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Park SW, Kim HK, Zaidi MH, Byon IS, Lee JE, Nguyen QD. Cystoid macular edema after vitrectomy and after phacovitrectomy for epiretinal membrane. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e596-e602. [PMID: 38145628 DOI: 10.1016/j.jcjo.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the incidence of cystoid macular edema (CME) after vitrectomy and CME after phacovitrectomy in patients requiring epiretinal membrane (ERM) removal. DESIGN A retrospective, comparative, interventional study. METHODS Medical records of patients who had undergone vitrectomy or phacovitrectomy for ERM removal by a single surgeon were retrospectively reviewed. Phacovitrectomy was performed in all phakic eyes and vitrectomy was performed in all pseudophakic eyes. Increased macular thickness (IMT) was defined as an increase in macular thickness by more than 10% at the postoperative week 4 visit compared to the measurements at baseline. RESULTS There were 214 and 53 eyes in the Phacovitrectomy group and the Vitrectomy group, respectively. IMT occurred in 15.4% of the Phacovitrectomy group, which was higher than the incidence of 3.8% in the Vitrectomy group (p=0.023). CONCLUSIONS IMT, that is suspected to be a type of CME, was not uncommon (15.4%) after phacovitrectomy in phakic eyes but was uncommon (3.8%) after vitrectomy alone in pseudophakic eyes. Irvine-Gass syndrome appears to be triggered by crystalline lens removal itself rather than intraocular surgery or surgical trauma alone.
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Affiliation(s)
- Sung Who Park
- Department of Ophthalmology, Pusan National University College of Medicine, Pusan, Korea; Biomedical Research Institute, Pusan National University Hospital, Pusan, Korea
| | - Hui Kyung Kim
- Department of Ophthalmology, Pusan National University College of Medicine, Pusan, Korea
| | - Moosa Hasan Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University College of Medicine, Pusan, Korea; Biomedical Research Institute, Pusan National University Hospital, Pusan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Pusan, Korea; Biomedical Research Institute, Pusan National University Hospital, Pusan, Korea
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA.
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Dai M, Feng K, Guo X, Cai J, Gong X, Daliko NA, Wang Y. A Period of Macular Hyperemia and Subclinical Edema Caused by Phacoemulsification Surgery in Noninfectious Uveitis. Ocul Immunol Inflamm 2024; 32:961-968. [PMID: 36731509 DOI: 10.1080/09273948.2023.2168700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify the changes in macular microvasculature in uveitic patients following phacoemulsification. METHODS A prospective cohort study was conducted by enrolling uveitic patients who underwent phacoemulsification at the Eye Hospital. Macular vessel densities (VD) of superficial and deep capillary plexus (SCP and DCP) and retinal thickness (RT) were quantified by optical coherence tomographic angiography (OCTA). RESULTS Twenty-one eyes obtained satisfactory OCTA scans at all the follow-up visits. After surgery, an increasing trend in SCP VD was found (p = .037) and reached its maximum (+2.79 ± 4.86%) at post-3 months (M). RT increased synchronously. The increases in SCP VD at post-3 M were significantly correlated with the changes in anterior chamber cells (ACCs) at post-1 M and 2 M (r = 0.450, p = .041; r = 0.477, p = .029, respectively). CONCLUSIONS Inflammation generates a long-term effect on retina demonstrated as an increase in SCP VD and RT which are associated with synchronous ACCs changes after phacoemulsification.
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Affiliation(s)
- Mali Dai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kemi Feng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xingneng Guo
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyong Cai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianhui Gong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nishimwe Anodine Daliko
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuqin Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Nijm L, Matossian C, Rhee MK, Stephens JD, Rosselson ME, Majmudar PA, Gollamudi SR, Patel RH, Bauskar A, Montieth A, Vantipalli S, Gibson A, Metzinger JL, Goldstein MH, Gurses Ozden R. Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert. Clin Ophthalmol 2024; 18:1391-1401. [PMID: 38784434 PMCID: PMC11114144 DOI: 10.2147/opth.s448973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops. Patients and Methods This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents. Results Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications. Conclusion Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.
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Affiliation(s)
- Lisa Nijm
- Warrenville EyeCare and LASIK, Warrenville, IL, USA
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | | | | | | | | | | | | | - Ravi H Patel
- Eye Associates of Central Texas, Round Rock, TX, USA
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Ruiss M, Pai V, Pilwachs C, Bayer N, Palkovits S, Findl O. Quality assurance via telephone interviews after cataract surgery: An explorative study. PLoS One 2024; 19:e0298149. [PMID: 38451971 PMCID: PMC10919583 DOI: 10.1371/journal.pone.0298149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/13/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Cataract surgery is a relatively safe procedure with satisfactory postoperative results in most patients. However, in rare cases severe complications can occur shortly after the intervention. Therefore, patients are advised to undergo an ophthalmological examination postoperatively, which should be performed as soon as possible in case of emergencies. However, exactly when these follow-up visits should take place is still discussed. A time- and cost-saving alternative to this could be short-term postoperative telemedical approaches. The aim of this study was to analyze patient complaints as well as satisfaction with and the best timepoint to perform telephone calls after cataract surgery. METHODS Patients scheduled for cataract surgery received a telephone call on the surgery day or the day after (study group) during which they were asked about complaints or additional examination visits. Patients without telephone calls served as control group. All patients had a follow-up visit one week after the intervention during which a questionnaire was filled out and the study group was asked about their satisfaction with the telephone calls. RESULTS 181 patients were recruited in this study. Ocular surface problems were the most common postoperative symptom. More than 80% of the patients were very satisfied with the telephone calls, with patients being contacted on the day of surgery being more calmed than those called on the next day. No difference in additional and planned follow-up visits was found between the study and the control group (P > .40). Postoperative patient complaints (Phi 0.372, P < .001) and additional prescribed therapy (Phi 0.480, P < .001) were moderately associated with additional visits. CONCLUSION Satisfaction with telephone reviews shortly after cataract surgery was very high and contacting patients on the evening of the day of the procedure could be a time- and cost-saving alternative to short-term in-house follow-up visits.
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Affiliation(s)
- Manuel Ruiss
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Viktoria Pai
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Caroline Pilwachs
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Natascha Bayer
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Stefan Palkovits
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
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Sim PY, Day AC, Leak C, Buchan JC. Cochrane Corner: immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Eye (Lond) 2023; 37:2841-2843. [PMID: 36765268 PMCID: PMC10517021 DOI: 10.1038/s41433-023-02436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Affiliation(s)
| | - Alexander C Day
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | | | - John C Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Ahmadyar G, Carlson JJ, Kimura A, Alobaidi A, Hallak J, Hansen RN. Real-world treatment patterns and economic burden of post-cataract macular edema. BMC Ophthalmol 2023; 23:380. [PMID: 37723463 PMCID: PMC10506304 DOI: 10.1186/s12886-023-03113-x] [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: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Post-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME. METHODS This retrospective claims analysis identified patients from the IBM® MarketScan® Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models. RESULTS Treatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 [30%]), topical nonsteroidal anti-inflammatory drug drops (321 [27%]), and intraocular or periocular injectable steroids (189 [15%]). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7-6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8-3.2), adding $371 in total cost (95% CI: $332 - $410). CONCLUSIONS PCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.
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Affiliation(s)
- Gina Ahmadyar
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA.
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA.
| | - Josh J Carlson
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
| | - Alan Kimura
- Colorado Retina Associates, 255 S. Routt St., Suite 200, 80228, Lakewood, CO, USA
| | - Ali Alobaidi
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Joelle Hallak
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Ryan N Hansen
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
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Steindor FA, Büchau TM, Borgardts KC, Borrelli M, Guthoff R, Geerling G, Spaniol K. Descemet Membrane Endothelial Keratoplasty and Triple Descemet Membrane Endothelial Keratoplasty in Eyes With Macular Comorbidity. Cornea 2023; 42:986-991. [PMID: 36542355 DOI: 10.1097/ico.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate results after Descemet membrane endothelial keratoplasty (DMEK) and DMEK with cataract surgery (triple DMEK) in eyes with endothelial dysfunction and concomitant macular pathology. METHODS A monocentric, prospective clinical observational study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from June 2013 to February 2016 was conducted. Sex, age, best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density, and central retinal thickness in the 1 millimeter zone were analyzed. RESULTS A total of 209 eyes were included in the study. Forty-two eyes (20.1%) had vision-limiting concomitant maculopathies. These were age-related macular degeneration (n = 17, 8.1%), epiretinal gliosis (n = 13, 6.2%), chronic macular edema (n = 7, 3.3%), macular holes (n = 3, 1.4%), and macular scarring (n = 2, 1.0%). BCVA significantly increased in patients without maculopathy from 0.6 ± 0.33 logMAR to 0.1 ± 0.15 logMAR ( P < 0.001) and also in patients with maculopathy from 0.9 ± 0.38 logMAR to 0.27 ± 0.23 logMAR 12 months postoperatively ( P < 0.001). There was a significant central retinal thickness increase of 34.1 μm 6 weeks after triple DMEK in the central 1-mm zone ( P = 0.011). This increase was insignificant after DMEK. Postoperative macular edema occurred in 5.9% of cases after DMEK and 8.1% after triple DMEK, which was not significantly different. CONCLUSIONS DMEK and triple DMEK significantly increase BCVA in eyes with concomitant maculopathy. Postoperative macular edema is a common disorder after lamellar keratoplasty; therefore, prophylactic treatment with nonsteroidal antiinflammatory drugs should be considered. Maculopathies did not predispose the development of postoperative macular edema.
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Ahmed TM, Siddiqui MAR, Hussain B. Optical coherence tomography as a diagnostic intervention before cataract surgery-a review. Eye (Lond) 2023; 37:2176-2182. [PMID: 36517576 PMCID: PMC10366081 DOI: 10.1038/s41433-022-02320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/19/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to perform a systematic review of existing literature on OCT screening before cataract surgery. Available literature was evaluated and projections on how it could be applied to enhance postoperative outcomes of cataract surgery were summarised. The PubMed, Embase and Cochrane databases were searched for articles pertaining to preoperative OCT screening. Selected articles were qualitatively and quantitatively analysed. Across 9 studies, the addition of OCT macular screening resulted in preoperative detection of macular pathology in 13.7% of eyes that were determined to be normal on fundoscopic examination alone. The types of macular pathology most frequently detected through preoperative OCT screening were interface abnormalities followed by macular degeneration. Comparative analysis of SS-OCT biometer and SD-OCT found that SS-OCT had a sensitivity of 0.48-0.81 in the detection of macular pathology in eyes with pathology diagnosed by SD-OCT. OCT screening prior to cataract surgery results in the detection of occult macular pathology that may influence postoperative visual outcomes in approximately 1 in 10 eyes (13.7%). As a result, OCT screening should be considered in the routine preoperative workup for cataract surgery.
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Affiliation(s)
| | - M A Rehman Siddiqui
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan.
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[Pseudophakic cystoid macular edema : Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:276-284. [PMID: 36692849 DOI: 10.1007/s00347-022-01771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/25/2023]
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10
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[Pseudophakic Cystoid Macular Edema - Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. Klin Monbl Augenheilkd 2023; 240:316-326. [PMID: 36977428 DOI: 10.1055/a-2019-9748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Elksne E, Steiner V, Hohensinn M, Reitsamer HA, Lenzhofer M. Radius-Maumenee syndrome: A case series with a long-term follow-up. Clin Case Rep 2023; 11:e6918. [PMID: 36814708 PMCID: PMC9939581 DOI: 10.1002/ccr3.6918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/11/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023] Open
Abstract
The aim of the case series is to highlight the surgical challenges experienced like failed intervention, choroidal effusion, a postoperative cystoid macular oedema, and describe treatment options for Radius-Maumenee syndrome. Authors reported on 3 bilateral cases of Radius-Maumenee syndrome which underwent medical treatment, trabeculectomy with Mitomycin C, implantation with XEN45, Ahmed glaucoma valve, Baerveldt glaucoma implant, and cyclophotocoagulation.
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Affiliation(s)
- Eva Elksne
- Department of Ophthalmology, European Reference Network on Rare Eye Diseases (ERN‐EYE)Children‘s Clinical University HospitalRigaLatvia
- Department of OphthalmologyRiga Stradins UniversityRigaLatvia
| | - Veit Steiner
- Department of Ophthalmology and OptometryParacelsus Medical University, Salzburger LandesklinikenSalzburgAustria
| | - Melchior Hohensinn
- Department of Ophthalmology and OptometryParacelsus Medical University, Salzburger LandesklinikenSalzburgAustria
| | - Herbert A. Reitsamer
- Department of Ophthalmology and OptometryParacelsus Medical University, Salzburger LandesklinikenSalzburgAustria
- Research Program Experimental Ophthalmology and Glaucoma ResearchParacelsus Medical UniversitySalzburgAustria
| | - Markus Lenzhofer
- Department of Ophthalmology and OptometryParacelsus Medical University, Salzburger LandesklinikenSalzburgAustria
- Research Program Experimental Ophthalmology and Glaucoma ResearchParacelsus Medical UniversitySalzburgAustria
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Özyol E, Özyol P, Günel-Karadeniz P. The Use of Prostaglandin Analogues and Cystoid Macular Edema after Uneventful Cataract Surgery: A Systematic Review and Meta-Analysis. Semin Ophthalmol 2023:1-8. [PMID: 36703301 DOI: 10.1080/08820538.2023.2170716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate whether using prostaglandin analogues (PGAs) perioperatively is associated with an increased rate of the development of clinical or subclinical cystoid macular edema (CME) after uneventful cataract surgery. METHODS The PubMed, Scopus, and ScienceDirect databases were searched to June 2022 for this systematic review and meta-analysis. Two authors independently screened search results. Random-effects meta-analyses were performed to calculate the overall incidence rate and odds ratio (OR). Quality of studies was assessed using the modified Newcastle-Ottawa scale. The incidences of CME for continued vs discontinued use of PGAs perioperatively, continued use of PGAs, discontinued use of PGAs, and PGA users vs non-PGA antiglaucomatous users were main outcomes. RESULTS Out of 544-articles, 9 studies that met the inclusion criteria were analyzed. The continued use of PGAs was not associated with an increased risk of the development of subclinical macular edema compared with discontinued use (OR = 1.32 [95% Confidence Interval (CI) = 0.49-3.51], p = .582). The overall incidence of CME was 34% (95% CI = 0.17-0.52) for continued use of PGAs and 7% (95% CI = 0.02-0.13) for discontinued use of PGAs. Using PGAs did not increase the risk of CME's development compared with non-PGA antiglaucomatous usage (OR = 2.29 [95% CI = 0.84-6.23], p = .103). CONCLUSIONS Discontinuing treatment with PGAs during the perioperative period in eyes without any known risk factors for CME has no clinically significant effect on reducing the development of postoperative CME based on the existing studies. Further, well-designed randomized controlled trials need to be performed.
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Affiliation(s)
- Erhan Özyol
- SANKO University Faculty of Medicine, Ophthalmology Department, Gaziantep, Turkey
| | - Pelin Özyol
- SANKO University Faculty of Medicine, Ophthalmology Department, Gaziantep, Turkey
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Bernal-Morales C, Navarro-Angulo MJ, Rodriguez-Maqueda M, Velazquez-Villoria D, Cubero-Parra JM, Marticorena J, Hernández-Martínez A, Ruiz-Miguel M, Adan A, Ruiz-Casas D, Zarranz-Ventura J. Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2. J Clin Med 2023; 12:jcm12020436. [PMID: 36675364 PMCID: PMC9862359 DOI: 10.3390/jcm12020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.
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Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | | | | | | | | | - Joaquín Marticorena
- Instituto Oftalmológico La Esperanza, HM La Esperanza, 15705 Santiago de Compostela, Spain
- Servicio de Oftalmología, Complejo Hospitalario Universitario, 15006 A Coruña, Spain
| | | | | | - Alfredo Adan
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Diego Ruiz-Casas
- Servicio de Oftalmología, Hospital Ramon y Cajal, 28029 Madrid, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Correspondence:
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List W, Steinwender G, Glatz W, Riedl R, Wedrich A, Ivastinovic D. The impact of surgeon's experience and sex on the incidence of cystoid macular edema after uneventful cataract surgery. PLoS One 2022; 17:e0279518. [PMID: 36574394 PMCID: PMC9794095 DOI: 10.1371/journal.pone.0279518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/22/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon's sex. METHODS Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient's sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon's sex. RESULTS 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03-2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02-1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons). CONCLUSION In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.
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Affiliation(s)
- Wolfgang List
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
- * E-mail:
| | | | - Wilfried Glatz
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
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15
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Niyadurupola N, Brodie J, Patel T, Chan J, Rahman MM, Svasti-Salee CR, Ching J, Misra A, Eke T, Broadway DC. Topical prostaglandin analogue use and cystoid macular oedema following uneventful cataract surgery: a randomised control trial. Br J Ophthalmol 2022; 106:1662-1666. [PMID: 34045222 DOI: 10.1136/bjophthalmol-2021-319149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS The association between the development of cystoid macular oedema (CMO) following uneventful cataract surgery and prostaglandin analogue (PGA) therapy has not been fully determined. The study aim was to investigate whether discontinuation of PGA therapy following uneventful cataract surgery affected the incidence of postoperative CMO. METHODS A prospective randomised controlled trial of 62 eyes of 62 participants with ocular hypertension (OH) or primary open angle glaucoma (POAG) treated with PGAs prior to cataract surgery. Participants were randomised to continue with PGA therapy after cataract surgery (CPGA) (n=31) or to discontinue PGA therapy (n=31). The primary outcome measure was the development of CMO at 1-month postoperatively, determined by a masked observer assessment of optical coherence tomography scans. The secondary outcome measure was change from baseline intraocular pressure (IOP). RESULTS The incidence of CMO was identical in both groups at 12.9% (4 of 31 eyes) at the 1-month postoperative visit (OR 1.000; 95% CI 0.227 to 4.415). At 1-month postoperatively, the IOP was significantly lower in the CPGA group compared with baseline IOP. CONCLUSION Continuation of PGA therapy following uneventful cataract surgery in eyes with normal macular morphology did not increase the incidence of CMO. Continuation of PGA therapy significantly reduced IOP at 1-month postoperatively suggesting that, when indicated, it might be beneficial to continue PGA therapy in patients with POAG or OH after uneventful cataract surgery in the absence of other risk factors for developing CMO.
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Affiliation(s)
- Nuwan Niyadurupola
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Brodie
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tejal Patel
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jason Chan
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Mohammad M Rahman
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Carl R Svasti-Salee
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jared Ching
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Aseema Misra
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tom Eke
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
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16
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Fang L, Liu J, Liu Z, Zhou H. Immune modulating nanoparticles for the treatment of ocular diseases. J Nanobiotechnology 2022; 20:496. [DOI: 10.1186/s12951-022-01658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractOcular diseases are increasingly influencing people’s quality of life. Complicated inflammatory mechanisms involved in the pathogenic process of ocular diseases make inflammation-targeting treatment a potential therapeutic approach. The limited efficacy of conventional anti-inflammatory therapeutic strategies, caused by various objective factors, such as complex ocular biological barriers, and subjective factors, such as poor compliance, are promoting the development of new therapeutic methods. With the advantages of considerable tissue permeability, a controllable drug release rate, and selective tissue targeting ability, nanoparticles have successfully captured researchers’ attention and have become a research hotspot in treating ocular diseases. This review will focus on the advantages of nanosystems over traditional therapy, the anti-inflammation mechanisms of nanoparticles, and the anti-inflammatory applications of nanoparticles in different ocular diseases (ocular surface diseases, vitreoretinopathy, uveal diseases, glaucoma, and visual pathway diseases). Furthermore, by analyzing the current situation of nanotherapy and the challenges encountered, we hope to inspire new ideas and incentives for designing nanoparticles more consistent with human physiological characteristics to make progress based on conventional treatments. Overall, some progress has been made in nanoparticles for the treatment of ocular diseases, and nanoparticles have rather broad future clinical translation prospects.
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17
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Kato K, Nagashima R, Matsubara H, Ikesugi K, Tsukitome H, Matsui Y, Nunome T, Sugimoto M, McCulloch DL, Kondo M. Transient Increase of Flicker Electroretinography Amplitudes after Cataract Surgery: Association with Postoperative Inflammation. OPHTHALMOLOGY SCIENCE 2022; 3:100243. [PMID: 36545261 PMCID: PMC9762194 DOI: 10.1016/j.xops.2022.100243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Purpose To determine the characteristics and cause of the increase in the amplitude of flicker electroretinography (ERG) after cataract surgery. Design Prospective, observational clinical study. Participants Thirty patients who underwent cataract surgery. Methods Flicker ERGs were recorded with the RETeval system without mydriasis. The central macular thickness (CMT) was measured by OCT and the aqueous flare value (AFV) by laser flare-cell photometry. These examinations were performed before surgery and 1 day, 1 week, 1 month, 2 months, and 3 months after surgery. Linear regression analysis through the origin was used to compare the correlations between the relative changes in flicker ERG amplitudes and the changes in the CMT and AFV at different times after the surgery. Main Outcome Measures The amplitude of flicker ERGs, CMT, and AFV. Results The mean amplitude of flicker ERGs increased significantly by 31% at 1 week after surgery (P < 0.001); a significant increase in the amplitudes was not present at 3 months after the surgery. The mean AFV was significantly increased at 1 day after surgery (P < 0.001), and the CMT was significantly increased at 1 to 3 months after surgery (P < 0.001). The changes in flicker ERG amplitudes at 1 week after surgery were significantly associated with the changes in the CMT at 1 to 3 months after surgery (P < 0.05), and they were weakly associated with the changes in AFV at 1 day after surgery (P = 0.05). Conclusions These results suggest that the increase in the amplitude of flicker ERGs after cataract surgery is a transient phenomenon that has a peak at 1 week after surgery. The increase of flicker ERG amplitude was associated with measures that are frequently used to evaluate postoperative inflammation. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kumiko Kato
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan,Correspondence: Kumiko Kato, MD, PhD, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | - Ryunosuke Nagashima
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kengo Ikesugi
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideyuki Tsukitome
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshitsugu Matsui
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takayasu Nunome
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Daphne L. McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
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Merad M, Vérité F, Baudin F, Ghezala IB, Meillon C, Bron AM, Arnould L, Eid P, Creuzot-Garcher C, Gabrielle PH. Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes. J Clin Med 2022; 11:jcm11164914. [PMID: 36013153 PMCID: PMC9410086 DOI: 10.3390/jcm11164914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.
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Affiliation(s)
- Malik Merad
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Fabien Vérité
- Agathe Group INSERM U 1150, UMR 7222 CNRS, ISIR (Institute of Intelligent Systems and Robotics), Sorbonne Université, 75005 Paris, France
| | - Florian Baudin
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Inès Ben Ghezala
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Cyril Meillon
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Alain Marie Bron
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Pétra Eid
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380-293-031
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Crawford AZ, Freundlich SEN, Lim J, McGhee CNJ. Endocapsular artificial iris implantation for iris defects: Reducing symptoms, restoring visual function and improving cosmesis. Clin Exp Ophthalmol 2022; 50:490-499. [PMID: 35420244 PMCID: PMC9542440 DOI: 10.1111/ceo.14083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Background To investigate repair of iris defects by endocapsular implantation of an artificial iris, in relation to visual outcomes, safety profile and patient satisfaction. Methods Retrospective, consecutive case series from Greenlane tertiary teaching hospital and Eye Institute, Auckland, New Zealand. Medical records of patients implanted with an endocapsular artificial iris were reviewed and followed for minimum 3 months. Patient characteristics, surgical management, clinical outcomes and subjective responses were recorded. Results Nineteen artificial irises were implanted in 18 patients. Etiologies were iris melanotic lesion excision (73.7%), trauma (10.5%), congenital aniridia (10.5%) and Urrets‐Zavalia syndrome (5.3%). During postoperative follow‐up [14.1 ± 12.4 months (range: 3 to 59 months)], best corrected visual acuity (BCVA) and intraocular pressure (IOP) did not change significantly [BCVA, 0.23 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen) preoperatively vs. 0.18 logMAR postoperatively (20/25 Snellen) (Z = −0.222, p = 0.824); IOP, 15 mmHg preoperatively vs. 17 mmHg postoperatively (Z = 1.377, p = 0.1447)]. Mild or self‐limiting complications included: elevated IOP (42.1%), cystoid macular oedema (15.8%); persisting postoperative uveitis (15.8%) and minor vaulting of the prosthesis (15.7%). Moderate or severe complications included significant vaulting of prosthesis requiring surgical revision (5.3%) and a single eye (5.3%) with trabeculectomy and corneal graft failure. 94.4% of patients were very satisfied with the cosmesis and would be highly likely to have the procedure again. Conclusions This study confirms that endocapsular insertion of an artificial iris is typically associated with good functional and cosmetic results and a relatively low risk of significant complications.
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Affiliation(s)
- Alexandra Z. Crawford
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre Auckland District Health Board Auckland New Zealand
| | - Simone E. N. Freundlich
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre Auckland District Health Board Auckland New Zealand
| | - Joevy Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre Auckland District Health Board Auckland New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre Auckland District Health Board Auckland New Zealand
- Eye Institute Auckland New Zealand
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20
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Herold TR, Vounotrypidis E, Liegl R, Koenig SF, Priglinger SG, Wolf A. LONG-TERM EFFICACY OF FLUOCINOLONE IN EYES WITH IRIS-LENS DIAPHRAGM DISRUPTION AND PCME WITH MEDICATION FIXED IN THE SCLERA (MEFISTO). Retina 2022; 42:1392-1398. [PMID: 35321998 PMCID: PMC9200227 DOI: 10.1097/iae.0000000000003472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of our prospective off-label, interventional clinical trial was to evaluate the efficacy and safety of the fluocinolone-loop-anchoring technique over two years in eyes with iris-lens diaphragm disruption and pseudophakic cystoid macular edema. METHODS In 10 eyes, scleral fixation of fluocinolone implant was performed. Main outcome measures were the development of best-corrected visual acuity (BCVA), central retinal thickness over 24 months, and general safety of the procedure. RESULTS A significant improvement to 0.57 ± 0.38 log MAR (Snellen 20/80) (range 0-1.30) was observed (P = 0.003) at 1 month. Further improvement to 0.45 ± 036 log MAR (Snellen 20/60) was observed until month 18 (P = 0.081). Mean central retinal thickness decreased by 22% from 601.6 ± 235.5 µm to 449.1 ± 128.9 µm at 1 month. In one patient, the implant has to be removed at Month 7 because of elevated intraocular pressure and one patient after globe rupture had a retinal redetachment at Month 4. CONCLUSION In this study, we showed that the treatment of recalcitrant pseudophakic cystoid macular edema with scleral fixated fluocinolone implant in eyes with disruption of the iris-lens diaphragm provides good anatomical and functional results with a reasonable safety profile over 24 months in eyes where pseudophakic cystoid macular edema is otherwise difficult to treat and often left untreated.
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Affiliation(s)
- Tina R. Herold
- Department of Ophthalmology, University Hospital, LMU Munich, Germany
| | | | - Raffael Liegl
- Department of Ophthalmology, University Hospital, Bonn, Germany; and
| | - Susanna F. Koenig
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Armin Wolf
- Department of Ophthalmology, University Hospital, Ulm, Germany
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21
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Xu Y, Yang W, Long T, Shang W, Xu X, Wang J, Yao J, Li K. Analysis of Microcirculation Changes in the Macular Area and Para-Optic Disk Region After Implantable Collamer Lens Implantation in Patients With High Myopia. Front Neurosci 2022; 16:867463. [PMID: 35663554 PMCID: PMC9160968 DOI: 10.3389/fnins.2022.867463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Myopia has become an important public health problem to be solved urgently. Posterior chamber phakic implantable Collamer lens (ICL) implantation is one of the latest and safest products for myopia correction worldwide. This prospective cross-sectional case series aimed to observe changes in the macular retinal thickness, retinal nerve fiber layer (RNFL) thickness of para-optic disk region, and blood flow density after posterior ICL implantation in patients with high myopia using optical coherence tomography angiography (OCTA). A total of 67 eyes of 67 patients with high myopia, who underwent ICL implantation at The Affiliated Eye Hospital of Nanjing Medical University from January 2020 and December 2020, were included. The spherical equivalent (SE) of the operative eyes was >−6.00 D. The changes in vision, intraocular pressure (IOP), SE, and vault were observed pre-operatively, and follow-up were performed 1 week, 1 month, and 3 months. OCTA was used to observe the changes in the CRT, retinal thickness of paracentral fovea, FAZ, superficial and deep retinal blood flow density in the macular area, RNFL thickness of para-optic disk region, and blood flow density before and after ICL implantation. The uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) of the patients post-operation were significantly improved (P < 0.001). The IOP increased in comparison with other time points at 1 week post-operation (P < 0.05). There were no significant changes in CRT post-operation. The retinal thickness in the upper, lower, nasal, and temporal quadrants of the paracentral fovea increased significantly at 1 month and 3 months post-operation (P < 0.05). The FAZ area at all postoperative time points were decreased (P < 0.001). At 3 months post-operation, the blood flow density of the superficial and deep retinal layers in the upper, lower, and nasal macular area were significantly reduced (P < 0.05). At 1 month post-operation, the RNFL thickness in the temporal para-optic disk region and blood flow density were significantly reduced (P = 0.001 and P < 0.05, respectively). ICL implantation for highly myopic eyes led to an increase of the retinal thickness in the upper, lower, nasal, and temporal regions of the paracentral fovea; reduction of RNFL thickness in the temporal area of para-optic disk; decrease in FAZ area; and decrease in the blood flow density of some deep and superficial retinal layers as well as that of the temporal para-optic disk region.
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Affiliation(s)
- Yingnan Xu
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Weihua Yang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Tan Long
- Department of Ophthalmology, Xi’an No. 1 Hospital, Xi’an, China
| | - Weihong Shang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangzhong Xu
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Jinfan Wang
- School of Marxism, Nanjing Medical University, Nanjing, China
- *Correspondence: Jinfan Wang,
| | - Jin Yao
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- Jin Yao,
| | - Keran Li
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- Keran Li,
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22
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Lockington D, Bloom P. Survey of UKISCRS consultant members regarding preferred practice management of persistent Cystoid Macular Oedema. Eye (Lond) 2022; 36:881-882. [PMID: 33767406 PMCID: PMC8956789 DOI: 10.1038/s41433-021-01513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- David Lockington
- grid.415302.10000 0000 8948 5526Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Philip Bloom
- grid.439733.90000 0004 0449 9216The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Comparison of Efficacy between Non-Steroidal Anti-Inflammatory Drugs and Anti-Vascular Endothelial Growth Factor in Preventing Macular Edema after Cataract Surgery in Diabetic Patients. J Pers Med 2022; 12:jpm12030351. [PMID: 35330351 PMCID: PMC8950132 DOI: 10.3390/jpm12030351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: There is no consensus regarding the optimal strategy to prevent macular edema after cataract surgery in diabetic patients. The purpose of study is to compare the efficacy of topical nonsteroidal anti-inflammatory agents (NSAIDs) and intravitreal injections of anti-VEGFs for the prevention of macular edema after cataract surgery in diabetic patients without pre-existing macular edema. (2) Methods: A literature search of the MEDLINE, PUBMED, and EMBASE databases was conducted in July 2021. Studies involving either topical NSAIDs or intravitreal injections of anti-VEGF arms that reported either the occurrence of macular edema or changes in best corrected visual acuity (BCVA) were included. Weighted mean differences and risk ratios were calculated along with 95% confidence intervals. (3) Results: Intravitreal injection of anti-VEGFs provided short-term structural protection for one month in patients receiving cataract surgery, but the protective effect ceased to exist after three months. The structural protection of topical NSAIDs, however, can last for at least three months. Meanwhile, neither anti-VEGFs nor NSAIDs provided significant visual improvement. (4) Conclusions: Our study suggested that topical NSAIDs eye drops is an effective prevention strategy for macular edema after cataract surgery in diabetic patients.
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Tariq F, Wang Y, Ma B, He Y, Zhang S, Bai L. Efficacy of Intravitreal Injection of Filtered Modified Low-Dose Triamcinolone Acetonide and Ranibizumab on Pseudophakic Cystoid Macular Edema. Front Med (Lausanne) 2022; 9:777549. [PMID: 35252233 PMCID: PMC8888519 DOI: 10.3389/fmed.2022.777549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the visual and morphological effects between intravitreal injection of filtered modified 2 mg triamcinolone acetonide (TA) and 0. 5 mg ranibizumab in patients with pseudophakic cystoid macular edema (PCME). Methods A retrospective, interventional study was conducted from January 2015 to February 2020 involving patients with PCME after uneventful cataract surgery. A total of 25 patients (25 eyes) with PCME received an intravitreal injection of 0.22 μm filtered modified 2 mg TA, while 15 patients (15 eyes) received 0.5 mg ranibizumab injection. Central macular thickness (CMT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), times of repeated injections, and other side effects were observed at 2 weeks, 1 month, 3 months, and 6 months after injection; then, the data were compared with preinjection information in each group and between the two groups. Results Both the TA and ranibizumab intravitreal injection can achieve improved BCVA and reduced CMT in patients with PCME (P < 0.05), with a trend toward greater improvement in the TA group, but the difference was only significant at 3 months (P < 0.05). IOP was in the normal range without any significant difference (P > 0.05). Thirty-three percent of patients in the ranibizumab group required repeated intravitreal injection compared to 4% in the TA group. Further stratified analysis showed that the better therapeutic effect of the TA group at 3 months after injection only existed in patients with diabetes mellitus (DM), while not in patients without DM. There was no repeat injection in the TA group and 12.5% in the ranibizumab group for patients without DM, while 16.7% in the TA group and 57.1% in the ranibizumab group required repeated injection for patients with DM, which had a significant difference (P < 0.05). Conclusion Intravitreal injection of filtered modified 2 mg TA is safe, effective, and an inexpensive alternative to antivascular endothelial growth factor (anti-VEGF) agents for patients with PCME, especially for patients concurrently with DM. A large number of clinical randomized controlled studies along with long-term follow-up observations are needed.
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Affiliation(s)
- Farheen Tariq
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanfen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Ma
- Department of Ophthalmology, The No.4 Hospital of Xi'an, Xi'an, China
| | - Yidan He
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills and Department of Geriatric Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Shu Zhang
| | - Ling Bai
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Ling Bai
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25
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Seth I, Bulloch G, Tan A, Thornell E, Agarwal S. Incidence of Pseudophakic Cystoid Macular Oedema Post-Cataract Surgery in Illawarra Shoalhaven Local Health District, Australia. Biomed Hub 2022; 7:1-10. [PMID: 35223872 PMCID: PMC8832185 DOI: 10.1159/000521053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Post-operatively, cataract surgery is associated with pseudophakic cystoid macular oedema (PCMO) causing vision disturbances. The presence of comorbidities may increase the incidence of PCMO post-cataract surgery. OBJECTIVE This observational study aimed to assess the incidence of PCMO in Australia (Illawarra region) and identify risk factors for developing PCMO. METHODS Retrospective analysis was performed on data from patients who underwent uncomplicated phacoemulsification and intraocular lens implantation between 1st March and June 30, 2016. Demographics, comorbidities, central subfield thickness (CST), visual acuity, and intraocular pressure (IOP) were collected preoperatively, day 1, and weeks 2, 4, and 6 post-operatively. Statistical analysis was performed using SPSS v.27.0 and GraphPad Prism v.9.0. The median and 95% confidence intervals were used to describe data. Logistic regression and χ2 tests were used to describe the associations. We followed the Declaration of Helsinki guidelines. RESULTS Fifty right and 35 left cataract eyes were operated on (58.8% were females; average age 72.8 ± 8.146 years). Total PCMO incidence was 10.6%, and true PCMO incidence (removing PCMO risk factors) was 4.2% at week 6 post-operatively. CST was slightly increased between pre- and post-cataract surgery at week 4 (p = 0.002) and week 6 (p < 0.0001; median = 259 μm, 264 μm, and 263 μm, respectively). IOP was found to be decreased (p < 0.0001) compared to day 1 (median = 17 mm Hg) and week 6 (median = 13 mm Hg). The probability of developing PCMO (odds ratio [OR] = 3) and vitreomacular traction (OR = 2.9) was higher in diabetic patients compared to non-diabetic patients and in patients >65 years old (OR = 1.5). CONCLUSION The true incidence of PCMO was found to be the greatest at 2-4 weeks post-operatively. Patients with diabetes or advanced age (>65 years) are at an elevated risk of developing PCMO after cataract surgery. The treatment regimens for the comorbid populations, especially diabetic patients, remain limited, and future efforts should target pharmaceutical management for these groups.
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Affiliation(s)
- Ishith Seth
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alvin Tan
- Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Erin Thornell
- Wollongong Eye Specialists, Wollongong, New South Wales, Australia
| | - Smita Agarwal
- Wollongong Eye Specialists, Wollongong, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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27
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Smith JR. Having impact. Clin Exp Ophthalmol 2021; 49:537-539. [PMID: 34351694 DOI: 10.1111/ceo.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Justine R Smith
- Flinders College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia
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28
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Iuliano L, Cisa di Gresy G, Fogliato G, Corbelli E, Bandello F, Codenotti M. Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes. EYE AND VISION (LONDON, ENGLAND) 2021; 8:29. [PMID: 34348801 PMCID: PMC8335864 DOI: 10.1186/s40662-021-00252-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the rate of occurrence and the risk factors of postsurgical macular edema (PSME) in eyes with idiopathic epiretinal membrane (iERM) or full-thickness macular hole (FTMH). METHODS Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period. Electronic medical charts and imaging data were analyzed preoperatively and at 1, 3 and 6 months after surgery. RESULTS From 101 patients diagnosed with iERM or FTMH, 71 patients were eligible for the study. Forty-nine eyes with iERM (69.0%) and 22 eyes with FTMH (31.0%) underwent vitrectomy either isolated (31.0%) or combined with cataract extraction (69.0%). The overall rate of PSME was 26.7%, without differences between the two groups (P = 0.9479). Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups (P = 0.9255 in FTMH and P = 0.8658 in iERM). If grouped by stage, eyes with stage 4 iERM though disclosed an increased rate of PSME (57.1%) compared to lower (1 to 3) stages (14.3%, P = 0.0021), particularly when combined with cataract surgery (71.4% vs. 15.4% in stages ≤ 3, P = 0.0021). The PSME odds ratio for a stage 4 iERM is 8 (95% CI: 1.933-33.1; P = 0.0041) compared to stages 3 and below. CONCLUSIONS PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH. Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1-3 stages, especially when combined with cataract extraction.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Gloria Cisa di Gresy
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Predisposing Factors for Severe Complications after Cataract Surgery: A Nationwide Population-Based Study. J Clin Med 2021; 10:jcm10153336. [PMID: 34362122 PMCID: PMC8347944 DOI: 10.3390/jcm10153336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 12/19/2022] Open
Abstract
We conducted a retrospective group study to evaluate the potential systemic risk factors for major postoperative complications of cataract surgery. Individuals diagnosed with (n = 2046) and without (n = 8184) serious complications after cataract surgery were matched 1:4 for age, sex, and index date obtained using Taiwan’s National Health Insurance Research Database. The outcome was defined as at least one new inpatient or outpatient diagnosis of systemic disease one year before the index date. The effect of demographic data on postoperative complications was also analyzed in the multivariable model. Data were analyzed using univariate and multivariate conditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals of the risk of developing serious complications. After the entire study interval, the major postoperative complications of cataract surgery were associated with the following systemic diseases: hypertension (adjusted OR (aOR) = 2.329, p < 0.001), diabetes mellitus (aOR = 2.818, p < 0.001), hyperlipidemia (aOR = 1.702, p < 0.001), congestive heart failure (aOR = 2.891, p < 0.001), rheumatic disease (aOR = 1.965, p < 0.001), and kidney disease needing hemodialysis (aOR = 2.942, p < 0.001). Additionally, demographic data including old age, higher urbanization level, higher level of care, and more frequent inpatient department visits were associated with a higher rate of postoperative complications. In conclusion, metabolic syndrome, chronic heart failure, end-stage renal disease, rheumatic disease, older age, and frequent inpatient department visits are correlated with the development of severe postoperative complications of cataract surgery. Therefore, cataract surgery patients should be informed about a higher possibility of postoperative complications.
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30
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Chen YC, Chen SJ, Li AF, Huang YM. Visual outcomes and incidence of pseudophakic cystoid macular oedema in eyes with cataract and idiopathic epiretinal membrane after two-step sequential surgery. Eye (Lond) 2021; 36:1597-1603. [PMID: 34290439 PMCID: PMC9307847 DOI: 10.1038/s41433-021-01673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine whether pars plana vitrectomy (PPV) or cataract surgery should be performed first in concurrent epiretinal membrane (ERM) and cataract treatment with respect to visual outcome and pseudophakic cystoid macular oedema (PCMO) incidence. METHODS Patients who underwent PPV and cataract surgery sequentially at a tertiary medical centre were retrospectively recruited. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured from optical coherence tomography (OCT) images collected before and after each surgery were documented. OCT-defined PCMO incidence and its influence on visual outcomes were analysed. RESULTS In total, 259 and 159 eyes received PPV (ERM-CATA) before and after cataract surgery (CATA-ERM), respectively. The ERM-CATA group had better final BCVA (logMAR: 0.274 vs. 0.558, p < 0.001) and greater BCVA gain (logMAR VA change: -0.379 vs. -0.220, p = 0.001) than did the CATA-ERM group. Baseline BCVA was positively correlated with final BCVA (p < 0.001), whereas baseline CMT, final CMT, and postoperative CMT changes were not. PCMO incidence did not differ significantly between the two groups (15.4% vs. 19.5%, p = 0.287), and final BCVA changes did not significantly differ between eyes with and without PCMO. PCMO incidence was much higher (29.40% vs. 16.30%, p = 0.008) in eyes with baseline CMT ≥ 500 μm. CONCLUSIONS When managing ERM and cataract, PPV should be performed before cataract surgery to yield better visual outcomes. Both surgical sequences yield similar PCMO rates. Greater baseline CMT is a risk factor for PCMO after cataract surgery.
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Affiliation(s)
- Yen-Cheng Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - An-Fei Li
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
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31
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Gillam M, Richardson T. Bilateral fingolimod-associated macular oedema development after cataract surgery. BMJ Case Rep 2021; 14:14/6/e240562. [PMID: 34088686 DOI: 10.1136/bcr-2020-240562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.
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Affiliation(s)
- Matthew Gillam
- Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Theresa Richardson
- Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK
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32
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Oli A, Waikar S. Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema. Indian J Ophthalmol 2021; 69:765-767. [PMID: 33595522 PMCID: PMC7942133 DOI: 10.4103/ijo.ijo_1464_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months.
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Affiliation(s)
- Avadhesh Oli
- Post Graduate Department of Ophthalmology, INHS Asvini, Colaba Mumbai, Maharashtra, India
| | - Shrikant Waikar
- Post Graduate Department of Ophthalmology, INHS Asvini, Colaba Mumbai, Maharashtra, India
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33
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Chen TA, Chen SP, Ahmad TR, Pasricha ND, Parikh N, Ramanathan S. Resident-performed immediate sequential bilateral cataract surgery during the COVID-19 pandemic. Indian J Ophthalmol 2021; 69:1579-1584. [PMID: 34011745 PMCID: PMC8302298 DOI: 10.4103/ijo.ijo_226_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To assess visual outcomes and patient satisfaction for senior resident-performed immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) during the COVID-19 pandemic, when minimizing healthcare-related exposures for patients and providers are paramount. Methods: This was a pilot retrospective cohort study of all ISBCS and DSBCS patients who underwent senior resident-performed cataract surgery from May to September 2020 at a single academic institution. Outcome measures were final corrected distance visual acuity (CDVA), final manifest refraction (MRx), intraoperative and postoperative complications rates, total number of visits, and patient satisfaction assessed postoperatively by telephone questionnaire. Results: Twenty-two eyes of 14 patients and 56 eyes of 28 patients underwent senior resident-performed ISBCS and DSBCS, respectively. Final CDVA was 20/25 or better in 21 (95%) ISBCS and 51 (91%) DSBCS eyes (P = 0.670). Deviation of final MRx from target refraction was within 0.50 D in 17 (77%) ISBCS and 47 (84%) DSBCS eyes (P = 0.522). There was no significant difference in intraoperative (P = 1.000) or postoperative (P = 1.000) complications. ISBCS patients averaged 3.5 fewer visits than DSBCS patients (5.9 vs 9.5, P < 0.001). All ISBCS and 20 DSBCS patients (87%) reported they were “very satisfied” or “satisfied” with their experience (P = 0.701). Five of six senior residents responded that they preferred performing ISBCS over DSBCS. Conclusion: This early experience suggests that senior resident-performed ISBCS is as safe and effective as DSBCS, with the added benefit of averaging fewer in-person visits. Residency programs should consider offering senior resident-performed ISBCS to select patients during the COVID-19 pandemic.
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Affiliation(s)
- Tiffany A Chen
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie P Chen
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Tessnim R Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Neel D Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Neeti Parikh
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Saras Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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34
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Mallandrich M, Calpena AC, Clares B, Parra A, García ML, Soriano JL, Fernández-Campos F. Nano-engineering of ketorolac tromethamine platforms for ocular treatment of inflammatory disorders. Nanomedicine (Lond) 2021; 16:401-414. [PMID: 33586454 DOI: 10.2217/nnm-2020-0403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: The development and optimization of Ketorolac tromethamine-loaded polylactic-co-glycolic acid nanoparticles (KT-NPs) for the treatment of inflammatory processes of the eye. Materials & methods: KT-NPs were developed by factorial design and characterized by assessing their physicochemical properties. Biopharmaceutical behavior studies, ocular tolerance, anti-inflammatory efficacy and bioavailability tests were performed on pigs. Results: Optimized KT-NPs of 112 nm, narrow distribution with encapsulation efficiency near 100% were obtained. KT release followed the Weibull model and there was significantly greater retention in the cornea and sclera than in the commercial reference. KT-NPs showed no signs of ocular irritancy and similar anti-inflammatory efficacy to the commercial reference. Conclusion: KT-NPs were a suitable alternative for the treatment of inflammatory disorders of the anterior and posterior segments of the eye as an alternative to conventional topical formulations.
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Affiliation(s)
- Mireia Mallandrich
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Ana C Calpena
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Beatriz Clares
- Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain.,Department of Pharmacy & Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Alexander Parra
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - María L García
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - José L Soriano
- Department of Pharmacy & Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Francisco Fernández-Campos
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Reig-Jofre Laboratories, Av. de les Flors s/n, 08970 Sant Joan Despí, Spain
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35
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Assil KK, Greenwood MD, Gibson A, Vantipalli S, Metzinger JL, Goldstein MH. Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction. Curr Opin Ophthalmol 2021; 32 Suppl 1:S1-S12. [PMID: 33273209 DOI: 10.1097/icu.0000000000000708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. RECENT FINDINGS Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. SUMMARY Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.
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Affiliation(s)
| | | | - Andrea Gibson
- Ocular Therapeutix, Inc., Bedford, Massachusetts, USA
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36
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Cagini C, Pellegrino A, Iannone A, Cerquaglia A, Modugno A, Fiore T, Messina M. Comparison of anti-inflammatory effects of eye drops formulations after uncomplicated cataract surgery. Ther Adv Ophthalmol 2020; 12:2515841420924304. [PMID: 33015542 PMCID: PMC7509714 DOI: 10.1177/2515841420924304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/03/2020] [Indexed: 11/28/2022] Open
Abstract
Aim: The aim of this study is to compare the efficacy of different dexamethasone eye drops formulations in controlling postoperative inflammation. Methods: Cataract surgery was carried out in 72 patients (35 males) divided into two groups: group A (36 patients, mean age = 78.0 ± 5.6) received four times daily for 2 weeks a suspension containing tobramycin 0.3% mg/ml + dexamethasone 0.1% mg/ml, and group B (36 patients, mean age = 76.2 ± 6.8) a solution containing tobramycin 0.3% mg/ml + dexamethasone 0.1% mg/ml. Both groups received ofloxacin 0.5% four times daily for 7 days, and nepafenac 0.1% three times daily for 3 weeks. Best-corrected visual acuity, intraocular pressure, corneal thickness, endothelial cells count, aqueous flare and macular thickness were evaluated preoperatively and at 1 day, 15 days, 1 and 2 months. Results: In group A, intraocular pressure, corneal thickness and aqueous humour flare values preoperatively and at the end of follow-up were 14.3 ± 1.8 and 13.2 ± 1.8 mmHg, 546.4 ± 34.6 and 539.6 ± 36.1 µm, 11.84 ± 4.44 and 13.52 ± 5.54 ph/ms, respectively, with no statistically significant difference. In group B, intraocular pressure, corneal thickness and aqueous humour flare values preoperatively and at the end of follow-up were 14.3 ± 1.5 and 13.1 ± 1.7 mmHg, 552.9 ± 37.4 and 548.1 ± 39.3 µm, 11.45 ± 4.06 and 13.73 ± 4.99 ph/ms, respectively, with no statistically significant difference. No difference was detected in the macular thickness values in the parafoveal area preoperatively and at 2 months follow-up in group A (332.18 ± 16.19 and 337.71 ± 16.33 µm) and group B (329.11 ± 18.28 and 334.37 ± 20.86 µm), respectively. Conclusion: The two different formulations of dexamethasone eye drops reached the same anti-inflammatory effects.
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Affiliation(s)
- Carlo Cagini
- Department of Biomedical and Surgical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, Piazza Menghini 1, 06126 Perugia, Italy
| | - Adriana Pellegrino
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alessia Iannone
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Antonella Modugno
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Tito Fiore
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Marco Messina
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Cimolai N. Comment on "Insights into the pathogenesis of cystoid macular edema: leukostasis and related cytokines". Int J Ophthalmol 2020; 13:1343-1344. [PMID: 32821693 DOI: 10.18240/ijo.2020.08.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/24/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
- Nevio Cimolai
- Department of Pathology and Laboratory Medicine, the University of British Columbia, Vancouver, British Columbia V6H3V4, Canada
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Preoperative central macular thickness as a risk factor for pseudophakic macular edema. Graefes Arch Clin Exp Ophthalmol 2020; 259:37-43. [PMID: 32783096 DOI: 10.1007/s00417-020-04862-x] [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: 05/14/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE This study aims to determine whether elevated central macular thickness (CMT) before uncomplicated cataract surgery may be a risk factor for developing cystic macular edema (CMEs) as measured by Cirrus-OCT and defined as the presence of macular intraretinal cysts. METHODS A prospective study in Hospital Universitario Poniente, Almeria, Spain, where 379 patients were included for optical coherence tomography (OCT) before cataract surgery, the following day, at 1 month and at 3 months and the presence of macular intraretinal cysts assessed by OCT. Patients with known risk factors for developing CME and patients who developed major surgical complications were excluded. RESULTS One hundred seventy-nine patients completed the study. The pre-surgical CMT was 257.75 (20.60) μm measured by Cirrus-OCT. After 1 month, there was an average increase in CMT of 277.86 (45.29) μm, and this increase in thickness decreased after 3 months to an average value of 267.86 (20.17) μm. There were 10.34% of patients with cysts in some of the controls after surgery. This study proposes a binary logistic model to predict the presence of CME depending on the pre-surgery CMT. The cut-off point was 260.5 μm. CONCLUSION Patients with pre-surgical macular thickness > 260.5 μm measured by Cirrus- OCT before cataract surgery, no known risk factors for developing CME and no major surgical complications presented 9.08 times more probability to develop macular intraretinal cysts after uncomplicated cataract surgery.
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Radeck V, Märker D, Prahs P, Helbig H, Krause L. Pseudophakes zystoides Makulaödem. Ophthalmologe 2020; 117:579-590. [DOI: 10.1007/s00347-020-01122-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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41
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Yang HJ, Kim KS. Changes in the Foveal Avascular Zone after Uncomplicated Cataract Surgery Based on Optical Coherence Tomography Angiography. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.5.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Erikitola OO, Siempis T, Foot B, Lockington D. The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery-a Scottish Ophthalmological Surveillance Unit study. Eye (Lond) 2020; 35:584-591. [PMID: 32376978 PMCID: PMC7202460 DOI: 10.1038/s41433-020-0908-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose Post-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients. Methods A Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation. Results Fourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44–86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2–0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270–788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1–0.3) with average mean CRT of 327microns (245–488). Conclusions We identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.
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Affiliation(s)
- Ore-Oluwa Erikitola
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - Thomas Siempis
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - Barny Foot
- Royal College of Ophthalmologists, London, UK
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK.
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Jauregui-Garcia GD, Acosta-Gonzalez R, Ibanez-Hernandez MA, Mora-Gonzalez GF, Armendáriz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomal Topical Formulation Improves Contrast Sensitivity Outcome After Femtosecond Laser-Assisted Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:512-521. [PMID: 31486694 PMCID: PMC6839423 DOI: 10.1089/jop.2019.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: To assess visual results, macular modifications, and the incidence of clinically significant macular edema (CSME) in patients using a topical triamcinolone acetonide-loaded liposomal formulation (TA-LF) after femtosecond laser-assisted cataract surgery (FLACS). Methods: Fifty-six eyes after FLACS were selected. Twenty-eight eyes in the combined therapy group (P + N) were treated with prednisolone 1% and nepafenac 0.1% for 21 days postoperatively, whereas 28 eyes in the TA-LF group received a liposomal formulation containing 2 mg/mL of TA (0.2%) for the same period of time. Follow-up visits at 1 day, 6 weeks, and 12 weeks after surgery consisted of visual acuity, contrast sensitivity (CS), central foveal thickness (CFT), total macular volume (TMV) measurements, and the detection of CSME. Results: CS improved in the TA-LF group (basal value: 1.087 ± 0.339 vs. 1.276 ± 0.147 at week 12, P = 0.0346), whereas in the P + N group, CS was not different from the baseline (basal value: 1.130 ± 0.331 vs. 1.274 ± 0.133 at week 12, P = 0.1276). There were similar increases in postoperative CFT and TMV in both groups. CFT and TMV significantly correlate with CS only in the TA-LF group. The r2 for CFT and CS was 0.1963 (P = 0.0206), whereas the r2 for TMV and CS was 0.3615 (P = 0.0007) at 12 weeks. No difference was observed in the incidence of CSME between the groups. Conclusion: TA-LF is associated with better CS outcomes compared to combined therapy after FLACS.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Jose Navarro-Partida
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Gerardo Daniel Jauregui-Garcia
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | | | | | | | - Juan Armendáriz-Borunda
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
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Levitz LM, Lim CHL, Grzybowski A, Kim SJ. Topical non-steroidal anti-inflammatory drugs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema. Clin Exp Ophthalmol 2019; 47:1102-1103. [PMID: 31313428 PMCID: PMC6899707 DOI: 10.1111/ceo.13591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/05/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - Chris H L Lim
- Department of Ophthalmology, National University Hospital, Singapore
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee
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Han JV, Patel DV, Squirrell D, McGhee CNJ. Topical non-steroidal anti-inflammatory drugs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema: Response. Clin Exp Ophthalmol 2019; 47:1104-1105. [PMID: 31309686 DOI: 10.1111/ceo.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Squirrell
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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