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Shalev D, Kleinmann G. Retention time of different ophthalmic viscosurgical devices during phacoemulsification in rabbit ocular model: A comparative analysis. Clin Exp Ophthalmol 2024. [PMID: 38769039 DOI: 10.1111/ceo.14401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND To compare retention times of various ophthalmic viscosurgical devices (OVDs) and soft-shell combinations. METHODS Experimental study. Eighteen rabbit eyes were divided into six groups of three eyes, based on OVDs tested. A: Endocoat, B: HealonPro, C: Viscoat, D: Provisc, E: Endocoat and HealonPro and F: Viscoat and Provisc. OVDs were stained with 10% fluorescein dye before being injected into the anterior chamber. Phacoemulsification, using fixed parameters, was performed. If OVD persisted after 60 s, a standardised irrigation and aspiration technique replaced phacoemulsification. The time until central and complete clearance of the OVD were video-recorded and measured. RESULTS Mean central retention times (CRT) were found to be: HealonPro-5.33 ± 2.56 s, Provisc-3.33 ± 1.11 s, Endocoat-75.0 ± 3.26 s, Viscoat-62.33 ± 5.19 s, combining HealonPro with Endocoat-22.67 ± 4.75 s and Provisc with Viscoat-11.0 ± 0.82 s. The mean total retention time (TRT) was: Endocoat-80.0 ± 8.17 s, Viscoat-81.67 ± 2.09 s, HealonPro with Endocoat-81.33 ± 3.35 s, and Provisc with Viscoat-71.0 ± 2.94 s. For HealonPro and Provisc, CRT and TRT remained identical across all trials. CONCLUSIONS Retention times varied, with cohesive OVDs exhibiting shorter durations than dispersive OVDs. Among dispersive OVDs, TRTs were comparable; however, Endocoat displayed an extended CRT. In soft shell trials, the combination of HealonPro and Endocoat exhibited prolonged CRT and TRT, suggesting enhanced corneal protection.
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Affiliation(s)
- Daf Shalev
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kleinmann
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine & Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Ibarz-Barberá M, Orts-Vila P, Martínez-Galdón F, Martín-García N, Tañá-Rivero P. Surgical Efficiency Comparison Between Two Phacoemulsification Systems. Clin Ophthalmol 2024; 18:1095-1102. [PMID: 38707769 PMCID: PMC11066661 DOI: 10.2147/opth.s453899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Methods Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. Results One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. Conclusion The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.
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Affiliation(s)
| | - Paz Orts-Vila
- Cataract and Refractive Surgery Department, Alicante, Spain
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El Helwe H, Samuel S, Falah H, Trzcinski J, Solá-Del Valle DA. Comparing outcomes of tube versus trabeculectomy among patients with angle-closure glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00068-1. [PMID: 38636705 DOI: 10.1016/j.ogla.2024.04.005] [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: 01/15/2024] [Revised: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with Mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG). DESIGN Retrospective, nonrandomized comparative study. SUBJECTS A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear. METHODS Reviewed and analyzed 390 visits from patient charts. MAIN OUTCOME MEASURES Kaplan-Meier (KM) success rates, Intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications. RESULTS Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher Kaplan-Meier complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P=0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P=0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P<0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P<0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube, and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups." CONCLUSION We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in ACG patients. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.
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Affiliation(s)
- Hani El Helwe
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Sandy Samuel
- Wills Eye Hospital, Ophthalmology Department, Philadelphia, PA, USA
| | - Henisk Falah
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
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Kalinovskiy A, Leser S, Ehrle A, Reese S, Jones S, Gerhards H. Phacoemulsification Combined with Pars Plana Vitrectomy: Outcome in Horses with Acquired Cataracts Associated with Uveitis. Animals (Basel) 2024; 14:1192. [PMID: 38672339 PMCID: PMC11047625 DOI: 10.3390/ani14081192] [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: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Cataracts resulting from equine recurrent uveitis (ERU) or other forms of uveitis are usually associated with rapid progression. ERU is the most common ocular disease cause of blindness and cause of cataracts in horses. The necessity for the posterior capsulorhexis (PC) during phacoemulsification (PE) is controversial. This study aimed to evaluate vision and complications after PE combined with pars plana vitrectomy (PPV) in horses with uveitis-associated cataracts and compare the PE technique with and without posterior capsulorhexis. METHODS Thirty-two eyes of 28 horses with uveitis-associated cataracts aged 14 months to 19.6 years were treated with PE-PPV under identical conditions. Twenty-three eyes of 21 horses were affected by an ERU-associated (ERU group), and nine eyes of 7 horses were affected by cataracts related to uveitis with pathogenesis different to ERU (non-ERU group). PE-PPV was performed in 12 eyes of 10 horses (PC group) and 20 eyes of 18 horses without posterior capsulorhexis (NPC group). Follow-up examination was performed at a mean of 1.7 ± 1.8 years postoperatively (range: 1 month-6.4 years). RESULTS In the period up to 1 month postoperatively, 17/20 (85%) NPC-eyes and 8/12 (67%) PC-eyes (total: 25/32 [78%]) were visual. From 1-6 months postoperatively, 16/20 (80%) NPC-eyes and 7/12 (58.3%) PC-eyes (total: 23/32 [72%]), and from 6-12 months, 7/11 (63.6%) NPC-eyes and 3/8 (37.5%) PC-eyes (total: 10/19 [52.6%]) were visual. From 12-18 months postoperatively, 3/7 (42.9%) NPC-eyes and 2/9 (22.2%) PC-eyes (total: 5/16 [31.3%]), and from 18-24 months, 3/8 (37.5%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 4/16 [25%]) were visual. After 24 months postoperatively, 2/7 (28.6%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 3/15 [20%]) were visual. Despite the higher number of visual eyes in the NPC group at each time point, differences were not significant. No obvious differences regarding postsurgical vision were observed between the ERU- and non-ERU groups at each time point. In the overall population, a significant decrease in the number of eyes with postoperative active uveitis was observed during the follow-up examinations (p < 0.001). A significant increase in the number of eyes that were blind due to retinal detachment was observed in the overall patient population as the examination period progressed (p < 0.001). Retinal detachment was the sole long-term cause of blindness. CONCLUSIONS In horses diagnosed with uveitis-associated cataracts and treated with PE-PPV, no persistent active uveitis was observed in the present study during follow-up examinations. However, the proportion of eyes that were blind due to retinal detachment increased. Whilst PE-PPV may prevent postsurgical persistent active uveitis and remove lens opacity, the prognosis for a visual outcome is guarded. A superior outcome in postsurgical vision was observed in the NPC group. However, caution is required when interpreting these results due to several factors that affect the independent comparison of the surgical groups.
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Affiliation(s)
| | | | - Anna Ehrle
- Equine Clinic, Surgery and Radiology, Free-University of Berlin, 14195 Berlin, Germany
| | - Sven Reese
- Veterinary Department, Institute of Veterinary Anatomy, Histology and Embryology, Ludwig-Maximilians-University Munich, 80539 Munich, Germany;
| | - Sara Jones
- Hanse Equine Clinic, 27419 Sittensen, Germany
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Sharif RK, Aljahdali FF, Aljabri HM, Alomari LK, Sagim RA, Alamri DM, Alshehri MA, Alshigari RA. Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2024; 18:1023-1032. [PMID: 38596663 PMCID: PMC11001549 DOI: 10.2147/opth.s446285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Background Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification and laser peripheral iridotomy (LPI) effectively control IOP elevation and widen the angle. This systematic review and meta-analysis compared Phacoemulsification and LPI Effectiveness for PACG. Methods We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared Phacoemulsification and LPI for individuals with PACG. We sought to evaluate the following outcomes: mean IOP, number of glaucoma medications, visual acuity (VA), visual field (VF) progression, peripheral anterior synechiae (PAS), Shaffer gonioscopy grading, central corneal thickness (CCT), central endothelial cell density (CECD), and poor response to surgery. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes. Results 5 RCTs that enrolled 917 participants were deemed eligible. The phacoemulsification group showed statistically significance lower mean CCT and CECD and lower risk of poor response to surgery compared to LPI (SMD = -1.10; 95% -1.50, -0.70; P<0.001, SMD -366.12; 95% -652.59, -79.65; P=0.01, and RR 0.35; 95% 0.23, 0.54; P<0.001 respectively). There were no significant improvement in IOP and number of medications between both groups (SMD = -0.74; 95% CI = -2.26, 0.78; P=0.34, and SMD -17.58; 95% CI = -50.28, 15.12; P=0.29 respectively). Finally, there were also no significant differences in VA, VF progression, PAS, and mean Shaffer gonioscopy grading between both groups. Conclusion Phacoemulsification showed statistically significant lower mean corneal thickness, central endothelial cell density, and lower risk of poor response to surgery compared to LPI. However, there were no significant differences in mean IOP, number of medications, VA, VF progression, PAS, and mean Shaffer gonioscopy grading between Phacoemulsification and LPI.
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Affiliation(s)
- Rahaf K Sharif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Faisal F Aljahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hind M Aljabri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Lugean K Alomari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Renad A Sagim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Duaa M Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Merai A Alshehri
- Department of Surgery, College of Medicine, University of Bisha, Bisha, Saudi Arabia
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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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Müller S, Jain M, Sachdeva B, Shah PN, Holz FG, Finger RP, Murali K, Wintergerst MWM, Schultz T. Artificial Intelligence in Cataract Surgery: A Systematic Review. Transl Vis Sci Technol 2024; 13:20. [PMID: 38618893 PMCID: PMC11033603 DOI: 10.1167/tvst.13.4.20] [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: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose The purpose of this study was to assess the current use and reliability of artificial intelligence (AI)-based algorithms for analyzing cataract surgery videos. Methods A systematic review of the literature about intra-operative analysis of cataract surgery videos with machine learning techniques was performed. Cataract diagnosis and detection algorithms were excluded. Resulting algorithms were compared, descriptively analyzed, and metrics summarized or visually reported. The reproducibility and reliability of the methods and results were assessed using a modified version of the Medical Image Computing and Computer-Assisted (MICCAI) checklist. Results Thirty-eight of the 550 screened studies were included, 20 addressed the challenge of instrument detection or tracking, 9 focused on phase discrimination, and 8 predicted skill and complications. Instrument detection achieves an area under the receiver operator characteristic curve (ROC AUC) between 0.976 and 0.998, instrument tracking an mAP between 0.685 and 0.929, phase recognition an ROC AUC between 0.773 and 0.990, and complications or surgical skill performs with an ROC AUC between 0.570 and 0.970. Conclusions The studies showed a wide variation in quality and pose a challenge regarding replication due to a small number of public datasets (none for manual small incision cataract surgery) and seldom published source code. There is no standard for reported outcome metrics and validation of the models on external datasets is rare making comparisons difficult. The data suggests that tracking of instruments and phase detection work well but surgical skill and complication recognition remains a challenge for deep learning. Translational Relevance This overview of cataract surgery analysis with AI models provides translational value for improving training of the clinician by identifying successes and challenges.
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Affiliation(s)
- Simon Müller
- University Hospital Bonn, Department of Ophthalmology, Bonn, Germany
| | | | - Bhuvan Sachdeva
- Microsoft Research, Bengaluru, India
- Sankara Eye Hospital, Bengaluru, Karnataka, India
| | | | - Frank G. Holz
- University Hospital Bonn, Department of Ophthalmology, Bonn, Germany
| | - Robert P. Finger
- University Hospital Bonn, Department of Ophthalmology, Bonn, Germany
- Department of Ophthalmology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Thomas Schultz
- B-IT and Department of Computer Science, University of Bonn, Bonn, Germany
- Lamarr Institute for Machine Learning and Artificial Intelligence, Dortmund, Germany
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Gerbutavicius R, Merle DA, Wolf A, Dimopoulos S, Kortuem KU, Kortuem FC. User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial. JMIR Form Res 2024; 8:e55742. [PMID: 38551619 PMCID: PMC11015376 DOI: 10.2196/55742] [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: 12/30/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. OBJECTIVE This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. METHODS All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the "Patient Journey" app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. RESULTS Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. CONCLUSIONS The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally.
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Affiliation(s)
- Rokas Gerbutavicius
- Department for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- University Eye Hospital, University of Ulm, Ulm, Germany
| | - David A Merle
- Department for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Armin Wolf
- University Eye Hospital, University of Ulm, Ulm, Germany
| | | | - Karsten Ulrich Kortuem
- University Eye Hospital, University of Ulm, Ulm, Germany
- Augenarztpraxis Dres. Kortuem, Ludwigsburg, Germany
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Cabrero M, Guyonnet A, Risi E, Bourguet A. Nutritional cataracts in a wolf litter treated by phacoemulsification. Vet Ophthalmol 2024. [PMID: 38499479 DOI: 10.1111/vop.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/21/2024] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To describe the clinical findings in a wolf litter with nutritional cataracts and determine the treatment outcomes after phacoemulsification. PROCEDURE Bilateral nutritional cataracts were diagnosed in four hand-fed 10-week-old wolves (Canis lupus). The information collected included signalment, physical and ophthalmic examination findings, ocular ultrasonography and electroretinography results, and postoperative outcomes. RESULTS All four wolves were rejected from the dam and hand raised with a commercial artificial milk replacer from 5 days of age until weaning at 6 weeks of age. At initial presentation, bilateral cataracts were observed in all patients (8/8 eyes), with vision deficits in three of the four wolves. The main ophthalmic anomalies were mature cataracts with lens-induced uveitis (3/8 eyes, two wolves), immature cataracts (1/8 eyes, one wolf), and perinuclear and posterior cortical/subcapsular lens opacities (4/8 eyes, three wolves). Three of the four wolves (six eyes) underwent bilateral one-handed phacoemulsification with intraocular lens implantation. At the last examination 2 months following surgery, all operated eyes (6/6) were visual, Elschnig pearl proliferation was present in 2/6 eyes, and mild posterior capsular opacification was observed in 6/6 eyes. In the nonoperated wolf, the cataracts remained stable and did not affect the visual axis of either eye. CONCLUSIONS This is the first description of phacoemulsification surgery in wolves. Phacoemulsification is a viable treatment option for captive wolves with nutritional cataracts. Special attention should be paid to hand-raised cubs to ensure that adequate amino acid levels are present in artificial milk.
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Affiliation(s)
- Maria Cabrero
- Ophthalmology Unit, Atlantia Veterinary Hospital Center, Nantes, France
| | | | - Emmanuel Risi
- FauneVet, Atlantia Veterinary Hospital Center, Nantes, France
| | - Aurelie Bourguet
- Ophthalmology Unit, Atlantia Veterinary Hospital Center, Nantes, France
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Wagner IV, Boopathiraj N, Lentz C, Dorairaj EA, Draper C, Kumar D, Checo L, Miller DD, Krambeer C, Dorairaj S. Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade. Clin Ophthalmol 2024; 18:713-721. [PMID: 38468916 PMCID: PMC10926857 DOI: 10.2147/opth.s451002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months. Patients and methods This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years. Results Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66-75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001). Conclusion In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.
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Affiliation(s)
| | | | - Connor Lentz
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Emily Aashna Dorairaj
- Department of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Devesh Kumar
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
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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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12
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Bayley KD, Gates MC, Anastassiadis Z, Read RA. The use of sub-Tenon's anesthesia versus a low-dose neuromuscular blockade for canine cataract surgery: A comparative study of 224 eyes. Vet Ophthalmol 2024; 27:114-126. [PMID: 37199512 DOI: 10.1111/vop.13111] [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: 07/14/2021] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Assess the utility of a Sub-Tenon's anesthesia (STA) protocol to provide suitable operating conditions for canine cataract surgery and compare it to an alternative low-dose neuromuscular blockade (LD-NMB) protocol used for canine cataract surgery. PROCEDURES Clinical study of dog eyes undergoing cataract surgery with either an STA or LD-NMB protocol. While intraoperative vitreal expansion scores and intraoperative complications were collected prospectively, globe position, intraocular pressure, return of vision, and postoperative complications were collected retrospectively. Statistical testing was used to compare results between the STA and the LD-NMB groups for the data available. RESULTS A total of 224 eyes from 126 dogs were assessed, with 133/224 (59.4%) eyes from 99/126 (78.6%) dogs receiving STA and 91/124 (40.6%) eyes from 72/126 (57.1%) dogs receiving LD-NMB. Forty-five of these dogs (45/126; 37.7%) received STA for one eye and LD-NMB for the other eye. There was no significant change in intraocular pressure measurements following STA administration. This was not measured for the LD-NMB group. The globe achieved a central position in 110/133 (82.7%) of eyes that received STA. This was not measured for the LD-NMB group. Intraoperative vitreal expansion scores were slightly higher in STA-treated eyes compared to LD-NMB-treated eyes. The intraoperative complication rate for STA-treated eyes was higher (73/133; 54.8%) compared to NMB-treated eyes (12/91; 13.2%). The most common intraoperative complication for STA was chemosis (64/133; 48.1%), the risk of which increased with an increase in the volume of local anesthetic injected. The post-operative complication rate was higher in STA-treated eyes (28/133; 21.1%) compared to NMB-treated eyes (16/91; 17.6%). Post-operative corneal ulceration was the most common postoperative complication in STA-treated eyes (6/133; 4.5%). CONCLUSION The STA protocol described resulted in suitable operating conditions, but more intraoperative and postoperative complications compared to the LD-NMB protocol. Despite these complications, the STA protocol did not cause a significant deleterious impact on post-operative outcomes as defined in the present study.
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Affiliation(s)
| | - M Carolyn Gates
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | | | - R A Read
- Veterinary Ophthalmic Referrals, Adelaide, Australia
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13
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Amaral DC, Louzada RN, Moreira PHS, de Oliveira LN, Yuati TT, Guedes J, Alves MR, Mora-Paez DJ, Monteiro MLR. Combined Endoscopic Cyclophotocoagulation and Phacoemulsification Versus Phacoemulsification Alone in the Glaucoma Treatment: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e55853. [PMID: 38590498 PMCID: PMC11001325 DOI: 10.7759/cureus.55853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
The complete safety and efficacy of endoscopic cyclophotocoagulation (ECP) remain unclear in the literature and, to our knowledge, there are no current meta-analyses on phaco-ECP versus phacoemulsification alone to date. Thus, we conducted a systematic review and meta-analysis comparing these two strategies through studies, assessing the effectiveness and safety of outcomes in a population with glaucoma. The protocol for this systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023482376). We systematically searched PubMed, Embase, and Web of Science from inception to December 2023. A random-effects model was used for all analyses due to heterogeneity. Review Manager 5.3 (Cochrane Centre, The Cochrane Collaboration, Denmark) was used for statistical analysis. Finally, nine studies were included in this comprehensive review and a total of 5389 eyes were analyzed in our study. In comparison to the ECP and phacoemulsification group, those receiving phacoemulsification alone showed better results in best-corrected visual acuity (MD 0.09; CI 95% 0.03 to 0.16; I²=0%), but worse outcomes in intraocular pressure (IOP) (MD -1.49; 95% CI -2.29 to -0.68; I²=29%) and use medications (MD -0.75; 95% CI -0.94 to -0.56; I²=0%) in the last visit. Complication rates, both general and serious, were significantly different between the groups, indicating the potential impact of combined procedures on patient outcomes. Thus, combining ECP with phacoemulsification for glaucoma treatment showed sustained IOP reduction and decreased medication dependence. However, higher complication rates suggest careful consideration of risks. More extensive research with larger trials and longer follow-ups is needed to validate findings and address limitations, providing valuable insights into this treatment approach.
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Affiliation(s)
- Dillan Cunha Amaral
- Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BRA
| | - Ricardo Noguera Louzada
- Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BRA
- Faculty of Medicine, Universidade de São Paulo, São Paulo, BRA
| | | | | | | | - Jaime Guedes
- Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA
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Au Eong JTW, Tsai JHJ, Au Eong KG. Severe astigmatism secondary to large intraocular lens pantoscopic tilt because of a malpositioned haptic following cataract surgery. J Surg Case Rep 2024; 2024:rjae134. [PMID: 38469204 PMCID: PMC10927352 DOI: 10.1093/jscr/rjae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular lens (IOL) implantation 5 weeks earlier. Her uncorrected visual acuity (VA) was 6/60 correctable with pinhole to 6/21. Her best-corrected VA was 6/15 with a subjective refraction of -0.50DS/-5.25DCx37. Her corneal astigmatism was -1.25DCx74. Ophthalmic examination disclosed a severely tilted single-piece posterior chamber IOL in the capsular bag. The inferior portion of the optic was tilted posteriorly because of a twisted and malpositioned haptic. The patient underwent remedial surgery to untwist and reposition the IOL haptic which led to immediate improvement of the IOL position. Her uncorrected VA improved to 6/12-2 correctable with pinhole to 12+1 with an autorefraction of +0.25DS/-2.00DCx74 on the first postoperative day. One month postoperatively, her best-corrected VA was 6/12 with a refraction of +0.50DS/-2.50DCx82. Her final vision was limited by myopic macular degeneration.
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Affiliation(s)
- Jonathan T W Au Eong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Jarryl H J Tsai
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Kah-Guan Au Eong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
- International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre and Farrer Park Medical Centre, 1 Farrer Park Station Road #14-07/08, Connexion, 217562, Singapore
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
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Lee E, Kim HA, Seo K, Kang S. Hyperproliferation of Elschnig pearl-type posterior capsule opacification and spontaneous regression in two pseudophakic canine eyes. Vet Ophthalmol 2024; 27:170-176. [PMID: 38071419 DOI: 10.1111/vop.13173] [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: 05/10/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe the hyperproliferation of Elschnig pearl-type posterior capsule opacification and concurrent uveitis in two canine eyes after phacoemulsification, followed by spontaneous resolution of the Elschnig pearls. ANIMAL STUDIED A 10-year-old castrated male Spitz (Case 1) and a 4-year-old spayed female Bichon Frise (Case 2). PROCEDURE Elschnig pearls proliferating beyond the anterior capsulotomy site were observed in the right eye 10 months after bilateral diabetic cataract surgery (Case 1) and 7 months after unilateral cataract surgery (Case 2). In both cases, hyperproliferation occurred where the anterior capsule did not overlap with the intraocular lens (IOL), and was accompanied by aqueous flare. In Case 1, the pearls extended from the anterior capsule and adhered to the iris, causing focal posterior synechia. No other possible causes of uveitis were apparent. RESULTS Initially, uveitis severity improved after the administration of topical and systemic anti-inflammatory drugs. However, uveitis recurred when the dosage of anti-inflammatory treatment was reduced. The Elschnig pearls underwent morphological changes throughout the follow-up period. In both cases, the pearls beyond the anterior capsulotomy resolved spontaneously after 5 months. Only a few pearls remained between the IOL and posterior capsule, and no recurrence of pearl proliferation was observed at the last follow-up. CONCLUSIONS To the best of our knowledge, this is the first report of spontaneous Elschnig pearl regression in dogs. Lens-induced uveitis (LIU) may have been caused by anterior chamber hyperproliferative pearls. LIU associated with hyperproliferative pearls may be managed with appropriate anti-inflammatory treatment and monitoring.
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Affiliation(s)
- Eunji Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | | | - Kangmoon Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - Seonmi Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
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16
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Lazaar H, Sefrioui M, Boutaj T, Azarkan B, El Hachimi R, Benchekroun S, Amazouzi A, Cherkaoui LO. Pattern of Preferred Cataract Surgery Practices in Morocco: A Survey-Based Study. Cureus 2024; 16:e55690. [PMID: 38586760 PMCID: PMC10997968 DOI: 10.7759/cureus.55690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and methodology The aim of the study was to describe the preferred cataract surgery practices among Moroccan ophthalmologists and compare them with practices in other countries. An online survey consisting of 29 multiple-choice questions was sent to Moroccan ophthalmologists. The questions were centered on the preferred cataract surgical practices of the participants. All the data obtained were collected and analyzed. Results A total of 276 participants responded to the survey. Of these, 178 (64,50%) were in the age group of 31-50 years. The visual acuity for which the operative indication was made was 4/10 for 144 (52.4%) participants). The most popular type of anesthesia was topical, reported by 172 (62.4%). Stop-and-chop was the most used technique for routine cataract surgeries, while hydroprolapse of the nucleus was the leading technique for soft cataracts. The two measures are considered crucial for postoperative endophthalmitis prophylaxis: Povidone-iodine instillation into the conjunctival sac and intracameral antibiotics were performed by 267 (97%) and 276 (100%) participants, respectively. Nonsteroidal anti-inflammatory drugs were prescribed by only 128 (46.5%) surgeons. Conclusion This study provides some insight into the present cataract surgery techniques in Morocco, which might differ considerably from one country to another. Studies in various countries need to be undertaken to develop a consensus and reach some evidence-based patterns. This study may serve as a guide for young surgeons starting their careers based on what the standard procedures are among their seniors and peers.
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Affiliation(s)
- Hamza Lazaar
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Meryem Sefrioui
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Taha Boutaj
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Boutayna Azarkan
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Rim El Hachimi
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Saad Benchekroun
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Abdellah Amazouzi
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Lalla Ouafa Cherkaoui
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
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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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Liu Z, Lu D, Pang M, Li J, Liu Y, Shi H, Liu G, Jin Y. The Effect of Intracameral Triamcinolone Acetonide on Controlling Common Complications following Phacoemulsification in Dogs. Animals (Basel) 2024; 14:547. [PMID: 38396515 PMCID: PMC10885903 DOI: 10.3390/ani14040547] [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: 12/20/2023] [Revised: 01/28/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
The intracameral injection of triamcinolone acetonide (TA) has achieved favorable clinical effects in controlling intraocular inflammatory reactions in humans after cataract surgery. However, the effect of this method remains unclear in veterinary practice. In this paper, 18 dogs with bilateral cataracts were randomly divided into three groups, with 6 dogs in each group. Phacoemulsification and intraocular lens implantation were performed on the 36 eyes of these dogs. A total of 0.1 mL of TA solution was injected into the oculus dexter (OD) anterior chambers. All oculus sinister (OS) anterior chambers of these dogs were used as controls. The results demonstrated that the corneal edema severity scores of the OD (1.5 mg TA) were lower than those of the OS from the 1st to 7th day after surgery, with a significant difference on the 3rd day after surgery (p = 0.033). The corneal edema severity scores in the OD (1.5 mg TA) were significantly lower than those in the OD (0.5 mg TA) on the 3rd day after surgery (p = 0.036). The aqueous humor protein concentration of the OD (1.5 mg TA) had a lower concentration than the OS on the 1st day after surgery (p = 0.004). Furthermore, on the 5th and 10th days, the aqueous humor protein concentration of the OD (1.5 mg TA) was lower than that of the OS (p = 0.038 and p = 0.044, respectively). The aqueous humor PGE2 concentration of the OD (1.5 mg TA) had a lower concentration than the OS on the 1st day after surgery (p = 0.026). The aqueous humor PGE2 concentrations in the OD (1.0 mg TA) and OD (1.5 mg TA) were lower compared to that in the OD (0.5 mg TA) on the 1st day after surgery (p = 0.041 and p = 0.037, respectively). It was demonstrated that TA-based treatment can be safely employed to effectively control common complications after phacoemulsification in dogs.
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Affiliation(s)
- Zichen Liu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Di Lu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Mo Pang
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Jing Li
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Yue Liu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Hao Shi
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Gang Liu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
| | - Yipeng Jin
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Rd, Haidian District, Beijing 100193, China
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19
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Barbosa RC, Carvalho R. Z-suture scleral fixation intraocular lenses: A refractive and safety report. Eur J Ophthalmol 2024:11206721241230566. [PMID: 38304925 DOI: 10.1177/11206721241230566] [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] [Indexed: 02/03/2024]
Abstract
PURPOSE Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses. METHODS A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique. RESULTS The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively. DISCUSSION The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation.
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Affiliation(s)
- Renato Correia Barbosa
- Ophthalmology Department, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, ULSM, Matosinhos, Portugal
| | - Rui Carvalho
- Ophthalmology Department, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, ULSM, Matosinhos, Portugal
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Romano V, Passaro ML, Bachmann B, Baydoun L, Ni Dhubhghaill S, Dickman M, Levis HJ, Parekh M, Rodriguez-Calvo-De-Mora M, Costagliola C, Virgili G, Semeraro F. Combined or sequential DMEK in cases of cataract and Fuchs endothelial corneal dystrophy-A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:e22-e30. [PMID: 37155336 DOI: 10.1111/aos.15691] [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: 02/23/2023] [Revised: 03/19/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta-analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin-I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (-0.06; -0.14, 0.03 LogMAR; 3 studies, I2 : 0%; p = 0.86); (2) postoperative ECD (-62; -190, 67 cells/mm2 ; 4 studies, I2 : 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I2 : 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I2 : 0%; p = 0.86). Of all the 5 non-randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms.
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Affiliation(s)
- Vito Romano
- Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Lombardy, Brescia, Italy
- Ophthalmic Unit, ASST Spedali Civili di Brescia, Lombardy, Brescia, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Bjoern Bachmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lamis Baydoun
- University Eye Hospital, Munster, Germany
- ELZA Institute Dietikon/Zurich, Zurich, Switzerland
| | - Sorcha Ni Dhubhghaill
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, University of Antwerp, Wilrijk, Belgium
| | - Mor Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mohit Parekh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Massachusetts, Boston, USA
| | | | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, Ophthalmology, University of Florence-Careggi, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Francesco Semeraro
- Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Lombardy, Brescia, Italy
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Mohite AA, Panthagani J, Sharif W, Feinberg L, Shah P, Masood I. Ethnic Differences in the Rates of Posterior Capsule Rupture and Long-Term Sequelae in Phacoemulsification Cataract Surgery. Cureus 2024; 16:e55270. [PMID: 38558611 PMCID: PMC10981541 DOI: 10.7759/cureus.55270] [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] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose The purpose of this study is to investigate the rates of posterior capsular rupture (PCR) and its sequelae during phacoemulsification across different ethnicities. Methods This is a retrospective cohort study of all consecutive phacoemulsification cases complicated by PCR that met the inclusion criteria over a four-year period at a single tertiary eye centre in the United Kingdom (UK). Results PCR occurred in 0.85% of cases overall (157/18,481). PCR rates were 1.8% (26/1485), 1.2% (51/4350), and 0.7% (75/10,927) in African-Caribbean, Indian subcontinent, and Caucasian patients, respectively (p < 0.001). Mean final corrected distance visual acuity improved (p < 0.05) in all ethnic groups (0.40 ± 0.57 logMAR) compared to pre-op (0.78 ± 0.61 logMAR). Post-operative cystoid macular oedema and unstable intraocular pressure rates following PCR did not statistically differ amongst ethnicities (p = 0.37 and p = 0.75, respectively). However, post-operative uveitis rates significantly differed at 11.5%, 15.7%, and 1.3% amongst the three ethnic groups, respectively (p = 0.01). Conclusion This is the first study to highlight a possible link between patient ethnicity and the risk of PCR during phacoemulsification cataract surgery. We observed significantly greater numbers of PCR cases amongst certain ethnic groups (highest in African-Caribbean eyes, then Indian subcontinental eyes, and lowest in Caucasian eyes) within the same multi-cultural urban population. Ethnicity may therefore be a contributing factor for PCR and should potentially be taken into consideration during preoperative risk stratification.
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Affiliation(s)
- Abhijit A Mohite
- Ophthalmology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, GBR
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Jesse Panthagani
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Walid Sharif
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Leo Feinberg
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Peter Shah
- Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
- Ophthalmology, Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, University Hospital Birmingham, Birmingham, GBR
- Ophthalmology, University College London, London, GBR
- Ophthalmology, Centre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton, GBR
| | - Imran Masood
- Ophthalmology, Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
- Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
- Ophthalmology, Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, University Hospital Birmingham, Birmingham, GBR
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Kim H, Seong J, Rho C. Comparison between Early Clinical Results of Dual-Linear and Conventional Foot-Pedal Control in Phacoemulsification. J Clin Med 2024; 13:693. [PMID: 38337387 PMCID: PMC10856448 DOI: 10.3390/jcm13030693] [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: 12/20/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of this study was to compare early clinical results regarding the safety and efficacy of dual-linear vs. conventional foot-pedal control in cataract surgery. METHODS This was a paired-eye contralateral, retrospective, observational study. Each patient underwent cataract surgery in both eyes: one eye with dual-linear foot-pedal control (study group) and the other eye with conventional foot-pedal control (control group). Absolute phaco time (APT), average phaco power, effective phaco time (EPT), and surgical complications were analyzed and compared. Corneal endothelial cell count, corneal thickness, corneal volume, and best-corrected distance visual acuity (BCDVA) were measured preoperatively and at 1 week, 1 month, and 3 months postoperatively. RESULTS A total of 94 patients (188 eyes) were enrolled. The respective APT, average phaco power, and EPT values were 7.05 ± 5.31 s, 28.4 ± 1.00, and 2.05 ± 1.56 s in the study group and 6.82 ± 6.48 s, 18.9 ± 1.74, and 1.35 ± 1.35 s in the control group. CONCLUSIONS The average phaco power and EPT values were significantly higher in the study group. The safety of the dual-linear foot pedal was comparable to that of a conventional pedal in terms of endothelial cell loss, central corneal thickness, and surgical complications.
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Affiliation(s)
- Hyungil Kim
- Gyeongju St. Mary’s Eye Clinic, Gyeongju 38146, Republic of Korea;
| | - Jiyun Seong
- Saevit Eye Hospital, Goyang 10447, Republic of Korea;
| | - Changrae Rho
- Saevit Eye Hospital, Goyang 10447, Republic of Korea;
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23
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Tahiri R, Albou-Ganem C, Gatinel D, Sandali O. Editorial: Innovations in cataract surgery. Front Med (Lausanne) 2024; 11:1367577. [PMID: 38323036 PMCID: PMC10844549 DOI: 10.3389/fmed.2024.1367577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Rachid Tahiri
- Department of Ambulatory Surgery, Avranches Granville Hospital, Granville, France
| | - Cati Albou-Ganem
- Department of Ophthalmology, Vision Clinic of Paris, Paris, France
| | - Damien Gatinel
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | - Otman Sandali
- Department of Ambulatory Surgery, Guillaume de Varye Clinic, Bourges, France
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24
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Geiger MD, Lynch AM, Palestine AG, Grove NC, Christopher KL, Davidson RS, Taravella MJ, Mandava N, Patnaik JL. Are there sex-based disparities in cataract surgery? Int J Ophthalmol 2024; 17:137-143. [PMID: 38239954 PMCID: PMC10754674 DOI: 10.18240/ijo.2024.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery. METHODS This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine. Data collected included the patient's health history, ocular comorbidities, operative and post-operative complications, and the post-operative best corrected visual acuity (BCVA). The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study. RESULTS A total of 11 977 eyes from 7253 patients were included in the study. Ocular comorbidities differed by sex, with males having significantly higher percentages of traumatic cataracts (males 0.7% vs females 0.1%), prior ocular surgery (6.7% vs 5.5%), and mature cataracts (2.8% vs 1.9%). Conversely, females had significantly higher rates of pseudoexfoliation (2.0% vs 3.2%). In unadjusted analysis, males had higher rates of posterior capsular rupture (0.8% vs 0.4%) and vitreous loss (1.0% vs 0.6%), but this difference was not significant after adjustment for confounders. Males had a significantly increased risk of post-operative retinal detachment, but in multivariable analysis this was no longer significant. Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for posterior capsule opacification (OR=0.8, 95%CI=0.7-0.9, P=0.0005). The BCVA was slightly worse for males pre-operatively; but post-operatively, both sexes exhibited similar visual acuity of Snellen equivalent 20/25. CONCLUSION The study finds that in a cohort of patients presenting for cataract surgery, sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males. However, observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.
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Affiliation(s)
- Matthew D Geiger
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nathan C Grove
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Richard S Davidson
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael J Taravella
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Pasquali A, Varano L, Ungaro N, Tagliavini V, Mora P, Goldoni M, Gandolfi S. Does Cataract Extraction Significantly Affect Intraocular Pressure of Glaucomatous/Hypertensive Eyes? Meta-Analysis of Literature. J Clin Med 2024; 13:508. [PMID: 38256642 PMCID: PMC10816145 DOI: 10.3390/jcm13020508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate the effect of cataract extraction on intraocular pressure at 6, 12, and 24 months and their difference compared to the baseline in diverse glaucoma subtypes. MATERIALS AND METHODS We carried out research in the MEDLINE, Cochrane Library and EMBASE databases, as of April 2022 for relevant papers, filtered according to established inclusion and exclusion criteria. The meta-analysis evaluated the Mean Reduction and relative Standard Error in these subpopulations at predetermined times. A total of 41 groups (2302 eyes) were included in the systematic review. Due to the significant heterogeneity, they were analysed through a Random Effects Model. RESULTS We obtained these differences from baseline: (1) Open Angle Glaucoma at 6, 12 and 24 months, respectively: -2.44 mmHg, -2.71 mmHg and -3.13 mmHg; (2) Angle Closure Glaucoma at 6, 12 and 24 months, respectively: -6.81 mmHg, -7.03 mmHg and -6.52 mmHg; (3) Pseudoexfoliation Glaucoma at 12 months: -5.30 mmHg; (4) Ocular Hypertension at 24 months: -2.27 mmHg. CONCLUSIONS Despite a certain variability, the reduction in ocular pressure was statistically significant at 6, 12 and 24 months in both Open Angle Glaucoma and Angle Closure Glaucoma, the latter being superior. Data for Pseudoexfoliation Glaucoma and for Ocular Hypertension are available, respectively, only at 12 months and at 24 months, both being significant.
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Affiliation(s)
- Andrea Pasquali
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
| | - Luigi Varano
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
| | - Nicola Ungaro
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
| | - Viola Tagliavini
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
| | - Paolo Mora
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
| | - Matteo Goldoni
- Department of Physics, University of Parma, 43126 Parma, Italy;
| | - Stefano Gandolfi
- Eye Clinic, University Hospital of Parma, 43126 Parma, Italy; (L.V.); (N.U.); (V.T.); (P.M.); (S.G.)
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Stopyra W, Cooke DL, Grzybowski A. A Review of Intraocular Lens Power Calculation Formulas Based on Artificial Intelligence. J Clin Med 2024; 13:498. [PMID: 38256632 PMCID: PMC10816994 DOI: 10.3390/jcm13020498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE The proper selection of an intraocular lens power calculation formula is an essential aspect of cataract surgery. This study evaluated the accuracy of artificial intelligence-based formulas. DESIGN Systematic review. METHODS This review comprises articles evaluating the exactness of artificial intelligence-based formulas published from 2017 to July 2023. The papers were identified by a literature search of various databases (Pubmed/MEDLINE, Google Scholar, Crossref, Cochrane Library, Web of Science, and SciELO) using the terms "IOL formulas", "FullMonte", "Ladas", "Hill-RBF", "PEARL-DGS", "Kane", "Karmona", "Hoffer QST", and "Nallasamy". In total, 25 peer-reviewed articles in English with the maximum sample and the largest number of compared formulas were examined. RESULTS The scores of the mean absolute error and percentage of patients within ±0.5 D and ±1.0 D were used to estimate the exactness of the formulas. In most studies the Kane formula obtained the smallest mean absolute error and the highest percentage of patients within ±0.5 D and ±1.0 D. Second place was typically achieved by the PEARL DGS formula. The limitations of the studies were also discussed. CONCLUSIONS Kane seems to be the most accurate artificial intelligence-based formula. PEARL DGS also gives very good results. Hoffer QST, Karmona, and Nallasamy are the newest, and need further evaluation.
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Affiliation(s)
- Wiktor Stopyra
- MW-Med Eye Centre, 31-416 Krakow, Poland;
- Department of Medicine, University of Applied Sciences, 34-400 Nowy Targ, Poland
| | - David L. Cooke
- Great Lakes Eye Care, Saint Joseph, MI 49085, USA;
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Poznan, Poland
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Tañá-Sanz S, Tañá-Sanz P, Rodríguez-Carrillo MD, Ruiz-Santos M, de Toledo CÁ, Tañá-Rivero P. Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens. Clin Ophthalmol 2024; 18:27-40. [PMID: 38192579 PMCID: PMC10773246 DOI: 10.2147/opth.s445128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL). Methods A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered. Results Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were -0.01±0.06, 0.03±0.09, 0.02±0.05 and 0.19±0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥20/25, and CDIVA ≥20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05±0.30D and 100% and 93.75% eyes were within ±1.00D and ±0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported. Conclusion This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.
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Affiliation(s)
| | - Pedro Tañá-Sanz
- Cataract and Surgery Department, Oftalvist Alicante, Alicante, Spain
| | | | - María Ruiz-Santos
- Cataract and Surgery Department, Oftalvist Alicante, Alicante, Spain
| | | | - Pedro Tañá-Rivero
- Cataract and Surgery Department, Oftalvist Alicante, Alicante, Spain
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28
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Kaminsky M, Hoffman A, Ofri R, Konrade K, Gantz L. Refractive error of canine cataract patients following implantation with three types of intraocular lenses. J Am Vet Med Assoc 2024; 262:1-6. [PMID: 37922709 DOI: 10.2460/javma.23.08.0445] [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: 08/12/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate refractive state outcomes following phacoemulsification and implantation of 3 different intraocular lenses (IOLs). ANIMALS A prospective, randomized, controlled study was conducted on 43 client-owned dogs undergoing phacoemulsification with IOL implantation. METHODS Eyes were randomized to receive either an-vision Fo-X (n = 26), an-vision MD8 (18), or I-MED I-LENS (24) IOL. Refraction was measured 1 week, 1 month, and 3 months postoperatively using streak retinoscopy by 2 examiners masked to each other's results. RESULTS Postoperative refractive outcomes were highly correlated and not significantly different between 2 examiners for all time points (r = 0.97, 0.98, and 1.00; P = .76, .94, and .98, respectively). One week postoperatively, the refractive errors (mean ± SD) for Fo-X, MD8, and I-LENS were -0.14 ± 2.02 diopters (D), 0.97 ± 2.01 D, and 0.15 ± 2.55 D, respectively. One month postoperatively, the refractive errors were 0.35 ± 2.04 D, 0.06 ± 2.41 D, and -0.82 ± 2.20 D, respectively. Three months postoperatively, the refractive errors were -0.16 ± 2.67 D, 1.60 ± 2.99 D, and 0.59 ± 1.51 D, respectively. There were no significant differences in refractive error outcomes between Fo-X, MD8, and I-LENS at 1 week, 1 month, and 3 months postoperatively (P = .16; F(df=2,66)- = 1.89). However, the Fo-X was the only IOL to yield nearly emmetropic outcomes (±0.50 D) at all 3 time points. CLINICAL RELEVANCE The postoperative refractive states of dogs were not statistically different when comparing 3 types of IOLs at 3 postoperative time points, though the Fo-X was the only IOL to yield nearly emmetropic outcomes at all 3 time points.
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Affiliation(s)
| | | | - Ron Ofri
- 2Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Israel
| | | | - Liat Gantz
- 3Department of Optometry and Vision Science, Hadassah Academic College Jerusalem, Israel
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29
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Shetty N, Aishwarya, Nayak RP, Kaweri L, Kanaradi RK, Pisharody AA. 3D visualization system and standard operating microscope for ease of visualization and surgeon comfort during phacoemulsification surgery. Indian J Ophthalmol 2024; 72:56-62. [PMID: 38131570 PMCID: PMC10841793 DOI: 10.4103/ijo.ijo_1332_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: 05/22/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To compare the ease of visualization and comfort of the surgeon during phacoemulsification surgery using NGENUITY® 3D (NG) visualization system and standard operating microscope (SOM). METHODS In this prospective, randomized, single-blind, single-center study, patients undergoing phacoemulsification surgery by one of the five surgeons were randomly assigned to two groups based on the visualization modality-NG and SOM. Ease of visualization and comfort of the surgeon was assessed using a 27-parameter in-house Surgeon Comfort Score questionnaire. RESULTS A total of 224 phacoemulsification with intraocular lens implantations were performed in senile immature cataract (SIMC, n = 174) and mature cataract patients (MC, n = 50). Surgeon's ease of visualization (4.92-5.00) and hand-eye coordination score (4.97-5.00) were comparable between the NG- and SOM-groups. Postoperative neck discomfort was lower in both the groups, with a relatively lower discomfort in the NG-group (score: 1.04 vs 1.56). The Spearman rank correlation coefficient (r) between illumination of the operation theatre room and the surgical field revealed a weak negative correlation for most of the patients in the NG-group, and a positive correlation for patients in the SOM-group. No correlation was obtained between brightness of the surgical field and comfort with the surgical field brightness. CONCLUSIONS Similar ease of visualization was experienced by the surgeons using NG- and SOM-system. Neck discomfort postsurgery was numerically lower in the NG-group, although not significant. Additionally, the NG-system permitted the safe performance of phacoemulsification using a lower surgical field illumination.
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Affiliation(s)
- Naren Shetty
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Aishwarya
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohitha P Nayak
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Cataract Department, Narayana Nethralaya, Rajajinagar, Bengaluru, Karnataka, India
| | | | - Anchana A Pisharody
- Imaging Biomechanics and Mathematical Modelling Solutions Lab, Narayana Nethralaya, Bommasandra, Bengaluru, Karnataka, India
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Sruthi R, Saikumar SJ, Gopalakrishnan M. Progression of diabetic retinopathy following uncomplicated phacoemulsification: A prospective study from South India. Oman J Ophthalmol 2024; 17:72-77. [PMID: 38524349 PMCID: PMC10957061 DOI: 10.4103/ojo.ojo_292_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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 03/26/2024] Open
Abstract
AIM The aim of this study was to study the progression of diabetic retinopathy (DR) and macular edema in uncomplicated phacoemulsification in patients with diabetes mellitus with a follow-up of 6 months. METHODS A prospective, nonrandomized study was conducted on patients with established or no DR in a known case of diabetes mellitus undergoing cataract surgery by phacoemulsification, with no intraoperative complications. Detailed ophthalmic evaluation including fundus examination was done in all cases, and DR staging was done. Optical coherence tomography and fundus fluorescein angiography were done in indicated cases. Fundus evaluation was done during the follow-up visits in 3 weeks, 3 months, and 6 months postsurgery and the tests were repeated if necessary. RESULTS In the current study, there was a statistically significant improvement in best-corrected visual acuity after cataract surgery compared to the preoperative value. From the 330 eyes we analyzed, there was a progression of DR in only 18 eyes (5.45%) following phacoemulsification. There was a statistically significant increase in central macular thickness (CMT) at 3 weeks postoperative (433.82 ± 137.572) compared to that of the preoperative CMT (295.98 ± 97.959). From the 22 eyes which showed a progression of diabetic maculopathy, 11 eyes had developed new-onset macular edema following the cataract surgery, 11 eyes had progression of preexisting edema, and 4 of them had to undergo intravitreal anti-vascular endothelial growth factor injections as the treatment. CONCLUSION The chance of progression of DR staging is low after uncomplicated phacoemulsification, on a short term. However, the chances of worsening of macular edema as well as worsening of proliferative stages should be kept in mind while advising a patient for cataract surgery.
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Affiliation(s)
- R. Sruthi
- Department of Cataract and Glaucoma, Giridhar Eye Institute, Cochin, Kerala, India
| | - Seshadri J. Saikumar
- Department of Cataract and Glaucoma, Giridhar Eye Institute, Cochin, Kerala, India
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Yusef YN, Yusef SN, Vvedenskiy AS, Ivanov MN, Alkharki L, Fokina ND. [Rotational technique for emulsification of soft lens nucleus]. Vestn Oftalmol 2024; 140:123-128. [PMID: 38739141 DOI: 10.17116/oftalma2024140022123] [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: 05/14/2024]
Abstract
Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus. PURPOSE This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus. MATERIAL AND METHODS Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed. RESULTS The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification. CONCLUSIONS The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - A S Vvedenskiy
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - M N Ivanov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - L Alkharki
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Liu L, Hwang YS, Wu WC, Lai CC, Liu JH. Trocar blade-assisted skewer technique for phacoemulsification of a dislocated lens. Taiwan J Ophthalmol 2024; 14:129-132. [PMID: 38654995 PMCID: PMC11034686 DOI: 10.4103/tjo.tjo-d-22-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023] Open
Abstract
A posteriorly dislocated lens is often managed with a fragmatome through a pars plana approach because it is difficult to manage anteriorly. The lens often sinks to the surface of the retina or floats around in the vitreous cavity during pars plana lensectomy. Mechanical trauma can occur while removing the dislocated lens fragments. However, sometimes the lens can be confined to the anterior vitreous cavity even though the zonules are completely disrupted. It would be ideal if there was a simple way to stabilize and support the lens so that the lens could remain in the posterior chamber while phacoemulsification is performed through a corneal incision as usual. We describe a technique using a trocar blade to stabilize the lens while performing phacoemulsification through a corneal incision. We found it to be a useful and safe instrument to support the subluxated lens during phacoemulsification.
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Affiliation(s)
- Laura Liu
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jorn-Hon Liu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
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Yusef YN, Yusef SN, Vvedenskiy AS, Ivanov MN, Alkharki L, Fokina ND. [Surgical technique for aspiration of soft lens nucleus with preoperative femtosecond laser-assisted fragmentation]. Vestn Oftalmol 2024; 140:109-115. [PMID: 38739139 DOI: 10.17116/oftalma2024140022109] [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: 05/14/2024]
Abstract
Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser. PURPOSE This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. MATERIAL AND METHODS The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. RESULTS The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. CONCLUSIONS Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - A S Vvedenskiy
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - M N Ivanov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - L Alkharki
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Sener H, Gulmez Sevim D, Evereklioglu C, Uludag MT, Gunay Sener AB, Polat OA, Arda H, Horozoglu F. Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Semin Ophthalmol 2024; 39:17-26. [PMID: 37296113 DOI: 10.1080/08820538.2023.2223292] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review. METHODS PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates. RESULTS This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [-1.73 (95%CrI: -3.53 to -0.13)] and phaco+GSL+GS [-3.92 (95%CrI: -6.91 to -1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [-3.11 (95%CrI: -5.82 to -0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [-0.45 (95%CrI: -0.81 to -0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures. CONCLUSIONS Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.
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Affiliation(s)
- Hidayet Sener
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Duygu Gulmez Sevim
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Cem Evereklioglu
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Muhammed Taha Uludag
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Osman Ahmet Polat
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Hatice Arda
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Fatih Horozoglu
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
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Yusef YN, Yusef SN, Vvedenskiy AS, Gamidov AA, Ivanov MN, Avetisov KS, Alkhumidi K. [The first experience of using femtosecond laser in the treatment of anterior capsular contraction syndrome]. Vestn Oftalmol 2024; 140:65-70. [PMID: 38450468 DOI: 10.17116/oftalma202414001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Prevention and treatment of anterior capsular contraction syndrome (ACCS) is a relevant problem in cataract surgery. PURPOSE The study was performed to develop a femtosecond laser-assisted technique for anterior capsulotomy in anterior capsular contraction syndrome and assess its preliminary results in preventing the progression of pathological changes in the capsular bag. MATERIAL AND METHODS The examination and femtosecond laser-assisted treatment without additional surgical intervention was performed in 6 patients (6 eyes) aged 69 to 73 years with anterior capsular contraction syndrome. Femtosecond laser-assisted anterior capsulotomy was performed using the VICTUS system (Technolas Perfect Vision, Germany). Capsulotomy diameter was 4.0-4.5 mm, laser radiation energy - 9000 nJ, laser exposure depth 900-1000 μm. RESULTS The diameter of the anterior capsulotomy before treatment was 2.85 mm [2.75; 2.93]. After 1 month, the diameter of the anterior capsular opening was 2.88 mm [2.78; 2.96] (p>0.05). One year after femtosecond laser intervention, the anterior capsulotomy opening was almost the same shape and diameter - 2.84 mm [2.74; 2.94] (p>0.05). CONCLUSION Femtosecond laser-assisted circular capsulotomy is an effective and safe method for preventing the progression of anterior capsular contraction syndrome in the absence of severe IOL decentration and for maintaining the diameter of the anterior capsular opening of at least 2.5-3.0 mm.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - A S Vvedenskiy
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - A A Gamidov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - M N Ivanov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - K S Avetisov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - K Alkhumidi
- Krasnov Research Institute of Eye Disease, Moscow, Russia
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Sarkar D, Anshukita A, Karkhur S, Sharma B, Gupta S. Anterior Chamber Biometric Parameters Associated With Intraocular Pressure Reduction After Phacoemulsification in Non-Glaucomatous Eyes With Open Angles. Cureus 2024; 16:e51500. [PMID: 38304690 PMCID: PMC10831583 DOI: 10.7759/cureus.51500] [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] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Decreased intra-ocular pressure after cataract surgery has been reported in eyes with and without glaucoma with variable magnitude. It is influenced by the anatomical structure of the anterior chamber. Preoperative evaluation of anterior chamber parameters can help to predict the change in intra-ocular pressure postoperatively. OBJECTIVE The objective of the study is to evaluate intraocular pressure (IOP) change after uneventful phacoemulsification in non-glaucomatous eyes with open angles and its correlation with preoperative anterior chamber parameters measured by anterior segment optical coherence tomography (AS-OCT). METHODS In this hospital-based prospective observational study, we included consecutive patients without glaucoma and open angles on gonioscopy who had undergone uncomplicated phacoemulsification with intraocular lens implantation (IOL). IOP and anterior chamber biometric parameters were measured preoperatively and compared with parameters obtained three months post-operatively by AS-OCT. The change in IOP and its relation to the parameters, including anterior chamber angle (ACA), anterior chamber depth (ACD), angle opening distance 500 μm anterior to the scleral spur (AOD500), anterior chamber width (ACW), lens vault (LV), and trabecular iris space area (TISA500) were evaluated. The main outcome measure was a change in IOP after phacoemulsification in normal eyes. RESULTS Sixty-four eyes of 64 patients were enrolled. The mean patient age was 58.5 ± 9.4 years. The average IOP reduction was 2.43±1.64 mm of Hg from a preoperative mean of 16.77±2.54 mmHg three months after phacoemulsification surgery. The mean AOD500 increased significantly (0.440 ± 0.07 to 0.522 ±0.092) from preoperatively to three months postoperatively (p < 0.001). Preoperative lens vault and preoperative IOP had a strong positive correlation with the change in IOP at three months (r-value = 0.606; p-value <0.001) and (r-value = 0.73; p-value <0.001). There was a significant negative correlation between pre-operative TISA and AOD with change in IOP at three months (r-value = -0.545; p-value <0.001) and (r-value = -0.69; p-value <0.01). CONCLUSION Phacoemulsification surgery results in IOP reduction in non-glaucomatous eyes. Pre-operative IOP, lens vault, AOD, and TISA were significant predictors for IOP reduction.
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Affiliation(s)
- Deepayan Sarkar
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Samendra Karkhur
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | - Bhavana Sharma
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | - Saroj Gupta
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
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Belov DF, Danilenko EV, Nikolaenko VP, Potemkin VV. [Evaluation of the accuracy of modern intraocular lens calculation formulas when optical biometry is not possible]. Vestn Oftalmol 2024; 140:34-39. [PMID: 38742496 DOI: 10.17116/oftalma202414002134] [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: 05/16/2024]
Abstract
PURPOSE This study evaluates the accuracy of modern intraocular lens (IOL) calculation formulas using axial length (AL) data obtained by ultrasound biometry (UBM) compared to the third-generation SRK/T calculator. MATERIAL AND METHODS The study included 230 patients (267 eyes) with severe lens opacities that prevented optical biometry, who underwent phacoemulsification (PE) with IOL implantation. IOL power calculation according to the SRK/T formula was based on AL and anterior chamber depth obtained by UBM (Tomey Biometer Al-100) and keratometry on the Topcon KR 8800 autorefractometer. To adapt AL for new generation calculators - Barrett Universal II (BUII), Hill RBF ver. 3.0 (RBF), Kane and Ladas Super Formula (LSF) - the retinal thickness (0.20 mm) was added to the axial length determined by UBM, and then the optical power of the artificial lens was calculated. The mean error and its modulus value were used as criteria for the accuracy of IOL calculation. RESULTS A significant difference (p=0.008) in the mean IOL calculation error was found between the formulas. Pairwise analysis revealed differences between SRK/T (-0.32±0.58 D) and other formulas - BUII (-0.16±0.52 D; p=0.014), RBF (-0.17±0.51 D; p=0.024), Kane (-0.17±0.52 D; p=0.029), but not with the LSF calculator (-0.19±0.53 D; p=0.071). No significant differences between the formulas were found in terms of mean error modulus (p=0.238). New generation calculators showed a more frequent success in hitting target refraction (within ±1.00 D in more than 95% of cases) than the SRK/T formula (86%). CONCLUSION The proposed method of adding 0.20 mm to the AL determined by UBM allows using this parameter in modern IOL calculation formulas and improving the refractive results of PE, especially in eyes with non-standard anterior segment structure.
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Affiliation(s)
- D F Belov
- Saint Petersburg Multifield Hospital No. 2, Saint Petersburg, Russia
- Saint Petersburg State University, Saint Petersburg, Russia
| | - E V Danilenko
- Medical Military Academy named after S.M. Kirov, Saint Petersburg, Russia
| | - V P Nikolaenko
- Saint Petersburg Multifield Hospital No. 2, Saint Petersburg, Russia
- Saint Petersburg State University, Saint Petersburg, Russia
| | - V V Potemkin
- Saint Petersburg Multifield Hospital No. 2, Saint Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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Yusef YN, Yusef SN, Vvedenskiy AS, Ivanov MN, Alkharki L, Fokina ND. [Influence of the pattern of femtosecond laser-assisted lens nucleus fragmentation on the energy and hydrodynamic parameters of phacoemulsification]. Vestn Oftalmol 2024; 140:129-135. [PMID: 38739142 DOI: 10.17116/oftalma2024140022129] [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: 05/14/2024]
Abstract
The influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy and hydrodynamic parameters of phacoemulsification remains insufficiently studied. PURPOSE This study evaluates the influence of various patterns of preliminary femtosecond laser-assisted fragmentation of the lens nucleus on the energy, hydrodynamic parameters of phacoemulsification, and the degree of corneal endothelial cell loss. MATERIAL AND METHODS Hybrid phacoemulsification was performed in 336 patients (336 eyes) with grade IV immature cataract according to the Buratto classification in three age-matched groups. Group 1 included 103 patients (103 eyes) who underwent hybrid phacoemulsification with preliminary femtosecond laser-assisted fragmentation of the nucleus with a «pizza» pattern (division of the nucleus with 10 radial cuts). Group 2 included 112 patients (112 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «cylinders» pattern (division of the nucleus with 8 radial cuts in combination with 5 circular cuts). Group 3 included 121 patients (121 eyes) who underwent femtosecond laser-assisted fragmentation of the nucleus with a «grid» pattern (division of the nucleus with 8 radial cuts in combination with multiple mutually perpendicular cuts in the central zone in the form of a grid with a 0.5 mm cell). Effective ultrasound time and the volume of irrigation solution for emulsification of the lens nucleus fragments were determined during the operation. The loss of corneal endothelial cells was assessed 3 months after surgery. RESULTS The minimum effective ultrasound time was noted after using the "grid" pattern - 4.05 (2.88; 4.74) s, which was significantly less than with the "cylinders" pattern - 4.97 (3.78; 5.88) s and the "pizza" pattern - 6.15 (4.52; 7.75) s (p<0.05). The effective ultrasound time when using the "cylinders" pattern was significantly less than with the "pizza" pattern (p<0.05). The volume of irrigation solution used for emulsification of the lens nucleus fragments was significantly less in the "grid" pattern - 41.5 (33.5; 49.5) ml compared to the "cylinders" patterns 58.5 (51.0; 66.0), p<0.05 and "pizza" pattern 75.0 (66.0; 83.5), p<0.01. The volume of irrigation solution when using the "cylinders" pattern was significantly less than when using the "pizza" pattern (p<0.05). The loss of corneal endothelial cells after using the "grid" pattern was 8.82 (7.59; 9.87)%, which was significantly less than after the "cylinders" patterns - 9.97 (8.81; 10.83)%, p<0.05 and "pizza" - 11.70 (10.62; 12.97)%, p<0.05. At the same time, the loss of endothelial cells after using the "cylinders" pattern was significantly less than after the "pizza" pattern (p<0.05). CONCLUSIONS The choice of the optimal pattern of preliminary femtosecond laser-assisted fragmentation of the lens nucleus provides a significant decrease in the energy and hydrodynamic parameters of phacoemulsification and, accordingly, the loss of corneal endothelial cells.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S N Yusef
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - A S Vvedenskiy
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - M N Ivanov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - L Alkharki
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Lee NSY, Ong K. Risk factors for corneal endothelial cell loss after phacoemulsification. Taiwan J Ophthalmol 2024; 14:83-87. [PMID: 38654985 PMCID: PMC11034697 DOI: 10.4103/tjo.tjo-d-23-00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the changes in corneal endothelial cell density (CECD) occurring after cataract phacoemulsification surgery and identify factors associated with cell loss. MATERIALS AND METHODS This was a retrospective study involving patients who underwent cataract phacoemulsification surgery between January 1, 2018, and December 31, 2018, at two private hospitals. Demographic data and biometric parameters were obtained preoperatively. Ultrasound metrics were recorded for each operation, including total on time (TOT), total equivalent power in position 3, and cumulative dissipated energy (CDE). Using corneal specular microscopy, CECD was measured preoperatively and postoperatively at 12, 24, and 36 months. Factors associated with decreased CECD were identified. RESULTS This study included 223 eyes of 133 patients. The mean CECD was 2530.03 ± 285.42 cells/mm2 preoperatively and significantly decreased to 2364.22 ± 386.98 cells/mm2 at 12 months (P < 0.001), 2292.32 ± 319.72 cells/mm2 at 24 months (P < 0.001), and 2242.85 ± 363.65 cells/mm2 at 36 months (P < 0.001). The amount of cell loss was associated with age, gender, preoperative CECD, preoperative anterior chamber depth, lens thickness, TOT, and CDE. Using multivariate analysis, age, preoperative CECD, and TOT were identified as independent predictors for CECD loss 12 months after surgery. CONCLUSION The greatest decrease in CECD occurred during the first year after cataract surgery, and the amount of cell loss was influenced by both baseline patient characteristics and ultrasound metrics. Longer-term prospective studies in a larger cohort may yield more information.
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Affiliation(s)
- Natalie Si-Yi Lee
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Keith Ong
- Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Chatswood Private Hospital, Sydney, Australia
- Department of Ophthalmology, Sydney Adventist Hospital, Sydney, Australia
- Save Sight Institute, University of Sydney, Sydney, Australia
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Pirogova ES, Fabrikantov OL, Nikolashin SI. [Optimization of phacoemulsification technique for Morgagnian cataract]. Vestn Oftalmol 2024; 140:24-32. [PMID: 38742495 DOI: 10.17116/oftalma202414002124] [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: 05/16/2024]
Abstract
PURPOSE This study was conducted to develop a new optimized phacoemulsification technique for Morgagnian cataract taking into account the anatomical and topographic parameters of the lens nucleus. MATERIAL AND METHODS A working classification of Morgagnian cataract was developed based on the size of the nucleus: if the edge of the nucleus is visualized at the upper edge of the pupil or between the upper edge and the middle of the pupil, it was classified as an initial stage of Morgagnian cataract with a large nucleus; if the upper edge of the nucleus is visualized in the middle of the pupil and below, it was classified as an advanced stage of Morgagnian cataract with a small nucleus. The first group included six patients who underwent surgery using the scaffold technique with removal of the whole small nucleus into the anterior chamber. The second group included 11 patients who underwent surgery using the scaffold technique with removal of the last fragment of the nucleus into the anterior chamber. RESULTS The use of the scaffold technique with removal of the nucleus into the anterior chamber helped reduce the number of intraoperative complications to 16.7% in the first group, compared to 27.3% in the second group, and the percentage of endothelial cell loss to 10.1% in the first group, compared to 10.7% in the second group. CONCLUSIONS The anatomical and topographic features of the lens and the anterior segment of the eye in Morgagnian cataract with a small nucleus allow for preliminary implantation of an intraocular lens into the capsular bag to protect the posterior capsule during phacoemulsification of the nucleus with minimal mechanical, hydrodynamic and acoustic damage to the surrounding structures of the eye.
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Affiliation(s)
- E S Pirogova
- Tambov branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Tambov, Russia
| | - O L Fabrikantov
- Tambov branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Tambov, Russia
| | - S I Nikolashin
- Tambov branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Tambov, Russia
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Tekcan H, İmamoğlu S, Mangan MS. Anterior Segment Changes and Refractive Outcomes after Cataract Surgery Combined with Gonioscopy-Assisted Transluminal Trabeculotomy in Open-Angle Glaucoma. Turk J Ophthalmol 2023; 53:369-376. [PMID: 38047480 PMCID: PMC10750090 DOI: 10.4274/tjo.galenos.2023.36080] [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: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To compare the accuracy of intraocular lens (IOL) calculation formulas in patients undergoing phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) and to determine the predictive factors for refractive errors. Materials and Methods Fifty-three eyes of 53 patients undergoing phaco-GATT were retrospectively reviewed. The preoperative and postoperative 3-month anterior segment (AS) parameters were measured by Scheimpflug camera. The mean prediction error (PE), mean absolute error (MAE) in the Sanders-Retzlaff-Kraft/theoretical (SRK/T), Barrett- Universal II, Hill-radial basis function (Hill-RBF) and Kane formulas were compared. The influence of biometric parameters on PE were analyzed by correlation analysis. Results Postoperatively, there was a statistically significant decrease in axial length (AL) and significant enlargement in anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (p<0.001). The mean PE using SRK/T (-0.08 diopters [D]) was more myopic than in the Barret (0.01 D) and Hill-RBF (0.01 D). The PE closest to zero was in the Kane formula (0.001 D). The Kane formula provided a lower MAE (0.30±0.28 D) than the SRK/T (0.38±0.32 D) and Barrett (0.36±0.30 D) (p<0.001). The MAE in Hill-RBF (0.32±0.28) was comparable with that in Kane (p=0.02). Preoperative AL was significantly associated with PE in all formulas except Kane. Barrett was the only formula that did not have a significant correlation between PE and postoperative ACD and ACA. Conclusion The Kane formula may provide higher predictability of the IOL power calculation than the SRK/T and Barrett-Universal II formulas in phaco-GATT surgery, which can cause significant changes in the AS and AL.
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Affiliation(s)
- Hatice Tekcan
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Serhat İmamoğlu
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Mehmet Serhat Mangan
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
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Borjan I, Stanić R, Pleština-Borjan I, Pavić M, Hertzberg SNW, Znaor L, Petrovski BÉ, Petrovski G. Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia. J Clin Med 2023; 13:38. [PMID: 38202045 PMCID: PMC10780027 DOI: 10.3390/jcm13010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome. METHODS This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes. RESULTS A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract. CONCLUSIONS All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.
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Affiliation(s)
- Ivan Borjan
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Robert Stanić
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
| | - Ivna Pleština-Borjan
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Maja Pavić
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Silvia N. W. Hertzberg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
| | - Ljubo Znaor
- Clinical Department of Ophthalmology, University Hospital Center, 21000 Split, Croatia; (I.B.); (R.S.); (L.Z.)
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
| | - Goran Petrovski
- University of Split, School of Medicine, 21000 Split, Croatia; (I.P.-B.); (M.P.)
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (S.N.W.H.); (B.É.P.)
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000 Bitola, North Macedonia
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Turicea B, Munevar CL, Edwards SG, Linton LL. Vision outcomes in dogs with primary glaucoma surgically treated with lensectomy and endolaser cyclophotocoagulation after an Ahmed valve gonioimplantation failure. Vet Ophthalmol 2023. [PMID: 38059879 DOI: 10.1111/vop.13172] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure. PROCEDURE Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months. RESULTS Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months. CONCLUSIONS Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.
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Affiliation(s)
- Bactelius Turicea
- Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa, USA
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Ghiasian L, Aghili S, Abdolalizadeh P. Impact of COVID-19 on cataract surgical competency of ophthalmology residents. Indian J Ophthalmol 2023; 71:3696-3700. [PMID: 37991306 PMCID: PMC10788761 DOI: 10.4103/ijo.ijo_1242_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: 05/12/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 11/23/2023] Open
Abstract
CONTEXT Coronavirus disease 2019 (COVID-19) pandemic led to a decrease in elective surgeries. PURPOSE To compare the performance of postgraduate year 4 prepandemic (2018-2019) and pandemic (2021-2022) ophthalmology residents. SETTINGS AND DESIGN This was an observational comparative study conducted at a university-based hospital. METHODS Ophthalmology residents of postgraduate year 4 during prepandemic (2018-2019) and pandemic (2021-2022) time periods were included. The performances of residents in phacoemulsification were scored by a single faculty assessor using the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR: phaco). The scores were compared between the two groups. STATISTICAL ANALYSIS USED The comparisons between the pre- and post-pandemic groups were performed using the Chi-square and Mann-Whitney U test. RESULTS Seventy-one surgeries were rated in each group. All task-specific and global scores of the pandemic group were lower than those of the prepandemic group (all P values < 0.001). The maximum intergroup difference was in capsulorrhexis circular completion (difference of 1.21 score, P < 0.001) and tissue handling (difference of 1.21 score, P < 0.001) among task-specific and global scores, respectively. The residents of the two groups had the highest similarity in irrigation and aspiration (difference of 0.61 score, P < 0.001) from task-specific scores and central eye position from global scores (difference of 0.93 score, P < 0.001). CONCLUSION The COVID-19 pandemic has negatively affected the surgical competency of ophthalmology residents in phacoemulsification.
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Affiliation(s)
- Leila Ghiasian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - SeyyedSaeed Aghili
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Akbari-Kamrani M, Heidarzadeh H, Naderan M, Gordiz A, Hemmati S, Chaibakhsh S, Mohammadi SS, Farsani MK, Zand A, Abdi F. Impact of first eye cataract surgery on falls among patients of advanced age: a comparative study. J Int Med Res 2023; 51:3000605231216685. [PMID: 38069864 PMCID: PMC10710751 DOI: 10.1177/03000605231216685] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To compare the incidence of falls between patients with visually significant cataracts in both eyes and those who have undergone first-eye cataract surgery. METHODS This retrospective case-control study involved patients with a history of cataracts in both eyes who had undergone first-eye cataract surgery within the past 9 to 12 months (pseudophakic group). The control group comprised patients with cataracts in both eyes (cataract group). We assessed best-corrected visual acuity (BCVA), systemic comorbidities and medications (using the Charlson comorbidity index), and independent daily activities (using the Lawton Instrumental Activities of Daily Living scale). The patients were questioned about experiencing two or more falls in the last 6 months. RESULTS Each group comprised 50 patients. Binocular BCVA was significantly better in the pseudophakic group (0.05 ± 0.06 logMAR) than in the cataract group (0.77 ± 0.34 logMAR). Of all participants, 22% reported experiencing two or more falls in the last 6 months. Multivariate analysis demonstrated significantly better BCVA in participants with less than two falls. CONCLUSIONS Patients of advanced age with visually significant cataracts in both eyes are at a higher risk of falling. First-eye cataract surgery may mitigate the occurrence of falls by improving binocular BCVA.
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Affiliation(s)
- Marjan Akbari-Kamrani
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamidreza Heidarzadeh
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Morteza Naderan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arzhang Gordiz
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sara Hemmati
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Department of Ophthalmology, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohsen Khosravi Farsani
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Zand
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Abdi
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Agarwal S, Thornell E. YAG Capsulotomy Rates in Patients Following Cataract Surgery and Implantation of New Hydrophobic Preloaded Intraocular Lens in an Australian Cohort: 3-Year Results. Clin Ophthalmol 2023; 17:3637-3643. [PMID: 38026609 PMCID: PMC10680474 DOI: 10.2147/opth.s437537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To assess the risk of posterior capsular opacification (PCO) following implantation of the Clareon lens. Materials and Methods Retrospective analysis was performed for 484 consecutive eyes that had undergone phacoemulsification and implantation of a monofocal lens (CNA0T) between April 2018 and February 2020. Eyes with other ocular pathology that may affect outcomes, previous refractive surgery or eyes corrected for a near target were excluded. Incidence of PCO and YAG capsulotomy was recorded and regression analysis was performed to determine risk factors associated with PCO formation. Results Overall incidence of PCO following implantation of the CNA0T monofocal lens was 3.7% (18 eyes) at 1 year with 1.9% (9 eyes) undergoing YAG capsulotomy. At 3 years, 8.7% (42 eyes) had developed PCO and 4.1% (20 eyes) had undergone YAG capsulotomy cumulatively. Primary open angle glaucoma (POAG; OR = 6.53; 95% CI = 18.68, 2.28; P = 0.0005), age-related macular degeneration (AMD; OR = 2.35; 95% CI = 5.21, 1.06; P = 0.036), vitreomacular traction (VMT; OR = 7.32; 95% CI = 45.08, 1.19; P = 0.032), retinal vein occlusion (RVO; OR = 8.42; 95% CI = 38.99, 1.82; P = 0.006) and history of anti-VEGF therapy (OR = 3.22; 95% CI = 10.26, 1.01; P = 0.048) were positively associated with an increased risk of PCO. Conclusions Incidence of PCO requiring YAG capsulotomy was relatively low. However, certain co-morbidities were found to increase the risk of PCO development, most significantly POAG and RVO.
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Affiliation(s)
- Smita Agarwal
- Wollongong Eye Specialists, Wollongong, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Erin Thornell
- Wollongong Eye Specialists, Wollongong, NSW, Australia
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Su S, Wu J, Ji M, Guan Y, Shen Y, Guan HJ. Comparison of three fundus inspection methods during phacoemulsification in diabetic white cataract. Int J Ophthalmol 2023; 16:1782-1788. [PMID: 38028526 PMCID: PMC10626363 DOI: 10.18240/ijo.2023.11.07] [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: 04/14/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To investigate whether Wild Field Imaging System (WFIS SW-8000), 25G endoilluminator, and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with suspicious diabetic retinopathy (DR) during phacoemulsification, especially in cases of white cataract. METHODS A cross-sectional study was carried out. A total of 204 dense diabetic cataractous eyes of 204 patients with suspected DR treated from April 2020 to March 2021 were included. Phacoemulsification combined with intraocular lens implantation was performed. Following the removal of the lens opacity, the 25G endo-illuminator, fundus photography, and iOCT were performed successively. Optical coherence tomography (OCT) and/or fundus fluorescein angiography (FFA) were used to verify the fundus findings postoperatively. Intraoperative and postoperative results were compared to verify the accuracy of intraoperative diagnosis in each group. RESULTS Intraoperative and postoperative examinations revealed 58 and 62 eyes with DR, respectively (positive rate, 28.43% and 30.39%, respectively). During the phacoemulsification, WFIS SW-8000 detected 44 eyes with DR (the detection rate, 70.97%); 25G endo-illuminator found 56 eyes with DR (the detection rate, 90.32%); iOCT found 46 eyes with DR (the detection rate, 74.19%); and 58 eyes with DR were found by combining the three methods (the detection rate, 93.55%). There were statistically significant differences in the diagnostic sensitivity for DR among the methods (χ2=16.36, P=0.001). CONCLUSION WFIS SW-8000, 25G endo-illuminator, iOCT, and especially their combination can be used to inspect the fundus and detect DR intraoperatively; they are helpful for the timely diagnosis and treatment of DR in patients with dense cataract.
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Affiliation(s)
- Shu Su
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jian Wu
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yu Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yao Shen
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Huai-Jin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Kim D, Goh YS, Kim H, Park SE, Hwang J, Kang N, Jung JS, Park KM. Evaluation of ciliary cleft changes after phacoemulsification using ultrasound biomicroscopy in dogs with cataracts. Front Vet Sci 2023; 10:1247127. [PMID: 38033645 PMCID: PMC10684783 DOI: 10.3389/fvets.2023.1247127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Glaucoma is one of the most serious complications that causes irreversible blindness after phacoemulsification in dogs; however, a clear mechanism has not been elucidated. This study aimed to analyse the possible anatomical factors associated with glaucoma after phacoemulsification using parameters that reflect the anatomical characteristics of dogs. Materials and methods A total of 69 eyes of 48 dogs were included in this study. The patients were divided into three groups: normal eye (n = 18), cataract (n = 39), and post-phacoemulsification for at least 2 months after surgery (post-phaco, n = 12). For further analysis, the dogs were subdivided into two groups according to cataract stage: phacoemulsification non-candidate and candidate groups. Non-cataracts and incipient cataracts were categorized into the non-candidate group, whereas immature and mature cataracts were categorized into the candidate group. Measurements of the ciliary cleft parameters, including the area of the ciliary cleft (CCA), length of the ciliary cleft (CCL), width of the ciliary cleft (CCW), iridocorneal angle, and angle opening distance, were obtained using ultrasound biomicroscopy. Results CCA, CCL, and CCW were significantly higher in the candidate group than in the non-candidate group. CCA, CCL, and CCW were significantly reduced in the post-phaco group compared to those in the cataract group. Based on these results, we found that the ciliary cleft expanded in cataract-affected eyes and narrowed after phacoemulsification. This may indicate that the space between the trabecular meshworks became narrower, potentially leading to an increase in the resistance of the aqueous humor. Conclusion A narrowed ciliary cleft after phacoemulsification may be an anatomical factor associated with glaucoma.
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Affiliation(s)
| | | | | | | | | | | | | | - Kyung-Mee Park
- Laboratory of Veterinary Surgery and Ophthalmology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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García-Tomás B, Marín-Sánchez JM, García-Elskamp C, Alcon-Ruiz E, Montesinos-López L, García Martínez-Lozano B. Clinical Outcomes of a Monofocal, Optimized, Aspheric, Hydrophobic Acrylic Intraocular Lens Implant. Clin Ophthalmol 2023; 17:3215-3224. [PMID: 37915319 PMCID: PMC10617528 DOI: 10.2147/opth.s434378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose To evaluate the refractive and visual outcomes of eyes implanted with monofocal, optimized, aspheric, hydrophobic acrylic intraocular lenses (IOL) following cataract surgery. Methods The study assessed 55 eyes implanted with CT LUCIA® 621P IOLs (Carl Zeiss Meditec AG, Jena, Germany) at 3-months postsurgery. The main outcome measures were refractive error, monocular corrected distance visual acuity (CDVA), monocular uncorrected distance visual acuity (UDVA), photopic and mesopic contrast sensitivity, and wavefront aberrations. Patients were asked to complete the Catquest-9SF questionnaire. Results At 3 months, the cumulative Snellen visual acuity was 20/20 in 94.55% of eyes and 20/25 or better in 100%. The difference between the UDVA and CDVA was either the same (70.91%) or better (29.09%) in all eyes. The mean Snellen decimal UDVA and DCVA were 1.07 ± 0.15 and 1.13 ± 0.11, respectively. The safety and efficacy indexes were 1.48 and 1.40, respectively. 47.27% of eyes showed a spherical equivalent ±0.13 D, with 92.73% of the eyes were within ±0.50 D and all eyes were within ±1.00 D. The mean spherical equivalent was -0.03 ± 0.30 D and the mean refractive cylinder -0.36 ± 0.34 D. The log photopic and mesopic contrast sensitivity functions were good and similar for all spatial frequencies. All patients reported being either fairly satisfied (score 3) or very satisfied (score 4) with their vision (mean = 3.64 ± 0.49). No intra- and postoperative complications were reported during the 3 months of follow-up. Conclusion The current study demonstrates that excellent visual and refractive outcomes, as well as patient satisfaction, can be achieved after cataract surgery with optimized, aspheric CT LUCIA 621P monofocal IOLs.
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Bajraktari G, Jukić T, Kalauz M, Oroz M, Radolović Bertetić A, Vukojević N. Early and Late Complications after Cataract Surgery in Patients with Uveitis. Medicina (Kaunas) 2023; 59:1877. [PMID: 37893595 PMCID: PMC10608233 DOI: 10.3390/medicina59101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Uveitis, a prevalent eye disorder characterized by inflammatory processes, often leads to cataract formation and significant visual impairment. This study aimed to evaluate preoperative conditions and postoperative outcomes following cataract surgery in uveitis patients. Materials and Methods: A retrospective study was conducted at the University Hospital Center Rebro Zagreb, Croatia, involving uveitis patients who underwent cataract surgery between 2013 and 2022. Eligible patients had uveitic cataracts affecting visual acuity or posterior segment visualization in a "quiet eye" and were disease-inactive for at least three months. Patients with certain pre-existing ocular conditions were excluded. The data collected included patient demographics, uveitis type, preoperative therapy, preexisting lesions, and postoperative outcomes such as visual acuity, intraocular pressure, central macular thickness, and complications. Statistical analysis was performed to identify risk factors associated with complications. Results: This study included 105 patients. The most common uveitis types were idiopathic uveitis, HLA-B27-associated uveitis, and JIA uveitis. After cataract surgery, there was a significant improvement in visual acuity at various time points, with 90% of eyes showing improvement. Intraocular pressure decreased over time. Central macular thickness increased at three months post-surgery but remained stable thereafter. Early and late complications were observed in 52.4% and 63.8% of eyes, respectively. The most common complications were posterior capsular opacification (53.3%), macular edema (26.6%), and epiretinal membrane formation (9.52%). The factors associated with complications varied between early and late stages but included age, age at the onset of uveitis, and the uveitis type. Conclusions: In patients with quiescent uveitis undergoing cataract surgery, significant visual improvement was achieved. This study highlights the importance of careful patient selection, preoperative and postoperative inflammation management, and precise surgical techniques. Although complications were common, the risk of capsular opacification, macular edema, and epiretinal membrane formation after surgery increased. However, future investigations should address this study's limitations and further refine perioperative strategies.
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Affiliation(s)
- Gentian Bajraktari
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinic of Ophthalmology, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Tomislav Jukić
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Martin Oroz
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | | | - Nenad Vukojević
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
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