Management of cataract surgery in Lowe syndrome.

Simultaneous bilateral cataract surgery in children is debated due to risks of complications like endophthalmitis and retinal detachment. Children with congenital cataracts often have systemic comorbidities and syndromic features, making anesthesia administration challenging due to difficult airway management, cardiac anomalies, and other systemic issues. We present a syndromic infant with bilateral cataracts and systemic comorbidities. To minimize anesthesia exposure and due to the limited availability of specialists, we opted for bilateral surgery. An interdisciplinary team, including pediatric ophthalmologists, intensivists, and anesthesiologists, managed the case. The surgery involved simultaneous lens aspiration, primary posterior capsulotomy, and planned surgical aphakia using meticulous techniques. A protocol was followed to separate the two surgeries performed in the same session, ensuring sterile precautions with a single surgeon. This case highlights anesthetic concerns in syndromic children undergoing bilateral cataract surgery and emphasizes the need for delinking surgeries with adequate aseptic measures.

To investigate the cost implications, safety, and refractive outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation in pediatric patients in a developing world setting. Children aged 3 months to 10 years with bilateral congenital or developmental cataracts who underwent surgery between January 1, 2007, and December 31, 2009, were eligible for inclusion in this retrospective study. Cost data were compared for simultaneous and sequential cases. Postoperative complications and refraction data were analyzed. Ninety-six children (192 eyes) were included, 48 in the SBCS group and 48 in the sequential group. The mean age of the SBCS group and the sequential group was 3.4 and 4.7 years, respectively (P = .04). The total estimated surgical cost was $274 per child for SBCS and $344 for sequential surgery, a reduction of 20.3% for cases of SBCS. Fibrin formation of any amount occurred in 52 of 192 eyes (27.1%), 25 in the SBCS group and 27 in the sequential group (P = .75). Twenty-one eyes (10.9%) had additional surgery to remove visual axis obstruction, 14 in the SBCS group and 7 in the sequential group (P = .11). The incidence of early endophthalmitis in all cases of pediatric cataract surgery in an 11-year period was 0.16%. The incidence of anesthetic-related death during the same period was 0.11%. Bilateral simultaneous pediatric cataract surgery with intraocular lens implantation may be a safe alternative to sequential surgery, with advantages in cost reduction and no difference in sight-threatening complications.

To evaluate the efficacy and safety of simultaneous bilateral cataract surgery with respect to patient satisfaction, outcomes, and complication rates. We conducted a prospective study of consecutive patients who had simultaneous bilateral cataract surgery on the same day or separate bilateral cataract surgery with an interval of 2 days between operations. The changes in refraction, visual acuity, degree of anisometropia, and complication rates were compared between the simultaneous bilateral cataract surgery and separate bilateral cataract surgery groups. Patient satisfaction was assessed with a questionnaire. Ninety-four patients who had simultaneous bilateral cataract surgery and 100 patients who had separate bilateral cataract surgery were enrolled in this study. The preoperative best-corrected visual acuity (logMAR) was 0.31 +/- 0.17 in the simultaneous bilateral cataract surgery group and 0.29 +/- 0.16 in the separate bilateral cataract surgery group, and it improved postoperatively to 0.11 +/- 0.12 in the simultaneous bilateral cataract surgery group and to 0.10 +/- 0.11 in the separate bilateral cataract surgery group. There was no significant difference between the two groups (P = 0.061). In addition, 96.8% of eyes in the simultaneous bilateral cataract surgery group and 97.0% of eyes in the separate bilateral cataract surgery group were within 1.0 diopters of the mean absolute error, and there were no sight-threatening intraoperative or postoperative complications in the two groups. Simultaneous bilateral cataract surgery may be an effective and safe bilateral cataract surgery option with a high degree of patient satisfaction.

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Simultaneous bilateral cataract surgery: Financial differences among nations and jurisdictions

OBJECTIVESThe aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps.METHODSThe medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications.RESULTSData from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45–80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded.CONCLUSIONSUnder the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.

To extend the findings of Li et al. on AH metabolomics in sequential cataract surgery by incorporating reference data on interocular symmetry/asymmetry in AH metabolomic profiles and illustrating variability in sequential cases. We drew on our prior study of simultaneous bilateral cataract surgery in emmetropic patients, which demonstrated high interocular similarity, and examined AH metabolomic variability in 2 patients undergoing sequential cataract surgery. Baseline interocular comparisons highlight metabolic symmetry in the AH among patients undergoing simultaneous cataract surgery. In 2 additional cases, we identified the most and least variable metabolites across 6 biochemical classes among patients undergoing sequential cataract surgery, complementing the observations of Li et al.Conclusion:Our reference data help contextualize Li et al.'s results. Although based on limited cases, our findings emphasize the need for caution when interpreting AH metabolomics in sequential surgery to distinguish true intra- and inter-individual biological variability from potential surgical effects on the second eye. Multimodal approaches integrating metabolomic and vascular metrics may improve biomarker selection and inform surgical timing.

Simultaneous Bilateral Pediatric and Juvenile Cataract Surgery Under General Anesthesia: Outcomes and Safety

The debate on role of ‘simultaneous bilateral cataract surgery’ (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the ‘developing world’ but also in the ‘developed world.’ Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with ‘delayed bilateral cataract surgery’ (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.

Bilateral Same-Day Cataract Surgery: An Idea Whose Time Has Come #COVID-19

BackgroundCataract is the major cause of visual impairment in humans. Phacoemulsification with intraocular lens (IOL) implantation is the standard technique for cataract treatment with a high success rate. In a few cases, the surgical cataract procedure and lens implantation have been applied in non‐human primates.Case DescriptionA +/− 40‐year‐old female chimpanzee (Pan troglodytes) in captivity was diagnosed with mature cataract optical density (OD) and posterior subcapsular cataract combined with cortical opacities OS after ophthalmic examination. To restore vision and facilitate far‐ and near sight, phacoemulsification OU with +22.5 diopter (D) IOL implantation OD and + 24 D OS were performed. Despite complicated surgery OD due to posterior capsular rupture, the outcome was successful during 1‐year follow‐up. The chimpanzee regained adequate vision, normal behavior, and was successfully re‐introduced to her group of chimpanzees.ConclusionThis is the first case report of a simultaneous bilateral cataract surgery with IOL implantations in both eyes, targeting emmetropia OS and near vision OD resulting in monovision, in a chimpanzee. Vision was restored without postoperative complications.

unilateral endophthalmitis after simultaneous bilateral cataract surgery

Purpose: To evaluate the cost and cost‐effectiveness of the simultaneous bilateral cataract surgery compared to sequential bilateral cataract surgery. Methods: Design: Helsinki Simultaneous Bilateral Cataract Surgery Study. Prospective randomized comparative trial.Participants: 520 patients scheduled for bilateral cataract surgery were selected based on strict inclusion criteria to be operated in one session or sequentially one month apart. In both groups every second patient was included in the economic cost analysis.Methods: The costs were evaluated from the societal perspective, taking into account health and non‐health care costs in both groups. The cost of surgery, complications, outpatient visits, medication, travel, patient's and care‐taker's time and possible home nurse visits were evaluated. The cost data was obtained from the participant questionnaires and phone interviews at 3 months, hospital cost data and public statistics. The effectiveness was evaluated based on VF‐7 and 15‐D scores.Main Outcome Measures: The cost of simultaneous vs. sequential bilateral surgery per treated patient. The cost‐ effectiveness of simultaneous bilateral surgery compared to sequential bilateral cataract surgery. Economic sensitivity analysis was carried on all main results. Results: The preliminary results show, that cost per treated patient was lower in the simultaneous bilateral cataract surgery group. The effectiveness was similar in both groups. Conclusions: Simultaneous bilateral cataract surgery is cost‐ effective procedure. If additionally the treatment processes are tailored to simultaneous bilateral surgery, more cost savings can be achieved. The proportion of bilateral cataract patients operated in one session has a substantial effect on the use of health care and non‐health care resources in the society.

Simultaneous Bilateral Cataract Extraction: ECCE versus ICCE

Bilateral cataract surgery in adult and pediatric patients in a single session