Cataract surgery and lens implantation

Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia

PURPOSE

To compare the short-term changes in cornea, retina, and choroid of femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract.

SETTING

Affiliated Hospital of Nantong University, Jiangsu Province, China.

DESIGN

Prospective single-center study.

METHODS

Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded.

RESULTS

97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group ( P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month ( P < .05). CDVA and IOP were similar in both groups at the final visit ( P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group.

CONCLUSIONS

FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.

COMBINED APPLICATION OF B-SCAN ULTRASONOGRAPHY AND EYE-STEERING ULTRAWIDE FIELD IMAGING TO IMPROVE THE DETECTION OF RETINAL TEARS BEFORE CATARACT SURGERY

PURPOSE

To investigate the efficacy of combined application of B-scan ultrasonography (US) and ultrawide field imaging (UWFI) in detecting retinal tears before cataract surgery.

METHODS

Of 1,277 cataract patients, 2,552 eyes were enrolled and received both B-scan US and UWFI examinations preoperatively. Three types of combination were applied: type 1 (union, B-scan US or centered UWFI), type 2 (intersection, B-scan US and centered UWFI), and type 3 (B-scan US and eye-steering UWFI). Sensitivity and specificity of detecting retinal tears by different methods were assessed.

RESULTS

Totally 4.55% (116/2,552) of eyes were presented with retinal tears. The sensitivity of B-scan US and UWFI was 87.93% and 84.48%, and specificity was 95.16% and 99.79%, respectively. By applying type 1 and type 2 combination, the sensitivity was 98.28% and 74.14%, and specificity was 95.03% and 99.92%, respectively. By type 3 combination, the sensitivity increased to 95.69% and specificity to 99.88%, both of which were comparable to indirect ophthalmoscopy regardless of the number, type, and location of tears ( P > 0.05). In eyes with any cataract type or axial length, type 3 combination also gained comparable performance to indirect ophthalmoscopy.

CONCLUSION

Combined application of B-scan US and eye-steering UWFI presented satisfactory performance in detecting retinal tears before cataract surgery.

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis.

METHODS

A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software.

RESULTS

Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near).

CONCLUSIONS

For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Peripheral Vision in Patients Following Intraocular Lens Implantation: A Systematic Review and Meta-Analysis

PURPOSE

To update the literature on peripheral optics and vision following intraocular lens (IOLs) implantation.

METHODS

We investigated how current IOLs influence peripheral visual function, peripheral optical quality, and visual perception and performance, in patients following cataract surgery. Peripheral vision is described as vision outside the central foveal region of the eye (beyond 4-5° of eccentricity). We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and gray literature for relevant references. Randomized controlled trials and observational studies were eligible for inclusion. Finally, 47 studies with a total of 5963 participants were eligible for this review, of which 15 were included in the meta-analysis.

RESULTS

Regarding visual fields, the meta-analysis showed that the pooled estimate of mean deviation (MD) measured with perimetry tests (standard automated perimetry [SAP], short-wavelength automated perimetry [SWAP], and frequency doubling technology [FDT]) appears to be lower than the mean of healthy age-matched controls, regardless of IOL design. Results for pooled estimate show that localized defects (pattern standard deviation [PSD]) were higher than those in the healthy age-matched controls for FDT. We also collected evidence demonstrating that pseudophakia increases peripheral astigmatism and a myopic shift from 20° onward, leading to decreased peripheral image quality compared with that in phakic eyes. Patient-reported outcomes on peripheral vision showed a pooled score estimate of 95.19, indicating high satisfaction, and for the Steps & Stairs questions, a pooled score estimate at 0.23, indicating no to little difficulty seeing steps and stairs.

CONCLUSIONS

Peripheral image quality is degraded in eyes after cataract surgery. Nevertheless, whether this degradation leads to impaired visual function in the periphery requires further investigation.

Advances in development of exosomes for ophthalmic therapeutics

Exosomes contain multiple bioactive molecules and maintain the connection between cells. Recent advances in exosome-based therapeutics have witnessed unprecedented opportunities in treating ophthalmic diseases, including traumatic diseases, autoimmune diseases, chorioretinal diseases and others. Utilization of exosomes as delivery vectors to encapsulate both drugs and therapeutic genes could yield higher efficacy and avoid the unnecessary immune responses. However, exosome-based therapies also come with some potential ocular risks. In this review, we first present a general introduction to exosomes. Then we provide an overview of available applications and discuss their potential risks. Moreover, we review recently reported exosomes as delivery vectors for ophthalmic diseases. Finally, we put forward future perspectives to grapple with its translation and underlying issues.

Effects of cataract surgery on blinking

PURPOSE

To assess the effects of cataract surgery on the spontaneous blinking pattern and blinking kinematics.

SETTING

FISABIO Oftalmología Médica Eye Hospital, Valencia, Spain.

DESIGN

Observational descriptive clinical study.

METHOD

Patients with senile cataract were evaluated before (visit 1) and at 1 month (visit 2) and 3 months (visit 3) after undergoing phacoemulsification cataract surgery. The blinking of patients was recorded for 90 seconds using an eye-tracking device. Blinks were analyzed by means of image analysis to obtain a noninvasive detailed description of blinking including blink rate, number of complete and incomplete blinks, percentage of incomplete blinks, and kinematic parameters, including amplitude, closing, contact, opening, and total durations and closing and opening speeds.

RESULTS

50 patients were included in this study. The blink rate was significantly smaller at visit 3 compared with baseline ( P = .03) and visit 2 ( P = .001). Likewise, the number of complete blinks was significantly smaller, and the percentage of incomplete blinks was significantly higher at 3 months postoperatively compared with baseline ( P = .02 and P = .01, respectively), although no differences were observed at 1 month postoperatively ( P > .05). Conversely, no differences in the number of incomplete blinks or any kinematic parameter were observed between visits ( P = .12).

CONCLUSIONS

Cataract surgery significantly altered the blinking pattern at 3 months postoperatively, although kinematic parameters remained unvaried. Clinicians should be aware of potential alterations in blinking after phacoemulsification cataract surgery and the implications this may have on the ocular surface of patients.

Visual function assessment of Chinese cataract patients after individual aspheric intraocular lens implantation according to preoperative cornea spherical aberration

BACKGROUND: Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. OBJECTIVE: This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. METHODS: We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p< 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. CONCLUSION: It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5∘, but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function.

Exploring the Protective Effect and Mechanism of Buddlejae Flos on Sodium Selenite-Induced Cataract in Rats by Network Pharmacology, Molecular Docking, and Experimental Validation

Objective

Buddlejae Flos has a long history of utilization by humans to treat ophthalmic diseases. Although in vitro study revealed that it can be used for treating cataract, the bioactive components and the mechanism of efficacy remained unclear. This study aims to discover the bioactive components and mode of efficacy of Buddlejae Flos in cataract treatment.

Methods

Several databases were screened for bioactive components and corresponding targets, as well as cataract-related targets. Using the String database, common targets were determined and utilized to construct protein-protein interactions (PPI). The drug-component-target-disease network map was drawn using Cytoscape software. R language was utilized to execute Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) pathway enrichment analysis. Molecular docking was done through Schrödinger Maestro software utilization. Luteolin's (LUT) effect on cataract induced by sodium selenite in rat pups was evaluated.

Results

Six bioactive components with 38 common targets were identified as being associated with cataract. TP53, AKT1, EGFR, CASP3, TNF, ESR1, INS, IL6, HIF1A, and VEGFA were identified as core targets in PPI analysis, and the binding energy of LUT with AKT was the lowest. LUT has been demonstrated to significantly lower MDA levels, raise glutathione (GSH) levels, and boost the activity of antioxidant enzymes like GST, SOD, GPx, and CAT. After LUT treatment, TNF-a, IL-2, and IL-6 levels were significantly lowered. Bcl-2 mRNA expression levels and p-PI3K and p-AKT protein expression were significantly elevated. In contrast, caspase-3 and Bax mRNA expression levels were significantly decreased.

Conclusion

This study demonstrates that LUT is a possible bioactive component that may be utilized for cataract treatment. Its mode of action includes oxidative stress suppression, reducing inflammation, and inhibiting apoptosis via regulating the PI3K/AKT single pathway.

Dynamic monocyte chemoattractant protein-1 level as predictors of perceived pain during first and second phacoemulsification eye surgeries in patients with bilateral cataract

Background

The purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract.

Methods

Consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups.

Results

pain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries.

Conclusions

MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.

Iris Registration Capsulotomy Marking Versus Manual Marking for Toric Intraocular Lens Alignment in Cataract Surgery

PURPOSE

To compare the accuracy of toric intraocular lens (IOL) alignment and visual outcomes using femtosecond laser-assisted capsulotomy marking (CM) versus conventional slit lamp-assisted manual marking (MM).

DESIGN

Prospective cohort study.

METHODS

A total of 57 patients who required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T8) were assigned to the CM group (26 eyes) or the MM group (31 eyes). Uncorrected distant visual acuity (UCDVA), best-corrected distant visual acuity (BCDVA), residual astigmatism (RA), IOL misalignment, and modulation transfer function (area ratio [AR] value) were measured 1 and 3 months after surgery.

RESULTS

Postoperative UCDVA (logarithm of minimal angle of resolution [logMAR]) was significantly lower in the CM group than that in the MM group (P < .05). Postoperative RA and IOL misalignment were significantly lower in the CM group than that in the MM group (both P < .05). No significant difference between the groups was observed for BCDVA or AR value (both P > .05). UCDVA (logMAR) was positively correlated with RA (r = 0.339; P < .05) and IOL misalignment (r = 0.317; P < .05) and negatively correlated with the the AR value (r = -0.272; P < .05); RA was positively correlated with IOL misalignment (r = 0.405; P < .05).

CONCLUSIONS

The accuracy of the axis alignment was significantly higher in the CM group, which resulted in lower residual astigmatism and better visual outcomes.

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

Background

With the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.

Methods

This retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.

Results

Twenty-one Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was − 0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ±0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.

Conclusions

Trifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.

Efficacy and safety of extended depth of focus intraocular lenses in cataract surgery: a systematic review and meta-analysis

Background

This study aims to evaluate the efficacy and safety of extended depth of focus (EDOF) intraocular lenes (IOLs) in cataract surgery.

Methods

All comparative clinical trials that involved bilaterally implanting EDOF IOLs in patients with cataract were retrieved from the literature database. We used random effects models to pool weighted mean differences (WMD) and risk ratio (RR) for continuous and dichotomous variables, respectively.

Results

Nine studies with a total of 1336 eyes were identified. The subgroup analysis was conducted according to the type of IOLs used in the control group. Compared with monofocal IOLs, EDOF IOLs produced better uncorrected intermediate visual acuity (WMD: -0.17, 95% CI: − 0.26 to − 0.08, P = 0.0001) and uncorrected near visual acuity (WMD: -0.17, 95% CI: − 0.21 to − 0.12, P < 0.00001). EDOF IOLs resulted in reduced contrast sensitivity, more frequent halos, however, higher spectacle independence (RR: 2.81, 95% CI: 1.06 to 7.46, P = 0.04) than monofocal IOLs. Compared with trifocal IOLs, EDOF IOLs produced worse near visual acuity (MD: 0.10, 95% CI: 0.07 to 0.13, P < 0.0001). EDOF IOLs performed better than trifocal IOls in contrast sensitivity, and there were no significant difference in halos and spectacle independence. Serious postoperative complications were rare, with no adverse events were reported in most studies.

Conclusions

Increasing the risk of contrast reduction and more frequent halos, EDOF IOLs provided better intermediate and near VAs than monofocal IOLs. At the expense of near vision, patients receiving EDOF IOLs have better contrast sensitivity than those receiving trifocal IOLs. Halo incidence and spectacle independence of EDOF IOLs were similar to those of trifocal IOLs.