Beginning Of Cataract Surgery Research Articles

Systemic effects of intracameral epinephrine during cataract surgery

Aims/Purpose: The objective of this study has been to evaluate the systemic safety that the use of intracameral adrenaline in cataract surgery has on blood pressure and heart rate. This study aims to demonstrate that this procedure is safe for the patient.Methods: A cohort of 777 patients undergoing cataract surgery was studied. Two differentiated groups were prospectively established. Group I with 394 patients included those in whom only mydriatic eye drops were used to achieve adequate operative mydriasis. Group II with 383 patients in whom operative mydriasis was achieved by using the same mydriatic eye drops as in Group I, reinforced by the use of intracameral adrenaline at the beginning of the intervention. The pre‐anaesthetic evaluation was carried out by the anaesthesiology service. Systolic, diastolic and mean blood pressure was monitored non‐invasively at 5‐min intervals from the start of surgery using an automatically inflating cuff. The heart rate was recorded at the beginning of the intervention and every 5 min until the end of the surgery. Oxygen saturation was monitored by digital pulse oximetry.Results: A total of 496 patients presented cardiovascular pathology, being hypertension the most frequent with 417 patients. 65% of the patients with cardiovascular pathology and 54.3% of the hypertense were dilated with intracameral adrenaline, finding no statistically significant differences between being diagnosed with cardiovascular pathology and receiving or not intracameral adrenaline. In all degrees of anaesthetic risk, the number of patients dilated with adrenaline was similar to those dilated with topical mydriatics. There were not significant differences in the variables recorded during surgery between patients treated with intracameral adrenaline and those who were not.Conclusions: We can conclude that intracameral injection of adrenaline at the beginning of cataract surgery did not statistically increase the risk of side effects on blood pressure or heart rate, when compared to the group of patients who only received pre‐operative topical mydriatics. The use of intracameral adrenaline at the start of phacoemulsification does not imply changes in control actions, drug administration or monitoring by the anaesthesia service.

Aqueous Humor Cytokine Response in the Contralateral Eye after First-Eye Cataract Surgery in Patients with Primary Angle-Closure Glaucoma, High Myopia or Type 2 Diabetes Mellitus.

Bilateral sequential cataract surgery within a short period is becoming more prevalent because of the efficiency and safety of modern cataract surgery. It has been reported that the first surgical eye might affect the contralateral eye. This study investigated the cytokines involved in the immunopathogenesis of pre-existing ocular or systemic conditions, as well as the inflammatory biomarkers in response to topical stimuli, by analyzing the cytokine profile of aqueous humor (AH) from cataract patients without these morbidities as control and with type 2 diabetes mellitus (DM), primary angle-closure glaucoma (PACG) or high myopia (HM) in each eye at the beginning of first (defined as baseline) and second eye cataract surgery. Forty patients were recruited in this cohort study (10/group). Bilateral sequential cataract surgeries were conducted at intervals of 12.08 ± 1.2 days. Aqueous humor samples (100-200 μL/eye) were separately collected from 40 first-eyes and 40 second-eyes at the beginning of the cataract surgeries. Twenty-seven selected cytokines were detected with Luminex-multiplex immunoassay. The concentrations of cytokines in the aqueous humor and their association with pre-existing ocular or systemic conditions were analyzed and compared between and within the groups. Before first-eye surgery (baseline), the levels of interleukin (IL)-1ra, IL-13 and tumor necrosis factor (TNF)-alpha were significantly increased in PACG compared with controls. The levels of IL-13 were increased while that of IL-15 were decreased in HM. Compared with controls, 11 cytokines were significantly increased in DM. In the AH of the contralateral eye after first-eye cataract surgery, basic fibroblast growth factor (bFGF) was significantly more abundant in PACG and HM, while the levels of monocyte chemoattractant protein-1 (MCP-1) and interferon gamma-induced protein 10 (IP-10) were decreased in PACG. We also identified 6 significantly upregulated cytokines in DM compared with controls. Compared with baseline, there was an overlap of 5 altered cytokines in the AH of contralateral eyes after first-eye surgery between the four groups. Some were exclusively altered in each subgroup, with 1 in the control group, 4 cytokines in the PACG and HM groups, and none in the DM group. From the initial profile, it is observed that patients with pre-existing ocular or systemic conditions have some degree of inflammation in their eyes before surgery and in the contralateral eye after the first eye cataract surgery, which could be peculiar of the morbid conditions of the patients. Inflammation was more detectable in patients with type 2 DM before surgery. PACG and HM patients showed stronger intraocular inflammatory reactions to topical stimuli compared with controls and DM patients. Our data suggest that ophthalmologists should pay closer attention to inflammatory responses, especially in cataract patients with pre-existing conditions, although the clinical significance of these changes following surgery remains to be further investigated.

Evaluation of intraoperative aphakic eye axial length measurements using swept-source OCT.

To evaluate intraoperative aphakic eye axial length (AL) measurements using swept-source optical coherence tomography (SS-OCT). Hanusch Hospital, Vienna, Austria. Prospective single-center study. Patients scheduled for cataract surgery were measured using SS-OCT (IOLMaster 700, Carl Zeiss Meditec AG) to assess the AL. Intraoperatively (intra-OP), SS-OCT measurements were performed with a prototype device (IOLMaster 700 connected to an OPMI Lumera 700 microscope, CZM) at the beginning of cataract surgery furthermore of the aphakic eye and 2 months after surgery. 106 patients were included. Of the 59 eyes of 59 patients, the phakic median AL preoperatively and intra-OP was 23.61 mm ± 0.96 (standard deviation [SD]) and 23.51 mm ± 0.96 (SD), respectively. The absolute median difference was 0.028 ± 0.02 (SD) (P = .049). Median phakic AL intra-OP vs 2 months postoperatively (post-OP) was 23.51 mm ± 0.97 (SD) vs 23.49 mm ± 0.95 (SD). The absolute median difference was 0.049 ± 0.04 (SD) (P = .000). Median AL intra-OP aphakic vs 2 months post-OP pseudophakic was 23.42 mm ± 0.97 (SD) vs 23.42 mm ± 0.97 (SD), respectively. Absolute median difference was 0.038 ± 0.04 (SD) (P = .379). Intra-OP, SS-OCT technology of the phakic and aphakic eye shows excellent comparability to preoperative and postoperative measurements. This technique allows AL measurements with high precision in cases in which preoperative biometric measurements are not possible.

Pharmacologic interventions for mydriasis in cataract surgery

Pharmacologic interventions for mydriasis in cataract surgery

Retrobulbar hemodynamics and aqueous humor levels of endothelin-1 in exfoliation syndrome and exfoliation glaucoma.

BackgroundEndothelin-1 (ET-1) is the most potent vasoconstrictor in the body. There are reports in the literature correlating plasma levels of ET-1 and its impact on retrobulbar hemodynamics. This study evaluates aqueous humor levels of ET-1 and retrobulbar hemodynamics in patients with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG).Patients and methodsPatients scheduled for cataract surgery were included. Patients were allocated to non-exfoliation non-glaucoma group (controls), XFG and XFS groups. Peak systolic velocity (PSV), end diastolic velocity, and resistivity index of the ophthalmic artery (OA), short posterior ciliary arteries, and central retinal artery (CRA) were determined preoperatively using color Doppler imaging. Aqueous humor samples obtained at the beginning of cataract surgery were analyzed with enzyme-linked immunosorbent assay.ResultsSixty-nine participants of similar age were included (controls: n=24, XFG: n=22, XFS: n=23). Multiple regression analysis showed that ET-1, OA-PSV, OA-resistivity index, CRA-PSV, and CRA-end diastolic velocity were influenced by group but not by sex or age. ET-1 for the XFG group (15.93±2.8 pg/mL) was significantly higher than for the XFS (8.92±2.7 pg/mL) and control (8.44±2.6 pg/mL) groups. The difference in ET-1 titers between the control and XFS groups was not statistically significant. All four hemodynamic parameters affected by group status significantly correlated with ET-1 levels in eyes with XFS. In eyes with XFG, two of the four hemodynamic parameters significantly correlated with ET-1 levels. In control eyes, no correlation between ET-1 and hemodynamic parameters affected by group status was detected.ConclusionET-1 aqueous levels in eyes with XFG were significantly higher than those of age-matched controls. Reduced blood flow and increased vascular resistivity were detected in the OA and the CRA in eyes with XFG/XFS. ET-1 levels in eyes with XFG/XFS exhibit a significant correlation with hemodynamic parameters that indicate reduced perfusion.

Evaluation of oxidative stress in pseudo-exfoliative glaucoma patients treated with and without topical coenzyme Q10 and vitamin E.

To evaluate the levels of oxidative stress markers such as superoxide dismutase and malondialdehyde in eyes with pseudo-exfoliative glaucoma treated with and without topical coenzyme Q10 (CQ10) and vitamin E (Coqun drop). This prospective, randomized clinical study was conducted on 64 eyes of 64 patients. All patients underwent phacoemulsification and intraocular lens implantation surgery. Aqueous humor samples were aspirated from the anterior chamber at the beginning of cataract surgery. The pseudo-exfoliative glaucoma + Coqun group received topical Coqun (100 mg CQ10, 500 mg Vitamin E TPGS) twice daily for 1 month preoperatively, while the pseudo-exfoliative glaucoma group consisted of pseudo-exfoliative glaucoma cases who had not taken Coqun. Pseudo-exfoliation syndrome cases formed the pseudo-exfoliation syndrome group. The main outcomes were the superoxide dismutase and malondialdehyde levels of aqueous humor in both groups. The mean aqueous humor superoxide dismutase level was significantly higher in the pseudo-exfoliative glaucoma group than in pseudo-exfoliative glaucoma + Coqun and pseudo-exfoliation syndrome groups (p < 0.001, p = 0.004, respectively). Also, the mean aqueous humor superoxide dismutase level was significantly lower in the pseudo-exfoliation syndrome group than in pseudo-exfoliative glaucoma + Coqun group (p = 0.009). The mean malondialdehyde levels showed no significant difference between the groups (p > 0.05 for all). Our study showed lower aqueous humor level of superoxide dismutase in pseudo-exfoliation syndrome patients compared to pseudo-exfoliative glaucoma patients. Significantly lower superoxide dismutase level was observed in pseudo-exfoliative glaucoma patients who received topical Coqun compared to pseudo-exfoliative glaucoma patients without Coqun treatment. No significant change was observed on the malondialdehyde level during 1-month follow-up period.

Pharmacologic interventions for mydriasis in cataract surgery

Pharmacologic interventions for mydriasis in cataract surgery

Aqueous humor pentraxin-3 levels in patients with diabetes mellitus.

PurposeTo evaluate aqueous humor (AH) pentraxin-3 (PTX3) levels in diabetic patients with and without diabetic retinopathy (DR).MethodsIn this prospective study, patients undergoing cataract surgery were enrolled. The study group was composed of 26 type-2 diabetic patients without DR (group 1), 32 diabetic patients with DR (group 2) and 29 age-matched subjects without any systemic disease (group 3). Fifteen proliferative DR (PDR) and 17 non-proliferative DR (NPDR) patients were enrolled in Group 2. HbA1c levels and duration of diabetes were noted. AH samples were obtained from anterior chamber at the beginning of cataract surgery and PTX3 levels were analyzed with Elisa kit.ResultsBaseline demographic characteristics were similar between groups. The mean duration of diabetes was 11.9±7.9 years in group 1 and 15.8±7.8 years in group 2 (P=0.11). The mean plasma HbA1c levels in group 1 was 9.1±2.6 and 8.2±2.4 in group 2 (P=0.36). PTX3 levels were 5.75±0.41 in group 1, 6.11±1.47 in group 2 and 4.93±0.84 ng/ml in group 3 (P=0.01). PTX3 levels in group 2 were higher than in group 1 and 3 (P=0.06 and P=0.01, respectively). There was no correlation between HbA1c and PTX3 levels (P=0.06 r=0.57, P=0.19 r=0.3, respectively). The mean PTX3 was 6.6±0.3 in PDR group and 5.6±0.5 ng/ml in NPDR group (P=0.04).ConclusionsPTX3 is an important marker especially for vascular endothelial damage. Since diabetic vascular changes are dependent on endothelial cell damage, high levels of AH PTX3 of DR patients may indicate the importance of PTX3 protein in the pathogenesis of DR.

ASSOCIATION BETWEEN AQUEOUS HUMOR CXC MOTIF CHEMOKINE LIGAND 13 LEVELS AND SUBFOVEAL CHOROIDAL THICKNESS IN NORMAL OLDER SUBJECTS.

To investigate the association of subfoveal choroidal thickness with intraocular inflammatory cytokines and chemokines. The subjects consisted of 76 eyes of consecutive cataract patients at the Japan Community Health Care Organization Tokyo Shinjuku Medical Center between September 2010 and August 2012. In addition, two autopsy eyes from elderly males were used for immunohistochemical study. Subfoveal choroidal thickness was measured using spectral domain optical coherence tomography before cataract surgery. At the beginning of cataract surgery, a sample of undiluted aqueous humor was manually aspirated and the concentrations of the following cytokines were determined using a multiplex cytokine assay: IP-10, MCP-1, MMP-9, IL-6, IL-10, CXCL1, CXCL12, CXCL13, and CCL11. The association of subfoveal choroidal thickness with intraocular cytokine concentration was analyzed. Expression of CXCL13 was examined in autopsy eyes. Among these factors, higher concentration of CXCL13 was associated with thicker choroid. In particular, multiple regression analysis showed that the concentration of CXCL13 was associated with subfoveal choroidal thickness (P = 0.001), independently of axial length (P = 0.049). By immunostaining, CXCL13 was clearly detected in choroidal endothelial cells. Aqueous humor concentration of CXCL13 is correlated with subfoveal choroidal thickness in normal subjects.

Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery

Background/aimsTo compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%,...

Effects of posterior vitreous detachment on aqueous humour levels of VEGF and inflammatory cytokines

PurposeTo investigate the association of posterior vitreous detachment (PVD) with aqueous levels of vascular endothelial growth factor (VEGF) and other inflammatory cytokines.MethodsThese are prospective comparative studies. Subjects comprised 98 eyes...

Anterior capsulotomy with an ultrashort-pulse laser

To assess the precision of laser anterior capsulotomy compared with that of manual continuous curvilinear capsulorhexis (CCC). Asociación Para Evitar La Ceguera en México IAP, Hospital Dr. Luis Sánchez Bulnes, Mexico City, Mexico. Nonrandomized single-center clinical trial. In patients presenting for cataract surgery, the LensAR Laser System was used to create a laser anterior capsulotomy of the surgeon's desired size. Capsule buttons were retrieved and measured and then compared with buttons retrieved from eyes having a manually torn CCC. Deviation from the intended diameter and the regularity of shape were assessed. When removing the capsule buttons at the start of surgery, the surgeon rated the ease of removal on a scale of 1 to 10 (1 = required manual capsulorhexis around the whole diameter; 10 = button free floating or required no manual detachment from remaining capsule during removal). The mean deviation from the intended diameter was 0.16 mm ± 0.17 (SD) for laser anterior capsulotomy and 0.42 ± 0.54 mm for CCC (P=.03). The mean absolute deviation from the intended diameter was 0.20 ± 0.12 mm and 0.49 ± 0.47 mm, respectively (P=.003). The mean of the average squared residuals was 0.01 ± 0.03 and 0.02 ± 0.04, respectively (P=.09). The median rating of the ease of removal was 9 (range 5 to 10). Laser anterior capsulotomy created a more precise capsule opening than CCC, and the buttons created by the laser procedure were easy to remove at the beginning of cataract surgery.

Capsular Tension Ring in the Management of Occult Lens Zonular Dehiscence in Infantile Glaucoma

The authors present a case of bilateral zonular dehiscence in a boy with infantile glaucoma who had developed cataracts. The zonular dehiscence was noted at the beginning of cataract surgery. The cataracts were removed and capsular tension rings and intraocular lenses were safely inserted and remained well centered.

Phospholipase A2 content of aqueous humour in cataract patients

In order to determine the content of group II phospholipase A2 in the aqueous humour we studied 41 cataract patients including 8 men and 33 women with age ranging between 65 and 92 (mean +/- SD being 77.0 +/- 6.7) years. In all patients preoperative biomicroscopy showed neither aqueous flare nor cells. Eleven patients (26.8%) had pseudoexfoliation syndrome. Aqueous humour tap was done at the beginning of cataract surgery before perforating the corneoscleral wound. We used time-resolved fluoroimmunoassay for the detection of group II phospholipase A2 in the aqueous humour. The group II phospholipase A2 content in the aqueous humor varied between less than measurable (in 23 patients) and 3.3 ng/ml, with an interquartile range from less than measurable to 1.4 ng/ml. There was no significant difference in the group II phospholipase A2 content of the aqueous humour whether or not the patient had pseudoexfoliation syndrome. The results show that the aqueous humour of cataract patients contains only minute amounts of group II phospholipase A2.