Cases Of Cataract Surgery Research Articles

Association between long-term statin use and cataract surgery: a nationwide study on 505 105 cataract surgery patients

AimsTo assess the association between statin use and cataract surgery according to different statin treatment durations in patients with different cardiovascular risk profiles.Methods and resultsWe performed a nested case–control study...

A case of accidental into-the-lens dexamethasone implant: watching or removing?

BackgroundTo report a case of cataract surgery in unintentional Ozurdex (Allergan, Inc., Irvine, California, USA) injection into the lens.Case presentationA 82-years old man reporting decreased visual acuity in his right eye came to our Ophthalmology service. Due to the clinical history, and on the basis of ophthalmoscopic and imaging examinations diabetic macular edema was diagnosed. Thus, intravitreal dexamethasone implant was scheduled and therefore performed. The following day Ozurdex appeared to be located into the lens. After careful evaluation and strict follow up examinations, due to the risks associated with the presence of the implant into the lens, phacoemulsification with Ozurdex removal and intraocular lens (IOL) implantation was scheduled and performed.ConclusionsIn this case report we reported the surgical management of accidental into-the lens dexamethasone implant carefully taking into account the dexamethasone pharmacokinetic.

Secondary Glaucoma after Cataract Surgery Performed in Infancy in Congenital Rubella Syndrome: A Case Control Study

ObjectiveTo compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with non-rubella cataracts and to identify associated risk factors. DesignRetrospective case control study. ParticipantsChildren with CRS who had undergone cataract surgery in infancy and age matched infants who had undergone cataract surgery for infantile cataracts were included. MethodsIncidence of glaucoma and probability of survival was compared among the two groups. Risk factors for the development of glaucoma were assessed. The minimum follow up was 1 year after cataract surgery. ResultsThe study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the non-rubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the two groups (p=0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (p=0.19). Mean follow-up was 5.8 ± 3.7years for CRS group and 6.4± 3.4years for the non-rubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 versus controls 0.8; log rank p-0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (p>0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83, 95% confidence interval 1.44-5.57; p=0.002) in CRS eyes. ConclusionThere was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared to infants who had undergone surgery for infantile cataracts. Since the ten year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow up is recommended especially in eyes with at-risk features.

Trends in immediate sequential bilateral cataract surgery in Ontario

ObjectiveBecause of increased evidence for safety and increased demands, there appears to be a recent adoption and endorsement of immediate sequential bilateral cataract surgery (ISBCS). This study aims to determine whether a paradigm shift has occurred in the delivery of cataract surgery in the province of Ontario and its the extent, if any, and to analyze the current role of ISBCS. DesignRetrospective health records analysis. MethodsWe analyzed aggregate Ontario Health Insurance Plan claim counts for cataract surgeries between 2016 and 2022, categorizing cases into unilateral, ISBCS, and delayed sequential bilateral cataract surgery (DSBCS) cases. We examined trends, compared wait times for second surgeries in the DSBCS cohort with wait times for first surgeries, and used previously published cost estimates for ISBCS to estimate annual savings in Ontario. ResultsThere were 1,122 ISBCS cases in 2016, which increased sixfold during the pandemic (2020–2021) and further increased to 11,876 cases in 2022. Unilateral and DSBCS cases decreased during the pandemic but rebounded in 2022 to 102% and 153% of baseline, respectively. ISBCS increased from 1% to 10%, unilateral cases decreased from 41% to 29% of total cases, and DSBCS increased from 58% to 61%. Median wait for patients’ first and second surgeries increased from 65 to 87 days and 28 to 33 days, respectively. Using estimates, ISBCS saved approximately $19 million in 2022. ConclusionOur study demonstrates a paradigm shift in Ontario in favour of ISBCS. ISBCS also may be a strategy to reduce increasing wait times while saving health care system dollars.

Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years.

Background: Scheimpflug tomography has for many years been an integral part of our pre-operative assessment in cataract extraction. We retrospectively reviewed the incidence of topographic keratoconus and keratoconus suspicion in our routine cataract surgery population over 5 years. Setting: The Laservision Clinical and Research Institute, Athens, Greece. Methods: In 1250 consecutive cataract surgery cases in otherwise naïve eyes, accounting for years 2017 to 2021, we retrospectively evaluated preoperative Pentacam HR imaging. The cases already classified as keratoconus were included in group A. The residual cases were assessed by five different experienced evaluators (two ophthalmic surgeons and three optometrists) for topographic and tomographic keratoconus suspicion based on irregular pachymetry distribution, astigmatism truncation, and/or astigmatic imaging irregularity and included in group B. Regular corneas, by this assessment, were included in group C; irregular corneas, as determined by the evaluators but unrelated to keratoconus, were included in group D. Results: Based on the above, 138 cases (11.08%) were classified by Pentacam tomography as keratoconus and by default were included in group A. Of the residual cases, 314 or 25.12% were classified as suspect keratoconus and included in group B; 725 cases (58%) were classified as normal and non-keratoconus and included in group C; and 73 cases or 5.84% were placed in group D as non-keratoconus but abnormal. There was no disagreement between the five evaluators over any of the cases in groups C and D, and little variance among them for cases included in group B (less than 5% by ANOVA). Conclusions: The incidence of keratoconus and corneas suspicious for keratoconus in Greece appears to be much higher than respective reports from other regions: one in ten Greeks appear to have topographic keratoconus, most not diagnosed even by the age of cataract surgery, and almost an additional one in four may have suspicious corneal imaging for keratoconus. These data strongly imply that routine screening for disease should be promoted among Greeks, especially during puberty, to halt possible progression; moreover, careful screening should be performed when laser vision correction is being considered.

Aspheric hydrophobic acrylic intraocular lens outcomes in patients with additional ocular pathology

Objectives: The objective of the study was to examine the real-world visual performance, refractive outcomes, and glistening occurrence of a hydrophobic acrylic aspheric monofocal intraocular lens (IOL) in patients with ocular comorbidities. Materials and Methods: All cases of cataract surgery with the implantation of a hydrophobic acrylic aspheric monofocal IOL in a single centre between September 2020 and March 2022 were reviewed in a retrospective cohort study. Refraction (autorefract), visual acuity, peri- and post-operative complications, and the presence of posterior capsular opacification (PCO) and glistenings were recorded. Due to facility and surgeon preference, this lens was utilised predominantly for younger patients with additional ocular pathology. Results: Data regarding 15 patients (21 eyes) were collected. The mean age was 57.3 years (Range: 37–70). Eleven patients (73%) had ocular pathology in addition to cataracts. One patient was excluded due to a lack of follow-up. Post-operative refraction was available for 13 eyes (61%). The median follow-up time was five months. Corrected distance visual acuity (logarithm of the minimum angle of resolution) improved from 0.52 ± 0.54 to 0.17 ± 0.21 (mean ± standard deviation; P = 0.01); 95% confidence interval 0.08–0.26). 77% of eyes were within 0.5 D of the refractive target, and 92% were within 0.7 D. Six patients (30%) had documented PCO, with two requiring YAG capsulotomy. No patients had IOL glistenings. Conclusion: The hydrophobic aspheric monofocal IOL performs well for young patients with ocular pathology in addition to cataracts. Further, long-term follow-up will help to support its use for patients who require greater than standard longevity from an IOL.

Склерокорнеальная фиксация заднекамерных интраокулярных линз в осложненных случаях хирургии катаракты с использованием политетрафторэтиленовых нитей

Original article Sclerocorneal fixation of posterior chamber intraocular lenses in complicated cases of cataract surgery using polytetrafluoroethylene sutures T.G. Sazhin, M.O. Sokolova Clinical Hospital «RZD-Medicine», Saint Petersburg, Russian Federation S.M. Kirov Militar y Medical Academy Ministr y of Defense of the Russian Federation, St. Petersburg, Russian Federation Relevance. Dislocation of the intraocular lens (IOL) is a serious complication in cataract surgery. Therefore, the search for an effective method of IOL fixation for non-standard surgical situations is still important. Purpose. To analyze clinical results of flanged corneoscleral IOL fixation the technique using polytetrafluoroethylene sutures. Material and methods. The results of surgical treatment of 34 patients (34 eyes) who underwent IOL suturing with suture material made of polytetrafluoroethylene 6-0 (Ecoflon) through the sclera and fixation of flanges in the lumen of corneal paracentesis (Sclerocorneal IOL Fixation Technique) without incisions of the conjunctiva and sclera were analyzed. Results. The average index of maximally corrected visual acuity before surgery was 0.27±0.11. A day after surgery, this parameter increased to 0.41±0.1. One week after surgery, the average index of maximally corrected visual acuity was 0.65±0.1, while the improvement in visual acuity was statistically significantly different from the parameter before surgery and a day after surgery (p<0.05). Conclusion. Application of polytetrafluoroethylene suture material in the ab externo technique, passing through the sclera and fixing the flanges in the lumen of the corneal paracentesis is safe and effective method. As a result, patients had positive visual acuity dynamics with a low frequency of complications. Key words: dislocation of IOL, aphakia, sclerocorneal fixation, polytetrafluoroethylene suture, flanged technique

Steroid Response Following Dropless Cataract Surgery Using Subconjunctival Triamcinolone.

To assess the rates of postoperative steroid response following dropless cataract surgery using a subconjunctival depot of triamcinolone versus conventional cataract surgery using topical prednisolone. We reviewed consecutive cataract surgery cases performed by a single surgeon to determine the likelihood of steroid response, defined as intraocular pressure (IOP) 50% above baseline or IOP > 24 mmHg postoperatively, excluding the first 72 hours. Logistic regression models were performed including baseline characteristics as exposures in the model and steroid response as the outcome. Main outcome measures were the proportion of eyes developing steroid response, risk factors for developing steroid response, and duration of steroid response. Of the 150 dropless and 218 conventional cases, 26 eyes developed steroid response (15 dropless and 11 conventional cases [10% vs 5%, P=0.096]). Risk factors for steroid response included dropless surgery (OR=2.43, 95% CI=1.03-6.02], P=0.046) and prior diagnosis of glaucoma (OR=7.18, 95% CI=2.66-19.22], P<0.001). Baseline IOP, age, sex, race, and axial length did not increase risk for steroid response. Of the eyes with steroid response, more dropless cases had an IOP elevation ≥30 days (9/15 eyes vs 1/11 eyes; P=0.008), including one patient with refractory IOP elevation in the dropless group who required urgent bilateral trabeculectomy for IOP control. Dropless cataract surgery increases the risk of prolonged steroid response postoperatively. Patients with glaucoma have an increased risk of steroid response and may not be good candidates for dropless cataract surgery with subconjunctival triamcinolone.

Complications of uneventful phacoemulsification on the first postoperative day: to determine the necessity of the first day review

Purpose: To establish the type and number of complications detected on the first postoperative day and to determine the necessity of the first day review.&#x0D; Study design: Clinical audit.&#x0D; Methods: This is a retrospective review of 297 patients who underwent routine phacoemulsification cataract surgery by qualified ophthalmologists and trainees from September to December 2020 at our day-care operation theatre. All cases of uncomplicated phacoemulsification were analysed for the types and frequency ofcomplications on postoperative day one.&#x0D; Results: Of 297 cases of routine cataract surgery, 6.7% of cases were excluded due to intraoperative complications. Of the remaining 277 cases, a total of 54 cases (19.5%) were found to have complications on day 1 postoperative review. These included raised intraocular pressure (67.0%), epithelial defect (20.0%), intense inflammation with presence of fibrin (5.0%), retained soft lens matter (4.0%), retained fibres (2.0%), and exposed corneal suture (2.0%). Two patients (0.7%) needed the removal of soft lens matter. Of 36 cases of raised intraocular pressure, 1 patient required anterior chamber paracentesis for retained viscoelastic, 18 patients required topical antiglaucoma medication, 15 patients needed systemic oral acetazolamide, and 2 patients with pre-existing glaucoma were instructed to continue their antiglaucoma medications.&#x0D; Conclusions: Following uneventful phacoemulsification, only 19.5% of patients were found to have complications on day 1 postoperative review. The most frequent complication was raised intraocular pressure, which can be detected on the day of surgery. Reviewing patients on the same day of surgery can reduce workload and demands on clinician time. It can also significantly reduce health care costs without compromising patient safety.

Assessing Resident Cataract Surgical Outcomes Using Electronic Health Record Data.

To demonstrate that electronic health record (EHR) data can be used in an automated approach to evaluate cataract surgery outcomes. Retrospective analysis. Resident and faculty surgeons. Electronic health record data were collected from cataract surgeries performed at the Johns Hopkins Wilmer Eye Institute, and cases were categorized into resident or attending as primary surgeon. Preoperative and postoperative visual acuity (VA) and unplanned return to operating room were extracted from the EHR. Postoperative VA and reoperation rate within 90 days. This study analyzed 14 537 cataract surgery cases over 32 months. Data were extracted from the EHR using an automated approach to assess surgical outcomes for resident and attending surgeons. Of 337 resident surgeries with both preoperative and postoperative VA data, 248 cases (74%) had better postoperative VA, and 170 cases (51%) had more than 2 lines improvement. There was no statistical difference in the proportion of cases with better postoperative VA or more than 2 lines improvement between resident and attending cases. Attending surgeons had a statistically greater proportion of cases with postoperative VA better than 20/40, but this finding has to be considered in the context that, on average, resident cases started out with poorer baseline VA.A multivariable regression model of VA outcomes vs. resident/attending status that controlled for preoperative VA, patient age, American Society of Anesthesiologists (ASA) score, and estimated income found that resident status, preoperative VA, patient age, ASA score, and estimated income were all significant predictors of VA. The rate of unplanned return to the operating room within 90 days of cataract surgery was not statistically different between resident (1.8%) and attending (1.2%) surgeons. This study demonstrates that EHR data can be used to evaluate and monitor surgical outcomes in an ongoing way. Analysis of EHR-extracted cataract outcome data showed that preoperative VA, ASA classification, and attending/resident status were important in predicting postoperative VA outcomes. These findings suggest that the utilization of EHR data could enable continuous assessment of surgical outcomes and inform interventions to improve resident training. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

Cataract surgery is one of the most commonly performed surgeries across medicine and an integral part of ophthalmologic care. Complex cataract surgery requires more time and resources than simple cataract surgery, yet it remains unclear whether the incremental reimbursement for complex cataract surgery, compared with simple cataract surgery, offsets the increased costs. To measure the difference in day-of-surgery costs and net earnings between simple and complex cataract surgery. This study is an economic analysis at a single academic institution using time-driven activity-based costing methodology to determine the operative-day costs of simple and complex cataract surgery. Process flow mapping was used to define the operative episode limited to the day of surgery. Simple and complex cataract surgery cases (Current Procedural Terminology codes 66984 and 66982, respectively) at the University of Michigan Kellogg Eye Center from 2017 to 2021 were included in the analysis. Time estimates were obtained using an internal anesthesia record system. Financial estimates were obtained using a mix of internal sources and prior literature. Supply costs were obtained from the electronic health record. Difference in day-of-surgery costs and net earnings. A total of 16 092 cataract surgeries were included, 13 904 simple and 2188 complex. Time-based day-of-surgery costs for simple and complex cataract surgery were $1486.24 and $2205.83, respectively, with a mean difference of $719.59 (95% CI, $684.09-$755.09; P < .001). Complex cataract surgery required $158.26 more for costs of supplies and materials (95% CI, $117.00-$199.60; P < .001). The total difference in day-of-surgery costs between complex and simple cataract surgery was $877.85. Incremental reimbursement for complex cataract surgery was $231.01; therefore, complex cataract surgery had a negative earnings difference of $646.84 compared with simple cataract surgery. This economic analysis suggests that the incremental reimbursement for complex cataract surgery undervalues the resource costs required for the procedure, failing to cover increased costs and accounting for less than 2 minutes of increased operating time. These findings may affect ophthalmologist practice patterns and access to care for certain patients, which may ultimately justify increasing cataract surgery reimbursement.

Efficacy of femtosecond laser for anterior capsulotomy in complex white cataracts

To determine the advantages and complication rate of capsulotomy performed with femtosecond laser in white complex cataract cases. Retrospective case series. Sixteen eyes of 16 patients. This was a single-center retrospective review of white cataract surgery cases in which the femtosecond laser (LenSx, Alcon Laboratories, Fortworth, Texas, USA) was used between May 2019 and February 2021. Outcome measures included an assessment of the capsulotomy, identification of tags, surgical time, cumulative dispersed energy (CDE) and postoperative management. Sixteen eyes of 16 patients were included in this study; capsule tags occurred in six patients (37.5%). In 2 patients, the capsule presented small adhesions that were identified and removed. One patient presented a very significant contraction of the anterior capsule with an incomplete cut zone of 2 to 4hours. In a patient with nystagmus, the capsulotomy was performed without complications under peribulbar anesthesia. The femtosecond laser permitted capsulotomies of better shape, size and regularity in complex cases of white cataract and in combination with conditions such as nystagmus and prior corneal transplantation. The microadhesions and untreated areas were identified with trypan blue, which is essential to use in these cases to avoid associated complications.

Phaco-handpiece used as a Fragmatome for managing nucleus drop.

Nucleus drop during cataract surgery is a dreaded complication and requires urgent vitreo-retinal intervention which is managed commonly using a fragmatome. However, a fragmatome is not readily available in routine ophthalmology set-ups because its use is very limited. On the other hand, a phaco-probe is commonly available with all surgeons and makes it cost-effective. The purpose is to demonstrate the utility of a phaco-probe as an alternative to a fragmatome in managing nucleus drop during cataract surgery, making it cost-effective and less time-consuming and simple. The video shows two cases of complicated cataract surgery in which a nucleus is dropped in the vitreous cavity. The sleeve of the phaco-probe was removed, and infusion was disconnected to make it function as a fragmatome. We noted reduced lenticular repulsion from the phaco-handpiece tip as compared to the fragmatome, and no scleral burns were observed. The cases were completed by secondary placement of an intra-ocular lens in the sulcus in the same sitting. Thus, the phaco-probe can be considered to manage nucleus drop in the absence of a fragmatome. A phaco-probe can be used as an alternative to a framgamtome, which is a cost-effective and simple technique. https://youtu.be/6c-40Bcijrc.

Treatment approaches to postoperative fibrinoid syndrome after phacoemulsification

BACKGROUND: Postoperative fibrinoid syndrome (PFS) is an early complication of phacoemulsification, manifested by fibrin deposition on the iris and the intraocular lens surface, which leads to visual acuity decrease.&#x0D; AIM: To assess the rate and the treatment efficacy (by YAG laser, enzymatic, medicalmentous) in PFS after phacoemulsification.&#x0D; MATERIALS AND METHODS: Retrospective analysis of 56,019 cataract surgery cases of 20172021. There were 49 patients with PFS divided into 3 groups according to treatment approaches: 1st group medicamentous treatment (MT) + YAG laser destruction of the fibrin film (n = 6); 2nd MT + prourokinase injection into the anterior chamber (n = 6); 3rd MT only (n = 37).&#x0D; RESULTS: There was no difference between groups in best-corrected visual acuity (BCVA) before the PFS development. There was a more rapid increase in BCVA in the 1st and the 2nd groups compared with the 3rd one on the third day (0.20 0.09 and 0.21 0.08 versus 0.09 0.08 for groups respectively, p = 0.001) and on the fifth day of treatment (0.25 0.10 and 0.27 0.13 versus 0.16 0.14, p = 0.029). Nevertheless, in one week, there was no difference in BCVA between groups. Unfortunately, BCVA did not return to baseline in any group.&#x0D; CONCLUSION: The incidence of PFS after phacoemulsification is relatively low and amounts to 0.093%. The most rapid BCVA recovery was observed in the 1st and the 2nd groups.

Имплантация интраокулярной линзы с механизмом формирования волнового фронта при хирургическом лечении катаракты у пациентов после сквозной кератопластики

Purpose. The article presents a clinical case of cataract surgery with implantation and preoperative calculation of the AcrySof IQ Vivity intraocular lens (IOL) (Alcon, USA) in a patient who underwent penetrating keratoplasty 15 months ago. Material and methods. IOL calculation was based on the actual data of the optical biometry, keratotopographic measurements. Considering complaints, a decrease in the quality of life, ophthalmic status data, it was decided to perform a penetrating subtotal keratoplasty of the right eye, followed by remote phacoemulsification and implantation of an intraocular lens. Results. Patient reports good quality of vision at a distance and average distance; does not experience difficulties when working with computer, feels comfortable while driving at night. Conclusion. Delayed cataract surgery with IOL implantation with the wavefront formation mechanism after penetrating subtotal keratoplasty, only in cases of donor material stabilization, allows to get accurate refraction. Even despite the high probability of refractive error, this type and design features of the lens made it possible to obtain the optimal quality of vision for the patient. Keywords: penetrating keratoplasty, cataract, intraocular lens, refractive error.

Automated Precision Pulse Capsulotomy Versus Manual Capsulorhexis In White Cataracts: Reduction In Procedural Time And Resource Utilization.

To compare the utility of Precision Pulse Capsulotomy (PPC) with manual capsulorhexis for capsulotomy in white cataracts. Hospital-based academic practice. Retrospective analysis of surgical case records and surgical videos from a single surgeon. Cases involving intumescent and non-intumescent white cataracts were identified. Capsulotomy outcomes, surgical outcomes, procedural time, and resource utilization as well as patient demographic and health data were analyzed and subjected to statistical testing. 15 cases of white cataract (10 Intumescent, 5 non-intumescent) performed using Continuous Curvilinear Capsulorhexis (CCC) were compared to 20 cases (9 Intumescent, 11 non-intumescent) performed using PPC. The cases covered a period of 14 months prior to and 30 months following surgeon adoption of PPC. There were no significant differences between the 2 groups in subject age, sex, ethnicity, ocular history, medical history and medications. PPC resulted in complete capsulotomies without tags or tears and intracapsular IOL implantation with 360-degree capsular overlap in all 20 cases. There was one CCC case resulting in the Argentinian Flag sign. Compared to CCC, PPC white cataract cases also demonstrated significant advantages in capsulotomy time, reduced use of trypan blue and ophthalmic viscosurgical device (OVD), and less overall procedural time. PPC is a safe and highly effective method to create consistent capsulotomies in both intumescent and non-intumescent white cataracts. The use of PPC provides benefits of significant reductions in capsulotomy time, overall procedural time and resource utilization resulting in a streamlined treatment of these complex cataract surgery cases.

Life-threatening hypotension in the immediate postoperative period of cataract surgery under topical anesthesia: a report of two cases

BackgroundCataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur.Cases presentationWe report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second.Conclusions and importanceEven though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.

A case of cataract surgery using phacoemulsification in a 12-year-old poodle

Myeong-Gon Kang, Dong-Hyun Han, Sei-Myoung Han, Eun-Gyeom Jung, Gyeong-Min Kim, Jae-Hyeon Cho, Phil-Ok Koh, Chung-Kil Won, Chung-Hui Kim, Dongbin Lee. Korean J. Vet. Serv. 2022;45:221-8. https://doi.org/10.7853/kjvs.2022.45.3.221

Risk factors affecting cataract surgery outcome: The Malaysian cataract surgery registry

This is a 5 years multicentre database study that recruited subjects from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR), aimed to determine risk factors that affect cataract surgery visual outcome and evaluates post-cataract surgery vision. All age-related cataract surgeries with primary intraocular lens (IOL) implantation were included. Cases with secondary cataract, previous ocular surgeries and incomplete data were excluded. A total of 131425 cases were included in the study. Amongst all types of cataract surgery, 92.9% attained post-operative best-corrected visual acuity better than 6/18 and the outcome improved to 97.1% when ocular comorbidities were excluded. Factors with Odds Ratio (OR) >1.5 associated with an impaired visual outcome included: elderly patients of 80 years old and above; systemic disease such as renal failure; ocular co-morbidities; pre-operative vision worse than 6/60; general anaesthesia, retrobulbar anaesthesia or subconjunctival anaesthesia; extracapsular cataract extraction (ECCE), intracapsular cataract extraction (ICCE), anterior chamber intraocular lens (ACIOL) implantation or combined cataract surgery; the presence of intra- and post-operative complications. In conclusion, a good visual outcome was achieved after cataract surgery in most cases. This large multicentre study provides information about risk factors for poor visual outcome post-cataract surgery and may serve as a basis for evidence-based guidelines.

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Purpose. Analysis of two clinical cases of immediate sequential bilateral cataract surgery according to the developed modified algorithm (mаISBCS).Materials and methods. The results of two clinical cases of mаISBCS are presented. In both cases, ultrasonic cataract phacoemulsification (FEC) was performed with implantation of an intraocular lens (IOL) under local anesthesia according to the standard technique through a corneal incision of 2.2–2.4 mm. IOL calculation was performed for emmetropic refraction. The modification (compared to the traditional one) of the technology of surgical intervention was based on the inclusion in the algorithm of a long (at least 60 minutes) break between operations for the purpose of a comprehensive ophthalmological examination with a further decision to perform an operation on the second eye.Results. In the first clinical case, the patient failed to measure the anterior-posterior axis by optical biometry before surgery. In such situations, the A-scan is used, which is considered less accurate due to human error and often leads to errors in the calculation of the IOL. In addition, a certain alertness was introduced by the fact of a significant (4 diopters) difference in the preoperative refraction of both eyes. Considering these provisions, after the first operation, after 60 minutes, the correctness of the IOL calculation was monitored by two methods — by measuring (optical biometrics) the anterior-posterior axis of the eye (APA, while the differences were less than 0.3 mm, which confirmed the A-scan data), as well as autorefractometry, which showed almost no deviation from the “target”. The presented results allowed us to formulate a decision to carry out the second operation. In the second clinical case, despite the absence of risk factors (optical biometrics was taken in two eyes, similar APA values), a postoperative refraction of +1.5 diopters was determined in the operated eye, which, apparently, is associated with the identified decrease (by 0.93 diopters) corneal curvature due to hydration of the corneal stroma in the area of surgical accesses and (or) changes in the tear film. The presented results allowed us to formulate a decision to postpone the second operation. At the same time, after a week, the restoration of the corneal tissue was noted, which was proved by the required (0.37 diopters) deviation of refraction from the target values.Conclusion. The use of mаISBCS technology provides the required clinical efficacy and can be recommended taking into account the epidemiological situation, especially for people with visually strenuous work.