Cases Of Cataract Surgery Research Articles

Study of visual outcomes and complications of cataract surgery in congenital cataract cases in tribal population of Jharkhand

Study of visual outcomes and complications of cataract surgery in congenital cataract cases in tribal population of Jharkhand

The role of vitreous management in the posterior capsule rupture associated with cataract surgery on the protection of the corneal endothelium.

Introduction:Advances in technology and technique have led to a significant improvement in the prognosis after cataract surgery. However, there are complications that can significantly affect this prognosis, such as posterior capsule rupture and corneal decompensation. For vitreous prolapse associated with posterior capsule rupture, classic or pars plana anterior vitrectomy is required.Aim:The aim of the study was to compare corneal endothelial cell destruction after cataract surgery associated with posterior capsule rupture and classical and pars plana anterior vitrectomy, respectively.Material and method:The study was prospective, on 12 consecutive cases of cataract surgery associated with posterior capsule rupture. Classical anterior vitrectomy was performed in group A, with 5 patients, while pars plana anterior vitrectomy was performed in group B. For all cases, the Stellaris phacoemulsification device (Baush & Lomb, tm) and the associated vitrectomy device was used.Results:Pars plana anterior vitrectomy had a statistically significant lower rate of corneal endothelial damage, both in absolute value and as a percentage of initial density.Conclusions:Pars plana anterior surgery is a somewhat unfamiliar technique for anterior pole surgeons. But it is easy to learn and brings a decrease in the rate of damage to the corneal endothelium.

Effect of surgical simulation training on the complication rate of resident-performed phacoemulsification

ObjectiveTo study the effect of additional training with ophthalmic surgical simulation on the intraoperative complication rates of phacoemulsification performed by residents.Methods and materialsThis was a retrospective study of phacoemulsification surgeries...

Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation.

This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after scleral-fixated sutured IOL implantation and evaluate the long-term outcomes of scleral re-fixation of IOL. The medical records of patients who underwent surgery for IOL dislocation between January 2011 and January 2021 were reviewed. The study included 164 patients (male: 131, female: 33) (176 eyes). Patient demographics, preoperative, intraoperative and postoperative data, and the ocular and systemic conditions associated with IOL re-dislocation were analyzed. The study included 176 consecutive cases of scleral-fixated sutured IOL. Twenty-six eyes (14.8%) showed re-dislocation of IOL after the initial IOL scleral fixation and underwent reoperation (mean 75.5 ± 62.5months after the first surgery); three (11.5%) of them required a third surgery. Younger adults (aged less than 40years), and patients who underwent IOL scleral fixation in complicated cataract surgery or aphakic state had a higher risk of re-dislocation. Diabetes mellitus (DM) was the only statistically significantly higher risk factor in the re-dislocated group (p = 0.041). The complication rate with scleral re-fixation was higher than that in the non-re-dislocated group. No statistically significant differences were observed, except for vitreous hemorrhage (p = 0.024). Caution should be exercised when performing sutured scleral fixation of IOL in younger patients, cases of complicated cataract surgery and aphakia, and patients with DM to prevent IOL re-dislocation. Scleral-fixated sutured IOL in eyes with recurrent IOL dislocation seems to be a safe and effective procedure with a relatively low complication rate.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary.

To compare the incidence of intraoperative complications during primary phacoemulsification (phaco) surgery between resident surgeons (residents) and staff surgeons (specialists) and to objectively determine the difficulty of stages in phaco surgery. This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists. A total of 3272 cases were included; 7.4% (n=241) of cases were performed by residents. The overall complication rate was 5.4% (n=177). The intraoperative complication rate was significantly higher (P<0.001) in residents (n=33, 13.7%) than in specialists (n=144, 4.8%). The most frequent complications were posterior capsule tear (n=85, 2.6%), anterior capsule tear (n=50, 1.53%), zonular fiber loss (n=45, 1.38%), and dropped nucleus (n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66 (60.0%), capsulorhexis in 21 (19.1%), irrigation/aspiration in 13 (11.8%), hydrodissection in 9 (8.2%), and intraocular lens (IOL) implantation in 1 (0.9%) case. Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study.

PURPOSE:To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs).METHODS:This single-center case–control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications.RESULTS:The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision.CONCLUSION:Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.

The Association of Ambient Air Pollution With Cataract Surgery in UK Biobank Participants: Prospective Cohort Study.

PurposeAir pollution is associated with chronic diseases of later life. Cataract is the most common cause of blindess globally. It is biologically plausible that cataract risk is increased by pollution exposure. Therefore, the relationship between air pollution and incident cataract surgery was examined.MethodsThis was a prospective, observational study involving 433,727 UK Biobank participants. Ambient air pollution measures included particulates, nitrogen dioxide (NO2) and nitrogen oxides (NOx). Outdoor air pollution was estimated based on land use regression models. Participants undergoing cataract surgery in either eye were ascertained via data linkage to the National Health Service procedure statistics. Those undergoing cataract surgery within 1 year of baseline assessment and those reporting cataract at baseline were excluded. Cox proportional hazards models were used to examine the associations between air pollutants and incident cataract surgery, adjusting for sociodemographic and lifestyle factors.ResultsThere were 16,307 incident cases of cataract surgery. Higher exposure to PM2.5 was associated with a 5% increased risk of incident cataract surgery (per interquartile range [IQR] increase). Compared to the lowest quartile, participants with exposures to PM2.5, NO2, and NOx in the highest quartile were 14%, 11%, and 9% more likely to undergo cataract surgery, respectively. A continuous exposure-response relationship was observed, with the likelihood of undergoing cataract surgery being progressively higher with greater levels of PM2.5, NO2, and NOx (P for trend P < 0.001).ConclusionsAlthough the results of our study showed a 5% increased risk of future cataract surgery following an exposure to PM2.5, NO2, and NOx, the effect estimates were relatively small. Further research is required to determine if the associations identified are causal.

Manufacturing defect of a Zeiss multifocal intraocular lens

Introduction: A case of cataract surgery with multifocal intraocular lens (IOL) insertion where the lens was found to have a manufacturing defect with decentred diffractive rings on the optic is reported. Patient and clinical findings: A toric AT LISA tri (Carl Zeiss Meditec AG) IOL was implanted into the capsular bag in the right eye of a 58-year-old woman. After implantation it was noted that the diffractive rings were off center and not aligned with the toric lens markings. Diagnosis, intervention, and outcomes: The IOL was explanted and another IOL of the same type and power was inserted. Conclusions: This case shows that centration defects of multifocal IOLs exist. Surgeons need to be aware of this and make sure they have instruments on hand for explantation and backup IOLs for each case.

Can a Set of Questions after Routine Cataract Surgery Predict Unexpected Findings and Avoid an Unnecessary Follow-Up Visit?

Background and Objectives: to evaluate whether a set of questions after a routine cataract surgery can predict unexpected findings and avoid an unnecessary follow-up visit. Materials and Methods: single-center, prospective, cohort study included 177 routine cataract surgery cases of two experienced surgeons between November 2019 and December 2020. Inclusion criteria included unremarkable postoperative day one follow-up examination. A set of seven questions regarding complaints with positive or negative answers was presented at the second follow-up visit (PV2)—one week (mean 8.34 ± 1.73 days) after the surgery. The outcome measures were the incidence of unexpected management changes (UMCs) at the PV2 visit (change or addition from a prescribed postoperative drop plan, extra procedures, an urgent referral to an ophthalmologist) and UMCs associations with the answers to a question set. Results: 81.4% of patients had no complaints about postoperative ocular status and answered with negative answers, 18.6% reported one or more complaint (positive answer): dissatisfaction with postoperative visual acuity (6.2%, 11 cases), eye pain (4.0%, 7 cases), increase in floaters after the surgery (4.0%, 7 cases), red eye (4.0%, 7 cases) and others. The prevalence of UMCs at PV2 was 1.7% (3 cases), of which 0.6% (1 case) was the prolonged antibiotic prescription due to conjunctivitis, 0.6% (1 case) was the addition of IOP lowering medication and 0.6% (1 case) was additional medication due to uveitis management. None of the complaints (positive answers) at PV2 were associated with the incidence of UMCs (p > 0.05). Conclusions: there were no associations of UMCs determined with positive answers to the questions. The prediction of UMCs incidence based on the positive answers was not obtained. Thus, we cannot exclude the necessity of a postoperative week one follow-up visit.

Temporal and Spatial Characteristics of Cataract Surgery Rates in China.

ObjectiveThe aim of the current study was to explore the spatial and temporal distribution characteristics of registered cases of cataract surgery in China from 2013 to 2017.MethodsA database for spatial analysis of cataract surgery in China in 2013–2017 was established using ArcGIS10.0 software as a platform for data management and presentation. Spatial autocorrelation analysis of cataract surgery was undertaken, and temporal and spatial scan analysis was done using SaTScan 9.5 software.ResultsFrom 2013 to 2017, annual cataract surgery rates (CSRs) in China were 1200, 1400, 1782, 2070, and 2205 per 1 million population, indicating a gradually increasing trend. Local Moran’s I autocorrelation analysis showed that there was spatial clustering of CSR in China, with Anhui being a low-high clustering region. Findings of global hotspot analysis Getis-Ord General G showed that General G index of national CSR was <0.01, Z = 1.12, P = 0.26. Findings of staged spatial-temporal scan analysis indicated that 18 areas of aggregation were found in 2 stages. Observed differences in each clustering area were statistically significant (P < 0.05).ConclusionCSRs in China showed increasing trend year by year and were randomly distributed, with spatial clustering, and Anhui was reported as a low-high clustering region. However, high-risk areas still persist, requiring focused attention and targeted prevention and control measures.

Is zero incidence of postoperative endophthalmitis after cataract surgery achievable

Purpose: For over 10 years, there have been zero cases of postoperative endophthalmitis (POE) after cataract surgery at Chatswood Private Hospital (CPH), Sydney, Australia. Study design: We conducted a retrospective audit study to evaluate the reasons for this, as well as the different preferences for route of antibiotic prophylaxis used. Methods: Deidentified data on cataract surgery cases for 2010–2020 were extracted and analyzed descriptively. Results: A total of 28,937 cataract surgery cases were performed at CPH from 2010-2020, for which no cases of POE were identified. The intracameral route for antibiotic prophylaxis was more commonly used compared to subconjunctival or both. Conclusion: Administration of prophylactic antibiotics, regardless of the route of administration, is beneficial and equally effective in preventing POE. Having operating theatres dedicated to ophthalmology helps maintain high standards of sterility of instrumentation and operating environments.

Toric IOL in Combined DMEK and Cataract Surgery.

IntroductionDescemet membrane endothelial keratoplasty (DMEK) is the current gold standard surgical procedure to treat Fuchs endothelial keratoplasty. Cataract removal and intraocular lens (IOL) implantation can be safely combined with this corneal procedure. This paper presents a case series in which a toric intraocular lens (IOL) was used in combined DMEK and cataract surgery to correct corneal astigmatism.MethodsFour eyes that had a toric IOL implanted in combined cataract and DMEK surgery were included.ResultsThere was a reduction in manifest refractive cylinder and improvement in uncorrected and best-corrected vision in all cases.DiscussionSurgeons may consider the use of toric IOLs in selected cases of combined DMEK and cataract surgery for Fuchs endothelial dystrophy.

Functional Monitoring after Trabeculectomy or XEN Microstent Implantation Using Spectral Domain Optical Coherence Tomography and Visual Field Indices-A Retrospective Comparative Cohort Study.

Simple SummaryPrimary open-angle glaucoma leads to a loss of retinal ganglion cells and a reduction in the retinal nerve fiber layer thickness, consequently leading to the development and growth of visual field defects. In its final stages, this results in visual loss and irreversible blindness if not treated adequately. A reduction in the intraocular pressure by means of medication and/or surgery is the only known treatment option for slowing, or at best, arresting disease progression. This study demonstrates that trabeculectomy and XEN microstent implantation are nearly equally effective techniques for reducing intraocular pressure and stabilizing visual acuity and pre-developed visual field defects over a follow-up period of 24 months after surgery. However, further analysis using spectral domain optical coherence tomography revealed that disease progression occurs in terms of further retinal nerve fiber layer loss after both trabeculectomy and XEN microstent implantation.The aim of this study was to compare the efficacy of trabeculectomy (TE), single XEN microstent implantation (solo XEN) or combined XEN implantation and cataract surgery (combined XEN) in primary open-angle glaucoma cases, naïve to prior surgical treatment, using a monocentric retrospective comparative cohort study. Intraocular pressure (IOP) and the number of IOP-lowering drugs (Meds) were monitored during the first 24 months after surgery. Further disease progression was monitored using peripapillary retinal nerve fiber layer (RNFL) thickness examinations using spectral domain optical coherence tomography (OCT) as well as visual acuity (VA) and visual field (VF) tests. In the TE group (52 eyes), the mean IOP decreased from 24.9 ± 5.9 to 13.9 ± 4.2 mmHg (p < 0.001) and Meds decreased from 3.2 ± 1.2 to 0.5 ± 1.1 (p < 0.001). In the solo XEN (38 eyes) and the combined XEN groups, the mean IOP decreased from 24.1 ± 4.7 to 15.7 ± 3.0 mmHg (p < 0.001) and 25.4 ± 5.6 to 14.7 ± 3.2 mmHg (p < 0.001), while Meds decreased from 3.3 ± 0.8 to 0.8 ± 1.2 (p < 0.001) and 2.7 ± 1.2 to 0.4 ± 1.0 (p < 0.001), respectively. The VF and VA indices showed no sign of further deterioration, the RNFL thickness further decreased in all treatment groups after surgery. TE and XEN led to comparable reductions in IOP and Meds. Although the VA and VF indices remained unaltered, the RNFL thickness continuously decreased in all treatment groups during the 24-month follow-up.

Acute Infectious Endophthalmitis After Cataract Surgery: Epidemiological Characteristics, Risk Factors and Incidence Trends, 2008-2019.

ObjectiveIntended to investigate the epidemiological characteristics, risk factors and incidence trend of endophthalmitis after cataract surgery in recent 12 years.MethodsA retrospective study was conducted on the patients who underwent cataract surgery in Qingdao Eye Hospital from January 1, 2008, to December 31, 2019, including age, sex, history of diabetes, intraoperative operation and complications. In addition, the related risk factors and incidence trend of acute infective endophthalmitis were analyzed. The incidence of endophthalmitis and its related factors were analyzed by univariate and multivariate logistic regression analysis.ResultsA total of 55,612 cases of cataract surgery were performed in our hospital in 12 years, and 42 cases of acute infective endophthalmitis occurred (the incidence rate was 0.076%). The average occurrence time was 10.57 days ± 11.17, with eye pain as the main complaint and anterior chamber fibrin exudation as the main clinical manifestation. In addition, there were eight cases of anterior chamber hypopyon and 18 cases of vitreous reaction, the results of anterior aqueous humor or vitreous fluid culture in 10 patients were positive. Univariate analysis showed that intraoperative rupture of posterior capsule, non-use of antibiotics and non-use of behind-the-lens washout were the risk factors of infectious endophthalmitis after cataract surgery (P=0.032, P=0.000, P=0.000). Besides, multivariate logistic regression analysis showed that intraoperative rupture of posterior capsule was the main risk factor.ConclusionThe occurrence of endophthalmitis after cataract surgery is mainly related to intraoperative rupture of posterior capsule, absence of antibiotics and behind-the-lens washout. In addition, the incidence of endophthalmitis after cataract surgery decreased during the past 12 years.

Case Report: Retained Lens Fragment in the Anterior Chamber 32 Years after Cataract Surgery

A 73-year-old Asian male presented to the eye clinic reporting a sudden onset of redness, irritation, and light sensitivity of the right eye 32 years after cataract surgery. While retained lens fragment in the anterior segment is an uncommon complication of cataract surgery, this case highlights a unique complication that should be considered as a differential diagnosis for cases of post-operational cataract surgery. It is important to consider a retained lens fragment as a differential when examining pseudophakic patients. Retained lens fragments can present weeks to years after cataract surgery with the more chronic cases secondary to nuclear fragments. Topical medications such as corticosteroids, non-steroidal anti- inflammatories, and cycloplegics can be used in treatment of the acute antiinflammatory event. If persistent inflammation and/or cystoid macular edema becomes an issue, management with subspecialty ophthalmology to remove the lens fragment is warranted. This case represents the longest time in literature between cataract surgery and the appearance of the retained lens fragment. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/case-report-retained-lens-fragment-in-the-anterior-chamber-32-years-after-cataract-surgery) Please check COPE course expiry dates prior to enrollment. The COPE course test must be taken before the course expiry date.

Alcohol Consumption and Incident Cataract Surgery in Two Large UK Cohorts

PurposeTo examine the association of alcohol consumption and type of alcoholic beverage with incident cataract surgery in 2 large cohorts.DesignLongitudinal, observational study.ParticipantsWe included 469 387 participants of UK Biobank with a mean age of 56 years and 23 162 participants of European Prospective Investigation of Cancer (EPIC)-Norfolk with a mean age of 59 years.MethodsSelf-reported alcohol consumption at baseline was ascertained by a touchscreen questionnaire in UK Biobank and a food-frequency questionnaire in EPIC-Norfolk. Cases were defined as participants undergoing cataract surgery in either eye as ascertained via data linkage to National Health Service procedure statistics. We excluded participants with cataract surgery up to 1 year after the baseline assessment visit or those with self-reported cataract at baseline. Cox proportional hazards models were used to examine the associations of alcohol consumption with incident cataract surgery, adjusted for age, sex, ethnicity, Townsend deprivation index, body mass index (BMI), smoking, and diabetes status.Main Outcome MeasuresIncident cataract surgery.ResultsThere were 19 011 (mean cohort follow-up of 95 months) and 4573 (mean cohort follow-up of 193 months) incident cases of cataract surgery in UK Biobank and EPIC-Norfolk, respectively. Compared with nondrinkers, drinkers were less likely to undergo cataract surgery in UK Biobank (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.85–0.93) and EPIC-Norfolk (HR, 0.90; 95% CI, 0.84–0.97) after adjusting for covariables. Among alcohol consumers, greater alcohol consumption was associated with a reduced risk of undergoing cataract surgery in EPIC-Norfolk (P < 0.001), whereas a U-shaped association was observed in the UK Biobank. Compared with nondrinkers, subgroup analysis by type of alcohol beverage showed the strongest protective association with wine consumption; the risk of incident cataract surgery was 23% and 14% lower among those in the highest category of wine consumption in EPIC-Norfolk and UK Biobank, respectively.ConclusionsOur findings suggest a lower risk of undergoing cataract surgery with low to moderate alcohol consumption. The association was particularly apparent with wine consumption. We cannot exclude the possibility of residual confounding, and further studies are required to determine whether this association is causal in nature.

Opportunities to Reduce Potential Bias in Ophthalmic Cost-Utility Analysis

Select research methods in cost-utility analysis (incremental cost-effectiveness analysis) might potentially bias against patient value (quality-adjusted life-year [QALY]) gain and cost-effectiveness associated with common ophthalmic interventions in disabled, elderly, and African American populations. To ascertain whether using nonpatient vision utilities and/or a maximum limit model constraining vision utility gain to the systemic comorbidity utility level biases against ophthalmic cost-utility outcomes. This economic evaluation predominantly used data from the Center for Value-Based Medicine database to perform preference-based comparative effectiveness and cost-utility analyses for cataract surgery and intravitreal ranibizumab therapy for neovascular age-related macular degeneration (NVAMD) using vision utilities acquired from patients with ophthalmic disease (ophthalmic patient utilities) and from surrogate individuals (nonophthalmic patient vision utilities) with and without integrating systemic comorbidity utility limits on vision utility gain. Ophthalmic patient data were collected from January 1, 2000, to December 31, 2016, and analyzed from April 1 to July 1, 2020. Cost-utility analysis with 3% discount rate in 2018 US dollars. QALY gains and dollars expended per QALY gain (the cost-utility ratio). A total of 309 participants in the nonophthalmic patient cohort and 505 patients in the ophthalmic patient cohort were included. A reference case of first-eye cataract surgery using ophthalmic patient vision utilities and no systemic comorbidity utility limits yielded a 2.574 (34.2%) QALY gain vs observation. Substituting nonophthalmic patient utilities resulted in a 1.502 (15.5%) QALY gain, whereas using the 0.76 patient systemic comorbidity utility to limit cataract surgery vision utility gain yielded a 1.337 (17.8%) QALY gain. Using both nonophthalmic patient utilities and systemic comorbidity utility limits yielded a 0.839 (8.7%) QALY gain. The substitutions decreased cataract surgery cost-effectiveness by 71.3% (95% CI, 70.6%-72.1%) for nonophthalmic patient utilities, 92.5% (95% CI, 51.9%-133.1%) for patient systemic comorbidity utility, and 206.8% (95% CI, 202.6%-211.2%) for both. The NVAMD ranibizumab therapy reference case yielded a 1.339 (26.1%) QALY gain. Similar substitutions resulted in QALY gains of 1.164 (22.7%) for nonophthalmic patient utilities while reducing cost-effectiveness by 16.4%, 1.001 (19.5%) for systematic-limiting comorbidity utility while reducing cost-effectiveness by 33.8%, and 0.971 (18.9%) for both while reducing cost-effectiveness by 37.9%. Using nonophthalmic patient vision utilities and/or the maximum limit model of limiting patient utility gains to the population systemic comorbidity utility level resulted in large decreases in patient value (QALY) gain and cost-effectiveness for common ophthalmic interventions. Ophthalmologists should realize these phenomena and consider correcting the potential discrimination against disabled, elderly, and African American populations. This negative potential bias could theoretically result in beneficial intervention denial, less research dollars, curbed therapeutic advances, and decreased interventional reimbursement.

Comparative study of phacoemulsification parameters with and without nitinol filament nuclear disassembly.

The purpose of this study was to evaluate the impact of nitinol microfilament lens disassembly using the miLOOP device on phacoemulsification parameters in routine cataract surgery. Private practice in Cleveland, Ohio. Retrospective comparative consecutive case series. A chart review of consecutive cataract surgery cases in a single center operated by a single surgeon was conducted. Eyes were grouped by whether they underwent nitinol filament nuclear disassembly. Phacoemulsification energy, phacoemulsification time, and irrigation/aspiration (I/A) recorded during the operation were compared. Bilateral eyes were included only if the contralateral eye was in the opposite group. A total of 212 eyes in 131 patients were eligible for analysis, including 81 subjects with both eyes. Most eyes (93%) had grade 2+ or 3+ nuclear sclerotic cataracts. A total of 102 eyes (48%) underwent nitinol filament nuclear disassembly preceding phacoemulsification. For all eyes, there was a 16% reduction in phacoemulsification energy, with a larger drop in grade 3+ eyes (-22%). Phacoemulsification and I/A times also reduced significantly (-19% and -37%, respectively, P < .02). Nitinol microfilament nuclear disassembly reduced total phacoemulsification energy and time during cataract surgery, particularly in severe cataracts.

Cataract surgery in a patient with bilateral necrotising scleritis and peripheral ulcerative keratitis associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)

Introduction. We report a rare case of cataract surgery in a patient with an extreme, widespread anterior staphyloma following severe bilateral necrotising anterior scleritis associated with granulomatosis with polyangiitis (GPA). Case report. A 61-year-old man with a history of GPA developed bilateral, rapidly progressive necrotising scleritis and peripheral ulcerative keratitis (PUK). Inflammation compromised the entire anterior globe and peripheral cornea in both eyes. More than 90% of the surface area healed within 8 weeks, following the treatment with 3 pulsed doses of methylprednisolone in addition to the cyclophosphamide treatment. Systemic steroid therapy was slowly tapered over a period of 6 months. Extraordinary scleral loss with a uveal bulge developed, following severe necrotising anterior scleritis associated with PUK. Once the full remission had been achieved after 6 months, uncomplicated phacoemulsification was performed in his left eye, the only functional one. Conclusion. Preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical techniques are critically important for optimal surgical outcome in such patients. To our knowledge, phacoemulsification in a patient with coexisting uveitic cataract and severe anterior staphyloma has not been previously reported.

Technique for posterior segment evaluation in paediatric cases undergoing cataract surgeries

We have devised a novel technique for intraoperative fundus assessment which we routinely use in our paediatric cataract surgery cases. After the routine steps of paediatric lens aspiration, just before...