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Mohan H, Narendran K. Slow swirl phaco. Indian J Ophthalmol 2024; 72:748-749. [PMID: 38324265 DOI: 10.4103/ijo.ijo_1329_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 02/08/2024] Open
Abstract
This article reports a novel surgical technique in the management of soft posterior polar cataracts. This technique avoids hydro procedures, trenching, and chopping. Viscodissection is avoided or minimal, and polar opacity is removed last. These modifications minimize the risk of intraoperative complications.
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Affiliation(s)
- Hridya Mohan
- Department of Cataract Sevices, Aravind Eye Hospital, Tirupur, Tamil Nadu, India
| | - Kalpana Narendran
- Department of Cataract Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Giglio R, Vinciguerra AL, Grotto A, Milan S, Tognetto D. Hitting the refractive target in corneal endothelial transplantation triple procedures: A systematic review. Surv Ophthalmol 2024; 69:427-434. [PMID: 38309315 DOI: 10.1016/j.survophthal.2024.01.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with phacoemulsification and intraocular lens (IOL) implantation (triple procedure). This surgery might cause a refractive shift difficult to predict. Early DMEK and DSAEK results have shown a tendency toward a hyperopic shift. Myopic postoperative refraction is typically intended to correct this postoperative refractive defect and to bring all eyes as close to emmetropia as possible. We sought to understand the mechanism underlying the hyperopization and to identify predictive factors for poorer refractive outcomes, the most suitable target refraction and IOL calculation methods in patients undergoing combined cataract extraction and lamellar endothelial corneal transplantation (DSAEK or DMEK) for endothelial dysfunctions. Of the 407 articles analyzed, only 18 were included in the analysis. A myopic target between -0.50 D and -0.75 was the most common (up to -1.50 for DSAEK triple procedures), even though no optimum target was found. Hyperopic surprises appeared more frequently in corneas that were flatter in the center than in the periphery (oblate posterior profile). Among the numerous IOL calculation formulas, there was no apparent preference.
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Affiliation(s)
- Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Lucia Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - Alberto Grotto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Milan
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Huynh B, Kibret G, Wechsler D, Lee A, Lim R, Clement C, Lawlor M. Outcomes of iStent inject combined with cataract surgery in Asian eyes: Australian data from the Fight Glaucoma Blindness international registry. Int Ophthalmol 2024; 44:200. [PMID: 38662305 DOI: 10.1007/s10792-024-03104-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: 10/18/2023] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification. METHODS This is a multi-centre, observational study of glaucomatous Asian eyes that have undergone iStent inject implantation combined with cataract surgery. Patient data were extracted from the Fight Glaucoma Blindness! Registry. Outcome measures included those of IOP reduction, glaucoma medication reduction, and adverse events including the need for secondary surgery. RESULTS 123 eyes of 86 patients with a mean age of 68.4 ± 9.3 years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4 mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12 months 30.8% of eyes demonstrated a reduction in IOP greater than 20%, the mean IOP reduction was 12.5% with an additional reduction of 0.7 glaucoma medications. 40% of eyes were using no medications at 12 months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window. CONCLUSION iStent inject implantation combined with phacoemulsification in Asian eyes showed a reduction of IOP and glaucoma medication use in a real-world clinical setting. The safety profile of the device is good with minimal adverse outcomes, however, a subset of patients required secondary procedures within the 12 month follow up.
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Affiliation(s)
- Brandon Huynh
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia.
| | - Getiye Kibret
- Macquarie University, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- University of Technology Sydney, Ultimo, Australia
| | - David Wechsler
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Department of Ophthalmology, Concord Hospital, Sydney, Australia
- School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Anne Lee
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
- Faculty of Medicine and Health, Western Sydney University, Penrith, Australia
- Department of Ophthalmology, Liverpool Hospital, Sydney, Australia
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Colin Clement
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
| | - Mitchell Lawlor
- Department of Ophthalmology, Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Save Sight Institute, Sydney, Australia
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Qu H, Abulimiti A, Liang J, Zhou S, Wu Z, Chen Y, Ju R, Wang Z, Xu R, Chen X. Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery. BMC Ophthalmol 2024; 24:189. [PMID: 38658894 PMCID: PMC11040763 DOI: 10.1186/s12886-024-03440-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS). SETTING Department of Ophthalmology, Shanghai Aier Eye Hospital, China. DESIGN A retrospective, observational study. METHODS Patients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months. RESULTS 101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group. CONCLUSIONS Panoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient's corneal astigmatism.
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Affiliation(s)
- Haokun Qu
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Adilamu Abulimiti
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
| | - Jianheng Liang
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Suowang Zhou
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Zheming Wu
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yun Chen
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Ruihong Ju
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Zheng Wang
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Rong Xu
- Hankou Aier Eye Hospital, Wuhan, China
| | - Xu Chen
- Jinan University, No.601, Huangpu Road West, Guangzhou, China.
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China.
- Department of Ophthalmology, Shanghai Aier Qingliang Eye Hospital, Qingpu, Shanghai, China.
- Department of Ophthalmology & Optometry, SinoUnited Health Clinic, Shanghai, China.
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Peixoto GV, Martinho GT, Conti CCTD, Villaça Filho E, Pinheiro RK. Cataract surgery and artificial iris implantation in patient with oculocutaneous albinism: a case report. Arq Bras Oftalmol 2024; 87:e2022. [PMID: 38656019 DOI: 10.5935/0004-2749.2022-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/07/2023] [Indexed: 04/26/2024] Open
Abstract
We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.
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Affiliation(s)
- Guilherme Vieira Peixoto
- Departamento de Oftalmologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Gabriela Tomaz Martinho
- Departamento de Oftalmologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Caio Cezar Toledo de Conti
- Departamento de Oftalmologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Villaça Filho
- Setor de Catarata, Departamento de Oftalmologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Renato Klingelfus Pinheiro
- Setor de Catarata, Departamento de Oftalmologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Liu Y, Li Y, Ji J, Fan Y, Hong J, Wang L. A Shape Memory Polymeric Shield for Protecting Corneal Endothelium During Phacoemulsification. Transl Vis Sci Technol 2024; 13:11. [PMID: 38578634 PMCID: PMC11005075 DOI: 10.1167/tvst.13.4.11] [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: 12/15/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024] Open
Abstract
Background The purpose of this study was to explore the protective effect of a shape memory polymeric shield on corneal endothelium during phacoemulsification in rabbits. Methods Poly-(glycerol dodecanedioate) (PGD) with a transition temperature of 24.416°C was prepared to make a shape memory shield with a thickness of 100 µm, an arc length of 14 mm, and a radius of curvature of 8.8 mm. In the control group, a phaco-tip with bevel-down was used to simulate injury to the corneal endothelium by phacoemulsification in rabbits. In the experimental group, the pre-cooled and curled shape memory shield was injected into and removed from the anterior chamber before and after phaco-power release. Anterior segment optical coherence tomography (AS-OCT), confocal microscope, trypan blue/alizarin red staining, and scanning electron microscope were performed to measure endothelial damage after surgery. Results One day postoperatively, the lost cell ratio of the control group and the experimental group were 28.08 ± 5.21% and 3.50 ± 1.43%, respectively (P < 0.0001), the damaged cell ratios were 11.83 ± 2.30% and 2.55 ± 0.52%, respectively (P < 0.0001), and the central corneal thicknesses (CCT) were 406.75 ± 16.74 µm and 340. 5 ±13.48 µm, respectively (P < 0.0001). Seven days postoperatively, the endothelial cell density (ECD) of the control group and the experimental group were 1674 ± 285/mm2 and 2561 ± 554/mm2, respectively (P < 0.05). The above differences were all statistically significant. Conclusions This PGD based shape memory shield has a protective effect on corneal endothelium during phacoemulsification. It reduces postoperative corneal edema and ECD decrease in the short term after surgery. Translational Relevance The shape memory PGD "shield" in this study may have a use in certain human patients with vulnerable corneas of low endothelial cell count or shallow anterior chambers.
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Affiliation(s)
- Yinan Liu
- Department of Ophthalmology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, 49th North Garden Road, Haidian District, Beijing, China
| | - Yuqi Li
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Jing Ji
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, 49th North Garden Road, Haidian District, Beijing, China
| | - Lizhen Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
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Goebel GJ, Price DA, Price MO, Price FW. Functional Approach to IOL Selection in Eyes With Combined Cataract and Keratoconus With an Option for Refractive Lens Exchange. J Refract Surg 2024; 40:e208-e217. [PMID: 38593256 DOI: 10.3928/1081597x-20240311-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. METHODS This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. RESULTS Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. CONCLUSIONS Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].
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Jeon HS, Kim MH, Joo K, Park SJ, Lee EJ, Hyon JY, Kim TW, Park KH, Woo SJ. Comparison of posterior capsule rupture rates during phacoemulsification using 3D heads-up visualization system and traditional microscopes. J Cataract Refract Surg 2024; 50:328-332. [PMID: 37919836 DOI: 10.1097/j.jcrs.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the posterior capsule rupture (PCR) rates of cataract surgery using a traditional ophthalmic surgical microscope (OSM) and a 3D heads-up visualization system (HUVS). SETTING Single tertiary referral center. DESIGN Retrospective study. METHODS This study included 10 101 eyes that underwent phacoemulsification cataract surgery. Surgeries were performed using either 3D HUVS (1964 eyes, performed by 2 surgeons, HUVS group) or traditional OSM (8137 eyes, performed by 6 surgeons, OSM group) from February 2018 to June 2022. Data were collected based on the diagnosis-related group system, and the rate of PCR requiring vitrectomy and the surgical time were evaluated. RESULTS The PCR rates were not significantly different between the OSM (n = 63; 0.7%) and HUVS (n = 19; 0.9%, P = .392) groups. The mean surgical time was significantly longer in the HUVS group (14.7 ± 10.6 minutes) than in the OSM group (12.9 ± 9.9 minutes, P < .001). In the 3D HUVS group, there were no PCR cases among the initial 100 patients. In both groups, no significant difference was observed in the PCR rates over time. Although the difference was not statistically significant, the PCR rate decreased over time in the HUVS group. CONCLUSIONS The results indicate that 3D HUVS-based cataract surgery performed by experienced cataract surgeons had a PCR rate similar to that of traditional OSM-based surgery during the 4-year study period. Although the surgical time was slightly longer with 3D HUVS, cataract surgery using 3D HUVS can be performed safely by experienced surgeons.
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Affiliation(s)
- Hyun Sun Jeon
- From the Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea (Jeon, M.H. Kim, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea (Jeon, Joo, S.J. Park, Lee, Hyon, T.-W. Kim, K.H. Park, Woo); Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea (K.H. Park)
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Dai X, Lee MJ, Schein OD, Wenick AS, Oboh-Weilke AM, Woreta FA. Surgical Approach for Monoclonal Gammopathy of Undetermined Significance-Related Ocular Copper Deposition. Cornea 2024; 43:531-533. [PMID: 38166178 DOI: 10.1097/ico.0000000000003451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/29/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE The aim of this study was to present the surgical management of a patient with ocular copper deposition associated with monoclonal gammopathy of undetermined significance (MGUS). METHODS This is a case report of a 44-year-old man with MGUS who presented to us with bilateral diffuse deposition of copper in the cornea and lens. RESULTS Despite initiating systemic therapy for MGUS, no corneal clearing was observed. A decision was made to proceed with cataract extraction in the left eye given worsening vision. Despite trypan blue staining and a central descemetorhexis, visualization remained too poor to complete phacoemulsification. Pars plana lensectomy and vitrectomy to remove the residual lens material and placement of a posterior chamber intraocular lens in the sulcus with endoillumination was subsequently performed. As vision in the left eye steadily improved postoperatively, cataract surgery was then performed in the right eye. With use of trypan blue, creation of a 6-mm central descemetorhexis, and a retinal light pipe for endoillumination anteriorly to augment visualization, capsulorhexis, phacoemulsification, and insertion of intraocular lens in the bag were completed without difficulty. The patient's vision improved at subsequent follow-ups, reaching a final best-corrected visual acuity of 20/20-1 in the right eye and 20/25-1 in the left eye. CONCLUSIONS Ocular copper deposition is a rare manifestation of MGUS. Cataract extraction is challenging, often requiring advanced techniques. Endoillumination is useful to improve visualization through the dense corneal copper deposition.
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Affiliation(s)
- Xi Dai
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Moon Jeong Lee
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Oliver D Schein
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Adam S Wenick
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | | | - Fasika A Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
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Coutinho CP, Schiano-Lomoriello D, Mazzotta C, Ferrise M, Hoffer KJ, Ribeiro FJ, Dias JM, Savini G. Differences Between Simulated Keratometry and Total Corneal Power in Eyes With Keratoconus and a Formula to Improve IOL Power Calculation Results. J Refract Surg 2024; 40:e253-e259. [PMID: 38593262 DOI: 10.3928/1081597x-20240311-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE To compare simulated keratometry (SimK) and total corneal power (TCP) in keratoconic eyes, to determine whether the differences are systematic and predictable and to evaluate an adjusted TCP-based formula for intraocular lens (IOL) power calculation. METHODS In a consecutive series of keratoconic eyes, measurements of SimK, TCP, posterior keratometry, and anterior and posterior corneal asphericities (Q-values) were retrospectively collected. The difference between SimK and TCP was linearly correlated to the biometric parameters. In a separate sample of keratoconic eyes that had undergone cataract surgery, IOL power was calculated with the Barrett Universal II, Hoffer QST, Holladay 1, Kane, and SRK/T formulas using the SimK and an adjusted TCP power. The respective prediction errors were calculated. RESULTS A total of 382 keratoconic eyes (271 patients) were enrolled. An increasing overestimation of SimK by TCP was detected from stage I to III, with a significant correlation between the SimK and TCP difference and SimK in the whole sample (P < .0001, r2 = 0.1322). Approximately 7% of cases presented an underestimation of SimK by TCP. IOL power calculation with the adjusted TCP improved outcomes, achieving a maximum of 80% of eyes with a prediction error within ±0.50 diopters with the Hoffer QST, Holladay 1, and Kane formulas. CONCLUSIONS Overall, SimK overestimated TCP. Such a difference could not be predicted by any variable. The proposed TCP-adjustment formula (TCPadj = TCP + 0.56 diopters) in keratoconic eyes for IOL power calculation might be valuable for improving refractive outcomes. [J Refract Surg. 2024;40(4):e253-e259.].
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Aiello F, Rampat R, Gallo Afflitto G, Din N, Mandal N, Maurino V. Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre. Can J Ophthalmol 2024; 59:67-72. [PMID: 36627103 DOI: 10.1016/j.jcjo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
| | - Radhika Rampat
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Niraj Mandal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Maurino
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Pérez-Sanz L, Vega F, Azor-Morón JA, Cuellar F, Millán MS, Garzón N. Tolerance to residual astigmatism of an isofocal intraocular lens. Graefes Arch Clin Exp Ophthalmol 2024; 262:1169-1180. [PMID: 37950754 DOI: 10.1007/s00417-023-06305-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE To evaluate the impact of residual astigmatism on the optical and visual performance of an enhanced-monofocal isofocal intraocular lens (EM Isopure, BVI medical, Belgium) compared to a monofocal one (Micropure, BVI medical, Belgium). METHODS Laboratory investigation and prospective, comparative and randomized clinical study. Optical quality was assessed on an optical bench for 2.0, 3.0, and 4.5 mm pupils. The effect of residual astigmatism was investigated from through-focus images recorded with increasing amounts of regular positive astigmatism induced with a deformable mirror. To evaluate the impact of residual astigmatism, 28 eyes of 28 patients were randomly assigned to either group. Residual astigmatism was induced with positive and negative cylinder lenses at 90 and 180°. Visual acuity (VA) was measured at each step. RESULTS The optical performance of both IOLs was quite similar for 2.0 and 3.0 mm pupils. For 4.5-mm pupil, the EM Isopure showed a significant reduction of its optical quality in comparison with the monofocal IOL. When visual performance was evaluated, no statistically significant differences were found for any power of induced astigmatism. More differences were found when positive induced astigmatism was compared within each group, and VA was better when the astigmatism was induced at 180° vs. 90°. The greatest differences were found for and induced positive astigmatism of + 1.50D (p = 0.009 for Isopure and p = 0.023 for Micropure). CONCLUSIONS The tolerance to residual astigmatism of the EM Isopure lens is similar to that of a reference monofocal lens with pupils up to 3.5 mm.
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Affiliation(s)
- Lidia Pérez-Sanz
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Avda. Arcos de Jalón 118, 28037, Madrid, Spain.
- Miranza IOA. C/Galileo 104, 28003, Madrid, Spain.
| | - Fidel Vega
- Grupo de Óptica Aplicada y Procesado de Imagen (GOAPI), Department of Optics and Optometry, Universitat Politècnica de Catalunya BarcelonaTech, Violinista Vellsolà 37, 08222, Terrassa, Spain
| | - Juan A Azor-Morón
- Grupo de Óptica Aplicada y Procesado de Imagen (GOAPI), Department of Optics and Optometry, Universitat Politècnica de Catalunya BarcelonaTech, Violinista Vellsolà 37, 08222, Terrassa, Spain
| | - Fátima Cuellar
- Grupo de Óptica Aplicada y Procesado de Imagen (GOAPI), Department of Optics and Optometry, Universitat Politècnica de Catalunya BarcelonaTech, Violinista Vellsolà 37, 08222, Terrassa, Spain
| | - María S Millán
- Grupo de Óptica Aplicada y Procesado de Imagen (GOAPI), Department of Optics and Optometry, Universitat Politècnica de Catalunya BarcelonaTech, Violinista Vellsolà 37, 08222, Terrassa, Spain
| | - Nuria Garzón
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Avda. Arcos de Jalón 118, 28037, Madrid, Spain
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Schartmüller D, Röggla V, Schwarzenbacher L, Meyer EL, Abela-Formanek C, Leydolt C, Menapace R. Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial. Ophthalmology 2024; 131:445-457. [PMID: 37914042 DOI: 10.1016/j.ophtha.2023.10.031] [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: 10/03/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL). DESIGN Intraindividual, randomized, double-masked, controlled clinical trial. PARTICIPANTS Patients scheduled for sequential same-day bilateral cataract surgery. METHODS All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT. MAIN OUTCOME MEASURES Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months. RESULTS One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively. CONCLUSIONS Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution. 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)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Berry Consultants, Vienna, Austria
| | | | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Hida WT, Moscovici BK, Cortez CM, Colombo-Barboza GN, Tzelikis PFDM, Motta AFP, De Medeiros AL, Nose W, Carricondo PC. Comparison of visual outcomes of bilateral dual-technology diffractive intraocular lens vs blended enhanced monofocal with dual-technology intraocular lens. J Cataract Refract Surg 2024; 50:401-406. [PMID: 38085244 DOI: 10.1097/j.jcrs.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/21/2023] [Indexed: 03/26/2024]
Abstract
PURPOSE To compare clinical outcomes after implantation of TECNIS Synergy (ZFR00V) intraocular lenses (IOLs) in both eyes and implantation of the TECNIS Synergy and TECNIS Eyhance (ICB00) combination in patients undergoing cataract surgery. SETTING Department of Cataract, Hospital Oftalmológico de Brasilia (HOB), Brasília, Brazil. DESIGN Prospective, interventional, randomized, parallel-group study. METHODS Patients were categorized into 2 groups: Group 1: ZFR00V IOL was implanted in both eyes. Group 2: An ICB00 IOL was implanted in the dominant eye, and a ZFR00V IOL was implanted in the nondominant eye. RESULTS Visual acuity was similar between the 2 groups (95% CI <0.1 logMAR). A superior visual acuity of ≥ 20/25 (at -2.00 to -2.50 diopters [D]) was achieved in Group 1 (bilateral ZFR00V) than in Group 2 (combination of ZFR00V/ICB00). The binocular defocus curve demonstrated better visual acuity at 40 cm (-2.00 D) and 50 cm (-2.50 D) in Group 1 than in Group 2 ( P < .05). Similar contrast sensitivity values were observed between the 2 groups. Patients in Group 1 reported higher satisfaction (completely satisfied) than those in Group 2 ( P < .05). However, halos and glare were more pronounced in Group 1 than in Group 2 ( P < .05). CONCLUSIONS Both presbyopia-correcting IOL combinations showed similar binocular visual acuity results. Group 1 demonstrated enhanced visual acuity in the defocus curve at 40 cm (-2.00 D) and 50 cm (-2.50 D). Comparable contrast sensitivity outcomes were observed in both groups. Patients were more completely satisfied in Group 1 than in Group 2, despite the higher frequency of postoperative nighttime halos and glare.
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Affiliation(s)
- Wilson Takashi Hida
- From the Department of Ophthalmology, Hospital Oftalmológico de Brasília (HOB), Brasília, Brazil (Hida, Cortez, Tzelikis); Department of Ophthalmology, University of Sao Paulo (HC-FMUSP), Sao Paulo, Brazil (Hida, Carricondo); Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil (Moscovici, Nose); Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil (Moscovici, Colombo-Barboza, Tzelikis); Department of Ophthalmology, Renato Ambrosio Research Center (CEORA), Brasília, Brazil (Cortez, Tzelikis, Motta, De Medeiros)
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Ma M, Wang M, Zhang X, Shao Y, Li X. Effects of a fortified balanced salt solution and Ringer's lactate solution on anterior chamber inflammation after phacoemulsification in diabetes. J Cataract Refract Surg 2024; 50:352-359. [PMID: 37962173 DOI: 10.1097/j.jcrs.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To compare the effects of a fortified balanced salt solution (fSS) and Ringer's lactate solution (Ringer) on anterior chamber (AC) inflammation in patients undergoing phacoemulsification. SETTING Tianjin Medical University Eye Hospital, Tianjin, China. DESIGN Prospective masked controlled trial. METHODS 80 patients (40 patients with regular cataract and 40 cataract patients with diabetes mellitus [DM]) were randomized to receive either fSS (n = 40) or Ringer's solution (n = 40). Anterior-segment optical coherence tomography was used to evaluate AC cells and flare. Transepithelial electrical resistance (TEER) and zonula occludens-1 (ZO-1) immunofluorescence were used for tight junction examination. Monocytic leukemia cell line (Tohoku Hospital Pediatrics-1 [THP-1]) transmigration assay was performed to observe the effects of the 2 perfusates on the inflammatory response in vitro. RESULTS In patients with regular cataracts, postoperative AC cells and flare on the 1st and 7th days were not significantly different between the Ringer and fSS groups. However, in cataract patients with DM, AC cells were higher in the Ringer group than in the fSS group ( P = .003) on postoperative day 1. The AC flare was also significantly higher in the Ringer group than in the fSS group ( P < .0001). No significant differences between the groups were observed on day 7. Compared with Ringer, fSS increased the TEER value and ZO-1 content and reduced the adhesion of THP-1 cells. CONCLUSIONS The results of this study indicated that early postoperative AC inflammation is more severe in patients with cataracts and DM. In addition, fSS attenuates inflammation by protecting the blood-aqueous barrier and inhibiting the exudation of inflammatory cells.
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Affiliation(s)
- Mingming Ma
- From the Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Perone JM, Luc MS, Zevering Y, Vermion JC, Gan G, Goetz C. Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research. PLoS One 2024; 19:e0298795. [PMID: 38512953 PMCID: PMC10956851 DOI: 10.1371/journal.pone.0298795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Identifying pre/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre/perioperative variables to predict ECL. METHODS PERCEPOLIS was conducted in 2015-2016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature. RESULTS Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL. CONCLUSIONS Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL via cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.
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Affiliation(s)
- Jean-Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Marie-Soline Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Yinka Zevering
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Grace Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Christophe Goetz
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
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Halkiadakis I, Ntravalias T, Kollia E, Chatzistefanou K, Kandarakis SA, Patsea E. Screening for multifocal intraocular lens implantation in cataract patients in a public hospital. Int Ophthalmol 2024; 44:151. [PMID: 38507136 DOI: 10.1007/s10792-024-03088-8] [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: 09/30/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To identify the rate and characteristics of cataract surgery candidates suitable for multifocal intraocular lens implantation among patients undergoing preoperative evaluation in a public hospital. MATERIALS AND METHODS Screening was performed based on the patient's medical records, comprehensive ophthalmic examination, optical biometry (Zeiss, IOL Master 700) and optical coherence tomography (OCT) (Heidelberg, OCT Spectralis) in accordance with the relevant indications and contraindications mentioned in the pertinent literature. Patients were included in the present study if they were eligible for bilateral cataract surgery. The exclusion criteria were the presence of central nervous system or motility issues, prior refractive surgery, the presence of astigmatism greater than 1 dioptre and/or the presence of important ocular comorbidities in either eye. RESULTS The study evaluated 1200 consecutive patients. Four hundred thirty-two patients (36%) were not eligible for bilateral surgery and were excluded from the study. Of the 768 patients included in the present study, 346 (45.1%) were considered suitable candidates. Four hundred twenty-two patients (54.9%) were excluded for one or both eyes. Among them, 121 (28.7%) were excluded because of retinal disease, 120 (28.4%) because of regular astigmatism (> 1.0 D of corneal astigmatism), 32 (7.5%) because of pseudoexfoliation or zonular instability, and 30 (7.1%) because of glaucoma or ocular hypertension; in addition, 90 (21.3%) patients were excluded for multiple reasons. Suitable candidates were significantly younger (70 and 75 years, respectively) (p < 0.001). After being informed about the potential risks and benefits of MOIL implantation, 212 of 346 (83.8%) eligible patients provided consent. CONCLUSION Close to half of cataract patients in a public hospital were eligible for MOIL implantation, and the majority of patients would proceed to surgery. The most prevalent contraindication was macular disease.
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Affiliation(s)
- Ioannis Halkiadakis
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece.
| | - Thomas Ntravalias
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
| | - Elpida Kollia
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
| | - Klio Chatzistefanou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Stylianos A Kandarakis
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Eleni Patsea
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
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Choi SH, Cho IH, Jeon GS, Chang IB, Ma DJ, Hong IH. Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens. Ophthalmic Res 2024; 67:221-231. [PMID: 38493781 DOI: 10.1159/000538316] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). METHODS This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. RESULTS There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). CONCLUSIONS In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.
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Affiliation(s)
- Se Hyun Choi
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - In Hwan Cho
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan-si, Republic of Korea
| | - Gang Seok Jeon
- Dasan Samsung Bright Eye Clinic, Seoul, Republic of Korea
| | | | - Dae Joong Ma
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
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El Sayed YM, Mettias NM, Elghonemy HME, Mostafa YSE. Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study. Acta Ophthalmol 2024; 102:e195-e203. [PMID: 37435985 DOI: 10.1111/aos.15733] [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: 01/05/2023] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To assess the safety and efficacy of combining phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) compared to phacoemulsification alone in the management of primary angle closure glaucoma (PACG). METHODS Prospective, institutional study in which eyes requiring surgery for PACG were randomized to undergo phacoemulsification followed by GATT (phaco-GATT group) or phacoemulsification alone. Success was defined as having a final IOP of 6-20 mmHg with no subsequent glaucoma surgery or vision-threatening complications. RESULTS Thirty-six eyes underwent phaco-GATT with 360° angle incision and 38 eyes underwent phacoemulsification alone. IOP and glaucoma medications were significantly lower in the phaco-GATT group at 1, 3, 6, 9 and 12 months. The success rate in the phaco-GATT group was 94.4% after 12.16 ± 2.03 months, with 75% of eyes being off medications compared to 86.8% after 12.47 ± 4.27 months in the phaco group, with 42.1% off medications. (p = 0.008). Hyphema and fibrinous anterior chamber reaction were the most common complications in the phaco-GATT group and resolved with conservative treatment or required YAG capsulotomy. Although this delayed visual rehabilitation in the phaco-GATT group, it did not affect the final visual outcome with no significant difference in the final best-corrected visual acuity between both groups (p = 0.25). CONCLUSION Combining phacoemulsification with GATT in PACG yielded more favourable outcomes in terms of IOP, glaucoma medications and surgical success. Although the postoperative hyphema and fibrinous reaction may delay visual rehabilitation, GATT further lowers the IOP by breaking residual peripheral anterior synechiae and removing the dysfunctional trabeculum circumferentially, while avoiding the risks inherent in more invasive filtering procedures.
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Alio JL, Pederzolli M, Grzybowski A. Refractive lens exchange: What are the red lines? Eur J Ophthalmol 2024; 34:317-322. [PMID: 38062638 DOI: 10.1177/11206721231218909] [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: 02/27/2024]
Abstract
Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.
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Affiliation(s)
- Jorge L Alio
- Research and Development Department, VISSUM Miranza, Alicante, Spain
- Division of Ophthalmology, Pathology and Surgery Department, Universidad Miguel Hernández, Alicante, Spain
| | - Matteo Pederzolli
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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Shekhar M, Chaudhary S, Pai A, Rajesh V, Balakrishnan L, Nagu K, Wijesinghe HK. Visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery. J Cataract Refract Surg 2024; 50:257-263. [PMID: 37885121 PMCID: PMC10878458 DOI: 10.1097/j.jcrs.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS). SETTING Tertiary-care eye hospital in southern India. DESIGN Retrospective interventional case series. METHODS Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment-induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed. RESULTS 191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes ( P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable ( P = .463). In 12 eyes (13.5%), improvement in vision was not significant. CONCLUSIONS This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.
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Affiliation(s)
- Madhu Shekhar
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Sushmita Chaudhary
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Aruna Pai
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Vedhanayaki Rajesh
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Logesh Balakrishnan
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Kamatchi Nagu
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
| | - Hiruni Kaushalya Wijesinghe
- From the Cataract Services, Aravind Eye Hospital, Madurai, India (Shekhar, Chaudhary, Pai, Wijesinghe); Uveitis Services, Aravind Eye Hospital, Madurai, India (R, Wijesinghe); Medical Research Foundation, Aravind Eye Hospital, Madurai, India (Balakrishnan, Nagu)
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Sabharwal J, Garg AK, Ramulu PY. How much does cataract surgery contribute to intraocular pressure lowering? Curr Opin Ophthalmol 2024; 35:147-154. [PMID: 38018796 DOI: 10.1097/icu.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW To review the literature evaluating the effect of cataract surgery on intraocular pressure (IOP) in patients with glaucoma. RECENT FINDINGS Recent high-quality secondary analyses of large and primary trials continue to show IOP lowering following cataract surgery. Likewise, cataract surgery remains a key treatment for angle closure glaucoma. Some micro-invasive glaucoma surgeries (MIGS) have strong evidence to be performed at the time of cataract surgery. Data clarifying when these surgeries should be combined with cataract surgery is emerging. The mechanism underlying IOP lowering after cataract surgery remains unclear. SUMMARY Patients who are glaucoma suspects with visually significant cataracts would benefit from cataract surgery alone. Those with mild-moderate damage on 1-2 classes of medications would most likely benefit from additional MIGS. Patients with advanced disease would benefit from cataract surgery and a choice of additional surgery, which depends on disease status and patient factors. Clear lens extraction is becoming a more accepted practice as a primary procedure for patients with angle closure and high IOP or glaucoma. The role of additional MIGS in angle closure needs further study.
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Ripa M, Ricci F, Rizzo S. Pain experience in patients undergoing topical anesthesia alone versus topical plus intracameral anesthesia during cataract surgery. Eur J Ophthalmol 2024; 34:425-431. [PMID: 37498980 DOI: 10.1177/11206721231187424] [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: 07/29/2023]
Abstract
PURPOSE To evaluate and compare the pain experience and discomfort during cataract surgery and over the 24 hours after surgery in patients undergoing either topical anesthesia alone or topical anesthesia plus intracameral anesthesia, provided by using a standard topical anesthesia regimen and a 0.2-mL dose of Mydrane®. METHODS Prospective study involving 100 patients who underwent cataract surgery receiving either topical anesthesia alone (group 1, n = 50) or topical anesthesia plus intracameral anesthesia (group 2, n = 50) between January 2021 and March 2022. The pain experienced by patients during and after surgery was assessed using a pain scale and a questionnaire. One hour after surgery, patients were asked to rate the intensity of discomfort they experienced throughout the procedure by pointing to a 0-100 Visual Analogue Scale (VAS). RESULTS According to VAS measurements, patients who underwent surgery under topical anesthesia reported more significant pain than those who underwent surgery under topical anesthesia plus intracameral anesthesia during and over the 24 hours after surgery. (p = 0.02 and p = 0.01, respectively). Patients undergoing topical anesthesia had 2.34-fold greater odds of having pain during surgery [95% Confidence Interval (CI): 1.58-5.25, p = 0.03]. CONCLUSIONS Topical anesthesia plus intracameral anesthesia lower intraoperative and postoperative pain levels, improving patient cooperation and representing a useful analgesic delivery method in cataract surgery.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Francesco Ricci
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Oh R, Hyon JY, Jeon HS. Accuracy of the PEARL-DGS Formula for Intraocular Lens Power Calculation in Post-Myopic Laser Refractive Corneal Surgery Eyes. Am J Ophthalmol 2024; 259:79-87. [PMID: 37914063 DOI: 10.1016/j.ajo.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To investigate the accuracy of the PEARL-DGS formula for intraocular lens (IOL) power calculation in post-myopic laser refractive corneal surgery eyes. DESIGN Retrospective case series. METHODS A total of 139 eyes of 139 patients (mean axial length: 27.4 ± 2.1 mm) who had prior myopic laser refractive corneal surgery and subsequent cataract surgery using Tecnis ZCB00 from March 2018 to February 2023 were included. Refractive outcomes of 5 formulas (Barrett True K, Haigis-L, Hoffer-QST, PEARL-DGS, and Shammas-PL) were evaluated. Prediction error was defined as the difference between the measured and predicted postoperative refractive spherical equivalent using the IOL power actually implanted. Mean prediction error (MPE), median absolute prediction error (MedAE), and mean absolute prediction error were calculated. RESULTS Without constant optimization, the PEARL-DGS resulted in a MPE of +0.05 ± 0.65 diopters (D), whereas the other formulas resulted in myopic shifts. The MedAEs of the formulas were 0.39, 0.53, 0.65, 0.85, and 1.11 D for the PEARL-DGS, Hoffer-QST, Barrett True K, Shammas-PL, and Haigis-L, respectively, in order of magnitude (P < .05). With constant optimization, there were no statistically significant differences in the MedAEs among the 5 formulas (P = .388). CONCLUSIONS In comparison to other IOL formulas, the PEARL-DGS resulted in better refractive outcomes after cataract surgery in post-myopic laser refractive corneal surgery eyes without constant optimization. We suggest that PEARL-DGS be considered as the first choice for IOL power calculation in these eyes when the clinicians do not have their optimized constants.
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Affiliation(s)
- Richul Oh
- From the Department of Ophthalmology (R.O., J.Y.H., H.S.J.), Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology (R.O.), Seoul National University Hospital, Seoul, Korea
| | - Joon Young Hyon
- From the Department of Ophthalmology (R.O., J.Y.H., H.S.J.), Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology (J.Y.H., H.S.J.), Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sun Jeon
- From the Department of Ophthalmology (R.O., J.Y.H., H.S.J.), Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology (J.Y.H., H.S.J.), Seoul National University Bundang Hospital, Seongnam, Korea.
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25
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Crincoli E, Savastano A, Ferrara S, Caporossi T, Miere A, Souied EH, Savastano MC, Kilian R, Rizzo C, Faraldi F, Rizzo S. Refractive outcome in combined phacovitrectomy: Anterior segment changes and corrective factor for IOL power calculation improvement. Eur J Ophthalmol 2024; 34:549-557. [PMID: 37401268 DOI: 10.1177/11206721231184502] [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: 07/05/2023]
Abstract
PURPOSE To analyze differences in refractive outcome Δ (difference between postoperative and expected refractive error) and in anterior segment changes between cataract surgery patients and combined phacovitrectomy patients. We also aimed to provide a corrective formula allowing to minimise the refractive outcome Δ in combined surgery patients. METHODS Candidates for phacoemulsification and combined phacovitrectomy (respectively PHACO and COMBINED groups) were prospectively enrolled in two specialised centres. Patients underwent best corrected visual acuity (BCVA) assessment, ultra-high speed anterior segment optical coherence tomography (OCT), gonioscopy, retinal OCT, slit lamp examination and biometry at baseline, 6 weeks postoperatively and 3 months postoperatively. RESULTS No differences in refractive Δ, refractive error and anterior segment parameters were noted between PHACO and COMBINED group (109 and 110 patients respectively) at 6 weeks. At 3 months, COMBINED group showed a spherical equivalent of -0.29 ± 0.10 D versus -0.03 ± 0.15 D in PHACO group (p = 0.023). COMBINED group showed a significantly higher Crystalline Lens Rise (CLR), angle-to-angle (ATA) and anterior chamber width (ACW) and a significantly lower anterior chamber depth (ACD) and refractive Δ with all 4 considered formulas at 3 months. For IOL power lower than 15, a hyperopic shift was observed instead. CONCLUSIONS Anterior segment OCT suggests anterior displacement of the effective lens position in patients undergoing phacovitrectomy. A corrective formula can be applied to IOL power calculation to minimize undesired refractive error.
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Affiliation(s)
- Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Silvia Ferrara
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Verona, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
| | | | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Faraldi
- Department of Ophthalmology, Istituto Oftalmico di Torino, Torino, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Fondazione Policlinico Universitario A Gemelli, Catholic University of "Sacro Cuore", Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze" Pisa, Pisa, Italy
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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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Aswin PR, Mohan N, Sundar B, Ponnat AK, Radhakrishnan S, Krishnadas SR, Schehlein E. Outcome of combined trabeculectomy with cataract surgery in patients on prostaglandin analogs and aqueous suppressants. Indian J Ophthalmol 2024; 72:439-446. [PMID: 38189457 PMCID: PMC11001227 DOI: 10.4103/ijo.ijo_2317_23] [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: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To compare the effect of prostaglandin analogs (PGA) against other glaucoma medications (non-PGA) on the intraocular pressure (IOP) outcomes of combined trabeculectomy with phacoemulsification, and the conjunctival cell profile in persons with primary open-angle (POAG) and pseudoexfoliation glaucoma (PXFG). METHODS A prospective cohort study was conducted among 116 patients with POAG or PXFG on glaucoma medications for a minimum of 3 months undergoing glaucoma triple procedure. Patients were divided into two groups (PGA and non-PGA) based on preoperative exposure to PGA. IOP outcomes were assessed for up to 2 years. Conjunctival biopsy specimens were obtained at the time of surgery, and histopathological analysis was performed. RESULTS Forty-two patients were in the PGA group, 67 were in the non-PGA group, and seven were lost to follow-up. The non-PGA group had lesser mean postoperative IOP and needed fewer postoperative medications compared to the PGA group in all visits up to 2 years. The non-PGA group had better complete success rate (50.7% vs. 14.3%, P < 0.001). Kaplan-Meier survival estimates showed a significant difference in cumulative complete success rate between non-PGA (67%) and PGA (26%) by 24 months ( P < 0.001). The Cox proportional model showed the type of drug to be significantly associated with surgical failure. Histopathological analysis revealed that the PGA group had higher numbers for each type of inflammatory cell (except mast cells) compared to the non-PGA group. CONCLUSION Patients on PGA are likely to have a higher postoperative IOP and may need more medications for IOP control after a glaucoma triple procedure.
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Affiliation(s)
- PR Aswin
- Department of Retina and Vitreous, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Neethu Mohan
- Department of Glaucoma Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Balagiri Sundar
- Department of Biostatistics, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | | | | | - Emily Schehlein
- Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland, USA
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Martínez-de-la-Casa JM, Marcos-Parra MT, Millá-Griñó E, Laborda T, Giménez-Gomez R, Larrosa JM, Urcola A, Teus MÁ, Perucho-Martínez S. Effectiveness and safety of XEN63 in patients with primary-open-angle glaucoma. Sci Rep 2024; 14:4561. [PMID: 38402310 PMCID: PMC10894194 DOI: 10.1038/s41598-024-55287-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/22/2024] [Indexed: 02/26/2024] Open
Abstract
This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.
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Affiliation(s)
- José María Martínez-de-la-Casa
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Universidad Complutense de Madrid, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | | | | | - Teresa Laborda
- Glaucoma Department. Hospital La Arruzafa, Córdoba, Spain
| | | | | | - Aritz Urcola
- Ophthalmology Department, Araba University Hospital, Álava, Spain
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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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Hwang HS, Lee H, Park JH, Chae JB, Kim DY. Cataract surgery with new monofocal intraocular lens enhanced for intermediate vision and standard monofocal intraocular lens for retinal disorder. Int Ophthalmol 2024; 44:104. [PMID: 38378994 DOI: 10.1007/s10792-024-03047-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
AIM To investigate the difference in the initial surgical results between a new monofocal intraocular lens (IOL) with enhanced intermediate vision and the standard monofocal IOL in patients with retinal disease. METHODS We retrospectively reviewed the medical records of patients with retinal disease who underwent cataract surgery due to accompanying cataracts. Types of retinal diseases were investigated and best-corrected distant visual acuity, distant uncorrected visual acuity (UCVA), intermediate UCVA, near UCVA, and spherical equivalent were recorded at each visit. The surgical results were investigated at 1 day, 1 week, and 1 month after surgery. RESULTS Seventeen eyes treated with a new monofocal IOL enhanced for intermediate vision (ICB00 group) and 18 eyes treated with the standard monofocal IOL (AAB00 group) were included in this study. There were no significant differences in the baseline characteristics, including the type of underlying retinal disease, between the groups. There were no significant differences between the groups in terms of distant, intermediate, or near UCVA at day 1 and week 1 after surgery. However, at 1 month after surgery, the ICB00 group showed a significantly better intermediate vision improvement than the AAB00 group (p = 0.001). CONCLUSION Even in patients with cataract accompanied by retinal disease, the use of the ICB00 IOL showed significant improvement in intermediate vision compared to the use of the AAB00 (standard monofocal) IOL. The ICB00 IOL might be a good option for patients with cataract and retinal disease in the era of increased intermediate vision needs in daily life.
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Affiliation(s)
- Hye Seong Hwang
- Department of Ophthalmology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hwanho Lee
- Nineteenth Fighter Wing, Republic of Korea Air Force, Chungju, Korea
| | | | - Ju Byung Chae
- Top Retina Center, 122, Gangseo-ro, Heungdeok-gu, Cheongju, 28387, Korea
| | - Dong Yoon Kim
- Top Retina Center, 122, Gangseo-ro, Heungdeok-gu, Cheongju, 28387, Korea.
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31
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Eom Y, Bae SH, Yang SK, Kim DH, Song JS, Cooke DL. Modified intraocular lens power selection method according to biometric subgroups Eom IOL power calculator. Sci Rep 2024; 14:4228. [PMID: 38378801 PMCID: PMC10879518 DOI: 10.1038/s41598-024-54346-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
This study evaluates the accuracy of a newly developed intraocular lens (IOL) power calculation method that applies four different IOL power calculation formulas according to 768 biometric subgroups based on keratometry, anterior chamber depth, and axial length. This retrospective cross-sectional study was conducted in at Korea University Ansan Hospital. A total of 1600 eyes from 1600 patients who underwent phacoemulsification and a ZCB00 IOL in-the-bag implantation were divided into two datasets: a reference dataset (1200 eyes) and a validation dataset (400 eyes). Using the reference dataset and the results of previous studies, the Eom IOL power calculator was developed using 768 biometric subgroups. The median absolute errors (MedAEs) and IOL Formula Performance Indexes (FPIs) of the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, Ladas Super, SRK/T, and Eom formulas using the 400-eye validation dataset were compared. The MedAE of the Eom formula (0.22 D) was significantly smaller than that of the other four formulas, except for the Barrett Universal II and Ladas Super formulas (0.24 D and 0.23 D, respectively). The IOL FPI of the Eom formula was 0.553, which ranked first, followed by the Ladas Super (0.474), Barrett Universal II (0.470), Holladay 1 (0.444), Hoffer Q (0.396), Haigis (0.392), and SRK/T (0.361) formulas. In conclusion, the Eom IOL power calculator developed in this study demonstrated similar or slightly better accuracy than the Barrett Universal II and Ladas Super formulas and was superior to the four traditional IOL power calculation formulas.
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Grants
- 13-2020-007 SNUBH Research Fund
- K1625491, K1722121, K1811051, K1913161, and K2010921 Korea University Ansan Hospital grant
- K1625491, K1722121, K1811051, K1913161, and K2010921 Korea University grant
- Project Number: 1711174253, RS-2020-KD000296 Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
- 2020002960007, NTIS-1485017544 Korea Environment Industry & Technology Institute(KEITI) through Technology Development Project for Safety Management of Household Chemical Products, funded by Korea Ministry of Environment(MOE)
- S3127902 Technology development Program(S3127902) funded by the Ministry of SMEs and Startups(MSS, Korea)
- S3305836 Technology development Program(S3305836) funded by the Ministry of SMEs and Startups(MSS, Korea)
- NRF-2021R1F1A1062017 National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT)
- No. RS-2023-00259877 'Technical start-up corporation fostering project' through the Commercialization Promotion Agency for R&D Outcomes(COMPA) grant funded by the Korea government(MSIT)
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea.
- Department of Ophthalmology, Emory University School of Medicine, Emory Clinic Building B, 1365B Clifton Road, Atlanta, NEGA, 30322, USA.
| | - So Hyeon Bae
- Department of Ophthalmology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Seul Ki Yang
- Space Optics Laboratory, Department of Astronomy, Yonsei University, Seoul, Republic of Korea
- Satellite System 3 Team, Hanwha Systems Co., Ltd., Yongin‑si, Gyeonggi‑do, Republic of Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
| | - David L Cooke
- Great Lakes Eye Care, 2848 Niles Road, Saint Joseph, MI, 49085, USA.
- Department of Neurology and Ophthalmology, School of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
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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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Gurdal F, Ozge G, Ayyildiz O. Determination of the toric axis by using internal astigmatism axis in non-dilated eyes. Int Ophthalmol 2024; 44:46. [PMID: 38336905 DOI: 10.1007/s10792-024-03003-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/19/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To determine the toric intraocular lens (IOL) axis by using internal astigmatism axis obtained from Optical Path Difference (OPD) Scan III (Nidek Co.) in non-dilate eyes. METHODS The eyes of patients who underwent toric IOL implantation for astigmatic correction were investigated. Patients who have ocular surface disorder, keratoconus, posterior capsule opacification were excluded. The IOL axis measured in non-dilated eyes in mesopic conditions by OPD scan III device and the IOL axis measured by using classical slit lamp biomicroscopy method in dilated eyes were detected at postoperative 1st and 6th months. Results were compared with correlation and linear regression analysis. RESULTS Totally, 26 eyes of 18 patients were included. The difference between biomicroscopic IOL axis and OPD internal astigmatism axis was 4.96 ± 4.41 degrees at the 1st month and 3.62 ± 3.5 degrees at the 6th month. There was a significant and high correlation between biomicroscopic IOL axis and OPD internal astigmatism axis at both 1st month (r = 0.992 p < 0.001) and 6th month (r = 0.995 p < 0.001). According to regression analysis, the results of two measurement methods were significantly compatible with each other at 1st month (R Sq = 0.984 p < 0.001) and 6th month (R Sq = 0.990 p < 0.001) and there was a close to ideal linear (R Sq = 1) relationship between two methods. CONCLUSIONS In eyes with toric IOL implantation, the IOL axis and IOL rotation according to target IOL axis can be detected easily and effectively in a short time by OPD scan internal astigmatism axis without the need to dilate the pupil.
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Affiliation(s)
- Fatih Gurdal
- Department of Ophthalmology, Gulhane Training and Research Hospital, University of Health Sciences, Tevfik Saglam Street, Kecioren, Ankara, 06010, Turkey.
| | - Gokhan Ozge
- Department of Ophthalmology, Gulhane Faculty of Medicine, University of Health Sciences, Tevfik Saglam Street, Kecioren, Ankara, 06010, Turkey
| | - Onder Ayyildiz
- Department of Ophthalmology, Gulhane Faculty of Medicine, University of Health Sciences, Tevfik Saglam Street, Kecioren, Ankara, 06010, Turkey
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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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Lundström M, Kugelberg M, Zetterberg M, Nilsson I, Viberg A, Bro T, Behndig A. Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register. Acta Ophthalmol 2024; 102:68-73. [PMID: 37133405 DOI: 10.1111/aos.15688] [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: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Kugelberg
- SöderÖgon, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
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Giger-Lange C, Rattenbacher-Kiser K, Di Lanzo J, Di Nardo S, Menapace R, Ille F. Systematic and objective wet-lab testing of instruments for phacoemulsification: new Formalin Quadrant Model. J Cataract Refract Surg 2024; 50:174-180. [PMID: 37816247 PMCID: PMC10805352 DOI: 10.1097/j.jcrs.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To validate an improved wet-lab model for systematic and objective efficiency testing of instruments for phacoemulsification. SETTING Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland. DESIGN Experimental study. METHODS Porcine lenses were incubated for different time spans in formalin to simulate different cataract densities. Lenses were cut in quadrants and emulsified in a silicone test chamber. The use of ultrasound was restricted to full occlusion and the minimal power needed to promote emulsification. Equivalence to the surgical situation and cataract consistency were judged by an experienced surgeon. Efficiency was rated by effective phacoemulsification time, liquid consumption, and total surgery time. RESULTS Formalin incubation times of 2 hours, 1.25 hours, and 0.5 hours were validated for hard, middle-hard, and soft cataracts, respectively. Systematic testing of different fluidics settings revealed the unique opportunities of the improved model: Experiments could be performed by laboratory staff without any surgical experience after a short training, and the model provided results in a fast and reproducible manner. Reduced effective phacoemulsification time, shorter total surgery time, and less liquid consumption were observed with higher fluidics settings, confirming and complementing earlier clinical findings. CONCLUSIONS The Formalin Quadrant Model can be used to test new designs of instrumentation on different cataract densities or various instrument settings for efficiency. Using a validated cataract substitute, it closely represents the clinical situation and thus renders valid results in a short time. Instruments can be tested and improved profoundly before costly and elaborate clinical trials have to be applied.
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Affiliation(s)
- Christina Giger-Lange
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
| | - Karin Rattenbacher-Kiser
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
| | - Jessica Di Lanzo
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
| | - Silvio Di Nardo
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
| | - Rupert Menapace
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
| | - Fabian Ille
- From the Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland (Giger-Lange, Rattenbacher-Kiser, Di Lanzo, Di Nardo, Ille); Departement of Ophthalmologie, Medical University of Vienna, Vienna, Austria (Menapace)
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Abe RY, Oltramari L, Vessani RM, Schimiti RB, Magacho L, Kanadani FN, Costa VP. Trabeculectomy in Eyes With High Myopia. J Glaucoma 2024; 33:110-115. [PMID: 37671507 DOI: 10.1097/ijg.0000000000002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
PRCIS Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.
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Affiliation(s)
- Ricardo Y Abe
- Department of Opthalmology, University of Campinas-UNICAMP
- Hospital Oftalmológico de Brasília, Brasília, Distrito Federal
| | - Laura Oltramari
- Hospital Oftalmológico de Brasília, Brasília, Distrito Federal
| | - Roberto M Vessani
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of Sao Paulo, São Paulo
| | - Rui B Schimiti
- Department of Opthalmology, University of Campinas-UNICAMP
| | - Leopoldo Magacho
- Department of Ophthalmology, Federal University of Goiás
- VER Hospital de Olhos, Goiânia, Goiás
| | - Fábio N Kanadani
- Department of Ophthalmology, Glaucoma Institute of Belo Horizonte, Belo Horizonte, Brazil
| | - Vital P Costa
- Department of Opthalmology, University of Campinas-UNICAMP
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Heit L, Datar M, Kyriakakos M, Orcutt C, Hsiao C, Pan SM, Shamie N. Comparing the time efficiency of two lasers used in FLACS: real-world observational study. J Cataract Refract Surg 2024; 50:116-121. [PMID: 37748033 PMCID: PMC10805351 DOI: 10.1097/j.jcrs.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To evaluate time efficiencies in the laser room for 2 different femtosecond laser systems. SETTING 1 private practice in Atlanta, Georgia, and 1 private practice in Los Angeles, California. DESIGN Prospective, observational, single-masked study. METHODS Patients scheduled to receive femtosecond laser-assisted cataract surgery (FLACS) included those who were not pregnant, had no previous eye surgeries, and were not scheduled to undergo additional surgical procedures at the time of treatment; patients who received a standard, monofocal lens without undergoing arcuate incisions were excluded. Patients taking Flomax or any tamsulosin were also excluded from the study. Each comparable step in the LenSx and CATALYS workflow was identified and clearly defined. Time for each step was evaluated and compared using t tests and regression analyses to control for patient and site-specific differences between the 2 groups. RESULTS Time data were collected for 89 patients (89 eyes). The overall procedure was 2.86 minutes shorter for the LenSx system when compared with the CATALYS system ( P < .05). Per patient, the LenSx system had significantly shorter time for patient positioning (57.26 vs 122.00 seconds; P < .05), imaging (33.23 vs 42.17 seconds; P < .05), laser treatment (21.57 vs 39.67 seconds; P < .05), and undocking/transition (67.13 vs 185.30 seconds; P < .05) compared with the CATALYS system. Regression analyses yielded similar results, with the LenSx system being over 35% (3.21 minutes; P < .05) shorter overall than the CATALYS system controlling for location, age, sex, lens thickness, cataract grade, fragmentation pattern, and arcuate incisions. CONCLUSIONS LenSx procedures were significantly shorter than the CATALYS procedures overall, which can enable ophthalmology practices to increase efficiency.
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Affiliation(s)
- Larry Heit
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Manasi Datar
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Maria Kyriakakos
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Cecelia Orcutt
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Carine Hsiao
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Sun-Ming Pan
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Neda Shamie
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
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Wei Y, Liu Y, Li H, Song H. Theoretical Accuracy of the Raytracing Method for Intraocular Calculation of Lens Power in Myopic Eyes after Small Incision Extraction of the Lenticule. Klin Monbl Augenheilkd 2024; 241:221-229. [PMID: 37722612 PMCID: PMC10898958 DOI: 10.1055/a-2177-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
AIM To evaluate the accuracy of the raytracing method for the calculation of intraocular lens (IOL) power in myopic eyes after small incision extraction of the lenticule (SMILE). METHODS Retrospective study. All patients undergoing surgery for myopic SMILE between May 1, 2020, and December 31, 2020, with Scheimpflug tomography optical biometry were eligible for inclusion. Manifest refraction was performed before and 6 months after refractive surgery. One eye from each patient was included in the final analysis. A theoretical model was invited to predict the accuracy of multiple methods of lens power calculation by comparing the IOL-induced refractive error at the corneal plane (IOL-Dif) and the SMILE-induced change of spherical equivalent (SMILE-Dif) before and after SMILE surgery. The prediction error (PE) was calculated as the difference between SMILE-Dif-IOL-Dif. IOL power calculations were performed using raytracing (Olsen Raytracing, Pentacam AXL, software version 1.22r05, Wetzlar, Germany) and other formulae with historical data (Barrett True-K, Double-K SRK/T, Masket, Modified Masket) and without historical data (Barrett True-K no history, Haigis-L, Hill Potvin Shammas PM, Shammas-PL) for the same IOL power and model. In addition, subgroup analysis was performed in different anterior chamber depths, axial lengths, back-to-front corneal radius ratio, keratometry, lens thickness, and preoperative spherical equivalents. RESULTS A total of 70 eyes of 70 patients were analyzed. The raytracing method had the smallest mean absolute PE (0.26 ± 0.24 D) and median absolute PE (0.16 D), and also had the largest percentage of eyes within a PE of ± 0.25 D (64.3%), ± 0.50 D (81.4%), ± 0.75 D (95.7%), and ± 1.00 D (100.0%). The raytracing method was significantly better than Double-K SRK/T, Haigis, Haigis-L, and Shammas-PL formulae in postoperative refraction prediction (all p < 0.001), but not better than the following formulae: Barrett True-K (p = 0.314), Barrett True-K no history (p = 0.163), Masket (p = 1.0), Modified Masket (p = 0.806), and Hill Potvin Shammas PM (p = 0.286). Subgroup analysis showed that refractive outcomes exhibited no statistically significant differences in the raytracing method (all p < 0.05). CONCLUSION Raytracing was the most accurate method in predicting target refraction and had a good consistency in calculating IOL power for myopic eyes after SMILE.
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Affiliation(s)
- Yinjuan Wei
- Department of Cataract, Tianjin Eye Hospital, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yianzhu Liu
- Department of Cataract, Tianjin Eye Hospital, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Hongyu Li
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Hui Song
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin, China
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Mohaseb K, Tischler A, Hall B, Isbister C, Godinho D, Goldberg A, Fine D. Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting. Can J Ophthalmol 2024; 59:e1-e6. [PMID: 36436668 DOI: 10.1016/j.jcjo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting. DESIGN Prospective multisurgeon study (6 surgeons at 2 sites). METHODS Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire. RESULTS Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance. CONCLUSIONS The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.
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Affiliation(s)
- Kam Mohaseb
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Aron Tischler
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and.
| | | | - Carolyn Isbister
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Derek Godinho
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - Aron Goldberg
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
| | - David Fine
- Division of Ophthalmology, Lions Gate Hospital, North Vancouver, BC; and
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Ferrara S, Crincoli E, Savastano A, Savastano MC, Catania F, Rizzo S. Refractive Outcomes With New Generation Formulas for Intraocular Lens Power Calculation in Radial Keratotomy Patients. Cornea 2024; 43:178-183. [PMID: 37126644 DOI: 10.1097/ico.0000000000003301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Radial keratotomies (RKs) are responsible for corneal irregularities resulting in biometric errors and lower best-corrected visual acuity (BCVA) due to lower-order and higher-order optical aberrations. The aim of the study was to compare performances of new and old generation formulas in a population of RK patients. METHODS RK patients who underwent phacoemulsification with intraocular lens (IOL) implantation were retrospectively recruited. Inclusion criteria were availability of preoperative and 6-month postoperative BCVA assessment, topography, and tomography. Documented refraction instability, corneal ectasia, and previous ocular surgery except for RK were exclusion criteria. Mean prediction error (ME), mean absolute prediction error (MAE), and incidence of MAE > 0.25D were calculated for SRK-T, Barrett True K, EVO 2.0, Kane, and PEARL-DGS. RESULTS Twenty-seven patients with a mean baseline BCVA of 0.32 ± 0.18 logMAR and a mean corneal root mean square (RMS) value of 1.59 ± 0.91 μm were included. EVO 2.0, Kane, and PEARL-DGS showed a significantly lower MAE and lower ME compared with all other formulas ( P < 0.001 and P < 0.001) and a significant lower incidence of MAE >0.25D ( P < 0.001). Significant differences were still detected when using 3-mm mean keratometry for IOL calculation. CONCLUSIONS PEARL-DGS, Kane, and EVO 2.0 formulas show superior accuracy in IOL power calculation compared with SRK-T and Barrett True K in RK patients, with no significant differences between the 3.
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Affiliation(s)
- Silvia Ferrara
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Fiammetta Catania
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; and
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze", Pisa, Italy
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Cioana M, Patodia Y, Tong L, Chiu HH, Tam ES, Somani S. Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS. J Cataract Refract Surg 2024; 50:160-166. [PMID: 37847109 DOI: 10.1097/j.jcrs.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients. SETTING Outpatient surgical center in Vaughan, Ontario, Canada. DESIGN Prospective cohort study. METHODS Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3). RESULTS Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter. CONCLUSIONS FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes.
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Affiliation(s)
- Milena Cioana
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Cioana); Uptown Eye Specialists, Vaughan, Ontario, Canada (Cioana, Tong, Chiu, Tam, Somani); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Patodia, Tong, Chiu, Tam, Somani); William Osler Health System, Brampton, Ontario, Canada (Tong, Chiu, Tam, Somani); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Chiu)
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Chua MJ, Varshney N, Eke T. Intracameral phenylephrine for surgical mydriasis and intraoperative floppy-iris syndrome: systemic adverse effects and optimal dose. J Cataract Refract Surg 2024; 50:187-194. [PMID: 37748029 PMCID: PMC10805356 DOI: 10.1097/j.jcrs.0000000000001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
Phenylephrine, a potent sympathomimetic, induces mydriasis via iris dilator muscle contraction. Intracameral (IC) phenylephrine has been successfully used in cataract surgery for initial mydriasis, maintaining mydriasis, and management of intraoperative floppy-iris syndrome. Serious systemic adverse events (mainly cardiovascular) have been described with topical phenylephrine drops, but we found very little evidence of such adverse events associated with IC phenylephrine use. However, we suspect under-reporting of such adverse events, as they may instead be ascribed to anxiety, positioning, anesthesia, etc. Optimal dosage/concentrations for IC phenylephrine use in different purposes have not been fully studied. In the absence of robust evidence, we suggest that lower but effective IC phenylephrine concentrations are used: a lower concentration (0.31%), in conjunction with an anticholinergic and lidocaine, may be used for initial mydriasis. For management of intraoperative floppy-iris syndrome, 0.31% may be effective, though a higher concentration (1% to 1.25%) may be required.
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Affiliation(s)
- Matthew J. Chua
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
| | - Natasha Varshney
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
| | - Tom Eke
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
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Lim H, Jang JH, Nam S, Lee K, Kim JY, Tchah H, Lee H. Refractive Predictability between Standard and Total Keratometry during the Femtosecond Laser-Assisted Cataract Surgery with Monofocal Intraocular Lens with Enhanced Intermediate Function. Korean J Ophthalmol 2024; 38:9-16. [PMID: 38110185 PMCID: PMC10869425 DOI: 10.3341/kjo.2023.0039] [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: 04/01/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE We aimed to compare the accuracy of the intraocular lens (IOL) calculation formula using the standard keratometry (K) and total K (TK) during the femtosecond laser-assisted cataract surgery (FLACS) with a monofocal IOL with enhanced intermediate function using currently used formulas. METHODS A retrospective review of 125 eyes from 125 patients who had undergone FLACS with implantation of monofocal IOL with enhanced intermediate function was conducted. The predicted refractive power was calculated using an optical biometer (IOLmaster 700) according to the K and TK in the Barrett Universal II, SRK/T, Haigis, and Holladay 2 formulas. Absolute prediction error (APE) obtained from the actual postoperative refractive outcomes and the refractive error predicted in each formula was compared one month after surgery. RESULTS Mean APE ranged between 0.29 and 0.39 diopters (D) regardless of the calculation formula and the method of measuring corneal curvature. Significant differences were observed in the APE from the four formulas and the two keratometric measurements (p = 0.014). In a total of 125 eyes from 125 patients, the mean APE was lowest with the Barrett Universal II formula. Across all formulas, both the mean APE and the median APE tended to be lower for K than for TK, although there was no significant difference. Approximately 70% to 80% of the patients were included within 0.5 D of the refractive error across all formulas. The percentage of eyes within 0.5 D of APE outcomes was not statistically different between the K and TK data when using each formula. CONCLUSIONS Keratometric measurements considering the poster corneal curvature did not show any additional advantages when implanting the monofocal IOL with enhanced intermediate function during the FLACS.
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Affiliation(s)
- Hyunah Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Hyuck Jang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sanghyu Nam
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Koeun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Diakonis VF, Tsaousis KT, Kretz FTA. ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome. Indian J Ophthalmol 2024; 72:S312-S313. [PMID: 38271429 DOI: 10.4103/ijo.ijo_3379_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/24/2023] [Indexed: 01/27/2024] Open
Abstract
We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.
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46
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LoBue SA, Rizzuti AE, Martin CR, Albear SA, Gill ES, Shelby CL, Coleman WT, Smith EF. Preventing the Argentinian flag sign and managing anterior capsular tears: A review. Indian J Ophthalmol 2024; 72:162-173. [PMID: 38273682 PMCID: PMC10941923 DOI: 10.4103/ijo.ijo_1418_23] [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: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 01/27/2024] Open
Abstract
The Argentinian flag sign (AFS) is a feared complication during cataract extraction. Intralenticular pressures, especially excessive posterior pressure, have been identified as potential mechanisms for capsular stress and tearing associated with AFS. Capsular tension is created by positive intralenticular pressures, which cause the irido-lens diaphragm to move anteriorly once the manual capsulorhexis has been initiated. This tension can cause inadvertent tears that self-propagate to the lens equator, causing an AFS, among other intraoperative complications. Thus, this review highlights the importance of identifying intumescent cataracts as well as a combination of techniques to relieve intracapsular pressures needed to prevent AFS. However, some instances of anterior capsular tears are unavoidable. Therefore, focus will also be placed on techniques during cataract extraction used to manage anterior capsular tears, mitigating extension to the posterior capsule.
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Affiliation(s)
- Stephen A LoBue
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Allison E Rizzuti
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Curtis R Martin
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Sinan A Albear
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ekjyot S Gill
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- Department of Ophthalmology, UCLA Stein Eye Institute, Los Angeles, CA, USA
| | - Christopher L Shelby
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Wyche T Coleman
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Edward F Smith
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Ianchulev T, Weinreb RN, Kamthan G, Calvo E, Pamnani R, Ahmed IK. Biotissue stent for supraciliary outflow in open-angle glaucoma patients: surgical procedure and first clinical results of an aqueous drainage biostent. Br J Ophthalmol 2024; 108:217-222. [PMID: 36593090 PMCID: PMC10850681 DOI: 10.1136/bjo-2022-322536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/16/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIMS To report a first-in-human trial in open-angle glaucoma (OAG) subjects treated with a new microinterventional biostent-reinforced cyclodialysis technique to enhance supraciliary aqueous drainage. METHODS Subjects (N=10; 74.1±7.9 years old) with OAG and cataracts underwent combined phacoemulsification cataract surgery with implantation of a permanent endoscleral supraciliary biostent to reinforce a controlled cyclodialysis cleft. The biostent comprised decellularised scleral allograft tissue microtrephined into a polymer tubular implant intraoperative/postoperative safety, intraocular pressure (IOP) and glaucoma medications were tracked through 12 months postimplantation. RESULTS Baseline medicated IOP averaged 24.2±6.9 mm Hg with subjects using 1.3±0.8 IOP-lowering medications. Successful biostent implantation was achieved in all individuals without significant complications. Immediate IOP lowering was sustained through 1 year. Twelve-month mean IOP was reduced 40% from baseline to 14.6±3.2 mm Hg (p=0.004; paired two-tailed t-test), and 80% of patients achieved >20% IOP reduction. Biostenting reduced glaucoma medication use 62%, from a baseline mean of 1.3 required medications to 0.5 medications (p=0.037) at postoperative 12 months. The biotissue implant was well tolerated and demonstrated good endothelial safety with only 11% endothelial cell loss at 12 months after combined phaco-biostenting surgery, similar to that expected after phacoemulsification alone. Mean BCVA increased from baseline 20/130 Snellen to 20/36 at postoperative 12 months (p=0.001). CONCLUSION Supraciliary biostenting in OAG patients is well tolerated, has a good safety profile and produces long-term IOP-lowering while reducing glaucoma medication requirements.
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Affiliation(s)
- Tsontcho Ianchulev
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
- UCSD, La Jolla, California, USA
| | | | - Gautam Kamthan
- New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
| | | | | | - Iqbal K Ahmed
- Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada
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Kenny PI, Kozhaya K, Truong P, Wang L, Koch DD, Weikert MP. Performance of IOL calculation formulas that use measured posterior corneal power in eyes following myopic laser vision correction. J Cataract Refract Surg 2024; 50:7-11. [PMID: 37702522 DOI: 10.1097/j.jcrs.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To compare the predictive accuracy of the biometer-embedded Barrett True-K TK and new total corneal power methods of intraocular lens (IOL) power calculation in eyes with prior laser vision correction (LVC) for myopia. SETTING Academic clinical practice. DESIGN Retrospective case series. METHODS IOL power formulas were assessed using measurements from a swept-source optical coherence biometer. Refractive prediction errors were calculated for the Barrett True-K TK, EVO 2.0, Pearl-DGS, and HofferQST, which use both anterior and posterior corneal curvature measurements. These were compared with the Shammas, Haigis-L, Barrett True-K No History (NH), optical coherence tomography, and 4-formula average (AVG-4) on the ASCRS postrefractive calculator, and to the Holladay 1 and 2 with non linear axial length regressions (H1- and H2-NLR). RESULTS The study comprised 85 eyes from 85 patients. Only the Barrett True-K TK and EVO 2.0 had mean numerical errors that were not significantly different from 0. The EVO 2.0, Barrett True-K TK, Pearl-DGS, AVG-4, H2-NLR, and Barrett True-K NH were selected for further pairwise analysis. The Barrett True-K TK and EVO 2.0 demonstrated smaller root-mean-square absolute error compared with the Pearl-DGS, and the Barrett True-K TK also had a smaller mean absolute error than the Pearl-DGS. CONCLUSIONS The Barrett True-K TK and EVO 2.0 formulas had comparable performance to existing formulas in eyes with prior myopic LVC.
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Affiliation(s)
- Peter I Kenny
- From the Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Gupta V, Pal H, Sawhney S, Aggarwal A, Vanathi M, Luthra G. Optimization of biometry for best refractive outcome in cataract surgery. Indian J Ophthalmol 2024; 72:29-43. [PMID: 38131567 PMCID: PMC10841781 DOI: 10.4103/ijo.ijo_1219_23] [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: 05/09/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 12/23/2023] Open
Abstract
High-precision biometry and accurate intraocular lens (IOL) power calculation have become essential components of cataract surgery. In clinical practice, IOL power calculation involves measuring parameters such as corneal power and axial length and then applying a power calculation formula. The importance of posterior corneal curvature in determining the true power of the cornea is increasingly being recognized, and newer investigative modalities that can estimate both the anterior and posterior corneal power are becoming the standard of care. Optical biometry, especially using swept-source biometers, with an accuracy of 0.01-0.02 mm, has become the state-of-the-art method in biometry. With the evolution of IOL formulas, the ultimate goal of achieving a given target refraction has also moved closer to accuracy. However, despite these technological efforts to standardize and calibrate methods of IOL power calculation, achieving a mean absolute error of zero for every patient undergoing cataract surgery may not be possible. This is due to inherent consistent bias and systematic errors in the measurement devices, IOL formulas, and the individual bias of the surgeon. Optimization and personalization of lens constants allow for the incorporation of these systematic errors as well as individual bias, thereby further improving IOL power prediction accuracy. Our review provides a comprehensive overview of parameters for accurate biometry, along with considerations to enhance IOL power prediction accuracy through optimization and personalization. We conducted a detailed search in PubMed and Google Scholar by using a combination of MeSH terms and specific keywords such as "ocular biometry," "IOL power calculations," "prediction accuracy of refractive outcome in cataract surgery," "effective lens position," "intraocular lens calculation formulas," and "optimization of A-constants" to find relevant literature. We identified and analyzed 121 relevant articles, and their findings were included.
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Affiliation(s)
- Vinita Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Himani Pal
- Department of Ophthalmology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Saurabh Sawhney
- Data Scientist, Department of Artificial Intelligence, Koverhoop Technologies, Canada
| | | | - Murugesan Vanathi
- Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Luthra
- Director and Consultant, Cataract and Refractive Services, Drishti Eye Institute, Dehradun, Uttarakhand, India
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50
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Khokhar S, Rani D, Rathod A, Nathiya V, Kapoor A. Bimanual phacoemulsification for subluxated cataractous lens. Indian J Ophthalmol 2024; 72:126-127. [PMID: 38131583 PMCID: PMC10841795 DOI: 10.4103/ijo.ijo_1188_23] [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: 05/07/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/23/2023] Open
Abstract
Bimanual phacoemulsification has been established as a safe and efficacious means of nuclear emulsification in the past. This case report presents the use of this technique in a man in his early forties, who had subluxated cataractous lenses in both eyes. The technique allowed for effective nuclear emulsification within a closed chamber, providing better control over intraocular events. The report emphasizes the safety and effectiveness of bimanual phacoemulsification in cataract extraction, even in challenging cases like a subluxated lens.
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Affiliation(s)
- Sudarshan Khokhar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Deeksha Rani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Aishwarya Rathod
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Venkatesh Nathiya
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anirudh Kapoor
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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