.008) in the index in 14 and 21 days after the first surgical procedure compared to the data obtained at 7 days after first operation.
CONCLUSION: Surgical treatment of binocular cataracts in heavy visual workload patients is based on earlier (in 710 days) surgery on the second eye or performing an immediately sequential bilateral cataract surgery.
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de Carvalho Tom Back BF, Henriques PR, Silva SAR, Hida RY. Femtosecond laser-assisted cataract surgery in small pupils using non-aligned iris expansion ring without viscoelastic and corneal suture. Int Ophthalmol 2021; 42:1175-1182. [PMID: 34761336 DOI: 10.1007/s10792-021-02102-7] [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: 11/06/2020] [Accepted: 10/21/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe a technique for cataract surgery in eyes with small pupils that combines the use of the femtosecond laser and an iris expansion device, but without the use of corneal sutures and an ophthalmic viscosurgical device (OVD) at the time of laser application. METHODS A retrospective case series of three eyes with small pupils were operated by the same surgeon without a corneal suture and with removal of anterior chamber OVD prior to laser application. RESULTS Corrected distance visual acuity (CDVA) for 1 eye in a 70 year-old patient was 20/70 preoperatively and 20/20 thirty days postoperatively. CDVA for a second patient was 20/50 and 20/200 in the two eyes, which improved to 20/25 two months postoperatively in both eyes. There were no complications observed and the intraocular lens were well-centered. CONCLUSION The use of mechanical pupil expander rings is safe and practical in setting small pupils during femtosecond laser-assisted cataract surgery.
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13
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Huang L, Jin H, Zhao P. Application of an iris speculum for removing Soemmerring's ring during secondary intraocular lens implantation in congenital cataract patients with small pupils. J Cataract Refract Surg 2021; 47:e1-e5. [PMID: 33149038 DOI: 10.1097/j.jcrs.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
An application of the XpandNT iris speculum in eyes with small pupils during secondary intraocular lens (IOL) implantation in congenital cataract patients is described. The iris speculum was first positioned in the eye to expand the pupil. A 30-gauge needle was used to separate the adhesion of the iris tissue and the capsular rim. Vitrectomy was used to clean Soemmerring's ring near the capsular rim. The iris expander was retracted with the Williamson XpandNT Manipulator. The IOL was then implanted. Fourteen aphakic eyes from 10 consecutive patients were studied retrospectively; pupil expansion was achieved in all 14 eyes intraoperatively without serious intraoperative or postoperative complications. The iris speculum was a safe and excellent tool for removing Soemmerring's ring and solving small pupil problems during secondary IOL implantation in pediatric cataract surgery patients.
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Affiliation(s)
- Liuhui Huang
- From the Department of Ophthalmology, Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China (Huang, Zhao); Tenth People's Hospital Affiliated with Shanghai Tongji University School of Medicine, Shanghai, China (Huang, Jin)
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14
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Salviat F, Febbraro JL, Zuber K, Yavchitz A, Moran S, Gatinel D. Evaluation of a uniplanar pupil expansion ring in small-pupil cataract surgery: a feasibility study. Int Ophthalmol 2021; 42:489-496. [PMID: 34655377 DOI: 10.1007/s10792-021-02065-9] [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: 05/28/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of a disposable uniplanar pupil expansion device in small-pupil cataract surgery. METHODS This is a feasibility study carried out at the Rothschild Foundation, Paris, France. Patients undergoing routine cataract surgery with a dilated pupil size < 6 mm, and who agreed to participate in the study were included. The trial enrolled 25 patients, of whom 21 proceeded to cataract surgery using the pupil expansion device to be evaluated. The pupil diameter was measured at defined stages during the cataract surgery, which was performed by a single surgeon, in a single center setting. The 1st generation Bhattacharjee pupil expansion ring was used if the preoperative pupil size was < 6 mm. Intraoperative and postoperative adverse events were recorded. RESULTS Pupil size immediately after the Bhattacharjee ring implantation was ≥ 6 mm for 15 eyes (71.4%). The mean dilated pupil size before ring insertion was 4.5 ± 0.8 mm (range 2.5-5.8 mm), and the mean pupil size after ring insertion was 6.1 ± 0.3 mm (range 5.9-6.8 mm). Mean pupil size following removal of the ring was 4.2 ± 0.8 mm (range 2.5-5.4 mm). Two adverse events occurred during the surgeries: 1 Bhattacharjee ring broke prior to implantation, and 1 implanted Bhattacharjee ring was unstable and removed before the end of the surgery. No postoperative adverse event was recorded. CONCLUSIONS The Bhattacharjee ring is an effective pupil expansion device, which facilitates stable pupil expansion during cataract surgery. This study was registered as a clinical trial at clinicaltrials.gov under the number NCT02434588.
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Affiliation(s)
- Flore Salviat
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | | | - Kevin Zuber
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | - Amélie Yavchitz
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | - Sarah Moran
- Department of Ophthalmology, South Infirmary Victoria University Hospital, Cork, Ireland.
| | - Damien Gatinel
- Department of Ophthalmology, Rothschild Foundation, Paris, France
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15
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Lee JH, Chung HS, Moon SY, Yoon J, Lee K, Lee H, Kim JY, Lim HT, Tchah H. Effect of preoperative eyedrops on cytokine concentrations in aqueous humor of patients undergoing femtosecond laser-assisted cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:885-891. [PMID: 34625847 DOI: 10.1007/s00417-021-05428-1] [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: 02/04/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the anti-inflammatory activity of preoperatively applied eyedrops, as determined by cytokine concentrations in aqueous humor collected during surgery in patients undergoing femtosecond laser-assisted cataract surgery. METHODS A total of 120 patients undergoing femtosecond laser-assisted cataract surgery were randomly assigned to four groups of 30 patients each. Groups were administered 0.1% fluorometholone eyedrops, 0.45% ketorolac tromethamine eyedrops, both 0.1% fluorometholone and 0.45% ketorolac tromethamine eyedrops, or no eyedrops. Eyedrops were instilled 1 h, 20 min, and just before surgery. After anterior capsulotomy and nuclear fragmentation using a femtosecond laser, 0.1 cc aqueous humor was obtained using a needle and syringe. Cytokine and prostaglandin E2 (PGE2) concentrations were quantitatively determined. RESULTS The 120 patients included 59 men and 61 women, of mean age 65.02 years. The mean interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations after treatment did not differ significantly in the four groups. The average interleukin-8 (IL-8) concentrations were significantly lower in the fluorometholone (4.80 pg/mL), ketorolac tromethamine (4.84 pg/mL), and fluorometholone + ketorolac tromethamine (4.68 pg/mL) groups than in the control group (6.83 pg/mL). Furthermore, the average PGE2 concentrations were significantly lower in the ketorolac tromethamine (270.04 pg/mL) and fluorometholone + ketorolac tromethamine (239.00 pg/mL) groups, but not in the fluorometholone (393.16 pg/mL) group, than in the control group (472.36 pg/mL). CONCLUSION Preoperative fluorometholone instillation reduced IL-8, and ketorolac tromethamine instillation reduced IL-8 and PGE2, in aqueous humor of patients undergoing femtosecond laser surgery, with the combination of both eyedrops being more effective than either alone. TRIAL REGISTRATION KCT0005717.
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Affiliation(s)
- Jae Hyuck Lee
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea.,Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Su Young Moon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jooyoung Yoon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Koeun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hungwon Tchah
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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16
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Uy HS, Cruz FM, Kenyon KR. Efficacy of a hinged pupil expansion device in small pupil cataract surgery. Indian J Ophthalmol 2021; 69:2688-2693. [PMID: 34571616 PMCID: PMC8597469 DOI: 10.4103/ijo.ijo_2857_20] [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] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the efficacy and safety of a hinged pupil expansion device (PED) in eyes with small pupils undergoing phacoemulsification. Methods: In this prospective, multicenter, interventional case series of 57 eyes with suboptimal pharmacologic pupil dilation (<5 mm diameter), a hinged PED (I-Ring, Beaver-Visitec International, Waltham, MA) was applied to facilitate surgical visualization during cataract surgery. The pupil diameters (PD) were measured at different stages of the procedure and at the 1-month follow-up visit. Rate of successful intraoperative PED deployment, pupil size, and shape were assessed. Results: The mean patient age was 70.5 ± 12.1 years. The I-Ring PED was successfully applied in all eyes. The mean PD at various stages were 4.1 ± 1.1 mm (dilation with eye drops only preoperatively), 4.3 ± 1.1 mm (dilation after intracameral epinephrine and ophthalmic viscoelastic device), 6.80 ± 0.00 mm (with PED applied), and 5.7 ± 1.1 mm (end of surgery). A statistically significant difference (P < 0.001) was observed between the mean PD with intracameral medications and with PED application. Postoperative circular pupil was observed in 54 of 57 eyes (94.7%) and the mean eccentricity index (n = 57 eyes) was 0.11 ± 0.22. No significant adverse events were observed. Conclusion: The I-Ring PED safely and effectively provided and maintained adequate pupil expansion and surgical visualization in eyes with small pupils undergoing cataract surgery. Postoperatively 95% of eyes attained circular pupils. This hinged PED is an additional instrumentation option for the safe and effective expansion of inadequately sized pupils during cataract surgery.
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Affiliation(s)
- Harvey S Uy
- Peregrine Eye and Laser Institute, Makati City; Department Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines
| | - Franz M Cruz
- Peregrine Eye and Laser Institute, Makati City; Department Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines
| | - Kenneth R Kenyon
- Department of Ophthalmology, New England Eye Centre, Tufts University School of Medicine, Boston, MA, USA
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17
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Cho J, Bruck B, Liu JC, Culican SM. Assessing the Clinical Requirement of 2.5% Phenylephrine for Diagnostic Pupil Examination. J Ocul Pharmacol Ther 2021; 37:284-289. [PMID: 33685234 PMCID: PMC8215398 DOI: 10.1089/jop.2020.0111] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Methods: Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. Results: There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; P = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; P = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, P = 0.67). Conclusion: The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.
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Affiliation(s)
- Junsang Cho
- University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Brent Bruck
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James C Liu
- Department of Ophthalmology, Duke University, Raleigh, North Carolina, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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18
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Shrivastava AK, Nayak S, Anto M. Efficacy of Nepafenac versus Flurbiprofen in Maintaining Intraoperative Mydriasis During Phacoemulsification: A Comparative Study. Clin Ophthalmol 2021; 15:1085-1093. [PMID: 33727791 PMCID: PMC7955764 DOI: 10.2147/opth.s303480] [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: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the efficacy of topical nepafenac (0.1%) with flurbiprofen (0.03%) in maintaining intra-operative mydriasis during phacoemulsification surgery. Patients and Methods This study comprised of 160 patients, who were divided into two arms of 80 each (arms A and B) after randomisation. Pre-operatively, all patients received one drop of tropicamide 0.8% and phenylephrine 5% (combination), 4 times, at an interval of 15 minutes on the day of surgery. Thereafter, Nepafenac drop in arm A/Flurbiprofen drop in arm B was administered 4 times, at an interval of 15 minutes keeping a gap of 10 minutes between tropicamide-phenylephrine and any of the experimental drugs. Phacoemulsification was performed one hour after the administration of last drop. Both vertical and horizontal pupillary diameter were measured at three steps; immediately before the surgical incision (baseline), at the end of emulsification of nucleus (before irrigation and aspiration) and at the end of surgery (after stromal hydration). Results The difference in pupillary diameter between two groups, was statistically insignificant for vertical diameter (P = 0.08) and horizontal diameter (P = 0.28) at the start of surgery. On the other hand, pupillary diameter difference was statistically significant after emulsification of nucleus and at the end of surgery as well when both vertical (P < 0.05) and horizontal diameter (P < 0.05) were considered. The total reduction in pupillary diameter (both vertically and horizontally) was significantly less in the Nepafenac as compared to Flurbiprofen group (P < 0.05). Analysis of mean cumulative dissipated energy did not document any appreciable difference between the two groups. Phacoemulsification time analysis yielded statistically significant results (P = 0.004) between the Nepafenac and Flurbiprofen group. Conclusion In the present study, topical Nepafenac (0.1%) proved to be more efficacious in maintaining intra-operative mydriasis during phacoemulsification surgery as compared to topical Flurbiprofen (0.03%).
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Affiliation(s)
- Ankur K Shrivastava
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, India
| | - Swatishree Nayak
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, India
| | - Mary Anto
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, India
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19
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Şahin AK, Kükner AŞ, Ulaş F, Doğan Ü. Effect of nepafenac 0.1% on retinal thickness after cataract surgery in patients without risk factors for cystoid macular edema. Int J Ophthalmol 2020; 13:1901-1907. [PMID: 33344188 DOI: 10.18240/ijo.2020.12.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/29/2020] [Indexed: 01/16/2023] Open
Abstract
AIM To evaluate the effect of topical preoperative nepafenac 0.1% treatment on postoperative macular edema using optical coherence tomography (OCT) after uncomplicated cataract surgery. METHODS Ninety eyes of 90 patients without any risk factors were included in the study. The patients were assigned to three groups: group 1, treated with topical prednisolone acetate 1%; group 2, treated with topical nepafenac 0.1% in addition to prednisolone acetate (1%); and group 3, those who started receiving nepafenac 0.1% treatment 3d prior to surgery and continued the treatment postoperatively in addition to prednisolone acetate (1%). Central retinal thickness (CRT) and macular volume values were recorded using OCT at weeks 3 and 6. RESULTS The increases in macular volume in the central 1 mm area after 3 and 6wk were significantly lower in patients who used prophylactic topical nepafenac preoperatively (group 3) compared with those in group 1 (P=0.028 and 0.008, respectively). No significant differences in the increase in macular volume and CRT were noted between groups 2 and 3 (P>0.05). In group 1, the increases in macular volume in the central 3 mm area at weeks 3 and 6 were significantly higher than that in group 2 and 3 (3rd week, P=0.004; 6th week, P=0.005). CONCLUSION Nepafenac 0.1% treatment in addition to topical steroids after uncomplicated cataract surgery reduce the increase in macular volume in the early postoperative period.
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Affiliation(s)
- Asena Keleş Şahin
- Department of Ophthalmology, Training and Research Hospital, Ordu University, Ordu 52000, Turkey
| | - Ahmet Şahap Kükner
- Department of Ophthalmology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu 14280, Turkey
| | - Fatih Ulaş
- Department of Ophthalmology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu 14280, Turkey
| | - Ümit Doğan
- Department of Ophthalmology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu 14280, Turkey
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20
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Tsui JL, Chan NC, Tham CC. The role of lens extraction in glaucoma management. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1550. [PMID: 33313295 PMCID: PMC7729306 DOI: 10.21037/atm-20-3251a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cataract extraction has become a much safer procedure with the development of phacoemulsification, extending its application in ocular conditions such as glaucoma for better disease control. This review aims at summarizing the effect of lens extraction with or without combined glaucoma surgeries in different types of glaucoma and describing the intraoperative techniques and changes of glaucoma care postoperatively. A comprehensive literature search was performed through Medline and PubMed, and 67 studies were selected for this review. In primary angle closure (PAC) diseases, studies have revealed significant intraocular pressure (IOP) and medication requirement reduction after lens extraction. Fewer studies described its application in primary open angle glaucoma (POAG) and ocular hypertension (OHT), but literature available suggests that it can also lead to better disease control. Likewise, lower postoperative IOP and pressure fluctuations have been shown in normal tension glaucoma (NTG). Advanced glaucoma, shallow anterior chamber and pseudoexfoliation glaucoma (PXG) are three difficult scenarios that are commonly encountered in cataract operations. Special techniques in preventing complications such as wipe out phenomenon are depicted. Goniosynechialysis, endoscopic cyclophotocoagulation and trabecular microbypass stents are a few of the popular choices of glaucoma procedures that can be performed concomitantly with phacoemulsification but evidence of their efficacy needs to be further verified. Cataract operation can improve visual field and retinal nerve fiber layer examination parameters and it is advised to set new baselines after the surgery for subsequent progression monitoring. Clearance of an optically significant cataract results in better quality of life, and with detailed and thorough explanation of the indications, expectations and risks of the surgery, cataract extraction could be considered even in cases of advanced glaucoma.
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Affiliation(s)
- Jolly L Tsui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Noel C Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Kowloon, Hong Kong, China
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21
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LoBue SA, Tailor P, LoBue TD. A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil. Clin Ophthalmol 2019; 13:2361-2367. [PMID: 31819361 PMCID: PMC6896912 DOI: 10.2147/opth.s220731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract. Methods A single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion. Results Nine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal. Conclusion Dense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.
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Affiliation(s)
- Stephen A LoBue
- Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA.,Lincoln Medical Center, Affiliated to Weill Cornell Medical College, Bronx, NY, USA
| | | | - Thomas D LoBue
- Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA
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22
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Lu K, Garcia M, Tian J, Karanjia R. Series of cataract surgeries with I-ring pupil expansion ring. World J Ophthalmol 2019; 8:1-6. [DOI: 10.5318/wjo.v8.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/28/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice. The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.
AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.
METHODS A retrospective chart review of 12 consecutive cases within the same year (2016) of cataract surgeries employing I-ring pupil expansion ring (Beaver-Visitec, International) by a single surgeon at the same ambulatory surgical center was conducted. Demographic, pre-op, intra-op, and post-op data were recorded. Total number of cataract cases performed was also recorded.
RESULTS 8 of 12 cases were planned I-ring cases. 1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink. The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small. 7 patients had IFIS from Flomax use. 2 patients had pseudoexfoliation syndrome as the cause of small pupil. 2 patients had narrow angles with brunescent cataracts. 2 patients had pre-op partial zonular dehiscence. 1 patient had 360o of posterior synechiae. 2 cases had ruptured posterior capsule that required anterior vitrectomy. No complications were attributed to the pupil expansion ring. A total of 296 cataract surgeries were performed that year by the surgeon, making the rate of pupil ring use 4.1%.
CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges, such as brunescent cataract, zonular weakness, and posterior synechiae in this series. I-ring helped to reduce at least one challenge in these difficult cases.
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Affiliation(s)
- Kenneth Lu
- Doheny Eye Institute, University of California, Los Angeles, CA 91007, United States
| | - Martin Garcia
- Doheny Eye Institute, University of California, Los Angeles, CA 91007, United States
| | - Jack Tian
- Doheny Eye Institute, University of California, Los Angeles, CA 91007, United States
| | - Rustum Karanjia
- Doheny Eye Institute, University of California, Los Angeles, CA 91007, United States
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Mirshahi A, A Ponto K. Changes in Pupil Area during Low-energy Femtosecond Laser-assisted Cataract Surgery. J Ophthalmic Vis Res 2019; 14:251-256. [PMID: 31660103 PMCID: PMC6815335 DOI: 10.18502/jovr.v14i3.4780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/24/2019] [Indexed: 01/30/2023] Open
Abstract
Purpose To study the potential changes in pupil area within low-energy femtosecond-laser assisted cataract surgery (FLACS). Methods A retrospective assessment of the pupil size was performed in the eyes undergoing FLACS using the Ziemer LDV Z8. We measured the pupil diameters as part of the images taken preoperatively and at the completion of laser pretreatment (after releasing the suction). We calculated the pupil area in 40 eyes of 40 patients (14 right and 26 left eyes). The mean ± standard deviation (SD) of age of the patients was 74 ± 7.4 years (range: 51-87). Paired t-test was used for statistical analyses. Subgroups were built with reference to age and preoperative pupil area (smaller than or equal to the median versus larger than the median). Results The mean ± SD axial length, anterior chamber depth, white-to-white distance and lens thickness were 24.01 ± 1.47, 3.23 ± 0.4, 11.97 ± 0.49, and 4.59 ± 0.41 mm, respectively. The mean ± SD pupil area was 39.33 ± 7.1 mm 2 preoperatively and 39.3 ± 6.75 mm 2 after laser pretreatment. The mean ± SD change in pupil area was -0.03 ± 2.12 mm 2 . There were no statistically significant changes between preoperative and post-laser pupil areas (P = 0.93, 95% CI: -0.71 to 0.65). Comparisons within subgroups also did not detect pupil area reduction. Conclusion This study did not detect statistically significant changes in pupil area after laser pretreatment using low-energy FLACS. This observation is in contrast to previous studies using other laser platforms.
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Affiliation(s)
| | - Katharina A Ponto
- Department of Ophthalmology, University Medical Center Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany
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Popiela MZ, Young-Zvandasara T, Nidamanuri P, Moore T, Leccisotti A, Kumar V. Factors influencing pupil behaviour during femtosecond laser assisted cataract surgery. Cont Lens Anterior Eye 2019; 42:295-298. [DOI: 10.1016/j.clae.2018.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
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Walter K, Delwadia N, Coben J. Continuous intracameral phenylephrine–ketorolac irrigation for miosis prevention in femtosecond laser–assisted cataract surgery: Reduction in surgical time and iris manipulation. J Cataract Refract Surg 2019; 45:465-469. [DOI: 10.1016/j.jcrs.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/23/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019; 13:453-464. [PMID: 30880906 PMCID: PMC6402616 DOI: 10.2147/opth.s181444] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Merve Inanc
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Ufuk Elgin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Tian JJ, Garcia GA, Karanjia R, Lu KL. Comparison of 2 pupil expansion devices for small-pupil cataract surgery. J Cataract Refract Surg 2018; 42:1235-7. [PMID: 27531301 DOI: 10.1016/j.jcrs.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 02/08/2023]
Abstract
UNLABELLED We compared the degree of postoperative iris distortion with the diamond-shaped Malyugin ring and the circular Visitec I-Ring iris dilators using postoperative iris photographs in a patient with bilateral small nondilating pupils. Routine phacoemulsification was performed in the right eye with the assistance of a Malyugin ring for iris dilation. One month later, the same procedure was performed in the left eye using the circular ring for iris dilation. Anterior chamber slitlamp photographs were taken of both eyes. The amount of distortion in the postoperative pupils was calculated using the ratio of the postoperative pupil area to the area of the circle of best fit. The circular ring, constructed from a softer material, resulted in 11% distortion and the Malyugin ring, 49%, suggesting that the circular ring caused less trauma to the iris. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jack J Tian
- From the Doheny Eye Institute (Tian, Garcia, Karanjia, Lu) and the Doheny Eye Center (Tian, Lu, Karanjia), David Geffen School of Medicine, University of California Los Angeles, and the University of California-Irvine School of Medicine (Garcia), Irvine, California, USA; the Ottawa Hospital Research Institute (Karanjia), and the Ottawa Eye Institute (Karanjia), University of Ottawa, Ottawa, Ontario, Canada.
| | - Giancarlo A Garcia
- From the Doheny Eye Institute (Tian, Garcia, Karanjia, Lu) and the Doheny Eye Center (Tian, Lu, Karanjia), David Geffen School of Medicine, University of California Los Angeles, and the University of California-Irvine School of Medicine (Garcia), Irvine, California, USA; the Ottawa Hospital Research Institute (Karanjia), and the Ottawa Eye Institute (Karanjia), University of Ottawa, Ottawa, Ontario, Canada
| | - Rustum Karanjia
- From the Doheny Eye Institute (Tian, Garcia, Karanjia, Lu) and the Doheny Eye Center (Tian, Lu, Karanjia), David Geffen School of Medicine, University of California Los Angeles, and the University of California-Irvine School of Medicine (Garcia), Irvine, California, USA; the Ottawa Hospital Research Institute (Karanjia), and the Ottawa Eye Institute (Karanjia), University of Ottawa, Ottawa, Ontario, Canada
| | - Kenneth L Lu
- From the Doheny Eye Institute (Tian, Garcia, Karanjia, Lu) and the Doheny Eye Center (Tian, Lu, Karanjia), David Geffen School of Medicine, University of California Los Angeles, and the University of California-Irvine School of Medicine (Garcia), Irvine, California, USA; the Ottawa Hospital Research Institute (Karanjia), and the Ottawa Eye Institute (Karanjia), University of Ottawa, Ottawa, Ontario, Canada
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Hoffman RS, Braga-Mele R, Donaldson K, Emerick G, Henderson B, Kahook M, Mamalis N, Miller KM, Realini T, Shorstein NH, Stiverson RK, Wirostko B. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg 2018; 42:1368-1379. [PMID: 27697257 DOI: 10.1016/j.jcrs.2016.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 10/20/2022]
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Grimfors M, Lundström M, Höijer J, Kugelberg M. Intraoperative difficulties, complications and self-assessed visual function in cataract surgery. Acta Ophthalmol 2018; 96:592-599. [PMID: 29575808 DOI: 10.1111/aos.13757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To study associations between intraoperative difficulties and changes in patient-perceived and postoperative visual function and visual satisfaction after cataract surgery. METHODS Swedish multicenter, prospective, cross-sectional, nonrandomized, National Cataract Register study. A total of 10 979 patients (n = 10 979) who underwent cataract surgery from 2008 to 2011 completed the Catquest-9SF questionnaire before and 3 months postoperatively. Using Rasch analysis, we converted the nonparametric grading of the answers to parametric data and performed parametric statistical analyses. Multiple regression models were used to examine possible predictors associated with self-assessed visual function after cataract surgery. RESULTS Greater improvement in self-assessed visual function was seen in patients in whom trypan blue dye was used; those without a posterior capsular tear or an ocular comorbidity; and those who were younger, female and had low preoperative corrected distance visual acuity (CDVA) or high postoperative CDVA compared with their counterparts. Significantly higher self-assessed postoperative visual function was seen in patients in whom trypan blue dye was used and those with no posterior capsular tear or ocular comorbidity and no use of capsular hooks; and those who were younger and had low preoperative or high postoperative CDVA compared with their counterparts. The risk of general dissatisfaction after cataract surgery was significantly greater in patients with a posterior capsule tear, ocular comorbidity or low postoperative CDVA, and those in whom mechanical pupillary stretching was performed. CONCLUSION Several intraoperative difficulties, posterior capsular tear, ocular comorbidity, age, gender, and preoperative and postoperative CDVAs affect patient improvement and self-assessed visual function after cataract surgery.
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Affiliation(s)
- Magnus Grimfors
- Department of Clinical Neuroscience; Division of Ophthalmology and Vision, Karolinska Institutet; St. Erik Eye Hospital Stockholm Sweden
| | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology; Faculty of Medicine; Lund University; Lund Sweden
| | - Jonas Höijer
- Unit of Biostatistics; Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience; Division of Ophthalmology and Vision, Karolinska Institutet; St. Erik Eye Hospital Stockholm Sweden
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Al-Hashimi S, Donaldson K, Davidson R, Dhaliwal D, Jackson M, Kieval JZ, Patterson L, Stonecipher K, Hamilton DR. Medical and surgical management of the small pupil during cataract surgery. J Cataract Refract Surg 2018; 44:1032-1041. [DOI: 10.1016/j.jcrs.2018.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 10/28/2022]
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Diakonis VF, Anagnostopoulos AG, Moutsiopoulou A, Yesilirmak N, Cabot F, Waren DP, O'Brien TP, Yoo SH, Weinstock RJ, Donaldson KE. The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E 2 Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy. J Ophthalmol 2018; 2018:1891249. [PMID: 30116626 PMCID: PMC6079456 DOI: 10.1155/2018/1891249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/24/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. METHODS This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. RESULTS Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. CONCLUSION Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.
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Affiliation(s)
- Vasilios F. Diakonis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Eye Institute of West Florida, Largo, FL, USA
| | | | | | - Nilufer Yesilirmak
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Florence Cabot
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel P. Waren
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Terrence P. O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Kendall E. Donaldson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Avetisov KS, Ivanov MN, Yusef YN, Yusef SN, Aslamazova AE, Fokina ND. [Morphological and clinical aspects of anterior capsulotomy in femtosecond laser-assisted cataract surgery]. Vestn Oftalmol 2018; 133:83-88. [PMID: 28980571 DOI: 10.17116/oftalma2017133483-88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The review covers morphological and clinical aspects of femtosecond laser-assisted anterior capsulotomy in cataract surgery. Literature data suggests that femtosecond laser-assisted capsulotomy is more accurate in size, shape, and centration than manual. Femtosecond laser-assisted anterior capsulotomy improves the accuracy of IOL positioning within the capsular bag.
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Affiliation(s)
- K S Avetisov
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - M N Ivanov
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - Yu N Yusef
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - S N Yusef
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - A E Aslamazova
- First Moscow State Medical University, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russia, 119991
| | - N D Fokina
- First Moscow State Medical University, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russia, 119991
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Wirbelauer C, Schmidt S, Puk C. [Mechanical pupillary dilatation using rings in small pupils during cataract surgery : Video article]. Ophthalmologe 2018; 115:329-335. [PMID: 29569057 DOI: 10.1007/s00347-018-0678-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of mechanical pupillary dilatation in small pupils is a sufficient visualization of the lens to be able to perform capsulorhexis, phacoemulsification and intraocular lens implantation. INDICATIONS The indications for mechanical dilatation are fulfilled in patients where a sufficient pharmacological preoperative pupil dilatation is not possible. SURGICAL TECHNIQUE During routine cataract surgery specific foldable rings can be employed to dilate the pupil with the appropriate injector under viscoelastic substances. These rings are carefully placed at the pupillary margin until circular pupillary dilatation up to 6-7 mm is achieved. After intraocular lens implantation and before removing the viscoelastic substance the rings are slowly folded into the injector and then removed. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. RESULTS Mechanical pupillary dilatation was possible in all patients studied (n = 14), which allowed uncomplicated phacoemulsification and intraocular lens implantation. For both ring systems studied the mean pupillary dilatation was 6.6 mm. At the end of surgery, the pupillary diameter was 4.89 mm using a Malyugin ring (MST, Redmond, Washington, USA) and 4.93 mm with an I‑ring (Visitec, Waltham, MA, USA; P > 0.05). Small lesions at the pupillary margin or pigment dispersion during implantation or explantation depended mostly on the individual patient situation and not on the ring used. CONCLUSION Mechanical pupillary dilatation with rings allows sufficient dilatation to perform cataract surgery. Both the Malyugin ring and the I‑ring achieved smooth and atraumatic pupillary dilatation.
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Affiliation(s)
- C Wirbelauer
- Augenklinik Berlin-Marzahn GmbH, Brebacher Weg 15, 12683, Berlin, Deutschland.
| | - S Schmidt
- Augenklinik Berlin-Marzahn GmbH, Brebacher Weg 15, 12683, Berlin, Deutschland
| | - C Puk
- Augenklinik Berlin-Marzahn GmbH, Brebacher Weg 15, 12683, Berlin, Deutschland
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Abstract
Purpose (1) To use finite element (FE) modelling to estimate local iris stresses (i.e. internal forces) as a result of mechanical pupil expansion; and to (2) compare such stresses as generated from several commercially available expanders (Iris hooks, APX dilator and Malyugin ring) to determine which design and deployment method are most likely to cause iris damage. Methods We used a biofidelic 3-part iris FE model that consisted of the stroma, sphincter and dilator muscles. Our FE model simulated expansion of the pupil from 3 mm to a maximum of 6 mm using the aforementioned pupil expanders, with uniform circular expansion used for baseline comparison. FE-derived stresses, resultant forces and area of final pupil opening were compared across devices for analysis. Results Our FE models demonstrated that the APX dilator generated the highest stresses on the sphincter muscles, (max: 6.446 MPa; average: 5.112 MPa), followed by the iris hooks (max: 5.680 MPa; average: 5.219 MPa), and the Malyugin ring (max: 2.144 MPa; average: 1.575 MPa). Uniform expansion generated the lowest stresses (max: 0.435MPa; average: 0.377 MPa). For pupil expansion, the APX dilator required the highest force (41.22 mN), followed by iris hooks (40.82 mN) and the Malyugin ring (18.56 mN). Conclusion Our study predicted that current pupil expanders exert significantly higher amount of stresses and forces than required during pupil expansion. Our work may serve as a guide for the development and design of next-generation pupil expanders.
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Visco D. Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis. Clin Ophthalmol 2018; 12:301-305. [PMID: 29440873 PMCID: PMC5804732 DOI: 10.2147/opth.s149522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the effect of intracameral phenylephrine/ketorolac (1%/0.3%) during cataract surgery on the use of iris fixation ring and surgical time in patients with poor pupil dilation (≤5.0 mm) or intraoperative floppy iris syndrome (IFIS). Setting Private practice outpatient surgical center. Design This retrospective analysis was conducted from January 1, 2014 to October 7, 2015. Materials and methods The use of iris fixation rings was evaluated in a retrospective analysis of 46 patients who underwent cataract surgery from January 1, 2014, to October 7, 2015, and who were identified before surgery to be at risk for intraoperative miosis. The qualifying factors were presurgical examination of pupil dilation ≤5.0 mm after being administered topical tropicamide 1% and phenylephrine 2.5% or history of IFIS during surgery in the fellow eye. All patients received a 2-day preoperative course of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and day-of-surgery preoperative dilation using topical cyclopentolate 1%, tropicamide 1%, and phenylephrine 10%. Phenylephrine/ketorolac 1%/0.3% (Omidria®) or epinephrine 1:1,000 with sulfites was added to the ophthalmic irrigation solution and delivered intracamerally at the start of the procedure and throughout surgery. The use of iris fixation rings and surgical time for each patient were captured for each group. Results Eighteen (50%) of the patients in the epinephrine group and no patients in the phenylephrine/ketorolac group required iris fixation ring insertion to maintain pupil dilation or to control IFIS (p=0.0034). Mean surgical time was significantly shorter in the group of patients who received phenylephrine/ketorolac (p=0.0068). Conclusion In this retrospective cohort analysis of patients with poorly dilated pupils and/or IFIS, the use of intracameral phenylephrine/ketorolac in patients at risk for intraoperative miosis resulted in significantly less iris fixation ring use and significantly shorter surgical time when compared with intracameral epinephrine use.
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Affiliation(s)
- Denise Visco
- Eyes of York Cataract & Laser Center, York, PA, USA
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Aykut A, Kukner AS, Karasu B, Palancıglu Y, Atmaca F, Aydogan T. Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil. Int Ophthalmol 2018; 39:385-391. [DOI: 10.1007/s10792-018-0823-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
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Rosenberg ED, Nattis AS, Alevi D, Chu RL, Bacotti J, LoPinto RJ, D'Aversa G, Donnenfeld ED. Visual outcomes, efficacy, and surgical complications associated with intracameral phenylephrine 1.0%/ketorolac 0.3% administered during cataract surgery. Clin Ophthalmol 2017; 12:21-28. [PMID: 29317798 PMCID: PMC5743109 DOI: 10.2147/opth.s149581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim The purpose of this study was to compare visual outcomes, surgical time, and perioperative surgical complications after intracameral use of either phenylephrine/ketorolac (P/K) or epinephrine (Epi) during cataract surgery. Methods This was a single-center, retrospective case review of patients undergoing cataract surgery from August to November 2015. Of the 641 eyes of 389 patients who underwent cataract surgery, 260 eyes were administered phenylephrine 1.0%/ketorolac 0.3% and 381 eyes received Epi in the irrigation solution intraoperatively. All patients received a topical nonsteroidal anti-inflammatory drug regimen (bromfenac 0.07%, nepafenac 0.3%, or ketorolac 0.5%) for 3 days before surgery and topical tropicamide 1.0%, cyclopentolate 1.0%, and phenylephrine 2.5% on the day of surgery. Results Mean length of surgery (LOS) was 15.4±0.6 minutes. Although a positive correlation was noted between patient age and LOS (p<0.001), P/K was associated with a decrease in the LOS, when controlled for age quartiles. A statistically significant lower incidence of complications (1.1%) was observed with P/K use than Epi (4.5%; p=0.018). Among surgeons who used mydriatic-assist devices more frequently, P/K use was associated with a reduction in the use of these devices (p<0.001). When controlling for age quartile, patients of age groups 69–76 and 76–92 years who received P/K had significantly better uncorrected visual acuity at postoperative day 1 than those receiving Epi (p=0.003). Conclusion Intracameral use of phenylephrine 1.0%/ketorolac 0.3% during cataract surgery may be effective in maintaining mydriasis. It appears to be superior to intracameral Epi at reducing intraoperative and postoperative complications, need for pupillary dilating devices, and surgical time.
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Affiliation(s)
| | | | - David Alevi
- Ophthalmic Consultants of Long Island, Rockville Centre, NY
| | | | - Joseph Bacotti
- Ophthalmic Consultants of Long Island, Rockville Centre, NY
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Liu JC, Green W, Van Stavern GP, Culican SM. Assessing the utility of 2.5% phenylephrine for diagnostic pupillary dilation. Can J Ophthalmol 2017; 52:349-354. [PMID: 28774515 DOI: 10.1016/j.jcjo.2017.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether the addition of phenylephrine to tropicamide produces any clinically significant change in pupil size during diagnostic eye examination. METHODS Twenty healthy adults at the Washington University School of Medicine Eye Clinic were enrolled in this prospective, nonrandomized, crossover trial. Each had 3 dilating eye drop regimens administered to the left eye on separate days. Tropicamide (T) + proparacaine (PP) + phenylephrine (PE) (T+PP+PE) was considered the standard therapy, to which tropicamide alone (T alone) and tropicamide + proparacaine (T+PP) were compared against. Main outcome measures were postdilation pupil size and proportion of pupils able to achieve adequate clinical pupil dilation of >7 mm. Comparisons were made using Wilcoxon signed-ranked tests and McNemar's test. RESULTS Mean postdilation pupil size was 7.94 ± 0.78 mm, 7.64 ± 0.78 mm, and 7.48 ± 0.77 mm for T+PP+PE, T+PP, and T alone, respectively. T+PP+PE was statistically superior to T+PP (p = 0.004) and T alone (p < 0.001) with respect to postdilation pupil size. The proportion of pupils able to achieve adequate pupil dilation of >7 mm was 90%, 80%, and 70% for T+PP+PE, T+PP, and T alone, respectively. No statistical difference was observed in each regimen's ability to achieve adequate pupil dilation of >7 mm (T+PP+PE and T+PP: p = 0.47; T+PP+PE and T alone: p = 0.13). CONCLUSION The addition of phenylephrine eye drops to tropicamide produced larger pupil dilation, but the magnitude of benefit was marginal and clinically insignificant in this young, healthy cohort. A single-dilating-agent regimen using tropicamide could be considered in routine clinical practice.
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Affiliation(s)
- James C Liu
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO; Indiana University School of Medicine Transitional Residency Program, Indianapolis, IN..
| | - Wesley Green
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
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Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet 2017; 390:600-612. [PMID: 28242111 DOI: 10.1016/s0140-6736(17)30544-5] [Citation(s) in RCA: 510] [Impact Index Per Article: 72.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 12/11/2022]
Abstract
An estimated 95 million people worldwide are affected by cataract. Cataract still remains the leading cause of blindness in middle-income and low-income countries. With the advancement of surgical technology and techniques, cataract surgery has evolved to small-incisional surgery with rapid visual recovery, good visual outcomes, and minimal complications in most patients. With the development of advanced technology in intraocular lenses, the combined treatment of cataract and astigmatism or presbyopia, or both, is possible. Paediatric cataracts have a different pathogenesis, surgical concerns, and postoperative clinical course from those of age-related cataracts, and the visual outcome is multifactorial and dependent on postoperative visual rehabilitation. New developments in cataract surgery will continue to improve the visual, anatomical, and patient-reported outcomes. Future work should focus on promoting the accessibility and quality of cataract surgery in developing countries.
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Affiliation(s)
- Yu-Chi Liu
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore
| | - Mark Wilkins
- Department of Cornea and External Eye Disease, Moorfields Eye Hospital, London, UK
| | - Terry Kim
- Department of Cornea and External Disease, Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Boris Malyugin
- Department of Cataract and Implant Surgery, S Fyodorov Eye Microsurgery State Institution, Moscow, Russia
| | - Jodhbir S Mehta
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Department of Clinical Sciences, Duke-NUS Medical School, Singapore.
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Fontana L, Coassin M, Iovieno A, Moramarco A, Cimino L. Cataract surgery in patients with pseudoex-foliation syndrome: current updates. Clin Ophthalmol 2017; 11:1377-1383. [PMID: 28814824 PMCID: PMC5546806 DOI: 10.2147/opth.s142870] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated.
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Affiliation(s)
- Luigi Fontana
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Marco Coassin
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Alfonso Iovieno
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Luca Cimino
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
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Diakonis VF, Kontadakis GA, Anagnostopoulos AG, Yesilirmak N, Waren DP, Cabot F, Yoo SH, Donaldson KE. Effects of Short-term Preoperative Topical Ketorolac on Pupil Diameter in Eyes Undergoing Femtosecond Laser–Assisted Capsulotomy. J Refract Surg 2017; 33:230-234. [DOI: 10.3928/1081597x-20170111-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/03/2017] [Indexed: 11/20/2022]
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Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E2 release during femtosecond laser–assisted cataract surgery. J Cataract Refract Surg 2017; 43:492-497. [DOI: 10.1016/j.jcrs.2017.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/18/2022]
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Yu S, Tan G, Liu D, Yang X, Pan W. Nanostructured lipid carrier (NLC)-based novel hydrogels as potential carriers for nepafenac applied after cataract surgery for the treatment of inflammation: design, characterization and in vitro cellular inhibition and uptake studies. RSC Adv 2017. [DOI: 10.1039/c7ra00552k] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Schematic illustration of the novel formulation (nanostructured lipid carriers-based novel hydrogels) instills into the surface of eyes and the results of cytotoxicity and cell uptake for optimal formulation.
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Affiliation(s)
- Shihui Yu
- Department of Pharmaceutics
- School of Pharmacy
- Shenyang Pharmaceutical University
- Shenyang 110016
- China
| | - Guoxin Tan
- Department of Pharmaceutics
- School of Pharmacy
- Shenyang Pharmaceutical University
- Shenyang 110016
- China
| | - Dandan Liu
- School of Biomedical & Chemical Engineering
- Liaoning Institute of Science and Technology
- Benxi 117004
- PR China
| | - Xinggang Yang
- Department of Pharmaceutics
- School of Pharmacy
- Shenyang Pharmaceutical University
- Shenyang 110016
- China
| | - Weisan Pan
- Department of Pharmaceutics
- School of Pharmacy
- Shenyang Pharmaceutical University
- Shenyang 110016
- China
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Diakonis VF, Yesilirmak N, Sayed-Ahmed IO, Warren DP, Kounis GA, Davis Z, Cabot F, Yoo SH, O'Brien TP, Donaldson KE. Effects of Femtosecond Laser-Assisted Cataract Pretreatment on Pupil Diameter: A Comparison Between Three Laser Platforms. J Refract Surg 2016; 32:84-8. [PMID: 26856424 DOI: 10.3928/1081597x-20151229-03] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms. METHODS This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler. RESULTS A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis. CONCLUSIONS FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (≤ 6 mm) after FLACS pretreatment.
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Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence 2016; 10:1795-1801. [PMID: 27695298 PMCID: PMC5029911 DOI: 10.2147/ppa.s90468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
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Affiliation(s)
- Roberto Gonzalez-Salinas
- Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico
- Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Adriano Guarnieri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Saenz-de-Viteri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
- Correspondence: Manuel Saenz-de-Viteri, Ave Pio XII 36, 31008 Pamplona, Navarra, Spain, Tel +34 948 948 25 54 00, Fax +34 948 296 500, Email
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Lok JYC, Young AL. Corneal injection track: an unusual complication of intraocular lens implantation and review. Int J Ophthalmol 2015; 8:631-3. [PMID: 26086020 DOI: 10.3980/j.issn.2222-3959.2015.03.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/05/2014] [Indexed: 11/02/2022] Open
Abstract
Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens (IOL) implantation by injection, allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines, improvement of IOL injection systems and further maturation of surgeons' techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.
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Affiliation(s)
- Julie Y C Lok
- Department of Ophthalmology & Visual Sciences, the Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, the Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong
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47
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Abstract
Small pupils pose problems for cataract surgery. The pupil is dilated with topical mydriatic drugs for all cataract surgeries to improve the surgeon's access to, and visualization of, the lens nucleus, cortex, and capsular structures. Limited dilation poses a risk of surgical complications such as iris trauma or tearing of the anterior or posterior capsule. There are many ways and methods to achieve the appropriate pupil dilation, from pre-operative medications to intraoperative pharmacological and/or surgical methods. A management algorithm for small pupil will be discussed in this review. The various methods and maneuvers may work in isolation or combination to achieve adequate pupil dilation.
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Affiliation(s)
- Vineet Ratra
- From the *The C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen; and †The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
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48
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Affiliation(s)
- Joanne W Ho
- Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
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