Bilateral Cataract Surgery Research Articles

Monovision versus multifocality for presbyopia during primary phacoemulsification: systematic review and network meta-analysis.

This systematic review and network meta-analysis (NMA) focuses on comparing monovision and bilateral multifocal lenses (bMFIOL) implantation methods in treating presbyopia, a common age-related condition often seen in post-cataract surgery patients. This review focuses on evaluating the efficacy, user satisfaction and limitations of these two approaches through direct or indirect comparison. A comprehensive search was conducted in Medline, Embase, and Cochrane library, considering studies up to 15 July 2022, with direct or indirect comparisons between any monovision and bMFIOL implantation with bilateral cataract surgery. The study protocol has been published in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022340257). Thirty-two studies (3082 patients) were included in the NMA for the primary outcome, complete post-operative spectacle independence. NMA showed monovision to be inferior to bMFIOLs, as bMFIOL was more likely to provide complete spectacle independence (RR = 2.06, 95% CI = 1.34 to 3.15, p = 0.002) compared to monovision. Monovision resulted in less glare compared to bMFIOL (RR = 0.343, 95% CI = 0.181 to 0.651, p = 0.001). There was no statistically significant difference between monovision and bMFIOL for binocular unadjusted distance visual acuity (MD = 70.01, 95% CI = -19.88 to 4.60, p = 0.437) and binocular unadjusted near visual acuity (MD = 5.46, 95% CI = -5.24 to 10.94, p = 0.191). When compared to monovision, bMFIOL provided greater complete spectacle independence at the expense of greater glare. This study was limited by data heterogeneity, and further studies with standardized reporting would be useful.

Clinical outcomes with a new diffractive multifocal intraocular lens optimized by the dynamic light utilization algorithm.

To evaluate the refractive outcomes, optical performance, and the quality of vision in patients implanted with a new diffractive intraocular lens (IOL), the Intensity Hanita. This observational, prospective, longitudinal study included 64 eyes underwent bilateral cataract surgery with the Intensity IOL (Hanita Israel) implantation. Main outcome measures after 6 months were the following visual acuities (VAs) of uncorrected and corrected distance (UDVA and CDVA), uncorrected and distance corrected intermediate VAs (UIVA and DCIVA), uncorrected and distance corrected near (UNVA and DCNVA), refraction, slitlamp biomicroscopy, defocus curve (DFC),high ocular aberrations (HOA), contrast sensitivity (CS), optical quality, subjective quality of vision (QoV) and near activity visual questionnaires (NAVQ). Sixty-six percent of eyes having UDVA 0.10 logMAR or better. DFC showed maximum vision at distance (0.02 ± 0.07 LogMAR at 0.0 D), with flat decline through intermediate and near vision (0.11 ± 0.08 LogMAR at -1.5 D and 0.12 ± 0.12 at -2.5 D). No significant changes in CS were found (all spatial frequencies, p ≥ 0.06). The RMS of HOA, coma, trefoil, and SA were 0.21 ± 0.10, 0.10 ± 0.06, 0.11 ± 0.07, and 0.00 ± 0.04 μm and the Strehl ratio was 0.12 ± .04 at 6 months. Subjective symptoms (halos and glare) were reported mild but well tolerated, not causing significant disturbance in daily activities. The NAVQ showed high levels of satisfaction performing daily near-vision tasks. The Hanita Intensity diffractive IOL successfully restores all distances of vision. The flat profile of the monocular defocus curve confirms the five-foci distribution principle that provides vision at all ranges while increasing the depth of focus.

Reading Performance Following Contralateral Implantation of an Extended Depth of Focus (EDOF) IOL and a Hybrid EDOF Multifocal IOL.

To assess objective reading performance at intermediate and near distances using the Salzberg Reading Desk (SRD) (SRD Vision) in patients with cataract who underwent the implantation of a diffractive extended depth of focus intraocular lens (EDOF IOL) in the dominant eye and a hybrid multifocal EDOF IOL in the non-dominant eye. This prospective, non-comparative, interventional study included 46 eyes of 23 patients with cataract who underwent bilateral cataract surgery with implantation of the DFR00V Tecnis Synergy IOL (Johnson & Johnson Surgical Vision) in the non-dominant eye and the DXR00V Tecnis Symfony OptiBlue IOL (Johnson & Johnson Surgical Vision) in the dominant eye. At postoperative 6 months, the Salzburg Reading Desk was used to assess distance-corrected reading performance at near and intermediate distances. Although the monocular reading acuity at the preferred intermediate distance was statistically significantly better in the eyes implanted with the DXR00V IOL, it was better with the DFR00V IOL at preferred near distances. The mean binocular distance-corrected preferred intermediate and near reading acuity was 0.07 ± 0.09 (20/23) and 0.13 ± 0.09 (20/27) logarithm of the minimum angle of resolution, respectively. Other parameters of reading performance, such as reading speed, reading distance, reading time, and smallest scale log print size, were similar between the two IOL groups when assessed monocularly. Implanting a DFR00V IOL in the non-dominant eye and a diffractive DXR00V IOL in the dominant eye resulted in excellent binocular reading acuity and speed at intermediate and near distances. [J Refract Surg. 2024;40(11):e778-e782.].

Visual and Surgical Outcomes of Outreach Cataract Surgeries in Ilam District of Nepal: An Observational Study

Introduction: Cataracts are the leading cause of preventable blindness worldwide. Although cataract blindness is reversible, its service coverage remains poor, particularly in rural and hilly areas of Nepal. The study aimed to evaluate visual outcomes of outreach cataract surgeries and associated intraoperative and post-operative complications. Methods: This cross-sectional study was conducted at a district of Eastern Nepal after ethical clearance was taken from the Institutional Review Committee (Reference number: 88). Total 131 subjects had cataract surgeries at the surgical camp, and their pre-operative, one-day and one-month post-operative visual acuities were compared, and intraoperative and post-operative surgical complications were recorded. Visual acuity ≥ 6/12 was considered normal. Data was collected in excel and analyzed in SPSS. Results: The mean age of participants was 71.8±9.51 years, with 70 (53.43%) male. A total of 156 eyes from 131 subjects underwent cataract surgeries and among them 25 (19.08%) cases underwent bilateral cataract surgeries. At the day one of surgery, visual acuity improved to normal in 137 (87.82%) of cases, while after one-month, visual acuity improved to normal in 150 (96.15%) of cases with best-corrected glasses. There were 4 (2.56%) intraoperative complications, which included surgery-induced subluxated bag, premature entry, iris trauma, and posterior capsule rent. Conclusions: The visual and surgical outcomes of cataract surgeries performed at an outreach surgical camp were excellent with minimal surgical complications.

Changes and Influencing Factors of Corneal Endothelial Cells and Central Corneal Thickness after Pediatric Cataract Surgery.

This study aimed to examine the impact of cataract surgery on the corneal endothelium and central corneal thickness (CCT) in pediatric patients, and to identify the factors associated with corneal alterations. This retrospective study included consecutive children undergoing bilateral or unilateral cataract surgery and intraocular lens (IOL) implantation at the Eye Hospital of Wenzhou Medical University, with or without posterior capsulorhexis and anterior vitrectomy, and an age-matched normal control group. This study aimed to assess whether changes in corneal parameters, including CCT, corneal endothelial cell density (CD), average cell area (AVE), standard deviation of size (SD), coefficient of variation (CV), percentage of hexagonal cells (6A) before and after surgery, and endothelial cell loss (ECL) differed among the bilateral cataract, unilateral cataract, and control groups. Furthermore, the potential effects of anterior vitrectomy, axial length (AL), preoperative anterior chamber depth (ACD), surgical duration, horizontal corneal diameter (HCD), intraoperative pupil diameter (PD), and the number of corneal sutures on corneal endothelial parameters and CCT were investigated. A total of 107 eyes from 107 children were included in the study. In the bilateral cataract group, CD significantly decreased, AVE and CCT significantly increased, and ECL was significantly higher than in the control group. The unilateral cataract group also exhibited a significant increase in CCT. Additionally, the numberofcornealsutures was negatively correlated with CD, and PD was negatively correlated with CV in the unilateral cataract group. Cataract surgery in pediatric patients results in increased CCT, reduced CD, and morphological changes in corneal cells. A greater number of corneal sutures and a smaller PD increased the risk of CD reduction and elevated CV in the unilateral cataract group, underscoring the need for ophthalmologists to minimize corneal damage in these children.

Prospective Evaluation of Clinical and Patient-Reported Outcomes Following Contralateral Implantation of an Extended Depth of Focus (EDOF) and Hybrid EDOF-Multifocal IOL.

To evaluate clinical outcomes following contralateral implantation of a diffractive extended depth of focus (EDOF) and a hybrid EDOF-multifocal intraocular lens (IOL) with a violet filter in a U.S.-based population. In this prospective, non-comparative study, 60 eyes of 30 patients aged 40 years and older underwent bilateral cataract surgery and implantation of a DXR00V IOL (Tecnis Symfony OptiBlue) in the dominant eye and a DFR00V (Tecnis Synergy) IOL in the non-dominant eye. Outcome measures included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, distance-corrected intermediate (DCIVA, 66 cm), near and very near visual acuity (DCNVA, 40 and 33 cm), and patient-reported outcomes. At 6 months postoperatively, binocular mean UDVA and CDVA were -0.10 ± 0.07 and -0.11 ± 0.05 logarithm of the minimum angle of resolution (logMAR), respectively. The mean DCIVA was 0.26 ± 0.08 logMAR in the DXR00V eyes and 0.23 ± 0.06 logMAR in the DFR00V eyes. The mean DCNVA at 40 and 33 cm were 0.28 ± 0.12 and 0.30 ± 0.15 logMAR, respectively, in the DXR00V eyes and 0.07 ± 0.08 and 0.07 ± 0.10 logMAR, respectively, in the DFR00V eyes. The mean binocular DCIVA and DCNVA at 33 and 40 cm were 0.18 ± 0.05, 0.06 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. The percentages of patients achieving spectacle independence at far, intermediate, and near distances were 100%, 100%, and 81%, respectively. Contralateral implantation of the diffractive EDOF and a hybrid EDOF-multifocal IOL yielded excellent binocular visual acuity at all distances, as well as high patient satisfaction and functional performance on visual tasks. [J Refract Surg. 2024;40(10):e699-e705.].

Ten-year trends of delayed sequential bilateral cataract surgery (DSBCS) in Sweden: a register-based study.

To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3months. The median time between the surgeries was 61days (interquartile range 26-161days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient's visual function into account.

Evaluation of Intermediate Visual Outcomes in Eyes Implanted with Bilateral Advanced Monofocal Intraocular Lens Targeting for Mini-Monovision and Its Association with Age and Corneal Asphericity.

To assess the visualoutcomes in patients bilaterally implanted with novel Clareon® intraocular lens when targeting mini monovision post-operatively. The study was conducted at Laxmi Eye Institute; itis a tertiary care eye institution in Panvel, India. This is an investigator initiated, prospective, single-centre longitudinal study of 45 patients to assess the visual outcomes in patients who were implanted with Clareon ® IOL bilaterally. Patients with corneal astigmatism of ≤0.75 D who underwent bilateral cataract surgery with pseudophakic mini-monovision and implanted with novel Clareon® intraocular lens were included. Patients having post op manifest refraction >±0.25 D in the dominant eye and <-0.5 D or >-0.75 D in the non-dominant eye were excluded. The main study outcomes were assessed at 1 and 3 months; itincluded uncorrected visual acuities assessment, defocus curve, and patient reported spectacle use. The mean (SD) binocular distance corrected intermediate visual acuity at 3 months was 0.22 (0.09) LogMAR. At 3 months, 54% of patients enjoyed 0.4 LogMAR or better BUCNVA. The defocus curve showed good distance and intermediate visual acuity with >0.2 LogMAR vision from +0.50 D to -1.50 D. We found a positive correlation between the Q value of the dominant eye and the BCIVA at 3 months postoperatively, however it was not statistically significant. The Q value was more negative when the intermediate vision was closer to 0 LogMAR. Post operatively, at3 months,95% patients did not need glasses for distance and intermediate vision and 73% of patients were comfortable for intermediate vision without glasses all the time. Mini-monovision with Clareon® monofocal IOL implantation can offer overall satisfactory vision for far and intermediate distances with minimal need for use of spectacles for near vision.

Comparing clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis for myopia

BackgroundTo compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK).MethodsA retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence.ResultsA total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night.ConclusionsCataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients’ satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups.

Clinical Outcomes after Implantation of a Novel Binocular Complementary Extended Depth-of-Focus Intraocular Lens Compared to Bilateral Low Near-Add Multifocal Intraocular Lenses

Introduction: Nowadays, patients expect to be less spectacle dependent at all distances after cataract surgery. However, all intraocular lens (IOL) models that currently offer this function can also have negative visual effects. Aim of this study was therefore to compare the visual function performance of a novel and a conventional IOL solution for multifocality. Methods: Patients scheduled for bilateral cataract surgery were randomized to receive one of two different IOL combinations: either a binocular complementary extended depth-of-focus IOL set or a low near-add MIOL. Patients had visual acuity (VA) assessment at distance, intermediate, and near as well as evaluation of contrast sensitivity, halometry, and reading performance. Results: In total, 56 eyes of 28 patients were enrolled. At 6 months, there were no statistically significant differences in binocular VA between the ARTIS SYMBIOSE and the AT LARA. Contrast sensitivity, measured binocularly, at 1.5 cycles per degree under photopic conditions without glare was 1.54 logCS with the ARTIS SYMBIOSE and 1.43 logCS with the AT LARA (p = 0.046), under mesopic conditions with glare at 1.5 and 3 cycles per degree 1.31 logCS and 1.28 logCS with the ARTIS SYMBIOSE, respectively, compared to 0.58 logCS and 0.51 logCS with the AT LARA (p = 0.002; p = 0.006). Binocular halos and reading performance between both groups were similar. Conclusion: There were no significant differences between both groups in VA at different distances, reading ability, or halometry. The contrast sensitivity at low spatial frequencies was better in the ARTIS SYMBIOSE group under photopic conditions without glare as well as mesopic conditions with glare, which could potentially improve quality of vision with these IOLs, especially under mesopic conditions.

Bilateral cataract surgery in children: immediate sequential versus delayed sequential surgery

PurposeTo compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS). MethodsThe medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery. ResultsA total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001). ConclusionsISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.

Scleral imbrication with vitreoretinal surgery as a primary procedure for retinal detachment in pathological myopia.

A 45-year-old male presented with diminution of vision in the right eye (RE) for the past 2 weeks. He underwent sequential bilateral cataract surgery 25 years ago, with an intraocular lens in RE, which was his better eye. The left eye was aphakic with a thick fibrous membrane at the pupillary plane. Visual acuity was hand movement in the RE with the iris claw lens and total bullous retinal detachment (RD). The axial length with RD was 28.6 mm in RE and 29 mm in the left eye (LE). We did a vitrectomy with scleral imbrication, endolaser, fluid gas exchange, and tamponade in the RE. The LE developed RD subsequently, and he underwent similar surgical procedures in his LE. The best corrected visual acuity in his RE was 20/80, and that in the LE was 20/120 on follow-up. RD with staphyloma is a surgical challenge as the thin atrophic retina at the posterior pole fails to conform to the concavity of staphyloma. Vitrectomy with tamponade alone does not take care of staphyloma and has more chances of recurrent detachment or persistent fluid at the posterior pole. Scleral imbrication shallows the staphyloma cavity and shortens the axial length, thereby giving a good surgical outcome.

Hypoparathyroidism: A dark horse differential in young age cataracts

In India, cataracts account for the lion’s share of cases of blindness. Age is still the single most important risk factor for cataracts. Cataracts in the young adult age group are less common and are usually secondary to various local and systemic conditions. The aetiology may be a challenging one to ascertain in certain cases of young-age cataracts. A rapidly developing cataract in a young age individual may further add to the diagnostic dilemma especially when the patient presents with multi-system affection necessitating the widening of the horizons of suspected local and systemic pathologies at play. Therefore, we report a case of a 25-year-old lady who presented with a history of seizures, headache, disc oedema and progressive bilateral blurring of vision due to rapidly developing cataracts over 4 months in a case of primary hypoparathyroidism. Correction of the underlying abnormalities resulted in the resolution of disc oedema and headache. Furthermore, the patient had no episodes of seizures in the 1½ years of follow-up. In addition, full visual recovery was achieved after bilateral cataract surgery. Awareness of this rare presentation can help in the early diagnosis and evaluation of cataracts, besides correction of the systemic pathologies for an overall better patient outcome.

Immediate sequential bilateral cataract surgery: Prevalence, attitudes and concerns Among Italian ophthalmologists.

to investigate the existing practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in Italy and to assess ophthalmologists' attitudes towards performing ISBCS in the future for cataract treatment. It is a multicenter cross-sectional study. From February,1st 2023 to March, 1st 2023 the Members of the Italian Society of Cataract and Refractive Surgery (AICCER) as well as the attendees of its annual national congress were invited to anonymously complete an electronic 7-item questionnaire on their current ICBCS practice. Questions included the average number of procedures per month, the main indications for ICBCS, and the main reasons for performing and not performing ISBCS. Data were analyzed using descriptive statistics. of the 2300 recipients, 246 (10.7%) completed the survey. Of the respondents, 156 (63.4%) replied to perform ISBCS, most of them (82%) occasionally (1 to 5 procedures per month). Fifty-three percent (130 ophthalmologists) considered adopting ISBCS as routine practice in the near future. The conditions most considered for ISBCS were age-related cataract surgery under general and topical anesthesia and congenital cataract surgery. The availability of separate instruments for the two eyes as well as patient and hospital advantages were the most important reasons for performing ISBCS. The risk of bilateral endophthalmitis and medicolegal issues were the main reasons for not performing ISBCS. ISBCS remains controversial among Italian surgeons, despite growing evidence of its safety and efficacy. The risk of potentially blinding complications such as bilateral endophthalmitis, together with medicolegal concerns are the principal barriers to ISBCS implementation in routine practice.

Combination of a monofocal and one type of extended depth-of-focus (zonal refractive) intraocular lens (COMEDI) in bilateral cataract surgery protocol: a monocentric, randomised, parallel group trial in cataract surgery

IntroductionModern intraocular lens (IOL) designs for cataract treatment can be broadly classified into three focal range categories; monofocal, extended depth-of-focus (EDOF) and multifocal IOLs.Monofocal IOLs allow spectacle independence for one...

A survey exploring ophthalmologists' attitudes and beliefs in performing immediate sequential bilateral cataract surgery in Singapore.

To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care. An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed. Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico-legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%). This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore.

Clinical and Patient Reported Outcomes of an Optimized Trifocal Intraocular Lens.

Background/Objectives: To evaluate the clinical and patient-reported outcomes (PROMs) obtained with an optimized version of a previously investigated trifocal IOL. Methods: Prospective non-comparative single-center study enrolling 29 patients (55-71 years) undergoing bilateral cataract surgery with implantation of the trifocal diffractive IOL Liberty 677CMY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). Visual and refractive outcomes as well as PROMs were evaluated during a 3-month follow-up: measurement of uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, DCIVA) and near visual acuities (UNVA, DCNVA), defocus curve, patient satisfaction, photic phenomena perception, spectacle independence, and difficulty in performing some vision-related activities. Results: A total of 100%, 92%, and 80% of patients achieved a postoperative binocular UDVA, UIVA, and UNVA of 20/25 or better, respectively. Likewise, 100%, 80%, and 84% of patients achieved a postoperative binocular CDVA, DCIVA, and DCNVA of 20/25 or better, respectively. In the defocus curve, all mean visual acuity values were better than 0.15 logMAR for all defocus levels. A total of 95.8%, 95.8%, and 91.7% of patients referred to be satisfied with their distance, intermediate, and near visual vision, respectively. Mean overall Catquest Rasch calibrated score was -3.12 ± 0.98. Most of the patients were spectacle independent: far (95.8%), intermediate (95.8%) or near vision (91.7%). No bothersome or minimal to moderately bothersome halo, starburst, and glare was perceived by 83.3%, 83.4%, and 83.3% of patients, respectively. Conclusions: The trifocal IOL evaluated provides a visual acuity improvement, with high levels of spectacle independence, patient satisfaction, and perceived visual quality associated.

Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust.

Immediate sequential bilateral cataract surgery (ISBCS) was first introduced into NICE guidelines in 2017. In this approach, patients undergo cataract surgery on both eyes on the same day. Although increasingly popular, only 0.5% of all cataract operations nationally are performed using this approach. We redesigned our service to routinely offer ISBCS and are now one of the leading NHS providers of ISBCS in the UK. We audited our cataract operations in 2022 and report our initial experiences with ISBCS here. We redesigned our cataract service to routinely offer ISBCS on the NHS. We audited all cataract operations performed in calendar year 2022. We performed 4652 NHS cataract operations including 498 (10.7%) operations on 249 patients using the ISBCS approach. Trainee surgeons performed 32.5% of these cases. There were two intraoperative complications, both during the second eye operation. One was a suspected suprachoroidal haemorrhage and the other was a posterior capsular rupture post lens implantation. Post-operatively there was one case of retinal detachment requiring vitrectomy following uncomplicated ISBCS and five cases of Irvine-Gass syndrome that were managed medically. From this data, ISBCS does not pose a greater risk to patients in terms of complications. Allowing trainees to operate on ISBCS cases improves the trainee experience. With appropriate pre-operative counselling, patients listed for unilateral surgery can be converted to ISBCS on the day of operation to fully utilise theatre capacity. Patients listed for ISBCS can also be converted to unilateral surgery on the day of operation when surgeons need time to deal with complications safely.

Bilateral spontaneous Descemet membrane detachment after uneventful immediate sequential bilateral cataract surgery

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a practice on the rise. To the authors' knowledge, this is the first reported case of bilateral Descemet membrane detachment (DMD) after uneventful same-day ISBCS, with emphasis on diagnosis and management. Patient and Clinical Findings: The case of a 66-year-old diabetic woman with chronic obstructive pulmonary disease and obstructive sleep apnea on home oxygen who developed spontaneous bilateral DMD after uneventful ISBCS for visually significant cataracts is presented. Although spontaneous DMD after uneventful phacoemulsification has been reported before, it has not been reported after same-day ISBCS to the authors' knowledge. The success rates with air pneumatic descemetopexy are excellent, with ranges between 90% and 95%. In this case, surgical intervention with gas injection in the anterior chamber and surgical peripheral iridotomies resulted in excellent visual acuity restoration in the patient. Diagnosis, Intervention, and Outcomes: Patient underwent same-day ISBCS under local anesthesia by different surgeons in either eye. Standard phacoemulsification techniques were used, and no intraoperative complications were noted. The patient returned with bilateral counting fingers vision 4 weeks postoperatively and reported her vision never improved after her cataract extraction. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of bilateral DMDs. Because of the patient's severely impaired vision, bilateral air descemetopexies were performed with clinical resolution of the DMD and excellent restoration of vision in both eyes. Conclusions: Sufficient evidence supports that performing ISBCS using internationally agreed protocols minimizes the risk of experiencing bilateral complications to a negligible level when compared with staged surgery. However, with ISBCS being on the rise, spontaneous bilateral DMDs may also be seen increasingly in those eyes with no underlying commonly recognized risk factors for spontaneous DMD. With unilateral DMD, watch and wait is a viable option. However, in bilateral DMD cases, earlier air or gas descemetopexy may be preferable to increase the likelihood of success and reduce the patient's period of decreased vision.

Where We Are Now: A Survey Exploring Colombian Ophthalmic Surgeons\' Attitudes on Performing Immediate Sequential Bilateral Cataract Surgery

Where We Are Now: A Survey Exploring Colombian Ophthalmic Surgeons\' Attitudes on Performing Immediate Sequential Bilateral Cataract Surgery