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Baydoun L, Vasiliauskaitė I, Luceri S, Jager MJ, Schaal SC, Bourgonje V, Oellerich S, Melles GRJ. Long-Term Outcome After Bilateral Descemet Membrane Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy. Cornea 2024; 43:726-733. [PMID: 37702586 DOI: 10.1097/ico.0000000000003379] [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: 05/27/2023] [Accepted: 08/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this study was to assess the long-term clinical outcome, complications, and graft survival of bilateral Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy. METHODS This was a retrospective cohort study of 181 patients (362 eyes) with sequential bilateral DMEK for Fuchs endothelial corneal dystrophy. Clinical outcomes were assessed up to 5 years postoperatively. Outcome measures were best-corrected visual acuity, pachymetry, endothelial cell density, graft survival, and complication rates. RESULTS Contralateral DMEK was performed on average 15 ± 11 months (range: 2-60 months) after the first eye. From 1 until 5 years after DMEK, best-corrected visual acuity, pachymetry, endothelial cell density, and graft survival did not differ between the first and second eyes (all P > 0.05). Graft detachment occurred in 67 eyes (19% [18% first eyes, 19% second eyes], 6% bilateral), graft rejection in 9 eyes (3% [3% first eyes, 2% second eyes], 1% bilateral), glaucoma in 25 eyes (7% [8% first eyes, 6% second eyes], 2% bilateral), and graft failure in 22 eyes (6% [4% first eye, 8% second eye], 2% bilateral). All differences were not significant (all P > 0.05). Five-year graft survival rates were comparable for first and second eyes (0.95 and 0.92, respectively; P = 0.15). CONCLUSIONS Clinical outcomes after bilateral DMEK are similar in both eyes and sustainable in the longer term. Within the first 5 years, the same complication may rarely occur in the contralateral eye.
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Affiliation(s)
- Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- University Eye Hospital, Munster, Germany
- ELZA Institute Dietikon/Zurich, Switzerland
| | - Indrė Vasiliauskaitė
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic, Rotterdam, the Netherlands
| | - Salvatore Luceri
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; and
| | - Sontje-Chiao Schaal
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Vincent Bourgonje
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic, Rotterdam, the Netherlands
- Amnitrans EyeBank, Rotterdam, the Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic, Rotterdam, the Netherlands
- Amnitrans EyeBank, Rotterdam, the Netherlands
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Ma M, Wang M, Zhang X, Shao Y, Li X. Effects of a fortified balanced salt solution and Ringer's lactate solution on anterior chamber inflammation after phacoemulsification in diabetes. J Cataract Refract Surg 2024; 50:352-359. [PMID: 37962173 DOI: 10.1097/j.jcrs.0000000000001364] [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: 04/06/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To compare the effects of a fortified balanced salt solution (fSS) and Ringer's lactate solution (Ringer) on anterior chamber (AC) inflammation in patients undergoing phacoemulsification. SETTING Tianjin Medical University Eye Hospital, Tianjin, China. DESIGN Prospective masked controlled trial. METHODS 80 patients (40 patients with regular cataract and 40 cataract patients with diabetes mellitus [DM]) were randomized to receive either fSS (n = 40) or Ringer's solution (n = 40). Anterior-segment optical coherence tomography was used to evaluate AC cells and flare. Transepithelial electrical resistance (TEER) and zonula occludens-1 (ZO-1) immunofluorescence were used for tight junction examination. Monocytic leukemia cell line (Tohoku Hospital Pediatrics-1 [THP-1]) transmigration assay was performed to observe the effects of the 2 perfusates on the inflammatory response in vitro. RESULTS In patients with regular cataracts, postoperative AC cells and flare on the 1st and 7th days were not significantly different between the Ringer and fSS groups. However, in cataract patients with DM, AC cells were higher in the Ringer group than in the fSS group ( P = .003) on postoperative day 1. The AC flare was also significantly higher in the Ringer group than in the fSS group ( P < .0001). No significant differences between the groups were observed on day 7. Compared with Ringer, fSS increased the TEER value and ZO-1 content and reduced the adhesion of THP-1 cells. CONCLUSIONS The results of this study indicated that early postoperative AC inflammation is more severe in patients with cataracts and DM. In addition, fSS attenuates inflammation by protecting the blood-aqueous barrier and inhibiting the exudation of inflammatory cells.
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Affiliation(s)
- Mingming Ma
- From the Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Matthaei M, Fassin A, Mestanoglu M, Howaldt A, Schrittenlocher SA, Schlereth S, Roters S, Grajewski RS, Bachmann BO, Cursiefen C. Blood-Aqueous Barrier Disruption in Penetrating and Posterior Lamellar Keratoplasty: Implications for Clinical Outcome. Klin Monbl Augenheilkd 2023; 240:677-682. [PMID: 37207639 DOI: 10.1055/a-2076-7829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND The blood-aqueous barrier (BAB) separates immunoprivileged tissue of the eye from the blood circulation. Disruption of the BAB is therefore a risk factor for rejection after keratoplasty. PURPOSE The present work provides a review of the work of our group and others on BAB disruption in penetrating and posterior lamellar keratoplasty and its implications for clinical outcome. METHODS A PubMed literature search was performed to generate a review paper. RESULTS Laser flare photometry provides an objective and reproducible method to assess the integrity of the BAB. Studies of the flare after penetrating and posterior lamellar keratoplasty demonstrate a mostly regressive disruption of the BAB in the postoperative course, which is influenced in extent and duration by multiple factors. Persistently elevated flare values or an increase in flare after initial postoperative regeneration may indicate an increased risk of rejection. DISCUSSION In case of persistent or recurrent elevated flare values after keratoplasty, intensified (local) immunosuppression may potentially be useful. This could become important in the future, especially for the monitoring of patients after high-risk keratoplasty. Whether an increase of the laser flare is a reliable early indicator of an impending immune reaction after penetrating or posterior lamellar keratoplasty has to be shown in prospective studies.
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Affiliation(s)
- Mario Matthaei
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Anne Fassin
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Mert Mestanoglu
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Antonia Howaldt
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | | | - Simona Schlereth
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Sigrid Roters
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Rafael S Grajewski
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Björn O Bachmann
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland
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Schoeneberger V, Eberhardt S, Menghesha L, Enders P, Cursiefen C, Schaub F. Association between blood-aqueous barrier disruption and extent of retinal detachment. Eur J Ophthalmol 2023; 33:421-427. [PMID: 35509193 DOI: 10.1177/11206721221099251] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the association between anatomical features of rhegmatogenous retinal detachment (RRD) and the extent of blood-aqueous barrier disorder measured by non-invasiv laser flare photometry. METHODS Retrospective evaluation of consecutive patients with RRD that underwent surgery between November 2016 and October 2018. Descriptive evaluation of pre- and postoperative parameters and correlation to preoperative laser flare value, extent of retinal detachment and re-detachment rate were performed. RESULTS 266 patients (mean age 62.73 ± 10.40 years, 62.8% male) were included. Mean preoperative flare value was 11.0 ± 11.9 pc/ms. In pseudophakia flare values were higher than in phakia (12.7 ± 10.4 pc/ms versus 9.8 ± 12.9 pc/ms; p = 0.042). Flare increased and correlated significantly with the number of affected retinal quadrants (Q) (1 Q 6.4 ± 3.3 pc/ms; 2 Q 10.5 ± 8.8 pc/ms; 3 Q 15.6 ± 9.1 pc/ms; 4 Q 27.5 ± 33.3 pc/ms; p < 0.001; r = 0.40). Macular status correlated significantly with flare values (macula on 8.6 ± 7.1 pc/ms, off 13.1 ± 15.0 pc/ms; p = 0.004; r = 0.17). CONCLUSION The level of objective tyndallometry in RRD seems to be influenced by lens status and extent of retinal detachment. Thus, the greater the affected retinal area is, the more blood-aqueous barrier disruption seems to be present.
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Affiliation(s)
- Verena Schoeneberger
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Somaie Eberhardt
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Leonie Menghesha
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Philip Enders
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
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Ripa M, Cuffaro G, Savastano MC, Grieco G, Rizzo S, Ricci F. Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma. Eur J Ophthalmol 2022; 33:1380-1389. [PMID: 36579807 DOI: 10.1177/11206721221146676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery. METHODS Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. RESULTS The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery. CONCLUSIONS Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Giovanni Cuffaro
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Giulia Grieco
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy.,Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Francesco Ricci
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
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Schoeneberger V, Menghesha L, Gerlach S, Gietzelt C, Eberhardt S, Cursiefen C, Schaub F. Lens status and degree of lens opacity influence laser flare photometry (objective tyndallometry). Eur J Ophthalmol 2022; 33:11206721221137169. [PMID: 36348627 DOI: 10.1177/11206721221137169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Objective tyndallometry using laser flare photometry can be utilized e.g., in management of uveitis. Previous studies showed a significant difference in flare values between pseudophakic and phakic eyes. We investigate a potential association between the degree of lens opacification and flare value in a large cohort phakic eyes. METHODS Retrospective, non-interventional single center study. Laser flare values of 460 healthy fellow eyes from two large cohorts (primary rhegmatogenous retinal detachment (RRD), macular holes (MH)) were correlated with lens status, degree of lens opacity, and age. RESULTS Out of 460 patients (mean age 64.6 ± 11.2, 57% male) 30.4% were pseudophakic (70.2 ± 10.9) and 69.6% phakic, of which 47.8% showed a clear lens (57.3 ± 9.1), 43.2% an mild cataract (65.2 ± 9.0) and 9.0% a moderate cataract (73.5 ± 9.0).In pseudophakia, flare (8.14 ± 4.6 pc/ms) was significantly higher compared to phakia (6.4 ± 3.9 pc/ms; p < 0.001). In phakic eyes, flare values increased significantly with increasing lens opacity (clear lens 5.3 ± 2.8 pc/ms; mild cataract 7.0 ± 4.0 pc/ms; moderate cataract 9.5 ± 6.1 pc/ms; p < 0.001). In clear lenses and mild cataract, age correlated significantly with flare (two-sided, p < 0.001, clear lenses R = 0.3; mild cataract R = 0.4). In clear lenses, flare values increased with age by 0.09 per year, in mild cataract by 0.17 (regression coefficients). No significant correlation was found between age and flare value in moderate cataract and pseudophakic eyes. CONCLUSION The level of objective tyndallometry seems to be dependent on lens status, degree of lens opacity and age. These factors should therefore be taken into account when interpreting laser flare values in the future.
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Affiliation(s)
- Verena Schoeneberger
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Leonie Menghesha
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Stefanie Gerlach
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Caroline Gietzelt
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Somaie Eberhardt
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
| | - Friederike Schaub
- Department of Ophthalmology, 27182Medical Faculty and University Hospital of Cologne, 14309University of Cologne, Cologne, Germany
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Sonmez K, Hekimsoy HK. Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy. Int J Ophthalmol 2022; 15:1279-1289. [PMID: 36017034 DOI: 10.18240/ijo.2022.08.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.
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Affiliation(s)
- Kenan Sonmez
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara 06240, Turkey
| | - Hilal Kilinc Hekimsoy
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara 06240, Turkey
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8
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Bacharach J, McCabe C, Jackson M, Rao S, Singh IP, Heersink S, Radcliffe N, Weinstock R, Paggiarino D, Patel K. First Real-World, Multicenter, Post-Marketing, Retrospective Study of Dexamethasone Intraocular Suspension for Inflammation After Cataract Surgery. Clin Ophthalmol 2022; 16:1783-1794. [PMID: 35685378 PMCID: PMC9172921 DOI: 10.2147/opth.s357267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate dexamethasone intraocular suspension 9% (intraocular DXM) in real-world clinical use to manage inflammation associated with cataract surgery. Setting Patients who underwent cataract surgery and received intraocular DXM at 22 outpatient eye surgery centers in the US. Design Retrospective, observational chart review. Methods Records of all patients who received intraocular DXM from March to December 2019 at participating centers were reviewed. Main Outcome Measures Outcomes included anterior chamber cell (ACC) grades, anterior chamber flare (ACF) grades, and visual acuity, as well as intraocular pressure (IOP) and adverse events (AEs) at postoperative days (PODs) 1, 8, 14, 30. Descriptive statistics were generated. Results The study population included 527 patients (641 eyes), with glaucoma history in 66 patients (80 eyes). Among eyes with recorded ACC grades, the percentage with grade 0 increased from 40% at POD 1 to 89.7% at POD 30, with similar results in eyes with glaucoma history. Among eyes with recorded ACF grades, the percentage with grade 0 increased from 78.4% at POD 1 to 97.1% at POD 30. At POD 30, 96.6% eyes with recorded results achieved target acuity. Mean IOP was 18.6 mmHg at POD 1 but declined to ≤15.2 mmHg thereafter. Investigators reported 22 AEs in 20 patients, all reported mild or moderate, the most common: IOP increase (7 events). Conclusion Patients undergoing cataract surgery and treated with intraocular DXM showed favorable inflammatory and visual outcomes, without unanticipated safety problems, consistent with results of previous controlled clinical trials.
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Affiliation(s)
- Jason Bacharach
- North Bay Eye Associates Petaluma, Petaluma, CA, USA
- Correspondence: Jason Bacharach, North Bay Eye Associates, 104 Lynch Creek Way, Suite 15, Petaluma, CA, 94954, USA, Email
| | | | | | - Sanjay Rao
- DeKalb Eye Consultants - Hauser-Ross Eye Institute, Sycamore, IL, USA
| | - I Paul Singh
- The Eye Centers of Racine & Kenosha, Racine, WI, USA
| | | | | | | | | | - Keyur Patel
- EyePoint Pharmaceuticals, Watertown, MA, USA
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Hansen NC, Erichsen JH, Holm LM, Kessel L. Corneal Thickness and Anterior Chamber Flare After Cataract Surgery: A Randomized Controlled Trial Comparing Five Regimens for Anti-Inflammatory Prophylaxis. Clin Ophthalmol 2021; 15:2835-2845. [PMID: 34234406 PMCID: PMC8254546 DOI: 10.2147/opth.s312350] [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: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the relationship between early post-operative anterior chamber inflammation (aqueous flare) and central corneal thickness (CCT) after cataract surgery and to evaluate the effect of anti-inflammatory prophylaxis on CCT. Setting Department of Ophthalmology, Rigshospitalet-Glostrup, University Hospital Copenhagen, Denmark. Design Post-hoc analysis of a prospective randomized controlled trial. Patients and Methods A total of 470 participants who underwent standard cataract surgery were randomly allocated to prophylactic treatment with nonsteroidal anti-inflammatory drug (NSAID, groups C and D) or a combination of NSAID and steroid eye drops (groups A and B), commenced either pre-operatively (A and C) or post-operatively on the day of surgery (B and D), or "drop-less surgery" (peri-operative subtenon depot of dexamethasone, group E). Aqueous flare was measured before and three days after surgery. CCT was measured before surgery, three days, three weeks, and three months after surgery. Data were analyzed according to the intention-to-treat method. Results Doubling of aqueous flare increased mean CCT by 15.6 microns (95% CI 9.8; 21.3, P<0.001) three days after surgery. Mean CCT increased from 549 microns (95% CI 545; 552) at baseline to 594 microns (95% CI 585; 602) three days after surgery and returned to 551 microns (95% CI 545; 557) three months after surgery. Mean CCT was thinner in group C compared to group A three days after surgery. No difference was found for any other groups or time points. Conclusion Increased anterior chamber inflammation was associated with significant corneal thickening three days after cataract surgery. Choice of anti-inflammatory regimen seemed to be of no or minimal importance on CCT when the effect of inflammation was accounted for. Corneal thickening is possibly mediated by underlying deterioration of the blood-aqueous barrier and corneal endothelium pump function caused by a post-operative inflammatory response.
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Affiliation(s)
| | | | - Lars Morten Holm
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Aaronson A, Taipale C, Achiron A, Aaltonen V, Grzybowski A, Tuuminen R. Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery. Transl Vis Sci Technol 2021; 10:15. [PMID: 34125145 PMCID: PMC8212433 DOI: 10.1167/tvst.10.7.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/12/2021] [Indexed: 01/31/2023] Open
Abstract
Purpose To assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients. Methods A post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery. Results Aqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT (P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare (P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups. Conclusions At 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy. Translational Relevance A 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Israel
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Vesa Aaltonen
- Department of Ophthalmology, Turku University Hospital, Turku, Finland
- Department of Ophthalmology, University of Turku, Turku, Finland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Lim SY, Betzler BK, Yip LWL, Dorairaj S, Ang BCH. Standalone XEN45 Gel Stent implantation versus combined XEN45-phacoemulsification in the treatment of open angle glaucoma-a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:3209-3219. [PMID: 33914156 DOI: 10.1007/s00417-021-05189-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The XEN45 Gel Stent is currently the only FDA-approved sub-conjunctival minimally invasive glaucoma surgery (MIGS) procedure. It has been used worldwide either as a standalone implantation procedure or in combination with phacoemulsification surgery. Concomitant phacoemulsification is understood to influence outcomes of traditional subconjunctival filtering surgery. However, the comparative efficacy between standalone XEN45 Gel Sent implantation ("Standalone XEN45") and combined XEN-phacoemulsification surgery ("XEN45-Phaco") remains unclear. This study aims to appraise current literature to compare the efficacy of Standalone XEN45 and XEN45-Phaco in open-angle glaucoma. METHODS A comprehensive search of PubMed, CINAHL, CENTRAL databases was performed with the terms "Xen surgery" followed by selective vetting. Pilot, cohort, observational studies and randomised controlled trials that included at least 10 patients undergoing either Standalone XEN45 or XEN45-Phaco surgeries for the treatment of open-angle glaucoma were deemed eligible for inclusion after independent assessment by 2 authors. The search workflow was reported according to the PRISMA guidelines. Data was pooled using random-effects model. A meta-analysis of continuous outcome and proportions was performed using the meta routine in R v3.2.1. RESULTS Ten studies were included. There was a statistically significant difference in IOP reduction favouring Standalone XEN45 at post-operative day 1, week 1, months 1, 3 and 6. There was a statistically significant difference in decrease in IOP-lowering medications favouring Standalone XEN45 at post-operative week 1 and month 1. CONCLUSION Standalone XEN45 has superior IOP-lowering outcomes compared to XEN45-Phaco in the early post-operative period, up to 6 months after surgery.
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Affiliation(s)
- Sheng Yang Lim
- Department of Ophthalmology, National University Hospital, National University Hospital Systems, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard Wei Leon Yip
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Rochester, USA
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
- Department of Ophthalmology, Woodlands Health Campus, Singapore, Singapore.
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12
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Matsumura T, Iwasaki K, Arimura S, Takeda R, Takamura Y, Inatani M. Topical bromfenac reduces multiple inflammatory cytokines in the aqueous humour of pseudophakic patients. Sci Rep 2021; 11:6018. [PMID: 33727659 PMCID: PMC7966778 DOI: 10.1038/s41598-021-85495-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
Intraocular surgery is associated with increased ocular inflammation. If maintained for a prolonged period after surgery, this inflammation can cause various complications, including subconjunctival fibrosis and bleb scarring. This clinical trial was a prospective, randomised, single-blind, interventional study comparing the efficacy and safety of 0.1% bromfenac sodium ophthalmic solution and 0.02% fluorometholone ophthalmic suspension in the inhibition of multiple inflammatory cytokines in the aqueous humour of 26 patients with pseudophakic eyes who had undergone phacoemulsification and intraocular lens implantation. The patients were randomly assigned to one of the trial drugs, and aqueous humour samples were collected before and after drug administration. Platelet-derived growth factor-AA levels significantly decreased in both drug groups, but they were significantly higher in the fluorometholone group than in the bromfenac group (P = 0.034). Bromfenac also significantly decreased vascular endothelial growth factor level (P = 0.0077), as well as monocyte chemoattractant protein-1 level (P = 0.013), which was elevated for a prolonged period after phacoemulsification. These data suggest that bromfenac is useful to alleviate prolonged microenvironmental alterations in the aqueous humour of pseudophakic eyes.
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Affiliation(s)
- Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan.,Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
| | - Shogo Arimura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
| | - Ryuji Takeda
- Department of Nutritional Sciences for Well-Being, Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan.
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13
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Sacchi M, Monsellato G, Villani E, Lizzio RAU, Cremonesi E, Luccarelli S, Nucci P. Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone. Eur J Ophthalmol 2021; 32:327-335. [PMID: 33685259 DOI: 10.1177/1120672121999997] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma. MATERIALS AND METHODS We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves. RESULTS Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group (p = 0.033, p = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months (p < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p = 0.0003). CONCLUSION In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.
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Affiliation(s)
- Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Gianluca Monsellato
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | - Elena Cremonesi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Saverio Luccarelli
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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14
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Mencucci R, Favuzza E, Scali G, Vignapiano R, Cennamo M. Protecting the Ocular Surface at the Time of Cataract Surgery: Intracameral Mydriatic and Anaesthetic Combination Versus A Standard Topical Protocol. Ophthalmol Ther 2020; 9:1055-1067. [PMID: 33052582 PMCID: PMC7708550 DOI: 10.1007/s40123-020-00311-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction An intracameral mydriatic and anaesthetic combination has been approved for injection into the anterior chamber in order to provide rapid and stable mydriasis and sustained intraocular anaesthesia during cataract surgery. Methods In this prospective study, conducted at the Eye Clinic, University of Florence, Italy, we compared phacoemulsification using the standard mydriatic-anaesthetic eye-drop protocol with that using the standard protocol in terms of corneal changes, ocular surface parameters and visual quality. Sixty patients (60 eyes) were included in the study, with 30 eyes receiving Mydrane®, a novel injectable intracameral solution, during phacoemulsification (Mydrane protocol, MP) and 30 eyes receiving the standard mydriatic-anaesthetic eye drops (standard protocol, SP). The following parameters were assessed using in vivo confocal microscopy (IVCM): central corneal thickness (CCT); flare and cells in the aqueous humor (Flare); keratocyte activation (KA), Langerhans’ cell density (LCD), nerve fibre density (NFD) and endothelial cell density (ECD). The Ocular Surface Disease Index (OSDI) score, tear breakup time (TBUT) and Schirmer’s test I (STI) were also evaluated. The Optical Scattering Index (OSI) and its standard deviation (OSI-SD) were assessed using the Optical Quality Analysing System (Visiometrics SL, Terrassa, Spain). Results In the MP group, CCT, Flare, KA and LCD values returned to baseline values within 15 postoperative days. The mean ECD and NFD decreased significantly in both groups from baseline at all follow-up assessments, with no statistically significant difference between groups. TBUT returned to the preoperative level at postoperative day 15 in the MP group. OSDI scores and STI were significantly worse in both groups at all follow-up assessments compared to baseline. At postoperative day 15 OSI and OSI-SD values were significantly better in the MP group than in the SP group. Conclusions The use of Mydrane during cataract surgery showed a good safety profile and few toxic side effects, ensuring better optical quality and tear film stability.
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Affiliation(s)
- Rita Mencucci
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy.
| | - Eleonora Favuzza
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Giulia Scali
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Roberto Vignapiano
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Michela Cennamo
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
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15
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An Alternative Approach to Cataract Surgery Using BSS Temperature of 2.7 °C. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study is to evaluate the difference in the number of endothelial cells after cataract operations with phacoemulsification by using a balanced salt solution (BSS) at standard temperature (about 20 °C) and at 2.7 °C. Two groups, comprising 214 individuals in total, participated in this study; patients were operated on using BSS bottle at about 20 °C and 2.7 °C in the first and second groups, respectively. All operations were conducted by the same surgeon and in similar conditions. One month after the operations, endothelial cells in the two groups were checked. For patients in Group 2, an important reduction in the loss of endothelial cells was observed.
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16
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Ikegami Y, Takahashi M, Amino K. Evaluation of choroidal thickness, macular thickness, and aqueous flare after cataract surgery in patients with and without diabetes: a prospective randomized study. BMC Ophthalmol 2020; 20:102. [PMID: 32169068 PMCID: PMC7071624 DOI: 10.1186/s12886-020-01371-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In diabetic eyes, various choroidal abnormalities are noted in addition to changes in the retinal circulation, and the risk of increased aqueous flare and retinal thickening after cataract surgery is higher in diabetic eyes. Inflammation caused by surgery induces breakdown of the blood-retinal barrier and affects the retina, although the influence on the choroid is unknown. Several researchers have evaluated the choroidal thickness (CT) after cataract surgery in patients with diabetes; however, the results are inconsistent. The purpose of this study was to evaluate the influence of uneventful small-incision phacoemulsification cataract surgery on the subfoveal choroidal thickness (SCT), the central macular thickness (CMT), and aqueous flare in patients with diabetes. METHODS This study included 59 randomly selected eyes (33 eyes of patients with diabetes and 26 eyes of control patients without diabetes) undergoing small-incision cataract surgery. Among the diabetic eyes, 26 were without diabetic retinopathy, and the remaining eyes had non-proliferative diabetic retinopathy. Aqueous flare, CMT, and SCT measurements were performed before and at 1 week, 1 month, and 3 months after surgery. RESULTS The postoperative CMT continued to increase significantly until 3 months in both groups. Although the CMT was more in patients with diabetes than in patients without diabetes during the follow-up period, there was no significant difference between the two groups. The aqueous flare value increased until 3 months after surgery in both groups. Although the increase was significant at 3 months after surgery in patients with diabetes, the increase in controls was not significant. The aqueous flare values differed significantly between the two groups before and at 3 months after surgery. There was no significant within-group or between-group difference in pre- and postoperative SCT values. CONCLUSION In diabetic eyes with early stage of retinopathy, even small-incision cataract surgery can induce increased aqueous flare and macular thickening until 3 months, although there is no significant change in the choroidal thickness. Further studies are essential to evaluate choroidal changes after the cataract surgery in diabetic eyes.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Miyuki Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kana Amino
- Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan
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17
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Cagini C, Pellegrino A, Cerquaglia A, Iaccheri B, Lupidi M, Fiore T. Comparison of the Effect of Diclofenac 0.1% and Nepafenac 0.1% on Aqueous Flare in Patients Undergoing Cataract Surgery: A Prospective Randomized Study. Curr Eye Res 2020; 45:1089-1093. [DOI: 10.1080/02713683.2020.1725061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Carlo Cagini
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Adriana Pellegrino
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Tito Fiore
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
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18
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Lindholm J, Taipale C, Ylinen P, Tuuminen R. Perioperative subconjunctival triamcinolone acetonide injection for prevention of inflammation and macular oedema after cataract surgery. Acta Ophthalmol 2020; 98:36-42. [PMID: 31210019 DOI: 10.1111/aos.14175] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. METHODS This prospective non-randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. RESULTS Central retinal thickness (CRT) increased in DEX but not in TA-treated eyes at 7 days (+1.2 ± 20.1 μm and -9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and -3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and -5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and -0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. CONCLUSIONS Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery.
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Affiliation(s)
- Juha‐Matti Lindholm
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Claudia Taipale
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Petteri Ylinen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Kymenlaakso Central Hospital Unit of Ophthalmology Kotka Finland
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19
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Reddy JK, Chaitanya V, Shah N, Guduru VP, Khan S, Kuttupalayam S. Safety & efficacy of single subconjunctival triamcinolone 5 mg depot vs topical loteprednol post cataract surgery: less drop cataract surgery. Int J Ophthalmol 2019; 12:774-778. [PMID: 31131235 DOI: 10.18240/ijo.2019.05.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide (SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. METHODS A total of 400 patients were randomized into 2 groups; Group A (200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine (0.5%) with ofloxacin (0.3%) combination for 3wk. Group B (200 patients) received tapering topical loteprednol etabonate (0.5%) along with ofloxacin (0.3%) and ketorolac tromethamine (0.5%) for 3wk. Outcomes evaluated were intraocular pressure (IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12wk. RESULTS Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A (P=0.82) and Group B (P=0.61) and postoperative IOP values in between both groups (P=0.14) at 1wk. Incidence of cells/flare postoperative was statistically not significant (P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. CONCLUSION SCTA appears to be an effective alternative to prolong postoperative topical steroid use.
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Affiliation(s)
| | - Vivek Chaitanya
- Department of Cornea, Sankara Eye Hospital, Coimbatore 641035, Tamil Nadu, India
| | - Neeraj Shah
- Department of Cornea, Sankara Eye Hospital, Coimbatore 641035, Tamil Nadu, India
| | | | - Shadab Khan
- Department of Cornea, Sankara Eye Hospital, Coimbatore 641035, Tamil Nadu, India
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20
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Jinagal J, Gupta G, Agarwal A, Aggarwal K, Akella M, Gupta V, Suri D, Gupta A, Singh S, Ram J. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67:69-74. [PMID: 30574896 PMCID: PMC6324120 DOI: 10.4103/ijo.ijo_713_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. METHODS Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. RESULTS 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. CONCLUSION Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Madhuri Akella
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepti Suri
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anju Gupta
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Surjit Singh
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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21
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VanSlyke JK, Boswell BA, Musil LS. Fibronectin regulates growth factor signaling and cell differentiation in primary lens cells. J Cell Sci 2018; 131:jcs.217240. [PMID: 30404825 DOI: 10.1242/jcs.217240] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/23/2018] [Indexed: 12/30/2022] Open
Abstract
Lens epithelial cells are bound to the lens extracellular matrix capsule, of which laminin is a major component. After cataract surgery, surviving lens epithelial cells are exposed to increased levels of fibronectin, and so we addressed whether fibronectin influences lens cell fate, using DCDML cells as a serum-free primary lens epithelial cell culture system. We found that culturing DCDMLs with plasma-derived fibronectin upregulated canonical TGFβ signaling relative to cells plated on laminin. Fibronectin-exposed cultures also showed increased TGFβ signaling-dependent differentiation into the two cell types responsible for posterior capsule opacification after cataract surgery, namely myofibroblasts and lens fiber cells. Increased TGFβ activity could be identified in the conditioned medium recovered from cells grown on fibronectin. Other experiments showed that plating DCDMLs on fibronectin overcomes the need for BMP in fibroblast growth factor (FGF)-induced lens fiber cell differentiation, a requirement that is restored when endogenous TGFβ signaling is inhibited. These results demonstrate how the TGFβ-fibronectin axis can profoundly affect lens cell fate. This axis represents a novel target for prevention of late-onset posterior capsule opacification, a common but currently intractable complication of cataract surgery.
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Affiliation(s)
- Judy K VanSlyke
- Department of Biochemistry and Molecular Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Bruce A Boswell
- Department of Biochemistry and Molecular Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Linda S Musil
- Department of Biochemistry and Molecular Biology, Oregon Health & Science University, Portland, OR 97239, USA
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22
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Gupta G, Ram J, Gupta V, Singh R, Bansal R, Gupta PC, Gupta A. Efficacy of Intravitreal Dexamethasone Implant in Patients of Uveitis Undergoing Cataract Surgery. Ocul Immunol Inflamm 2018; 27:1330-1338. [PMID: 30239239 DOI: 10.1080/09273948.2018.1524498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To assess postoperative inflammation using laser flare photometer, following phacoemulsification with or without single intraoperative intravitreal dexamethasone implant in addition to standard of care, in patients of uveitis with cataract.Methods: Prospectively, 30 eyes with uveitic cataract were randomized into 2 groups (i) standard of care (SOC group) (ii) Dexamethasone implant (DEXA group). Both the groups underwent phacoemulsification with intraocular lens implantation and standard of care treatment for uveitis, but DEXA group additionally received intraoperative intravitreal dexamethasone implant. Patients were followed at least till 6 months.Results: DEXA group had significantly less postoperative flare (LFP values) (P<0.05) as compared to SOC group and also recovery of flare to preoperative value occurred much early in DEXA group. 37.5% cases developed CME in SOC group but none in DEXA group. Mean CMT (267.81±34.26μm) and final logMar BCVA (0.036±0.063) was significantly better in DEXA group (p<0.04).Conclusions: Intraoperative intravitreal dexamethasone implant is a safe and effective option for preventing and managing the postoperative inflammation in uveitic cataract.
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Affiliation(s)
- Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Agarwal A, Joshi D, Katoch D, Aggarwal K, Singh R, Gupta V. Application of Laser Flare Photometry in the Quantification of Blood-Aqueous Barrier Breakdown after Micro-incision Vitrectomy. Ocul Immunol Inflamm 2018; 27:651-657. [PMID: 30205420 DOI: 10.1080/09273948.2018.1449867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: The purpose of the study is to quantify aqueous flare using laser flare photometry (LFM) in patients undergoing 25-G pars plana vitrectomy (PPV) and assess the need for postoperative topical corticosteroid administration . Methods: Prospective evaluation of 50 eyes (50 patients) was performed using LFM until day 30 postoperative. Duration of surgery, indication of PPV, and use of laser and/or cryotherapy were noted. Topical corticosteroids were used if mean LFM values were >50, or if there was anterior chamber fibrin. Results: Mean age of the subjects was 48.62 ± 10.07 years. The preoperative LFM value for 50 subjects was 17.42 ± 25.20. Topical corticosteroids were initiated in only 22 patients. The LFM values of subjects were not different from baseline at 1 month whether or not the subjects received corticosteroids (p > 0.106). Conclusions: With 25-G PPV, there is minimal breakdown of blood-aqueous barrier. LFM helps in monitoring postoperative inflammation, obviating the need for topical corticosteroids in significant number of patients.
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Affiliation(s)
- Aniruddha Agarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Deepti Joshi
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Deeksha Katoch
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Kanika Aggarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ramandeep Singh
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishali Gupta
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Islamaj E, Wubbels RJ, de Waard PW. Primary Baerveldt versus trabeculectomy study after one-year follow-up. Acta Ophthalmol 2018; 96:e740-e746. [PMID: 30022618 DOI: 10.1111/aos.13658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/05/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare a Baerveldt implant and trabeculectomy with respect to intraocular pressure (IOP) and failure rate at 1 year of follow-up. Secondary outcomes are pharmacological therapy and complications at 1 year of follow-up. METHODS This was a randomized, comparative study. A total of 119 glaucoma patients without previous ocular surgery were included at the Rotterdam Eye Hospital, the Netherlands. One eye of each subject was randomized to either a Baerveldt glaucoma drainage device (BGI) or trabeculectomy (TE). Follow-up visits were conducted at 1 day, 2 weeks, 6 weeks, 3 months, 6 months and 1 year after surgery. RESULTS After one year, the final IOP was equivalent for both treatment groups: 14 ± 4 mmHg (mean ± SD) for the Baerveldt group versus 13 ± 4 mmHg for the trabeculectomy group. Statistically, we found no significant difference in failure rate between the two groups. However, the Baerveldt group needed significantly more medication to decrease IOP. Overall, self-limiting complication rate was similar in both groups. Diplopia, a serious complication, was significantly more present in the BGI group. CONCLUSION One year after surgery, TE shows better results than the BGI. The final IOP, IOP reduction and failure rate are similar, but the need for additional IOP lowering medication in the BGI group is higher as well as the complication rate. The increased risk of developing diplopia after placement of a BGI must be taken into consideration.
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Affiliation(s)
- Esma Islamaj
- Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
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Quantitative Assessment of Aqueous Flare After Descemet Membrane Endothelial Keratoplasty for Fuchs Endothelial Dystrophy. Cornea 2018; 37:848-853. [PMID: 29547408 DOI: 10.1097/ico.0000000000001576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess aqueous flare as a measure of subclinical inflammation after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy. METHODS In this prospective cross-sectional and longitudinal case series at a tertiary referral center, 173 DMEK eyes of 169 patients and 19 age-matched healthy control eyes were included. Aqueous flare [photon count per millisecond (ph/ms)] was assessed by laser flare photometry at 1 day, 1 week, and 1 month after DMEK in group I (evaluation of postsurgical blood-aqueous barrier recovery; n = 25) and on average 28 (±19) months (range, 3-86 months) after DMEK in group II (evaluation of long-term inflammation; n = 148). RESULTS In group I, flare levels decreased from 1 day to 1 week [25.1 (±9.1) ph/ms vs. 13.4 (±4.8) ph/ms; P = 0.003] and remained stable up to 1 month after DMEK [12.1 (±3.2) ph/ms; P = 0.387]. However, average flare at 1 month was higher than that in healthy controls (P < 0.001). The long-term flare value after DMEK (group II) was 9.6 (±4.2) ph/ms and was higher in eyes associated with allograft rejection (n = 6) versus those without rejection [16.7 (±7.8) ph/ms vs. 9.3 (±3.8) ph/ms, respectively, P < 0.001]. All eyes associated with rejection had flare values above 10 ph/ms. CONCLUSIONS Aqueous flare after DMEK quickly decreased within the first postoperative month, indicating fast recovery of the blood-aqueous barrier. Long-term flare levels were higher in eyes associated with rejection, suggesting persistent subclinical inflammation. A flare level above 10 ph/ms may be used as a threshold for identifying eyes associated with or at risk of allograft rejection after DMEK.
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Comparison of Phacoemulsification Cataract Surgery with Low versus Standard Fluidic Settings and the Impact on Postoperative Parameters. Eur J Ophthalmol 2016; 27:39-44. [DOI: 10.5301/ejo.5000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/20/2022]
Abstract
Purpose To compare complications after cataract surgery using 2 different phacoemulsification fluidic settings. Methods One cataract surgeon (M.K.) performed phacoemulsification cataract surgery in one eye of 43 patients in this randomized prospective clinical study conducted at St. Erik Eye Hospital, Stockholm, Sweden. The patients were randomized to phacoemulsification with low fluidic settings in one group and standard fluidic settings in the other group. Corrected distance visual acuity (CDVA), central corneal thickness (CCT), endothelial cell density (ECD), anterior chamber flare, intraocular pressure (IOP), and macular thickness were measured preoperatively and postoperatively, with a final evaluation at 3 months. Surgical time, ultrasound energy, and amount of balanced saline solution used intraoperatively were recorded. Results Twenty-one patients were included in the group with standard settings and 22 patients were in the group with low settings. There were no significant differences between the groups in CDVA, CCT, flare, IOP, macular thickness, or ECD at 1 day, 3 weeks, or 3 months postoperatively. The surgical time was significantly (p = 0.009) longer and cumulative dissipated energy was significantly (p<0.001) higher in the group with low fluidic settings. Conclusions Although the surgical time and ECD were significantly higher in the group with low fluidic settings, there were no differences in the CCT, ECD, macular thickness, or inflammation postoperatively between the low and standard fluidic settings during phacoemulsification.
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Do JR, Oh JH, Chuck RS, Park CY. Transient corneal edema is a predictive factor for pseudophakic cystoid macular edema after uncomplicated cataract surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:14-22. [PMID: 25646056 PMCID: PMC4309864 DOI: 10.3341/kjo.2015.29.1.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
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Affiliation(s)
- Jae Rock Do
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jong-Hyun Oh
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
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Merkoudis N, Wikberg Matsson A, Granstam E. Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery. Acta Ophthalmol 2014; 92:623-8. [PMID: 24479722 DOI: 10.1111/aos.12358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 12/22/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery. METHODS Two groups of 25 patients each were included in this prospective randomized controlled trial. Patients in the injection group were given a subconjunctival injection of 20 mg methylprednisolone and the topical group received the conventional postoperative care with steroid eye drops (dexamethasone 1 mg/ml). The patients were examined 1 week and 1 month after surgery. Slit-lamp evaluation of anterior chamber inflammation and IOP were performed. Changes in IOP of ≥2.4 mmHg were considered clinically relevant. RESULTS In the injection group, mean IOP decreased from 15.4 ± 2.2 mmHg (baseline) to 14.1 ± 3.2 mmHg at 1 week (p = 0.03). The topical group had a stable IOP at 1 week (16.3 ± 2.6 mmHg) compared to baseline (16.1 ± 2.7 mmHg; p = 0.74). At 1 month, mean IOP was 14.3 ± 2.6 mmHg (p = 0.03) in the injection group and 15.6 ± 2.3 mmHg (p = 0.2) in the topical group. The intragroup changes were neither statistically significant nor clinically relevant at any postoperative visit. Both groups had the highest values of intraocular inflammation at the 1-week postoperative visit, followed by a decline to barely traceable levels at 1 month. The difference was not clinically relevant at any postoperative visit. CONCLUSIONS The subconjunctival injection of methylprednisolone appears to be as safe and effective as the conventional treatment, and it might therefore be considered for treatment of individuals with compliance issues.
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Affiliation(s)
- Nikolaos Merkoudis
- Department of Neuroscience/Ophthalmology; Uppsala University Hospital; Uppsala Sweden
| | - Anna Wikberg Matsson
- Department of Neuroscience/Ophthalmology; Uppsala University Hospital; Uppsala Sweden
| | - Elisabet Granstam
- Centre for Clinical Research; Uppsala University; County Council of Västmanland; Västmanland County Hospital; Västerås Sweden
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Bilateral acute pyogenic conjunctivitis with iritis induced by unilateral topical application of bacterial peptidoglycan muramyl dipeptide in adult rabbits. Exp Eye Res 2013; 116:324-36. [DOI: 10.1016/j.exer.2013.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 10/01/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
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Ersoy L, Caramoy A, Ristau T, Kirchhof B, Fauser S. Aqueous flare is increased in patients with clinically significant cystoid macular oedema after cataract surgery. Br J Ophthalmol 2013; 97:862-5. [PMID: 23613514 DOI: 10.1136/bjophthalmol-2012-302995] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND To analyse the relationship of clinically significant cystoid macular oedema (CME after phacoemulsification to blood-aqueous barrier breakdown as determined by aqueous flare, visual acuity and retinal thickness in optical coherence tomography (OCT). MATERIALS AND METHODS 30 eyes of 30 consecutive patients with clinically significant CME and vision loss were included. 46 pseudophakic and 45 phakic eyes without CME served as controls. Clinical data included age, gender, best-corrected visual acuity (BCVA) and spectral domain OCT volume scans. Retinal thickness measuring of the foveal central subfield was determined. Aqueous flare was measured quantitatively with the Kowa FM-500 Laser Flare-Cell Meter. RESULTS Patients with CME had significantly higher flare values compared with pseudophakic patients (p<0.0001). For patients with CME, aqueous flare values correlated significantly with BCVA (Spearman rs=0.4, p=0.041), while there was no correlation with retinal thickness. Using flare values to predict CME, receiver operating characteristic analysis returned an area under the curve of 0.976. CONCLUSIONS Aqueous flare as a marker for inflammation and breakdown of the blood-retinal barrier is increased in patients with CME after cataract surgery.
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Affiliation(s)
- Lebriz Ersoy
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
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Time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment. Retina 2013; 32:1862-7. [PMID: 22466487 DOI: 10.1097/iae.0b013e3182456f38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment (RD) and to determine the clinical factors related to an increase in aqueous flare. METHODS The present study included 22 unilateral patients with RD undergoing primary 20-gauge vitrectomy. Aqueous flare intensity was measured preoperatively and at 1 week, 2 weeks, 1 month, and 3, 6, and 12 months postoperatively using the laser flare meter. RESULTS Before vitrectomy, aqueous flare intensity was significantly higher in eyes with RD than in contralateral normal eyes. Vitrectomy increased aqueous flare intensity, and the peak was observed at the first postoperative week. Aqueous flare intensity decreased to a stable level at 3 months postoperatively but remained significantly higher than that of contralateral and preoperative eyes throughout the observation period. Clinical factors that were found to be significantly correlated with an increase in aqueous flare intensity included 1) before the surgical procedure: extent of RD and intraocular pressure, and 2) 3 months postoperatively: size of retinal breaks, number of laser photocoagulation spots, operation time, and performance of combined cataract surgery. Multiple regression analysis revealed that aqueous flare intensity at 3 months postoperatively had significant correlation with the size of retinal breaks (P < 0.005) and the number of laser photocoagulation spots (P < 0.05). CONCLUSION Aqueous flare intensity after vitrectomy for RD decreased to a stable level at 3 months postoperatively but remained significantly higher than the normal level. The size of retinal breaks and the degree of surgical invasion were associated with the increase in aqueous flare.
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Choi S, Lee HJ, Cheong Y, Shin JH, Jin KH, Park HK, Park YG. AFM study for morphological characteristics and biomechanical properties of human cataract anterior lens capsules. SCANNING 2012; 34:247-56. [PMID: 22331648 DOI: 10.1002/sca.21001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/13/2011] [Indexed: 05/20/2023]
Abstract
The aim of this study was to quantitatively investigate the morphologies (surface roughness) and biomechanical properties (Young's modulus) of human anterior lens capsules (ALCs) for noncataract and cataract groups using atomic force microscopy. Eight human ALCs obtained during phacoemulsification from patients with senile cataracts (72 ± 13 years) were investigated in both the hydrated and dehydrated conditions. The cataract group showed clearly the proliferated lens epithelial cells (LECs) with a monomorphic cell structure, a diameter of 12.54 ± 4.31 μm, and a height of 0.23 ± 0.04 μm, whereas the control group showed no LECs. A substantial amount of false-positive calcification was observed caused by the deposition of remnants of dried salt solution. Cataract group showed significantly higher surface roughness (382.06 nm, p ≤ 0.001) than control group in the anterior side of ALCs, whereas cataract group showed significantly lower surface roughness (353.79 nm, p ≤ 0.001) than control group in their posterior side. Cataract group showed significantly higher Young's modulus (69.52 kPa, p ≤ 0.001) compared to the control group, regardless of the ALC side. Therefore, it is significant that this study provides a new method to examine the nanostructural characteristic and biomechanical property of human ALCs through a nanometer-scale resolution microscopy technique.
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Affiliation(s)
- Samjin Choi
- Department of Biomedical Engineering and Healthcare Industry Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Phase II placebo-controlled study of nepafenac ophthalmic suspension 0.1% for postoperative inflammation and ocular pain associated with cataract surgery in Japanese patients. J Ophthalmic Inflamm Infect 2011; 1:147-55. [PMID: 21932014 PMCID: PMC3223346 DOI: 10.1007/s12348-011-0036-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 07/21/2011] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to examine the efficacy and safety of nepafenac ophthalmic suspension compared to placebo in the management of postoperative inflammation and ocular pain in Japanese patients undergoing cataract surgery. Methods This was a multicenter, randomized, double-masked, placebo-controlled clinical study. Patients received nepafenac or placebo TID beginning 1 day before cataract surgery and continuing on the day of surgery for 14 days. One additional drop was administered on the day of surgery. The primary efficacy variables were the percentage of patients cured at postoperative day 14 visit (cure defined as aqueous cells score + aqueous flare score = 0) and the percentage of patients who were pain free at all postoperative visits. Results The cure rate on day 14 after surgery was 71.4% (75/105) in the nepafenac group and 28.6% (30/105) in the placebo group, showing a significant difference in cure rate between groups. The nepafenac group demonstrated higher cure rates than those in the placebo group, with a significant difference in cure rate on days 7 and 14 postoperatively. The ocular pain-free rate was 96.2% (102/106) in the nepafenac group and 67.6% (71/105) in the placebo group, showing a significant difference between groups. Concerning adverse events (AEs), 26 AEs were reported in 21 subjects (19.6%) in the nepafenac group and 31 AEs were reported in 24 subjects (22.4%) in the placebo group. Conclusion Nepafenac ophthalmic suspension is a nonsteroidal anti-inflammatory drug effective in the prevention of postoperative inflammation and ocular pain associated with cataract surgery.
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Kemény-Beke A, Szekanecz Z, Szántó S, Bodnár N, Módis L, Gesztelyi R, Zsuga J, Szodoray P, Berta A. Safety and efficacy of etanercept therapy in ankylosing spondylitis patients undergoing phacoemulsification surgery. Rheumatology (Oxford) 2010; 49:2220-1. [PMID: 20833644 DOI: 10.1093/rheumatology/keq288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Maca SM, Amon M, Findl O, Kahraman G, Barisani-Asenbauer T. Efficacy and tolerability of preservative-free and preserved diclofenac and preserved ketorolac eyedrops after cataract surgery. Am J Ophthalmol 2010; 149:777-84. [PMID: 20152959 DOI: 10.1016/j.ajo.2009.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the anti-inflammatory efficacy and subjective tolerability of preservative-free and preserved diclofenac 0.1% and preserved ketorolac 0.5% eye drops for prophylaxis and management of inflammation after cataract surgery. DESIGN Prospective, randomized, investigator-masked, parallel-group, comparative clinical trial. METHODS One hundred two patients who underwent small-incision phacoemulsification cataract surgery in an institutional setting were assigned randomly to receive preservative-free diclofenac sodium 0.1% (Voltaren ophtha SDU; Novartis Pharma), preserved diclofenac sodium 0.1% (Voltaren ophtha; Novartis Pharma), or preserved ketorolac tromethamine 0.5% (Acular; Pharm Allergan) eyedrops 4 times daily for 4 weeks after surgery. During the 1-month follow-up, anterior chamber flare and mean foveal thickness were evaluated for objective comparison of the anti-inflammatory effect. Ocular tolerability was assessed by observer-based grading of conjunctival hyperemia and ocular discomfort, as well as obtaining subjective ratings of ocular tolerability on a visual analog scale. Distance and near visual acuity and intraocular pressure served as safety measures. RESULTS All 3 formulations demonstrated equal anti-inflammatory efficacy as measured by reduction of anterior chamber flare after surgery and prevention of postoperative macular edema. Patients treated with preservative-free diclofenac eyedrops reported significantly better subjective tolerability values (P = .001), were classified as having less ocular discomfort (P < .001), and experienced earlier reduction of postoperative conjunctival hyperemia (P = .029). CONCLUSIONS Anti-inflammatory efficacy was comparable for all 3 agents. However, preservative-free diclofenac 0.1% eyedrops exhibited a significantly better postoperative subjective and objective tolerability when compared with preserved eyedrops containing ketorolac or diclofenac.
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Woon WH, Greig D, Savage MD, Spokes D, Skorski S, Thompson GL, Murphy B, Taylor S. Evidence for the aqueous absorption of gas from the eye following vitreoretinal surgery. Phys Med Biol 2008; 53:3309-16. [PMID: 18523343 DOI: 10.1088/0031-9155/53/12/016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A standard part of vitrectomy surgery is to inject a bubble of gas into the eye, and an important question for the surgeon and patient alike is to know the volume of the bubble and how long it is likely to last. A related question of considerable importance is the mechanism by which it is absorbed. In this paper, we show how to use patients' measurements of the daily variation of their far points to calculate the changing volume of the bubble and hence the rate of gas absorption throughout the post-operative period. The results show that the rate of absorption contains a term in time squared, indicative of absorption through the exposed surface area of the aqueous fluid rather than via the exposed retina.
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Affiliation(s)
- W H Woon
- Department of Ophthalmology, St James's University Hospital, Leeds LS9 7TF, UK
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Stifter E, Menapace R. "Instant vision" compared with postoperative patching: clinical evaluation and patient satisfaction after bilateral cataract surgery. Am J Ophthalmol 2007; 143:441-8. [PMID: 17223061 DOI: 10.1016/j.ajo.2006.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/28/2006] [Accepted: 11/03/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare two methods of postoperative dressing regimen: patching vs "instant vision" without patch. DESIGN Prospective randomized clinical trial. METHODS Sixty consecutive hospitalized, nonambulatory patients with cataract surgery under topical anesthesia on both eyes at different days were enrolled prospectively. In randomized order, one eye was patched for the first 24 hours postoperatively; the other eye was left open without patch to obtain "instant vision." Both eyes received the same anti-inflammatory and antibiotic drop therapy. RESULTS Twenty-four hours postoperatively, no significant differences between patching and "instant vision" could be found for corrected and uncorrected visual acuity, corneal epithelial defects, conjunctival inflammation, anterior chamber flare, and intraocular pressure (P > .05). During the first 24 hours postoperatively, all tear film parameters were significantly worse in the "instant vision" eyes (P < .001), indicating a transient tear film instability. During the first four hours after cataract surgery, pain scores in the "instant vision" eyes were significantly higher than in the patched eyes (P < .001). Eight hours postoperatively and later, there were no significant differences in any pain scores (P > .05). After experiencing both methods, 27% of the patients subjectively rated the two methods as equivalent; 8% of the patients preferred "instant vision." Despite of the benefits of immediately improved orientation, 65% of the tested patients preferred patching to "instant vision" because of lower pain and foreign body sensations and psychologic arguments. CONCLUSIONS The clinical examinations showed that both methods were equally safe for postoperative therapy. However, further efforts have to be made to increase the patients' comfort with "instant vision" in the first hours after cataract surgery.
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Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Austria
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Elgohary MA, Hollick EJ, Bender LE, Heatley CJ, Wren SM, Boyce J, Missotten T, Spalton DJ, Dowler JG. Hydrophobic acrylic and plate-haptic silicone intraocular lens implantation in diabetic patients. J Cataract Refract Surg 2006; 32:1188-95. [PMID: 16857508 DOI: 10.1016/j.jcrs.2006.01.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the capsular and uveal reaction after implantation of a plate-haptic silicone intraocular lens (IOL) (C11UB, Chiron) and a hydrophobic acrylic (AcrySof MA60, Alcon) IOL in diabetic patients. SETTING Moorfields Eye Hospital and St. Thomas' Hospital, London, United Kingdom. METHODS Thirty-five diabetic patients were recruited consecutively and randomly assigned to have implantation of either of the 2 IOLs. The percentage area of posterior capsule opacification (PCO), anterior capsule contraction (ACC), and postoperative inflammatory indices (flare and cells) were assessed objectively at 2 to 3 weeks, 6 months, and 1 year. Between-group and within-group analyses were conducted using the Student t test or Mann-Whitney test and Friedmann test, respectively. RESULTS Between-group analysis showed the percentage area of PCO was significantly greater in patients with plate-haptic silicone IOLs at 6 and 12 months (P = .002). At 6 months, ACC was significantly greater in the plate-haptic group (P = .04), but the difference was not significant at 12 months. There was higher flare in the hydrophobic acrylic IOL group than in the plate-haptic silicone IOL group at 2 to 3 weeks (P = .08). Within-group analysis showed that over the follow-up period, the plate-haptic silicone group, but not the hydrophobic acrylic group, had a progressive increase in PCO (P = .003). In the hydrophobic acrylic group, but not the plate-haptic silicone group, there was a significant reduction in the mean anterior chamber flare value (P = .01). There was no significant difference in visual acuity or contrast sensitivity at any postoperative visit. CONCLUSION In diabetic patients, hydrophobic acrylic IOLs can lead to an increased flare in the early postoperative period but they seem to be more favorable than plate-haptic silicone IOLs because the latter lead to more PCO.
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Barbour W, Saika S, Miyamoto T, Ohnishi Y. Biological compatibility of polymethyl methacrylate, hydrophilic acrylic and hydrophobic acrylic intraocular lenses. Ophthalmic Res 2005; 37:255-61. [PMID: 16037680 DOI: 10.1159/000087100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 01/21/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE Extensive clinical investigations of the biocompatibility of different intraocular lenses (IOLs) have been made in an effort to optimize the outcome of modern cataract surgery. The aim of this study was to add animal eye experimental implantation data regarding cellular reaction on the anterior surface of IOLs. METHODS Thirteen adult albino rabbits had phacoemulsification/aspiration of the crystalline lens followed by implantation of a posterior chamber IOL in each eye. Three types of IOLs were studied: Hydroview (Bausch and Lomb; n = 7), Acrysof (Alcon, USA; n = 7), and polymethyl methacrylate (PMMA; HOYA, Japan; n = 7). The animals were killed by intravenous pentobarbital 1, 4, or 8 weeks later. The IOLs were explanted and stained with hematoxylin and eosin, and observed under a light microscope. The shape of mouse ascites-induced macrophages on the anterior surface of the three different IOL types (Hydroview, PMMA, and Acrysof) was studied after 24 h of oven culture. RESULTS Hydrophilic acrylic IOLs showed the highest affinity for lens epithelial cell (LEC) outgrowth, and the lowest and slowest maturation rate reaction of macrophages. PMMA IOLs showed the lowest affinity for LEC outgrowth, and the highest reaction of macrophages. Hydrophobic acrylic IOLs showed intermediate results both regarding LECs and macrophages. CONCLUSIONS Results suggest that IOL biomaterial properties are the key factor that influences the quantity of monocytes/macrophages as well as the process of their maturation/senescence. LEC outgrowth is influenced both by the biomaterial of IOLs and by the monocyte/macrophage reaction.
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Affiliation(s)
- Walid Barbour
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan.
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Liu Y, Luo L, He M, Liu X. Disorders of the blood-aqueous barrier after phacoemulsification in diabetic patients. Eye (Lond) 2004; 18:900-4. [PMID: 15017379 DOI: 10.1038/sj.eye.6701349] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the function of the blood-aqueous barrier after phacoemulsification with implantation of a foldable intraocular lens (IOL) in diabetic patients. METHODS All patients were enrolled from those scheduled for phacoemulsification with intraocular lens implantation in Zhongshan Ophthalmic Center Guangzhou from March 2002 to June 2002. The classification on diabetic retinopathy (DR) was based on the fundus examination after cataract surgery. The blood-aqueous barrier function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative days 1, 7, 30, and 90 by an independent examiner who was masked to the DR classification. Patients were operated by one experienced surgeon as per standard clinical protocol and were provided the same postoperative medical care. A linear regression and Wilcoxon test were used for the analysis. RESULTS A total of 112 patients were divided into three groups: patients without diabetic mellitus as normal control (n=56), diabetic patients without diabetic retinopathy (n=2), with nonproliferation diabetic retinopathy (NPDR) (n=37), and diabetic patients with proliferation diabetic retinopathy (PDR) (n=17). All patients were examined and successfully followed up for 3 months after cataract surgery. Aqueous flare mean photon counts in PDR, NPDR, and control eyes were 8.94+/-0.57, 7.03+/-0.27, and 6.94+/-0.34 before surgery and increased to 32.42+/-0.67, 26.07+/-0.83, 26.27+/-1.37 on the first day after surgery (P<0.05), then decreased to 19.86+/-0.78, 14.08+/-0.54 and 13.96+/-1.05 at 7 days after surgery (P<0.05), 13.24+/-0.29, 9.86+/-0.33, and 9.07+/-0.43 at 30 days after surgery (P<0.05); eventually, the counting decreased to 11.25+/-0.31, 7.24+/-0.67, and 7.16+/-0.27 at 90 days after surgery (P<0.05). Linear regression model suggested that other potential variables, such as age, sex, eye (left/right), phaco time, phaco energy, and hypertension were not related to the outcome. For patients without diabetes mellitus and diabetic patients with NPDR, highly statistically significant differences (P<0.05) were found between preoperative flare value and those measured on days 1, 7, and 30 after surgery, but no statistically significant differences (P>0.05) were found between the preoperative flare value and those measured on postoperative days 90. However, patients with PDR still had a higher flare value even on postoperative day 90. The patients with intraoperative iris prolapse had a higher flare value between days 1 and 7 postoperatively. CONCLUSION Phacoemulsification with a foldable intraocular lens implantation affects the blood-aqueous barrier more severely in diabetic patients with PDR than patients with NPDR and nondiabetic patients.
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Affiliation(s)
- Y Liu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Peoples Republic of China.
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Meacock WR, Spalton DJ, Bender L, Antcliff R, Heatley C, Stanford MR, Graham EM. Steroid prophylaxis in eyes with uveitis undergoing phacoemulsification. Br J Ophthalmol 2004; 88:1122-4. [PMID: 15317700 PMCID: PMC1772319 DOI: 10.1136/bjo.2003.032482] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To compare the efficacy of two preoperative steroid regimens for cataract surgery in patients with uveitis. METHODS 40 uveitis patients with cataract underwent phacoemulsification and intraocular lens (IOL) implantation. Preoperatively they were randomised into two groups: group 1 (20 patients) received a single dose of intravenous methylprednisolone (15 mg/kg) half an hour before surgery, and group 2 (20 patients) received a 2 week course of oral prednisolone (0.5 mg/kg) which was tapered postoperatively. Preoperatively patients had aqueous flare and cells measured with the Kowa laser flare meter. On days 1, 7, 28, and 90 aqueous flare and cells were measured, and on days 7 and 90 fluorescein angiography was performed to determine the incidence of cystoid macular oedema (CMO). RESULTS At all postoperative visits the mean increase in flare was greater for group 1 (intravenous steroid). Patients with posterior synechiae had greater blood-aqueous barrier damage (BAB) postoperatively. There were no statistically significant differences in logMAR visual acuity and incidences of CMO between the two groups at 7 and 90 days. CONCLUSION A 2 week course of oral prednisolone, tapered postoperatively, produced a better recovery of the BAB than a single dose of intravenous methylprednisolone and is thus the recommended preoperative regimen.
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Affiliation(s)
- W R Meacock
- Tremona Road, Eye Unit, Southampton General Hospital, Southampton, Hants, UK.
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Mayama C, Tomidokoro A, Araie M, Mizuno K. Influence of peripheral iridectomy on intravitreous penetration of topical nipradilol. Curr Eye Res 2004; 28:129-33. [PMID: 14972718 DOI: 10.1076/ceyr.28.2.129.26238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Penetration of drug from the anterior chamber to the vitreous is substantial in aphakic eyes, but negligible in normal phakic eyes. The purpose of this study is to investigate the effect of the presence of peripheral iridectomy (PI) which bypasses iris-lens diaphragm on the drug penetration from the anterior chamber to the vitreous. METHODS Twelve Japanese White rabbits underwent PI in a randomly chosen eye and the same procedures except removal of the peripheral iris in the contralateral eye. Nine weeks after the procedure, topical instillation of 20 microl of 1% nipradilol into the both eyes was repeated three times at five-minute intervals, and two hours later the animals were sacrificed and the both eyes were enucleated. Concentrations of nipradilol in the aqueous and vitreous were determined using a high-performance liquid chromatography. RESULTS The concentrations of nipradilol were significantly greater in the eyes with PI than those in the contralateral control eyes in the aqueous (5636 +/- 1688 vs 2835 +/- 663 ng/g, mean +/- standard error, n = 12, p = 0.0028) and in the anterior vitreous (11.9 +/- 2.5 vs 5.6 +/- 1.0 ng/g, p = 0.0047), while not in the posterior vitreous or in the posterior retina-choroid. The ratios of the nipradilol concentrations in the anterior or posterior vitreous to that in the aqueous were not significantly different between the both eyes. CONCLUSIONS The presence of PI had little effect on the penetration of topically instilled nipradilol from the anterior chamber to vitreous.
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Affiliation(s)
- Chihiro Mayama
- Department of Ophthalmology, University of Tokyo School of Medicine, Japan.
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Abstract
PURPOSE To evaluate postoperative inflammation after implantation of the implantable contact lens (ICL) to treat moderate to high myopia. DESIGN Noncomparative, prospective case series. PARTICIPANTS Five hundred twenty-five eyes of 293 patients with between 3 and 20 diopters of myopia participating in the United States Food and Drug Administration clinical trial of the ICL for myopia. INTERVENTION Implantation of the ICL. MAIN OUTCOME MEASURES Clinical assessments of anterior chamber flare and cellular reaction for up to 3 years after surgery and laser flare-cell meter measurements for up to 2 years after surgery. RESULTS Clinical flare and cellular reaction was reported as absent in 99.6% to 100% of cases and in no case demonstrated more than trace reaction at all postoperative visits 1 month or more after surgery. In a small subset of the study participants who were tested with the laser flare and cell meter, measurements taken between 3 months and 3 years after surgery were within the normal range. CONCLUSIONS The implantation of the ICL does not cause a long-term (2-3 years) inflammatory response within the eye.
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Küchle M, Naumann GOH. Intraocular inflammation after cataract surgery. Ophthalmology 2003; 110:1269-70. [PMID: 12799271 DOI: 10.1016/s0161-6420(03)00597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ikeda N, Hayasaka S, Nagaki Y, Hayasaka Y, Kadoi C, Matsumoto M. Effects of kakkon-to and sairei-to on aqueous flare elevation after complicated cataract surgery. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2003; 30:347-53. [PMID: 12230023 DOI: 10.1142/s0192415x02000375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluate prospectively the effects of traditional herbal medicines on elevation of aqueous flare after complicated cataract surgery. Twenty-seven patients with bilateral complicated cataract undergoing phacoemulsification with intraocular lens implantation were studied. The patients received no herbal medicine when the right eyes underwent cataract surgery. Fifteen patients were given kakkon-to (ge-gen-yang in Chinese) granules (7.5 g daily) and 12 patients were given sairei-to (cai-ling-tang in Chinese) granules (9.0 g daily), for 3 days before surgery, the day of surgery, and for 7 days after surgery when the left eyes underwent cataract surgery. Diclofenac eyedrops were instilled in all patients. Aqueous flare was measured before and after surgery. The differences in preoperative flare intensities between groups treated with Kakkon-to and Sairei-to were not significant. In the untreated right eyes of the kakkon-to and Sairei-to groups, the flare was 99.1 and 89.6 photon counts/msec, respectively, on day 1, and then gradually decreased. The flare intensities on days 1, 3, and 5 in the kakkon-to treated left eyes were significantly lower than in those of the untreated right eyes (Fig. 1). The flare intensities in the Sairei-to treated left eyes were the same as those in the untreated right eyes. Kakkon-to contributed to a reduction of aqueous flare elevation after surgery for complicated cataract.
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Affiliation(s)
- Nariko Ikeda
- Division of Ophthalmology, Itoigawa General Hospital, Japan.
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Küchle M, Naumann GOH. Intraocular inflammation after cataract surgery. Ophthalmology 2003; 110:632-3. [PMID: 12689877 DOI: 10.1016/s0161-6420(02)01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abela-Formanek C, Amon M, Schild G, Schauersberger J, Kolodjaschna J, Barisani-Asenbaum T, Kruger A. Inflammation after implantation of hydrophilic acrylic, hydrophobic acrylic, or silicone intraocular lenses in eyes with cataract and uveitis: comparison to a control group. J Cataract Refract Surg 2002; 28:1153-9. [PMID: 12106723 DOI: 10.1016/s0886-3350(02)01321-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the course of inflammation after small-incision cataract surgery with implantation of 1 of 3 types of foldable intraocular lenses (IOLs) in eyes with uveitis. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS Seventy-four eyes with uveitis and cataract and 68 control eyes with cataract were prospectively selected to receive a foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia) IOL. All surgery was performed by the same surgeon using a standardized protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag IOL implantation. Preoperative and postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 28, 90, and 180 days after surgery using the Kowa FC-1000 laser flare-cell meter. All uveitic eyes were in remission for at least 3 months before surgery. RESULTS In the uveitic eyes, there was no statistically significant difference in the postoperative course of flare and cell among the 3 IOL groups. Six months after surgery in uveitic eyes, flare values reached preoperative levels and the cell count was lower than preoperatively in all 3 IOL groups. Relative flare values were higher in the eyes with uveitis and a CeeOn 911 IOL; however, the difference between this group and the 2 acrylic IOL groups was not significant. CONCLUSIONS There were no significant differences in inflammation after implantation of foldable IOLs in uveitic eyes. Although absolute flare values and cell counts in eyes with uveitis were higher than in control eyes, primarily because of a damaged blood-aqueous barrier (BAB), BAB recovery was similar between the 2 groups. The changes in the BAB indicate that foldable IOL implantation is safe in uveitic eyes.
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Werner L, Apple DJ, Pandey SK, Trivedi RH, Izak AM, Macky TA. Phakic posterior chamber intraocular lenses. Int Ophthalmol Clin 2001; 41:153-74. [PMID: 11481545 DOI: 10.1097/00004397-200107000-00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Werner
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA
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Küchle M, Naumann GO. Measurement of blood-aqueous barrier breakdown. Ophthalmology 2001; 108:638. [PMID: 11297469 DOI: 10.1016/s0161-6420(00)00443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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50
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Ikeda N, Hayasaka S, Nagaki Y, Hayasaka Y, Kadoi C, Matsumoto M. Effects of traditional Sino-Japanese herbal medicines on aqueous flare elevation after small-incision cataract surgery. J Ocul Pharmacol Ther 2001; 17:59-65. [PMID: 11322638 DOI: 10.1089/108076801750125694] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated prospectively the effects of traditional Sino-Japanese herbal medicines on elevation of aqueous flare. Fifty-four patients with age-related cataract undergoing phacoemulsification with intraocular lens implantation were studied. In the control group, 20 patients received no herbal medicine. In the treated groups, 14 patients were given Orengedoku- to (Huanglian-Jie-Du-Tang in Chinese) granules (7.5 g daily), 10 patients were given Kakkon-to (Ge-Gen-Tang in Chinese) granules (7.5 g daily), and 10 patients were given Sairei-to (Cai-Ling-Tang in Chinese) granules (9.0 g daily), for 3 days before surgery, the day of surgery, and for 7 days after surgery. Aqueous flare was measured before and after surgery. The differences in preoperative flare intensities among the four groups were not significant. In the control group, the flare was 29.4 photon counts/msec on day 1, and then gradually decreased. The flare intensities on days 1, 3, and 5 in the Orengedoku-to and Kakkon-to groups were significantly lower than in the control group. The flare intensities in the Sairei-to group were the same as those of the controls. Oral administration of Orengedoku-to and Kakkon-to decreased aqueous flare elevation after small-incision cataract surgery. Sairei-to had no effect on the elevation.
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Affiliation(s)
- N Ikeda
- Department of Ophthalmology, Toyama Medical and Pharmaceutical University, Japan.
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