Bilateral Cataract Surgery Research Articles

Impact of Delayed Sequential Bilateral Cataract Surgery on Diabetic Macular Edema: A Real-World Study in Northwestern China.

To assess the incidence and characteristics of treatment-requiring diabetic macular edema (TR-DME) in eyes after delayed sequential bilateral cataract surgery in patients with diabetes mellitus. This was a retrospective study involving patients with diabetes who underwent cataract surgery at Shaanxi Eye Hospital between January 2019 and December 2021. The incidence and characteristics of a first episode of TR-DME after delayed sequential bilateral cataract surgery were observed. A total of 1553 individuals (3106 eyes) were included in the study. All patients underwent bilateral cataract surgery with the prescribed interval of surgery within one month. The incidence of TR-DME was 0.52% in the year before surgery versus 1.87% in the year after surgery (p < 0.05). The highest risk period was between 2 and 4 months after surgery. A first episode of TR-DME was observed in 58 eyes of 35 patients after delayed sequential bilateral cataract surgery. The patients were divided into four groups according to the interval between bilateral cataract surgeries. A higher incidence of TR-DME was observed when the interval between the surgeries was less than two weeks. This is the first real-world study of the effects of cataract surgery on the development of TR-DME. The study was performed at the largest ophthalmic center in Northwestern China. The findings demonstrate that the incidence of TR-DME increased significantly after cataract surgery, with the highest incidence between two and four months after surgery. Patients with shorter intervals between bilateral cataract surgeries were at a high risk.

Vitamin A deficiency with nyctalopia after bilateral cataract surgery with multifocal intraocular lenses

Introduction: The purpose of this case study was to report an unusual case of vitamin A deficiency (VAD) with nyctalopia that was diagnosed after bilateral cataract surgery with multifocal intraocular lenses (IOLs). Patient and Clinical Findings: After cataract surgery with multifocal IOLs, a 66-year-old man developed progressive intolerable night vision symptoms, requesting IOL exchange. Diagnosis, Intervention, and Outcomes: Only careful history and investigation revealed the cause to be VAD secondary to celiac disease, rather than lens-related. The patient was commenced on parenteral vitamin A resulting in a complete resolution of nyctalopia. Conclusions: To our knowledge, this is the only reported case of VAD diagnosed in this context. We reflect on the importance of thorough history taking, particularly in patients referred for cataract surgery by their optometrist, where the provided medical history may be incomplete.

Effect of Lipiflow (Thermal Pulsation) on Ocular Surface Disease Management After Cataract Surgery.

The aim of the current study was to investigate the efficacy of Thermal pulsation treatment, completed one month prior to cataract surgery, as a means of eliminating or significantly mitigating the exacerbating effects of cataract surgery on dry eye patients. Glendale, Arizona. Prospective, longitudinal, non-masked, randomized clinical investigation. The treatment group received Thermal pulsation therapy approximately 1 month prior to undergoing immediate sequential, same-day bilateral cataract surgery. The control group did not receive pre-operative Thermal pulsation but had cataract surgery performed in the same way, approximately 1 month after their baseline visit. Subjective questionnaires and objective clinical findings were evaluated at baseline, 1, 3, and 6 months after cataract surgery in the treatment group and control group. A total of 62 patients were randomized into two groups of 31 representing 124 eyes. Subjective improvement was observed in the treatment group with OSDI and SPEED II scores. Mean (SD) of the OSDI improved significantly (p<0.01) from 56.98 (18.30) from visit 1 to 14.73 (12.22) at visit 4, and the mean (SD) of the SPEED II scores improved significantly (p=0.01) from 13.84 (6.12) during visit 1 to 7.1 (5.00) at visit 4 in the treatment group. Pre-operative Thermal pulsation treatment in patients with dry eye secondary to MGD appears to reduce dry eye symptoms after cataract surgery. Expectations should be moderated by the fact that the reduction in symptoms appears to reduce prior to 3 months post-op after cataract surgery.

Wybrane aspekty chirurgii zaćmy wieku dziecięcego

The authors present a selected practical problems in pediatric cataract surgery (simultaneous bilateral cataract surgery in congenital cataract, anterior and posterior capsular bag treatment, laser capsulotomy, intraocular lens calculation).

Predictors of Glaucoma After Pediatric Cataract Surgery.

Glaucoma after pediatric cataract surgery is common and challenging. Age at surgery and the presence of microcornea or other anterior segment (AS) abnormalities can be used to identify those at greatest risk. To establish risk factors for developing glaucoma after pediatric cataract surgery [glaucoma following cataract surgery (GFCS)]. Single-center, retrospective, longitudinal study of patients who underwent lensectomy for pediatric cataracts from 2008 to 2020. Included eyes presented with congenital or acquired pediatric cataracts or an anterior form of persistent fetal vasculature, and a follow-up of at least 1 year. Exclusion criteria were the presence of preexisting intraocular pressure elevation, congenital glaucoma, syndromic cataracts, and a history of trauma or uveitis. Demographic and clinical data were collected. Our primary outcome was the development of GFCS. Multivariable logistic regression with generalized estimating equations was used to model the association between potential predictors and the risk of GFCS. A total of 110 eyes from 74 patients were included, 38 with unilateral and 36 with bilateral pediatric cataract surgery. The average surgery age was 24.71 ± 37.26 months, with 74 eyes (67.3%) undergoing surgery ≤12 weeks of age. Patients were followed for 9.96 ± 3.64 years after surgery. Twenty-eight eyes (25.45%) developed GFCS, all requiring glaucoma surgery. In multivariable analysis, surgery before 12 weeks of age [odds ratio (OR): 34.74; P < 0.001], presence of microcornea (OR: 12.90; P = 0.002), and presence of other AS abnormalities (OR: 52.71; P < 0.001) were significantly associated with the development of GFCS. The development of GFCS is a common and relevant adverse event after pediatric cataract surgery whose management is challenging. Age at surgery, the presence of microcornea, and the presence of other AS abnormalities can be used to identify those at greatest risk.

Clinical Results and Factors Affecting Visual Function in Eyes Implanted with an Enhanced Monofocal Intraocular Lens.

To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the distance, intermediate, and near vision. Patients were included who underwent bilateral consecutive cataract surgeries using the same IOLs with follow-up to 1 month postoperatively. Refractions, monocular UDVA and CDVA, and binocular distance-corrected functional visual acuity at 5 meters (BDCFVA), at 66 centimeters (BDCIFVA) and at 40 centimeters (DCNVA) were assessed. Multiple regression analysis was used to assess the factors affecting binocular BDCFVA, BDCIFVA, and BDCNFVA. Subjective symptoms were assessed using the Near Activity Visual Questionnaire (NAVQ) and visual analogue scale (VAS). Sixty patients (120 eyes) implanted with the Tecnis Eyhance IOL (30 patients, 60 eyes) or the Tecnis monofocal IOL (30 patients, 60 eyes) were included. The Tecnis Eyhance IOL provided significantly better binocular BDCIFVA than the Tecnis monofocal IOL in patients under 70 years of age. Multiple regression analysis showed that age was the only factor affecting distance and intermediate visual function in eyes with the Tecnis Eyhance IOL; gender, pupillary diameter, axial length, and average keratometry were not significant. There were no significant differences in subjective symptoms. The comprehensive cohort analysis did not confirm the advantage on the intermediate vision of the Tecnis Eyhance IOL. Younger age may be an important factor to benefit from the unique optical characteristics of this IOL.

Cytokines in aqueous humor of patients with congenital cataract during delayed sequential bilateral cataract surgery

BackgroundTo explore the changes of cytokines expression in aqueous humor (AH) of eyes of patients with congenital cataract (CC) who underwent delayed sequential bilateral cataract surgery (DSBCS).Methods28 patients with CC underwent DSBCS. AH samples were collected from each eye before surgery. The contents of cytokines in AH were detected by Luminex xMAP Technology.ResultsThere was no significant difference in the expression of IL-8, IP-10, MCP-1 and PDGFAA in the AH of the first and second eyes (P = 0.35, 0.39, 0.17, respectively). The level of IL-8 in the first-eye AH was negatively correlated with age (ρ=– 0.519, P = 0.008). IP-10 and MCP-1 in the second-eye AH were negatively correlated with age (ρ=– 0.483, P = 0.009; ρ=– 0.445, P = 0.018,respectively).ConclusionThe first-eye surgery in patients with CC may not cause the change of cytokines in the contralateral eye. The expression of IL-8, IP-10 and MCP-1 in the AH was negatively correlated with the age of patients.Trial registrationThe study was registered at www.chictr.org.cn on March 22, 2022 and the clinical trial number is ChiCTR2200057927.

The Clinical Outcomes of Manual Continuous Curvilinear Capsulorhexis and Precision Pulse Capsulotomy

Purpose: To compare the safety and consistency of manual capsulorhexis and precision pulse capsulotomy performed using pulsed energy during bilateral cataract surgery and to explore the differences in clinical outcomes.Methods: A total of 101 patients with bilateral cataracts were selected. Precision pulse capsulotomy was performed on one eye and manual continuous curvilinear capsulorhexis on the other. The independent-samples t-test was used to compare the duration of continuous curvilinear capsulorhexis, incisional size and roundness, complications such as radial tears, the cumulative dissipated energy, the visual acuity after surgery, and the corneal epithelial cell count.Results: There was no significant difference in the capsulorhexis time between the pulse energy and manual groups. The extent of capsulorhexis was significantly smaller and the circularity of capsulorhexis was higher in the former group. Complications occurred in two manual capsulorhexis patients but in no pulse energy capsulotomy patient. There was no significant between- group difference in any of postoperative visual acuity, best-corrected visual acuity, or the corneal endothelial cell count.Conclusions: During bilateral cataract surgery on the same patients, precision capsulotomy using pulse energy afforded smaller and more circular capsulorhexis and fewer complications than did manual capsulorhexis. However, there was no significant between- group difference in the postoperative clinical outcomes.

Patient’s Perception Regarding Vision Related Quality of Life in Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Cataract is the main cause of visual impairment and treatable blindness in the world and surgery can restore normal sight to the patients. In bilateral cataract patient, surgery in the second eye is as important and meaningful as surgery in the first eye and it can be performed by immediate sequential (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS). There is no statistically significant difference in surgical complications, visual acuity or long term self-perceived visual function between these two methods. To adopt surgical procedure, to improve the patient’s satisfaction and to improve the quality of services, patient opinion should be a great concern. This evaluative study was done to find out various recommendations and suggestions from patients regarding merits &amp; demerits of both types of cataract surgery that will be helpful for the decision-maker and administrator for future practice of cataract surgery in Canada. In this study, vision related quality of life improved in both groups. Participants in DSBCS group experienced different types of difficulties during the gap period between first eye and second eye cataract surgery i.e. visual imbalance between the two eyes and difficulty in driving. They recommended and suggested that cataract surgery wait time should be reduced and the difficulties experienced during the gap period can be eliminated by adopting ISBCS procedure. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 07-13

Immediate sequential vs. delayed sequential bilateral cataract surgery: a systematic review and meta-analysis.

The main aim of this Systematic Review and Meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared to delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were post-operative visual acuity, post-operative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema and posterior capsule rupture. Thirteen articles met criteria for final inclusion. A total of 11,068,622 participants (18,802,043 eyes) were included. No statistically significant differences between ISBCS or DSBCS was identified in all the postoperative outcomes evaluated. However, a higher risk for posterior capsule rupture was identified in the ISBCS group from the pooled analysis of NRSs (RR: 1.34, 95% CI: 1.08 - 1.67, p = 0.0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable to DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.

Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial

PurposeTo evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt and axial stability of a 11.0mm plate haptic intraocular lens (IOL) DesignIntraindividual, randomized, double masked, controlled, clinical trial. ParticipantsPatients scheduled for sequential same day bilateral cataract surgery. MethodsAll patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. IOL axis assessment was performed at the end of surgery (EOS), 1 hour (1h), 1 week (1w), 1 month (1m) and 6 months (6m) using a high precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed preoperatively, at 1w and 6m using an anterior segment OCT (AS-OCT). Main outcome measuresRotational stability from EOS to 6m and at all follow up visits. Decentration and tilt at 6m. Differences in axial shift between 1w and 6m. ResultsOne hundred and thirty eyes of 65 patients were included in the study. Absolute rotation from EOS to 6m was 2.8°±3.9° and 3.2°±5.3° for the CTR and control groups, respectively (p=0.613). IOL decentration and IOL tilt at 6m were 0.29±0.1mm and 0.24±0.1mm and 6.7°±2.8° and 5.6°±1.6° for the CTR and control groups, respectively (p=0.058, p<0.01). A posterior IOL shift of 0.31±0.31 mm and 0.19±0.14 mm was observed in the CTR and control groups, respectively. ConclusionsConcomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared to the control group. A negative effect of the CTR on decentration, tilt and axial stability was observed. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution.

Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery

PurposeThe impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. MethodWe studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. ResultsBefore the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). ConclusionAt the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

A quality analysis of internet patient information for immediate, sequential, bilateral cataract surgery (ISBCS).

Due to surgical capacity pressures, induced by the COVID-19 pandemic, immediate bilateral simultaneous cataract surgery (ISBCS) has been utilised increasingly throughout the U.K. This surgical method comes with both novel risks and benefits, so the consent process must be modified. Prior randomised trials have demonstrated that appropriate online information may act as an adjunct to the surgical consent process. This study aims to assess the quality of available internet information for ISBCS. Terms searched were 'bilateral cataract surgery patient information', 'double cataract surgery patient information', and 'immediate sequential bilateral cataract surgery patient information'. The Google search engine was used. The DISCERN instrument and JAMA benchmarks were used to assess healthcare information for quality. The Flesch Reading Ease Score (FRE), Flesch Kincaid Grade (FKG) Level and Gunning Fog Score (GFS) were used to assess for readability. HONcode certification was used to assess transparency and quality. Forty-six websites were found. The average DISCERN score was 41.3, meaning a "fair" quality which is below what many patients would anticipate discovering when trying to find information. National Healthcare Service websites had higher DISCERN scores than private healthcare-provided websites (p < 0.01; 95% CI: 1.13-1.88.). Fair patient information for ISBCS has been demonstrated. Specific internet information sources with appropriate information should be further developed, with cited sources, and patients signposted to them if felt appropriate.

Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope.

To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. 4 tertiary institutions in Korea. Prospective, randomized, paired-eye, controlled pilot study. 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.

Improvement of positive dysphotopsia with multifocal intraocular lenses by hormone replacement therapy

Introduction: The case of a patient with positive dysphotopsia (PD) affected by hormone replacement therapy (HRT) after multifocal intraocular lens (IOL) insertion is reported. Patient and Clinical Findings: A 66-year-old woman underwent bilateral cataract surgery and multifocal IOL implantation. Postoperatively, the uncorrected distance and near visual acuity improved bilaterally. The patient experienced mild PD symptoms in the left eye. She had been using an estradiol patch for menopausal disorders. 6 months postoperatively, the use of an estradiol patch was discontinued because of dermatitis and she noticed a marked worsening of her PD. Diagnosis, Intervention, and Outcomes: With the patient's cooperation, full-field electroretinography (ERG) and contrast sensitivity tests were performed before and after estradiol discontinuation. After the discontinuation, the amplitude of both rod and cone ERGs decreased, contrast sensitivity decreased, and PD deteriorated. There were no changes in anterior-segment condition and retinal shape. Conclusions: PD symptoms worsened after the discontinuation of estrogen hormone therapy. ERG amplitude and contrast sensitivity decreased when HRT was discontinued, suggesting that retinal function in the presence of estrogen receptors may be related to the development of PD.

Двусторонняя хирургия катаракты в одну госпитализацию

The aim of the work was to analyze the results of bilateral cataract surgery in one hospitalization with an interval of several days. Material and methods. An analysis was made of data from 141 patients operated on in a round-the-clock hospital of the Kirov Clinical Ophthalmological Hospital for bilateral cataracts during one hospitalization for the period 2022–2023. Results. The interval between operations on the eyes of patients ranged from 1 to 7 days, on average 2.7 days. No cases of endophthalmitis were noted. Visual acuity increased from 0.1 to 0.6. In 85.8%, the target refraction was achieved. Conclusion. Bilateral cataract surgery in one hospitalization is possible and often more preferable in terms of a combination of medical, economic, time, quality indicators with a balanced approach from the ophthalmologist-surgeon and strict adherence to the patient safety protocol. Keywords: bilateral surgery, surgery in one hospitalization

Comparison of binocular visual quality in six treatment protocols for bilateral cataract surgery with presbyopia correction: a prospective two-center single-blinded cohort study

Objective To compare the postoperative binocular visual quality in six treatment protocols for bilateral age-related cataract surgery with presbyopia correction for clinical decisions. Materials and methods In this prospective two-center single-blinded cohort study, participants from North or South China who underwent bilateral phacoemulsification and intraocular lens implantation were divided into six protocols: monovision, diffractive bifocal, mixed, refractive bifocal, trifocal, and micro-monovision extended range of vision (EROV). Binocular visual quality was evaluated at 3 months postoperatively, including binocular uncorrected full-range visual acuity, binocular defocus curves (depth of focus [DoF] and area under the curve [AUC]), binocular visual function (fusion function and stereopsis), binocular subjective spectacle independence rates, visual analog scale (VAS) of overall satisfaction, 25-item visual function questionnaire (VFQ-25), and binocular dysphotopsia symptoms. Results Of the 300 enrolled patients, 272 (90.7%; 544 eyes) were analyzed. The trifocal protocol showed excellent binocular full-range visual acuity and the best performance for most DoFs and AUCs. The monovision protocol presented the worst binocular visual quality in most perspectives, especially in convergence, distance, and near stereopsis (p < 0.001). The full-range subjective spectacle independence rates were sorted from highest to lowest as follows: trifocal (84.8%), refractive bifocal (80.9%), EROV (80.0%), mixed (73.3%), diffractive bifocal (65.2%), and monovision (32.6%) protocols, with no statistically significant differences between the former five protocols (p > 0.05). The EROV protocol achieved the highest VAS and VFQ-25 scores. The incidence of postoperative binocular dysphotopsia symptoms was comparable in all protocols. Conclusions The trifocal protocol showed the best performance, and the monovision protocol presented the worst performance in most perspectives of binocular visual quality for presbyopia correction. The refractive bifocal, mixed, or EROV protocols can provide an approximate performance as a trifocal protocol. Ophthalmologists can customize therapies using different protocols.

Visual Performance at All Distances and Patient Satisfaction With a New Aspheric Inverted Meniscus Intraocular Lens.

To evaluate visual performance, spectacle independence, and quality of vision of new intraocular lenses (IOLs) for presbyopia correction with an aspheric inverted meniscus optical design (ArtIOLs; Voptica SL) in patients undergoing bilateral cataract surgery. In this prospective study, 60 eyes from 30 patients implanted bilaterally with Art40 and Art70 IOLs were included. These new IOLs were designed with an inverted meniscus shape to improve the peripheral performance and with aspheric surfaces to induce different amounts of negative spherical aberration in each IOL model. Distance-corrected and uncorrected through-focus visual acuities and contrast sensitivity were measured 1 to 3 months after surgery. Twenty-eight patients answered Patient Reported Spectacle Independence (PRSIQ) and Quality of Vision (QoV) questionnaires. Mean monocular (Art40 and Art70) and binocular (Art40/70) corrected distance visual acuities (CDVA) were zero logMAR (20/20). Binocular uncorrected distance visual acuity (UDVA) at far, intermediate (66 cm), and near (40 cm) distances was 0.00 ± 0.01, 0.01 ± 0.03, and 0.09 ± 0.09 logMAR, respectively. Spectacle independence was achieved by 24 (85.7%) patients for far and intermediate vision and 20 patients (71.4%) for near vision. The number of patients never reporting experiencing glare, halos, and starbursts was 28, 27, and 26 (100%, 96.4%, and 92.9%), respectively. The binocular combination of two ArtIOLs models (Art40 and Art70) significantly extended the depth of focus up to at least 40 cm. This combination resulted in a full range of vision with a high level of spectacle independence and without the compromise of halos or dysphotopsias. [J Refract Surg. 2023;39(9):582-588.].

Risk and dose-response relationship of diabetes mellitus for endophthalmitis after cataract surgery in a nationwide cohort study in Taiwan.

To investigate the risk of endophthalmitis after cataract surgery in patients with diabetes mellitus (DM) and evaluate the dose-response relationship. This retrospective cohort study enrolled patients who underwent bilateral cataract surgeries from 2000 to 2017 in Taiwan National Health Insurance Research Database. The endophthalmitis rates within 3 months after cataract surgery were compared between DM and non-DM cohorts using a generalised estimating equation. The diabetes complications severity index (DSCI) score was adopted to assess the dose-response effect on the endophthalmitis rate. A total of 883 398 patients (1 766 796 eyes) were included. Patients with DM had an increased risk of endophthalmitis after cataract surgery than patients without DM (0.261% vs. 0.242%, adjusted odds ratio = 1.09, 95% confidence interval = 1.03-1.16). The higher endophthalmitis rate in the DM group than in the non-DM group remains after excluding those with prior vitrectomy or intravitreal injection (IVI), and took IVI between the cataract surgery and endophthalmitis (p = 0.0156, 0.0048, and 0.0139). There was a significant dose-response relationship on the likelihood of endophthalmitis in DM patients when DCSI score >10. The endophthalmitis rate is highest among DM complications in patients with metabolic disorders (0.342%). DM was a risk factor for endophthalmitis after cataract surgery after adjusting for age, sex, common systemic disorders, and excluding those with prior vitrectomy or IVI and having IVI between cataract surgery and endophthalmitis. A dose-response relationship was noted in DM patients with a DCSI score >10.