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Vallée R, Meduri E, Vallée JN, Lallouette A, Haffane Z, Paillard A, Mansouri K, Mermoud A. Predictive biomarkers of intra-ocular pressure decrease after cataract surgery associated with trabecular washout in patients with pseudo exfoliative glaucoma. Sci Rep 2024; 14:13567. [PMID: 38866840 PMCID: PMC11169244 DOI: 10.1038/s41598-024-53893-5] [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: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 06/14/2024] Open
Abstract
To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOPBL) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOPBL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOPBL was 0.85 and 0.94 (p < 0.0001, respectively), with IOPBL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOPBL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease.
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Affiliation(s)
- Rodolphe Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France.
- Mathematics and Applications Laboratory (LMA), CNRS UMR7348, LRCOM i3M-DACTIMMIS, University of Poitiers, Poitiers, France.
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Enrico Meduri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Jean-Noël Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France
| | - Athena Lallouette
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Zakarya Haffane
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Archibald Paillard
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Ophthalmology Department, Colorado University Medical School, Denver, CO, USA
| | - André Mermoud
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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Wang X, Jiang X, Liu Z, Wang C, Li X. Coexistence of MRCS syndrome, extremely long axis and exfoliation syndrome: a case report and literature review. BMC Ophthalmol 2023; 23:241. [PMID: 37254066 DOI: 10.1186/s12886-023-02965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The coexistence of MRCS (microcornea, retinal dystrophy, cataract, and posterior staphyloma) syndrome and extremely long axis is rare since microcornea frequently accompanies with diminution of entire anterior segment and occasionally the whole globe. In the case presented here, combination of these two elements were identified, together with XFS (exfoliation syndrome). CASE PRESENTATION A 66-year-old Han Chinese woman presented for consultation due to impaired vision which accompanied throughout her entire life span and worsened during the last 2 years. Combination of MRCS syndrome and extremely long axial length was evidently diagnosed in both eyes, with XFS confirmed in her right eye, but mutation screening failed to identify disease-causing sequence variants in some specific genes reported previously, including BEST1 and ARL2. However, likely pathogenic mutations in FBN2 gene were identified. Bilateral cataract phacoemulsification without intraocular lens implantation was performed using scleral tunnel incision and under general anesthesia. At 3-month follow-up, ocular recovery of the patient was satisfactory. CONCLUSIONS The case presented here exhibited rare coexistence of MRCS syndrome, extremely long axis and XFS. The complexity of her ocular abnormalities brought challenges to surgical management, in which multidisciplinary collaboration is often required. Furthermore, the genetic analysis in this case yielded a possible novel candidate gene for MRCS syndrome and provided evidence in support of genetic heterogeneity in this phenotype.
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Affiliation(s)
- Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China.
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Haidian District, 49 North Garden Road, Beijing, China.
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Shouchane-Blum K, Zahavi A, Geffen N, Nahum Y, Livny E, Rosenblatt I, Sella R, Bahar I, Sternfeld A, Gaton D. Long-Term Evaluation of Pseudoexfoliation Syndrome Post-Cataract Extraction. J Pers Med 2023; 13:jpm13050818. [PMID: 37240988 DOI: 10.3390/jpm13050818] [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: 04/07/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to examine the effect of cataract extraction on ophthalmologists' ability to detect pseudoexfoliation (PXF) syndrome. A total of 31 patients admitted for elective cataract surgery were enrolled in this prospective comparative study. Prior to surgery, patients underwent slit-lamp examination and gonioscopy conducted by experienced glaucoma specialists. Subsequently, patients were re-examined by a different glaucoma specialist and comprehensive ophthalmologists. Pre-operatively, 12 patients were diagnosed with PXF on the basis of a Sampaolesi line (100%), anterior capsular deposits (83%), and pupillary ruff deposits (50%). The remaining 19 patients acted as controls. All patients were re-examined 10-46 months post-operatively. Of the 12 patients with PXF, 10 (83%) were correctly diagnosed post-operatively by glaucoma specialists and 8 (66%) by comprehensive ophthalmologists. There was no statistically significant difference in PXF diagnosis. However, detection of anterior capsular deposits (p = 0.02), Sampaolesi lines (p = 0.04), and pupillary ruff deposits (p = 0.01) were significantly lower post-operatively. Diagnosis of PXF is challenging in pseudophakic patients as the anterior capsule is removed during cataract extraction. Therefore, PXF diagnosis in pseudophakic patients relies mainly on the presence of deposits at other anatomical sites, and careful attention to these signs is required. Glaucoma specialists may be more likely than comprehensive ophthalmologists to detect PXF in pseudophakic patients.
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Affiliation(s)
- Karny Shouchane-Blum
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alon Zahavi
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noa Geffen
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Nahum
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eitan Livny
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Rosenblatt
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ruti Sella
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Bahar
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amir Sternfeld
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dan Gaton
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Suzuki T, Fujishiro T, Tachi N, Ueta Y, Okamoto Y, Fukutome T, Sasajima H, Ishida H, Watanabe Y, Hashimoto Y. Three-Year Outcomes of Immediate Primary Phacoemulsification on Acute Primary Angle Closure Eyes and the Fellow Eyes. Clin Ophthalmol 2023; 17:1035-1045. [PMID: 37041964 PMCID: PMC10083023 DOI: 10.2147/opth.s406067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
Purpose This study investigated the long-term outcomes (> 3 years) of immediate primary phacoemulsification in eyes with acute primary angle closure (APAC) and in the fellow eyes with shallow anterior chamber to prevent APAC development. Patients and Methods This is a retrospective study of phacoemulsification for APAC using bilateral eyes. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative month 1 (1m), year 3 (3y), and last visit were compared between 14 eyes with APAC and their 14 fellow eyes. The number of corneal endothelial cells (CECs) at Pre and at more than 2 weeks after phacoemulsification was compared. The visual field mean deviation (MD) within 1 year after phacoemulsification and at the last visit was also compared. Results For APAC eyes, BCVA was significantly improved at 1m, 3y, and at the last visit as compared with Pre (p < 0.05). IOP significantly decreased at 1m, 3y, and at the last visit compared with Pre (p < 0.05). IOP-lowering medication use decreased significantly from Pre to 1m (p < 0.05). The number of CECs was not significantly different between Pre and more than 2 weeks after phacoemulsification. BCVA was significantly worse in APAC eyes than in fellow eyes at Pre (p < 0.05). IOP and the number of IOP-lowering medications were significantly higher in APAC eyes than in fellow eyes at Pre (p < 0.05). Conclusion Primary phacoemulsification improved visual acuity for APAC eyes and maintained good IOP control without the need for reoperation. Moreover, it preserved the number of CECs for the APAC and fellow eyes in the long term.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo, Japan
- Correspondence: Takashi Fujishiro, Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongō, Bunkyō-ku, Tokyo, 113-8655, Japan, Tel +81-3-3815-5411, Email
| | - Naoko Tachi
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Tachi Eye Clinic, Toyama, Japan
| | - Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Yasuhiro Okamoto
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Takao Fukutome
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Hidetoshi Ishida
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Yuji Watanabe
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
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Rajendran S, Rajalakshmi AR, Srikanth K, Ezhumalai G. Manual small incision cataract surgery: a viable option for cataract with pseudoexfoliation. Int Ophthalmol 2021; 42:1447-1455. [PMID: 34839453 DOI: 10.1007/s10792-021-02134-z] [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: 06/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to assess the spectrum of clinical presentation, intraoperative challenges and immediate surgical outcome of cataract patients with pseudoexfoliation syndrome (PXF) following manual small incision cataract surgery (MSICS). METHODS This prospective observational study which was conducted in a rural tertiary care hospital included adult patients with cataract and associated PXF. MSICS was performed for all after a complete ophthalmic and systemic examination. Clinical profile, intraoperative and post-operative complications were noted. Uncorrected visual acuity on first day post-surgery was used to assess the surgical outcome following MSICS. RESULTS MSICS was performed in 80 eyes with varying grades of cataract and PXF. The mean age of the patients was 62.5 ± 8.9 years. PXF material on pupillary margin in 77(96%) patients was the most common finding noted. Majority of the patients had advanced cataract (72, 90%) and inadequate mydriasis (62, 77.5%). Posterior capsular rent (8, 10%) and zonular dehiscence (8, 10%) were the intraoperative difficulties faced. Uncorrected visual outcome on first post-operative day was moderate to good in 71 (88.8%) patients, limited by post-operative corneal oedema (21, 26.3%), iritis (31, 38.8%) and aphakia (9, 11.3%). CONCLUSION Patients with pseudoexfoliation had poor pupillary dilatation, advanced cataracts and higher rate of posterior capsular rent. Our study showed good outcome of MSICS in PXF patients, even with advanced cataract suggesting that MSICS is a safe, effective and viable option for patients with PXF and cataract.
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Affiliation(s)
- Sruthi Rajendran
- Anand Eye Hospital Clear Vision Centre, Trivandrum, Kerala, India.,Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India.
| | - K Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - G Ezhumalai
- Senior Statistician & Research consultant, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
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Parija S, Chakraborty K. Management of cataract in a case of retinitis pigmentosa with bilateral pseudoexfoliation syndrome. BMJ Case Rep 2021; 14:14/2/e238936. [PMID: 33547126 PMCID: PMC7871273 DOI: 10.1136/bcr-2020-238936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Retinitis pigmentosa (RP) patients are at higher risk for macular oedema, anterior capsular phimosis and spontaneous dislocation of the implanted lens after cataract surgery. A 70-year-old hypertensive woman presented with diminution of vision in her left eye since 2 years. She had history of cataract surgery in the right eye 1 year ago. Her visual acuity was 20/200 in right eye and hand movements in left eye. Slit-lamp examination showed anterior capsular phimosis with intraocular lens in the right eye and pseudoexfoliation in both the eyes. Fundus examination revealed features of RP in both the eyes. Optical coherence tomography showed bilateral foveal atrophy. The patient underwent phacoemulsification cataract surgery with intraocular lens implantation in left eye and Nd:YAG laser capsulotomy in right eye. Postoperative best corrected distance visual acuity was 20/125 in right eye and 20/80 in left eye. This case highlights a rare coincidence of pseudoexfoliation syndrome in a patient with RP and the precautions undertaken during cataract surgery for an optimal visual outcome.
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Affiliation(s)
- Sucheta Parija
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Koyel Chakraborty
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Efremov YM, Bakhchieva NA, Shavkuta BS, Frolova AA, Kotova SL, Novikov IA, Akovantseva AA, Avetisov KS, Avetisov SE, Timashev PS. Mechanical properties of anterior lens capsule assessed with AFM and nanoindenter in relation to human aging, pseudoexfoliation syndrome, and trypan blue staining. J Mech Behav Biomed Mater 2020; 112:104081. [PMID: 32961392 DOI: 10.1016/j.jmbbm.2020.104081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/05/2020] [Accepted: 09/05/2020] [Indexed: 01/05/2023]
Abstract
The purpose of this study is the mechanical characterization of the mid-to- old-age human anterior lens capsules (ALCs) obtained by capsulorhexis using Atomic Force Microscopy (AFM) and a nanoindenter at different spatial scales. The dependencies on the human age, presence or absence of pseudoexfoliation syndrome (PEX), and application of trypan blue staining during the surgery were analyzed. The measurements on both the anterior (AS) and epithelial (ES) sides of the ALC were conducted and the effect of cells present on the epithelial side was carefully accounted for. The ES of the ALC had a homogenous distribution of the Young's modulus over the surface as shown by the macroscale mapping with the nanoindenter and local AFM indentations, while the AS was more heterogeneous. Age-related changes were assessed in groups ranging from the mid-age (from 48 years) to old-age (up to 93 years). We found that the ES was always stiffer than the AS, and this difference decreased with age due to a gradual decrease in the Young's modulus of the ES and an increase in the modulus of the AS. No significant changes were found in the mechanical properties of ALCs of PEX patients versus the PEX-free group, as well as in the properties of the ALC with and without trypan blue staining.
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Affiliation(s)
- Yuri M Efremov
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia.
| | | | - Boris S Shavkuta
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia; Institute of Photon Technologies of Federal Scientific Research Centre "Crystallography and Photonics" of Russian Academy of Sciences, Pionerskaya 2, Troitsk, Moscow, 108840, Russia
| | - Anastasia A Frolova
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia
| | - Svetlana L Kotova
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia; N.N. Semenov Institute of Chemical Physics, 4 Kosygin St., Moscow, 119991, Russia
| | - Ivan A Novikov
- Research Institute of Eye Diseases, 11 Rossolimo St., Moscow, 119021, Russia
| | - Anastasia A Akovantseva
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia
| | | | - Sergei E Avetisov
- Research Institute of Eye Diseases, 11 Rossolimo St., Moscow, 119021, Russia; Sechenov University, 2 Bol'shaya Pirogovskaya St., Bldg.4, Moscow, 119991, Russia
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov University, 8 Trubetskaya St., Moscow, 119991, Russia; Institute of Photon Technologies of Federal Scientific Research Centre "Crystallography and Photonics" of Russian Academy of Sciences, Pionerskaya 2, Troitsk, Moscow, 108840, Russia; N.N. Semenov Institute of Chemical Physics, 4 Kosygin St., Moscow, 119991, Russia; Chemistry Department, Lomonosov Moscow State University, Leninskiye Gory 1-3, Moscow, 119991, Russia
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Tulu Aygun B, Altan C, Kirmaci Kabakci A. Comparison of phacoemulsification parameters in eyes with and without exfoliation syndrome. J Fr Ophtalmol 2020; 43:1031-1038. [PMID: 32972757 DOI: 10.1016/j.jfo.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate and to compare the phacoemulsification machine parameters in eyes with and without XFS, requiring cataract surgery. METHODS Patients who underwent phacoemulsification and in-the-bag IOL implantation for cataract were included in this retrospective study. All surgeries were performed by the same experienced surgeon using the stop & chop technique with the same phacoemulsification device (Infiniti Vision System, Alcon Laboratories, Inc., USA). Patients were divided into two groups according to the presence of exfoliation material (XFM). Each group consisted of consecutive patients. Their characteristics and intraoperative phacoemulsification parameters were compared. RESULTS Sixty-eight eyes of 68 patients [29 in the exfoliation syndrome (XFS) (-) group, 39 in XFS (+)] were enrolled. There were no statistical differences regarding preoperative patient characteristics. There was a statistically significant difference in total U/S time, phaco time, aspiration time and estimated fluid used between the XFS (+) and XFS (-) groups (P=0.021, P=0.017, P=0.009 and P=0.002, respectively). Considering that the use of a CTR (capsule tension ring) might be an important factor potentially affecting surgical parameters, the data were analyzed accordingly. Aspiration time and estimated fluid used remained statistically significant (P=0.046 and P=0.017, respectively); however, although the U/S total and phaco time were found to be longer in XFS (+) group compared to XFS (-) group, the difference did not show statistical significance (P=0.061 and P=0.059, respectively). There were no differences between groups regarding endothelial cell loss or any other postoperative complications. CONCLUSIONS The presence of XFS results in longer total U/S time, phaco and aspiration time and more estimated fluid used in phacoemulsification, but this prolongation does not result in additional complications.
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Affiliation(s)
- B Tulu Aygun
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Istanbul, Turkey.
| | - C Altan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Istanbul, Turkey
| | - A Kirmaci Kabakci
- University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Evaluation of the Utility of Capsular Stabilization Devices in a Zonular Fiber Defect Model with the Slit Side View System. J Ophthalmol 2020; 2020:5921965. [PMID: 32832137 PMCID: PMC7429767 DOI: 10.1155/2020/5921965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
Capsular stabilization devices were evaluated in a zonular fiber defect model using the slit side view (SSV) system to confirm their utility for capsular stabilization during phacoemulsification. A zonular fiber defect model was made by cutting Zinn’s zonule under observation with a slit lamp microscope in a porcine eye. Phacoemulsification was performed, and the movement of the lens capsule and the depth of the anterior chamber were observed using the SSV in three groups: control group: no surgical instruments used, CE group: a capsule expander was inserted, and CTR group: a capsular tension ring was inserted. In the control group, the equator of the lens was unstable and was easily suctioned to the port of the ultrasound handpiece. The lens capsule was stable in both in the CE and CTR groups. In the CTR group, the equator responsible for the zonular rupture also returned and closed true to its original position. The utility of the capsular stabilization devices in this zonular fiber defect model was confirmed with the SSV system.
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Łukasik U, Kosior-Jarecka E, Wróbel-Dudzińska D, Kustra A, Milanowski P, Żarnowski T. Clinical Features of Pseudoexfoliative Glaucoma in Treated Polish Patients. Clin Ophthalmol 2020; 14:1373-1381. [PMID: 32546945 PMCID: PMC7247722 DOI: 10.2147/opth.s239371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to describe clinical characteristics of glaucomatous optic neuropathy in treated Polish patients with pseudoexfoliative glaucoma. METHODS In the course of the study, 348 eyes of 231 patients with pseudoexfoliative glaucoma. The patients involved in the study were treated in the Department of Diagnostic and Microsurgery of Glaucoma in Lublin between 2012 and 2019. The following parameters were assessed in the examination: visual acuity, slit-lamp biomicroscopy with evaluation of anterior segment of the eye, gonioscopic examination, stereoscopic fundus examination of the eye, intraocular pressure, visual field, and pachymetry. RESULTS The mean age of all the patients was 73.16 years (SD±8.03). The mean age of women was 74.06 (SD±6.97), and the mean age of men was 71.8 (SD±8.51, p=0.006265). Women represented 37.93% (n=132) of the studied group, while men 62.07% (n=216). In the group of patients younger than 65 years of age, 27.9% were male and 15% female (p=0.0021). In the whole studied group, mean peak IOP was 29.25 mmHg with higher mean values in male patients (M vs F: 33.24 mmHg vs 26.86 mmHg; p=0.000). Peak values exceeding 30 mmHg were significantly more frequent in males (M vs F: 56.5% vs 31.9%; p=0.0000). Peak IOP never exceeding 21 mmHg was observed in 18.6% of the patients. The mean value of MD (Mean Deviation) was -12.85 dB in the whole group. The men were more likely to have more advanced glaucoma, according to MD (M vs F: -16.35 dB vs -11.13 dB; p=0.0000). CONCLUSION Pseudoexfoliative glaucoma was more frequently observed in men with younger age, higher IOP, and more advanced glaucoma. Normotensive glaucoma was observed in 18.6% of the patients with pseudoexfoliative glaucoma.
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Affiliation(s)
- Urszula Łukasik
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kustra
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Piotr Milanowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
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12
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Visual impairment in pseudoexfoliation from four tertiary centres in India. PLoS One 2020; 15:e0233268. [PMID: 32469900 PMCID: PMC7259498 DOI: 10.1371/journal.pone.0233268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyse the disease burden of pseudoexfoliation (PXF) disease stages from East and South India. Design Prospective hospital based study of patients seen at 4 tertiary centres. Subjects, participants, and/or controls Consecutive old and new patients of pseudoexfoliation with normal intraocular pressure (IOP), raised IOP (PXF with Ocular hypertension, OHT) and irreversible disc/field changes (pseudoexfoliation glaucoma, PXG) seen from April 2016-March 2017 at a tertiary centre in Odisha, East India and 3 centres in Andhra Pradesh and Telangana, South India, recruited into the prospective study were screened for baseline characteristics. Methods The clinical and demographic details including visual acuity, laterality, intraocular pressure (IOP) with details of medical/surgical therapy at presentation were collected from the hospital database at all 4 centres. Intervention or exposure The World Health Organization WHO visual criteria were used for defining visual impairment/absolute blindness in different disease stages. Outcome measures The visual impairment/blindness rates with comorbidities in the anterior/posterior segment in PXF, OHT and PXG at baseline were compared and the influence of age, IOP fluctuations and laterality was analysed using multivariate logistic regression. Results Of 6284 PXF eyes (of 3142 patients) included from all centres, OHT and PXG was seen in 2.1% and 29% respectively which included 3676 (>50%) bilateral PXF eyes. Reversible visual impairment rates caused by PXF associated co-morbidities in PXF and OHT were 33% and 26% respectively with cataract being the major cause (67% in PXF and 74% in OHT). Irreversible blindness rate was higher in bilateral PXG eyes (30.5%) compared to bilateral PXF (23.2%) or bilateral OHT (21.6%) with overall absolute blindness rates of 28.2% at presentation. Older age (p<0.001), bilaterality and higher baseline IOP were significantly associated with higher rates of blindness in PXF eyes. Conclusion and relevance Pseudoexfoliation is associated with ≥30% visual impairment across all stages and 28% absolute blindness rate which is a huge hidden burden of glaucoma. Adequate disease staging and assessment of comorbidities is required for accurate prognostication at baseline and reducing avoidable pseudoexfoliation blindness.
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13
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Ozates S, Berker N, Cakar Ozdal P, Ozdamar Erol Y. Phacoemulsification in patients with uveitis: long-term outcomes. BMC Ophthalmol 2020; 20:109. [PMID: 32183739 PMCID: PMC7079372 DOI: 10.1186/s12886-020-01373-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To assess the long-term outcomes of phacoemulsification and intraocular lens (IOL) implantation in eyes with uveitis. METHODS One hundred and five eyes of 81 patients, who underwent phacoemulsification and IOL implantation between January 2009 and July 2016, were included in this study. The demographic data, preoperative clinical findings, postoperative outcomes, and intraoperative and postoperative complications were recorded. All collected data and risk factors with regard to visual prognosis were analyzed with the help of the Statistical Package for the Social Sciences version 20.0 software program (IBM Corp., Armonk, NY, USA). RESULTS During follow-up (mean: 35.2 ± 22.2 months), corrected distance visual acuity (CDVA) improved in 87.7% of all eyes and reached a level of 0.3 LogMAR or greater in 61.3% of eyes. Postoperative complications included posterior capsule opacification (50.9%), posterior synechiae (21.7%), cystoid macular edema (16%), epiretinal membrane (13.2%), glaucoma (11.3%), increased intraocular pressure (8.5%), and severe inflammation (6.6%). Uveitis recurred in 55.7% of all eyes. The risk for the development of cystoid macular edema was found to be associated with recurrence in the early postoperative period. Low visual acuity risk was 11.1-fold higher with macular scarring (p = 0.001) and 14-fold higher with optic atrophy (p < 0.001), respectively. CONCLUSIONS With appropriate management during the pre- and postoperative periods, phacoemulsification and IOL implantation surgery can be safe and effective in eyes with uveitis. However, great caution must be taken to prevent complications both before and after the surgery.
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Affiliation(s)
- Serdar Ozates
- Department of Ophthalmology, Kars Harakani State Hospital, Yenişehir Mahallesi, İsmail Aytemiz Blv. No:55, 36200, Merkez, Kars, Turkey.
| | - Nilufer Berker
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Cakar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasemin Ozdamar Erol
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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14
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Mohammadpour M, Khorrami-Nejad M. Stop and Flip: A Simple and Safe Phacoemulsification Technique. CLINICAL OPTOMETRY 2020; 12:45-47. [PMID: 32214860 PMCID: PMC7083636 DOI: 10.2147/opto.s241811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
We introduce a simple, easy to learn, fast and safe technique to facilitate nucleus management in patients with zonular weakening in uncomplicated cases. The surgery begins with a temporal 3.2 mm clear corneal incision under topical anesthesia. Two side-port incisions are made on the inferior and superior sides. Anterior continuous curvilinear 5-6 mm diameter capsulorhexis and hydrodissection are performed to loosen capsule cortical attachments. The nucleus is not rotated, and an appropriated groove (80-90% depth) is sculpted using phaco machine. The groove is cracked into two hemispheres; lateral pressure and a side port manipulator. Then, 15-30 degree phaco tip is introduced and embedded into one hemisphere of nucleus beside the capsulorhexis edge at temporal or nasal part. After complete removal of the first hemisphere, the second is flipped again from bag into iris plane and phacoemulsified in the same manner.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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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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16
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Núñez MX, Henriquez MA, Escaf LJ, Ventura BV, Srur M, Newball L, Espaillat A, Centurion VA. Consensus on the management of astigmatism in cataract surgery. Clin Ophthalmol 2019; 13:311-324. [PMID: 30809088 PMCID: PMC6376888 DOI: 10.2147/opth.s178277] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.
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Affiliation(s)
- Maria X Núñez
- Unit of Cornea, Cataract and Refractive Surgery, Grupo de Investigacion Vision Sana, Clinica de Oftalmología de Cali, Universidad Javeriana, Cali, Colombia,
| | - Maria A Henriquez
- Department of Cataract, Department of Research, Oftalmosalud Instituto de Ojos, Lima, Peru
| | - Luis J Escaf
- Clinica Oftalmologica del Caribe (Cofca), Universidad Javeriana, Barranquilla, Colombia
| | - Bruna V Ventura
- Department of Cataract, Altino Ventura Foundation, HOPE Eye Hospital, Recife, Brazil
| | - Miguel Srur
- Centro de la Visión, Filial Clínica Las Condes, Universidad de Los Andes, Santiago de Chile, Chile
| | | | - Arnaldo Espaillat
- Cataract and refractive surgery service, Espaillat Cabral Institute, Santo Domingo, Dominican Republic
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17
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Morya AK, Bhandari S, Naidu A. Retrospective study on outcomes of terminal chop technique of nuclear fragmentation in phacoemulsification and combined surgery: An observational study. Indian J Ophthalmol 2019; 67:217-220. [PMID: 30672473 PMCID: PMC6376810 DOI: 10.4103/ijo.ijo_711_18] [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: 11/06/2022] Open
Abstract
Purpose: Terminal chop, a new technique of nuclear segmentation, has been recently described in literature. The technique is considered to be a safe and effective option. Methods: We did a retrospective study to evaluate the outcome of terminal chop. Patients operated for terminal chop (phacoemulsification with or without trabeculectomy) from October 2016 to July 2018 were included in the study. Results: In all, 933 patients were included in the study. The grade of nuclear sclerosis ranged from 2 to 5. All the patients had a significant visual improvement at 1 month postop. Around 3.4% had pseudoexfoliation and 8.89% of the eyes underwent combined surgery. Cumulative dissipated energy showed a proportionate relation with the grade of nucleus. Intraoperative complication rate was 0.08%. Postoperative complication rate was 3.50%. Conclusion: Terminal chop proved to be a safe, reproducible, and effective technique of nuclear segmentation in different grades of cataract.
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Affiliation(s)
- Arvind K Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sahil Bhandari
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anushree Naidu
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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18
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Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 2018; 102:1342-1350. [PMID: 29567789 DOI: 10.1136/bjophthalmol-2017-311321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022]
Abstract
Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.
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Affiliation(s)
- Samir Nazarali
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraz Damji
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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19
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Asfuroglu Y, Kemer OE. Central corneal thickness and corneal volume changes in eyes with and without pseudoexfoliation after uneventful phacoemulsification. Int Ophthalmol 2017; 39:275-280. [PMID: 29260501 DOI: 10.1007/s10792-017-0804-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
AIM To investigate the effects of uneventful phacoemulsification on central corneal thickness (CCT) and corneal volume (CV) in pseudoexfoliative eyes during a 3 months postoperative period and compare these changes to eyes without pseudoexfoliation (PEX) syndrome. Another purpose of this study was to compare the CCT measurements done by ultrasound pachymetry (UP) with those done by the Oculus Pentacam. MATERIAL AND METHOD A total of 42 eyes of 42 consecutive patients with cataracts and PEX syndrome that underwent uneventful phacoemulsification were enrolled in this prospective study. A control group of 42 eyes of 42 patients with cataracts/without PEX was employed for comparison. CV and CCT measurements were obtained preoperatively and at 1 and 3 months postoperatively with the Pentacam. CCT values were also measured with UP. T test and Wilcoxon sign test were used to compare the variables. RESULTS The mean age of the patients was 72.1 ± 8.3 and 66.6 ± 9.6 years in PEX and non-PEX group, respectively. In both groups, there were no significant differences between preoperative and postoperative CV (Fig. 1), CCT by the Pentacam (Fig. 2) and CCT by UP (Fig. 3) values (p > 0.05). CCT measurements obtained by two devices were also similar, and there were no statistically significant differences (p > 0.05). Changes in CV and CCT remained stabile at 3 months postoperatively. CONCLUSION Eyes with and without PEX syndrome exhibit similar corneal features before and after phacoemulsification. A surgery in early stages of cataracts in PEX syndrome, not only provides a non-complicated surgery, but also leads to a less damaged cornea similar to eyes without PEX.
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Affiliation(s)
- Yonca Asfuroglu
- Osmancik State Hospital, Omer Derindere Boulivard Number: 105, 19500, Osmancik, Corum, Turkey.
| | - Ozlem Evren Kemer
- University of Health Sciences, Numune Education and Research Hospital, Talatpasa Boulivard Number: 44, 06230, Altindag, Ankara, Turkey
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20
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Kliuchnikova AA, Samokhina NI, Ilina IY, Karpov DS, Pyatnitskiy MA, Kuznetsova KG, Toropygin IY, Kochergin SA, Alekseev IB, Zgoda VG, Archakov AI, Moshkovskii SA. Human aqueous humor proteome in cataract, glaucoma, and pseudoexfoliation syndrome. Proteomics 2017; 16:1938-46. [PMID: 27193151 DOI: 10.1002/pmic.201500423] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 12/28/2022]
Abstract
Twenty-nine human aqueous humor samples from patients with eye diseases such as cataract and glaucoma with and without pseudoexfoliation syndrome were characterized by LC-high resolution MS analysis. In total, 269 protein groups were identified with 1% false discovery rate including 32 groups that were not reported previously for this biological fluid. Since the samples were analyzed individually, but not pooled, 36 proteins were identified in all samples, comprising the constitutive proteome of the fluid. The most dominant molecular function of aqueous humor proteins as determined by GO analysis is endopeptidase inhibitor activity. Label-free protein quantification showed no significant difference between glaucoma and cataract aqueous humor proteomes. At the same time, we found decrease in the level of apolipoprotein D as a marker of the pseudoexfoliation syndrome. The data are available from ProteomeXchange repository (PXD002623).
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Affiliation(s)
| | - Nadezhda I Samokhina
- Institute of Biomedical Chemistry, Moscow, Russia.,Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | | | - Dmitry S Karpov
- Institute of Biomedical Chemistry, Moscow, Russia.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Mikhail A Pyatnitskiy
- Institute of Biomedical Chemistry, Moscow, Russia.,Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | | | | | | | - Igor B Alekseev
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | | | | | - Sergei A Moshkovskii
- Institute of Biomedical Chemistry, Moscow, Russia.,Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
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21
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Moghimi S, Johari M, Mahmoudi A, Chen R, Mazloumi M, He M, Lin SC. Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syndrome. Br J Ophthalmol 2016; 101:283-289. [PMID: 27281754 DOI: 10.1136/bjophthalmol-2016-308601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 05/11/2016] [Indexed: 11/03/2022]
Abstract
AIM To evaluate anterior chamber biometric factors and intraoperative metrics associated with the intraocular pressure (IOP) reduction after phacoemulsification in non-glaucomatous pseudoexfoliative syndrome (PXS) eyes. METHOD Thirty-three patients were enrolled in this prospective interventional study. Images were excluded if they had poor quality, poor perpendicularity or inability to locate sclera spurs. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris area, iris curvature, lens vault, angle opening distance (AOD500, AOD750) and trabecular iris space area (TISA500, TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared preoperatively and 3 months postoperatively. Cumulative dissipated energy (CDE), aspiration time and infusion fluid usage during cataract surgery were obtained from the phacoemulsification machine's metrics record. Postoperative IOP change was compared with these anatomical and intraoperative metric parameters. RESULTS Mean IOP was 18.1±3.4 mm Hg preoperatively and decreased by 3.3 mm Hg (18%) to 14.8±3.6 mm Hg at 3 months postoperatively (p<0.001). All angle parameters, ACD and ACA increased significantly postoperatively (p<0.001 for all) and iris curvature decreased (p<0.001). In univariate analysis, preoperative IOP (B=-0.668, p=0.002), infusion fluid usage (B=-0.040, p=0.04) and aspiration time (B=-0.045, p=0.003) were negatively associated with IOP decrease after phacoemulsification. Changes in IOP did not demonstrate significant associations with CDE measurements or anterior segment optical coherence tomography measurements, including preoperative angle, iris or anterior segment parameters. In the final multivariate regression model, preoperative IOP (B=-0.668, p=0.002) and infusion fluid usage (B=-0.041, p=0.04) were significantly associated with IOP drop and together can predict 45.1% (p=0.002) of the variability in IOP change. CONCLUSIONS Non-glaucomatous patients with PXS experience moderate IOP reduction following phacoemulsification, and this effect is correlated with preoperative IOP, aspiration time and infusion fluid used intraoperatively.
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Affiliation(s)
- Sasan Moghimi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Beckman Vision Center, University of California, San Francisco, California, USA
| | | | - Alireza Mahmoudi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca Chen
- Beckman Vision Center, University of California, San Francisco, California, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mehdi Mazloumi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mingguang He
- Department of Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Shan C Lin
- Beckman Vision Center, University of California, San Francisco, California, USA
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22
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Gunes A, Yasar C, Tok L, Tok O. Prevalence of Pseudoexfoliation Syndrome in Turkish Patients with Senile Cataract. Semin Ophthalmol 2016; 32:297-301. [PMID: 26795697 DOI: 10.3109/08820538.2015.1068344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the prevalence of pseudoexfoliation syndrome (PEX) among Turkish patients with senile cataract. MATERIALS AND METHODS Records of 352 eyes of 352 patients who underwent cataract surgery were analyzed in this retrospective study. The presence of PEX, type of cataract, intraocular pressure (IOP), glaucoma, age-related macular degeneration, and systemic diseases (coronary artery disease, hypertension, diabetes mellitus) were recorded. RESULTS The overall prevalence of PEX syndrome was detected to be 11%. The mean age of PEX patients was significantly higher than without PEX (74.4 ± 7.2 years and 69.3 ± 11.4 years, respectively, p = 0.004). The most common cataract type in the PEX patients was mixed-type cataract determined in 51.2% of patients. IOP was significantly higher in eyes with PEX than in eyes without it (16.1 ± 4.5 mmHg and 14.7 ± 3.8 mmHg, respectively; p = 0.03). Moreover, the prevalence of age-related macular degeneration was found to be significantly higher, and prevalence of glaucoma slightly higher in PEX patients than without PEX. CONCLUSION Pseudoexfoliation syndrome is a common condition in Turkish people. PEX is associated with mixed type of cataract, age-related macular degeneration, and elevated IOP. Therefore, PEX patients should be checked for concomitant diseases.
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Affiliation(s)
- Alime Gunes
- a Department of Ophthalmology , Süleyman Demirel University, Faculty of Medicine , Isparta , Turkey
| | - Cigdem Yasar
- a Department of Ophthalmology , Süleyman Demirel University, Faculty of Medicine , Isparta , Turkey
| | - Levent Tok
- a Department of Ophthalmology , Süleyman Demirel University, Faculty of Medicine , Isparta , Turkey
| | - Ozlem Tok
- a Department of Ophthalmology , Süleyman Demirel University, Faculty of Medicine , Isparta , Turkey
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Mohammadi SF, Hashemi H, Mazouri A, Rahman-A N, Ashrafi E, Mehrjardi HZ, Roohipour R, Fotouhi A. Outcomes of Cataract Surgery at a Referral Center. J Ophthalmic Vis Res 2016; 10:250-6. [PMID: 26730309 PMCID: PMC4687257 DOI: 10.4103/2008-322x.170358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. Methods: Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of “less than excellent outcome,” i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. Results: Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). Conclusion: Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.
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Affiliation(s)
- Seyed-Farzad Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Arash Mazouri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Rahman-A
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ashrafi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Z Mehrjardi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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24
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Stabilizing the capsular bag and expanding the pupil with a pupil expansion device. J Cataract Refract Surg 2015; 41:1801-3. [PMID: 26471052 DOI: 10.1016/j.jcrs.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED We describe a surgical technique for management of zonular instability and pupillary miosis using a pupil expansion device (Malyugin ring) in patients who need cataract surgery. In this technique, the pupil expansion device is first used in the usual fashion. After a capsulorhexis has been created, lateral scrolls of the pupil expansion device are released and repositioned to entrap both the anterior capsulorhexis and the pupil margin at the against-the-wound meridian (3 o'clock and 9 o'clock position) to fixate the unstable capsular bag to the iris. Phacoemulsification is performed, and the ring is removed after intraocular lens implantation. With this method, capsular stabilization and pupil expansion are achieved simultaneously with the same instrument. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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25
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Abstract
Background The purpose of this study was to investigate the demographics of pseudoexfoliation syndrome (PXF) and pseudoexfoliative glaucoma (PXG) in a Singapore hospital eye outpatient clinic. Methods A retrospective study of 93 consecutive patients (146 eyes) with PXF was undertaken by a single ophthalmologist over a period of 37 months (July 1, 2006, to July 31, 2009). Results Ninety-three (2.8%) of 3,297 patients seen during the study period were diagnosed with PXF. Forty-three (46.2%) of the 93 PXF patients were male. Indians were 5.04 times more likely to develop PXF than Chinese (P<0.001, 95% confidence interval 3.05–8.33), while Malays were 2.22 times more likely to develop PXF as compared with Chinese (P=0.029, 95% CI 1.08–4.55). Twenty-two (23.7%) of the 93 PXF patients had PXG at the time of diagnosis. There was no statistically significant difference in mean age between PXF and PXG patients. There was a larger proportion of males with PXG than females (P<0.001). Conclusion PXF is not infrequent in elderly Singapore eye clinic patients, and is more likely to occur in Indians than in Chinese. In the Singapore eye clinic setting, males may be more likely to develop PXG, although larger studies will be required to confirm this.
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Affiliation(s)
| | | | - Su Ling Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
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Abstract
Pseudoexfoliation (PXF) syndrome is characterized by the deposition of distinctive fibrillar material in the anterior segment of the eye. It is an age-related process that is associated with open and narrow angle glaucomas and the formation of cataracts. Not only is PXF associated with the formation of dense nuclear cataracts, it is also well known that those presenting with PXF are at a higher risk of developing complications during, and even after, cataract surgery. Complications associated with cataract surgery in PXF can occur from poor pupillary dilation, zonular weakness leading to intraoperative or postoperative lens dislocation and vitreous loss, postoperative intraocular pressure (IOP) spikes potentiating glaucomatous damage, capsular phimosis, prolonged inflammation, and postoperative corneal decompensation. The surgeon should be prepared to encounter the various potential intraoperative and postoperative complications in eyes with pseudoexfoliation syndrome during cataract surgery. In this way, the surgeon can plan his/her surgical technique to help avoid surprises during cataract surgery and be prepared to manage the potential postoperative complications that can occur in pseudoexfoliation eyes.
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Affiliation(s)
- Neha Sangal
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston, Massachusetts , USA
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Demircan S, Atas M, Yurtsever Y. Effect of torsional mode phacoemulsification on cornea in eyes with/without pseudoexfoliation. Int J Ophthalmol 2015; 8:281-7. [PMID: 25938041 DOI: 10.3980/j.issn.2222-3959.2015.02.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/05/2014] [Indexed: 01/28/2023] Open
Abstract
AIM To evaluate the effect of torsional mode phacoemulsification on central corneal thickness, corneal endothelial cell density, and morphology in eyes with/without pseudoexfoliation (PEX) syndrome. METHODS Fourty-two consecutive patients with and 42 patients without PEX as a control group scheduled for cataract surgery was studied. Phacoemulsification, using OZiL IP system, was performed with quick chop technique. Using noncontact specular microscopy, the central endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, and the central corneal thickness (CCT) were evaluated preoperatively and postoperatively at 1, 7 and 30d. RESULTS The ECD in PEX syndrome was statistically significantly lower than that in the control group preoperatively and postoperatively (P≤0.001). Percentage change in ECD was statistically significantly higher in PEX than that in control group after surgery follow up (P≤0.04). There was no statistically significant difference between both groups comparing percentage of hexagonal cells and coefficient of variation in the cell size before and after the surgery. At 1 and 7d after surgery, percentage change in CCT was statistically significantly higher in PEX group than that in the control group (P≤0.041). CONCLUSION Although torsional mode phacoemulsification and intraocular lens (IOL) implantation provided a safe and favorable surgical outcome in patients with/without PEX, torsional phacoemulsification led to significantly higher ECD loss in the PEX group than that in the control group during the whole follow up period. In addition, more corneal swelling in the PEX group than that in the control group during the early postoperative period has indicated that the corneal endothelium, in presence of PEX endotheliopathy, seems to be more susceptible to the effects of phacoemulsification surgery in eyes with PEX. The increased risk of anterior chamber manipulations in patients with PEX should be taken into account for an increased risk of bullous keratopathy.
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Affiliation(s)
- Süleyman Demircan
- Eye Clinic, Kayseri Training and Research Hospital, Kayseri 38010,Turkey
| | - Mustafa Atas
- Eye Clinic, Kayseri Training and Research Hospital, Kayseri 38010,Turkey
| | - Yusufcan Yurtsever
- Eye Clinic, Kayseri Training and Research Hospital, Kayseri 38010,Turkey
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Investigation of phacoemulsification on exfoliation syndrome combined cataract with different nuclear hardness. Eur J Ophthalmol 2015; 25:416-21. [PMID: 25684159 DOI: 10.5301/ejo.5000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated the clinical staging and management of cataracts to decrease the incidence of complications of phacoemulsification and improve the postoperative visual function of patients with exfoliation syndrome (XFS) with cataract. METHODS Cataracts with XFS were divided into early, middle, and late stages using the Emery-Little lens opacities classification system. Phacoemulsification and intraocular lens (IOL) implantation were performed in all eyes. The incidences of intraoperative and early postoperative complications of phacoemulsification were compared, and differences in the outcomes of phacoemulsification were evaluated. RESULTS There were 23, 31, and 34 eyes with early-, middle- and late-stage XFS, respectively. The mean ultrasound time, cumulative dissipated energy, and incidence of moderate to severe corneal edema and wound burn in the late-stage group were significantly higher than in the early- and middle-stage groups (p<0.05). The incidence of zonular dehiscence, capsular rupture, vitreous loss, and iritis were not significant among the 3 groups (p>0.05). Intraocular pressure rise in the early postoperative period and the level of optic atrophy in the late-stage group were significantly higher than in the other 2 groups (p<0.05). The gain in visual acuity in the early- and middle-stage groups after surgery was better than in the late-stage group of XFS, and the difference was statistically significant (p<0.05). CONCLUSIONS The clinical staging of cataract with XFS contributed to the choice of operation time and its management. Phacoemulsification and IOL implantation in early- and middle-stage XFS induced fewer complications and led to better recovery of visual function after surgery.
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Abstract
PURPOSE OF REVIEW Presence of a small pupil is still considered a major challenge for cataract surgeons. Appropriate mydriasis and maintaining it is of paramount importance to prevent potential serious complications. Recently, more interventions and instruments are available for the cataract surgeons to deal with these challenging cases. The intention of this review is to discuss the preoperative and intraoperative considerations and techniques for cataract surgery in small pupil and related conditions and to discuss new developments in management of small pupil in femtosecond laser-assisted cataract surgery. RECENT FINDINGS There are new techniques and pharmaceuticals available to cataract surgeons in the setting of small pupil. Intracameral ketorolac may soon be available to maintain mydriasis and to control pain and inflammation. Malyugin ring has been added to pupil expansion rings and has already been used for small pupil in different settings. In femtosecond laser-assisted cataract surgery, presence of a small pupil can now be managed by applying intracameral mydriatics and intraocular devices successfully. SUMMARY Accurate preoperative examinations adjunct with intraoperative use of appropriate pharmacologic and mechanical devices can yield favorable outcomes in cataract surgery with a small pupil.
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Chiras D, Kitsos G, Petersen MB, Skalidakis I, Kroupis C. Oxidative stress in dry age-related macular degeneration and exfoliation syndrome. Crit Rev Clin Lab Sci 2014; 52:12-27. [PMID: 25319011 DOI: 10.3109/10408363.2014.968703] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oxidative stress refers to cellular or molecular damage caused by reactive oxygen species, which especially occurs in age-related conditions as a result of an imbalance between the production of reactive oxygen species and the antioxidant defense response. Dry age-related macular degeneration (AMD) and exfoliation syndrome (XFS) are two common and complex age-related conditions that can cause irreversible vision loss. Two subtypes of AMD, which is the leading cause of blindness in the Western world, exist: the most prevalent dry type and the most severe wet type. Early dry AMD is characterized by formation of drusen, which are sub-retinal deposits, in the macular area and may progress to geographic atrophy with more dramatic manifestation. XFS is a systemic disorder of the extracellular matrix characterized by the accumulation of elastic fibrils that leads, in most cases, to glaucoma development with progressive and irreversible vision loss. Due to the aging population, the prevalence of these already-widespread conditions is increasing and is resulting in significant economic and psychological costs for individuals and for society. The exact composition of the abnormal drusen and XFS material as well as the mechanisms responsible for their production and accumulation still remain elusive, and consequently treatment for both diseases is lacking. However, recent epidemiologic, genetic and molecular studies support a major role for oxidative stress in both dry AMD and XFS development. Understanding the early molecular events in their pathogenesis and the exact role of oxidative stress may provide novel opportunities for therapeutic intervention for the prevention of progression to advanced disease.
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Affiliation(s)
- Dimitrios Chiras
- Department of Ophthalmology, University Hospital of Ioannina , Ioannina , Greece
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32
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Cataract extraction surgery in patients with uveitis in Taiwan: Risk factors and outcomes. J Formos Med Assoc 2014; 113:377-84. [DOI: 10.1016/j.jfma.2013.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/16/2013] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
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Jonas JB, Nangia V, Matin A, Bhojwani K, Sinha A, Khare A, Agarwal S, Bhate K. Pseudoexfoliation: normative data and associations. The Central India Eye and Medical Study. PLoS One 2013; 8:e76770. [PMID: 24204672 PMCID: PMC3804587 DOI: 10.1371/journal.pone.0076770] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/29/2013] [Indexed: 12/26/2022] Open
Abstract
Purpose To assess the prevalence of pseudoexfoliation (PEX) and its associations in a population-based setting. Design Population-based, cross-sectional study. Methods The Central India Eye and Medical Study included 4711 individuals. All study participants underwent a detailed ophthalmological examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp based biomicroscopy. Results Slit lamp examination results were available for 4646 (98.6%) study participants with a mean age of 49.3±13.3 years (range: 30–100 years). PEX was detected in 87 eyes (prevalence: 0.95±0.10% (95%CI: 0.75, 1.15) of 69 subjects (prevalence: 1.49±0.18% (95%CI: 1.14, 1.83). PEX prevalence increased significantly (P<0.001) from 0% in the age group of 30–39 years, to 2.85±0.56% in the age group of 60–69 years, to 6.60±1.21% in the age group of 70–79 years, and to 12.3±4.11% in the age group of 80+ years. In multivariate analysis, PEX prevalence was associated with higher age (P<0.001; regression coefficient B:0.11; odds ratio (OR): 1.11 (95%CI: 1.09, 1.13)), lower body mass index (P = 0.001; B: −0.12; OR: 0.88 (95CI: 0.82, 0.95)) and higher diastolic blood pressure (P = 0.002; B: 0.02; OR: 1.03 (95%CI: 1.01, 1.04)). In the multivariate analysis, PEX was not associated with retinal nerve fiber layer cross section area (P = 0.76) and presence of open-angle glaucoma (P = 0.15). Conclusions In a rural Central Indian population aged 30+ years, PEX prevalence (mean: 1.49±0.18%) was significantly associated with older age, lower body mass index and higher diastolic blood pressure. It was not significantly associated with optic nerve head measurements, refractive error, any ocular biometric parameter, nuclear cataract, early age-related macular degeneration and retinal vein occlusion, diabetes mellitus, smoking, and dyslipidemia.
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Affiliation(s)
- Jost B. Jonas
- Suraj Eye Institute, Nagpur, India
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany
- * E-mail: (VN); (JBJ)
| | - Vinay Nangia
- Suraj Eye Institute, Nagpur, India
- * E-mail: (VN); (JBJ)
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Abstract
A critical step in phacoemulsification (as well as extracapsular cataract extraction) is making a window in anterior capsule wall (i.e. anterior capsulotomy). Continuous Curvilinear Capsulorhexis (CCC) has become recognized as the standard method of anterior capsulectomy. Techniques employed for CCC have undergone sustained evolution. The present review evaluates elementary principles of CCC. Management of CCC in the presence of small pupil and pseudoexfoliation syndrome is discussed. Main differences of pediatric CCC from its adult-style counterpart and finally several techniques of rescue of an extending capsulorhexis are also reviewed.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Centre, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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35
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Dikopf MS, Chow CC, Mieler WF, Tu EY. Cataract extraction outcomes and the prevalence of zonular insufficiency in retinitis pigmentosa. Am J Ophthalmol 2013; 156:82-88.e2. [PMID: 23628349 DOI: 10.1016/j.ajo.2013.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction. DESIGN Retrospective observational case series. PATIENTS AND METHODS In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications. RESULTS Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3 months (range, 1 day - 95 months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3 months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8 months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery. CONCLUSION Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuity of 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.
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Affiliation(s)
- Mark Samuel Dikopf
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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You QS, Xu L, Wang YX, Yang H, Ma K, Li JJ, Zhang L, Jonas JB. Pseudoexfoliation: normative data and associations: the Beijing eye study 2011. Ophthalmology 2013; 120:1551-8. [PMID: 23622877 DOI: 10.1016/j.ophtha.2013.01.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/06/2013] [Accepted: 01/11/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting. DESIGN Population-based, cross-sectional cohort study. PARTICIPANTS Of 4403 eligible subjects with an age of ≥ 50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6 ± 9.8 years; range, 50-93 years). METHODS All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy. MAIN OUTCOME MEASURES Prevalence and associations of PEX. RESULTS Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84-2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8-4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99-6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥ 80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04-1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36-0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion. CONCLUSIONS In a North Chinese population aged ≥ 50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84-2.93), suspect PEX was 3.4% (95% CI, 2.8-4.1) and overall PEX was 5.82% (95% CI, 4.99-6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
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Paletta Guedes RA, Paletta Guedes VM, Aptel F. [Multifocal, toric, and aspheric intraocular lenses for glaucoma patients]. J Fr Ophtalmol 2011; 34:387-91. [PMID: 21507514 DOI: 10.1016/j.jfo.2011.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 02/14/2011] [Indexed: 11/20/2022]
Abstract
Cataract surgery has greatly developed over recent years, mainly due to the introduction and availability of newer intraocular lenses (IOLs) with modern platforms and better visual outcomes. Aspheric, multifocal, and toric lenses are among these new lenses. Glaucomatous eyes have a number of particularities that can influence the way these implants are indicated and used. Contrast sensitivity is usually reduced in eyes with glaucoma and, sometimes, a poor IOL choice can aggravate the disease. Small pupils and zonular weakness are frequently associated with certain types of glaucoma (e.g. pseudoexfoliative glaucoma) and can limit the indication of some of the newer IOLs. Lastly, in some cases of combined surgery, the postoperative axial length and anterior chamber depth can change after surgery, requiring adjustments in the IOL power calculation. The purpose of this article is to quickly review some of the specific features of cataract surgery in the glaucomatous eye, some of the IOL choices, and the necessary precautions for these eyes.
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Affiliation(s)
- R-A Paletta Guedes
- Centre ophtalmologique Paletta-Guedes, université fédéral de Juiz-de-Fora, avenue Rio-Branco 2337, sl. 801/807/808 Centre, 36010-905 Juiz-de-Fora, Brésil.
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