1
|
Martini K, Baillif S, Nahon-Esteve S, Denis P, Martel A. Intraoperative iStent versus postoperative selective laser trabeculoplasty in early glaucoma patients undergoing cataract surgery: A retrospective comparative study. J Fr Ophtalmol 2024; 47:103956. [PMID: 37783587 DOI: 10.1016/j.jfo.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To compare the efficacy and safety of iStent inject® versus 360° selective laser trabeculoplasty (SLT) in patients with early glaucoma undergoing cataract surgery. METHODS A retrospective non-randomized study was conducted in 73 eyes divided into two groups: cataract surgery+intraoperative iStent (n=40) versus cataract surgery+postoperative SLT at one month (n=33). The primary endpoint was intraocular pressure (IOP) lowering≥20% between baseline and 6 months postoperatively. The secondary endpoints were IOP lowering at 1, 6 and 12 months, and the mean number of IOP-lowering medications at 6 and 12 months. RESULTS The mean baseline IOP was 19.1 mmHg with no significant difference between groups. The mean baseline number of IOP-lowering medications was higher in the iStent group (n=1.95) compared to the SLT group (n=1.53; P=0.04). At 6 months, 18 (60%) patients in the SLT group and 20 (51%) patients in the iStent group achieved IOP lowering≥20% with no significant difference between groups (P=0.431). At 6 months, no difference in the mean number of IOP-lowering medications was found between groups (-0.92 and -0.89 in the iStent and SLT groups, respectively). Similar results were found at 12 months. CONCLUSION These results suggest similar safety and efficacy of intraoperative iStent and postoperative 360° SLT in lowering IOP and reducing glaucoma eye drops in early glaucoma patients undergoing cataract surgery. Treatment choice should be based on the ophthalmologist's experience and on the cost-benefit ratio.
Collapse
Affiliation(s)
- K Martini
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - S Baillif
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - S Nahon-Esteve
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - P Denis
- Ophtalmology Department, University Hospital of La-Croix-Rousse, grande rue de la Croix-Rousse, Lyon, France
| | - A Martel
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France
| |
Collapse
|
2
|
Oberfeld B, El Helwe H, Hall N, Falah H, Chang TC, Solá-Del Valle D. Comparative outcomes of phacoemulsification combined with micro-invasive glaucoma surgery plus: Schlemm canal microstent versus Ab interno trabecular excision. J Fr Ophtalmol 2023; 46:266-275. [PMID: 36801112 DOI: 10.1016/j.jfo.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE To report the relative efficacy of combining phacoemulsification with a Schlemm's canal microstent (Phaco/Hydrus) or dual blade trabecular excision (Phaco/KDB). DESIGN Retrospective study. METHODS One hundred and thirty-one eyes of 131 patients who underwent Phaco/Hydrus or Phaco/KDB procedures from January 2016 to July 2021 at a tertiary care center were included and assessed for up to 36months postoperatively. Primary outcomes were intraocular pressure (IOP) and number of glaucoma medications, evaluated by generalized estimating equations (GEE). Two Kaplan-Meier estimates (KM) assessed survival without additional intervention or pressure lowering medication while maintaining: (1) IOP≤21mmHg and≥20% IOP reduction or (2) IOP≤preoperatively designated goal. RESULTS Mean preoperative IOP was 17.70±4.91 (SD) mmHg on 0.28±0.86 medications in the Phaco/Hydrus cohort (n=69) and 15.92±4.34mmHg on 0.19±0.70 medications in the Phaco/KDB cohort (n=62). At 12months, mean IOP was reduced to 14.98±2.77mmHg on 0.12±0.60 medications after Phaco/Hydrus and 13.52±4.13mmHg on 0.04±0.19 medications after Phaco/KDB. GEE models of IOP (P<0.001) and medication burden (P<0.05) showed significant patterns of reduction across all timepoints in both cohorts. There were no differences in IOP reduction (P=0.94), number of medications (P=0.95) or survival (P=0.72 by KM1, P=0.11 by KM2) between procedures. CONCLUSIONS Both Phaco/Hydrus and Phaco/KDB resulted in significantly reduced IOP and medication burden for over 12months. Phaco/Hydrus and Phaco/KDB confer similar outcomes in terms of IOP, medication burden, survival, and procedural time in a population with predominantly mild and moderate open-angle glaucoma.
Collapse
Affiliation(s)
- B Oberfeld
- Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - H El Helwe
- Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - N Hall
- Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - H Falah
- Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - T C Chang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
| | - D Solá-Del Valle
- Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.
| |
Collapse
|
3
|
Maroun A, El Shami M, Hoyek S, Antoun J. Comparison of the accuracy of nine intraocular lens power calculation formulas using partial coherence interferometry. J Fr Ophtalmol 2023; 46:341-347. [PMID: 36746741 DOI: 10.1016/j.jfo.2022.09.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/31/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023]
Abstract
Cataract surgery is the most performed procedure in the world. To achieve the target refraction, several intraocular lens (IOL) power calculation formulas have been developed to improve the accuracy of IOL power predictions. We compared the accuracy of 9 IOL power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, Barrett Universal II, Kane, EVO 2.0, Ladas Super formula and Hill-RBF 3.0) using partial coherence interferometry (PCI). We collected data from patients who underwent uncomplicated cataract surgery with implantation of 1 of 3 IOL types currently used in our center. All preoperative biometric measurements were performed using PCI. Prediction errors (PE) were deduced from refractive outcomes evaluated 3 months after surgery. The mean prediction error (ME), mean absolute prediction error (MAE), median absolute prediction error (MedAE), and standard deviation of prediction error (SD) were calculated, as well as the percentage of eyes with a PE within ± 0.25, ± 0.50, ± 0.75 and ± 1.00D for each formula. We included 126 eyes of 126 patients. Kane achieved the lowest MAE and SD across the entire sample as well as the highest percentage of PE within ± 0.50D and was shown to be more accurate than Haigis and Hoffer Q (P<001). For an axial length of more than 26.0mm, EVO 2.0 and Barrett obtained the lowest MAEs, with EVO 2.0 and Kane showing a higher percentage of prediction at ±0.50D compared to old generation formulas except for SRK/T (P=04). All investigated formulas achieved good results; there was a tendency toward better outcomes with new generation formulas, especially in atypical eyes.
Collapse
Affiliation(s)
- A Maroun
- Faculty of medicine, Saint Joseph University, P.O. Box 17-5208, Mar Mikhael, 1104 2020 Beirut, Lebanon.
| | - M El Shami
- Faculty of medicine, Saint Joseph University, P.O. Box 17-5208, Mar Mikhael, 1104 2020 Beirut, Lebanon; Department of neurological surgery, University of Pittsburgh, Pennsylvania, United States of America
| | - S Hoyek
- Faculty of medicine, Saint Joseph University, P.O. Box 17-5208, Mar Mikhael, 1104 2020 Beirut, Lebanon
| | - J Antoun
- Faculty of medicine, Saint Joseph University, P.O. Box 17-5208, Mar Mikhael, 1104 2020 Beirut, Lebanon; Department of ophthalmology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| |
Collapse
|
4
|
Cela D, Brasnu E, Hamard P, Baudouin C, Labbé A. Safety and efficacy of iStent Inject trabecular micro-bypass stents in combination with phacoemulsification for chronic open angle glaucoma associated with cataract. J Fr Ophtalmol 2023; 46:129-136. [PMID: 36642595 DOI: 10.1016/j.jfo.2022.08.007] [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: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The goal of this study was to assess the efficacy and safety of phacoemulsification combined with iStent Inject® implantation for the treatment of chronic open-angle glaucoma controlled on topical anti-glaucoma medications and associated with cataract. METHODS This study was a retrospective analysis of patients who underwent phacoemulsification and implantation of an iStent Inject® for chronic open-angle glaucoma associated with cataract. For all patients, pre- and postoperative characteristics, including number of glaucoma medications and intraocular pressure (IOP), were compared using Paired-sample t-tests and Wilcoxon signed-rank tests, respectively. Postoperative visits were scheduled at 7 days and 1, 3, 6, and 12 months after surgery. RESULTS Forty-nine eyes of 39 patients were included in the study. Mean preoperative IOP at baseline was 16.3±4.3mmHg (range, 10-29mmHg) with a mean of 2.2±1.0mmHg antiglaucoma medications. At 1 month, the mean IOP reduction was 16% (P<0.05) along with an 18.7% reduction in the mean number of medications. At 6 months, the mean IOP was 12.8±2.6, with a mean of 1.1±0.9 antiglaucoma medications. The mean IOP reduction at 6 months was 22% (P<0.05) along with a 49% reduction in the mean number of medications. At 12 months, the mean IOP was 13.8±2.5 with a mean of 1.1±1.2 medications. The mean IOP reduction at 12 months was 15% (P<0.05) along with a 47% reduction in the mean number of medications. No severe device-related side effects were observed. CONCLUSIONS iStent Inject® implantation combined with phacoemulsification resulted in effective IOP reduction and medication burden in patients with mild to advanced chronic open-angle glaucoma and preoperative IOP well controlled with topical hypotensive medications.
Collapse
Affiliation(s)
- D Cela
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU Foresight, Paris, France.
| | - E Brasnu
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU Foresight, Paris, France
| | - P Hamard
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU Foresight, Paris, France
| | - C Baudouin
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU Foresight, Paris, France; Departement of Ophthalmology, Ambroise Paré Hospital, APHP, IHU Foresight, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - A Labbé
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU Foresight, Paris, France; Departement of Ophthalmology, Ambroise Paré Hospital, APHP, IHU Foresight, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| |
Collapse
|
5
|
Lama PL, Sovogui MD, Ouendeno NA, Sow M, Sagno C, Diallo OR. [Functional results of cataract surgery by Phaco-emulsification performed by a Spanish medical mission in Guinea]. Mali Med 2022; 37:28-31. [PMID: 38506209] [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] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
PURPOSE To evaluate the functional results of Phaco-emulsification cataract surgery performed by a Spanish medical mission in Guinea. PATIENTS AND METHOD This is a descriptive cross-sectional prospective collection study from February 1 to April 30, 2019, in patients aged at least 40 years of age operated on by the phaco-E technique. Socio-demographic data, pre- and post-operative visual acuity, causes of poor functional outcomes and patient satisfaction were assessed. Functional outcomes were analyzed in accordasing with WHO guidelines and recommendations for post-operative functional outcomes of cataract surgery. RESULTS We included 400 eyes from 368 patients. The average age was 65.53 years - 8.63 years with a male predominance of 67.4%. Preoperative visual acuity was in 75.75% - sees hands move (VBM). In biometrics, the average power was 21.50 dioptries. The implant installed was 100% adequate. Without correction, visual results were poor in less than 1.5%, limits in 9.5%, and good in 89% following World Health Organization standards. At J30, only 182 patients with 222 eyes had responded to the test with 198 eyes of good result, 18 eyes of average result and 6 eyes of poor results. The causes of poor visual acuities were dominated by ocular pathologies associated with cataracts (4 eyes), intraoperative complications (1 eye) and postoperative complications (1 eye). Almost all patients were satisfied with the functional outcome of the operated eye (354 patients out of 368, or 96.20%). CONCLUSION Phacoemulsification, a technique used by this Spanish medical mission, gives excellent functional results, with few complications. Guinean ophthalmologists will have to make this technique the gold standard in cataract surgery.
Collapse
Affiliation(s)
- P L Lama
- Programme National de lutte contre les maladies non Transmissibles
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| | - M D Sovogui
- Clinique Ophtalmologique Bartimée
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| | - N A Ouendeno
- Service d'Ophtalmologie Hôpital Préfectoral de Siguiri
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| | - M Sow
- Service d'Ophtalmologie du Centre médical communal les Flamboyants
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| | - C Sagno
- Service d'ophtalmologie de l'hôpital régional de N'Zérékoré
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| | - O R Diallo
- Chaire Chirurgie maxillo-faciale-Ophtalmologie de la Faculté des sciences et techniques de la santé, université Gamal Abdel Nasser
| |
Collapse
|
6
|
Stopyra W. Comparison of the accuracy of six intraocular lens power calculation formulas for eyes of axial length exceeding 25.0mm. J Fr Ophtalmol 2021; 44:1332-1339. [PMID: 34531068 DOI: 10.1016/j.jfo.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intraocular lens power calculation formulas for eyes longer than 25.0mm in terms of absolute error and the percentages of postoperative emmetropia and hyperopia. METHODS The data for myopic patients who underwent uneventful phacoemulsification between October 2015 and June 2019 were reviewed. Intraocular lens power was calculated using Holladay 1, SRK/T, Hoffer Q, Holladay 2, Haigis, and Barrett Universal II formulas. The power of the lens implanted was based on Holladay 2. Three months after phacoemulsification, the refraction was measured, and the mean absolute error was calculated. The percentage of patients with good uncorrected visual acuity and percentage of hyperopic patients for each formula was established. ROC curves with a cut-off point of axial length were drawn for each formula and the area under the curve was evaluated. RESULTS Seventy patients (81 eyes) whose ocular axial length ranged between 25.01mm and 28.57mm were included. The Barrett Universal II formula achieved the lowest mean absolute error of 0.08±0.08D. Additionally, with the Barrett Universal II, the percentage of patients with good uncorrected visual acuity (81.5%) was the highest, and the percentage of hyperopic patients (4.9%) was the lowest. The Barrett Universal II and Holladay 1 formulas had the largest area under curve (0.764 and 0.718, respectively). CONCLUSION 1. The Barrett Universal II formula is recommended for intraocular lens power calculation for eyes with axial length greater than 25.0mm. 2. Considering the ROC curve method, the Barrett Universal II and Holladay 1 formulas appear to be the most appropriate.
Collapse
|
7
|
Tulu Aygun B, Altan C, Kirmaci Kabakci A. Comparison of phacoemulsification parameters in eyes with and without exfoliation syndrome. J Fr Ophtalmol 2020; 43:1031-1038. [PMID: 32972757 DOI: 10.1016/j.jfo.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/15/2019] [Revised: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate and to compare the phacoemulsification machine parameters in eyes with and without XFS, requiring cataract surgery. METHODS Patients who underwent phacoemulsification and in-the-bag IOL implantation for cataract were included in this retrospective study. All surgeries were performed by the same experienced surgeon using the stop & chop technique with the same phacoemulsification device (Infiniti Vision System, Alcon Laboratories, Inc., USA). Patients were divided into two groups according to the presence of exfoliation material (XFM). Each group consisted of consecutive patients. Their characteristics and intraoperative phacoemulsification parameters were compared. RESULTS Sixty-eight eyes of 68 patients [29 in the exfoliation syndrome (XFS) (-) group, 39 in XFS (+)] were enrolled. There were no statistical differences regarding preoperative patient characteristics. There was a statistically significant difference in total U/S time, phaco time, aspiration time and estimated fluid used between the XFS (+) and XFS (-) groups (P=0.021, P=0.017, P=0.009 and P=0.002, respectively). Considering that the use of a CTR (capsule tension ring) might be an important factor potentially affecting surgical parameters, the data were analyzed accordingly. Aspiration time and estimated fluid used remained statistically significant (P=0.046 and P=0.017, respectively); however, although the U/S total and phaco time were found to be longer in XFS (+) group compared to XFS (-) group, the difference did not show statistical significance (P=0.061 and P=0.059, respectively). There were no differences between groups regarding endothelial cell loss or any other postoperative complications. CONCLUSIONS The presence of XFS results in longer total U/S time, phaco and aspiration time and more estimated fluid used in phacoemulsification, but this prolongation does not result in additional complications.
Collapse
Affiliation(s)
- B Tulu Aygun
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Istanbul, Turkey.
| | - C Altan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Istanbul, Turkey
| | - A Kirmaci Kabakci
- University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Benzekri R, Marie-Louise J, Chahed S. [Cost of teaching cataract surgery in a public hospital]. J Fr Ophtalmol 2017; 40:860-864. [PMID: 29129336 DOI: 10.1016/j.jfo.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The gold standard of cataract surgery, phacoemulsification is the most commonly performed surgical procedure in France. Surgical instruction often takes place in the operating room where residents and fellows perform real surgery, supervised by an experienced surgeon. The goals of this study were double: evaluate surgical times according to the person performing the surgery, in order to quantitate the cost incurred by teaching and compare complication rate between surgeons. METHODS A retrospective single center study was performed at Simone-Veil Hospital, Eaubonne-Montmorency, France. Over a period of 13 consecutive weeks from January to March 2016, all patients who underwent phacoemulsification for cataract extraction were included. Patients were separated into three groups, according to the primary surgeon: group S for Senior was composed of two experienced surgeons who typically performed over 500 procedures per year; group A for assistant was composed of three residents who performed less than 500 procedures per year; 2 inexperienced interns constituted group I. Surgery duration was recorded by the OR nurse in minutes between the first incision and removal of the lid speculum. The cost of operating room time was estimated at seven euros per minute. The occurrence of complications was determined from the operative report. RESULTS 408 cataract surgeries were performed during the study period, divided into 156 eyes in group S, 142 in group A and 110 surgeries in group I. The mean age at surgery was 74.1±9 years (39-95), comparable in the 3 groups. The operative time was significantly shorter in group S (11.7min) than in A (18.7min; P<0.001) and in I (18.8min; P<0.001). The complication rate was higher in group I than in group S (P=0.03). The average additional cost related to the lengthening of the teaching procedure was 49 euros for Group A and 49.7 euros for Group I. DISCUSSION The hospital reimbursement for cataract surgery is higher in the public sector than in the private sector; it can absorb the cost of university training. CONCLUSION Teaching cataract surgery entails an additional financial cost for the hospital. It is also responsible for a higher human cost due to a greater number of operative complications with interns.
Collapse
Affiliation(s)
- R Benzekri
- Hôpital Simone-Veil, site d'Eaubonne, 14, rue de Saint-Prix, 95600, Eaubonne, France
| | - J Marie-Louise
- Hôpital Simone-Veil, site d'Eaubonne, 14, rue de Saint-Prix, 95600, Eaubonne, France.
| | - S Chahed
- Hôpital Simone-Veil, site d'Eaubonne, 14, rue de Saint-Prix, 95600, Eaubonne, France
| |
Collapse
|
9
|
Jeancolas AL, Lhuillier L, Renaudin L, Boiche M, Ghetemme C, Goetz C, Ouamara N, Perone JM. Central corneal thickness assessment after phacoemulsification: Subluxation versus Divide-and-Conquer. J Fr Ophtalmol 2017; 40:744-750. [PMID: 29050928 DOI: 10.1016/j.jfo.2017.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the impact of two phacoemulsification techniques (subluxation versus divide-and-conquer) on postoperative corneal edema at postoperative hour 1 and day 4. DESIGN Comparative study. METHOD Ninety-six consecutive patients (110 eyes; 43 men and 53 women, mean age 70.9±9.8 years) with equivalent cataract grades underwent cataract surgery and were followed up for 6 months. The presence of corneal edema was determined using central corneal thickness (CCT). CCT was measured preoperatively, and at postoperative hour 1 and day 4. MAIN OUTCOME MEASURES Ultrasound power (US %), duration of ultrasound (TPA), effective ultrasound time (TPE), surgical duration and final suture (%). RESULTS Eyes of participants were divided into two phacoemulsification technique groups: subluxation (n=50 eyes) and divide-and-conquer (n=60 eyes). Non-inferiority analysis revealed similar CCT increases at postoperative hour 1 in both groups, with 69.9±44.9μm and 64.4±42.9μm, observed in the subluxation and divide-and-conquer groups, respectively (P=0.033). TPE was similar in both groups, taking 6.2±3.4 and 7.3±4.5seconds in the subluxation and divide-and-conquer groups, respectively (P=0.150). No correlation was seen between TPE and edema at postoperative hour 1, or between TPE and day 4 edema. Rate of final suture use was similar between the subluxation and divide and conquer groups, at 36% and 30%, respectively. CONCLUSION The study findings suggest that cataract surgery performed using the subluxation technique does not result in greater CCT than the divide-and-conquer technique. CCT appears to normalize by postoperative day 4, regardless of the technique used.
Collapse
Affiliation(s)
- A-L Jeancolas
- Department of ophthalmology, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - L Lhuillier
- Department of ophthalmology, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - L Renaudin
- Clinical research support unit, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - M Boiche
- Department of ophthalmology, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - C Ghetemme
- Department of ophthalmology, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - C Goetz
- Clinical research support unit, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - N Ouamara
- Clinical research support unit, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France
| | - J-M Perone
- Department of ophthalmology, Mercy hospital, Metz-Thionville regional hospital center, 1, allée du Château, 57085 Metz cedex 03, France.
| |
Collapse
|
10
|
Gayadine-Harricham Y, Amzallag T. [Prevalence and causes of pain after cataract surgery: Comparison of 1st and 2nd eyes]. J Fr Ophtalmol 2017; 40:505-511. [PMID: 28571837 DOI: 10.1016/j.jfo.2016.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In our practice, patients undergoing bilateral cataract surgery complain of more significant pain after the 2nd eye surgery. The goal of this study was to compare postoperative pain between the 1st and 2nd eyes with cataract surgery under topical anesthesia and to identify the causes of this pain. PATIENTS AND METHODS We conducted a prospective observational study between May and September 2015. We included 69 consecutive adults scheduled for bilateral cataract surgery under topical anesthesia within 2 months by the same surgeon. A self-assessment questionnaire of anxiety (the Amsterdam Preoperative Anxiety and Information Scale [APAIS]) was completed before each procedure. Postoperative pain was assessed by the visual analogue scale (VAS) in the recovery room. RESULTS Among the 69 included patients (mean age: 70±1.3 years), 13 (19%) experienced more pain after the 2nd eye procedure. The median VAS was 0 (EI: 0-1) after the first eye versus 0 (EI: 0-2) after the second eye (P=0.836). The patients with the most pain after the second eye surgery had a median anxiety score of 5 (EI: 4 to 9.5), which was comparable to those without pain (P=0.589). On bivariate analysis, women had more pain after second eye surgery (27%) than men (4%) (P=0.026). However, this association lost its significance when the analysis was adjusted for the level of anxiety (adjusted OR 7.7, 95% CI [0.91; 64.6]). In fact, women were more anxious [median anxiety score of 6 (EI: 4 to 8.5)] before 2nd eye surgery than men [median score: 4 (EI: 4-6); P=0.013]. DISCUSSION Pain levels appeared to be very moderate on both sides when measured postoperatively, as opposed to statements often made in the immediate postoperative period. There is a discrepancy with the literature data. However, each study had small sample sizes. CONCLUSION We did not find any significant difference in pain between 1st and 2nd eye cataract surgery under topical local anesthesia. While postoperative pain appeared greater among women, we have noted the possible influence of anxiety, which could justify specific preoperative support.
Collapse
Affiliation(s)
- Y Gayadine-Harricham
- Service ophtalmologique universitaire, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
| | - T Amzallag
- Institut ophtalmique Nord-de-France, 28, rue Anatole-France, 59490 Somain, France
| |
Collapse
|
11
|
Mutlu FM, Yildiran ST, Saracli MA, Gümral R, Durukan H, Sobaci G, Mutlu AG. The first case of fungal endophthalmitis caused by Emericella nidulans after cataract surgery. J Mycol Med 2016; 26:271-6. [PMID: 27091580 DOI: 10.1016/j.mycmed.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 11/24/2022]
Abstract
Emericella nidulans is a species that has only rarely been implicated in human disease after cataract surgery. Here, we report the first postoperative case in the literature, as far as we know. The patient was a 50-year-old patient presented with mild anterior uveitis one week after cataract surgery, and hypopion developed over the next two days. First microbiological evaluation and the results of direct microscopy and cultures of the anterior chamber and vitreous samples were found to be negative. Despite vigorous topical and intravitreal (vancomycin and amikacin) therapy, the endophthalmitis did not improve. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens (IOL) were performed. The anterior chamber, vitreous fluid samples and IOL were submitted to the microbiology laboratory: the culture yielded E. nidulans growth. Ocular inflammation resolved and vision improved on intravenous, subconjunctival and long-term oral voriconazole treatment. E. nidulans can be an important cause of ocular fungal infections including endophthalmitis, and voriconazole seems to be effective for the treatment of E. nidulans endophthalmitis.
Collapse
|
12
|
Bouazza M, Chakib A, Amrani H, Cherkaoui S, Benhmidoune L, Rachid R, Amraoui A. [Long-term results of phacoemulsification in pseudoexfoliation syndrome]. J Fr Ophtalmol 2016; 39:364-9. [PMID: 27039980 DOI: 10.1016/j.jfo.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The prevalence of pseudoexfoliation syndrome is estimated at 8 % of all cataracts operated within our institution. The goal of our study was to describe the frequency of intraoperative and postoperative complications and long-term anatomical and functional results of phacoemulsification in pseudoexfoliation syndrome. PATIENTS AND METHODS A retrospective observational study of a series including 103 patients (107 eyes) with cataract associated with pseudoexfoliation syndrome admitted between January 2010 and September 2014. All patients underwent phacoemulsification. RESULTS The average age of our patients was 72.5±6 years. The average initial corrected visual acuity was 0.52±0.14LogMAR. The cataract was grade C3N3 in 58 % of cases. The pseudoexfoliation syndrome was bilateral in 69 % of cases. Pupillary dilatation was≤6mm in 54 % of cases. Among intraoperative complications, zonular dialysis was found in 1.8 % of cases. Posterior capsular rupture and vitreous loss was noted at 5.4 % of patients. The incidence of secondary cataract was 31.7 % at 12 months. The mean postoperative best corrected visual acuity was 0.13±0.15 LogMAR. DISCUSSION The small pupil associated with high grade of the cataracts in our series explains the slightly higher frequency of intraoperative zonular dialysis. Cataract surgery by phacoemulsification allows for a statistically significant improvement in visual acuity (P<0.001). The incidence of secondary cataract, the main postoperative complication, is higher in our series compared to data in the literature. CONCLUSION Pseudoexfoliation syndrome is common in our country. Functional results of phacoemulsification are very satisfactory, and secondary cataract is the main complication. A meticulous search for pseudoexfoliation is mandatory during the initial examination in order to reduce intraoperative complications. Careful removal of the cortex and systematic polishing of the lens capsule should limit the incidence of secondary cataracts.
Collapse
Affiliation(s)
- M Bouazza
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc.
| | - A Chakib
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| | - H Amrani
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| | - S Cherkaoui
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| | - L Benhmidoune
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| | - R Rachid
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| | - A Amraoui
- Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des Hôpitaux, Casablanca, Maroc
| |
Collapse
|
13
|
Kassir M, Kassas MC, Ajine M, Hammoud M, Mahmoud W. [Role of deep sedation phacoemulsification with scleral tunnel]. J Fr Ophtalmol 2015; 38:752-7. [PMID: 26341020 DOI: 10.1016/j.jfo.2015.03.007] [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: 03/12/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a method of deep sedation without adjunctive periocular injection in phacoemulsification with a scleral tunnel technique. METHODS All patients undergoing phacoemulsification with a scleral tunnel and foldable intraocular lens for cataract between May 2011 and November 2014 received deep sedation including a bolus of midazolam and fentanyl followed by a continuous perfusion of dexmedetomidine throughout the surgical procedure. The patients and medical team evaluated pain, sedation, clinical status of the patient, and surgeon comfort. RESULTS One thousand and five hundred patients were included, representing 1763 eyes. Ramsay's sedation score was 2 in 7.13% of cases and 3 in 86.3%, which allowed surgery to be performed under very satisfactory conditions. On a scale of 1 to 10, intraoperative pain was less than or equal to 1 in 81.2% of cases. The bradycardic and hypotensive effects of dexmedetomidine were appreciable, while respiratory depression was not observed. Only 1 case of severe agitation during surgery directly resulted in a vitreous issue. Some simple precautions allow optimization of the advantages of this method of anesthesia. CONCLUSION The deep sedation method including bolus injections of midazolam and fentanyl and continuous perfusion of dexmedetomidine affords a certain comfort to the patient as well as the surgeon in phacoemulsification of cataract through a scleral tunnel without adjunctive periocular injection.
Collapse
Affiliation(s)
- M Kassir
- Service d'ophtalmologie, Labib Medical Centre, rond-point ELIA, immeuble Dandachli Plaza, BP 644, Saïda, Liban.
| | - M C Kassas
- Service d'anesthésie-réanimation, Victoria Hospital, Riyad, Arabie Saoudite; Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - M Ajine
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - M Hammoud
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| | - W Mahmoud
- Service d'anesthésie-réanimation, Labib Medical Centre, Saïda, Liban
| |
Collapse
|
14
|
Loriaut P, Kaswin G, Rousseau A, Meziani L, M'nafek N, Pogorzalek N, Labetoulle M. [Induced astigmatism after corneal suture removal after cataract surgery]. J Fr Ophtalmol 2014; 37:226-30. [PMID: 24559514 DOI: 10.1016/j.jfo.2013.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery. METHODS A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured. RESULTS Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks. CONCLUSION Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.
Collapse
|
15
|
Dot C, El Chehab H, Agard E, Russo A, Ract-Madoux G, Dussart C. [Optical quality after 2.2mm microincisional cataract surgery with bimanual I/A in 154 eyes]. J Fr Ophtalmol 2013; 36:868-73. [PMID: 24210935 DOI: 10.1016/j.jfo.2013.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 12/18/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE A prospective study to analyze the effects of 2.2mm microincisional coaxial phacoemulsification with bimanual irrigation/aspiration on the optical quality of the cornea and whole eye. METHODS We compare two groups. Group A: 102 consecutive eyes undergoing this three-incision procedure and implanted with an Alcon® SN60WF IQ aspheric intraocular lens. Astigmatism, corneal and total asphericity, as well as H/B ratio were measured by OPD scann II, Nidek®, Japan, preoperatively (Day 0), 15 days postoperatively (Day 15) and 1 month postoperatively (M1). Group B: 52 eyes with corneal astigmatism greater than 1.25D, undergoing the same procedure but implanted with a Toric IOL (Alcon® Toric IQ SN6AT), followed in the same manner but with additional follow-up at 1 year. RESULTS Corneal surgically induced astigmatism (SIA) was essentially neutral: 0.065D ± 0.86 at Day 30 in group A, and 0.06D ± 0.34 at 1 month and -0.008D ± 0.4 at 12 months in group B. Corneal topographic astigmatism underwent a mean axis shift of 29.95° ± 27.6 in group A compared to 5.3° ± 3.7 in Group B, and remained stable at 1 year. Corneal asphericity did not change significantly between Day 0 and 30 in either group. H/B ratio increased significantly in both groups, with a gain of 22 % to 24 % after surgery. CONCLUSIONS This three-incision procedure does not degrade the optical quality of the cornea. Postoperative shift in the axis of astigmatism is only an issue in cases of low or asymmetric astigmatism and must be kept in mind for low-power toric IOL implantation.
Collapse
Affiliation(s)
- C Dot
- Service d'ophtalmologie, hôpital Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
| | | | | | | | | | | |
Collapse
|