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Yang C, An Q, Zhou H, Ge H. Research progress on the impact of cataract surgery on corneal endothelial cells. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:194-201. [PMID: 39319216 PMCID: PMC11421245 DOI: 10.1016/j.aopr.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/17/2024] [Accepted: 08/06/2024] [Indexed: 09/26/2024]
Abstract
Background Cataracts are a common eye disease and a major cause of blindness in China and worldwide. In China, the incidence of cataracts among people over 60 years old is as high as 80%. Surgery is the primary treatment for various types of cataracts, but such invasive procedures can affect corneal endothelial cells to some extent. Content Cataract surgery can damage corneal endothelial cells, leading to complications such as corneal edema in mild cases. Severe damage can result in endothelial decompensation, necessitating secondary corneal endothelial transplantation. Preoperative thorough assessment of endothelial status, intraoperative endothelial protection measures, and postoperative active use of medications to prevent further damage to endothelial cells can reduce endothelial cell loss. Factors influencing endothelial cell status include whether the patient has related systemic diseases or ocular conditions, the hardness of the nucleus, the choice of surgical incision, the method of nuclear fragmentation, the type of viscoelastic agent used, the orientation of the phacoemulsification needle bevel, the duration and energy of ultrasound use, the choice of fluid control system, the use of protective auxiliary instruments, the application of intraocular lens scaffold technology, femtosecond laser assistance, and the use of certain medications. Conclusions Actively regulating the factors affecting corneal endothelial cells to reduce damage related to cataract surgery is crucial. This paper reviews the existing literature on various factors affecting corneal endothelial cells during cataract surgery and explores future developments and research directions.
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Affiliation(s)
- Chen Yang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qi An
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Han Zhou
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongyan Ge
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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2
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Ifantides C, SooHoo JR, Christopher KL. Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program. Indian J Ophthalmol 2023; 71:2474-2477. [PMID: 37322664 PMCID: PMC10417980 DOI: 10.4103/ijo.ijo_1339_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/02/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low-resource clinical care at home and abroad. Low-resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small-incision cataract surgery (MSICS) curriculum was started in the University of Colorado's residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States-based residency program. Methods This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low-resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that "MSICS is a valuable skill to have". Eighty percent of respondents agreed or strongly agreed that "exposure to MSICS has increased my likelihood of doing any type of outreach work in the future" and 86.67% agreed or strongly agreed that "exposure to MSICS increased my understanding about sustainable outreach work". The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4-12). Conclusion A formal MSICS curriculum for US-based ophthalmology residents was well-received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program's curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.
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Affiliation(s)
- Cristos Ifantides
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora, CO, USA
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Sabur H, Unsal U. The efficacy and safety profile of cataract procedures performed with a sensor-embedded handpiece and a new hybrid phaco tip. Eur J Ophthalmol 2022; 32:3438-3443. [PMID: 35229694 DOI: 10.1177/11206721221084764] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the new Intrepid Hybrid tip and Active Sentry handpiece in comparison to the Intrepid Balanced tip and Centurion Ozil handpiece. METHODS One hundred sixty-eight eyes were included in the study and randomized into Group 1 (Active Sentry handpiece + Intrepid Hybrid tip, n = 86) and Group 2 (Centurion Ozil handpiece + Intrepid Balanced tip, n = 82). Data were collected from the phaco device, including total U/S time, cumulative dissipated energy (CDE), the total number of active surge mitigation actuations (ASM actuations), torsional amplitude, torsional amplitude on time, estimated fluid of aspirated, and aspiration time. Endothelial cell count (ECC) and central corneal thickness (CCT) were assessed. A correlation analysis was performed between ASM actuations, phaco metrics, and patient characteristics in Group 1. RESULTS The CDE, torsional amplitude measured in Group 1 (8.8 ± 3.9, 51.2 ± 13.3, respectively) were significantly lower than those of Group 2 (10.4 ± 4.2, 65.2 ± 9.3, respectively). While no complications were observed in group 1, there were posterior capsule rupture in 2 eyes and iris damage in 1 eye in group 2. The mean ECC and CCT were similar at 1 month. The ASM actuations were more engaged in the eyes with pseudoexfoliation and small pupils. CONCLUSION The combination of the new Intrepid Hybrid tip and Active Sentry handpiece enables safer cataract procedures without compromising efficacy due to its surge prevention mechanisms and special tip design. It could be a good option for residents in training.
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Affiliation(s)
- Huri Sabur
- Department of Ophthalmology, Izzet Baysal State Hospital, Bolu, Turkey
| | - Ugur Unsal
- Department of Ophthalmology, Batigoz Eye Health Center, Izmir, Turkey
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Fernandes AG, Ferraz AN, Lemos RDS, Watanabe SES, Berezovsky A, Salomão SR. Trends in cataract surgical treatment within the Brazilian national public health system over a 20-year period: Implications for Universal Eye Health as a global public health goal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000328. [PMID: 36962381 PMCID: PMC10021674 DOI: 10.1371/journal.pgph.0000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Cataract is a highly prevalent, treatable, and sight threatening condition considered one of the main focuses of public health policies addressing visual impairment and blindness towards Universal Eye Health. We aimed to investigate the trends on number of cataract surgical procedures performed through the Brazilian national health system (SUS) from 2000 to 2019 while also evaluating costs associated with it. The Brazilian Public Health System Information Database (DATASUS) was used as the primary data source for procedures including extracapsular cataract extraction (ECCE) and phacoemulsification. Trends along the years were evaluated through generalized linear models. A total of 8,424,521 cataract procedures were performed from 2000 to 2019, with a significant increase along the years from 228,145 in 2000 to 663,186 in 2019 (p<0.001), a cataract surgical procedure rate change from 13.15 to 32.28 procedures per 10,000 people. It was observed a significant increase on the number of phacoemulsification (p<0.001) and a significant decrease on the number of ECCE (p<0.001). A shift on the predominant technique has occurred between 2007 and 2008 with phacoemulsification increasing its percentual representativity from 34.3% to 69.7% of all procedures, reaching 96.1% in 2019. Phacoemulsification costs per procedure increased 30.5% from from USD$119.00 to USD$155.33 (p = 0.007) and the ECCE costs per procedure increased 29.1% from USD$78.57 to USD$101.43 (p = 0.001). There is an increasing trend of procedures related to cataract treatment performed through SUS along the 20-years period and a switch on the technique predominance from ECCE to phacoemulsification was observed after 2007. The costs associated with both techniques have increased but have not followed the country's overall inflation. Data derived from DATASUS is important to understand the overall panorama of ocular health offered by the national health system and to provide information to guide healthcare leaders on management and planning of public health policies within the system.
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Affiliation(s)
- Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
- Department of Anthropology and Archaeology, University of Calgary, Calgary, Alberta, Canada
| | - Aline Nunes Ferraz
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Rafael da Silva Lemos
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Sung Eun Song Watanabe
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Adriana Berezovsky
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
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Tsou BC, Vongsachang H, Purt B, Srikumaran D, Justin GA, Woreta FA. Cataract Surgery Numbers in U.S. Ophthalmology Residency Programs: An ACGME Case Log Analysis. Ophthalmic Epidemiol 2021; 29:688-695. [PMID: 34913813 DOI: 10.1080/09286586.2021.2015395] [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: 10/19/2022]
Abstract
PURPOSE To describe and assess the cataract experience of ophthalmology residents throughout the United States (U.S.). METHODS Cataract procedures logged by graduating ophthalmology residents nationwide and published by the Accreditation Council for Graduate Medical Education (ACGME) from 2009 to 2020 were analyzed using linear regression on log-transformed response variables with robust variance. RESULTS As primary surgeon, average numbers logged for phacoemulsification increased yearly by an average of 4.1% prior to 2019 and then decreased by 22.1% in 2019 for an overall average yearly increase of 2.9% (95% CI: 0.5, 5.4%, p = .03), non-phacoemulsification extracapsular extraction decreased yearly by an average of 4.6% (95% CI: -7.7, -1.5%, p = .01), other cataract/intraocular lens surgeries decreased yearly by an average of 8.4% (95% CI: -10.1, -6.6%, p < .001), anterior vitrectomies decreased yearly by an average of 12.5% (95% CI: -14.9, -10.1%, p < .001), and laser capsulotomies increased yearly by an average of 6.0% prior to 2019 and then decreased by 3.0% for an overall average yearly increase of 5.3% (95% CI: 4.5, 6.2%, p < .001). As assistant, average numbers logged in all ACGME minimum categories showed decreasing trends. CONCLUSIONS Over the last decade, the average numbers of phacoemulsification and laser capsulotomies logged by residents as primary surgeon increased while other ACGME cataract minimum procedures decreased. Surgical volume in 2019-20 was lower due to the coronavirus disease-19 pandemic but higher than from 2009 to 2013.
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Affiliation(s)
- Brittany C Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Boonkit Purt
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Outcomes and longitudinal trend of traumatic cataract wound dehiscence in patients with blunt ocular injury. Sci Rep 2021; 11:18191. [PMID: 34521923 PMCID: PMC8440533 DOI: 10.1038/s41598-021-97723-4] [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: 01/27/2021] [Accepted: 08/30/2021] [Indexed: 11/08/2022] Open
Abstract
Longitudinal trends on traumatic cataract wound dehiscence are scant. In this study, we present the characteristics of traumatic cataract wound dehiscence using 15 years of longitudinal trend in one of the largest medical centers in Taiwan for a period when cataract surgeries were gradually shifting from extracapsular cataract extraction (ECCE) to phacoemulsification. All patients with a prior cataract surgery who suffered from blunt open globe trauma between 2001 and 2015 at a tertiary referral center in Taiwan were included. The number of cases per year; type of prior cataract surgery; visual acuity (VA); mechanism and place of injury were analyzed. The risk factors associated with final VA were investigated in patients followed up for ≥ 1 month. Seventy-six eyes of 75 patients were included and all of them were traumatic cataract wound dehiscence with a prior ECCE (65 eyes) or phacoemulsification. The most common mechanism and place of injury was fall and at home in both cataract surgical types. The mean log of the minimal angle resolution (logMAR) of final VA was 2.15 ± 0.88 (ECCE) and 1.61 ± 0.83 (phacoemulsification) (P = .026). The most significant risk factors associated with worse final VA were retinal detachment at the initial visit and low ocular trauma score (both P < .001). Long-term visual outcome of phacoemulsification wound dehiscence was better than that of ECCE wound after a blunt trauma.
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Rana K, Bahrami B, van Zyl L, Esterman A, Goggin M. Efficacy of intracameral antibiotics following manual small incision cataract surgery in reducing the rates of endophthalmitis: A meta-analysis. Clin Exp Ophthalmol 2021; 49:25-37. [PMID: 33426771 DOI: 10.1111/ceo.13890] [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: 07/24/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Manual small incision cataract surgery (MSICS) is a widely used technique for cataract surgery in the developing world. Higher rates of postoperative endophthalmitis have been reported with this technique compared with phaco-emulsification. The purpose of this study was to evaluate the efficacy of prophylactic intracameral (IC) antibiotics in reducing the rates of postoperative endophthalmitis following MSICS. METHODS Systematic review and meta-analysis of patients undergoing MSICS. A literature search in PubMed and EMBASE databases was performed to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Two authors independently assessed eligibility, extracted data and assessed the risk of bias. Heterogeneity was assessed using the I2 test. RESULTS Twelve studies enrolling 1 494 307 eyes were included. IC antibiotics were used in 725 324 (48.5%) eyes. The risk ratio of developing endophthalmitis was 2.94 (95% CI, 1.07-8.12; P = .037) in eyes that did not receive IC antibiotics. CONCLUSIONS Routine use of IC antibiotics may help to reduce the rates of endophthalmitis following MSICS and significantly improve the safety of this effective form of cataract surgery.
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Affiliation(s)
- Khizar Rana
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Bobak Bahrami
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lourens van Zyl
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michael Goggin
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Chuang J, Shih KC, Chan TC, Wan KH, Jhanji V, Tong L. Preoperative optimization of ocular surface disease before cataract surgery. J Cataract Refract Surg 2019; 43:1596-1607. [PMID: 29335106 DOI: 10.1016/j.jcrs.2017.10.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
An impaired ocular surface adversely affects preoperative planning for cataract surgery, including intraocular lens (IOL) calculations, toric IOL axis and magnitude estimates, keratometry, and topography measurements. It also increases surgical difficulty. We performed a review to evaluate the connection between cataract surgery and dry eye and to determine the best management for these patients. Of the 16 papers included in this review, 6 were randomized controlled trials. Cataract surgery was shown to worsen ocular parameters and aggravate dry-eye disease. Physicians should recognize and aggressively treat cataract patients with poor prognostic factors and/or with existing dry-eye disease. Increased incision extent, operation time, irrigation, and microscopic-light exposure time decreased the tear breakup time and mean goblet cell density. Postoperatively, the use of eyedrops was associated with worsening of goblet cell density; hence, these medications should be tapered off when no longer needed.
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Affiliation(s)
- Jasmine Chuang
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kendrick Co Shih
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Tommy C Chan
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin H Wan
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal Jhanji
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louis Tong
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lynds R, Hansen B, Blomquist PH, Mootha VV. Supervised resident manual small-incision cataract surgery outcomes at large urban United States residency training program. J Cataract Refract Surg 2019; 44:34-38. [PMID: 29502616 DOI: 10.1016/j.jcrs.2017.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/26/2017] [Accepted: 09/27/2017] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine the outcomes of resident-performed manual small-incision cataract surgery (SICS) in an urban academic setting. SETTING Parkland Memorial Hospital, Dallas, Texas, USA. DESIGN Retrospective case series. METHODS Manual SICS was used only in selected cases for which phacoemulsification was expected to be difficult, namely for mature or brunescent cataracts, traumatic cataracts, and pseudoexfoliation syndrome or other causes of zonular weakness. All manual SICS cases performed by resident physicians as the primary surgeon over a 5-year period were reviewed. Postoperative visual acuity, intraoperative complications, and early postoperative complications were the main outcomes measured. RESULTS For the 52 cases identified, the mean preoperative visual acuity was 2.165 logarithm of the minimum angle of resolution (logMAR) ± 0.141 (SD) (95% confidence interval) (slightly better than had motion acuity), improving to 0.278 ± 0.131 logMAR (Snellen 20/38) corrected visual acuity postoperatively. Of the 52 cases, the most frequent intraoperative complications were iris prolapse (5 cases [9.6%]) and zonular dialysis (4 cases [7.7%]), with vitreous loss occurring in 1 case (1.9%). The most frequent postoperative complications were cystoid macular edema (3 cases [5.8%]), retained ophthalmic viscosurgical device (2 cases [3.8%]), intraocular lens displacement (2 cases [3.8%]), and microhyphema (2 cases [3.8%]). CONCLUSIONS Although the more advanced wound construction in manual SICS might be challenging to surgeons unfamiliar with the technique, it was a safe and efficacious technique in the hands of learning residents. With several advantages over phacoemulsification, such as cost and ability to remove very dense nuclei, manual SICS will play a valuable role in modern cataract surgery.
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Affiliation(s)
- Ross Lynds
- From the Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brock Hansen
- From the Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - V Vinod Mootha
- From the Texas Southwestern Medical Center, Dallas, Texas, USA.
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10
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Zafar S, Chen X, Sikder S, Srikumaran D, Woreta FA. Outcomes of resident-performed small incision cataract surgery in a university-based practice in the USA. Clin Ophthalmol 2019; 13:529-534. [PMID: 30962673 PMCID: PMC6433105 DOI: 10.2147/opth.s198870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess outcomes of resident-performed small incision cataract surgery (SICS) at a single academic institute and to determine the availability of SICS-oriented educational resources in residency programs across the USA. Patients and methods A retrospective chart review was conducted on all patients who underwent SICS performed by postgraduate year 4 residents between January 2014 and January 2018 at the Wilmer Eye Institute, Baltimore, MD, USA. Postoperative visual acuity, intraoperative complications, and postoperative complications were the main outcomes measured. In addition, a survey was administered to all ophthalmology residency program directors in the USA to assess the presence of SICS-related content in their surgical training curriculum. Results Twenty-two eyes of 17 patients underwent planned resident-performed SICS, mainly for white cataracts. Intraoperative complications occurred in two (9.1%) eyes. The most common postoperative complication was transient increased intraocular pressure (two eyes, 9.1%). Mean preoperative best-corrected visual acuity (BCVA) was approximately 20/4,000. The large majority (95.2%) of eyes experienced improved BCVA following SICS, with a mean postoperative BCVA of 20/138 over an average follow-up of 4.2 months. Forty-seven programs responded to the survey (40.1% response rate). Residents were trained in SICS in 66.7% of these programs. However, more than half of all the programs did not have SICS-oriented educational resources available for residents. Conclusion Resident-performed SICS was found to be a safe and effective technique for cataract management. Considering the limited surgical volume for SICS in the USA, training programs might instead consider implementing SICS-oriented content in their surgical curriculum, including wet labs.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Xinyi Chen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA,
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11
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Hegde S, Sekharreddy M, Sugantharaj V. Surgically induced astigmatism in manual small-incision cataract surgery: A comparative study between superotemporal and temporal scleral incisions. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_23_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Wu S, Xu J. Incidence and risk factors for post-penetrating keratoplasty glaucoma: A systematic review and meta-analysis. PLoS One 2017; 12:e0176261. [PMID: 28430806 PMCID: PMC5400257 DOI: 10.1371/journal.pone.0176261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/07/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives To establish the incidence and risk factors for post penetrating keratoplasty glaucoma (PKKG). Methods Studies published between 1947 and 2016 regarding penetrating keratoplasty (PK) were identified using an electronic search and reviewed. For search purpose, PKKG was defined as ocular hypertension (> 21mmHg) after PK. The incidence and risk factors of PKKG were extracted for all studies. Pooled incidence, odd ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results Thirty studies reporting on 27146 patients were included in the analysis of the incidence and risk factors for PKKG. Exact PKKG definitions used in the literature could be classified in to three subgroups: I, ocular hypertension (> 21mmHg) after PK; II, I plus > 4 weeks medical treatment required; III, II plus treatment escalation among patients with preexisting glaucoma. Overall (Definition I) pooled incidence in all studies was 21.5% (95% CI 17.8%, 25.7%). The incidence varied according to different definitions. The highest incidence value was found when only studies using Goldmann tonometer were included (22.5%), while the lowest incidence was found when a strict definition was used and steroid-induced PPKG was excluded (12.1%). The incidence was higher in patients with preexisting glaucoma, bullous keratopathy (BK), aphakia, pseudophakia, failed graft, and surgical indication of trauma. A triple procedure (combined PK with extra capsular cataract extraction and intraocular lens implantation) was not identified as being associated with the increased risk for PKKG. Conclusions The overall pooled incidence of PKKG was 21.5%, but it varied according to the criteria used to define the presence of PPKG. Strong risk factors for PKKG included preexisting glaucoma and aphakia, while modest predictors included pseudophakia, regrafting, and preoperative diagnosis like BK and trauma. There may not be sufficient evidence to identify a significant association between a triple procedure and PKKG.
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Affiliation(s)
- Suqian Wu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianjiang Xu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Postoperative Corneal and Surgically Induced Astigmatism following Superior Approach Manual Small Incision Cataract Surgery in Patients with Preoperative Against-the-Rule Astigmatism. J Ophthalmol 2016; 2016:9489036. [PMID: 28116142 PMCID: PMC5225371 DOI: 10.1155/2016/9489036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to report postoperative corneal and surgically induced astigmatism (SIA) in patients with preoperative against-the-rule (ATR) astigmatism who underwent superior approach manual small incision cataract surgery (MSICS). 58 eyes of 58 cataract patients with preoperative ATR astigmatism were involved in this study. All patients had operable cataracts and underwent superior approach MSICS. Keratometric (K) readings were taken prior to surgery and at 12 weeks after surgery. Centroid values of SIA, preoperative astigmatism, and postoperative astigmatism were calculated using Cartesian coordinates based analysis. Wilcoxon signed rank test was used to compute statistical significance between mean preoperative and postoperative corneal astigmatism. Cohen's d was used as effect size measure. Centroid values of 1.42 D × 179, 2.48 D × 0, and 1.07 D × 1 were recorded, respectively, for preoperative astigmatism, postoperative astigmatism, and SIA. Wilcoxon signed rank test indicated that mean ± SD postoperative corneal astigmatism (2.80 ± 1.40 D) was statistically significantly greater than preoperative corneal astigmatism (1.49 ± 1.34 D), Z = −6.263, p < 0.0001. A high Cohen's d of 1.32 was found. Our results suggest statistical and clinically significant greater postoperative corneal astigmatism than preoperative corneal astigmatism for ATR astigmatism cataract patients who underwent superior approach MSICS.
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Mavrakanas N, Dhalla KA, Jecha J, Kapesa I, Odouard C, Murdoch I. Results and safety profile of trainee cataract surgeons in a community setting in East Africa. Indian J Ophthalmol 2016; 64:818-821. [PMID: 27958204 PMCID: PMC5200983 DOI: 10.4103/0301-4738.195594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. Results: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). Conclusion: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.
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Affiliation(s)
- Nikolaos Mavrakanas
- Department of Ophthalmology, Glaucoma Service, Moorfields Eye Hospital, London, UK
| | - Kazim A Dhalla
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Jerry Jecha
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Imani Kapesa
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital, Dar es Salaam, Tanzania
| | - Capucine Odouard
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Ian Murdoch
- Institute of Ophthalmology, University College London, London, UK
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Jauhari N, Chopra D, Chaurasia RK, Agarwal A. Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery. Int J Ophthalmol 2014; 7:1001-4. [PMID: 25540754 DOI: 10.3980/j.issn.2222-3959.2014.06.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/27/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS). METHODS A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software. RESULTS The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant. CONCLUSION Inverted V (Chevron) incision gives minimal SIA.
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Affiliation(s)
- Nidhi Jauhari
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandpuri, Lucknow, Uttar Pradesh 226001, India
| | - Deepak Chopra
- Department of Community Medicine, Integral University of Medical Sciences and Research, Kursi Road, Lucknow, Uttar Pradesh 226026, India
| | - Rajan Kumar Chaurasia
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandpuri, Lucknow, Uttar Pradesh 226001, India
| | - Ashutosh Agarwal
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandpuri, Lucknow, Uttar Pradesh 226001, India
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van Zyl L, Kahawita S, Goggin M. Manual small incision extracapsular cataract surgery in Australia. Clin Exp Ophthalmol 2014; 42:729-33. [DOI: 10.1111/ceo.12324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Lourens van Zyl
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Shyalle Kahawita
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Michael Goggin
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
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Henderson BA, Oetting TA, Yang EB, Rankin JK, Aaron MM, Yang Z, Broocker G, Blomquist PH. Teaching manual cataract extraction. Ophthalmology 2012; 119:2191. [PMID: 23034293 DOI: 10.1016/j.ophtha.2012.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022] Open
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Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg 2012; 38:1360-9. [DOI: 10.1016/j.jcrs.2012.04.025] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/27/2012] [Accepted: 04/02/2012] [Indexed: 11/19/2022]
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Kloek CE, Andreoli MT, Andreoli CM. Characteristics of traumatic cataract wound dehiscence. Am J Ophthalmol 2011; 152:229-33. [PMID: 21621188 DOI: 10.1016/j.ajo.2011.01.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize the clinical course of cataract wound dehiscence. DESIGN Retrospective, comparative case series. METHODS Charts of open globe injuries (848 injuries in 846 patients) treated surgically at the Massachusetts Eye and Ear Infirmary between 2000 and 2009 were retrospectively reviewed. Time from original surgery to wound dehiscence, type of initial surgery, Ocular Trauma Score, age, gender, mechanism of injury, and visual acuity were analyzed. RESULTS Of 846 patients with 848 open globe injuries, 63 experienced cataract wound dehiscence. The majority of these cataract wounds (89%) were extracapsular cataract extraction (ECCE), with only 7 (11%) phacoemulsification wounds. The mean patient age in the wound rupture group was 78.2 years. Female patients comprised the majority (67%) of this subpopulation. The most common mechanisms of injury were fall (65%), blunt trauma (23%), and motor vehicle accident (7%). The median raw ocular trauma score was 47 in wound dehiscence patients. Visual acuity at presentation was light perception in the wound dehiscence group. The best postoperative visual acuity was significantly worse in the wound dehiscence group (hand motion) than in the remaining patients (20/40; P=.0002). When considering the phacoemulsification patients alone, these patients fared much better, with a median postoperative vision of 20/60. CONCLUSIONS Despite recent advances in cataract surgery, wound dehiscence remains a significant source of visual disability, mainly in the geriatric population. Rupture ECCE wound patients have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.
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Affiliation(s)
- Carolyn E Kloek
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02215, USA
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Hashemi H, Mohammadi SF, Mazouri A, Majdi-N M, Jabbarvand M, Z-Mehrjardi H. Transition to phacoemulsification at the farabi eye hospital, iran. Middle East Afr J Ophthalmol 2011; 18:173-7. [PMID: 21731331 PMCID: PMC3119289 DOI: 10.4103/0974-9233.80709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
PURPOSE To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran. MATERIALS AND METHODS Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients (405 eyes) in 2006 and 125 patients (153 eyes) in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P <0.05 was considered statistically significant. RESULTS The phacoemulsification rate increased from 25% to greater than 90% between 2003 and 2006, rates of corneal incisions and use of foldable intraocular lenses tripled, administration of general anesthesia dropped from 80% to 12%, the outpatient admission rate rose from 5.2% to 71%, 4% vs. 66% of the operations were performed by a senior phacoemulsification surgeon and the number of advanced surgeons changed from 6% to 38% (all P-values < 0.001). In 2006, more patients at the two extremes of age, more patients with poor systemic conditions and myopes underwent surgery (all P-values < 0.05); the cataract surgery volume increased by 49% and post-operative visual acuity improved (P = 0.03) while patient satisfaction was unchanged. CONCLUSION We objectively documented the transition in cataract surgery technique to phacoemulsification at the Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill.
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Affiliation(s)
- Hassan Hashemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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