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Gobeka HH, Erakgün T. Optimising image quality with EyeMax Mono lens in dry age-related macular degeneration. Ir J Med Sci 2023; 192:1979-1986. [PMID: 36094732 DOI: 10.1007/s11845-022-03151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To investigate clinical outcomes in patients with dry age-related macular degeneration (AMD) after intracapsular implantation of a novel EyeMax Mono macular lens. METHODS In this study, 22 phakic eyes of 19 moderate to advanced dry AMD patients with macular disciform scar and/or macular atrophy who were followed up for ≥ 3 months after surgery were studied. A thorough pre-operative ophthalmological examination was performed, including measurement of corrected distance visual acuity in logMAR and ETDR. Following phacoemulsification, the EyeMax Mono lens was implanted intracapsularly via a 2.2-mm clear corneal incision to improve retinal image quality in all areas of the macula ≤ 10° from the central fovea. Main outcome measures included optimisation of corrected distance visual acuity and surgical safety. RESULTS Male-to-female ratio was 13:6. Mean age at surgery was 68.37 ± 10.23 years. The mean duration of post-operative follow-up was 7.91 ± 3.42 months. The mean post-operative refractive spherical equivalent improved to + 2.31 ± 1.56 D with significant visual improvement as early as 3 months post-operatively. Post-operative corrected distance visual acuity improved significantly from 1.05 ± 0.45 to 0.72 ± 0.43 logMAR (P < 0.001), equivalent to mean ETDRS of 49.55 ± 20.05 (P < 0.001). There were no major surgical complications, either intra- or post-operatively, except in two patients who experienced intra-operative haptic rupture. CONCLUSIONS Extended macular vision lenses appear to have a comparable safety profile as standard IOLs in the short to medium term. It could be the preferred lens for improving and preserving visual acuity in moderate to advanced dry AMD patients.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey.
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Mackenbrock LHB, Weindler JN, Labuz G, Baur ID, Auffarth GU, Khoramnia R. Change in Subfoveal Choroidal Thickness following Cataract Surgery Imaged with Enhanced Depth Imaging Optical Coherence Tomography. Klin Monbl Augenheilkd 2023; 240:989-996. [PMID: 37567233 DOI: 10.1055/a-2120-7415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Due to its invasive nature, cataract surgery can lead to inflammatory processes in the posterior segment, which can result in prolonged recovery times, reduced functional outcomes, and late-onset complications. The aim of the current study was to identify wherever phacoemulsification parameters play a role in choroidal thickness change following cataract surgery. METHODS This prospective single-center study enrolled 31 patients (31 eyes) scheduled to undergo routine cataract surgery. Patients with previous ocular surgeries, pathologies or general disorders affecting vision were excluded. Patients were examined preoperatively, as well as 1, 4, and 12 weeks after surgery. Corrected distance visual acuity (CDVA), intraocular pressure (IOP) as well as cumulative dissipated energy (CDE), ultrasound time (UT), and fluids used during surgery were recorded. Subfoveal choroidal thickness was measured manually by two masked independent experts using enhanced depth imaging (EDI) optical coherence tomography (OCT). Furthermore, cataract density was automatically calculated using a custom MATLAB script and an anterior segment OCT. RESULTS Subfoveal choroidal thickness increased significantly (p < 0.001, Student's paired sample t-test) and continuously during the 12-week-long follow-up period. Both the nuclear lens density and the improvement in CDVA correlated significantly with this increase (r = 0.413, p = 0.021 and r = 0.421, p = 0.018, respectively). Neither the CDE (r = 0.334, p = 0.071), the UT (r = 0.102, p = 0.629), the amount of fluid used (r = 0.237, p = 0.27) nor the decrease in IOP (r = - 0.197, p = 0.288) showed any significant correlation with the choroidal swelling. CONCLUSION Cataract surgery leads to an increase in subfoveal choroidal thickness. While no statistically significant correlation to the phacoemulsification parameters could be established, this might be because of a selection bias due to the technological constraints of the OCT. Nevertheless, the choroid might play a central role in early- and late-onset complications.
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Affiliation(s)
- Lars H B Mackenbrock
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan N Weindler
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Grzegorz Labuz
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Isabella D Baur
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
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Association between Cataract Surgery and Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. J Ophthalmol 2022; 2022:6780901. [PMID: 35573811 PMCID: PMC9098349 DOI: 10.1155/2022/6780901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/24/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We performed a systematic review and meta-analysis to evaluate the association between cataract surgery and the development and progression of AMD. Methods This meta-analysis was registered at PROSPERO (CRD42017077962). We conducted a systematic literature search in August 2020 in Embase and PubMed and included cohort studies, case-control studies, or randomized controlled trials (RCTs) if they examined the association between cataract surgery and AMD. Odds ratio (OR) was used as a measure of the association with a random effect model. The analysis was further stratified by factors that could affect the outcomes. Results 15 studies were included in this study. In the overall analysis, cataract surgery was significantly associated with the incidence of late AMD (OR, 1.80; 95% CI, 1.26–2.56; P = 0.001), particularly geographic atrophy (OR, 3.20; 95% CI, 1.90–5.39; P ≤ 0.001). No significant associations were observed between cataract surgery and the incidence of early AMD. Subgroup analysis showed that the OR for incidence of early and late AMD was significantly higher for cataract surgery performed more than 5 years compared with less than 5 years. We also found an increased risk of progression of AMD after cataract surgery performed more than 5 years (OR, 1.97; 95% CI, 1.29–3.01; P = 0.002). Conclusions Our results suggest that cataract surgery may be associated with an increased risk of late AMD development and AMD progression. In addition, increasing the follow-up time since cataract surgery may further increase the risk for the development and progression of AMD. In the future, prospective multicenter studies with well-designed RCTs are required to confirm our findings.
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Borkenstein AF, Borkenstein EM, Murphy K, Primo SA. Testing Activities of Daily Living (ADL) in Patients with Age-Related Macular Degeneration Undergoing Cataract Surgery: Lessons Learned from the Past and Development of a New Quality of Life (QOL) Test. Clin Ophthalmol 2022; 16:385-387. [PMID: 35185330 PMCID: PMC8847117 DOI: 10.2147/opth.s356423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Graz, 8010, Austria
- Correspondence: Andreas F Borkenstein, Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Kreuzgasse 35, Graz, 8010, Austria, Tel +433163313880, Email
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein, Private Practice and Privatklinik der Kreuzschwestern, Graz, 8010, Austria
| | - Karen Murphy
- VisionWorks Rehabilitation, LLC, Novi, MI, 48374, USA
| | - Susan A Primo
- Emory University School of Medicine, Department of Ophthalmology, Atlanta, GA, 30322, USA
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Karesvuo P, Elbaz U, Achiron A, Hecht I, Kaarniranta K, Tuuminen R. Effect of cataract surgery on wet age-related macular degeneration activity. Acta Ophthalmol 2022; 100:e262-e269. [PMID: 33838002 DOI: 10.1111/aos.14864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Wet age-related macular degeneration (AMD) and age-related cataract are often coexisting causes of visual impairment. Yet, the timing of cataract surgery in wet AMD patients is controversial. METHODS One hundred and eleven eyes of 111 patients with wet AMD underwent cataract surgery at Helsinki University Hospital in Finland during 2014-2018. Best-corrected visual acuity and central subfield macular thickness (CSMT) were analysed at the time of wet AMD diagnosis, at the last recording prior to cataract surgery and at the first recording and at 1 year after surgery. The cumulative number of antivascular endothelial growth factor (anti-VEGF) injections at surgery, systemic and topical medication and postoperative anti-VEGF burden were recorded. RESULTS Mean age was 78.9 ± 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 ± 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 ± 0.46 logMAR units preoperatively to 0.39 ± 0.40 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, p < 0.001 for both) and anti-VEGF treatment intervals lengthened despite the surgery (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, p = 0.246, and to 7.05 ± 2.57 weeks at the last documented visit, p = 0.035). A CSMT increase of over 30% from the preoperative values was seen in only one case (1 out of 111 eyes, 0.9%). Macular status at surgery, wet AMD subtype, comorbidity of type II diabetes, systemic drugs and topical anti-inflammatory medication were not associated with macular changes nor with treatment intervals after surgery. The cumulative number of anti-VEGF injections correlated neither with CSMT change postoperatively (r = -0.051, p = 0.619) nor with CSMT change at 1 year (r = 0.091, p = 0.426). CONCLUSION Satisfactory visual outcomes and controlled disease activity were seen in patients with wet AMD undergoing cataract surgery. We found no evidence to support delaying surgery in patients who require it.
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Affiliation(s)
- Petteri Karesvuo
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Uri Elbaz
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Rabin Medical Center Petach‐Tikva, Tel Aviv Israel
| | - Asaf Achiron
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Wolfson Medical Center Holon Israel
- Bristol Eye Hospital Bristol UK
| | - Idan Hecht
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Shamir Medical Center Tel Aviv Israel
| | - Kai Kaarniranta
- Department of Ophthalmology University of Eastern Finland Kuopio Finland
- Department of Ophthalmology Kuopio University Hospital Kuopio Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Borkenstein AF, Borkenstein EM. Efficacy of Large Optic Intraocular Lenses in Myopic Eyes with Posterior Segment Pathology. Ophthalmol Ther 2021; 11:443-452. [PMID: 34843086 PMCID: PMC8770767 DOI: 10.1007/s40123-021-00433-3] [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: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
We report a case series of patients with high myopia (axial length 25.04–27.59 mm) diagnosed with cataract and maculopathy who underwent a combined procedure of phacoemulsification with implantation of a large optic intraocular lens (IOL) and intravitreal injection. Six patients with a mean (± standard deviation) age of 73.20 ± 7.19 years received the 7.0-mm optic ASPIRA-aXA IOL (HumanOptics AG, Erlangen, Germany) and intravitreal injection of aflibercept at the end of the surgery. The corrected distance visual acuity (CDVA) improved significantly (p = 0.001) from a preoperative logMAR of 0.87 ± 0.28 logMAR to 0.49 ± 0.18 logMAR at 10 weeks postoperatively. Even though all patients had a persisting central scotoma due to their maculopathy, there was a significant improvement in their subjective quality of life and self-autonomy. Patients reported no postoperative dysphotopsia. During surgery and postoperative examinations, the wide IOL optic permitted an enhanced view of the fundus. The IOLs remained stable after implantation, especially during the intravitreal injection at the end of the surgery. No IOL displacement or shift of the lens was observed. Retinal diseases are sight-threatening and diminish the patient’s quality of life due to reduced visual acuity and visual field defects. When cataract surgery is performed in this patient group, a reduced prognosis can be assumed. Our results show that implantation of the large optic IOL enables a wide view of the fundus during and after surgery without any additional risks or negative effects. It may also reduce the risk of dysphotopsia in cases of IOL decentration in large capsular bags, but comparative studies with a higher number of cases are needed to confirm this. A large rhexis and large IOL optic seem to be advantageous for the retinal surgeon in follow-up surgeries on the posterior segment of the eye.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria
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Recurring themes during cataract assessment and surgery. Eye (Lond) 2021; 35:2482-2498. [PMID: 33927353 DOI: 10.1038/s41433-021-01548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
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Chen AX, Haueisen A, Rasendran C, Hom GL, Conti TF, Conti FF, Greenlee TE, Briskin IN, Bena JF, Singh RP, Talcott KE. Visual outcomes following cataract surgery in age-related macular degeneration patients. Can J Ophthalmol 2021; 56:348-354. [PMID: 33609442 DOI: 10.1016/j.jcjo.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate visual acuity (VA) outcomes, prognostic factors, and changes in disease severity in patients with age-related macular degeneration (AMD) undergoing cataract surgery. DESIGN Retrospective cohort study PARTICIPANTS: Patients with AMD or healthy control patients who underwent cataract surgery between 2012 and 2017. METHODS Eyes were categorized into 3 AMD groups-intermediate AMD (iAMD), fovea-involving geographic atrophy (GA), neovascular AMD (nAMD)-and 3 preoperative VA-matched control groups (iAMDc), fovea-involving geographic atrophy control (GAc), neovaascular AMD control (nAMDc). RESULTS We compared 216 iAMD, 35 GA, and 184 nAMD eyes with 130, 31, and 129 controls. At postoperative month 12 (POM12), VA increased significantly in iAMD and nAMD (+10.1 ± 14.5 and +9.7 ± 18.9 letters, p < 0.001), but not in GA (p = 0.68). All control groups showed significant VA gains (iAMDc: +17.1 ± 9.7, GAc: +30 ± 12.9, and nAMDc: +26.4 ± 15.6 letters, p < 0.001). For AMD groups, POM12 VA and gain in VA were significantly lower than that of controls (p < 0.01), and better preoperative VA predicted smaller VA gains (p ≤ 0.007). Longer duration of AMD in iAMD, ellipsoid zone disruption in nAMD, and lower central subfield thickness in GA were associated with poorer VA outcomes (p < 0.05). Development of nAMD occurred in 8 iAMD eyes and was associated with longer duration of disease (p = 0.001). For nAMD eyes, injection frequency did not vary between the 12-month pre- and postoperative periods (p = 0.051). CONCLUSIONS Cataract surgery improves VA for patients with iAMD and nAMD, albeit not to the level of those without retinal pathology. Preoperative VA, AMD duration, and optical coherence tomography parameters may be important prognostic factors for cataract surgery in patients with AMD.
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Affiliation(s)
- Andrew X Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Grant L Hom
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Thais F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Felipe F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler E Greenlee
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Isaac N Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Age-Related Macular Degeneration: Epidemiology and Clinical Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:1-31. [PMID: 33847996 DOI: 10.1007/978-3-030-66014-7_1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the risk of progression to late AMD. Late AMD is divided into neovascular and atrophic forms, though these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible, and can comprise profoundly decreased central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience substantially decreased quality of life and independence. Recent advances in retinal imaging have led to the recognition of an expanded set of AMD phenotypes, including reticular pseudodrusen, nonexudative macular neovascularization, and subtypes of atrophy. These developments may lead to refinements in current classification systems.
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Borkenstein AF, Borkenstein EM. Four Years of Observation to Evaluate Autonomy and Quality of Life after Implantation of a High-Add Intraocular Lens in Age-Related Macular Degeneration Patients. Case Rep Ophthalmol 2020; 11:448-456. [PMID: 32999675 PMCID: PMC7506221 DOI: 10.1159/000508914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
Visual impairment resulting from advanced dry age-related macular degeneration (AMD) limits the ability to perform activities required for independent living and adversely affects quality of life. We aimed to determine changes in these parameters in patients with AMD-related geographic atrophy who underwent magnifying cataract surgery (MAGS) using a foldable, bifocal high-add intraocular lens (IOL). The high-add IOL (LENTIS® MAX LS-313 MF 80, Oculentis) was implanted in the better seeing or dominant eye of eligible patients with clinically significant cataract, best corrected distance visual acuity 1.3–0.5 logMAR (20/400–20/63), best corrected near visual acuity >0.8 logMAR (20/125), and stable advanced dry AMD. Self-reported feasibility of performing routine activities and change in quality of life were the main outcome measures. Eleven of 15 operated patients had complete follow-up to 48 months. There were no significant intraoperative or postoperative complications. AMD converted from dry to wet in 2 patients. All patients reported functional gains in the first 3–6 months after surgery, and 10/11 patients reported improved quality of life. From baseline to 48 months, functional performance remained improved in all patients, and quality of life remained improved in the 9 patients with stable AMD. Best corrected distance visual acuity and uncorrected near visual acuity improved in all cases after surgery.
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Gan AT, Man RE, Cheung CMG, Kumari N, Fenwick EK, Sabanayagam C, Tham YC, Tan NY, Mitchell P, Wong TY, Cheng CY, Lamoureux EL. Cataract Surgery and the 6-year Incidence of Age-Related Macular Degeneration in a Multiethnic Asian Cohort. Asia Pac J Ophthalmol (Phila) 2020; 9:130-136. [PMID: 31996565 DOI: 10.1097/apo.0000000000000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether cataract surgery was associated with age-related macular degeneration (AMD) development in Asian patients. DESIGN Longitudinal cohort study. METHODS Participants from the Singapore Malay and Indian Eye Studies were recruited between 2004 and 2015. A total of 6790 late-AMD-free eyes from 3475 individuals were followed for 6 years on average. Multivariable regression analysis using generalized estimating equations determined associations between cataract surgery and the incidence of any, early, and late AMD. RESULTS The mean age (SD) of participants was 55.5 (9.1) years; 48.1% were male; 11.3% of eyes had cataract surgery recorded; incident any, early, and late AMD developed in 238 (3.6%), 222 (3.4%), and 29 (0.4%) eyes, respectively. Operated eyes had higher incidence of late AMD [1.4% vs 0.3%; adjusted risk ratio (RR): 3.47, 95% confidence interval (CI) 1.40-8.57], but not early AMD (6.0% vs 3.0%, adjusted RR: 1.12, 95% CI 0.76-1.64) or any AMD (6.9 vs 3.2%, adjusted RR: 1.23, 95% CI 0.85-1.78). CONCLUSIONS Our data are consistent with findings in population-based Caucasian studies that cataract surgery may be associated with incidence of late AMD. However, the absolute risk of late AMD development remains low and physicians should continue to balance the benefits and risks of cataract surgery in elderly patients.
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Affiliation(s)
- Alfred Tl Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ryan Ek Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore
| | - Neelam Kumari
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nicholas Yq Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore
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Borkenstein AF, Borkenstein EM. A case report detailing use of a new intraocular lens with advanced technology, designed specifically for patients with center-involving macular disorders. Medicine (Baltimore) 2019; 98:e16583. [PMID: 31348295 PMCID: PMC6709155 DOI: 10.1097/md.0000000000016583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Many studies have shown that cataract surgery can be performed safely and improve visual acuity, without increasing the risk of progression of existing age-related macular degeneration (AMD). Data are emerging for an intraocular lens (IOL) that utilizes an advanced optical design to optimize the image supplied to all areas of the macula and not just the foveal center, which may benefit patients with center-involving macular disorders. PATIENT CONCERNS An 83-year-old Caucasian female presented with poor contrast sensitivity and color perception with increasing glare over the preceding year. DIAGNOSIS She had a progressive cortical cataract and stable dry AMD in the left eye, and wet AMD in the right eye. In the left eye, preoperative best-corrected distance visual acuity (BCDVA) was 0.2 (decimal) and best-corrected near visual acuity (BCNVA) was 0.05 (decimal). INTERVENTIONS Standard small-incision phacoemulsification was performed in the left eye, with capsular bag implantation of EyeMax Mono (LEH Pharma, London, UK), a single-piece, soft, hydrophobic, acrylic IOL designed to optimize image quality across the macula, rather than a standard monofocal lens. OUTCOMES At 6 months postoperation, visual acuity in the left eye had markedly improved, with a BCDVA of 0.5 (decimal) and a BCNVA of 0.2 (decimal). CONCLUSION In this first case undertaken at our center (and the first in Austria), cataract extraction and EyeMax Mono implantation were performed safely, with good subjective and objective outcome measures consistent with the effects of image optimization across the macula. Further studies of this IOL in patients with center-involving macular disorders, such as AMD, are warranted.
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Modenese A, Gobba F. Macular degeneration and occupational risk factors: a systematic review. Int Arch Occup Environ Health 2018; 92:1-11. [PMID: 30191305 PMCID: PMC6323067 DOI: 10.1007/s00420-018-1355-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/04/2018] [Indexed: 01/08/2023]
Abstract
Purpose Macular degeneration is a multi-factorial disease, leading cause of blindness for people over 50 years old in developed countries. To date, the knowledge on possible occupational factors involved in the development of the disease is scant. Method We performed a systematic scientific literature search on the association between macular degeneration and occupational risk factors searching the MedLine and Scopus databases. Results We examined 158 articles and, according to the inclusion criteria, 13 peer-reviewed studies evaluating occupational risk factors for macular degeneration or reporting the frequency of the disease in specific groups of workers were included in the review. Ten on thirteen articles evaluated the presence of macular degeneration in workers exposed to solar radiation. Only one study found that non-specific history of occupational chemical exposure was associated with the disease. Two studies showed an association between macular degeneration and the general category of “blue-collar” workers, but they did not identify the specific risk factors involved. Conclusions To date few studies have examined occupational risk factors for macular degeneration. Nevertheless, available data indicate that long-term occupational solar radiation exposure, in particular for its blue-light component, is associated with macular degeneration in outdoor workers. Electronic supplementary material The online version of this article (10.1007/s00420-018-1355-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125, Modena, Italy.
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125, Modena, Italy
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Chen H, Wu Z, Chen Y, He M, Wang J. Short-term changes of choroidal vascular structures after phacoemulsification surgery. BMC Ophthalmol 2018; 18:81. [PMID: 29566650 PMCID: PMC5865294 DOI: 10.1186/s12886-018-0749-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the changes of choroidal vascular structures in patients after phacoemulsification surgery. METHODS A self-control study was conducted on 36 eyes of 36 patients who had uneventful phacoemulsification. Choroidal images were acquired preoperatively, 7 days (D7), 1 month (M1), and 3 months (M3) after surgery from enhanced depth imaging (EDI) optical coherence tomography (OCT) scans. Choroidal vascularity index (CVI) was used to assess vascular status of the choroid using image binarization by the Niblack method. The postoperative values of mean CVI were compared with baseline by paired t-test. Univariate and multiple linear regression analyses were performed to determine the associations between CVI and other factors. RESULTS The mean age of the recruited patients was 63.1 ± 6.9 years. The mean CVI at baseline was 60.1 ± 5.5%. After surgery, the CVI significantly increased to 61.7 ± 5.3% at D7, 63.6 ± 4.4% at M1 and 64.8 ± 4.0% at M3 (p = 0.035, 0.0006, < 0.0001, respectively). Univariate and multiple regression analysis revealed a positive association between CVI and subfoveal choroidal thickness (SFCT) at pre-operation and no significant association with age, axial length (AL), intraocular pressure (IOP) and gender at all timepoints. CONCLUSIONS Phacoemulsification induced increased CVI in patients diagnosed with cataract. Evaluation of the long-term change of CVI following surgery may provide valuable information for studying the relationship between phacoemulsification and disorders of the choroid.
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Affiliation(s)
| | - Zheming Wu
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Yun Chen
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Manshan He
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Jiawei Wang
- Eye Center of Shandong University, The Second Hospital of Shandong University, Shandong University, Jinan, 250000, China.
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Intraocular Telescopic System Design: Optical and Visual Simulation in a Human Eye Model. J Ophthalmol 2017; 2017:6030793. [PMID: 28469941 PMCID: PMC5392401 DOI: 10.1155/2017/6030793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/26/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose. To design an intraocular telescopic system (ITS) for magnifying retinal image and to simulate its optical and visual performance after implantation in a human eye model. Methods. Design and simulation were carried out with a ray-tracing and optical design software. Two different ITS were designed, and their visual performance was simulated using the Liou-Brennan eye model. The difference between the ITS was their lenses' placement in the eye model and their powers. Ray tracing in both centered and decentered situations was carried out for both ITS while visual Strehl ratio (VSOTF) was computed using custom-made MATLAB code. Results. The results show that between 0.4 and 0.8 mm of decentration, the VSOTF does not change much either for far or near target distances. The image projection for these decentrations is in the parafoveal zone, and the quality of the image projected is quite similar. Conclusion. Both systems display similar quality while they differ in size; therefore, the choice between them would need to take into account specific parameters from the patient's eye. Quality does not change too much between 0.4 and 0.8 mm of decentration for either system which gives flexibility to the clinician to adjust decentration to avoid areas of retinal damage.
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Patient-centered advancements in cataract surgery. Curr Opin Ophthalmol 2016; 28:1-2. [PMID: 27820749 DOI: 10.1097/icu.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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