Bilateral Phacoemulsification Research Articles

Functional outcomes and quality of life after AcrySof IQ Vivity intraocular lens implantation in a real-world study

The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden’s Quality of Vision test and Morlock’s Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients.

Bilateral Hypocalemic Cataract Post Thyroidectomi : A Case Report

Introduction : Young adult cataracts are negligible, and their prevalence is rarely reported in Indonesia. We reporta rapidly developing cataract in a 25-year-old woman due to secondary hypoparathyroidism. Cataracts in this case, progress remarkably fast compared to primary cataracts.
 Case Illustration : A twenty-five-year-old female patient presented bilateral vision loss and a history of a total thyroidectomy caused by diffused toxic goiter 7 years before admission. Postoperative calcium levels were extremely depleted. The uncorrected visual acuity examination measured 1/300 in the right eye and 20/200 in the left. Slit lamp examination revealed cortical opacities in both eyes. We diagnosedit as bilateral hypocalcemia cataracts. Patient has undergone bilateral phacoemulsification and intraocular lens implantation. The day following surgery visual acuity in the right eye was 20/30 and the left eye was 20/30 without correction. After one year of evaluation the visual acuity in RE become RE was 20/20 with a correction of -0.50 D sphere and the LE was 20/20 with a correction of -1.0 D sphere.
 Discussion : Patients with hypoparathyroidism risk developing cataracts due to chronic hypocalcemia, which inhibits the lenticular Na/K pump and induces intracellular sodium flux. This high sodium level triggers the osmosis process, followed by swelling of the lens fibers to form dystrophic calcifications. Thyroid surgery procedures suspectedly involving the parathyroid gland may cause hypocalcemia, thus leading to development of cataract.
 Conclusion : Clinicians should always consider hypoparathyroidism as the cause of bilateral cataracts in patients with a previous total thyroidectomy.

Simultaneous Bilateral Phacoemulsification and Cataract Extraction - A New Operation Method

Simultaneous Bilateral Phacoemulsification and Cataract Extraction - A New Operation Method

Clinical and Diagnostic Efficiency of the Study of the Quality of Life According to the Questionnaires PHEC-22 and Catquest-9SF after Bilateral Cataract Phacoemulsification and Monofocal IOL Implantation

Purpose: сomparative clinical and diagnostic efficiency of the quality of life (QОL) according to the PHEC-22 and Catquest-9SF questionnaires after bilateral cataract phacoemulsification and monofocal IOL implantation. Patients and Methods. We observed 148 patients with binocular cataract (mean age 58.6 ± 1.8 years). All patients underwent standard cataract phacoemulsification with implantation of a monofocal IOL. Patients were examined before and after (one month after surgery on the second eye) surgery. The results of the survey on the questionnaires PHEC-22 and Catquest-9SF were evaluated by the general indicator of testing (GIT) as the sum of points for all questions (taking into account the “weight” coefficients in the questionnaire PHEC-22). Along with this, each of the patients underwent a study of binocular BCVA. Results. A statistically significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire compared to Catquest-9SF was established, which is confirmed by a higher (by 0.17 rel. units, p < 0.01) level of correlation with BCVA, as well as a higher probability of compliance of the QOL level with the BCVA range, especially at low (0.4 and less rel. units, by 18.5 %, p < 0.01) and medium (0.5–0,8 relative units, by 7.3 %, p < 0.05) values of BCVA, while in the range of BCVA 0.9–1.0 relative units, no significant differences between the questionnaires were found (p > 0.05). Conclusion. The results of a comparative study after bilateral cataract phacoemulsification and monofocal IOL implantation using the PHEC-22 and Catquest-9SF questionnaires revealed a significantly higher clinical and diagnostic efficiency of the PHEC-22 questionnaire, which is associated with the methodological principles for developing a questionnaire based on the “social model” of health with the involvement of expert ophthalmologists and the use of the optimal procedure for scaling the patient’s responses. The results obtained (taking into account clinical normalization) allow us to recommend the PHEC-22 questionnaire for inclusion in the complex diagnosis of patients with cataracts both before and after surgery in solving a number of urgent problems — a comparative assessment of IOL, a study of the effectiveness of methods for postoperative rehabilitation of patients, the choice of the optimal formula for calculating IOL and some others.

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.

Interobserver agreement between central topography and Scheimpflug tomography for premium intraocular lens selection.

To assess the inter-observer agreement and reliability of central topography (CT) of IOL Master 700 with that of Pentacam HR, as a screening tool for determining the suitability for premium (toric, monofocal and presbyopia correcting) intraocular lens (IOL) implants. Nethradhama Superspeciality Eye Hospital, Bangalore, India. 200 eyes of eligible patients undergoing unilateral or bilateral phacoemulsification with premium IOL's were included in the study. Preoperatively, IOL Master 700 CT and Pentacam scans were performed for corneal topography evaluation. 2 experienced clinicians were randomised to interpret the axial map of either of the scans at a time and their responses were then enclosed in an envelope, and forwarded to a third observer for analysis. If there was a conflict, final decision was based on the interpretation of the Pentacam scan. Of the total scans interpreted by the 2 observers, 77.5% (n = 155) showed agreement whereas 22.5% (n = 45) showed disagreement. The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of IOL Master 700 CT in diagnosing irregular corneas when compared with Pentacam HR, was 72.73%, 78.09%, 29.09% and 95.86% respectively. The Cohen's κ inter-observer agreement value was 0.44, signifying a moderate degree of agreement, which was statistically significant (P < .00). High NPV of IOL Master CT suggested that the device efficiently ruled out irregular corneas, while any suspicious scan should be confirmed with Pentacam HR or a similar device for appropriate decision-making regarding premium IOL selection. CTRI/2021/11/038053.

Phacoemulsification Complicated Subluxation of the Crystalline Lens, Anterior Megalophthalmos, Central Cloudy Corneal Dystrophy of Francois and High Myopia

A case is described of a 47-old man with anterior megalophthalmos, high myopia (&gt;31.0 mm) and who underwent bilateral consecutive phacoemulsification. In addition a bilateral dislike corneal opacity was present which was classified as central cloudy corneal dystrophy of Francois. Special attention must be paid to both surgical technique and IOL selection. In the first eye a single-piece foldable IOL was implanted into a capsule bag, in the second eye three-piece foldable IOL were sutured fixed to the iris. In the meantime, phacoemulsification in patients with dystrophy of Francois safe and does not lead to progression. We calculated the IOL power for our case with the Haigis and Barret II Universal formula retrospectively.

Coexistence of MRCS syndrome, extremely long axis and exfoliation syndrome: a case report and literature review

BackgroundThe coexistence of MRCS (microcornea, retinal dystrophy, cataract, and posterior staphyloma) syndrome and extremely long axis is rare since microcornea frequently accompanies with diminution of entire anterior segment and occasionally the whole globe. In the case presented here, combination of these two elements were identified, together with XFS (exfoliation syndrome).Case presentationA 66-year-old Han Chinese woman presented for consultation due to impaired vision which accompanied throughout her entire life span and worsened during the last 2 years. Combination of MRCS syndrome and extremely long axial length was evidently diagnosed in both eyes, with XFS confirmed in her right eye, but mutation screening failed to identify disease-causing sequence variants in some specific genes reported previously, including BEST1 and ARL2. However, likely pathogenic mutations in FBN2 gene were identified. Bilateral cataract phacoemulsification without intraocular lens implantation was performed using scleral tunnel incision and under general anesthesia. At 3-month follow-up, ocular recovery of the patient was satisfactory.ConclusionsThe case presented here exhibited rare coexistence of MRCS syndrome, extremely long axis and XFS. The complexity of her ocular abnormalities brought challenges to surgical management, in which multidisciplinary collaboration is often required. Furthermore, the genetic analysis in this case yielded a possible novel candidate gene for MRCS syndrome and provided evidence in support of genetic heterogeneity in this phenotype.

Astigmatism Tolerance and Visual Outcomes After Bilateral Implantation of a Hybrid Continuous Transitional Focus IOL.

To evaluate the astigmatism tolerance and the visual outcomes after implantation of a premium intraocular lens (IOL) with a continuous transitional focus (Precizon Presbyopic; Ophtec BV) in pseudophakic presbyopia correction. This prospective study enrolled 20 patients (40 eyes) after bilateral phacoemulsification and IOL implantation. Corrected and uncorrected visual acuities at 4 m and 80, 67, and 40 cm (CDVA, UDVA, DCI80VA, UI80VA, DCI67VA, UI67VA, DCNVA, and UNVA), astigmatic and spheric defocus curve, mean reading speed (MRS), critical print size (CPS), contrast sensitivity, optical aberrations (modulation transfer function [MTF] cut-off, Strehl ratio, and higher order aberration root mean square [HOA RMS]), objective halometry, and National Eye Institute Refractive Error Quality of Life Instrument 42 [NEI RQL-42] questionnaire were evaluated 3 months after surgery. Astigmatic defocus curves revealed a tolerance up to -1.00 and +0.75 diopters (D) for with-the-rule astigmatism, and up to -1.00 and +1.00 D for against-the-rule astigmatism. Binocular spheric defocus curve showed that the mean visual acuity was greater than 0.15 logMAR from 1.00 to -1.00 D. MRS, CPS, MTF cut-off, Strehl ratio, and HOA RMS were 116.97 ± 21.94 words/min, 0.45 ± 0.06 logRDA, 20.03 ± 4.86 cycles/degree, 0.11 ± 0.07, and 0.28 ± 0.09, respectively. Contrast sensitivity was within the normal range for all tested light conditions. The NEI RQL-42 evidenced high subjective satisfaction for all subscales, especially for far vision, activity limitations, dependence on correction, suboptimal correction, appearance, and satisfaction with correction. The Precizon Presbyopic IOL allows good astigmatism tolerance and both objective and subjective high quality of vision. [J Refract Surg. 2023;39(1):33-39.].

Improved glycemic control and cardiovascular risk in patients with diabetes mellitus Type II following cataract phacoemulsification surgery

Objective: The objective of the study was to assess the glycemic control and cardiovascular risk (CV risk) change in diabetes mellitus type II (DM-II) patients undergoing uncomplicated bilateral cataract phacoemulsification surgery.Design: Retrospective study.Participants: We selected 28 patients who underwent uncomplicated bilateral cataract surgery at Centro Hospitalar de Entre o Douro e Vouga between January 2018 and December 2019.Inclusion Criteria: We included patients submitted to bilateral cataract surgery without other known ophthalmological pathology. Furthermore, there were available records of their comorbidities, lipid profile, blood pressure, glycated hemoglobin (HbA1c), and body max index (BMI) prior to and in the 6 months following surgery.Materials and Methods: We assessed our patient cohort for changes in HbA1c, lipid profile, BMI, and blood pressure before and after surgery. We further subdivided our patient cohort into two different groups: group 1 – no to mild visual impairment, ≤0.48 logarithm of the Minimum Angle of Resolution (LogMAR); Group 2 – moderate to severe visual impairment, >0.48 LogMAR, and assessed for the same variables at the mentioned time points. Comparisons were done using paired samples Student's t-test or Wilcoxon rank and repeated measures ANOVA with Tukey's post hoc tests, respectively.Results: Following cataract surgery and subsequent improved visual acuity (VA), our patient cohort showed decreased HbA1c, lower arterial blood pressure, and decreased BMI, with an improved CV risk score within 6 months of cataract surgery. These improvements were more evident in the patients with worse baseline VA.Conclusions: Phacoemulsification cataract surgery resulted in improved CV risk and glycemic control in DM-II patients.

Evaluation of extended depth-of-focus hydrophobic intraocular lens with an optic concept based on combination of high-order aberrations.

Extended depth-of-focus (EDOF) intraocular lenses (IOLs) provide a continuous range of uncorrected vision at different distances. To assess visual acuity, refractive outcomes, and patient satisfaction after cataract surgery using the LuxSmart EDOF IOL (Bausch+Lomb). A two-center, prospective observational clinical study. This study includes patients who have undergone bilateral phacoemulsification with bilateral implantation of the LuxSmart EDOF IOL, with the aim of achieving emmetropia. Visual acuity (VA) and subjective refraction were obtained in all patients preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective measures were obtained using the Catquest-9SF questionnaire and the Patient-Reported Spectacle Independence Questionnaire (PRSIQ). Contrast sensitivity and a glare assessment were undertaken postoperatively. Safety outcomes were additionally assessed. Sixty eyes from thirty patients were recruited for this study. The mean spherical equivalent was 1.04 ± 1.67 D preoperatively and -0.30 ± 0.46 D at 6 months. Monocular uncorrected distance VA was 0.57 ± 0.32 (logMAR) preoperatively and 0.09 ± 0.12 (logMAR) at 6 months. Mean 6-month monocular uncorrected VA was 0.11 ± 0.13, 0.12 ± 0.15, and 0.31 ± 0.15 (logMAR) at 80, 66, and 40 cm, respectively. More than 90% of patients were either fairly or very satisfied with their vision. There was one case of suspected vitreomacular traction postoperatively. The LuxSmart EDOF IOL offers good refractive, VA, and safety outcomes. The single elongated focal point designed to enhance the DOF shows good results for VA and patient satisfaction.

DIABETIC CATARACT IN DOGS: COMPLICATIONS, TREATMENT, OUTCOMES

Diabetic cataracts are common in diabetic dogs and lead to blindness and lens-induced uveitis, the complications of which may lead to the need to remove the eyeball. The objectives of this study were to provide a clinical and ophthalmological characteristics of diabetic cataract in dogs, to describe pre-, intra- and postoperative complications of diabetic cataract phacoemulsification in dogs, and to identify relationships between different parameters of phacoemulsification, types of complications, and outcomes of treatment for diabetic cataract in dogs. The study included 22 dogs of various breeds with diabetes mellitus complicated by bilateral mature cataract, all animals underwent a complete ophthalmological examination, including biomicroscopy, ophthalmotonometry, examination of chromatic pupillary reflexes, ultrasound examination of the eyeball, and uni- or bilateral cataract phacoemulsification. In the course of the study, it was found that diabetic cataract in dogs develops on average 3.4 ± 2.9 months from the moment the patient has diabetes mellitus, is characterized by the formation of cracks in the anterior lens suture (77%), the average lens thickness is 0.82 ±0.16 cm, lens -induced uveitis. Preoperative complications included: aqueous flare, posterior capsular rupture, capsular fibrosis, and lens subluxation. Intraoperative complications: the release of liquefied cortex into capsulorhexis, are widespread (75%). The most common postoperative complications of diabetic cataract include POH (16.7%) and corneal dystrophy (13.9%). Correlation analysis revealed the relationship between the time to surgery, various parameters of the operation and types of complications, preoperative complications, in particular, spontaneous rupture of the posterior capsule, small lens thickness, and intraoperative complications are associated in this study with a negative outcome in terms of vision.

Ocular Biocompatibility of a Nitinol Capsular Tension Ring (CTR)

Abstract Introduction: The biocompatibility of nitinol in the human body has extensively been demonstrated. Although nitinol is already being used for intraocular surgeries such as lens fragmentation and foreign body extraction, little is known about its intracapsular, long-term behavior. The purpose of this study is to evaluate the long-term uveal and capsular biocompatibility of a nitinol CTR placed in the capsular bag after cataract surgery in an animal model. Method: After approval of the study by the Institutional Animal Care and the Ethics Committee, bilateral phacoemulsification was performed in 6 rabbits; 1 eye received a nitinol CTR and the other a control polymethylmethacrylate (PMMA) open-ended ring. Ophthalmic evaluation for the presence of infections in all 12 eyes was performed after 7 days, 4 weeks, 3 months, and 6 months follow-up period. After a follow-up period of 6 months, the eyes were enucleated, and a histopathologic evaluation was performed. Results: Neither of the groups showed any clinical signs of posterior capsule opacification (PCO) or inflammation. The nitinol group showed slightly less inflammation during histopathologic examination compared to the PMMA group. No biocompatibility issues have been observed in this animal study. Conclusions: There were no histological differences between eyes implanted with nitinol and eyes implanted with PMMA rings. Nitinol has proven to show high biocompatibility when implanted in the capsular bag of the rabbit eye.

Rationale for early lens extraction in the treatment of primary angle closure disease

PURPOSE. To demonstrate the advisability of early lens extraction in the treatment of primary angle closure disease in clinical practice.METHODS. The study presents three clinical cases with patients at different stages of primary angle closure disease (PACD). The first one is related to the development of a bilateral acute attack of primary angle closure (PAC) that happened in the intensive care unit during treatment for acute respiratory distress syndrome (ARDS) associated with COVID-19 pneumonia in a patient with a previously undiagnosed PACD. The second case demonstrates the progression of glaucomatous optic neuropathy (GON) in early primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and delayed selective laser trabeculoplasty (SLT) in a patient with increased lens thickness. The third example illustrates the progression of advanced PACG in the right eye (OD) and moderate PACG in the left eye (OS) due to formation of goniosynechiae after bilateral LPI, which required transscleral diode cyclophotocoagulation (TSCP) in OD and trabeculectomy in OS. Subsequently, bilateral cataract phacoemulsification with intraocular lens implantation (CPE+IOL) and SLT were performed.RESULTS. In the first clinical case, advanced PACG developed in both eyes within 2 months. After bilateral LPI, trabeculectomy, compensation of intraocular pressure (IOP) was achieved, visual functions stabilized. In the second clinical case, 5.5 years after LPI and SLT, an increase in the thickness of the lens was revealed (in OD by 0.2 mm, in OS by 0.48 mm). GON did not progress in OD (thinning rate of the retinal nerve fiber layer was 0.94 µm/year, p=0.32) and the progression rate in OS was -1.04 µm/year (p=0.018). Taking into account the lens-involved mechanism of PACD progression, bilateral CPE+IOL was recommended. In the third clinical example, IOP remained elevated after bilateral LPI, TSCP in OD and trabeculectomy in OS as a result of goniosinechiogenesis, and therefore CPE+IOL also did not lead to its decrease. After bilateral SLT, compensation of IOP was achieved without local hypotensive therapy (IOP measured by Icare: OD 18.0 mm Hg, OS 15 mm Hg).CONCLUSION. In order to preserve visual functions, CPE+IOL is highly recommended at the very beginning of PACD, before the formation of GON and goniosynechiae. This is dictated by the dominant role of the lens-involved mechanism in PACD formation, as demonstrated in the described clinical examples.

Prophylactic efficacy of intravenous paracetamol administration to reduce the incidence of post-operative ocular hypertension in dogs undergoing phacoemulsification: A pilot study.

To determine whether intravenous administration of paracetamol can prevent postoperative ocular hypertension (POH) in dogs following routine phacoemulsification. Diabetic and non-diabetic patients (total 54 dogs) undergoing unilateral or bilateral phacoemulsification were recruited to this placebo-controlled, prospective study. The control group received 1 ml/kg saline via intravenous infusion while the treatment group received 10mg/kg paracetamol via intravenous infusion. Infusions were administered 30min prior to surgery and repeated 12h following initial administration. All patients received topical latanoprost at the conclusion of surgery. Intraocular pressure (IOP) was measured before premedication (baseline), and at 1h, 3h, 5h and 18 h following extubation. POH was defined as an IOP above 25 mmHg (POH25). In addition, the number of patients with an IOP exceeding 20 mmHg was analyzed (POH20). POH20 occurred in 33 of 54 animals (61.1%), including 19 of 25 animals (76.0%) in the control group and 14 of 29 animals (55.2%) in the treatment group. POH25 occurred in 23 of 44 animals (52.3%), including 13 of 25 animals (52.0%) in the control group and 10 of 29 animals (34.5%) in the treatment group. Paracetamol administration showed a significant positive effect on reducing the incidence of POH20 (p=.048), but not POH25 (p=.221). When comparing groups, treatment with paracetamol showed a statistically significant reduction in the incidence of POH20, although no differences were observed in the incidence of POH25 between groups. Further studies are warranted to explore whether alternative drug regimes or routes of administration can provide enhanced efficacy in the prevention of POH25.

Bilateral phacoemulsification of cataract: the opinion of foreign ophthalmologists

Рurpose: to present the opinion of foreign ophthalmic surgeons on simultaneous bilateral phacoemulsification of cataract (SBPEC) by analyzing literature data. We performed an analysis of papers listed by Pubmed in 2000–2020 which contained expert assessments of SBPEC effectiveness based on polling. Ophthalmic surgeons were offered special questionnaires largely close in content, which were designed to establish the rating of factors that affected the respondents’ decision for or against the surgery. Our results indicate that, depending on the country, from 13.9 to 86 % of ophthalmic surgeons practice SBPEC, while from 14.0 to 67.2 % refrain from using this technology. The surveys revealed three major factors in favor of SBPEC — reduced number of clinical visits, the patient’s convenience during rehabilitation, and a high risk of complications after a second general anesthesia. The main factors against SBPEC are the risk of endophthalmitis (noted by 69–73 % of respondents), the absence of information on the postoperative refractive result in the first eye, which could determine the choice of the intraocular lens on the second eye (74–80 %), the risk of bilateral vision loss (73–79 %), as well as possible forensic problems (52–58 %).Conclusion. The surveying highlights certain negative factors that need to be overcome in order for SBPEC to become more widespread. Raising the awareness of SBPEC practice and approval by the ophthalmic community is essential for a sustainable culture change regarding this technology. To achieve this aim, standardization of the SBPEC procedure is needed, followed by the development of training manuals and protocols for surgical intervention.

Hyperopic shift after refractive lens surgery in a patient with prior history of radial keratotomy

Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.

Refractive outcomes of second-eye adjustment methods on intraocular lens power calculation in second eye.

To investigate the refractive outcomes of second-eye adjustment (SEA) methods in different intraocular lens (IOL) power calculation formulas for second eye following bilateral sequential cataract surgery. This retrospective consecutive case-series study included 234 eyes from 234 patients who underwent bilateral sequential phacoemulsification and implantation of enVista MX60 in a hospital setting. Postoperative refraction outcomes calculated by standard formulas (SRK/T and Barrett Universal II, BUII) with SEA method were compared with those calculated by an artificial intelligence-based IOL power calculation formula (PEARL DGS) under second eye enhancement (SEE) method. The median absolute error (MedAE), mean absolute error (MAE) and percentage prediction errors (PE) of eyes within ±0.25 diopters (D), ±0.50 D, ±0.75 D and ± 1.00 D were determined. Overall, the improvement in MedAE after SEA was significant for PEARL DGS (p < 0.01), SRK/T (p < 0.001) and BUII (p=0.031), which increased from 74.36, 71.37, and 77.78% to 83.33, 80.34, and 79.49% of eyes within a PE of ±0.50 D, respectively. For first eyes with a medium axial length (22-26 mm), PEARL DGS with SEE had the lowest MedAE (0.21 D). For a first-eye MAE over 0.50 D, SEA method led to significant improvement in the second eye (p < 0.01). Interocular axis length differences exceeding 0.3 mm were associated with weaker effects using SEA in the studied formulas (p > 0.05). Either SEA method with SRK/T and BUII formulas or second-eye enhancement method based on the PEARL DGS formula can improve postoperative refractive outcomes in second eye.

Correlation between Hyperalgesia and Upregulation of TNF-α and IL-1β in Aqueous Humor and Blood in Second Eye Phacoemulsification: Clinical and Experimental Investigation.

The aim of this study was to explore the correlation between intraoperative hyperalgesia of the second eye and the dynamic changes of tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels in aqueous humor (AH) of the second eye and whole blood after the first eye cataract surgery. A rabbit model of monocular phacoemulsification was established by administration of 0.3% levofloxacin. Whole blood and AH samples from non-surgical eyes in the experimental group (n =25) and second eye in the blank control group (n =15) were obtained and corneal sensitivity was examined after surgery (1, 3, 7, 14, and 21 days postoperatively). TNF-α and IL-1β levels in AH and TNF-α mRNA and IL-1β mRNA levels in whole blood were measured. In a clinical study, 30 patients who underwent bilateral phacoemulsification within 1 month were divided into six groups in accordance with the operation intervals (1, 3, 7, 10, 14, and 21days). TNF-α and IL-1β levels in AH were measured at the beginning of surgery and intraoperative pain was assessed immediately after surgery. Corneal sensitivity (F =244.910, P <0.05), TNF-α and IL-1β levels in AH (F =184.200, 82.900, P <0.05) of non-surgical eyes and in whole blood (F =272.800, 193.530, P <0.05) in the experimental group were significantly higher than the baseline levels after phacoemulsification. In the clinical study, NRS scores of second eye surgery were higher than those of the first eye(P =0.0025) and 19 (63.3%) patients reported more pain during the second eye surgery. TNF-α and IL-1β concentrations in AH of the second eye were significantly higher than those of the first eye (F =123.60, P <0.05; F =59.60, P <0.05). In conclusion, within 1 month after the first eye phacoemulsification, higher pain sensitivity (hyperalgesia) exists in the second eye, which may be related to dynamic changes in TNF-α, IL-1β levels in AH or whole blood.

Dynamic monocyte chemoattractant protein-1 level as predictors of perceived pain during first and second phacoemulsification eye surgeries in patients with bilateral cataract

BackgroundThe purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract.MethodsConsecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups.Resultspain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries.ConclusionsMCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.