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Icoz M, Gurturk Icoz SG. Importance of optical coherence tomography before cataract surgery. BMC Ophthalmol 2024; 24:339. [PMID: 39135029 PMCID: PMC11320843 DOI: 10.1186/s12886-024-03622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE To determine the importance of optical coherence tomography (OCT) in patients scheduled for cataract surgery who present with no pathologies in biomicroscopic fundus examination. DESIGN Retrospective study. METHODS In this study, the routine ophthalmologic examination of patients who were recommended cataract surgery was performed.Occult retinal pathologies were evaluated using OCT in patients without any pathologies in biomicroscopic fundus examination.According to whether retinal pathologies were detected on OCT, the patients were divided into two groups: normal and abnormal OCT.The findings of patients with retinal pathologies on OCT and their distribution according to age were also evaluated. RESULTS A total of 271 eyes from 271 patients were evaluated.The number of patients with retinal pathologies on OCT despite normal fundoscopic examination findings was 38(14.0%).Of these patients,15(39.4%) had an epiretinal membrane,10(26.3%) had age-related macular degeneration, eight(21%) had vitreomacular traction, two(5.2%) had a lamellar hole, and 1(2.6%) patient each had a full-thickness macular hole, an intraretinal cyst, and photoreceptor layer damage.The age distribution of the patients with retinal pathologies was as follows: two patients,<60 years; six patients,60-70 years;14 patients,70-80 years; and 16 patients,>80 years.The rate of patients aged > 70 years and above was 78.9%.There was no statistically significant difference between the normal and abnormal OCT groups in terms of age, gender, the presence of systemic diseases, visual acuity, central macular thickness, and cataract type or density(p > 0.05 for all). CONCLUSION In one of seven patients evaluated, retinal pathologies were detected on OCT despite normal fundoscopic examination findings.OCT can be used to detect occult retinal pathologies that cannot be detected by biomicroscopic fundus examination before cataract surgery.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey.
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Kanda M, Malik M, Miller M, Deshmukh R. Poppers maculopathy missed in a patient with cataract highlights the importance of preoperative optical coherence tomography. BMJ Case Rep 2024; 17:e259477. [PMID: 38834306 DOI: 10.1136/bcr-2023-259477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Poppers maculopathy is a complication of alkyl nitrate (poppers) inhalation. It presents with non-specific symptoms and variable signs, which can make it difficult to diagnose. We present a case of coexisting cataract and poppers maculopathy in a patient. He had vague visual symptoms that were attributed entirely to his cataract and he went on to have cataract surgery. Suboptimal postoperative visual acuity and normal clinical examination triggered further investigation with spectral-domain optical coherence tomography (SD-OCT), after which poppers maculopathy was diagnosed. We highlight the importance of performing OCT in the preoperative assessment of a cataract patient, especially where the cataract is mild and may not fully account for symptoms. The patient showed complete visual recovery on drug cessation despite ongoing maculopathy on OCT scans.
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Affiliation(s)
- Mumta Kanda
- A&E, Cataract, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mohsan Malik
- Adnexal, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael Miller
- Moorfields Private, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Rajesh Deshmukh
- Cataract, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Yeu E, Berdahl JP, Gupta PK, Patterson M. Sensitivity and specificity of SS-OCT for detecting macular pathologies vs SD-OCT. J Cataract Refract Surg 2024; 50:481-485. [PMID: 38192061 PMCID: PMC11045393 DOI: 10.1097/j.jcrs.0000000000001394] [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: 06/26/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To evaluate the sensitivity and specificity of swept-source optical coherence tomography (SS-OCT) biometer compared with the gold standard spectral-domain optical coherence tomography (SD-OCT) for detecting macular pathology in patients with cataract. SETTING Eye Centers of Tennessee, Crossville, TN. DESIGN Prospective, cross-sectional, observational, examiner-masked. METHODS The study included 132 participants aged 50 years and older, who underwent precataract surgery work-up. All participants underwent fixation check retinal scans using SS-OCT biometer (IOLMaster 700) as well as full macular scans using Cirrus SD-OCT. 3 independent masked examiners evaluated the scans if they were normal or had a suspected pathology. Different measures of diagnostic accuracy were calculated for 3 examiners. RESULTS True positive rate (sensitivity) ranged from 71.1% (32/45) to 79.2% (42/53), and false negative rate was between 20.8% (11/53) and 28.9% (13/45) for the 3 examiners. True negative rate (specificity) ranged from 86.8% (59/68) to 94.1% (64/68), and false positive rate was between 5.9 (4/68) and 13.2% (9/68). The fitted receiver operating characteristic area ranged from 0.83 to 0.95. CONCLUSIONS Using retinal SS-OCT biometer scans as a replacement of the dedicated macular SD-OCT for screening or diagnosing macular health would not be appropriate because of its low sensitivity. SS-OCT biometer may potentially fail to identify approximately one-fourth of patients who actually have the disease. Therefore, the final decision on macular health should be based on the gold standard SD-OCT scans. When full macular SD-OCT scans are not accessible, the limited retinal scan information from SS-OCT biometer may still provide useful insights into the macular health.
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Affiliation(s)
- Elizabeth Yeu
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - John P. Berdahl
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - Preeya K. Gupta
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - Michael Patterson
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
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Ahmed TM, Siddiqui MAR, Hussain B. Optical coherence tomography as a diagnostic intervention before cataract surgery-a review. Eye (Lond) 2023; 37:2176-2182. [PMID: 36517576 PMCID: PMC10366081 DOI: 10.1038/s41433-022-02320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/19/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to perform a systematic review of existing literature on OCT screening before cataract surgery. Available literature was evaluated and projections on how it could be applied to enhance postoperative outcomes of cataract surgery were summarised. The PubMed, Embase and Cochrane databases were searched for articles pertaining to preoperative OCT screening. Selected articles were qualitatively and quantitatively analysed. Across 9 studies, the addition of OCT macular screening resulted in preoperative detection of macular pathology in 13.7% of eyes that were determined to be normal on fundoscopic examination alone. The types of macular pathology most frequently detected through preoperative OCT screening were interface abnormalities followed by macular degeneration. Comparative analysis of SS-OCT biometer and SD-OCT found that SS-OCT had a sensitivity of 0.48-0.81 in the detection of macular pathology in eyes with pathology diagnosed by SD-OCT. OCT screening prior to cataract surgery results in the detection of occult macular pathology that may influence postoperative visual outcomes in approximately 1 in 10 eyes (13.7%). As a result, OCT screening should be considered in the routine preoperative workup for cataract surgery.
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Affiliation(s)
| | - M A Rehman Siddiqui
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan.
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Dos Santos BB, Ribeiro Junior MDLB, Garcia NP, Colombo Barboza GN, Colombo Barboza MN. OCT to identify macular changes not clinically detectable in elderly patients with cataract. J Cataract Refract Surg 2023; 49:711-715. [PMID: 36888557 DOI: 10.1097/j.jcrs.0000000000001179] [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: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To demonstrate the importance of optical coherence tomography (OCT) in identifying macular changes not detected at clinical examination preceding cataract surgery in patients older than 60 years. SETTING Hospital Oftalmológico Visão Laser, Santos, São Paulo, Brazil. DESING Prospective case series. METHODS Patients older than 60 years were selected for this cross-sectional prospective study conducted during preoperative examination for cataract surgery. Eyes with a previous diagnosis or clinical evidence of macular disease or with media opacity preventing OCT from being performed were excluded from the study. All the study participants underwent OCT and were then divided into 2 groups: patients with macular changes and patients without macular changes found on OCT. RESULTS Of 364 eyes screened (212 patients), 300 eyes (180 patients) were included in the study. OCT identified macular changes in 40 eyes (13.3%), with age-related macular degeneration being found in 13 eyes (4.3%), epiretinal membrane in 12 eyes (4%), intraretinal fluid in 12 eyes (4%), and macular hole in 3 eyes (1%). In the group with macular changes, the mean age was 74.4 ± 6.3 years compared with 70.4 ± 6.7 years for those without changes ( P < .001). CONCLUSIONS OCT proved an effective method for identifying macular diseases not detected at clinical evaluation before cataract surgery. Therefore, the relevance of performing OCT in these cases was confirmed and should be taken into consideration, particularly when evaluating patients older than 60 years.
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Hinnig RB, Martins LFS, Penha FM. Spectral domain oct for screening of macular diseases prior to multifocal intraocular lens implantation. Int J Retina Vitreous 2022; 8:77. [PMID: 36273199 PMCID: PMC9587646 DOI: 10.1186/s40942-022-00427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cataract surgery with multifocal IOLs could give patients good vision and great satisfaction, at the same time generating high expectations; therefore, its precise indication is essential if we are to reach our goal. The use of optical coherence tomography may be a valuable tool in the screening of macular diseases, which often cannot be detected in routine clinical examinations. This study evaluates the benefit of including spectral domain optical coherence tomography (SD-OCT) in routine preoperative cataract surgery protocols for better case selection in multifocal IOLs. Methods Observational and retrospective clinical study that includes patients with an indication for multifocal IOL implantation who underwent retinal fundus exam and SD-OCT examination between 2018 and 2019. The clinical examination with ophthalmoscopy and SD-OCT imaging results were evaluated to observe their influence on the final choice of the lens implanted lens in cataract surgery. Results 405 eyes from 207 patients with multifocal IOL indication were included. It was found that 220 (54.2%) of all indicated multifocal or trifocal IOLs were in fact implanted. The most important reason for not implanting the indicated IOL was financial, in 116 (59.46%) eyes. The second cause were retinal abnormalities detected by SD-OCT, 63 eyes (15.6%). Those abnormalities included dry age-related macular degeneration (AMD) (50.7%), neovascular AMD (3.1%), vitreomacular adhesion (11.1%), diabetic macular edema (3.1%), epiretinal membrane (ERM) (25.3%) and other macular abnormalities (6.3%). Of the 63 eyes with an abnormal SD-OCT result, 44 (69.8%) were also identified by fundus examination. Nineteen (30.2%) eyes had abnormalities detected only by SD-OCT imaging with a normal clinical exam. Conclusions Routine use of SD-OCT imaging may help diagnose pre-existing macular pathologies not identified by clinical exam, helping both physicians and patients choose the ideal IOL individually and has the potential to prevent unsatisfactory functional results.
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Affiliation(s)
- Rodrigo Braz Hinnig
- Fundacao Universidade Regional de Blumenau, Rua Antonio Veiga 140 ZIP, Blumenau, SC, 89030-903, Brazil
| | - Luiz Felipe Silva Martins
- Fundacao Universidade Regional de Blumenau, Rua Antonio Veiga 140 ZIP, Blumenau, SC, 89030-903, Brazil
| | - Fernando Marcondes Penha
- Fundacao Universidade Regional de Blumenau, Rua Antonio Veiga 140 ZIP, Blumenau, SC, 89030-903, Brazil. .,Botelho Hospital da Visão, Rua 2 de Setembro 2958, Blumenau, SC, 89052-504, Brazil.
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Marchese A, Bandello F. Current Challenges in the Postoperative Management of Cataract Surgery. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Delyfer M, Legout P, Le Goff M, Blaizeau M, Rougier M, Schweitzer C, Korobelnik J, Delcourt C. Prevalence of epiretinal membranes in the ageing population using retinal colour images and SD-OCT: the Alienor Study. Acta Ophthalmol 2020; 98:e830-e838. [PMID: 32304162 DOI: 10.1111/aos.14422] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyse and compare the prevalence of epiretinal membranes (ERMs) obtained using either standard retinal colour images or spectral-domain optical coherence tomography (SD-OCT) in a population-based setting of French elderly subjects. METHODS Six hundred twenty-four subjects of the Alienor cohort aged 75 years or older underwent both colour fundus imaging and SD-OCT examinations. The ERMs were graded from retinal images and SD-OCT macular scans in a masked fashion. On SD-OCT images, the early ERMs, mature contractile ERMs without foveal modifications and mature contractile ERMs with foveal alterations were distinguished. RESULTS 610 (97.8%) subjects had gradable SD-OCT examinations, and 511 (81.9%) had gradable fundus images in at least one eye. According to colour photographs, 11.6% of participants had definite ERMs. From SD-OCT images, 52.8% of the subjects had early ERMs, 7.4% had mature ERMs without foveal involvement, and 9.7% had mature ERMs with foveal alterations. Regardless of the imaging method used, the ERMs were more often observed in pseudophakic eyes than in phakic eyes. Comparison of ERM assessment using fundus photographs versus SD-OCT images demonstrated that the specificity of retinal colour images was good (>89.3%), whereas the sensitivity remained low even though it increased with ERM severity on SD-OCT images. CONCLUSIONS Spectral-domain optical coherence tomography (SD-OCT) examinations have high feasibility in this elderly population and are much more sensitive than standard colour images for ERM assessments, especially in the early stages of the disease. Our results further highlight the need to use SD-OCT instead of colour retinal photographs for the classification of ERMs in epidemiological studies.
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Affiliation(s)
- Marie‐Noëlle Delyfer
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
- Department of Ophthalmology Bordeaux University Hospital Bordeaux France
| | - Pierre Legout
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
- Department of Ophthalmology Bordeaux University Hospital Bordeaux France
| | - Mélanie Le Goff
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
| | - Marion Blaizeau
- Department of Ophthalmology Bordeaux University Hospital Bordeaux France
| | | | - Cédric Schweitzer
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
- Department of Ophthalmology Bordeaux University Hospital Bordeaux France
| | - Jean‐François Korobelnik
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
- Department of Ophthalmology Bordeaux University Hospital Bordeaux France
| | - Cécile Delcourt
- Inserm Bordeaux Population Health Research Center, team LEHA UMR 1219 Univ. Bordeaux Bordeaux France
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Leung EH, Gibbons A, Koch DD. Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens. Ophthalmology 2020; 127:859-865. [PMID: 32173111 PMCID: PMC7311225 DOI: 10.1016/j.ophtha.2020.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation. DESIGN Cost-effectiveness analysis. PARTICIPANTS A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery. METHODS The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs). RESULTS Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios. CONCLUSIONS A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.
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Affiliation(s)
- Ella H Leung
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
| | - Allister Gibbons
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Douglas D Koch
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Reply. Retina 2020; 40:e38-e39. [PMID: 32349099 DOI: 10.1097/iae.0000000000002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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