Double safe suture during cataract surgery on post radial keratotomy patients using clear corneal incisions

Radial keratotomy: background and how to manage these patients nowadays

In this review, we presented the principles of radial keratotomy (RK), its evolution, enhancement, and complications, and strategies to manage the consequences of RK in the present day. It is essential to understand the RK procedure f, the theoretical background that supported this surgery, the current effect on the cornea, and how to approach patients needing vision improvement. These patients are developing cataracts that need to be handled well, from the IOL calculation to the surgical procedure. Guided keratorefractive surgery is the most accurate procedure to improve these patient's vision and life. Nevertheless, some patients may need other approaches, such as sutures, penetrating keratoplasty, corneal rings, and pinhole implants, depending on the degree of irregularity of the cornea, ablation depth for guided surgery or if the sutures are open.

Cataract surgery following refractive surgery: Principles to achieve optical success and patient satisfaction

A growing number of patients with prior refractive surgery are now presenting for cataract surgery. Surgeons face a number of unique challenges in this patient population that tends to be highly motivated to retain or regain functional uncorrected acuity postoperatively. Primary challenges include recognition of the specific type of prior surgery, use of appropriate intraocular lens (IOL) power calculation formulas, matching IOL style with spherical aberration profile, the recognition of corneal imaging patterns that are and are not compatible with toric and/or presbyopia-correcting lens implantation, and surgical technique modifications, which are particularly relevant in eyes with prior radial keratotomy or phakic IOL implantation. Despite advancements in IOL power formulae, corneal imaging, and IOL options that have improved our ability to achieve targeted postoperative refractive outcomes, accuracy and predictability remain inferior to eyes that undergo cataract surgery without a history of corneal refractive surgery. Thus, preoperative evaluation of patients who will and will not be candidates for postoperative refractive surgical enhancements is also paramount. We provide an overview of the specific challenges in this population and offer evidence-based strategies and considerations for optimizing surgical outcomes.

Unexpected ocular morphological changes after corneal refractive surgery: A review

Corneal refractive surgery (CRS) currently is widely used to correct refractive errors because of its efficacy and reliability. Several studies dealt with the corneal modification induced by this type of surgery, but it is still debated if CRS can induce unexpected changes namely anterior chamber depth (ACD) and axial length (AL). A literature review was performed, including all articles regarding CRS and eye-variations from 1999 to December 2021. Excluding articles about specific systemic conditions (e.g., pregnancy), pathological conditions, post-surgical complications or about only corneal flattening and thinning post CRS, we found nine studies that met the search criteria. We divided the found articles according to the type of surgery performed (radial keratotomy, PRK/LASEK, lasik) and analyzed the results about ACD and AL. Finally, according to the literature, we can conclude that CRS not only gives a corneal flattening, thinning and biomechanical changes, but also induces AL and ACD decrease. This makes the AL and ACD measurements obtained before CRS uselessness in case of IOL power calculation.

Prevalence and Risk Factors for Adult Cataract in the Jingan District of Shanghai

Purpose

We report the prevalence of age-related cataract (ARC) in the Jingan district of Shanghai and analyze the risk factors for ARC to be better prepared for the increasing burden of cataracts as a significant cause of visual impairment worldwide.

Methods

From March to June 2010, a population-based, cross-sectional study was conducted in a community selected by stratified cluster sampling in the Jingan district of Shanghai. Residents aged 40 and older were recruited and investigated by questionnaires and ophthalmic examination. Univariate and multivariate logistic regression models were used to evaluate the association of these risk factors with any cataract.

Results

A total of 2894 subjects aged 40 years and above were included in our study. Nine hundred forty-eight people (32.8%) were diagnosed with cataract, including 845 with bilateral cataracts (29.2%) and 292 with moderate and severe visual impairment (low vision, 10.1%). There were significant differences in low vision among different age groups and gender (Χ2 age = 84.420, P age < 0.001, Χ2 gender = 7.696, P gender = 0.021). For any cataract, we found age (OR = 1.107, 95% CI: 1.094-1.120) and refractive error (OR = 1.352, 95% CI: 1.127-1.622) were independent risk factors.

Conclusion

The prevalence of cataract is estimated to be nearly one-third of the sample, increasing with age. We provided further evidence that age and refractive error are independent cataract risk factors.

Calculating intraocular lens power in anterior megalophthalmos: A case report

Introduction

We report a case of a man with cataract and anterior megalophthalmos (AM), in which some myopia was retained when calculating intraocular lens (IOL) power using the Haigis formula to avoid postoperative farsightedness.

Case description

A 59-year-old Chinese man was referred to our clinic for cataract surgery in his right eye. He had strong bilateral megalocornea, and his left eye had undergone surgery four times. After complete preoperative examinations and repeated biometry, the Haigis formula was used, and a 3-piece IOL was implanted with a target power of −1.97 D. At 1-year follow-up, the patient showed the best-corrected distance vision of 20/20 with the refraction of −1.50 DC × 160°, and the IOL was stable.

Conclusion

Our patient with anterior megalophthalmos showed postoperative hyperopia drift even though the Haigis formula was used as suggested in previous studies. To prevent farsightedness after surgery, some myopia should be retained when calculating IOL power. The Kane, Holladay II with AL adjustment, and Barrett Universal II formulas may be more accurate for calculating IOL power in such patients.

Visual Outcomes after Implantation of Lucidis EDOF IOL

Purpose. To evaluate the visual performance and clinical outcomes after implantation of Lucidis EDOF IOL following cataract surgery. Design. In this retrospective study, medical records from all enrolled patients were analyzed, and the following information was extracted retrospectively over 3 months following surgery. Materials and Methods. We reviewed retrospectively 181 eyes of 98 patients, who underwent cataract surgery with Lucidis extended depth of focus IOL. Results. 44 patients were males (45%) and 54 were females (55%). The average age of the study population was 68 ± 11 years. The mean preoperative BCVA (logMAR) was 0.19 ± 0.18. The mean root mean square (RMS) high order aberration (HOA) was 0.18 ± 0.1. Monocular BCVA results were 0.02 ± 0.04 (logMAR) and 0.028 ± 0.04 (logMAR) 1 month and 3 months postoperatively, respectively. Between the baseline and 1-month measures, monocular distance BCVA improved by an average of 0.17 ± 0.14 logMAR ( $p$  = 0.0001). Between the baseline and 3-month postoperative measures, monocular distance BCVA improved by an average of 0.16 ± 0.13 logMAR ( $p$  = 0.0001). Monocular UDVA 1 and 3 months postoperatively was 0.08 ± 0.1 logMAR and 0.067 ± 0.08 logMAR, respectively. 1-Month postoperative binocular UDVA was 0.036 ± 0.05 logMAR, binocular UIVA was 0.1 ± 0.08 logMAR, and binocular UNVA was 0.12 ± 0.14 logMAR. 3-Month postoperative binocular UDVA was 0.038 ± 0.05 logMAR, binocular UIVA was 0.09 ± 0.1 logMAR, and binocular UNVA was 0.16 ± 0.14 logMAR. Conclusions. Lucidis EDOF IOL achieves good visual performances in all distances.

Application of Intraoperative Optical Coherence Tomography Technology in Anterior Segment Surgery

The use of optical coherence tomography (OCT) technology in anterior segment diseases allows for precise assessment of the changes following anterior segment surgery. Advances in microscope-integrated OCT systems have allowed the utilization of intraoperative OCT (iOCT) in anterior segment surgeries, i.e., cornea, cataract, and refractive surgery. iOCT has enabled real-time precise visualization of anterior segment tissues as well as interactions between surgical instruments and ocular tissue; thus, the device can facilitate surgical procedures and provide valuable information for decision-making during anterior segment surgeries. In this review, the authors will introduce studies regarding the development of iOCT technology and its application in various anterior segment surgeries. Multiple studies have shown the efficacy of the iOCT for intraoperative assistance and guidance, suggesting the potential of the device for optimizing the surgical outcomes after cornea, cataract, and refractive surgery.