Study on the impact and clinical effect of high-quality nursing intervention on the quality of life of elderly cataract patients

Objective

To evaluate the impact and clinical effect of high-quality nursing intervention on the quality of life of elderly cataract patients and its clinical effect.

Methods

This is a clinical comparative study. One hundred and twenty elderly cataract patients admitted to Tianjin Medical University Eye Hospital for surgical treatment were recruited and randomly divided into two groups: the control and experimental group, with 60 cases in each group from January 15, 2021 to January 15, 2022. Patients in the control group were given conventional nursing care in the perioperative period, while those in the experimental group were given high-quality nursing intervention in the perioperative period. The differences in anxiety (SAS) scores, depression (SDS) scores, intraocular pressure (IOP) recovery, the incidence of surgical complications and satisfaction before and after treatment between the two groups were compared and analyzed.

Results

No statistically significant difference was observed between the two groups in physical functioning, psychological functioning, social functioning and material life status scores before intervention(P>0.05). After the intervention, the above indicators improved significantly in the experimental group compared to the control group, with statistically significant differences (P=0.00). Moreover, SAS and SDS decreased significantly in the experimental group compared to the control group, with statistically significant differences(P=0.00).

Conclusions

High-quality nursing intervention improves various benefits in the treatment of elderly cataract patients, such as effectively reducing intraocular pressure, ameliorating patients' quality of life, lowering the incidence of postoperative complications, and improving patient satisfaction.

Effect of Phacoemulsification on Sub Foveal Choroidal and Central Macular Thickness as measured by Swept Source Optical Coherence Tomography

Objectives

To study the effect of Phacoemulsification on Sub Foveal Choroidal Thickness (SFCT) and Central Macular Thickness (CMT) as measured by Swept Source Optical Coherence Tomography (OCT).

Methods

This experimental study was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from April 2021 to February 2022. One hundred eyes of 100 patients with age related cataract underwent uneventful phacoemulsification surgery. Pre-operative SFCT and CMT was measured and compared with SFCT and CMT at one week, one month and three months after surgery using swept source OCT.

Results

Mean age of study population was 56.76±8.31 years. Out of 100 patients, 46 (46%) were males and 54 (54%) were females. Mean pre-operative CMT, one week, one month and three months post-operative CMT was 233.95±9.46 μm, 232.88±8.59 μm, 230.38±10.62 μm and 230.67±7.55 μm respectively. Mean pre-operative SFCT, one week, one month and three months post-operative SFCT was 337.14±8.41 μm, 339.14±9.63 μm, 339.39±11.96 μm and 351.39±9.19 μm respectively. The difference of mean change in CMT from baseline at one week, one month and three months post-operatively was not statistically significant. The difference of mean change in SFCT from baseline at one week and one month post-operatively was not statistically significant. However, the difference of mean change in SFCT from baseline at three months post-operatively was statistically significant (p<0.05).

Conclusion

Uneventful phacoemulsification surgery does not have any effect on central macular thickness, however there is a significant increase in subfoveal choroidal thickness at three months after surgery.

Biometry and Intraocular Lens Power Calculation by Combined Scheimpflug-Placido Disc versus Optical Interferometry Devices

Purpose

To compare the results of the current gold standard, laser interferometry, and keratometry by the IOL-Master, with a newly developed Galilei G6 using raytracing software Okulix for intraocular lens (IOL) power calculations.

Methods

For comparison of the IOL-power calculation of both devices, we analyzed the difference between the actual one-month postoperative subjective refraction and the theoretically calculated target refraction before cataract surgery. The IOL was selected according to the IOL Master recommendation aiming for emmetropia after surgery.We analyzed the differences of the measurements of the basic biometric data in 205 healthy eyes by each device.

Results

Our study included 205 healthy, unoperated eyes from 117 patients (61 women, 56 men) aged 20 to 75 years. Twenty-two eyes of cataract patients were also included in this retrospective study design. The mean difference between the prediction of the postoperative refraction and the refraction actually achieved was 0.03 D for the IOL Master and -0.23 D for the Galilei G6. The difference was not statistically significant (P = 0.059). The difference between the IOL power calculation of the IOL Master and the calculation of the G6 was not statistically significant (P = 0.064). The difference between the predicted refraction of the G6 and the refraction achieved after one month was also not statistically significant (P = 0.12) and neither was the difference between the predicted refraction of the IOL Master and the achieved refraction (P = 0.39). The mean axial length was calculated as 24.21 ± 0.80 mm using the IOL Master and 24.27 ± 0.82 mm using the Galilei G6 device. The mean value regarding anterior chamber depth (ACD) of the IOL master was 3.46 ± 0.23 mm and for the Galilei was G6 3.51 ± 0.25 mm. When comparing the white to white (WTW) values of the IOL master, it showed mean values of 12.32 ± 0.31 and Galilei showed mean values of G6 12.21 ± 0.28. All of these differences (between Galileo and IOL Master measurements) were statistically significant (P < 0.001).

Conclusion

Both the laser interferometry/keratometry performed by the IOL Master and the interferometry/raytracing biometry strategy performed by the Galilei G6 demonstrated equal results when executing the IOL power calculation before cataract surgery in eyes with no prior ocular surgery.

Comparison of Anterior Segment Measurements with a New Multifunctional Unit and Five Other Devices

Purpose

To evaluate the clinical availability of a multifunctional ocular biometric unit, MR-6000, for simultaneous keratometry, tonometry, topography, and pachymetry evaluation, and compare anterior segment measurements with five other devices: autokeratometer (KR-1), Scheimpflug camera (Pentacam HR), swept-source optical coherence tomography (IOLMaster 700), Placido disk scanning-slit topography (Orbscan II), and noncontact tonometry (FT-1000).

Methods

Thirty eyes from thirty patients who visited Severance Hospital for cataract surgery were examined using MR-6000 and the other devices. The mean keratometry, central corneal thickness (CCT), white-to-white (WTW) distance, and intraocular pressure (IOP) values were compared. Repeated measures analysis of variance, Wilcoxon signed-rank test, intraclass correlation coefficient (ICC), and Bland-Altman plot were used to assess the correlation and agreement between devices.

Results

Thirty eyes of thirty patients were evaluated. Statistically significant differences in mean keratometry between MR-6000, KR-1, Pentacam HR, and IOLMaster 700 were not observed (p > 0.05). All five devices, including Orbscan II, had almost perfect agreement in measuring keratometry (ICC > 0.80, p < 0.05). CCT measured by MR-6000 was significantly different from that of Pentacam HR and Orbscan II measurements (p < 0.05) but correlated with that of Pentacam HR and Orbscan II measurements (ICC > 0.60, p < 0.05). The WTW distance measured by MR-6000 was not significantly different from that measured by IOLMaster 700 but was different from that measured by Orbscan II. IOP measured by MR-6000 was not correlated with FT-1000.

Conclusions

Keratometric values obtained through MR-6000 can be used interchangeably with other devices based on good correlation and agreement. However, the CCT, WTW, and IOP values were not interchangeable with a single multifunctional unit for cataract surgery preoperative examination.

Effect of Blue Light-Filtering Intraocular Lenses on Age-Related Macular Degeneration: A Nationwide Cohort Study With 10-Year Follow-up

PURPOSE

To determine the incidence rate of age-related macular degeneration (AMD) after cataract surgery and compare the relative incidence of AMD in pseudophakes with blue light-filtering intraocular lenses (BF-IOLs) and non-BF-IOLs.

DESIGN

A nationwide cohort study conducted using the Taiwan National Health Insurance Research Database.

METHODS

We enrolled 186,591 patients who underwent cataract surgery in both eyes between 2008 and 2013 and monitored them from the index date (the date of first cataract surgery) until AMD, death, loss to follow-up, or December 31, 2017, whichever occurred first. Propensity score matching (PSM) was used to balance the baseline characteristics between the BF-IOL and non-BF-IOL groups.

RESULTS

BF-IOLs were implanted in 21,126 patients (11.3%) and non-BF-IOLs were implanted in 165,465 patients (88.7%). Patients in the BF-IOL group tended to be younger, with fewer men, different cataract surgery years, higher income, more nonmanual workers, more patients from urban and suburban areas, and fewer chronic diseases compared with the non-BF-IOL group. With a mean follow-up period of 6.1 years (range, 1-10 years) after cataract surgery, 12,533 and 1655 patients developed non-exudative AMD and exudative AMD, respectively. The incidence rate of non-exudative AMD and exudative AMD (per 1000 person-years) was 9.95 and 1.22 for the BF-IOL group and 11.13 and 1.44 for the non-BF-IOL group, respectively. After PSM, no statistical difference in the incidence rate of nonexudative AMD (hazards ratio, 0.95; 95% CI, 0.88-1.03) and exudative AMD (hazard ratio, 0.96; 95% CI, 0.77-1.18) was observed between the BF-IOL and non-BF-IOL groups.

CONCLUSIONS

In Taiwan, the incidence rate of AMD after cataract surgery was 11.59 per 1000 person-years. The use of a BF-IOL for up to 10 years had no apparent advantage over a non-BF-IOL in the incidence of AMD.

All India Ophthalmological Society (AIOS) Task Force guidelines to prevent intraocular infections and cluster outbreaks after cataract surgery

Infectious endophthalmitis is a serious and vision-threatening complication of commonly performed intraocular surgeries such as cataract surgery. The occurrence of endophthalmitis can result in severe damage to the uveal and other ocular tissues even among patients undergoing an uncomplicated surgical procedure. If the infections result from common factors such as surgical supplies, operative or operation theater-related risks, there can be a cluster outbreak of toxic anterior segment syndrome (TASS) or infectious endophthalmitis, leading to several patients having an undesirable outcome. Since prevention of intraocular infections is of paramount importance to ophthalmic surgeons, the All India Ophthalmological Society (AIOS) has taken the lead in the formation of a National Task Force to help ophthalmic surgeons apply certain universal precautions in their clinical practice. The Task Force has prepared a handy checklist and evidence-based guidelines to minimize the risk of infectious endophthalmitis following cataract surgery.

Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose

To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs).

Methods

In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items.

Results

mean patients' age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001).

Conclusion

Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision.

Anti-inflammatory Pharmacotherapy for the Prevention of Cystoid Macular Edema After Cataract Surgery

PURPOSE

To elucidate strategies for and controversies surrounding the use of anti-inflammatory medications after uneventful cataract surgery, with a focus on the prevention of irreversible vision loss due to cystoid macular edema (CME).

DESIGN

Perspective.

METHODS

Expert commentary on the management of inflammation after cataract surgery. Discussion includes combination therapy with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), dosing strategies, and emerging therapies.

RESULTS

While prescribing both NSAIDs and corticosteroids for cataract surgery is common, these classes have overlapping mechanisms. Combination therapy may speed visual recovery, but there remains little evidence for improved long-term visual outcomes from NSAIDs. The last 2 decades have seen increasing data on potential benefits of pretreatment with NSAIDs 1-3 days prior to cataract surgery. Simultaneously, newly approved "dropless" delivery systems hold promise, and clinical trials are ongoing to assess outcomes of such formulations.

CONCLUSIONS

Optimal pharmacologic treatment for inflammation after cataract surgery remains controversial. A consensus definition for clinically significant CME may facilitate the comparison of anti-inflammatory drugs. And there remains a need for well-designed trials examining both topical and extended-release drug-delivery systems to refine the treatment paradigm.

Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.

Semi-Automated Extraction of Lens Fragments via a Surgical Robot Using Semantic Segmentation of OCT Images with Deep Learning - Experimental Results in ex vivo Animal Model

The overarching goal of this work is to demonstrate the feasibility of using optical coherence tomography (OCT) to guide a robotic system to extract lens fragments from ex vivo pig eyes. A convolutional neural network (CNN) was developed to semantically segment four intraocular structures (lens material, capsule, cornea, and iris) from OCT images. The neural network was trained on images from ten pig eyes, validated on images from eight different eyes, and tested on images from another ten eyes. This segmentation algorithm was incorporated into the Intraocular Robotic Interventional Surgical System (IRISS) to realize semi-automated detection and extraction of lens material. To demonstrate the system, the semi-automated detection and extraction task was performed on seven separate ex vivo pig eyes. The developed neural network exhibited 78.20% for the validation set and 83.89% for the test set in mean intersection over union metrics. Successful implementation and efficacy of the developed method were confirmed by comparing the preoperative and postoperative OCT volume scans from the seven experiments.

Effect of Benson's Relaxation Technique on Propofol Consumption and Preoperative Anxiety of Patients Undergoing Cataract Surgery

Background

Benson’s relaxation (BR) technique is a suitable non-pharmacological approach to reduce preoperative anxiety (PA).

Objectives

This study aimed to investigate the effect of BR therapy on PA and the induction and maintenance dose of propofol during cataract surgery (CS).

Methods

Seventy-two patients were randomly divided into two experiments or BR and control groups. The Amsterdam and Spielberger State-Trait Anxiety inventory (STAI) scores were used to assess PA directly two days and a half-hour before the CS. The control group did not receive any preoperation intervention or relaxation. Benson’s relaxation method was performed three times, each time for 20 minutes, including two days before surgery, a night before surgery, and an hour before the surgery in the presence of a researcher by an audio file. The induction and maintenance dose of anesthetic drug was recorded and compared between the two groups.

Results

The mean propofol consumption was significantly reduced during the induction of anesthesia in the intervention group compared to the control group (0.99 ± 0.29 versus 1.29 ± 0.49; P = 0.005) as well as the maintenance of anesthesia (84.66 ± 17.98 versus 108.33 ± 34.38, P = 0.001). The results of the post-intervention Amsterdam anxiety score showed a significant decrease in the intervention group compared to the control group (P = 0.032, F = 9.61, Eta2 = 0.12). The control group showed a higher Spielberger state score compared to the intervention group as well as the Spielberger trait (P < 0.001, F = 14.78, Eta2 = 0.18).

Conclusions

The BR method effectively reduces the level of PA in patients undergoing CS. Moreover, it reduces the need for anesthetic drug, propofol, during surgery.

Spectacle Independence After Cataract Surgery: A Prospective Study With a Multifocal Intraocular Lens

Our aim was to review clinical outcome and patient satisfaction after cataract surgery to obtain spectacle independence following multifocal intraocular lens (IOL) implantation. A prospective case-series study was designed to evaluate the safety and efficacy of the Hanita FullRange pseudophakic multifocal intraocular lens in patients with programmed cataract surgery, performed between October 2017 and May 2018, with follow-up after 12 months. Manifest refraction spherical equivalent (SE), SE refractive accuracy, uncorrected distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA) and a binocular defocus curve were evaluated. In addition, a short "satisfaction questionnaire" was developed. Surgeries were performed without viscoelastic substance. The corneal endothelial cell density (ECD), central corneal thickness (CCT) and intraocular pressure (IOP) were also evaluated. A total of 480 eyes of 240 patients with mean ± standard deviation (SD) of age of 75 ± 6.12 years were included. The mean ± standard deviation (SD) of preoperative SE was 2.0 ± 2.18 D (range; -5.50 to 4.75) which decreased to -0.04 ± 0.28 D (range; -0.75 to 0.625) 12 months after surgery. Regarding SE refractive accuracy 82.9 % of eyes obtained SE values between -0.5 and 0.5 D. There was no loss of lines of vision and 98.3% of patients achieved UDVA between 20/20 and 20/25. The UNVA (binocular) obtained was J1 for 72.5% and J2 for 27.5% of patients. Regarding defocus curve, 0.04 logMAR for -3.0 D, 0.09 logMAR for -1.5 D and 0.03 logMAR for 0 D was achieved. The mean CCT was increased by 6.62 ± 2.79 micrometer (1.24%), the mean ECD was decreased by 226.08 ± 11.63 cell/mm² (9.00 %) and the IOP remained stable one year after surgery. In response to the satisfaction questionnaire, 92% of patients stated that they had obtained spectacle independence. Finally, spectacle independence was achieved in most of the cases, with a high level of patient satisfaction one year after implantation of a FullRange IOL. No complications were detected. We concluded that the refractive efficacy of FullRange multifocal IOL was proved in majority of cases. A large follow up period is necessary in future studies to confirm the results.

Increased frequency of cataract surgery in patients over age 50 with pituitary macroadenomas and chiasmal compression

BACKGROUND

Patients with visual loss from macroadenomas compressing their optic apparatus may also have concomitant age-related visual pathology such as cataracts. How these two pathologies interact with each other is not well documented.

OBJECTIVE

The interaction between these two pathologies in elderly patients is the subject of this study.

METHODS

We identified a series of non-functioning macroadenoma patients over age 50 years with tumors compressing the chiasm who underwent transsphenoidal surgery at our institution between 2004 and 2018. Pre- and post-operative visual complaints, tumor size and extent of resection were analyzed. Prevalence of the diagnosis of cataract and prevalence of cataract surgery in each decade were compared with national averages.

RESULTS

We identified 200 patients who met selection criteria. 18% of these patients had a diagnosis of cataract and 12.5% had cataract surgery. Compared with the Eye Diseases Prevalence Research Group (EDPRG) study, the prevalence of cataract surgery was 2.5 times the national average of 5.1%. 32% of these patients had no improvement in their vision after cataract surgery but 76% improved after transsphenoidal surgery.

CONCLUSIONS

We reported a high prevalence of cataract surgery in patients over age 50 in patients with pituitary macroadenomas compressing the optic pathway compared with national averages in patients without adenomas. While visual loss from adenoma likely precipitated more cataract surgeries in this group of patients, some who may not have required it, those patients with cataracts who did not have their cataracts extracted were less likely to recover vision after transsphenoidal surgery. Addressing both pathologies is beneficial.

Changes in Pupil Area during Low-energy Femtosecond Laser-assisted Cataract Surgery

Purpose

To study the potential changes in pupil area within low-energy femtosecond-laser assisted cataract surgery (FLACS).

Methods

A retrospective assessment of the pupil size was performed in the eyes undergoing FLACS using the Ziemer LDV Z8. We measured the pupil diameters as part of the images taken preoperatively and at the completion of laser pretreatment (after releasing the suction). We calculated the pupil area in 40 eyes of 40 patients (14 right and 26 left eyes). The mean ± standard deviation (SD) of age of the patients was 74 ± 7.4 years (range: 51-87). Paired t-test was used for statistical analyses. Subgroups were built with reference to age and preoperative pupil area (smaller than or equal to the median versus larger than the median).

Results

The mean ± SD axial length, anterior chamber depth, white-to-white distance and lens thickness were 24.01 ± 1.47, 3.23 ± 0.4, 11.97 ± 0.49, and 4.59 ± 0.41 mm, respectively. The mean ± SD pupil area was 39.33 ± 7.1 mm 2 preoperatively and 39.3 ± 6.75 mm 2 after laser pretreatment. The mean ± SD change in pupil area was -0.03 ± 2.12 mm 2 . There were no statistically significant changes between preoperative and post-laser pupil areas (P = 0.93, 95% CI: -0.71 to 0.65). Comparisons within subgroups also did not detect pupil area reduction.

Conclusion

This study did not detect statistically significant changes in pupil area after laser pretreatment using low-energy FLACS. This observation is in contrast to previous studies using other laser platforms.

Wet Lab-Based Cataract Surgery Training Curriculum for the PGY 2/PGY 3 Ophthalmology Resident

Introduction

Studies have shown that structured cataract surgery training curricula are beneficial for resident surgeons-in-training, yet nearly one-third of US training programs do not have one, and public dissemination of said curricula are lacking.

Methods

We created a microsurgical simulation center and accompanying structured training curriculum. Weekly lectures focused on the steps of cataract surgery, variations on technique, and complications. Each didactic was followed by a 1.5- to 2-hour time block with faculty supervision in the wet lab. Finally, to demonstrate proficiency, residents submitted a recorded video illustrating their competency within 1 week of the lecture. We reviewed videos and provided written feedback via a standardized form. Curriculum effectiveness was evaluated through formative feedback on the course itself and complication rates for resident-performed cataract surgery before and after implementation of the curriculum.

Results

The course was implemented in 4 consecutive academic years, allowing time for nine junior residents to participate in the course at least once before operating as a senior. The incidence of posterior capsule tears for senior residents decreased from 3.07% in the 4 years preceding curriculum implementation to 1.13% for the senior residents who completed the course at least once as juniors (p = .0571). Supervised wet lab sessions and submitted videos allowed faculty to identify surgically struggling residents early.

Discussion

Implementation of a cataract surgery training curriculum for junior ophthalmology residents provides a safe and effective environment to practice surgical techniques. Such a curriculum may decrease the complication rates of beginner surgeons.

Medical Litigations Associated with Cataract Surgery in Korea

BACKGROUND

To analyze the results of court rulings about medical litigations related to cataract surgery in Korea.

METHODS

We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded.

RESULTS

Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010).

CONCLUSION

Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.

Descemet membrane detachment in femtosecond laser-assisted cataract surgery: a case report

Background

Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel technique. However, descemet membrane detachment (DMD) began to be found as the complication after FLACS. We report a case of serious DMD following FLACS due to the inappropriate incision design.

Case presentation

An 85-year-old man with apparent cornea arcus senilis underwent femtosecond laser-assisted cataract surgery in his right eye. A biplanar model was chosen for the main incision. A serious descemet membrane detachment (DMD) occurred at the end of phacoemulsification, which was connected with the main incision. However, the surgeon confused it with the transient swelling of corneal endothelium, and did not treated DMD timely. DMD was confirmed by anterior segment optical coherence tomography (AS-OCT) at the postoperative 1-month follow-up. Eventually DMD was resolved by intracameral perfluropropane (C3F8) gas injection.

Conclusions

This case suggests that a careful incision separation and a triplanar incision design in FLACS may reduce the incidence of DMD in cataract surgery.

Predictors of Successful Laser Capsulotomy for Significant Posterior Capsule Opacification after Phacoemulsification

Purpose:

This study aimed to determine the reasons behind the failure of laser capsulotomy (LC) performed for significant posterior capsular opacification (PCO).

Methods:

Eighty-eight eyes of 88 patients referred for LC at a tertiary care center were retrospectively analyzed. The data recorded included the cause of cataract, visual acuity, duration of PCO, location of PCO, intraocular lens (IOL) position, IOL type, and lens capsule status. These data were later analyzed for determining the requirement of high pulse energy during LC and the success rate of primary LC.

Results:

The mean age of the participants was 55.77 ± 18.60 years with 58 (65.9%) male patients. The mean duration between cataract and LC surgeries was 45.58 ± 37.33 months. Senile (n=58), uveitic (n=12), post-pars plana vitrectomy (PPV) (n=12), and traumatic (n=6) cataracts were the common causes. Late-presenting PCO, trauma, uveitis, sulcus placement of IOLs, irregular capsulorhexis shape, and polymethyl methacrylate (PMMA) IOLs were significantly associated with unsuccessful LC and/or higher pulse energy settings during LC.

Conclusion:

Significant PCO is often associated with cataract caused by uveitis or trauma, and after PPV. PCO associated with trauma, sulcus placement of IOLs, and PMMA IOLs may need multiple LCs.

Comparison of the Posterior Capsule Rupture Rates Associated with Conventional (Start to Finish) Versus Reverse Methods of Teaching Phacoemulsification

Purpose:

Comparison of the rates of posterior capsule rupture (PCR) associated with conventional versus a reverse method of teaching phacoemulsification.

Methods:

Trainees were taught conventional (start-to-finish) phacoemulsification beginning with an incision (tunnel construction) to capsulorhexis, sculpting, nucleus cracking, segment removal, cortex aspiration, intraocular lens implantation, and viscoelastic removal. In the reverse method, after incision and capsulorhexis, the trainees were progressively taught viscoelastic wash, cortex aspiration, segment removal, nucleus cracking, sculpting, and intraocular lens implantation. Trainees from a Tertiary Eye Care Centre were classified as beginners, for their first 30 cases and then trainees for their next 70 surgeries. Data were collected on posterior capsular rent and vitreous loss during each step of training.

Results:

Thirty-two ophthalmic surgeons learning phacoemulsification surgery on 609 cataracts cases were supervised by 3 trainers. Fifteen beginners performed 287 surgeries using the conventional method, and 17 beginners performed 322 surgeries with the reverse method. The incidence of PCR was 18/287 (6.2%) with the conventional method and 15/322 (4.6%) with the reverse method (P = 0.38). PCR occurred during cortex aspiration (8/287, 2.8%) and segment removal (5/287, 1.7%) in the conventional method. PCR occurred during nucleus cracking, segment removal, and cortex aspiration (4/322 surgeries for each step, 1.2%). In the follow, 70 cases (trainees) there was no difference in PCR with either method (4.7% vs. 4.3%, P = 0.705).

Conclusion:

Conventional and reverse method for training phacoemulsification were both safe in a supervised setting.

Safety and Efficacy of the Transition from Extracapsular Cataract Extraction to Manual Small Incision Cataract Surgery in Prevention of Blindness Campaigns

PURPOSE

To compare the safety and the visual outcomes of two experienced cataract surgeons who converted from extracapsular cataract extraction (ECCE) to manual small incision cataract surgery (MSICS) during a campaign for the prevention of blindness.

METHODS

Two surgeons used the ECCE technique (ECCE group) during a campaign in Burkina Faso on 93 consecutive cataract patients with a corrected distance visual acuity (CDVA) <20/80 in the best eye. Both surgeons used MSICS for the first time on 98 consecutive cases in another campaign in Kenya after theoretical instructional courses.

RESULTS

There were no significant differences in CDVA at 3 months postoperatively. There were 69% of eyes with uncorrected distance visual acuity ≥20/60 in the MSICS group and 49% eyes in the ECCE group. Spherical equivalents ranged between -1D and +1D in 55% of the MSICS group versus 43% in the ECCE group. There were significant differences in the changes in the vertical component of astigmatism (J45) but not the horizontal (J0) component. There were no significant differences in the intraoperative complications. The most common postoperative complication was corneal edema on the first day in 40.86% and 19.38% of the ECCE and MSICS groups, respectively.

CONCLUSION

Transitioning from ECCE to MSICS for experienced cataract surgeons in surgical campaigns is safe. The rate of complications is similar for both techniques. Slightly better visual and refractive outcomes can be achieved due to the decreased induction of corneal astigmatism.

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy

Objective:

To determine the efficacy of topical Nepafenac (0.1%), administered post-operatively in prevention of Macular Edema (ME), after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy (NPDR).

Methods:

This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness (CMT) of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography.

Results:

Mean age of study population was 60.97±4.91 years. Out of 60 patients, 34 (56.7%) were males and 24 (43.3%) were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5±10.86µm, 228.83±14.56 µm, 2.33±10.45 µm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93±11.69µm, 236.17±16.16 µm, 12.23±12.40µm and 5.51% respectively. ME was observed in one patient (3.3%) in Group-1, and seven patients (23.3%) in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant (p<0.05).

Conclusion:

0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR).

Outcome of Single-piece Intraocular Lens Sulcus Implantation following Posterior Capsular Rupture during Phacoemulsification

Purpose:

To assess the safety and outcome of single-piece posterior chamber intraocular lens (PC-IOL) implantation in the ciliary sulcus following posterior capsular rupture during cataract surgery.

Methods:

Patients with posterior capsular rupture during cataract surgery with a single-piece acrylic IOL implanted into the ciliary sulcus were studied. Complete ocular examinations were performed after 6 months postoperatively.

Results:

Twenty-four eyes were included. Mean follow-up duration was 8.33 ± 2.33 months. There was no significant difference between preoperative and postoperative keratometric cylinder or intraocular pressure. Visual acuity of 87.50% of patients was ≥20/40 after surgery. Complications included foveopathy (10 eyes), iris transillumination defect (4 eyes), iris chafing (2 eyes), pigmented keratic precipitate (KP) (4 eyes), clinical IOL tilt (6 eyes), endothelial pigment dusting (14 eyes), IOL pigment dusting (17 eyes), iris bowing (6 eyes), IOL decentration (4 eyes), and IOL tilt detected with ultrasonography biomicroscopy (UBM) (4 eyes). IOL pigment dusting was significantly higher in eyes with short axial lengths, high IOL power, small sulcus-to-sulcus (STS) diameter, large STS IOL diameter mismatch, and small anterior chamber depth and angle. Significant relationships were observed between pigmented KP with small STS diameter and large STS IOL diameter mismatch, UBM and clinical IOL tilt with large anterior chamber depth and between iris transillumination defect and STS IOL diameter mismatch.

Conclusion:

This implantation is associated with higher incidence of complications. Single-piece acrylic IOLs are not designed for sulcus implantation. However, they may be used in eyes with longer axial length if the 3-piece IOL is not available.

Is the Capsular Bag Perimeter Round or Elliptical?

Purpose:

To report findings that could suggest an elliptical shape of the capsular bag.

Methods:

Five eyes of three patients with axial length greater than 24 mm underwent phacoemulsification cataract surgery with plate-haptic multifocal toric intraocular lens (IOL) implantation oriented in the vertical meridian.

Results:

In all cases, correct orientation of the IOLs was verified 30 minutes after surgery. After 24 hours, all eyes demonstrated unwanted rotation of the IOLs ranging from 15 to 45 degrees. The IOLs remained stable in the new position in all cases until adhesion of the capsular bag took place.

Conclusion:

These observations could suggest that the perimeter of the capsular bag has an elliptical shape. Therefore, the IOL tends to become fixated in a meridian of the capsular bag that best fits the diagonal diameter of the IOL.

Cataract and Cataract Surgery: Nationwide Prevalence and Clinical Determinants

This study aimed to investigate the prevalence and clinical determinants of cataract and cataract surgery in Korean population. The 2008-2012 Korean National Health and Nutrition Examination Survey was analyzed, which included 20,419 participants aged ≥ 40 years. The survey is a multistage, probability-cluster survey, which can produce nationally representative estimates. Prevalence of cataract and cataract surgery was estimated. Clinical determinants for those were investigated using logistic regression analyses (LRAs). The prevalence of cataract was 42.28% (95% confidence interval [CI], 40.67-43.89); 40.82% (95% CI, 38.97-42.66) for men and 43.62% (95% CI, 41.91-45.33) for women (P = 0.606). The prevalence of cataract surgery was 7.75% (95% CI, 7.30-8.20); 6.38% (95% CI, 5.80-6.96) for men and 9.01% (95% CI, 8.41-9.61) for women (P < 0.001). Cataract was associated with older age (P < 0.001), men (P = 0.032), lower household income (P = 0.031), lower education (P < 0.001), hypertension (P < 0.001), and diabetes mellitus (DM) (P < 0.001). Cataract surgery was consistently associated with older age, occupation, DM, asthma, and anemia in two LRAs, which compared participants with cataract surgery to those without cataract surgery and those having a cataract but without any cataract surgery, respectively. Hypertension, arthritis, and dyslipidemia were associated with cataract surgery at least in one of these LRAs. These results suggest that there are 9.4 million individuals with cataract and 1.7 million individuals with cataract surgery in Korea. Further studies are warranted to reveal the causality and its possible mechanism of developing/exacerbating cataract in novel determinants (i.e., anemia, asthma, and arthritic conditions) as well as well-known determinants.

Comparison of the Effects of Dexmedetomidine and Remifentanil on Cognition State After Cataract Surgery

BACKGROUND

Dexmedetomidine is a potent and highly specific α2-adrenoreceptor agonist that induces sedative and analgesic effects over a short-term period. As a result of these benefits, dexmedetomidine may be a better alternative than other available drugs for keeping the patient's cognition state in an acceptable condition after outpatient ophthalmic surgeries.

OBJECTIVES

This randomized study was conducted to compare the sedative effects of dexmedetomidine and remifentanil on the cognitive state of patients who have undergone cataract surgery.

PATIENTS AND METHODS

A total of 100 patients who were candidates for cataract surgery under local anesthesia received either dexmedetomidine (50 patients; D group) or remifentanil (50 patients; R group) in a double-blind, randomized study. The baseline cardiovascular status and mini mental state examination (MMSE) score for each patient were recorded. As a loading dose, dexmedetomidine (0.5 µg/kg) and remifentanil (0.1 µg/kg) were infused at 10 minutes and 5 minutes before topical anesthesia, respectively. Subsequently, the maintenance dose was administered at 0.2 µg/kg/hour and 0.05 µg/kg/minutes in the D and R groups, respectively. The surgical procedure was begun when the bispectral index (BIS) reached 70 - 80. MMSE test was done at a postanesthetic care unit (PACU) 120 minutes after the discontinuation of the drug.

RESULTS

There was no statistically significant difference between the MMSE scores of the two groups before surgery (P = 0.6), but the MMSE test conducted at the PACU revealed significantly better cognitive outcomes in the D group than in the R group in patients younger and older than 65 years (P = 0.03 and P = 0.0001, respectively).

CONCLUSIONS

This study revealed that dexmedetomidine may be a suitable agent for sedation in cataract surgery because it results in a more favorable postoperative cognitive status than remifentanil. Likewise, dexmedetomidine had no significant adverse effects on cardiovascular or respiratory systems.

Outcomes of Cataract Surgery at a Referral Center

Purpose:

To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes.

Methods:

Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of “less than excellent outcome,” i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason.

Results:

Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%).

Conclusion:

Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.

Frequency of Hepatitis-B and C in patients undergoing cataract surgery in a tertiary care Centre

Objective:

To analyze the frequency of hepatitis B and C in patients undergoing cataract surgery.

Methods:

This descriptive study was conducted at department of Ophthalmology Jinnah Post Graduate Medical Centre. The duration of study was seven months from May 2013 to November 2013. After taking informed consent from the patient and hospital ethical committee all patients presenting with cataract and undergoing cataract surgery were evaluated for the existence of hepatitis C and B. Diagnosis of hepatitis C or B was made on the criteria that a patient must be positive for either Anti-HCV or HBsAg or both. Proformas were filled and data was collected and analysis was done. Pearson’s correlation coefficients were calculated to calculate the occurrence of hepatitis C and B in general population undergoing cataract surgery.

Results:

Six hundred and forty-eight patients were operated on for cataract surgery at Jinnah Post Graduate Medical Centre during the study period. Mean age of patients was 63 years, 300 (46.29%) were male and 348 (53.70%) female. Out of them 57 (8.79%) patients were carriers of either Hepatitis C or B. Hepatitis B accounted for 17 cases (2.62%) however Hepatitis C positive were 40 cases (6.17%). Nobody was simultaneously affected by both hepatitis C and B.

Conclusion:

Significant number of asymptomatic carriers of hepatitis C and B were found in preoperative cataract patients. It is recommended that preoperative screening of all cataract patients should be done so that asymptomatic carriers might not become a threat for spread of disease.

Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa

PURPOSE

To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city.

METHODOLOGY

A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content.

RESULTS

Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers.

CONCLUSION

The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.

Comparison of morphological and functional endothelial cell changes after cataract surgery: phacoemulsification versus manual small-incision cataract surgery

PURPOSE

To compare the morphological (cell density, coefficient of variation and standard deviation) and functional (central corneal thickness) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS).

DESIGN

Prospective randomized control study.

MATERIALS AND METHODS

In this prospective randomized control study, patients were randomly allocated to undergo phacoemulsification (Group 1, n = 100) or MSICS (Group 2, n = 100) using a random number Table. The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively and at 1and 6 weeks postoperatively. Functional and morphological endothelial evaluation was Noncon ROBO PACHY SP-9000 specular microscope. Phacoemulsification was performed, the chop technique and MSICS, by the viscoexpression technique.

RESULTS

The mean difference in central corneal thickness at baseline and 1 week between Group 1 and Group 2 was statistically significant (P = 0.027). However, this difference at baseline when compared to 6 week and 1 week, 6 weeks was not statistically significant (P > 0.05). The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant (P = 0.016). The mean coefficient of variation and mean standard deviation between groups were not statistically significant (P > 0.05, both comparisons).

CONCLUSION

The central corneal thickness, coefficient of variation, and standard deviation were maintained in both groups indicating that the function and morphology of endothelial cells was not affected despite an initial reduction in endothelial cell number in MSICS. Thus, MSICS remains a safe option in the developing world.

Clear corneal incision in cataract surgery

Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature.

Cataract surgery in eyes with filtered primary angle closure glaucoma

PURPOSE

To evaluate the effect of cataract surgery on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG).

METHODS

In this prospective interventional case series, 37 previously filtered eyes from 37 PACG patients with mean age of 62.1±10.4 years were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 12 months after trabeculectomy. Visual acuity, IOP and the number of glaucoma medications were recorded preoperatively, and 1, 3, 6 and 12 months after surgery. Anterior chamber (AC) depth was measured preoperatively and 3 months after cataract surgery with A-scan ultrasonography. The main outcome measure was IOP at 12 months.

RESULTS

IOP was decreased significantly from 18.16±5.91 mmHg at baseline to 15.37±2.90 mmHg at final follow-up (P<0.01). The mean number of glaucoma medications was significantly decreased from 1.81±0.24 to 0.86±1.00 (P=0.001) at 1 year postoperatively. At final follow up, 36 (97.2%) eyes and 32 (86.4%) eyes had IOP≤21 and IOP≤18 mmHg, respectively; 14 (37.8%) eyes and 9 (24.3%) eyes had IOP≤21 and IOP≤18 mmHg without medications, respectively. The magnitude of IOP reduction was correlated with higher preoperative IOP (r=0.85, P<0.001), shallower preoperative AC depth (r=-0.38, P=0.01) and greater changes in AC depth (r=-0.39, P=0.01).

CONCLUSION

Cataract surgery reduces IOP and the number of glaucoma medications in previously filtered PACG eyes. This reduction seems to be greater in patients with higher preoperative IOP and shallower anterior chambers.

Intravitreal bevacizumab for pseudophakic cystoid macular edema; a systematic review

Cystoid macular edema (CME) is a major cause of decreased vision after complicated or uncomplicated cataract surgery. This paper reviews the use of intravitreal bevacizumab (IVB) injection for treatment of pseudophakic CME. In a literature search of all articles available on Medline and Scopus databases, 11 studies including one prospective and 4 retrospective studies, 4 case reports, one letter to editor and one review article were identified. All articles except one, reported the use of IVB for chronic CME unresponsive to at least one conventional treatment modality. The level of evidence for all studies was categorized as low or very low. Although intravitreal bevacizumab might be effective for many cases of pseudophakic CME, its use should be reserved for eyes unresponsive to conventional treatment modalities.

Transition to phacoemulsification at the farabi eye hospital, iran

PURPOSE

To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran.

MATERIALS AND METHODS

Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients (405 eyes) in 2006 and 125 patients (153 eyes) in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P <0.05 was considered statistically significant.

RESULTS

The phacoemulsification rate increased from 25% to greater than 90% between 2003 and 2006, rates of corneal incisions and use of foldable intraocular lenses tripled, administration of general anesthesia dropped from 80% to 12%, the outpatient admission rate rose from 5.2% to 71%, 4% vs. 66% of the operations were performed by a senior phacoemulsification surgeon and the number of advanced surgeons changed from 6% to 38% (all P-values < 0.001). In 2006, more patients at the two extremes of age, more patients with poor systemic conditions and myopes underwent surgery (all P-values < 0.05); the cataract surgery volume increased by 49% and post-operative visual acuity improved (P = 0.03) while patient satisfaction was unchanged.

CONCLUSION

We objectively documented the transition in cataract surgery technique to phacoemulsification at the Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill.

Six year Trend in Cataract Surgical Techniques in Iran

Purpose

To determine the cataract surgery techniques performed in Iran from 2000 to 2005.

Materials and Methods

This study was part of the Iranian Cataract Surgery Survey (ICSS) which was a retrospective cross-sectional study. All major ocular surgery units and 10% of randomly selected minor units throughout Iran were included. Excluding the 2 week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data on all cataract surgeries performed during these weeks were collected by reviewing patient records. The ANOVA repeated measure test was performed to determine longitudinal changes with a P<0.05 denoting statistical significance.

Results

Phacoemulsification with intraocular lens (IOL) implantation has become the surgical method of choice in Iran, increasing from less than 7% in 2000 to 57% in 2005 (P<0.0001). Extracapsular cataract extraction showed a reverse trend compared to phacoemulsification, decreasing from greater than 91% in 2000 to 41% in 2005 (P<0.0001). Intracapsular cataract extraction and lensectomy were rarely performed without significant changes over time (P>0.05).

Conclusion

Phacoemulsification with IOL implantation has become the preferred cataract surgery method in Iran during recent years.

Combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery in cases with cataract and posterior segment diseases

BACKGROUND

Combined cataract surgery and transconjunctival sutureless vitrectomy are a good option in patients with cataract and vitreoretinal diseases.

AIM

To evaluate the effectiveness, outcomes, and complications of combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery.

SETTINGS AND DESIGN

A retrospective case series was conducted at the Beyoglu Eye Education and Research Hospital.

MATERIALS AND METHODS

In this study, 28 eyes of 28 patients underwent combined 23-gauge transconjunctival sutureless vitrectomy and phacoemulsification and IOL implantation for cataract and various posterior segment diseases. The outcome measures included, visual acuity, intraocular pressure changes, and anatomical success were evaluated.

RESULTS

The mean follow-up was 4.8 months (range, 3-15 months). Mean overall preoperative visual acuity was 20/333, and final acuity was 20/95 (P < 0.001). Mean intraocular pressure (IOP) on the preoperative and first postoperative day was 15.6 ± 7.5 and 13.8 ± 3.3 mmHg, respectively (P > 0.05). Three eyes (10.7%) had postoperative hypotony (<6 mmHg)that all recovered spontaneously within the first postoperative week. Three eyes (10.7%) required laser treatment for iatrogenic retinal tears. Anatomical success was obtained in all cases. No serious complications such as endophthalmitis were observed during the follow-up period.

CONCLUSION

Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in patients with significant lens opacities and vitreoretinal pathology. Although the anatomic and visual outcomes were satisfactory, the outcomes depended mainly on underlying vitreoretinal pathology.