Evaluation of Anterior Segment Parameter Changes Using the Sirius after Uneventful Phacoemulsification

The evaluation of pupil diameter by using Sirius before and after phacoemulsification in healthy, diabetic and hypertension patients

BACKGROUND

Pupil size can affect the selection of the ablation region in refractive surgery and intraocular lens design in cataract surgery. Therefore, the evaluation of pupil diameter (PD), one of the anterior segment parameters, is an important component of ophthalmological examination.

MATERIAL AND METHODS

Seventy-one healthy patients, 64 patients with Systemic Hypertension (HT), and 65 patients with Diabetes Mellitus (DM) scheduled for phacoemulsification were included in the study. PD was measured before and one month after surgery using combined Scheimpflug-Placido disk topography (Sirius, CSO Inc.). Preoperative PD values of the groups were compared. The PD of the groups was compared in the 1st month after surgery. Then, preoperative and postoperative pupil diameter values of the groups were compared. The effect of the surgery on the change in pupil diameter (effect value) in the groups was also examined.

RESULTS

Pre- and postoperative PD only differed significantly between the healthy and DM groups (P = .039 and P = .045, respectively). PD decreased in all three groups after phacoemulsification. Pre-and postoperative PD differed significantly in the healthy group (4.78 ± 0.94 and 3.01 ± 0.48 mm, respectively, P < .05). Pre- and postoperative PD values also differed significantly (4.69 ± 0.84 and 2.95 ± 0.42 mm, respectively, P < .05). In the DM group, Pre- and postoperative PD also differed significantly in the DM group (4.38 ± 1.08 and 2.82 ± 0.43 mm, respectively, P < .05). The effect values of PD changes differed in the healthy, DM, and HT groups (1.95, 1.41, and 2.28, respectively). Phacoemulsification was observed to have a greater effect on PD change in HT patients.

CONCLUSIONS

PD was smaller in DM patients than in the other groups. PD decreased in all three groups after phacoemulsification. This change should be remembered when planning cataract surgery for chronic metabolic patients.

Pupil size differences between female and male patients after cataract surgery

PURPOSE

To evaluate the changes in pupil diameter in women and men after cataract surgery. The correlation of pupillary changes with the variables age and anterior chamber depth will be analyzed.

METHODS

The values of 109 randomized eyes who underwent cataract surgery were obtained and divided into two groups, 71 women and 38 men. Pupil diameter was measured preoperatively and 3-months postoperatively using the pupillometer software of the Topolyzer Vario (Wavelight Laser Technologie AG). Anterior chamber depth was obtained with Pentacam® (Oculus). Differences in pupillary diameters were investigated and correlations with age and anterior chamber depth were analyzed.

RESULTS

For mesopic pupils, the male group had greater reduction in their postoperative pupillary diameter, -0.56 mm (-12.4%), than the female group, -0.38 mm (-8.2%), P = 0.025. Photopic postoperative pupils reduced to a lesser extent, yet more in men than in women (-0.11mm [-4.5%] vs. -0.04 [-1.6%], P = 0.048). Weak significant negative correlation was found between photopic pupillary changes in women with age (r = -0.24, P = 0.041), and positive correlation for mesopic pupillary changes in men with age (r = +0.34, P = 0.039).

CONCLUSIONS

Patients experience pupil reduction after cataract surgery in general, but more in men than in women and for both photopic and mesopic lighting conditions. The differences are statistically significant and have moderate clinical relevance. Concerning pupillary changes, weak but opposite sign correlations were found between male/female gender and age. Trial registration number at ClinicalTrials.gov Identifier: NCT04286646.

The change of anterior chamber angle parameters after cataract surgery in diabetic patients

Purpose:

The purpose of this study is to investigate the change of anterior chamber angle morphology after cataract surgery in patients with type 2 diabetes mellitus (DM2) using anterior segment optical coherence tomography (AS-OCT).

Methods:

In this prospective and comparative study, 57 eyes of the patients with cataract were investigated. The patients were divided into two groups. The DM2 group included cataractous type 2 diabetic patients without diabetic retinopathy (n = 30) and the non-DM2 group included nondiabetic participants with cataract (n = 27). The AS-OCT examinations were performed at baseline and 1 month after the cataract surgery. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), angle-opening distance at 500 µm (AOD-500) and trabecular iris space area at 500 µm (TISA-500), and scleral spur angle (SSA) in temporal quadrant were analyzed.

Results:

The mean age, sex, and axial length values were similar in both groups (p > 0.05 for all). The CDVA was significantly improved in both groups (p < 0.001). The mean AOD-500, TISA-500, and SSA were increased and the mean IOP was decreased after cataract surgery in both groups (p < 0.001 for all). There were not any statistically significant intergroup differences in CDVA, IOP, and AS-OCT measurements between the DM2 and non-DM2 groups (p > 0.05 for all).

Conclusion:

Cataract surgery showed significant increases in mean anterior chamber angle parameters and reductions in IOP values in both diabetic and nondiabetic patients without intergroup significant differences. These results suggested the safety and effectiveness of cataract surgery, especially regarding anterior chamber angle parameters and so IOP changes.

Measurement of Force Required for Anterior Displacement of Intraocular Lenses and Its Defining Parameters

Intraocular stability during or after cataract and glaucoma filtration surgeries and vitreous surgery with a gas/silicone oil tamponade might differ among intraocular lenses (IOLs). We used six different one-piece IOL models and measured the force that displaced the IOLs from the vitreous cavity to anterior chamber as a measure of stability against the pressure gradient between the anterior and posterior IOL surfaces. We measured IOL hardness, haptics junction area, and posterior IOL bulge to identify what determines the IOL displacement force. The KOWA YP2.2 IOL (1.231 mN) required significantly greater force than the HOYA XY1 (0.416 mN, p = 0.0004), HOYA 255 (0.409 mN, p = 0.0003), Alcon SN60WF (0.507 mN, p = 0.0010), and Nidek NS60YG (0.778 mN, p = 0.0186) IOLs; J&J ZCB00V IOL (1.029 mN) required greater force than the HOYA XY1 (p = 0.0032) and HOYA 255 (p = 0.0029) IOLs; the Nidek NS60YG IOL required greater force than the HOYA 255 (p = 0.0468) IOL. The haptics junction area was correlated positively with the IOL displacement force (r = 0.8536, p = 0.0306); the correlations of the other parameters were non-significant. After adjusting for any confounding effects, the haptics junction area was correlated significantly with the IOL displacement force (p = 0.0394); the IOL hardness (p = 0.0573) and posterior IOL bulge (p = 0.0938) were not. The forces that displace IOLs anteriorly differed among one-piece soft-acrylic IOLs, and the optics/haptics junction area was the major force determinant.

Intraocular Pressure and Anterior Segment Morphometry Changes after Uneventful Phacoemulsification in Type 2 Diabetic and Nondiabetic Patients

Purpose

To compare intraocular pressure (IOP) and anterior segment (AS) morphometry changes after uneventful phacoemulsification between nonglaucomatous eyes with open-angles from patients with and without type 2 diabetes mellitus (DM) and determine which factors may predict greater IOP-lowering effect.

Methods

Forty-five diabetic (45 eyes) and 44 (44 eyes) age- and sex-matched non-DM patients with age-related cataract were enrolled in this prospective observational study. Goldmann applanation tonometry and AS Scheimpflug tomography (Pentacam® HR) were performed preoperatively and at 1- and 6-month follow-up. Linear regression analysis was performed to evaluate the clinical variables related to postoperative IOP changes at 6 months.

Results

There was a significant postoperative IOP reduction 6 months after surgery (p < 0.001) by an average of 2.9 ± 2.9 mmHg (15.5%) and 2.4 ± 2.8 mmHg (13.0%) in the DM group and non-DM groups (p = 0.410), respectively. All AS parameters (anterior chamber depth, volume, and angle) increased significantly postoperatively (p < 0.001). Multivariate linear regression analysis showed that higher preoperative IOP was significantly associated with IOP reduction at 6-month follow-up (p < 0.05).

Conclusion

Nonglaucomatous eyes with open-angles from both type 2 diabetic and nondiabetic patients experienced similar AS changes and IOP reductions following uneventful phacoemulsification, and this IOP-lowering effect was strongly correlated with preoperative IOP.