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Llaneras CN, Quan A, Lieux C, Rivera-Grana E, Gajardo C, Duerr E, O'Brien RC, Gedde SJ, Vazquez LE. A Retrospective Comparison of Phaco-Tube vs. Phaco-Trabeculectomy in Glaucoma Patients. Ophthalmol Glaucoma 2024:S2589-4196(24)00072-3. [PMID: 38697359 DOI: 10.1016/j.ogla.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery. DESIGN Single-center, retrospective, comparative case series. PARTICIPANTS A total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group. METHODS Eligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed. MAIN OUTCOME MEASURES The primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on two consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those that used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications. RESULTS The cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P= 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4 to 10.4 months). IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P= 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P= 0.015). LogMAR VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P= 0.82) and VFMD was -18.3 ± 9.0 dB in the phaco-tube group and -14.1 ± 7.0 dB in the phaco-trab group (P= 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P= 0.28). CONCLUSIONS Phaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success.
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Affiliation(s)
- Cristina N Llaneras
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ann Quan
- Division of Ophthalmology, Scripps Clinic, La Jolla, California, USA
| | - Caroline Lieux
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Erick Rivera-Grana
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Consuelo Gajardo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric Duerr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert C O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven J Gedde
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis E Vazquez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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de Paula A, Gattazzo I, Savini G, Schiano Lomoriello D, Corsi A. An analysis of the factors involved in IOL decentration after phacoemulsification using CASIA 2 anterior segment optical coherence tomography. Int Ophthalmol 2024; 44:194. [PMID: 38656707 DOI: 10.1007/s10792-024-03126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. METHODS 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. RESULTS The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). CONCLUSION Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.
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Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, Policlinico Casilino, Via Casilina, 1049, 00169, Rome, Italy.
| | - Irene Gattazzo
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Andrea Corsi
- Ophthalmology Unit, Policlinico Casilino, Via Casilina, 1049, 00169, Rome, Italy
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Wlaź A, Kustra A, Aung T, Żarnowski T. Evaluation of changes of anterior segment parameters in patients with pseudoexfoliation syndrome after cataract surgery using anterior segment optical coherence tomography. Sci Rep 2024; 14:8279. [PMID: 38594403 PMCID: PMC11004152 DOI: 10.1038/s41598-024-58564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
The aim of the study was to compare the anterior segment parameters after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes. We conducted a prospective comparative study of 36 eyes (PEX group), 16 eyes (PEXG group) and 46 eyes (control group) of 98 patients after phacoemulsification with intraocular lens implantation. Before surgery, 1 week, 1 month and 3 months postoperatively, anterior chamber parameters were evaluated by swept source anterior segment optical coherence tomography (AS-OCT). Anterior chamber depth (ACD), angle opening distance (AOD500/750), trabecular-iris space area (TISA500/750), trabecular-iris angle (TIA500/750) and lens vault (LV) were assessed at each study visit. Preoperatively, ACD, AOD500/750 and TISA500/750 were significantly smaller, while LV was significantly greater in PEX and PEXG eyes than in controls. 3 months postoperatively all irido-corneal parameters and ACD were significantly greater in all study groups without intergroup differences. ACD and LV significantly increased in PEX group between 1 and 3 months after surgery while being stable in control group. Relative increases in ACD, AOD500, TISA750, TIA500/750 were significantly higher in PEX and PEXG groups than in controls. Our study finds that ACD and iridocorneal parameters in AS-OCT demonstrated significantly greater relative increases 3 months after phacoemulsification in PEX and PEXG groups than in control eyes. Significantly greater deepening of anterior chamber and opening of the irido-corneal angle may be a reason for different refractive outcomes and IOP control in patients with PEX and PEXG after routine cataract surgery.
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Affiliation(s)
- Aleksandra Wlaź
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Chmielna 1, 20-079, Lublin, Poland.
- Optegra Eye Clinic, Gęsia 5, 20-719, Lublin, Poland.
| | - Agnieszka Kustra
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Chmielna 1, 20-079, Lublin, Poland
| | - Tin Aung
- Singapore Eye Research Institute & Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Chmielna 1, 20-079, Lublin, Poland
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Mitchell W, Yang SA, Ondeck C, Stewart I, Zhao Y, Roldan AM, Halawa O, Hall N, Elze T, Miller J, Lorch A, Zebardast N. Effectiveness of Angle-Based Minimally Invasive Glaucoma Surgery after Laser Trabeculoplasty: An Analysis of the IRIS® Registry (Intelligent Research in Sight). Ophthalmol Glaucoma 2024:S2589-4196(24)00048-6. [PMID: 38519027 DOI: 10.1016/j.ogla.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Angle-based minimally invasive glaucoma surgery (ab-MIGS) has grown substantially, although long-term efficacy is poorly understood. We analyze ab-MIGS effectiveness with and without preceding laser trabeculoplasty (LTP). DESIGN Retrospective cohort study. SUBJECTS Eyes undergoing ab-MIGS (Canaloplasty, Goniotomy, Trabectome, and iStent) with and without prior laser trabeculoplasty (< 2 years preceding MIGS) were identified in the IRIS® Registry (Intelligent Research in Sight) 2013 to 2018. METHODS Propensity score matching (PSM) was undertaken to define the following 4 cohorts: (1) standalone ab-MIGS, no prior LTP vs. (2) standalone ab-MIGS, with prior LTP; and (3) ab-MIGS + phacoemulsification, no prior LTP vs. (4) ab-MIGS + phacoemulsification, with prior LTP. MAIN OUTCOME MEASURES Failure was defined as subsequent glaucoma reoperation after ab-MIGS (either MIGS or traditional glaucoma surgery). Time-to-event outcome and incidence rates were calculated using survival analysis, and adjusted hazard ratios (aHRs) were generated using multivariate Cox proportional hazards models. Medication data were not available for analysis. RESULTS A total of 164 965 unique MIGS procedures were performed, from 2013 to 2018. After PSM, we identified 954 eyes undergoing standalone ab-MIGS and 7522 undergoing ab-MIGS + phacoemulsification. For eyes undergoing standalone ab-MIGS, those with prior LTP (n = 477) were more likely to undergo reoperation vs. those without LTP (n = 477) at 6 and 12 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53; CI, 1.15-2.04; P = 0.004). For eyes undergoing ab-MIGS + phacoemulsification, those with prior LTP (n = 3761) were more likely to undergo reoperation vs. those without LTP (n = 3761) at 12, 24, and 36 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53 CI, 1.15-2.04; P = 0.004). CONCLUSIONS Prior LTP may be associated with a higher chance of subsequent glaucoma surgery following ab-MIGS, either with or without concurrent phacoemulsification. These findings have important implications for understanding who may benefit most from ab-MIGS, and for guiding patient and surgeon treatment expectations. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- William Mitchell
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Shuang-An Yang
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Courtney Ondeck
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | | | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ana M Roldan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Omar Halawa
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Tobias Elze
- Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joan Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts.
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Zhang Y, Lai C, Zhao S, Li L, Luo X, Chen Y, Niu Y, Qin Y, Zhang H. Comparison of bleb morphologies between phacoemulsification combined with Ex-PRESS mini shunt implantation, phacotrabeculectomy and trabeculectomy alone: a two-year retrospective in vivo confocal microscopy study. BMC Ophthalmol 2024; 24:108. [PMID: 38448910 PMCID: PMC10916144 DOI: 10.1186/s12886-024-03364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To compare the bleb morphologies of phacoemulsification combined with Ex-PRESS implantation (Phaco-ExPRESS), phaco trabeculectomy (Phaco-Trab), and trabeculectomy (Trab) in postoperative two years. METHODS Patients with primary open-angle glaucoma (POAG) with or without cataracts were included in this study. All patients underwent surgeries of either Phaco-ExPRESS, Phaco-Trab, or Trab. The morphologic structures of the filtering bleb, including microcysts area, hyperreflective dot density, and stromal connective tissue under in vivo confocal microscope (IVCM), were compared between the three groups. The data were collected preoperatively and postoperatively at 2 weeks, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months. RESULTS Eighty-nine eyes from 89 patients were enrolled, including 32 in the Phaco-ExPRESS group, 25 in the Phaco-Trab group, and 32 in the Trab group. In a 24-month follow-up, bleb morphologies in Phaco-ExPRESS were similar to the Trab group. The area of epithelial microcysts was significantly increased in Phaco-ExPRESS and Trab groups while significantly decreased in Phaco-Trab. At postoperative 24 months, the complete success rate was 65.1% in Phaco-ExPRESS, 32.0% in Phaco-Trab, and 59.4% in the Trab group (P = 0.03). The phaco-Trab group had more postoperative anti-glaucoma medications than the other two groups (P < 0.05). CONCLUSIONS Phaco-ExPRESS group and Trab group had similar blebs morphologies in IVCM, with larger microcyst area, looser connective tissue, and less inflammation than Phaco-Trab, indicating that the function of blebs in the Phaco-ExPRESS and Trab group, was more potent than that of Phaco-Trab. All these surgical methods provided adequate IOP control, but Phaco-Trab required more anti-glaucoma medications.
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Affiliation(s)
- Yuqiao Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chunxin Lai
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Suwen Zhao
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China
| | - Ling Li
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China
| | - Xiaoyang Luo
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanlei Chen
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yongyi Niu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yongjie Qin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hongyang Zhang
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China.
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Maheshwari D, Grover DS, Ramakrishnan R, Pillai MR, Chautani D, Kader MA. Early Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma. Ophthalmol Glaucoma 2024; 7:123-130. [PMID: 37839794 DOI: 10.1016/j.ogla.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To study the early postoperative efficacy and safety of an Ab Interno microhook trabeculotomy (microLOT) combined with cataract surgery in patients with open-angle glaucoma. METHODS This prospective, randomized, interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate open-angle glaucoma. One hundred fourteen patients were included for analysis. The patients were randomized to undergo microhook trabeculotomy with phacoemulsification (group 1) or phacoemulsification alone (group 2). All patients were evaluated on postoperative day 1, 15, and 30, as well as 3, 6, and 12 months postoperatively. A P value < 0.05 was considered statistically significant. Baseline and follow-up visits were compared to determine significant differences in the number of antiglaucoma medications (AGMs), intraocular pressure (IOP), and best-corrected visual acuity. RESULTS There were 57 patients in each group. The baseline characteristics were similar between the 2 groups, except the number of AGMs, which was greater in group 2. The mean preoperative IOP for group 1 (phaco-microLOT) was 26.5 mmHg ± 5.2 and group 2 (phaco-alone group) was 25.3 mmHg ± 3.1 which decreased to 12.5 mmHg ±3.6 (P < 0.001) and 20.0 mmHg ± 2.7(P < 0.001) at 12 months, respectively. Logarithm of the minimum angle of resolution visual acuity improved from 0.48 (interquartile range [IQR], 0.30-0.60) preoperatively to 0.00 (0.00-0.18) postoperatively (P < 0001) in group 1 and improved from 0.30 (IQR, 0.30-0.48) to 0.00 (0.00-0.00) in group 2 (P < 0.001). In group 1, the mean (standard deviation [SD]) AGM used preoperatively was 0.6 (0.9) which was significantly reduced to 0.2 (0.5) at 12 months postoperatively, whereas in group 2, at 12 months, the mean (SD) AGM used was reduced from 1.4 (0.6) to 1.1 (0.9). In group 1, 90.3% of eyes achieved complete success at the end of 1 year. The most common complication was hyphema, noted in 4 patients with 1 eye requiring an anterior chamber washout. CONCLUSION Ab interno microhook trabeculotomy (microLOT) combined with phacoemulsification in patients with open-angle glaucoma is an efficacious procedure with relatively minimal complications. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli, India.
| | | | - Rengappa Ramakrishnan
- Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli, India
| | - Madhavi Ramanatha Pillai
- Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli, India
| | - Drishti Chautani
- Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli, India
| | - Mohideen Abdul Kader
- Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli, India
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Kaup S, Kondal D, Shivalli S, Buchan J. Statistical analysis plan for the phaco TIp position during clear corneal Phacoemulsification Surgery (TIPS) randomized controlled trial. Trials 2024; 25:138. [PMID: 38388956 PMCID: PMC10882898 DOI: 10.1186/s13063-024-07979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cornea is the most important refractive media in the eye, and damage to the corneal endothelium is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The role of phaco tip position during phacoemulsification on corneal endothelial damage is ambiguous, and there is no consensus regarding the most cornea-friendly phaco tip position (bevel-up or bevel-down). The objective of the trial is to compare the effect of phaco tip position (bevel-up vs. bevel-down) during phacoemulsification using direct chop technique on corneal endothelial cell count. METHODS AND DESIGN TIPS is a randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio. A total of 480 eligible participants, aged > 18 years with immature cataract, will be randomly allocated into bevel-up and bevel-down groups at two centres. Randomisation will be stratified according to the cataract grade. The primary outcome is postoperative endothelial cell count at 1 month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30 and difference in intraoperative complications. CONCLUSION In this paper, we describe the detailed statistical analysis plan (SAP) for the TIPS trial, which was prepared prior to database lock. The SAP includes details of planned analyses and unpopulated tables, which will be reported in the publications. We plan to lock the database in July 2023 and publish the results later in the same year. SAP Version 0.1 (dated: 28 April 2023) Protocol version:2.0 TRIAL REGISTRATION: Clinical Trial Registry of India CTRI/2019/02/017464. Registered on 5 February 2019; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=29764&EncHid=&userName=2019/02/017464.
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Affiliation(s)
- Soujanya Kaup
- Department of Ophthalmology, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, 575018, India.
- DBT/Wellcome Trust India Alliance (Early Career - Clinical and Public Health) Fellow, Hyderabad, 500034, India.
| | - Dimple Kondal
- Centre for Chronic Disease Control, Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016, India
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Siddharudha Shivalli
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Niu TT, Xin WJ. A case of iridoschisis with partial lens dislocation in both eyes. BMC Ophthalmol 2024; 24:66. [PMID: 38355462 PMCID: PMC10865630 DOI: 10.1186/s12886-024-03330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Iridoschisis is a rare condition that primarily affects individuals aged 60-70 years. The predominant characteristics of iridoschisis involve the tissue splitting and separation of the iris stromal layers, often resulting in two distinct layers and the presence of floating fibers in the anterior chamber. This article reports the case of a 48-year-old male with iridoschisis with partial lens dislocation in both eyes. CASE PRESENTATION Trauma is the leading factor in the development of iridoschisis. However, there is no documented case of ocular trauma in the patient's medical history. Visible white atrophic fibers were observed bilaterally in the anterior iris stroma of both eyes of the individual, accompanied by a small quantity of iris tissue within the anterior chamber. In this instance, the magnitude of the iridoschisis corresponded with the degree of lens dislocation. We were apprised that the patient had regularly used a cervical massager for a prolonged period of time, positioning it upon the ocular region. Frequent stimulation of both eyes with excessive force resulted in the development of iridoschisis and the partial dislocation of the lens.During the initial surgical procedure, phacoemulsification (Phaco) was carried out on the left eye without the placement of an intraocular lens (IOL). Following a two-month interval, we proceeded with the IOL suspension. Subsequently, the right eye underwent Phaco, accompanied by the implantation of an IOL. After closely monitoring the patient's progress for two months, it was evident that their vision had significantly improved, substantiating the success of the surgical interventions. CONCLUSIONS This finding posits that the recurrent friction applied to both eyes may induce iridoschisis and various ocular complications. In the event of ocular intricacies manifesting, expeditious medical intervention becomes imperative.
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Affiliation(s)
- Tong-Tong Niu
- Department of Ophthalmology, Xinjiang 474 Hospital, Urumchi, 830000, China
| | - Wen-Jian Xin
- Department of Ophthalmology, Xinjiang 474 Hospital, Urumchi, 830000, China.
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Yalçınkaya Çakır G, Altan Ç, Çakır İ. Anterior chamber flare and choroidal vascular index as inflammatory markers after uncomplicated phacoemulsification surgery. Int Ophthalmol 2024; 44:35. [PMID: 38332452 DOI: 10.1007/s10792-024-02959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine the effect of phacoemulsification surgery, which is one of the types of cataract surgery by using ultrasonic power to break up the crystalline lens and clean it with vacuum, on anterior chamber flare (ACF) and choroidal vascular index (CVI). METHODS For this cross-sectional study, patients were included if they had cataract with nucleus hardness grade 2 or 3, no systemic inflammatory disease, and not use of anti-inflammatory drugs/prostaglandins preoperatively. ACF using a laser flare meter and CVI in patients underwent uncomplicated phacoemulsification was recorded preoperatively, on the postoperative 1st day, 1st week, and 1st month. RESULTS Fifty-six eyes were included. ACF was 9.00 ± 2.90 ph/ms preoperatively. Although ACF increased significantly on postoperative day-1 (39.38 ± 23.31ph/ms) and decreased gradually until the 1st month (14.03 ± 6.03ph/ms) after the operation, it was still significantly higher at the 1st month (p < 0.001). Macular and peripapillary CVI increased significantly on postoperative day-1 (0.64 ± 0.03/0.63 ± 0.05) and week-1 (0.64 ± 0.04/0.62 ± 0.04) (p = 0.01, p < 0.001); the postoperative 1st month was similar to the preoperative one (0.59 ± 0.06/0.58 ± 0.06). The relationship between the change in ACF and the change in CVI was not significant. CONCLUSION Phacoemulsification causes raises in ACF and CVI due to increased intraocular inflammation. The fact that ACF was significantly higher in postoperative month-1 and CVI returned to its preoperative value suggests that the effect of uncomplicated phacoemulsification surgery on the increase in inflammation in the anterior segment lasts longer than in the posterior segment. These results suggest that ACF and CVI follow-up may be clinically important in the follow-up of postoperative inflammation.
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Affiliation(s)
| | - Çiğdem Altan
- Beyoglu Eye Training and Research Hospital, , University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, Istanbul, Turkey
| | - İhsan Çakır
- Beyoglu Eye Training and Research Hospital, , University of Health Sciences Turkey, Bereketzade Street Number: 2, Beyoglu, Istanbul, Turkey
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Wood K, Pessach Y, Kovalyuk N, Lifshitz M, Winter H, Pikkel J. Corneal endothelial cell loss and intraocular pressure following phacoemulsification using a new viscous-cohesive ophthalmic viscosurgical device. Int Ophthalmol 2024; 44:10. [PMID: 38319386 DOI: 10.1007/s10792-024-02997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/19/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To compare results of two ophthalmic viscosurgical devices (OVDs)-Viscoat (a dispersive OVD, Alcon) and FR-Pro (a viscous-cohesive OVD, Rayner), in phacoemulsification surgery. METHODS A prospective randomized controlled study. Patients undergoing phacoemulsification were randomly assigned to receive one of the two OVDs. Exclusion criteria were age under 40, preoperative endothelial cell count (ECC) below 1,500 cells/mm2 and an eventful surgery. The primary outcome was change in ECC from baseline to postoperative month one and month three. Secondary outcomes were the difference between ECC at postoperative month one and month three, changes in IOP and occurrence of an IOP spike ≥ 30 mmHg after surgery. RESULTS The study included 84 eyes-43 in the Viscoat group and 41 in the FR-Pro group. Mean cell density loss at month one and month three was 17.0 and 19.2%, respectively, for the Viscoat group and 18.4 and 18.8%, respectively, for the FR-Pro group, with no statistically significant difference between the groups (p = 0.772 and p = 0.671, respectively). The mean ECC difference between the month one and month three visits was 50.5 cells/mm2 and was not statistically significant (p = 0.285). One eye in each group had an IOP spike ≥ 30 mmHg, both normalized by postoperative week one. CONCLUSIONS Viscoat and FR-Pro have comparable results following phacoemulsification surgery, suggesting that while FR-Pro is not a dispersive OVD, its endothelial cell protection may be comparable to one, perhaps due to the addition of sorbitol. Furthermore, a one-month follow-up of ECC seems sufficient in such trials.
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Affiliation(s)
- Keren Wood
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel.
| | - Yuval Pessach
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Natalya Kovalyuk
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Michal Lifshitz
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Halit Winter
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
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Lin HZ, Wang JH, Lee YC. Factors Associated with the Efficacy of XEN Gel Implant. Ophthalmol Ther 2024; 13:597-614. [PMID: 38180631 PMCID: PMC10787716 DOI: 10.1007/s40123-023-00876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Microinvasive glaucoma surgery (MIGS) is a growing trend, and XEN gel implant is one of the most effective types of MIGS. This study aimed to examine factors associated with the surgical success of XEN gel implants. METHODS This retrospective cohort study enrolled patients with glaucoma receiving XEN implantation alone or combined with phacoemulsification (PHACOXEN) with a follow-up period of more than 6 months at Hualien Tzu Chi Hospital, Taiwan. If intraocular pressure (IOP) elevated above 20 mmHg during the follow-up, needling or open revision was performed. The primary outcome measures included IOP and the number of glaucoma medications. RESULTS Male patients had lower postoperative IOP; male patients and higher preoperative IOP were associated with higher IOP change rates, and older patients had a higher chance of achieving IOP < 18 mmHg and being medication-free at months 12, 24, and 36. The Kaplan-Meier curve showed that the probability of free-of-rescue intervention over the follow-up period was not different between the XEN alone and the PHACOXEN group (P = 0.859). Both needling and open revision were effective rescue interventions, but open revision had a higher chance of achieving IOP ≤ 18 mmHg and being medication-free (P = 0.031) and required less medication afterward (P = 0.044). Older age (P = 0.013) and male patients (P = 0.022) had a lower IOP after rescue interventions. Compared with open revision, needling was associated with higher IOP (P = 0.048) and more required medications (P = 0.048). CONCLUSIONS XEN alone and PHACOXEN had comparable surgical outcomes, whereas open revision had a better IOP lowering effect than needling as a rescue intervention. Male and older patients had better surgical results in primary XEN implantations and rescue interventions.
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Affiliation(s)
- Hong-Zin Lin
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yung Road, Hualien, 97002, Taiwan, ROC
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yung Road, Hualien, 97002, Taiwan, ROC.
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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12
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Icoz M, Gurturk Icoz SG. Comparison of dominant- and non-dominant-hand cateract surgery outcomes by a single surgeon. Photodiagnosis Photodyn Ther 2024; 45:103895. [PMID: 37977225 DOI: 10.1016/j.pdpdt.2023.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare dominant and non-dominant hand phacoemulsification surgery outcomes. METHODS This retrospective, single-center study included 300 patients who underwent phacoemulsification surgery by a single, right-handed surgeon. The patients were divided into two groups according to whether the surgeon used his dominant or non-dominant hand during surgery. Right eye operations were performed with the right hand, and left eye operations were performed with the left hand. Detailed ophthalmological examinations were performed on all patients preoperatively and postoperatively. Intraoperative phacoemulsification parameters, the presence of intraoperative and postoperative complications, postoperative refractive errors, visual acuity, and surgically induced astigmatism values were compared between the groups. RESULTS There were 171 patients in the dominant hand phacoemulsification group and 129 patients in the non-dominant hand phacoemulsification group. The distributions of age, gender, systemic diseases, and lens opacification were similar between the groups (p>0.05, for all). No statistically significant difference was observed between the two groups in terms of total operation time, phaco power, ellips fx, or ultrasonic time (p>0.05, for all). There was also no significant difference in relation to intraoperative and postoperative complication distributions, postoperative third-month refractive errors, visual acuity, or surgically induced astigmatism values (p>0.05, for all). CONCLUSION This study demonstrated that cataract surgery performed by a single surgeon can be effectively and safely performed using both hands on patients in a real operating theater environment. More objective results can be obtained with surgeries performed by a larger number of experienced surgeons.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey.
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13
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Liu X, Hu Y, Yang T, Wang Z, Wang Z. Impact of improved minimally invasive anterior vitrectomy on the prognosis of patients with malignant glaucoma. BMC Ophthalmol 2024; 24:39. [PMID: 38267918 PMCID: PMC10809461 DOI: 10.1186/s12886-024-03310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The importance of communicating the anterior chamber and vitreous cavity for managing malignant glaucoma (MG) is widely recognized. This study investigated the impact of improved minimally invasive anterior vitrectomy (IAV) on the prognosis of MG. METHODS This retrospective interventional study included patients with MG who underwent conventional surgery or improved minimally IAV in Nanchang Aier Eye Hospital between January 2011 and April 2021. For the improved step, a small amount of triamcinolone acetonide was injected into the vicinity of the iris. Then, the residual vitreous body adhering to triamcinolone acetonide was excised. Comparisons were made using repeated measures ANOVA, t-test, and chi-squared test. RESULTS Thirty-one eyes from 26 patients were included: 15 eyes from 13 patients in the conventional group and 16 eyes from 13 patients in the IAV group. The 1-week, 1-month, and 3-month intraocular pressure (IOP) and the 3-month mean central anterior chamber depth were comparable between the two groups (all P > 0.05). The conventional group showed one eye with intraoperative vitreous hemorrhage and two eyes with postoperative re-shallowing of the anterior chamber; such events did not occur in the IAV group, and none developed corneal endothelial decompensation, IOL deviation, suprachoroidal hemorrhage, or retinal detachment during treatment and follow-up. CONCLUSION Patients with MG who undergo improved minimally IAV might have similar postoperative IOP and central anterior chamber depth compared with conventional surgery but with reduced complications such as intraoperative vitreous hemorrhage and postoperative re-shallowing of the anterior chamber. Improved minimally IAV might be an alternative surgery for MG.
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Affiliation(s)
- Xuequn Liu
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China.
| | - Yan Hu
- Nanyang Eye Hospital of Henan Province, 473000, Nanyang, China
| | - Tian Yang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
| | - Zhong Wang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
| | - Zhen Wang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
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Lidder AK, Vanner EA, Chang TC, Lum F, Rothman AL. Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight). Ophthalmology 2024:S0161-6420(24)00081-2. [PMID: 38246424 DOI: 10.1016/j.ophtha.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective clinical cohort study. PARTICIPANTS Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. METHODS Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. MAIN OUTCOME MEASURES Incidence and OR of IOP spike. RESULTS We analyzed data from 1 191 034 eyes (patient mean age, 71.3 years; 61.2% female sex; and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma, and 3.2% of eyes without glaucoma (P < 0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR, 1.57 per 3 mmHg), male sex (OR, 1.79), glaucoma (OR, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. Hispanic), older age (OR, 1.07 per 10 years), and complex surgery coding (OR, 1.22; all P < 0.0001). Diabetes (OR, 0.90) and aphakia after surgery (OR, 0.60) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-blocker use (OR, 0.68) was protective (both P < 0.0001). CONCLUSIONS Higher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alcina K Lidder
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Wutthayakorn W, Chansangpetch S, Tunruttanakul S. Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial. BMC Ophthalmol 2024; 24:20. [PMID: 38216983 PMCID: PMC10785538 DOI: 10.1186/s12886-024-03284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND This study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification. METHODS This double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher's exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors. RESULTS In total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique. CONCLUSIONS The addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage. TRIAL REGISTRATION Trial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.
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Affiliation(s)
| | - Sunee Chansangpetch
- Center of Excellent in Glaucoma, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suppadech Tunruttanakul
- Department of Surgery, Sawanpracharak Hospital, 43 Atthakawee Road, Muang, Nakhon Sawan, 60000, Thailand.
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Andrews HW, Lin GT, Lindsey JL, Ji X, Chen Q, Chomsky AS. Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series. BMC Ophthalmol 2024; 24:18. [PMID: 38200502 PMCID: PMC10777645 DOI: 10.1186/s12886-023-03278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time. METHODS This retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications. RESULTS Longer operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001). CONCLUSION The results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.
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Affiliation(s)
- Hans W Andrews
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA.
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA.
| | - George T Lin
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- Vanderbilt University School of Medicine, 2209 Garland Ave, Nashville, TN, 37232, USA
| | - Jennifer L Lindsey
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA
| | - Xiangyu Ji
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Nashville, TN, 37232, USA
| | - Qingxia Chen
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Nashville, TN, 37232, USA
| | - Amy S Chomsky
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA
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Chan W, Zhang C, Mittal A, Fink A, Michalovic S, Weiner A. Effect of Preoperative Trabecular Meshwork Pigmentation and Other Eye Characteristics on Outcomes of Combined Phacoemulsification/Minimally Invasive Glaucoma Surgery. Ophthalmol Glaucoma 2024:S2589-4196(24)00008-5. [PMID: 38185378 DOI: 10.1016/j.ogla.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To investigate associations between pigmentation of the trabecular meshwork (PTM) and other preoperative eye characteristics and outcomes of minimally invasive glaucoma surgery combined with phacoemulsification (Phaco/MIGS). DESIGN Retrospective interventional case series. PARTICIPANTS Academic glaucoma clinic patients with symptomatic cataract and glaucoma treated with combined Phaco/MIGS. METHODS Analyzing preoperative PTM, intraocular pressure (IOP), IOP-lowering medications and visual acuity (VA) data in relation to Phaco/MIGS outcomes. MAIN OUTCOME MEASURES Pigmentation of the trabecular meshwork and other preoperative eye characteristics in relation to Phaco/MIGS success defined as postoperative IOP between 5 and 21 mmHg and IOP reduction of ≥ 20% and/or a reduction of ≥ 1 IOP-medications compared to baseline, and final IOP, IOP-lowering medications and VA. RESULTS A total of 265 eyes (172 patients, mean age, 73.5 [standard deviation, 10.0], range 35-95 years, male 40.0%) were identified and categorized with high PTM (108 eyes, 40.8%) or low PTM (157 eyes, 59.2%). The high PTM group, compared with the low PTM group, demonstrated higher preoperative IOP (16.7 [standard error 0.4] vs. 15.2 [0.4] mmHg, P = 0.009), included more eyes with primary open-angle glaucoma (POAG, P = 0.03), fewer eyes with normal-tension glaucoma (NTG, P = 0.01), and fewer eyes with mild stage glaucoma (P = 0.001). Compared to baseline, final IOP decreased by 6.5 [2.4]% and 13.4 [3.0]% (P = 0.075) to 13.5 [0.3] mmHg and 13.6 [0.4] mmHg (P = 0.77) in the low and high PTM groups, respectively, and IOP-lowering medications decreased by 34.6 [4.9]% (n = 116) and 18.1 [7.3]% (n = 85), respectively (P = 0.062). Surgical success was 59.9% and 58.3%, respectively (P = 0.87). It was positively associated with higher preoperative IOP (hazard ratio 1.08 [95% confidence interval 1.04-1.12] P < 0.0001) and higher number of preoperative IOP-medications (1.20 [1.05-1.37] P = 0.007), negatively associated with history of selective laser trabeculoplasty (SLT, 0.40 [0.23-0.68] P = 0.0009) and longer axial length (0.87 [0.80-0.94], P = 0.0006), but was not associated with PTM. CONCLUSIONS Higher PTM was associated with POAG rather than NTG, with more severe glaucoma and higher preoperative IOP, but not with Phaco/MIGS success. Surgical success was positively associated with higher preoperative IOP and number of IOP-medications and negatively associated with history of SLT and longer axial length. These findings may help guide glaucoma surgeons in surgical planning and patient counseling. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Weilin Chan
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Charles Zhang
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Abhiniti Mittal
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Andrew Fink
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Sharon Michalovic
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Asher Weiner
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York.
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Giglio R, Vinciguerra AL, Inferrera L, Tognetto D. Phacoemulsification Wound Burn and Its Management. Case Rep Ophthalmol 2024; 15:303-309. [PMID: 38590942 PMCID: PMC11001284 DOI: 10.1159/000537741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction The production of ultrasonic energy during phacoemulsification is associated with heat generation that could damage ocular tissues, particularly at the corneoscleral wound site. Case Presentation This study presents an 89-year-old patient with senile hypermature cataract and Fuchs endothelial dystrophy developing severe thermal corneoscleral injury during phacoemulsification. At presentation, visual acuity was finger count at 40 cm and there was a 1 × 2-mm area of corneal melting at the corneal tunnel with diffuse corneal oedema. After 1 month, a temporal circular corneal patch graft was applied to the corneal burn. A penetrating keratoplasty was performed 16 months after the first surgery. Conclusion Corneal surgery, including lamellar patch grafts and full-thickness penetrating grafts, could be used, when necessary, to restore the cornea's integrity. These procedures could eliminate corneal scarring, decrease astigmatism, and improve vision in patients with phacoemulsification burns.
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Affiliation(s)
- Rosa Giglio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Leandro Inferrera
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Dossantos J, An J. A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation. J Curr Glaucoma Pract 2024; 18:37-41. [PMID: 38585161 PMCID: PMC10997961 DOI: 10.5005/jp-journals-10078-1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose This study seeks to highlight and explore the occurrence of uveitis with obstructive peripheral anterior synechiae (PAS) after a combined OMNI canaloplasty and Hydrus microstent implantation with phacoemulsification, particularly in a patient with a background of psoriatic arthritis. Observations A 56-year-old male with a medical history of psoriatic arthritis (in remission for 10 years) and primary open-angle glaucoma (POAG) underwent a combined OMNI canaloplasty and Hydrus microstent with phacoemulsification. The surgical procedure was uncomplicated. However, within 2 weeks postsurgery, the patient presented with severe symptoms, including uveitis, elevated intraocular pressure (IOP), and a significant reduction in best-corrected visual acuity (BCVA). This postoperative response was unexpected, especially given the lack of any past history of uveitis in the patient. The complication, potentially influenced by the patient's history of psoriatic arthritis, led to the need for additional interventions, including the implantation of an Ahmed glaucoma valve. Conclusion This case underscores the potential for postoperative complications, specifically uveitis with obstructive PAS, following combined OMNI canaloplasty and Hydrus microstent with phacoemulsification, especially in patients with a history of autoimmune diseases. Careful preoperative history, postoperative monitoring, and a nuanced approach to surgical planning are crucial. The association between systemic inflammatory conditions and ocular complications warrants deeper exploration to ensure optimal patient care. How to cite this article Dossantos J, An J. A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation. J Curr Glaucoma Pract 2024;18(1):37-41.
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Affiliation(s)
- Jason Dossantos
- Department of Ophthalmology, GW School of Medicine and Health Sciences (SMHS), Washington, DC, State of Washington, United States of America
| | - Jella An
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, State of Washington, United States of America
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Cheng AMS, Vedula GG, Kubal AA, Moxam J, Yang DTY, Gupta SK. Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification. J Curr Glaucoma Pract 2024; 18:28-30. [PMID: 38585167 PMCID: PMC10997956 DOI: 10.5005/jp-journals-10078-1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/16/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and background Combined endocyclophotocoagulation and phacoemulsification (ECP/Phaco) are uncommonly associated with complications. We present the first case of a rare complication following ECP/Phaco. Case description A 72-year-old patient with dense nuclear sclerotic cataracts and primary open-angle glaucoma (POAG) underwent bilateral surgery uneventfully. He experienced a brief episode of postoperative elevated intraocular pressure (IOP), but only one eye with a lower baseline IOP developed a dilated pupil. No pupillary response was observed after applying 4% pilocarpine. The fixed mydriasis persisted without reaction to light or near stimulus, and the best-corrected vision (BCVA) was 20/30 in the affected eye. Conclusion This case reports a possible rare complication when undergoing ECP/Phaco therapy. The pathogenesis of Urrets-Zavalia syndrome is unknown, but we hypothesized that eyes with more pronounced increases in IOP from baseline may be more susceptible to ischemic injury to the pupillary sphincter, resulting in a chronically dilated pupil. Clinical significance Even a modest transient rise in postoperative IOP in a glaucomatous eye with normal baseline IOP could result in a chronically dilated pupil. How to cite this article Cheng AMS, Vedula GG, Kubal AA, et al. Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification. J Curr Glaucoma Pract 2024;18(1):28-30.
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Affiliation(s)
- Anny MS Cheng
- Department of Ophthalmology, Broward Health, Fort Lauderdale; Department of Ophthalmology, Specialty Retina Center, Coral Springs; Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States of America
| | - Geetha G Vedula
- Department of Ophthalmology, Your Eye Specialists, Weston, Florida, United States of America
| | - Aarup A Kubal
- Department of Ophthalmology, Your Eye Specialists, Weston, Florida, United States of America
| | - Jillene Moxam
- Department of Ophthalmology, Specialty Retina Center, Coral Springs, Florida, United States of America
| | - David TY Yang
- College of Biological Science, University of California, Davis, Sacramento, California, United States of America
| | - Shailesh K Gupta
- Department of Ophthalmology, Broward Health, Fort Lauderdale; Department of Ophthalmology, Specialty Retina Center, Coral Springs, Florida, United States of America
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21
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Memon MS, Mahmood T, Qidwai U, Ahsan S, Arslan M, Fahim MF. A comparative analysis of postoperative visual outcomes following cataract surgery with different brands of Monofocal Intraocular Lenses. Pak J Med Sci 2024; 40:195-199. [PMID: 38196465 PMCID: PMC10772437 DOI: 10.12669/pjms.40.1.8157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To compare visual outcomes after cataract surgery using three intraocular lenses (IOL) of different prices but similar properties. Methods A comparative study with retrospective data of patients operated for phacoemulsification with monofocal IOL implants was carried out at Al-Ibrahim Eye Hospital (AIEH) from April 2021 to Feb 2022. Patients with diabetes, any preoperative ocular morbidity and unclear diagnosis were excluded from the study. Pre and post-operative best corrected visual acuity (BCVA) on 1st day, 7th day and 4-6 weeks were analyzed. IOLs were categorized on the basis of price into economical, standard and premium lenses. To minimize surgical bias, data was further stratified on the basis of surgical expertise. Results Data of 3237 patients was analyzed. Economical lens (A) was implanted in 2647, standard (B) in 254 and premium (C) in 336 patients. On average BCVA (6/6 to 6/12) was achieved in 88.2% of patients. No significant difference was found at third follow up among BCVA of three IOls operated by senior surgeon, χ2(2) = 3.216, p = 0.20, with median (IQR) is 0.2(0.2) logMAR for Group-A, 0.1(0.2) logMAR for Group-B and 0.2(0.1) logMAR for Group-C. When results of the rest of the surgeons was considered, significant difference was found among BCVA at 3rd follow-up, χ2(2) = 6.661, p = 0.036, with median (IQR) is 0.3(0.2) logMAR for Group-A, 0.2(0.1) logMAR for Group-B and 0.2(0.3) logMAR for Group-C. Conclusion When surgical factors mainly, surgeon bias is removed, all three types of monofocal IOL had similar visual outcomes.
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Affiliation(s)
- Muhammad Saleh Memon
- Muhammad Saleh Memon, FRCS(Eden) Department of Ophthalmology, Al Ibrahim Eye Hospital, Isra Postgraduate, Institute of Ophthalmology, Karachi, Pakistan
| | - Tauseef Mahmood
- Mr. Tauseef Mahmood, M.Sc. (Statistics) Department of Research, Al Ibrahim Eye Hospital, Isra Postgraduate, Institute of Ophthalmology, Karachi, Pakistan
| | - Umair Qidwai
- Dr. Umair Qidwai, FRCOphth, FRCS, FCPS, MBBS Department of Ophthalmology, Al Ibrahim Eye Hospital, Isra Postgraduate, Institute of Ophthalmology, Karachi, Pakistan
| | - Shahid Ahsan
- Dr. Shahid Ahsan, M. Phil (Bio), M. Phil (NCD), PhD fellow Department of Biochemistry, Jinnah Medical & Dental College, Karachi, Pakistan
| | - Muhammad Arslan
- Mr. Muhammad Arslan, (MCSW) Department of Research & Excellence, Al-Tibri Medical College, Karachi, Pakistan
| | - Muhammad Faisal Fahim
- Mr. Muhammad Faisal Fahim, M.Sc. (Statistics) Department of Research, Bahria University of Medical and Dental College, Karachi, Pakistan
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Zhang Y, Cheng G, Chen Y, Bian A, Zhou Q, Li L, Zhang S. Comparison of Long-Term Effects Following Phacoemulsification Combined with Goniosynechialysis and Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Cataract. Ophthalmol Ther 2024; 13:423-434. [PMID: 38041720 PMCID: PMC10776539 DOI: 10.1007/s40123-023-00823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/19/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. METHODS A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. RESULTS The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. CONCLUSIONS Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.
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Affiliation(s)
- Yang Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Gangwei Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China.
| | - Yao Chen
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Qi Zhou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Lüe Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
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Stopyra W, Langenbucher A, Grzybowski A. Intraocular Lens Power Calculation Formulas-A Systematic Review. Ophthalmol Ther 2023; 12:2881-2902. [PMID: 37698825 PMCID: PMC10640516 DOI: 10.1007/s40123-023-00799-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE The proper choice of an intraocular lens (IOL) power calculation formula is an important aspect of phacoemulsification. In this study, the formulas most commonly used today are described and their accuracy is evaluated. METHODS This review includes papers evaluating the accuracy of IOL power calculation formulas published during the period from January 2015 to December 2022. The articles were identified by a literature search of medical and other databases (PubMed/MEDLINE, Crossref, Web of Science, SciELO, Google Scholar, and Cochrane Library) using the terms "IOL formulas," "Barrett Universal II," "Kane," "Hill-RBF," "Olsen," "PEARL-DGS," "EVO," "Haigis," "SRK/T," and "Hoffer Q." Twenty-nine of the most recent peer-reviewed papers in English with the largest samples and largest number of formulas compared were considered. RESULTS Outcomes of mean absolute error and percentage of predictions within ±0.5 D and ±1.0 D were used to evaluate the accuracy of the formulas. In most studies, Barrett achieved the smallest mean absolute error and PEARL-DGS the highest percentage of patients with ±0.5 D in short eyes, while Kane obtained the highest percentage of patients with ±0.5 D in long eyes. CONCLUSIONS The third- and fourth-generation formulas are gradually being replaced by more accurate ones. The Barrett Universal II among vergence formulas and Kane and PEARL-DGS among artificial intelligence-based formulas are currently most often reported as the most precise.
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Affiliation(s)
| | - Achim Langenbucher
- Department of Experimental Ophthalmology, Saarland University, 66421, Homburg, Germany
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553, Poznan, Poland.
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24
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Ton L, Zhang W, Saifee M, Walia A, Oatts J, Han Y. Severe proptosis during cataract surgery. Am J Ophthalmol Case Rep 2023; 32:101901. [PMID: 37554298 PMCID: PMC10405188 DOI: 10.1016/j.ajoc.2023.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE We report an unusual case of severe proptosis during phacoemulsification in a 58-year-old female with a history of Crohn's disease, bilateral chronic panuveitis, prior bilateral central retinal vein occlusion, and uncontrolled steroid-associated ocular hypertension requiring bilateral Ahmed glaucoma drainage device (GDD) implantation with pars plana tube placement. OBSERVATIONS During phacoemulsification of the right eye, the patient developed significant proptosis. Following lid speculum removal and mechanical eyelid manipulation, the proptosis resolved within 20 minutes without requiring a lateral canthotomy. The patient had no permanent visual complications. CONCLUSIONS AND IMPORTANCE The likely pathophysiology of intraoperative proptosis in this case was accumulation of fluid in the retrobulbar space due to a functioning Ahmed tube shunt with the tube placed in the vitreous cavity. To avoid this complication, concurrent cataract surgery may be considered for patients with pars plana tube placement GDD surgery.
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Affiliation(s)
- Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wanlin Zhang
- University of California Berkeley, Berkeley, CA, USA
| | - Murtaza Saifee
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Anushka Walia
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Julius Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Tranos P, Dimacali V, Vasileiou D, Koronis S, Rasoglou A, Panos GD, de Politis PB, Ambrosio R, Gatzioufas Z. The Effects of Uneventful Phacoemulsification on Subfoveal Choroidal Thickness. Ophthalmol Ther 2023; 12:3013-3023. [PMID: 37656400 PMCID: PMC10640452 DOI: 10.1007/s40123-023-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION To evaluate the impacts of phacoemulsification preoperative and intraoperative factors on postoperative subfoveal choroidal thickness (SFCT). METHODS This prospective interventional study was conducted on patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation at the private clinic Ophthalmica Eye Institute, in Thessaloniki, Greece. Forty-six eyes of 46 patients were included in the study. Operative time (OT), phacoemulsification time (PT), effective phacoemulsification time (EPT) and phacoemulsification power (PP) were recorded for each patient. All patients received dexamethasone and nepafenac drops for 4 weeks postoperatively. Choroidal thickness (CT) at five anatomical locations was measured preoperatively and at 1 week, 1 month and 3 months postoperatively. RESULTS Subfoveal choroidal thickness significantly increased over baseline thickness at 1 week postoperatively, returned to preoperative levels at 1 month and increased again at 3 months. Changes at 1 week and 3 months postoperatively correlated to baseline choroidal thickness (p = 0.023 and p = 0.011, respectively). Spherical equivalent (SE) inversely correlated to SFCT throughout the entire follow-up period (baseline p = 0.044, 1-week p = 0.011, 1-month p = 0.013, 3-month p = 0.018). EPT was the most significant determinant of increased SFCT at all time points (1-week p = 0.011, 1-month p = 0.01, 3-month p = 0.015). PT and PP significantly correlated to the SFCT increase at 3 months postoperatively (p = 0.033 and p = 0.043, respectively). OT was not associated with a change in SFCT at any time point (p > 0.05). CONCLUSION Phacoemulsification can alter choroidal thickness until at least 3 months after surgery. Preoperative and intraoperative factors, notably SE, baseline SFCT, PT, PP and especially EPT, can influence postoperative CT increase.
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Affiliation(s)
| | | | | | | | | | - Georgios D Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Rd, Lenton, Nottingham, NG7 2UH, UK.
- Division of Ophthalmology and Visual Sciences, Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | | | - Renato Ambrosio
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Zisis Gatzioufas
- Department of Ophthalmology, University of Basel, Basel, Switzerland
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Wu X, Liu X, Xiao S, Cai Y, Yu M, Xu B, Wang Y, Wu W. Efficacy and safety of primary customized phacoemulsification combined with goniosynechialysis for refractory acute primary angle closure. Int Ophthalmol 2023; 43:4515-4525. [PMID: 37572168 DOI: 10.1007/s10792-023-02852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE To assess the safety, efficacy, and long-term clinical outcomes of primary customized phacoemulsification (phaco) combined with goniosynechialysis (GSL; phaco-GSL) in refractory acute primary angle closure (APAC) eyes with uncontrolled high intraocular pressure (IOP). METHODS This retrospective case series comprised 51 eyes of 42 consecutive patients with refractory APAC and high IOP who were treated using primary customized phaco-GSL at 3 hospitals in China, from 2014 to 2021. Preoperative and postoperative IOP, corrected distant visual acuity (CDVA), corneal endothelial cell density (CECD), intraoperative and postoperative complications were recorded. The safety, efficacy and subsequent long-term clinical outcomes were analyzed. RESULTS The mean CDVA (LogMAR) was improved from 1.67 ± 0.94 preoperatively to 0.23 ± 0.26 postoperatively (P < 0.001). Preoperative CECD was 2309.39 ± 541.03 cells/mm2 in 33 eyes and inaccessible in 18 eyes due to severe corneal edema; at the final follow-up, the mean CECD of all patients was 1823.50 ± 533.40 cells/mm2 (P < 0.001). The mean IOP decreased from 48.51 ± 6.25 mmHg preoperatively to 15.66 ± 2.27 mmHg at the final follow-up (P < 0.001). Among 51 eyes, additional customized procedures performed were corneal indentation in 42 eyes, epithelial debridement in 9 eyes, giant epithelial bullae view in 4 eyes, pars-plana fluid aspiration in 3 eyes, and secondary intraocular lens implantation in 7 eyes. The IOP of all eyes was well controlled eventually and 47 eyes (92.16%) were successfully treated by phaco-GSL alone. No significant intraoperative or postoperative complications were observed. CONCLUSIONS Primary customized phaco-GSL is a safe and effective surgical management strategy for patients with refractory APAC and high IOP.
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Affiliation(s)
- Xinna Wu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China
| | - Xiaobao Liu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Suzhen Xiao
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yajing Cai
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Mengting Yu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong, China
| | - Binqiang Xu
- Department of Ophthalmology, Guangze County Hospital, Nanping, China
| | - Yanling Wang
- Department of Ophthalmology, Funing County Hospital, Ningde, China
| | - Wenjie Wu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
- Department of Ophthalmology, Fujian Provincial Hospital, 134.Dongjie Rd, Fuzhou, 350001, Fujian Province, China.
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Ahmad KT, Chauhan MZ, Soliman MK, Elhusseiny AM, Yang YC, Sallam AB. Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study. Graefes Arch Clin Exp Ophthalmol 2023; 261:3511-3520. [PMID: 37347245 DOI: 10.1007/s00417-023-06120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery. DESIGN Retrospective clinical database study. METHODS Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26). MAIN OUTCOMES AND MEASURES We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD). RESULTS Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different. CONCLUSION In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.
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Affiliation(s)
- Kinza T Ahmad
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Muhammad Z Chauhan
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman M Elhusseiny
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA.
- Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom.
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Mahmoud MSED, Omar IAN, AttaAllah HR. Evaluation of the corneal thickness and endothelial changes following uncomplicated phacoemulsification in diabetic and non-diabetic patients with pseudo-exfoliation syndrome by specular microscopy. Int Ophthalmol 2023; 43:4773-4780. [PMID: 37721703 DOI: 10.1007/s10792-023-02877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX. METHODS This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT. RESULTS By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction. CONCLUSION Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications. STUDY REGISTRATION NUMBER The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).
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Affiliation(s)
| | | | - Heba Radi AttaAllah
- Ophthalmology Department, Faculty of Medicine, Minia University Hospital, Minia, Egypt.
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Jevnikar K, Počkar S, Umek L, Rothova A, Valentincic NV. Prognostic factors of cataract surgery in patients with uveitis. Int Ophthalmol 2023; 43:4605-4612. [PMID: 37697081 PMCID: PMC10724088 DOI: 10.1007/s10792-023-02860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To evaluate the long-term visual outcomes of patients with uveitis undergoing cataract surgery and to identify possible factors influencing the visual prognosis and the development of postoperative complications. METHODS Retrospective study of all patients with uveitis who underwent cataract surgery between January 2015 and February 2020 in our tertiary referral center. RESULTS A total of 78 eyes from 78 patients were included in the study. The best-corrected visual acuity (BCVA) improved in 86% of patients, and a BCVA of 0.5 or better was achieved in 57 (73%) patients. A significant correlation was shown between the preoperative and postoperative BCVA (Spearman r = 0.521, p < 0.01). Final BCVA differed between diverse anatomical uveitis entities (p = 0.047), and anterior uveitis demonstrated the best outcomes. Chronic uveitis resulted in a worse final BCVA than acute recurrent uveitis (p = 0.001). The presence of CME any time before the surgery and intermediate uveitis were associated with worse visual prognosis, while systemic therapy for uveitis before surgery and iris manipulation during surgery were not related to visual outcomes. Postoperative development of cystoid macular edema (CME) was closely associated with preexisting CME (p < 0.001) and intermediate uveitis (p = 0.01). CONCLUSIONS Visual results of cataract surgery in patients with uveitis were beneficial, but limited visual outcomes were more frequently observed in patients with chronic uveitis and intermediate uveitis with a history of CME. In consequence, prevention, or adequate treatment of CME, especially in patients with intermediate uveitis, might result in better visual results of their cataract surgery.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Saša Počkar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lan Umek
- Faculty of Public Administration, University of Ljubljana, Ljubljana, Slovenia
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasa Vidovic Valentincic
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Galvis V, Prada AM, Tello A, Parra MM, Camacho PA, Polit MP. Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3215-3221. [PMID: 37227478 PMCID: PMC10587335 DOI: 10.1007/s00417-023-06095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Angelica Maria Prada
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia.
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia.
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Maria Margarita Parra
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
| | - Paul Anthony Camacho
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - María Paz Polit
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
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Wang HF, Pan DY, Wei XH. Posterior microphthalmos with exudative retinal detachment after piggyback intraocular lens implantation: A case report. Asian J Surg 2023; 46:4924-4926. [PMID: 37311672 DOI: 10.1016/j.asjsur.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Hui-Fang Wang
- Department of Ophthalmology, Shijiazhuang Aier Eye Hospital, Shijiazhuang, 050000, China; Aier School of Ophthalmology, Central South University, Changsha, 410000, China
| | - Dong-Yan Pan
- Department of Ophthalmology, Shijiazhuang Aier Eye Hospital, Shijiazhuang, 050000, China
| | - Xing-Hong Wei
- Department of Ophthalmology, Shijiazhuang Aier Eye Hospital, Shijiazhuang, 050000, China; Aier School of Ophthalmology, Central South University, Changsha, 410000, China.
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Nagata M, Matsushima H, Mukai K, Senoo T, Nishi O. Inhibition of anterior capsule opacification and contraction by the elevated anterior rim of the intraocular lens optic. Jpn J Ophthalmol 2023; 67:693-698. [PMID: 37535105 DOI: 10.1007/s10384-023-01013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate. STUDY DESIGN Retrospective cohort study. METHODS We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images. RESULTS The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes. CONCLUSION The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.
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Affiliation(s)
- Mayumi Nagata
- Department of Ophthalmology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Hiroyuki Matsushima
- Department of Ophthalmology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Koichiro Mukai
- Department of Ophthalmology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Tadashi Senoo
- Department of Ophthalmology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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Gobeka HH, Gülyeşil FF, Yozgat Z, Sabaner MC. Quality assessment and comparison of two- and three-dimensional YouTube videos as additional educational tools for cataract surgery: "METAVERSE". Ir J Med Sci 2023; 192:2427-2433. [PMID: 36529822 DOI: 10.1007/s11845-022-03252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To compare the content and quality of 3D YouTube videos with 2Ds as additional educational tools for phacoemulsification surgery. METHODS This cross-sectional study included 2D and side-by-side 3D phacoemulsification videos found on YouTube by searching for "phacoemulsification," "phaco," and "cataract." Data was collected on video length (min), time since upload (days), number of views, likes, dislikes, cataract type, chop technique, and visualization system. Video popularity and interaction were calculated by video power index, interaction index, and viewing rate. Two senior ophthalmologists (SOs) and two ophthalmology residents (ORs) evaluated videos using the DISCERN, global quality score (GQS), and usefulness scoring systems. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC). RESULTS A total of 457 videos were screened, with 85 in 2D and 85 in 3D deemed appropriate for analysis. 2D videos received significantly more views, likes, dislikes, days since upload, video power index, and viewing rate than 3Ds (p < 0.001). Video length and interaction index in 3D videos were significantly greater than in 2Ds (p < 0.001). All video scoring systems revealed that 3D videos outperformed 2Ds in ORs (p < 0.05). ICC confirmed good inter-rater reliability agreement even at the lowest value (SOs: 0.924, 95% CI, 0.910-0.937; ORs: 0.892, 95% CI, 0.878-0.908). CONCLUSIONS 3D YouTube videos as additional educational tools could help not only SOs but also ORs fully comprehend the breadth and depth of ocular surgeries, particularly phacoemulsification, by improving depth perception. They can also be used to review previously learned procedures, observe new ones, and recall old ones.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | | | - Zubeyir Yozgat
- Department of Ophthalmology, Training and Research Hospital, Kastamonu University, Kastamonu, Turkey
| | - Mehmet Cem Sabaner
- Department of Ophthalmology, Kütahya Health Sciences University, Evliya Celebi Training and Research Hospital, Kütahya, Turkey
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Kim JY, Kim H, Jun I, Kim TI, Seo KY. Effect and Safety of Pressure Sensor-equipped Handpiece in Phacoemulsification System. Korean J Ophthalmol 2023; 37:387-394. [PMID: 37562441 PMCID: PMC10587456 DOI: 10.3341/kjo.2022.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/14/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To evaluate the effect of the Active Sentry handpiece of the Centurion Vision System compared to the Centurion Ozil handpiece for phacoemulsification in cataract surgery. METHODS A retrospective study was conducted on 281 patients (449 eyes) who underwent cataract surgery between August 2020 and June 2021. Preoperative measurements, intraoperative parameters, complication rate, and postoperative outcomes were compared between the Active Sentry handpiece and the Centurion Ozil handpiece groups. Additionally, the parameters were compared in different cataract severity groups and multiple predictive factors for the number of active surge mitigation (ASM) actuations were assessed with the Active Sentry handpiece. RESULTS There were 198 eyes in the Active Sentry group and 251 eyes in the Centurion Ozil group. There were no statistically significant differences between the two groups, as the cumulative dissipated energy in the Active Sentry and Centurion Ozil groups were 8.32 ± 7.74 and 7.87 ± 9.25 μJ, respectively (p = 0.576). Total surgery time, ultrasound usage time, aspiration time, amount of fluid aspirated, postoperative corrected distant visual acuity, and postoperative decrease in corneal endothelial cell density were comparable between the two groups. The significant contributors to the number of ASM actuations were age, preoperative corrected distant visual acuity, axial length, and total ultrasound time. CONCLUSIONS There was no clear advantage of the Active Sentry handpiece compared to the Centurion Ozil handpiece. ASM actuation increases with age, poor visual acuity before surgery, short axial length, and prolonged ultrasound usage time. It is expected that in more severe and high-risk cataract surgery, the Active Sentry handpiece functions more effectively, possibly affecting the safety and prognosis.
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Affiliation(s)
- Jin Yeong Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Harin Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Tae-Im Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
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Rodrigues MV, Garcia JMB, Pacheco KD, Borges FT, Isaac DLC, Avila M. Pseudophakic macular edema in nondiabetic and diabetic patients without diabetic retinopathy treated with intravitreal dexamethasone implant. Int J Retina Vitreous 2023; 9:56. [PMID: 37723594 PMCID: PMC10506302 DOI: 10.1186/s40942-023-00489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the impact of intravitreal dexamethasone (DEX) implant during a 12-month period in nondiabetic and diabetic patients without diabetic retinopathy (DR) as a treatment for refractory pseudophakic cystoid macular edema (PCME) following prior treatment with topical nepafenac 0.1% and prednisolone 1%. METHODS Forty-two consecutive medical records of patients diagnosed with PCME after uneventful cataract surgery were included. The outcomes measured included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Linear regression analysis was statistically applied. RESULTS Following topical treatment, nondiabetic and diabetic subjects presented a mean ± SD gain of - 0.11 ± 0.11 and - 0.18 ± 0.11 BCVA logMAR and a CFT reduction of - 43.42 ± 53.66 µm and - 58.76 ± 36.28 µm, respectively. The mean BCVA gain at month 12 subsequent to DEX implantation was - 0.35 ± 0.17 in nondiabetic (p < 0.001) and - 0.55 ± 0.26 in diabetic patients (p < 0.001), with CFT reductions of - 195.71 ± 93.23 µm (p < 0.001) and - 260.81 ± 198.69 µm (p < 0.001), respectively. Patients who responded with better VA after topical treatment presented better visual outcomes at month 12 following DEX implantation (r2 = 0.46; rho = - 0.71, p < 0.01). CONCLUSION Nondiabetic and diabetic patients without DR demonstrated similar results after DEX implant after combined topical therapy, suggesting that selected diabetic patients may have a response comparable to that of nondiabetic patients with PCME.
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Affiliation(s)
- Magna Vanessa Rodrigues
- Centro Brasileiro da Visao, Brasilia, DF, Brazil.
- Federal University of Goias, Centro de Referencia em Oftalmologia (CEROF), Goiania, GO, Brazil.
| | | | | | | | | | - Marcos Avila
- Centro Brasileiro da Visao, Brasilia, DF, Brazil
- Federal University of Goias, Centro de Referencia em Oftalmologia (CEROF), Goiania, GO, Brazil
- Centro Brasileiro de Cirurgia de Olhos, Goiania, GO, Brazil
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Wilczynski M, Kucharczyk-Pospiech M, Omulecki W. The influence of corneal tunnel length on surgically induced astigmatism after various types of microincision phacoemulsification. Eur J Ophthalmol 2023; 33:1939-1945. [PMID: 36851812 DOI: 10.1177/11206721231160387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques. METHODS Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA. RESULTS Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method. CONCLUSIONS Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.
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Gunay BO. Paracentral acute middle maculopathy in a fasting patient after cataract surgery and its response to hyperbaric oxygen therapy. Photodiagnosis Photodyn Ther 2023; 43:103714. [PMID: 37454919 DOI: 10.1016/j.pdpdt.2023.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Paracentral acute middle maculopathy (PAMM) is a structural optical coherence tomography (OCT) sign secondary to ischemia in the intermediate and deep retinal vascular network, characterized by hyperreflectivity in the inner nuclear layer (INL). AIM Our objective is to demonstrate PAMM development following uncomplicated cataract surgery, possibly triggered by fasting and dehydration. We also aim to emphasize the potential role of hyperbaric oxygen therapy in treating PAMM. CASE PRESENTATION A 66-year-old man with a past medical history of Neurofibromatosis type 1 and cardiovascular disease underwent uncomplicated cataract surgery in the left eye. The patient was also fasting due to Ramadan. The patient complained of very low vision during the routine postoperative examination on the third day. His-best-corrected visual acuity (BCVA) was counting fingers at 1 meter. His-anterior and posterior segment examination was unremarkable. In infrared imaging, a large hyporeflective area was observed in the parafoveal region, and structural OCT also showed increased hyperreflectivity in the middle retinal layers corresponding to the junction of INL and outer plexiform layer (OPL) involving the entire INL which suggested PAMM. Following 14 sessions of hyperbaric oxygen therapy, the patient's BCVA increased to 0.9 on the 14th day of diagnosing PAMM. CONCLUSION To the best of our knowledge, this is the first case representing a patient with PAMM triggered by fasting and cataract surgery who responded positively to hyperbaric oxygen therapy. However, triggering of PAMM by fasting is entirely unproven and that this observation occurred in a highly complex case with many other possible contributing factors. Also, the triggering of PAMM by some manipulation during surgery is equally unproven.
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Affiliation(s)
- Betul Onal Gunay
- Department of Ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
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Zhang Y, Wang S, Lin H, He B, Liu Y, Yang B, Chen Y, Niu Y, Qin Y, Zhang H. Ocular Characteristics of Pseudophakic Eyes with Malignant Glaucoma. Ophthalmic Res 2023; 66:1159-1168. [PMID: 38130005 PMCID: PMC10614631 DOI: 10.1159/000533496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/04/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the clinical characteristics and treatment outcomes of the pseudophakic eyes with malignant glaucoma (MG). METHODS This retrospective case-control study enrolled 53 eyes of 47 patients with primary angle-closure glaucoma having cataract surgery history, including 19 patients (25 eyes) diagnosed with MG and 28 patients (28 eyes) without MG as the match. Among patients diagnosed with MG, 14 patients (18 eyes) underwent zonulo-hyaloido-vitrectomy (ZHV) and the other 5 patients (7 eyes) received conservative treatments. The visual acuity, refraction status, intraocular pressure (IOP), extent of peripheral anterior synechia, classes of anti-glaucoma medications, and ultrasound biomicroscopy (UBM) examination were recorded before cataract surgery, at the diagnosis of MG, and 3 months after ZHV or atropine application, respectively. RESULTS In the pseudophakic eyes with MG, the IOP cannot be well controlled compared to the matched eyes (27.24 ± 8.72 mm Hg vs. 14.30 ± 2.63 mm Hg, p < 0.001). In addition, there was a difference in the average spherical equivalent refractive error between 2 groups of patients (-2.23 ± 0.84 D in MG vs. -0.12 ± 0.64 D in the matched eyes, p < 0.001). By UBM analysis, the anterior chamber depth (ACD) was shallower in MG than that in the matched eyes (2.34 ± 0.20 mm vs. 3.47 ± 0.29 mm, p < 0.001). The difference between the anterior vault distance of the pseudophakic eyes with MG and that of the matched eyes was also significant (p < 0.001). After treated with ZHV, the IOP was greatly decreased from 27.84 ± 10.14 mm Hg to 15.85 ± 4.41 mm Hg (p < 0.001). The refractive error also changed from -2.11 ± 0.91 D to +0.42 ± 0.99 D (p < 0.001). At the same time, the central ACD was significantly deepened from 2.30 ± 0.39 mm to 3.30 ± 0.31 mm (p < 0.001). CONCLUSION Uncontrolled IOP and shallow anterior chamber both centrally and peripherally are the primary clinical characteristics for the pseudophakic eyes with MG. An unexpected refractive error or myopic shift for the eyes with PACG after cataract surgery can be an important hint for diagnosis of MG. The typical UBM image is an anterior displacement of the lens-iris diaphragm and a bow-shaped change of the intraocular lens. It is an effective way to treat pseudophakic MG with the ZHV through a peripheral iridectomy.
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Affiliation(s)
- Yulin Zhang
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Sheng Wang
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongliang Lin
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Beiting He
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yiliang Liu
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Baodi Yang
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Yanlei Chen
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yongyi Niu
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yongjie Qin
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Hongyang Zhang
- Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
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Baumgarten S, Lohmann T, Prinz J, Walter P, Plange N, Fuest M. [Ab interno trabeculotomy without/with cataract operation-An alternative treatment before or instead of trabeculectomy in patients with high intraocular pressure?]. Ophthalmologie 2023; 120:825-831. [PMID: 36934332 DOI: 10.1007/s00347-023-01835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Trabeculotomy with the Kahook knife is a new ab interno minimally invasive glaucoma surgery (MIGS) procedure. The MIGS are usually performed in early to intermediate glaucoma eyes. In this retrospective study we analyzed the intraocular pressure (IOP) and topical glaucoma eye drop therapy (Meds) reduction achieved by the Kahook trabeculotomy (TO) without (n = 19) or with (n = 18) combined cataract operation (Cat-TO) as initial treatment before or to avoid filtering surgery. MATERIAL AND METHODS A total of 37 eyes of 37 patients were examined when IOP was > 21 mm Hg in at least 2 examinations despite the maximum tolerable Meds applied. Cat-TO was performed in 18 phakic eyes (primary open-angle glaucoma, POAG = 11, pseudoexfoliation glaucoma, PEX = 5, ocular hypertension, OHT = 2). In 19 pseudophakic eyes (POAG = 12, PEX = 6, OHT = 1) an isolated TO was executed. Complete success (no Meds) and relative success (irrespective of Meds) for IOP ≤ 21 mm Hg, ≤ 18 mm Hg, ≤ 16 mm Hg were evaluated 2, 6 and 12 months postoperatively. RESULTS The IOP was significantly reduced from preoperatively to 2 months after Cat-TO as well as after TO (Cat-TO: 26.8 ± 5.9 mm Hg to 16.0 ± 2.9 mm Hg, p < 0.001; TO: IOD 28.2 ± 5.6 mm Hg to 16.3 ± 3.5 mm Hg, p < 0.001). Meds reduction after Cat-TO as well as after TO was not significant (Cat-TO: 2.1 ± 1.3 to 1.3 ± 1.3, p = 0.11; TO: Meds 2.7 ± 1.1 to 2.2 ± 1.3, p = 0.23); however, Meds reduction after 6 and 12 months was significantly greater in the Cat-TO group compared to the TO group (p = 0.02). The IOP and Meds did not change significantly from 2 to 6 months. After Cat-TO, qualified success after 12 months for IOP ≤ 18 mm Hg was 61% (11/18) and for IOP ≤ 16 mm Hg 28% (5/18). After TO, qualified success after 12 months for TO was 47% (9/19) for IOP ≤ 18 mm Hg and 26% (5/19) for IOP ≤ 16 mm Hg. The intervention was not sufficient for 7 patients after TO and 2 patients after Cat-TO (IOP two times > 21 mm Hg). CONCLUSION The first year results show that TO as well as Cat-TO are effective minimally invasive interventions to delay or even avoid a filtrating operation. In case of Meds intolerance and target IOP ≤ 16 mm Hg Cat-TO is not sufficient.
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Affiliation(s)
- Sabine Baumgarten
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Tibor Lohmann
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Julia Prinz
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Peter Walter
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Niklas Plange
- Augenzentrum am Annapark, Steigerweg 3, 52477, Alsdorf, Deutschland
| | - Matthias Fuest
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Choi YJ, Jee D. Postoperative Refractive Outcomes of Biometric Formulas in Phacovitrectomy with Gas Tamponade. Korean J Ophthalmol 2023; 37:322-327. [PMID: 37563972 PMCID: PMC10427902 DOI: 10.3341/kjo.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To investigate the refractive accuracy of intraocular lens (IOL) power calculation for biometric formulas in phacovitrectomy. METHODS This retrospective study included 357 eyes of 357 patients who underwent phacovitrectomy using four commonly available IOL power formulas: Hoffer Q (87 eyes), Holladay 1 (78 eyes), Holladay 2 (91 eyes), and SRK/T (101 eyes). The mean refractive error (ME) and the mean absolute refractive error (MAE) were calculated based on the predicted postoperative refraction error, and they were compared using analysis of variance test. Subjects were divided into high myopic eyes (axial length, ≥26 mm) and nonhigh myopic eyes (axial length, <26 mm). RESULTS The ME and the MAE after phacovitrectomy did not show a significant difference among the four IOL power formulas (p = 0.546 and p = 0.495, respectively). There was no significant statistical difference in formulas when the eyes were grouped into high myopia and nonhigh myopia (ME: p = 0.526 and p = 0.482, respectively; MAE: p = 0.715 and p = 0.627, respectively). The ME showed myopic shift in all formulas regardless of IOL formula used. The ME showed greater myopic shift in high myopia group than nonhigh myopia group in all formulas. CONCLUSIONS Our study did not find evidence for superiority of any formula in phacovitrectomy. However, in phacovitrectomy, possible myopic shift should be considered for IOL power calculation. Especially, in phacovitrecotmy in patients with high myopia, more myopic shift should be considered when selecting IOL.
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Affiliation(s)
- Yu-Jin Choi
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Kuerten D, Walter P, Baumgarten S, Fuest M, Plange N. 12-month outcomes of ab interno excisional goniotomy combined with cataract surgery in primary open-angle glaucoma and normal tension glaucoma. Int Ophthalmol 2023; 43:2605-2612. [PMID: 36862355 PMCID: PMC10371902 DOI: 10.1007/s10792-023-02659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of excisional goniotomy performed with the Kahook Dual Blade (KDB) combined with cataract surgery in patients with pimary open angle glaucoma (POAG) and Normal Tension Glaucoma (NTG) under topical therapy. Further sub-analysis was performed to compare between 90 and 120 degrees goniotomy. METHODS This was a prospective case series of 69 eyes from 69 adults (age 78 ± 5.9 years; male = 27, female = 42). Indications for surgery included insufficient IOP control with topical medication, glaucomatous damage progression under topical therapy and reduction of medication burden. Complete success was defined as IOP lowering below 21 mmHg without the need for topical medication. For NTG patients, complete success was defined as IOP lowering below 17 mmHg without the need for topical medication. RESULTS IOP was significantly lowered from 19.7 ± 4.7 to 15.1 ± 2.7 at 2 months, 15.8 ± 2.3 at 6 months and 16.1 ± 3.2 at 12 months (p < 0.05) for POAG and 15.1 ± 2.5 to 14.1 ± 2.4 at 2 months, 14.1 ± 3.1 at 6 months and 13.6 ± 1.8 at 12 months (p > 0.08) for NTG, respectively. Complete success was achieved in 64% of the patients. IOP lowering under 17 mmHg without the need for topical medication was achieved in 60% of the patients at 12 months. In NTG patients (14 eyes) IOP lowering under 17 mmHg without the need for topical medication was achieved in 71%. No significant difference was recorded in terms of IOP lowering at 12 months in-between 90° and 120° of treated trabecular meshwork (p > 0.7). No severe adverse reactions were recorded in this study. CONCLUSION One-year results show that KDB combined with cataract surgery is an effective treatment option for glaucoma patients. IOP lowering was successfully achieved in NTG patients with complete success in 70% of the patients. In our study, no significant differences were recorded in-between 90° and 120° of treated trabecular meshwork.
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Affiliation(s)
- David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany.
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Sabine Baumgarten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Niklas Plange
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
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Park SS, Tseng M, Mian Z, Moon JY, Shrivastava A. The impact of case complexity in resident-performed cataract surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:2307-2314. [PMID: 36929055 PMCID: PMC10018582 DOI: 10.1007/s00417-023-06027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. METHODS Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. RESULTS Of the 1,348 cases, 371 (27.5%) documented capsular staining ("Dye-only"), 91 (6.8%) required pupil expansion ("PED-only"), and 100 (7.4%) used both capsular stain and a PED ("Both"). The remainder of cases (n=786, 58.3%) were classified as "Routine." Compared to the "Routine" group, "PED-only" and "Both" had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27-6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07-5.12, P=0.04). Among the PPVx cases, the "PED-only" group has significantly higher odds than "Routine" and "Dye-only" (OR=4.64, 95% CI 1.68-12.79, P=0.01; and OR=6.48, 95% CI 1.7-25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46-42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1-8.43, P=0.032) had increased odds of complication. CONCLUSION Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.
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Affiliation(s)
- Sally Se Park
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Michael Tseng
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Zara Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA.
- Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Ave, 3rd Floor, Bronx, NY, 10467, USA.
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Sritrakoon N, Areevijittrakul L, Nimitchaiyapong N, Khamchomphu N, Duangurai T. Phacoemulsification in a chinchilla (Chinchilla lanigera). Open Vet J 2023; 13:1032-1036. [PMID: 37701661 PMCID: PMC10495097 DOI: 10.5455/ovj.2023.v13.i8.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/16/2023] [Indexed: 09/14/2023] Open
Abstract
Background A cataract is one of the underlying causes of blindness in animals. Phacoemulsification is the standard procedure in cataract surgery for humans and animals. This procedure has been used to restore vision in cataracts in a variety of animals. However, this technique is difficult in very small animals, such as rodents, due to their small eyes. Case Description A 4-year-old male domestic chinchilla was presented with cloudiness in the lenses for 1 month. The ophthalmic examination revealed cataracts (oculus uterque: both eyes). Positive dazzle reflex oculus sinister; left eye (OS) and negative reflex oculus dexter; right eye (OD) were noted. The electroretinography was low amplitude OS whereas a flat waveform presented OD. In this case, cataract surgery was performed using phacoemulsification without intraocular lens implantation OS. Postoperative, the chinchilla was alert and could jump on and jump off the ledge in a house. When the veterinarian approached closely to OS, the chinchilla displayed an erect body posture and open eyes, whereas the chinchilla was ignored when the veterinarian doing the same OD. The chinchilla was alert and had improved vision observe by this chinchilla can jump on and jump off the ledge in his house throughout the follow-up period 18 months later. Conclusion In this chinchilla, phacoemulsification was successfully performed and resulted in better overall vision. The chinchilla was alert and could jump on and jump off the ledge in a house after cataract surgery throughout the follow-up period of 18 months.
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Affiliation(s)
- Natthanet Sritrakoon
- Ophthalmology Unit, Kasetsart University Veterinary Teaching Hospital, Bangkok, Thailand
| | | | | | - Natruree Khamchomphu
- Exotic Unit, Kasetsart University Veterinary Teaching Hospital, Bangkok, Thailand
| | - Taksaon Duangurai
- Exotic Unit, Kasetsart University Veterinary Teaching Hospital, Bangkok, Thailand
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
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Lin Y, Zhou B, Yao Y, Ye Q, Zhu Y, Wang X. Clinical observation of phacoemulsification under the low perfusion pattern and low negative pressure in patients with low corneal endothelial cell density. BMC Ophthalmol 2023; 23:340. [PMID: 37525138 PMCID: PMC10391892 DOI: 10.1186/s12886-023-03095-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND To observe the safety and effect of phacoemulsification combined with intraocular lens (IOL) implantation in patients with low corneal endothelial cell density (CD) under the low perfusion pattern with low negative pressure. METHODS In this retrospective case series study, a total of 16 patients (17 eyes) were studied. They had all been diagnosed with low corneal endothelial (CD) and cataracts in the First Affiliated Hospital of Fujian Medical University from December 2019 to October 2021. They underwent phacoemulsification combined with IOL implantation under the low perfusion pattern with low negative pressure. The variations of corneal endothelial( CD), coefficient of variation (CV) of the cell area, central corneal thickness (CCT), visual acuity, and intraocular pressure before and after the operation were observed and assessed. Then a paired t-test, repeated measures analysis of variance, and Pearson correlation analysis were adopted for data analysis. RESULTS The mean intraocular pressure of the 17 eyes was 16.88 ± 6.47 mmHg before the operation and 14.41 ± 3.10 mmHg after the operation, showing a statistically significant difference of t = 2.222, and p = 0.041. Before the operation, the mean visual acuity was 0.16 ± 0.09, and after the operation, it was 0.45 ± 0.16, displaying a statistically significant difference of t = -9.917, p < 0.001. Before and after the operation, four of the 17 eyes had no detectable CD. The mean CD of the other 13 eyes at one month after the operation (644.308 ± 106.24 cells/mm2) was lower than that before the operation (709.62 ± 119.19 cells/mm2), and the differences were statistically significant (F = 20.044, p < 0.001). However, no statistically significant differences were found in the mean CV before the operation (31.23 ± 4.21), and at one month after the operation (32.62 ± 3.80; F = 2.130, p = 0.157). Moreover, the mean CCT of 14 eyes at one month after the operation (562.72 ± 27.82 μm) was larger than that before the operation (534.79 ± 24.69 μm). CONCLUSIONS The low perfusion pattern with low negative pressure is safe and effective for corneal endothelial dysfunction patients complicated with cataracts.
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Affiliation(s)
- Yan Lin
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Biting Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yihua Yao
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qin Ye
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yihua Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
| | - Xiaohui Wang
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Dong P, Wang LF, Zhang LX, Li F, Yin HS, Dou ZX, Huang XJ, Xu R, Zhang WL. Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification. World J Clin Cases 2023; 11:5073-5082. [PMID: 37583853 PMCID: PMC10424011 DOI: 10.12998/wjcc.v11.i21.5073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine. AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy. METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups. RESULTS More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety. CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.
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Affiliation(s)
- Ping Dong
- Department of Acupuncture and Rehabilitation, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Li-Fang Wang
- Department of Surgical Anesthesia, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Li-Xiang Zhang
- Department of Pediatrics, Hebei General Hospital For Veterans, Xingtai 054000, Hebei Province, China
| | - Fang Li
- Department of Surgical Anesthesia, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Hui-Su Yin
- Department of Science and Education, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Zhi-Xia Dou
- Department of Ocular Trauma, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Xiu-Ju Huang
- Department of Surgical Anesthesia, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Rui Xu
- Department of Surgical Anesthesia, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Wu-Lin Zhang
- Department of Cataract, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
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Mohammad-Rabei H, Sabbaghi H, Emamverdi M, Karimi S, Ramezani A, Nikkhah H, Kheiri B, Yaseri M, Sheibani K, Bahreini R. The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients. BMC Ophthalmol 2023; 23:320. [PMID: 37452330 PMCID: PMC10347851 DOI: 10.1186/s12886-023-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo. METHODS A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls. RESULTS 49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all). CONCLUSION Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients. TRAIL REGISTRATION The study protocol was registered into www. CLINICALTRIAL gov with the RCT registration number NCT03551808. (2018/06/11 ) CLINICAL TRIAL REGISTRATION NUMBER: NCT03551808.
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Affiliation(s)
- Hossein Mohammad-Rabei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Opposite to Bou-Ali Hospital, Damavand Ave., Tehran, Iran
| | - Mehdi Emamverdi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- School of Public Health and Public Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bahreini
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Opposite to Bou-Ali Hospital, Damavand Ave., Tehran, Iran.
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Wai YZ, Chong YY, Lim LT, Chan JB, Chandrasekaran S. Preferred cataract surgery practices in Malaysia: a survey based study. BMC Res Notes 2023; 16:116. [PMID: 37349840 DOI: 10.1186/s13104-023-06391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND To describe the preferred cataract surgery practices among Malaysian ophthalmologists and medical officers in comparison with the recommended practices. METHODS An online questionnaire was sent out in April 2021, to Malaysian Ophthalmologists and medical officers who perform cataract surgeries. The questions were focused on the preferred cataract surgery practices of the participants. All data obtained were collected, tabulated and analysed. RESULTS A total of 173 participants responded to the online questionnaire. 55% of the participants were within 31-40 years of age. 56.1% preferred peristaltic pump over venturi system. 91.3% of participants practised povidone iodine instillation to the conjunctival sac. With regards to the main wound incision, more than half of the surgeons (50.3%) preferred fixed superior incision and 72.3% of them preferred 2.75 mm microkeratome blade. Most of the participants (63%) were inclined towards C-Loop clear intraocular lens (IOL) with a single-handed push preloaded system. 78.6% of the surgeons routinely use carbachol in their cataract surgery. CONCLUSIONS This survey provides some insight into the current practices among Malaysian ophthalmologists. Most of the practices are in line with international guidelines for preventing postoperative endophthalmitis. This article could help trainees and ophthalmologists benchmark and observe the common cataract surgery practices among their seniors and peers in Malaysia.
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Affiliation(s)
- Yong Zheng Wai
- Department of Ophthalmology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | - Lik Thai Lim
- Faculty of Medicine, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia.
- Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia.
| | - Jan Bond Chan
- International Specialist Eye Center, Kuala Lumpur, Malaysia
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Wenzel DA, Schultheiss C, Druchkiv V, Hellwinkel OJC, Spitzer MS, Schultheiss M, Casagrande M, Steinhorst NA. Effect of elevated irrigation bottle height during cataract surgery on corneal endothelial cells in porcine eyes. BMC Ophthalmol 2023; 23:211. [PMID: 37170242 PMCID: PMC10173645 DOI: 10.1186/s12886-023-02954-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Cataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances. METHODS Intermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15. RESULTS Relative ECL significantly correlated with irrigation BH (control (n = 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n = 12): -9.69 ± 4.81%-p = 1.000; BH125 (n = 14): -19.44 ± 7.30% - p < 0.001; BH150 (n = 13): -21.99 ± 6.70%-p < 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n = 14; -10.92 ± 4.09%-p = 1.000) showed a cell loss comparable to the control group. CONCLUSIONS ECL is altered by I/A BH and reduced when viscoelastic substances are used.
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Affiliation(s)
- Daniel A Wenzel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany.
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Constanze Schultheiss
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf J C Hellwinkel
- Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tan DNH, Tan M, Liew H, Shen L, Ngiam KY, Chen DZ. A data-driven approach to evaluate factors affecting resident performance in cataract surgery. Int Ophthalmol 2023:10.1007/s10792-023-02730-1. [PMID: 37160586 DOI: 10.1007/s10792-023-02730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the operative duration and clinical performance of ophthalmology residents performing standard phacoemulsification cataract surgeries using information available from electronic health records (EHR). METHODS This is a retrospective cohort study. De-identified surgical records of all standard phacoemulsifications performed in a tertiary institution between 1st January 2015 and 8th August 2018 were retrieved from the hospital EHR. The main outcome measures were improvement in operative duration with case experience, corrected distance visual acuity (CDVA) improvement, and intra-operative complication rates. RESULTS Twelve ophthalmology residents performed a total of 1427 standard phacoemulsifications. The median operative duration was 27 min (interquartile range, 22-34 min), which improved from 31 to 24 min (before the 101st case [Group 1] versus 101st case onwards [Group 2], p < 0.001). Gradient change analysis (non-linear regression) showed significant reduction until the 100th case (p = 0.043). Older patients (0.019), worse pre-operative CDVA (0.343), and surgery performed by Group 1 (1.115) were significantly associated with operative duration above 30 min. LogMAR CDVA improved from a mean of 0.57 ± 0.52 pre-operatively to 0.10 ± 0.18 post-operatively (p < 0.001). Posterior capsule rupture (PCR) rate decreased from 4.0% [Group 1] to 2.1% [Group 2] (p = 0.096), while overall complication rate decreased from 8.9% to 3.1% (p < 0.001). CONCLUSION The median operative duration reduced consistently with surgical experience for the first 100 cases. Older patients, poorer pre-operative VA, and surgical experience of less than 100 cases were significantly associated with an operative duration above 30 min. There was a statistically significant decrease in complication rate between Group 1 and 2.
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Affiliation(s)
- Darren Ngiap Hao Tan
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Marcus Tan
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Hariz Liew
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery (Endocrine and Thyroid Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - David Z Chen
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Cantero F, Ortillés Á, Teresa Peña M, Leiva M. Prevalence of ocular findings and their association with glycemia in dogs with diabetes mellitus: A 10-year clinical study (2009-2019). Open Vet J 2023; 13:620-628. [PMID: 37304611 PMCID: PMC10257449 DOI: 10.5455/ovj.2023.v13.i5.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/17/2023] [Indexed: 06/13/2023] Open
Abstract
Background Although ocular findings in diabetic patients are well described, prevalence data for those is unknown. Aim To describe the prevalence of ocular findings and their association with glycemia in dogs with diabetes mellitus. Methods Medical records from diabetic dogs assessed by the ophthalmology and the internal medicine services at the Veterinary Teaching Hospital of the Autonomous University of Barcelona were reviewed (2009-2019). Results Seventy-five dogs (150 eyes) of both genders (51/75 females; 68% and 24/75 males; 32%) and a mean age of 9.37 ± 2.43 years, were included. The most common ocular findings were cataracts (146/150; 97.3%), vitreous degeneration (45/98; 45.9%), anterior uveitis (47/150; 31.3%), aqueous deficiency dry eye (ADDE) (33/150; 22%), diffuse corneal edema (31/150; 20.7%), non-proliferative retinopathy (13/98; 13.3%), and lipid keratopathy (9/150; 6%). The most prevalent type of cataracts observed (78/146; 53.4%) was intumescent, which was commonly accompanied by non-proliferative retinopathy (p = 0.003). Among the diabetic dogs, blood glucose levels were statistically higher in dogs with non-proliferative retinopathy or anterior uveitis (p < 0.005). Conclusions Ocular complications of diabetes mellitus in dogs are numerous, being the most frequent intumescent cataracts, vitreous degeneration, anterior uveitis, ADDE, diffuse corneal edema, and non-proliferative retinopathy. This high prevalence warrants a more detailed ophthalmic evaluation in diabetic dogs especially for those undergoing cataract surgery. Furthermore, a predisposition for anterior segment inflammation and non-proliferative retinopathy is suggested when fasting plasma glucose is higher than 600 mg/dl..
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Affiliation(s)
- Francisco Cantero
- Servei d’Oftalmologia, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ángel Ortillés
- Servei d’Oftalmologia, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - M. Teresa Peña
- Servei d’Oftalmologia, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Leiva
- Servei d’Oftalmologia, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Spain
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