1
|
Sun Y, Chen T, Chen Z, Jia W, Liu Y, Zhao Z, Jiang Y. Application of sutureless corneal incision for patients with congenital ectopia lentis - Is it feasible, effective and safe? Int J Med Sci 2024; 21:1541-1551. [PMID: 38903929 PMCID: PMC11186419 DOI: 10.7150/ijms.93994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose: To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients. Methods: Patients with CEL who received phacoemulsification combined with intrascleral fixation of capsular hook (CH) and implantation of capsular tension ring (CTR) and in-the-bag intraocular lens (IOL) were included in this study. Results: A total of 68 eyes of 34 patients aged 18 years or younger were enrolled in this study. Incisions of 21 patients (34 eyes) did not require sutures while sutures were applied in 21 patients (34 eyes). Postoperative uncorrected distance visual acuity, best corrected distance visual acuity and intraocular pressure measurements were comparable on follow-up visits (P > 0.05). The magnitude of surgically induced astigmatism was significantly greater (P = 0.001) in the suture group (Median: 0.47; IQ: 1.63, 2.97) than in the sutureless group (Median: 0.88; IQ: 0.63, 1.35). No cases of endophthalmitis and retinal detachment were found postoperatively in either group, while suture-related complications were observed in the sutured group, including loose suture with discomfort in 5 (14.71%) eyes, loose suture with mucus infiltration in 3 (8.82%) eyes. In total, 22 sutures (64.71%) of 34 eyes required removal. Conclusions: Sutureless clear corneal incision in CEL patients can achieve satisfactory clinical results comparable to sutured wound closure in terms of the efficacy and safety. Advantages of this approach are the reduced risk of suture-related complications, no need for additional surgery under general anesthesia for suture removal, and less cost.
Collapse
Affiliation(s)
- Yang Sun
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Tianhui Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Zexu Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Wannan Jia
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yan Liu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Zhennan Zhao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| |
Collapse
|
2
|
Dan TT, Liu TX, Luo HY, Liao YL, Li ZZ. The comparison of corneal higher-order aberration and surgically induced astigmatism between the clear corneal incision and the limbus tunnel incision of posterior chamber implantable collamer lens implantation. BMC Ophthalmol 2024; 24:40. [PMID: 38273262 PMCID: PMC10809649 DOI: 10.1186/s12886-024-03311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND This study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation. METHODS A total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z40, coma coefficients (Coma RMS) Z3-1 Z31, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam. RESULTS One week after the operation, the corneal back Z31 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z40 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z31, Z40, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation. CONCLUSION Our data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation.
Collapse
Affiliation(s)
- Ting-Ting Dan
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Huichuan District, No. 149 Dalian Road, Zunyi, 563003, Guizhou Province, China
- Guizhou Eye Hospital, Zunyi, 563000, Guizhou Province, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563000, Guizhou Province, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563000, Guizhou Province, China
| | - Tai-Xiang Liu
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Huichuan District, No. 149 Dalian Road, Zunyi, 563003, Guizhou Province, China.
- Guizhou Eye Hospital, Zunyi, 563000, Guizhou Province, China.
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563000, Guizhou Province, China.
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563000, Guizhou Province, China.
| | - Hong-Yang Luo
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Huichuan District, No. 149 Dalian Road, Zunyi, 563003, Guizhou Province, China
| | - Yi-Lu Liao
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Huichuan District, No. 149 Dalian Road, Zunyi, 563003, Guizhou Province, China
| | - Zong-Ze Li
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Huichuan District, No. 149 Dalian Road, Zunyi, 563003, Guizhou Province, China
| |
Collapse
|
3
|
Nakatani S, Yamaguchi M, Iwamoto S. Descemet stripping automated endothelial keratoplasty via a frown incision. Jpn J Ophthalmol 2024; 68:50-56. [PMID: 38163816 DOI: 10.1007/s10384-023-01038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To assess the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) via a sclerocorneal frown incision. STUDY DESIGN Retrospective comparative study. METHODS The outcomes of Descement stripping endothelial keratoplasty (DSAEK) were retrospectively compared between 36 patients (36 eyes) who underwent surgery via a 3.8-mm frown incision (frown incision group) and 20 patients (20 eyes) who underwent surgery via a 4.6-mm straight incision (straight incision group). In all patients, an NS Endo-Inserter was used as the graft inserter and the incision for a frown incision was via the superior sclerocorneal site and for the straight incision via the temporal cornea. DSAEK was performed by the standard technique, except for the incision. At 1 year after surgery, the two groups were compared with respect to the visual acuity, decrease of corneal endothelial cell density, the severity of corneal astigmatism (diopters), the number of sutures for wound closure, and intraoperative/postoperative complications. RESULTS There was no significant difference between the two groups in terms of postoperative visual acuity, corneal astigmatism, and intraoperative/postoperative complications one year after surgery. On the other hand, the number of sutures required for wound closure was 1.13 ± 0.42 in the frown incision group, whereas in the straight incision group, it was 3.20 ± 0.40, showing a significant difference (P<0.001). In addition, there was no decreased corneal endothelial cell density associated with the reduction in incision width. CONCLUSIONS A sclerocorneal frown incision is useful for performing DSAEK with an NS Endo-Inserter as it does not affect endothelial cell loss despite its short incision width.
Collapse
Affiliation(s)
- Satoru Nakatani
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Satoshi Iwamoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8431, Japan
| |
Collapse
|
4
|
Ichioka S, Ishida A, Takayanagi Y, Manabe K, Matsuo M, Tanito M, Tanito M. Roles of Toric intraocular Lens implantation on visual acuity and astigmatism in glaucomatous eyes treated with iStent and cataract surgery. BMC Ophthalmol 2022; 22:487. [PMCID: PMC9749338 DOI: 10.1186/s12886-022-02707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background To assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and minimally invasive glaucoma surgery (MIGS), visual and refractive outcomes were compared between eyes implanted with non-toric and toric IOLs during iStent triple procedures. Methods In this retrospective study, open angle glaucoma eyes with preexisting corneal astigmatism of -1.5 diopter (D) or more and implanted with non-toric (n = 9) or toric (n = 9) IOLs were included. The main outcome measures were the intergroup difference in the uncorrected visual acuity (UCVA) and refractive astigmatism at 3 months postoperatively. Results Preoperatively, the logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism were equivalent between the groups. Postoperatively, the logMAR UCVA (non-toric, 0.45 ± 0.31; toric, 0.14 ± 0.15; P = 0.021) was significantly better and the refractive astigmatism (non-toric, -2.03 ± 0.63 D; toric, -0.67 ± 0.53 D; P = 0.0014) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (-0.21, P = 0.020) and refractive astigmatism (+ 1.72 D, P = 0.0039). Vector analyses showed the postoperative centroid magnitude and confidence eclipses of refractive astigmatism was less in the toric group (0.47 D at 173°±0.73D) than the non-toric group (1.10 D at 2°±1.91D). Postoperatively, 78% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 11% in the non-toric group. Surgically induced astigmatism (non-toric, 0.18 D at 65°; toric, 0.29 D at 137°) did not differ between groups. Conclusion Use of toric IOLs is a reasonable option for better visual outcomes when the combined cataract and iStent surgery is performed in glaucomatous eyes with corneal astigmatism.
Collapse
Affiliation(s)
- Sho Ichioka
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Akiko Ishida
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Yuji Takayanagi
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Kaoru Manabe
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Masato Matsuo
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Masaki Tanito
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| | - Masaki Tanito
- grid.411621.10000 0000 8661 1590Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501 Shimane Japan
| |
Collapse
|
5
|
Rathi M, Dahiya M, Dabas R, Rustagi IM, Sachdeva S, Dhania S. Re-inventing the straight incision with a single central suture in manual small-incision cataract surgery to minimize surgically induced astigmatism. Indian J Ophthalmol 2022; 70:3875-3878. [PMID: 36308118 PMCID: PMC9907257 DOI: 10.4103/ijo.ijo_1533_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose To calculate the surgically induced astigmatism (SIA) in MSICS through a superiorly placed straight scleral incision closed with a single, central, perpendicular 10-0 polyamide suture and to document any suture-related complaints and complications. Methods A retrospective, hospital-based study was carried out in 50 cases of uncomplicated senile cataract (>50 year) with nuclear sclerosis ≥ grade 4, "with the rule" astigmatism who underwent MSICS through a superior, straight incision with a single, central, perpendicular 10-0 nylon suture. Patients with "against the rule" astigmatism, keratoconus, pre-existing corneal opacity, astigmatism >2D, distorted or oblique mires, and previous ocular surgeries and unwilling to participate were excluded. Results The mean age of the patients was 64.81 + 2.824 years, with a male: female ratio of 1.38:1. The mean SIA at day 7, week 6, and 12 weeks was 0.539 + 0.118, 0.529 + 0.134, and 0.524 + 0.129, respectively. Only 6 patients (12%) complained of foreign body sensation. No patient developed any suture-related complications. Conclusion SIA is significantly reduced in straight incision by applying a single, central, and perpendicular 10-0 polyamide suture, as compared to a straight incision without a suture.
Collapse
Affiliation(s)
- Manisha Rathi
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Monika Dahiya
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Ruchi Dabas
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Inder Mohan Rustagi
- Department of Ophthalmology, World College of Medical Sciences and Research, Jhajjar, Haryana, India,Correspondence to: Dr. Inder Mohan Rustagi, World College of Medical Sciences and Research, Jhajjar, Haryana, India. E-mail:
| | - Sumit Sachdeva
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Sweety Dhania
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| |
Collapse
|
6
|
Nada M, Rohit D, Singh SV, Khurana AK, Lochab S, Kharolia A. Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3854-3857. [PMID: 36308112 PMCID: PMC9907302 DOI: 10.4103/ijo.ijo_1618_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V-shaped, chevron) of scleral incisions for cataract surgery on corneal curvature. Methods The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian-whether superior or temporal-and then patients of these two groups were randomized for frown and V-shaped incision; in this way, four groups of 50 patients each were formed. Follow-up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow-up, post-operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student's t-test, Chi-squared test, and the Pearson correlation coefficient. Results In all the four groups, the difference of preoperative astigmatism and surgically-induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8. Conclusion Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.
Collapse
Affiliation(s)
- Manisha Nada
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India,Correspondence to: Prof. Manisha Nada, 22/9J, Medical Campus, PGIMS, Rohtak, Haryana, India. E-mail:
| | - D Rohit
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India
| | - SV Singh
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India
| | - AK Khurana
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India
| | - Sakshi Lochab
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India
| | - Anjali Kharolia
- Regional Institute of Ophthalmology, PGIMS, Rohtak, Haryana, India
| |
Collapse
|
7
|
Goel R, Sontakke R, Shah S, Nagpal V, Kumar S, Koli O, Ojha S, Saini S, Arya D. Correction of pre-existing astigmatism by on-axis incision size modulation in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3858-3863. [PMID: 36308113 PMCID: PMC9907282 DOI: 10.4103/ijo.ijo_1603_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To study the effect of wound size modulation on pre-existing astigmatism by on-axis placement of incision in manual small-incision cataract surgery (MSICS). Methods In this prospective interventional study conducted at a tertiary care centre, 40 eyes of 40 consecutive senile cataract patients with 1.00-3.00 D corneal astigmatism were enrolled for the study. MSICS by modified Blumenthal's technique was performed through 6.0, 6.5, and 7.0 mm on-axis incision in 1.0-1.49 D (group A), 1.50-1.99 D (group B), and 2.00-3.00 D (group C) astigmatism, respectively. Surgically induced astigmatism (SIA) was calculated by vector analysis and double angle plots (DAP) at 12 weeks postoperatively. Results There were 22 males and 18 females with mean age of 58.12 ± 1.18 years. The mean SIA at 12 weeks was 0.85 ± 0.28 D in group A (17 eyes), 1.32 ± 0.65 D in group B (10 eyes), and 1.91 ± 0.69 D in group C (13 eyes). The overall median uncorrected visual acuity was 0.18 (IQR = 0 to 0.2). The mean astigmatism decreased from 1.95 ± 0.74 D to 1.04 + 0.57 D (P = 0.00) in superior incision and from 1.70 + 0.50 D to 0.92 ± 0.45 D (P = 0.00) in temporal incision group with central shift of centroid in all cases. Conclusion The customization of on-axis external incision size can be used to manage pre-existing corneal astigmatism of less than 3.00 D using both temporal and superior incisions effectively.
Collapse
Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India,Correspondence to: Dr. Ruchi Goel, Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi - 110 002, India. E-mail:
| | - Ruchita Sontakke
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Vaibhav Nagpal
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Sushil Kumar
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Omeshwer Koli
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Shweta Ojha
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Swati Saini
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| | - Deepanjali Arya
- Department of Ophthalmology, Guru Nanak Eye Centre and Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
8
|
Pattanayak S, Patra SHS, Nanda AK, Subudhi P. Stabilization of refraction and timing of spectacle prescription following manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3938-3941. [PMID: 36308131 PMCID: PMC9907244 DOI: 10.4103/ijo.ijo_95_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To determine the stabilization of refraction at 2 weeks following MSICS by comparing the difference in spherical, cylindrical component and also spherical equivalent of refraction of 2 weeks follow-up with that of 6 weeks following surgery. Methods The difference of spherical, cylindrical component and also spherical equivalent of refraction at 2 weeks and 6 weeks follow-up of 194 eyes that underwent uncomplicated MSICS with implantation of PMMA IOL conducted by a single experienced surgeon were compared to find out the amount of change and its significance was statistically tested by Wilcoxon-Signed Rank Test. Results The difference in spherical power (0.04 ± 0.30), cylinder power (0.03 ± 0.40), and spherical equivalent (0.06 ± 0.34) were very small and not significant statistically (P-value ≤0.05). Conclusion Necessary spectacle correction can safely be prescribed after 2 weeks following MSICS as subjective refraction stabilizes by that time without undergoing significant change. However, our observation was applicable in patients who had an uneventful cataract surgery without any risk factor, which can delay wound healing or cause poor visual outcome.
Collapse
Affiliation(s)
- Sabyasachi Pattanayak
- Senior Consultant Ophthalmologist, RGH Rourkela, Odisha, India,Correspondence to: Dr. Sabyasachi Pattanayak, 30 A, Bima Vihar, Sector 6, CDA, Cuttack, Odisha - 753 014, India. E-mail:
| | - S Hari Sankar Patra
- Senior Consultant Ophthalmologist, SSB Eye Hospital, Bhubaneswar, Odisha, India
| | | | | |
Collapse
|
9
|
Sinha A, Gurnani B, Kaur K, Niharika J, Bejjenki P, Venkatesh D, Morya AK. Commentary: Surgically induced astigmatism in manual small-incision cataract surgery incision types: Is the correlation linear? Indian J Ophthalmol 2022; 70:3869-3870. [PMID: 36308116 PMCID: PMC9907283 DOI: 10.4103/ijo.ijo_2235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Bharat Gurnani
- Cataract, Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - J Niharika
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Priyanka Bejjenki
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Dharavath Venkatesh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India,Correspondence to: Dr. Arvind Kumar Morya, Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana, India. E-mail:
| |
Collapse
|
10
|
Soumya HV, Yadav P, Prabhakar SK. Study of changes in pre-existing against-the-rule astigmatism after temporal manual small-incision cataract surgery using frown, straight, and smile incisions. Indian J Ophthalmol 2022; 70:3871-3874. [PMID: 36308117 PMCID: PMC9907248 DOI: 10.4103/ijo.ijo_1197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To assess the change in the amount of astigmatism caused by frown, straight, and smile incision in patients with pre-existing against-the-rule (ATR) astigmatism of more than and equal to 1 diopter. Methods This is a prospective, comparative study conducted over 18 months on 60 patients. Twenty patients were allocated to each incision using simple random sampling. Demographic details, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment evaluation, and A-scan were done. An average of three measurements of K horizontal (Khavg), K vertical (Kvavg), and difference between the two (Khavg - Kvavg) were taken using manual keratometry. All surgeries were performed by a single surgeon. All the data analyses were performed by using IBM Statistical Package for the Social Sciences (SPSS) version 20 software. Frequency distribution and cross tabulation were performed to prepare the tables. Results In frown incision, Khavg - Kvavg was significantly decreased on day 45 from the preoperative value (P < 0.001), followed by straight incision (P < 0.001), and smile incision (P < 0.001). Maximum decrease was observed in frown incision (49.15%) followed by straight (37.75%) and smile (28.57%) incisions. Conclusion Our results are consistent with reduction of pre-existing ATR astigmatism with temporal incisions, and frown incision seems to be the best approach.
Collapse
Affiliation(s)
- H V Soumya
- Department of Ophthalmology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Prashansa Yadav
- Department of Ophthalmology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India,Correspondence to: Dr. Prashansa Yadav, 192 W, Madhuri Kunj, Shivapuram East Basharatpur, Gorakhpur - 273 003, Uttar Pradesh, India. E-mail:
| | - S K Prabhakar
- Department of Ophthalmology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| |
Collapse
|
11
|
Rathi M, Dabas R, Verma R, Rustagi IM, Mathur S, Dhania S. Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3865-3868. [PMID: 36308115 PMCID: PMC9907301 DOI: 10.4103/ijo.ijo_1589_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose : The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS). Methods A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared. Results The mean age of all the patients was 66.22 ± 8.05 years. BCVA of at least 6/18 or better at 12 weeks post-operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D ± 0.22D, in Group S was 0.97D ± 0.29D, and in Group F was 0.575D ± 0.25D. Conclusion SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.
Collapse
Affiliation(s)
- Manisha Rathi
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Ruchi Dabas
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Ritesh Verma
- Department of Ophthalmology, DMC, Ludhiana, Punjab, India
| | - Inder M Rustagi
- Department of Ophthalmology, World College of Medical Sciences and Research, Jhajjar, Haryana, India,Correspondence to: Dr. Inder M Rustagi, World College of Medical Sciences and Research, Jhajjar, Haryana, India. E-mail:
| | - Satanshu Mathur
- Director, Hi-Tech Eye Institute and Laser Centre, Kashipur, Uttarakhand, India
| | - Sweety Dhania
- Regional Institute of Ophthalmology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| |
Collapse
|
12
|
Bali J, Bali O, Sahu A, Boramani J, Senthil T, Deori N. State of the nation survey on cataract surgery in India. Indian J Ophthalmol 2022; 70:3812-3817. [PMID: 36308101 PMCID: PMC9907269 DOI: 10.4103/ijo.ijo_1151_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To study the knowledge, attitudes, and practices of the ophthalmologists in India regarding cataract extraction practices. Methods A prospective, online, descriptive study was conducted from January 2022 to April 2022 using a self-developed validated questionnaire attached which was administered through a generated link. Results The mean age of these 153 respondents was 47.02 (SD = 11.53) years with a male preponderance (70.59%). The majority (52.9%) had completed a fellowship after their post-graduation, and 56.20% provided sub-specialty services. Comprehensive ophthalmology (69.93%) and anterior segment (50.32%) practice were the most popular. Although 76.47% of respondents used a mix of techniques, 11.11% surgeons used only phaco-emulsification and 9.8% used only manual small-incision cataract surgery (MSICS) as the lone cataract treatment modality. Roughly 38% felt that outcomes were comparable for phaco-emulsification and MSICS, whereas about 44% opined that the outcomes of phaco-emulsification were better. MSICS outcomes were reported to be better by approximately 15%. The frown incision (53.59%), the straight incision (19.60%), and the straight incision with back cuts (10.45%) were popular. The majority (71.24%) of the respondents were willing to train fellow ophthalmologists and youngsters in MSICS. Standalone practices and family practices (42.48%), private eye institutes (10.45%), medical colleges (12.41%), and government non-teaching hospitals (11.11%) were the major service providers. 4% were working in rural hinterland. Conclusion The majority of the surgeons use a mix of cataract extraction operative techniques. A large, willing talent pool of manual small-incision cataract surgeons exists. India can be a global hub for MSICS delivery and training.
Collapse
Affiliation(s)
- Jatinder Bali
- Department of Ophthalmology, Narela Polyclinic, North Delhi Municipal Corporation, Delhi, India,Correspondence to: Dr. Jatinder Bali, 55-D, Third Floor, DDA FLATS, Kalidas Road, Gulabibagh, Delhi - 110 007, India. E-mail:
| | - Ojasvini Bali
- Department of Medicine, Maulana Azad Medical College, Delhi, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
| | - Jagannath Boramani
- Department of Ophthalmology, Surya Netralaya, Navi Mumbai, Maharashtra, India,MGM’s New Bombay Hospital, Navi Mumbai, Maharashtra, India
| | - Tamilarasan Senthil
- Department of Ophthalmology, Pranav Eye Care Centre, Chennai, Tamil Nadu, India
| | - Nilutparna Deori
- Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| |
Collapse
|
13
|
Pattanayak S, Mathur S, Nanda AK, Subudhi BNR. Postoperative astigmatic considerations in manual small-incision cataract surgery - A review. Indian J Ophthalmol 2022; 70:3785-3790. [PMID: 36308097 PMCID: PMC9907315 DOI: 10.4103/ijo.ijo_1627_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract remains a major cause of visual impairment worldwide including in India. The sutureless manual small-incision cataract surgery (MSICS) as an alternative to phacoemulsification, gives equivalent visual results at lower expenses. Still the procedure is often discredited for higher astigmatism due to the larger size of the incision. High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. However, there are enough studies in the literature to prove that surgically induced astigmatism (SIA) can be minimized and also eliminated by adopting appropriate wound construction techniques during surgery. Even pre-existing astigmatism if any can be neutralized by changing wound architecture during surgery. Here, we review the various techniques of scleral tunnel construction described in the literature to care for postoperative astigmatism in MSICS.
Collapse
Affiliation(s)
- Sabyasachi Pattanayak
- Senior Consultant Ophthalmologist, Department of Ophthalmology, RGH, Rourkela, Odisha, India,Correspondence to: Dr. Sabyasachi Pattanayak, Senior Consultant Ophthalmologist, RGH, Rourkela - 769 004, Odisha, India. E-mail:
| | - Satanshu Mathur
- Department of Ophthalmology, Director, Hitech Hospital, Kashipur, Uttarakhand, India
| | - Ashok K Nanda
- Department of Ophthalmology, Director, Kar Vision Eye Hospital, Bhubaneswar, Odisha, India
| | | |
Collapse
|
14
|
Shekhar M, Mishra C, Prasad S, Koshy TA. Commentary: Modulation of the incision size for the correction of astigmatism in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3863-3864. [PMID: 36308114 PMCID: PMC9907236 DOI: 10.4103/ijo.ijo_2122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Madhu Shekhar
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India,Correspondence to: Dr. Madhu Shekhar, Chief, Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai - 625 020, Tamil Nadu, India. E-mail:
| | - Chitaranjan Mishra
- Department of Vitreo-Retinal Services, Trilochan Netralaya, Sambalpur, Odisha, India
| | - Senthil Prasad
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Tony Alex Koshy
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| |
Collapse
|
15
|
Gupta SN, Goel R, Kumar S. Factors affecting surgically induced astigmatism in manual small-incision cataract surgery. Indian J Ophthalmol 2022; 70:3779-3784. [PMID: 36308096 PMCID: PMC9907311 DOI: 10.4103/ijo.ijo_1034_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract is the most common cause of avoidable blindness in the world. While cataract surgery is continually evolving, manual small-incision cataract surgery (MSICS) still remains highly relevant, especially with the threat of the coronavirus disease 2019 (COVID-19) still looming large over the world. MSICS today has a renewed significance, since it does not involve the use of any advanced machinery and relies mainly on easily sterilizable instruments, thereby making it a safe and inexpensive option. A self-sealing valvular tunnel entry forms the basis of MSICS, and proper positioning and construction of the tunnel is imperative to the success of the surgery. With more and more people demanding spectacle independence after surgery, it becomes important to have a thorough understanding of the factors that may influence surgically induced astigmatism in MSICS. These include the incision location, size and shape, configuration of the sclero-corneal tunnel, pre-existing ocular pathology, role of sutures, amongst others. With proper knowledge, many of these factors can be modulated to achieve best results.
Collapse
Affiliation(s)
- Smriti Nagpal Gupta
- Consultant Ophthalmologist, Pixel Eye Care, New Delhi, India,Correspondence to: Dr. Smriti Nagpal Gupta, Pixel Eye Care, Kalkaji, New Delhi, India. E-mail:
| | - Ruchi Goel
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Sushil Kumar
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
16
|
Kumar N, Kaur G, Chadha C, Sethi N, Gupta NR, Gauri S. Visual outcome after manual small-incision cataract surgery by viscoexpression technique. Indian J Ophthalmol 2022; 70:3933-3937. [PMID: 36308130 PMCID: PMC9907260 DOI: 10.4103/ijo.ijo_1582_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9-12 million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. Methods This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Results Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. Conclusion This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.
Collapse
Affiliation(s)
- Narinder Kumar
- Department of Ophthalmology, Consultant Ophthalmologist, Guru Nanak Dev Super Speciality Hospital, Tarn Tarn, Punjab, India
| | - Gagandeep Kaur
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India,Correspondence to: Dr. Gagandeep Kaur, Assistant Professor Department of Ophthalmology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab - 151 204, India. E-mail:
| | - Charu Chadha
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Neha Sethi
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - NR Gupta
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Sugandhi Gauri
- Department of Ophthalmology, Consultant Ophthalmologist, Guru Nanak Dev Super Speciality Hospital, Tarn Tarn, Punjab, India
| |
Collapse
|
17
|
Gurnani B, Mishra D, Kaur K, Heda A, Sahu A. Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review. Indian J Ophthalmol 2022; 70:3773-3778. [PMID: 36308095 PMCID: PMC9907246 DOI: 10.4103/ijo.ijo_1567_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.
Collapse
Affiliation(s)
- Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Amritsar, Punjab, India
| | - Deepak Mishra
- Associate Professor, Department of Ophthalmology, Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India,Correspondence to: Dr. Deepak Mishra, Associate Professor, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail:
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus Services, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Aarti Heda
- Consultant Glaucoma, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
| |
Collapse
|
18
|
Comparison of effectiveness and complications in trabeculotomy with phacoemulsification between ab externo and ab interno using a spatula-shaped microhook. Sci Rep 2021; 11:17259. [PMID: 34446777 PMCID: PMC8390659 DOI: 10.1038/s41598-021-96701-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
To compare the short-term surgical effectiveness and safety profile of trabeculotomy ab externo and ab interno with microhook in terms of the recovery of visual acuity. A retrospective chart review was performed on patients who underwent trabeculotomy combined with phacoemulsification and lens implantation at Asahi General Hospital, with 6 months of follow-up. The patients treated by trabeculotomy were classified into two groups depending on the surgical procedures: ab interno with Tanito microhook (TMH) and ab externo with rigid probe trabeculotome (LOT). The demographics, preoperative and postoperative intraocular pressure (IOP), number of medications (Med), best-corrected visual acuity (BCVA), surgical-induced astigmatism (SIA), and postoperative complications were analyzed at pre-operation, and 1 week and 1–6 months post-operation. Fifty-two eyes of 38 Japanese patients underwent TMH and 42 eyes of 32 patients underwent LOT. The decreases in IOP and Med from the baseline were significant at all time points in both groups (p < 0.001), but there were no significant differences between the two groups. BCVA improved significantly in TMH and LOT after the operation (p < 0.001). BCVA and SIA significantly improved, mostly at 1 week in TMH, compared with LOT (p = 0.02 and 0.003). Hyphema and IOP spike exceeding 30 mmHg (spike) occurred in 11% and 6% of participants in TMH, and 33% and 26% of participants in LOT, respectively. Hyphema and IOP spike occurred more frequently in the LOT than in the TMH group (p = 0.01 and 0.005). Ab interno trabeculotomy showed similar IOP-lowering effects as ab externo, but had less postoperative complications.
Collapse
|
19
|
Rajappa SA, Bhatt H. Minimizing surgically induced astigmatism in non-phaco manual small incision cataract surgery by U-shaped modification of scleral incision. Indian J Ophthalmol 2020; 68:2107-2110. [PMID: 32971618 PMCID: PMC7727977 DOI: 10.4103/ijo.ijo_1696_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the amount and type of surgically induced astigmatism (SIA) in manual small incision cataract surgery (SICS) with a 4.5 mm U-shaped scleral incision. Methods: A prospective cross-sectional study was done on a total of 61 patients above 40 years of age with senile cataract. All patients underwent complete examination including preoperative uncorrected visual acuity (UCVA), refraction, best-corrected visual acuity (BCVA), and keratometry using a manual keratometer (Bausch and Lomb). All 61 patients underwent manual SICS with a 4.5 mm U-shaped scleral incision within the astigmatic neutral incisional funnel. Patients were thoroughly examined on immediate postoperative day 1 and findings of UCVA, BCVA, refraction, and keratometry were noted at the end of the 1st week, 4th week, and 6th week follow-up visits. SIA was calculated for all the follow-ups using the SIA calculator version 2.1, a free software program. The changes in the amount and type of postoperative SIA were tested for statistical significance using Fischer's exact test. Variance was tested using intraclass score effect. The threshold for statistical significance was set to P < 0.001. Results: Postoperatively, the average SIA was 0.43 ± 0.13 D at the end of 1st week, 0.29 ± 0.20 D at the end of the 4th week, and remained the same 0.29 ± 0.21 D at the end of 6th week. The type of astigmatism shifted more towards against-the-rule (ATR) type in 45.9% of cases during the final postoperative follow-up. Conclusion: In our study, we conclude that the incision within the funnel of astigmatic neutralization is one of the major determinants of SIA in manual SICS. We were able to achieve phacocomparable SIA in our study mainly because of our type of incision.
Collapse
Affiliation(s)
- Suresha Anepla Rajappa
- Department of Ophthalmology, Bapuji Eye Hospital, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India
| | - Hima Bhatt
- Department of Ophthalmology, Bapuji Eye Hospital, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India
| |
Collapse
|
20
|
Abstract
BACKGROUND Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis. SDA probably constitutes less than 3% of all amblyopia cases, although precise estimates of prevalence are unknown. In high-income countries, most people present under the age of one year; in low- to middle-income countries, people are likely to be older at the time of presentation. The mainstay of treatment is correction of the obstruction (e.g., removal of the cataract) and then occlusion of the better-seeing eye, but regimens vary, can be difficult to execute, and traditionally are believed to lead to disappointing results. OBJECTIVES To evaluate the effectiveness of occlusion therapy for SDA in an attempt to establish realistic treatment outcomes and to examine evidence of any dose-response effect and assess the effect of the duration, severity, and causative factor on the size and direction of the treatment effect. SEARCH METHODS We searched CENTRAL (2018, Issue 12), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; and five other databases. We used no date or language restrictions in the electronic searches. We last searched the databases on 12 December 2018. SELECTION CRITERIA We planned to include randomized controlled trials (RCTs) and controlled clinical trials of participants with unilateral SDA with visual acuity worse than 0.2 LogMAR or equivalent. We specified no restrictions for inclusion based upon age, gender, ethnicity, comorbidities, medication use, or the number of participants. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We identified no trials that met the inclusion criteria specified in the protocol for this review. AUTHORS' CONCLUSIONS We found no evidence from RCTs or quasi-randomized trials on the effectiveness of any treatment for SDA. RCTs are needed in order to evaluate the safety and effectiveness of occlusion, duration of treatment, level of vision that can be realistically achieved, effects of age at onset and magnitude of visual defect, optimum occlusion regimen, and factors associated with satisfactory and unsatisfactory outcomes with the use of various interventions for SDA.
Collapse
Affiliation(s)
- Aileen Antonio‐Santos
- Hauenstein Neurosciences, Mercy Health Saint Mary's245 Cherry Street SESuite 204Grand RapidsMichiganUSA49503
| | - S Swaroop Vedula
- Johns Hopkins University3400 N. Charles StreetBaltimoreMarylandUSA21218
| | - Sarah R Hatt
- Mayo ClinicDepartment of OphthalmologyGuggenheim 9200 1st St. SWRochesterMinnesotaUSA55905
| | - Christine Powell
- Royal Victoria InfirmaryDepartment of OphthalmologyClaremont WingQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | | |
Collapse
|
21
|
Villegas EA, Alcón E, Rubio E, Marín JM, Artal P. One-year follow-up of changes in refraction and aberrations induced by corneal incision. PLoS One 2019; 14:e0224823. [PMID: 31738783 PMCID: PMC6860439 DOI: 10.1371/journal.pone.0224823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/22/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the surgically induced changes in refraction (sphere and astigmatism) and higher order aberrations by corneal incision for one year. Setting University Hospital “Virgen de la Arrixaca”, Murcia, Spain. Design Retrospective interventional case series. Methods Corneal power, astigmatism and higher order aberrations (HOA) were calculated from corneal topography measured in 27 eyes prior to surgery and at 2 weeks, 1, 2, 3 and 6 months and 1 year following cataract surgery with 3.2-mm corneal incision. At every stage, optical changes were calculated as the difference between pre- and post-surgery data (in each follow-up) using the formulas of obliquely crossed cylinders for the refraction and Zernikes coefficients for HOA. Results At 2 weeks after surgery the mean corneal values of induced sphere, cylinder and the root mean square (RMS) of HOA were +0.54±0.27 D, -0.77±0.32 D and 0.15 microns respectively. These parameters decreased significantly (p-values between 0 and 0.01) at 3 months to +0.33±0.27 D sphere, -0.50±0.24 D cylinder and 0.10±0.05 microns HOA and were stable at the next follow-ups. Induced spherical equivalent was around zero at all visits. The changes in HOA were mainly due to trefoil aberration. Conclusions Linear corneal incisions do not change the spherical power but can induce significant values of astigmatism and trefoil aberration in the cornea. However, these changes revert fully or partially to preoperative values by the third month after surgery and remain stable with time.
Collapse
Affiliation(s)
- Eloy A. Villegas
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
- * E-mail:
| | - Encarna Alcón
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
| | - Elena Rubio
- Servicio de Oftalmología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - José María Marín
- Servicio de Oftalmología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Pablo Artal
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
| |
Collapse
|
22
|
Sharma U, Sharma B, Kumar K, Kumar S. Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery. Indian J Ophthalmol 2019; 67:1073-1078. [PMID: 31238414 PMCID: PMC6611319 DOI: 10.4103/ijo.ijo_1261_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3-4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.
Collapse
Affiliation(s)
- Unnati Sharma
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | - Bhavana Sharma
- Department of Ophthalmology, Gandhi Medical College, Bhopal; Department of Ophthalmology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Kavita Kumar
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | - Salil Kumar
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| |
Collapse
|
23
|
Tanito M, Matsuzaki Y, Ikeda Y, Fujihara E. Comparison of surgically induced astigmatism following different glaucoma operations. Clin Ophthalmol 2017; 11:2113-2120. [PMID: 29238159 PMCID: PMC5713703 DOI: 10.2147/opth.s152612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To compare surgically induced astigmatism (SIA) among glaucomatous eyes treated with trabeculectomy (LEC), EX-PRESS® shunt (EXP), ab externo trabeculotomy (exLOT), or microhook ab interno trabeculotomy (μLOT). Subjects and methods Eighty right eyes of 80 subjects who underwent LEC (n=20), EXP (n=20), exLOT (n=20), or μLOT (n=20) were included. The dataset including the best-corrected visual acuity (BCVA), intraocular pressure (IOP), and keratometry recordings preoperatively and 3 months postoperatively was collected by chart review. The means of the vector magnitude, vector meridian, and arithmetic magnitude of the preoperative and postoperative astigmatism and SIA were calculated. The correlations among the SIA magnitude, postoperative BCVA, and IOP were assessed. Results The mean astigmatic arithmetic magnitudes did not differ significantly (P=0.0732) preoperatively among the four groups, but the magnitude was significantly (P=0.0002) greater in the LEC group than the other groups postoperatively. The mean SIA vectors were calculated to be 1.01 D at 56°, 0.62 D at 74°, 0.23 D at 112°, and 0.12 D at 97° for the LEC, EXP, exLOT, and μLOT groups, respectively. The mean SIA arithmetic magnitudes were significantly (P<0.0001) greater in the LEC group than the other groups. Three months postoperatively, the SIA magnitude was correlated positively with the logarithm of the minimum angle of resolution (logMAR) BCVA (r=0.3538) and negatively with the IOP (r=−0.3265); the logMAR BCVA was correlated negatively with the IOP (r=−0.3105). Conclusion EXP, exLOT, and μLOT induce less corneal astigmatism than LEC in the early postoperative period.
Collapse
Affiliation(s)
- Masaki Tanito
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
| | - Yukari Matsuzaki
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
| | - Yoshifumi Ikeda
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
| | - Etsuko Fujihara
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
| |
Collapse
|
24
|
Postoperative Corneal and Surgically Induced Astigmatism following Superior Approach Manual Small Incision Cataract Surgery in Patients with Preoperative Against-the-Rule Astigmatism. J Ophthalmol 2016; 2016:9489036. [PMID: 28116142 PMCID: PMC5225371 DOI: 10.1155/2016/9489036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to report postoperative corneal and surgically induced astigmatism (SIA) in patients with preoperative against-the-rule (ATR) astigmatism who underwent superior approach manual small incision cataract surgery (MSICS). 58 eyes of 58 cataract patients with preoperative ATR astigmatism were involved in this study. All patients had operable cataracts and underwent superior approach MSICS. Keratometric (K) readings were taken prior to surgery and at 12 weeks after surgery. Centroid values of SIA, preoperative astigmatism, and postoperative astigmatism were calculated using Cartesian coordinates based analysis. Wilcoxon signed rank test was used to compute statistical significance between mean preoperative and postoperative corneal astigmatism. Cohen's d was used as effect size measure. Centroid values of 1.42 D × 179, 2.48 D × 0, and 1.07 D × 1 were recorded, respectively, for preoperative astigmatism, postoperative astigmatism, and SIA. Wilcoxon signed rank test indicated that mean ± SD postoperative corneal astigmatism (2.80 ± 1.40 D) was statistically significantly greater than preoperative corneal astigmatism (1.49 ± 1.34 D), Z = −6.263, p < 0.0001. A high Cohen's d of 1.32 was found. Our results suggest statistical and clinically significant greater postoperative corneal astigmatism than preoperative corneal astigmatism for ATR astigmatism cataract patients who underwent superior approach MSICS.
Collapse
|
25
|
Amedo AO, Amoah K, Koomson NY, Ben Kumah D, Osae EA. Assessment of corneal astigmatism following frown and straight incision forms in sutureless manual small incision cataract surgery. CLINICAL OPTOMETRY 2016; 8:47-52. [PMID: 30214348 PMCID: PMC6095366 DOI: 10.2147/opto.s98920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To investigate which of two tunnel incision forms (frown versus straight) in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through >12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients' cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P<0.05); frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P>0.05). Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher's exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P>0.05).
Collapse
Affiliation(s)
- Angela Ofeibea Amedo
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
| | - Kwadwo Amoah
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
| | - Nana Yaa Koomson
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
| | - David Ben Kumah
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
| | - Eugene Appenteng Osae
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
| |
Collapse
|
26
|
Yu YB, Zhu YN, Wang W, Zhang YD, Yu YH, Yao K. A comparable study of clinical and optical outcomes after 1.8, 2.0 mm microcoaxial and 3.0 mm coaxial cataract surgery. Int J Ophthalmol 2016; 9:399-405. [PMID: 27158610 PMCID: PMC4844058 DOI: 10.18240/ijo.2016.03.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical and optical outcomes after clear corneal incision cataract surgery (CICS) with three different incision sizes (1.8, 2.0 and 3.0 mm). METHODS Eyes of 150 patients with age-related cataract scheduled for coaxial cataract surgery were randomized to three groups: 1.8, 2.0, or 3.0 mm CICS. Intraoperative data and postoperative outcomes including surgically induced astigmatism (SIA), the corneal incision thickness, wavefront aberrations and modulation transfer function (MTF) of cornea were obtained. RESULTS There were no significant differences among the three groups in demographic characteristics and intraoperative outcome. The 1.8 and 2.0 mm microincisions showed more satisfactory clinical outcomes than the 3.0 mm incision. The 1.8 mm incision showed significantly less SIA than the 2.0 mm incision until postoperative 1mo (P<0.05), but the difference was only 0.14-0.18 D. Combined with less increased incision thickness only at postoperative 1d (P=0.013), the 1.8 mm incision presented better uncorrected distance visual acuity (UCDVA) than the 2.0 mm incision only at 1d postoperatively (P=0.008). For higher-order aberrations and other Zernike coefficients, there were no significant differences between the 1.8 mm group and 2.0 mm group (P>0.05). CONCLUSION Converting from 3.0 mm CICS to 1.8 or 2.0 mm CICS result in better clinical and optical outcomes. However, when incision is 1.8 mm, the benefits from further reduction in size compared with 2.0 mm are limited. The necessity to reduce the incision size is to be deliberated.
Collapse
Affiliation(s)
- Yi-Bo Yu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou 310009, Zhejiang Province, China
| | - Ya-Nan Zhu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Wei Wang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yi-Dong Zhang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yin-Hui Yu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou 310009, Zhejiang Province, China
| |
Collapse
|