Cataract Extraction Surgery Research Articles

Diagnosis of cystoid macular edema by comparison of pre-operation and post-operation macular thickness calculated by optical coherence tomography (OCT) after cataract extraction surgery with and without pre-operative use of NSAIDS.

ABSTRACT… Objective: To compare mean macular thickness after cataract extraction surgery with and without pre-operative NSAIDs. Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, Madinah Teaching Hospital, Faisalabad. Period: 21-10-2022 to 20-04-2023. Methods: Total 640 patients (320 in each group) were involved in the study. In group-A patients received one drop of NSAID three times a day for one day prior surgery. In group-B, patients not received NSAID. Results: Results showed that there was a total 395 males and 245 females. Mean age of the patients was 48.24±5.54 in group A and 47.05±5.20 in group B. Comparison of macular thickness showed that thickness was 215.69±14.20 in group A and 227.99±06.09 in group B. There was a significant difference in macular thickness of two groups (P <0.001). Conclusion: In conclusion, preoperative usage of NSAIDs revealed statistically significant (p0.001) and clinically relevant benefits in avoiding macular edoema and preserving visual acuity in patients undergoing cataract surgery as compared to the non-NSAIDs group.

SUSTAINED-RELEASE LOW-DOSE FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT FOR CHRONIC POSTOPERATIVE CYSTOID MACULAR EDEMA: TWO CASE REPORTS.

To describe two cases of patients diagnosed with chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis who had limited treatment response to previous corticosteroid modalities and then received a single intravitreal fluocinolone 0.18-mg implant. Chronic postoperative cystoid macular edema (CME) may occur after intraocular surgery and is a common cause of postoperative visual loss. Sometimes called Irvine-Gass syndrome or persistent pseudophakic CME, chronic postoperative CME complicates roughly 0.1% to 2.0% of low-risk, small-incision phacoemulsification surgeries. There are a number of conventional approaches to chronic postoperative CME management, including topical corticosteroids with or without nonsteroidal anti-inflammatory drugs, intravitreal corticosteroid injections, and vascular endothelial growth factor (VEGF) inhibitor injections, but these options have several limitations. A major shortcoming of conventional formulations of anti-inflammatory therapies for chronic postoperative CME (i.e., topical drops, intraocular, and periocular injections) is the need for repeated dosing in chronic cases, which is expensive and burdensome to patients. Series of two case reports. Patient 1, a 75-year-old Latina woman, presented with a history of longstanding, recurrent inflammation after cataract extraction and subsequent vitreoretinal surgeries. Patient 2, an 85-year-old white woman, presented with acute blurred vision, swelling, and pain 5 years after cataract surgery and laser peripheral iridotomy. Both were diagnosed with chronic postoperative CME and ultimately treated with the 3-year sustained-release fluocinolone acetonide intravitreal implant (FAi) 0.18 mg. Compared with baseline, both patients experienced resolution of their disease symptoms, >3 lines of visual acuity improvement, and macular edema reduction of 56.2% and 38.4% at 15 and 6 months, respectively, after the fluocinolone implant. No steroid related adverse events including any intraocular pressure measurement >25 mmHg were observed. A single intravitreal fluocinolone 0.18-mg implant can effectively and safely treat vision loss and increased central macular thickness because of chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis. The FAi 0.18 mg provides a safe, long-acting, low-dose anti-inflammatory treatment in patients with noninfectious posterior-segment inflammation associated with chronic postoperative CME.

Impact of dexmedetomidine as an adjuvant to peribulbar anesthesia on the retinal vasculature in glaucoma patients: an optical coherence tomography angiography study

Objectives To assess Dexmedetomidine’s effect as an adjuvant to peribulbar anesthesia on the retinal vasculature in patients with glaucoma undergoing cataract extraction surgery via optical coherence tomography angiography (OCT-A). Participants Thirty-nine glaucoma participants planned for phacoemulsification were allocated into two groups. A 10 ml mixture of peribulbar anesthesia was administered to group I. This anesthetic mixture consisted of 4.5 ml of lidocaine 2% mixed with 4.5 ml of bupivacaine 0.5%,1 ml of dexmedetomidine (50 µg), and 150 IU hyaluronidase. Group II was administered a peribulbar anesthetic mixture consisting of 4.5 ml of lidocaine 2% combined with 4.5 ml of bupivacaine 0.5%,150 IU of hyaluronidase, and 1 ml of normal saline, totaling 10 ml. Optical coherence tomography angiography was used 10 mi before and 10 min after injection to scan optic disc total vessel density, foveal superficial deep capillary plexuses (DCP) density, radial peripapillary capillary network density, and total vessel density plus foveal avascular zone (FAZ) diameter. We also checked the intraocular pressure (IOP) before and 10 min after the anesthetic injection. Results After the administration of the peribulbar anesthetic, group II demonstrated a notably higher significance in the DCP fovea median percent change (–43.7%) compared with group I (-2%) (P<0.001). Additionally, group II experienced a considerably greater median percent change in DCP total density (–22.4%) postinjection compared to group I (–0.8%) (P value < 0.001). The postinjection median percent changes in foveal total vessel density and superficial vessel density were −16.2% and −56.8% in group II, and −1% and −2.4% in group I, respectively, with a P value less than 0.001. Moreover, following the injection, the median percentage change in the diameter of the foveal avascular zone was significantly higher in group II (–40.6%) than in group I (–2.3%) (P value < 0.001). Additionally, there was a noteworthy increase in the optic disc’s total vessel density and the median percentage shift in radial peripapillary capillary network density in group II (–13.1 and −13.7%, respectively) compared with group I (–1.2 and −1%, respectively, P value < 0.001). IOP before and after injecting the anesthesia was insignificantly different between the studied groups (P =0.198 and 0.069, respectively). Conclusion The addition of dexmedetomidine to the peribulbar anesthesia demonstrates a protective effect on the retinal microvasculature against the ischemic impact of anesthetic drugs with no significant effect on the IOP. This effect holds significant implications for glaucoma patients.

Capsular Tension Ring and Iris Hook Use in The Management of Cataract with Phacoemulsification Method in Dogs

The purpose of this study is to evaluate the surgical outcome of capsular tension ring and iris hook use during phacoemulsification in dogs with zonular weakness and miotic pupils. This study includes nineteen dogs (29 eyes) that underwent phacoemulsification (15 dogs/25 eyes) and extracapsular cataract extraction surgery (4 dogs/4 eyes) between February 2014 and February 2015. Patients with any ophthalmic problem other than cataracts were not included in the study. Some dogs did not achieve pharmacologic pupil dilation. These dogs required the use of iris hooks or the insertion of capsular tension rings. The capsular tension ring insertion was used in dogs with zonular rupture in more than half of the zonules. Capsular tension rings were inserted in cases of zonular dialysis and iris hooks were placed to widen the pupil. Fifteen dogs (25 eyes) underwent phacoemulsification, while 4 (4 eyes) received extracapsular cataract extraction (ECCE) surgery due to the difficulty of phacoemulsification in hypermature cataracts. Iris hooks were used in four dogs (8 eyes) for drug-resistant miotic pupils. Capsular tension rings were inserted to stabilize the lens capsule during phacoemulsification and to centralize the intraocular lens (IOL) in the bag. Capsular tension rings in cases of zonular dialysis and iris hooks in drug-resistant miotic pupils improved the success of cataract operations with phacoemulsification. Both are safe and useful for zonular weakness and for maintaining mydriasis during surgery.

Teaching of manual cataract extraction in ophthalmic surgical training programmes

BackgroundManual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.AimsThis study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.MethodsAn electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.ResultsNineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1–3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.ConclusionsThere is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.

FREQUENCY OF CYSTOID MACULAR EDEMA ON OPTICAL COHERENCE TOMOGRAPHY IN TWO DIFFERENT TYPES OF CATARACT SURGERY

Cystoid macular edema (CME), also known as Irvine-Gass syndrome, has been recognized as a non-specific manifestation of various ocular conditions, with cataract surgery being a significant contributing factor. First reported by Sir Irvine in 1953 and further discussed by Sir Norton in 1966, CME following cataract surgery remains a topic of interest and concern in ophthalmology. The precise etiology of CME in post-cataract surgery patients remains elusive; however, it is widely accepted that post-surgical inflammation plays a pivotal role. To address this issue, we conducted a comparative study to assess the frequency of CME using spectral-domain optical coherence tomography (SD-OCT) in patients undergoing extracapsular cataract extraction (ECCE) versus phacoemulsification cataract surgeries. The study was conducted at the Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences; Medical Teaching Institute Hayatabad Medical Complex, Peshawar, over a period of 6 months. Utilizing a randomized controlled trial design and non-probability consecutive sampling, we determined a sample size of 70 patients, with 35 patients allocated to each group (Group A: ECCE, Group B: Phacoemulsification). The age of the participants ranged from 50 to 85 years, with a median of 60 years and a mean of 65±8 years. Our findings revealed that CME was observed in 11% of patients in Group A and 6% in Group B, indicating a lower frequency in post-operative cases. However, the difference in CME incidence between ECCE and phacoemulsification cases was not statistically significant. These results suggest that the risk of CME in post-operative cases may be influenced by various factors, including surgical technique and patient-specific variables. In conclusion, our study contributes to the understanding of CME following cataract surgery and underscores the importance of continued vigilance and further research in this area. Improved surgical techniques and perioperative management may help mitigate the risk of CME and enhance patient outcomes in the postoperative period.

Appropriate addition power for aphakic infants determined by a smart wearable device Clouclip

ABSTRACT Clinical relevance It is particularly important to perform reasonable and effective optical correction to enable visual development after primary lens removal surgery for congenital cataracts. Aphakic infants need a suitable addition power of prescription (ADD) to help them focus on close visual objects. Background It is challenging to obtain appropriate ADD power for infants due to poor cooperation and lack of subjective feedback. We aimed to determine the appropriate ADD for aphakic infants using a recently developed smart wearable device called Clouclip. Methods The study was a cross-sectional, observational pilot study. Twenty-three aphakic infants (aged from 6 months to 3.5 years) were invited to wear a smart wearable device for 7 days consecutively to monitor the near viewing distance in real life. Viewing habits and its associations with the possible influencing factors were investigated based on the data obtained from the device. Results The average proportion of near viewing time was 77.9% (95% confidence interval (CI) 72.1–83.7%). The average of the median near viewing distance was 23.8 cm (95% CI 20.6 cm-27.0 cm), which corresponded to an ADD of +4.25 D (95% CI + 3.75 D – +4.75 D) spectacle prescription. The height of the child was found to be positively correlated with the median of near viewing distance (r = 0.646, p = 0.001). Age, current ADD, age of cataract extraction surgery and bilaterality or monocularity of the aphakic eyes showed no significant correlation with the aforementioned viewing habits (all p > 0.05). Conclusion By using the novel wearable device, we found the suitable ADD of spectacle prescription for aphakic infants is about +4.25 D. The height of the child was an influencing factor for ADD.

HEBREW TRANSLATION AND VALIDATION OF THE CATQUEST- 9SF QUESTIONNAIRE

Aims: The purpose of this study is to translate and validate a Hebrew version of the Catquest-9SF questionnaire, an efficient patient-reported outcome measure (PROM), for the assessment of cataract surgery outcome Methods: This is a prospective questionnaire validation study. The Catquest-9SFquestionnaire was translated from English to Hebrew following a standard procedure. The study population included candidates for cataract extraction surgery in both eyes. They were 21 years of age or older, Hebrew-speaking, and had Internet access. They completed the questionnaire in 2 stages, once before the surgery on the first eye and again 4-6 weeks following the surgery on the second eye. A Rasch analysis was performed to validate the Hebrew version of the questionnaire, and a sensitivity analysis was performed for the patients who completed both the preoperative and postoperative questionnaire. Results: Of the 133 patients included in the study, 125 completed the first questionnaire, and 24 also completed the second questionnaire by the time of study closure. The Hebrew translation of Catquest-9SF demonstrated 1-dimensionality, ordered response categories and good person separation. The sensitivity analysis on the 24 paired Catquest-9SF questionnaires showed good effect size (1.85). Conclusions: The Hebrew versions of the Catquest-9SF questionnaire is valid and reliable with psychometric properties of good quality and good effect size. It is applicable to Hebrew-speaking cataract patients for clinical assessment and research purposes

MANAGEMENT OF PHACOMORFIC GLAUCOMA WITH FILTRATION SURGERY

Introduction : Phacomorphic glaucoma is form of glaucoma that occurs due to a swollen cataractous lens. Filtration surgery in one of the option for managing phacomorphic glaucoma. This surgical approach can be effective in controlling intraocular pressure and preventing further damage to the optic nerve
 Case Illustration : A 53 yo female complaints of progressively blurry vision in her left eye. The LE visual acuity 6/30 and IOP 25,9. The gonioscopy showed a close-angle impression in all quadrants, VH gr 1. Also thereis increase lens opacity , Posterior segment examination revealed ]cup/disc ratio of 0.9 and cupping. The patient was diagnosed with secondary glaucoma (phacomorphic). Filtration surgery of trabeculectomy + 5-FU is performed
 Discussion : The patient was treated with trabeculectomy and 5-FU, resulting in IOP to 17 mmHg. The surgical procedure is aim to reduce intraocular pressure to create a channel and reservoir for blocked aqueous humor, resulting in decreased IOP and stopping the damage process to the optic nerve. This approach aims to increase the success rate and reduce the likelihood of complications during the operation.
 Conclusion : The limportance of prompt management of phacomorphic glaucoma to prevent permanent vision loss, and the use of trabeculectomy as an effective surgical approach in controlling intraocular pressure and preventing further damage to the optic. Cataract extraction surgery remains the definitive therapy for phacomorphic glaucoma cases, and this approach should be considered in the future management of the patient

Энергетическая хирургия катаракты в Санкт-Петербургском филиале МНТК «Микрохирургия глаза»: анализ 27-летнего опыта

Purpose. Based on a comparative analysis of the results of using various laser methods of cataract treatment in the process of developing energy surgery in the St. Petersburg branch The S. Fyodorov Eye Microsurgery Federal State Institution, to determine the advantages and disadvantages of the technologies used. Material and methods. Analysis of the results of laser cataract extraction, ultrasonic phacoemulsification and combined surgery is based on data from a study of 28 802 surgical interventions (Phacoemulsification (Phaco) – 15 520, laser cataract extraction (LCE) – 7945, FemtoPhaco – 5135, FemtoLCE – 202) performed over the period 1995–2022. Results.The operative complication rate was 0.6, 0.55, 0.5 and 0% for Phaco, LCE, FemtoPhaco and FemtoLCE respectively. Visual acuity after LCE and FemtoLCE >0.8 was observed in more than 70% of cases, and in other groups such a functional result was achieved in 57% of cases. Comparing the postoperative spherical equivalent, a significant difference was noted only between the FemtoPhaco and standard Phaco (p=0.03), and between FemtoLCE and LCE groups (p=0.01), it indicates the advantage of femtolaser support for cataract surgery getting in target refraction. Analysis of endothelial cells loss reflects a significant advantage in groups with femtolaser support (p=0.01; p=0.02), as well as in the group of LCE and FemtoLCE over standard Phaco (p=0.01; p=0.02, respectively). Conclusion. Laser cataract extraction is an effective and safe technology that can be compared to ultrasonic phacoemulsification. The use of femtosecond laser assistance provides significantly lower deviation from the planned postoperative refraction. Modern laser technologies are safe and can reduce the risk of endothelial loss more effectively than standard Phaco. Key words: laser cataract extraction, femtosecond laser, femto laser assisted cataract surgery, cataract phacoemulsification, endothelial cell density

Assessment of Cataract Risk after Diagnostic Head CT Scan Radiation Exposure in Ontario, Canada.

Ionizing radiation is one of the known risk factors for cataract development, however, there is still debate regarding the level of risk after low dose exposures. One of the largest sources of radiation exposure to the lens of the eye is diagnostic CT scans. The aim of this study was to examine whether ionizing radiation associated with head CT scans increases cataract risk in residents of Ontario, Canada. Data were collected from January 1, 1994 to December 31, 2015 (22 years) from anonymized Ontario Health Insurance Plan (OHIP) medical records for over 16 million subjects. A lens dose was estimated for each CT scan using the National Cancer Institute dosimetry system for CT (NCICT) program combined with Canada-specific CTDIvol data. Multivariate Cox proportional hazards analysis was performed with cataract extraction surgery as the primary outcome and lens dose as the main variable of interest, with inclusion of various medical and demographic covariates. Lag periods of 3, 5 and 7 years were incorporated. When lens dose was treated as a continuous variable, hazard ratios (per 100 mGy) ranged from 0.82 (0.80-0.84) to 1.10 (1.09-1.11) depending on the lag period. As a secondary analysis, when individuals were binned based on their total cumulative dose, no significant dose response pattern was observed in the low dose region. Overall, within the bounds of this study, the data do not support an increased risk of vision impairing cataracts after diagnostic head CT scan radiation exposure.

Prediction of MIGS outcomes on second eyes using first eyes' response.

To evaluate how well outcomes following cataract extraction and microinvasive glaucoma surgery in one eye predict outcomes in sequential second eye. Retrospective study of 78 patients who underwent cataract extraction and microinvasive glaucoma surgery in both eyes. Linear regressions using Pearson correlation coefficients were used to evaluate correlations in intraocular pressure and glaucoma medication change between eyes. Multivariable logistic regression models were used to evaluate the associations between first-eye variables and the likelihood of second-eye surgical success at 6 months. Surgical success was defined as meeting target intraocular pressure without additional medications compared to baseline or secondary surgical interventions. Baseline ocular characteristics were comparable between fellow eyes, with the majority having mild glaucoma. Intraocular pressure changes between fellow eyes at 6 months were modestly correlated between eyes (R = 0.48; P < .001). Changes in glaucoma medications were strongly correlated between eyes at all time points, and month 6 demonstrated the most significant correlation (R = 0.80; P < .001). First and second eye cohorts achieved 82% and 83% surgical success. Multivariate analysis for predictive factors of successful second eye surgery showed patients with successful first eye surgery at 6 months were significantly more likely to have successful second eye surgery (odds ratio, 20.67; P < .001). Reductions in intraocular pressure and glaucoma medications at 6 months following surgery in first eyes are correlated to second eye reductions. Successful surgical outcomes at 6 months following first eye surgeries are strongly associated with successful sequential second eye outcomes.

Endoscopy-assisted pars plana vitrectomy in retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes

BackgroundProliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes.MethodsRetrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients’ demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance.ResultsEighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year.ConclusionE-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

Clinical Factors Associated With Long-Term OCT Variability in Glaucoma

To examine clinical factors associated with long-term optical coherence tomography (OCT)-measured retinal nerve fiber layer thickness (RNFLT) variability in glaucoma. Retrospective cohort study. Glaucoma eyes from DIGS/ADAGES with≥2-years and 4-visits follow-up were included. RNFLT variability was calculated per-visit as the absolute error of optic nerve head RNFLT residuals across longitudinal follow-up. Clinical factors examined included general demographics, baseline ocular measurements, prior and intervening cataract extraction (CE) or glaucoma surgery, scan quality, baseline RNFLT and RNFLT thinning rate, follow-up duration, visit/testing frequency, etc. Three multivariable linear mixed models (full model, baseline model, and parsimonious model) were fit to evaluate the effects of clinical factors on RNFLT variability, with ten-fold cross-validation to estimate real-world model performance. A total of 1140 eyes (634 patients) were included. The overall mean (95% CI) RNFLT variability was 1.51(1.45, 1.58) µm. Across different models, African-American race (β[standard error, SE] = 0.18[0.06]), intervening CE (β[SE] = 0.52[0.07]), intervening glaucoma surgeries (β[SE] = 0.15[0.03]), and more positive RNFLT thinning rate (β[SE] = 0.06[0.02] per 1um/year more positive) showed consistent association with greater RNFLT variability, whereas more frequent visits/testing (β[SE] = -0.11[0.05] per 1 visit/year higher) was associated with smaller RNFLT variability (P<0.05 for all). Relevant clinical factors affecting long-term RNFLT variability in glaucoma were identified. These data enhance the evaluation of longitudinal structural change. Increasing the testing frequency, especially in eyes at risk of higher measurement variability, and resetting of baseline imaging after intervening procedures may help to more reliably detect OCT progression.

Comparison of the Barrett toric calculator using measured and predicted posterior corneal astigmatism and the Kane and Abulafia-Koch calculators.

To compare the accuracy of the Barrett toric calculator with measured and predicted posterior corneal astigmatism (MPCA and PPCA, respectively), the Abulafia-Koch (AK) formula, and the toric Kane formula. Ein-Tal Eye Center, Tel-Aviv, Israel. Retrospective cohort. Consecutive cases of patients who underwent uneventful cataract extraction surgery with implantation of a toric intraocular lens between March 2015 and July 2019 were retrospectively reviewed. 1 eligible eye from each patient was included. The predicted postoperative refractive astigmatism was calculated using each method and compared with the postoperative refractive astigmatism to give the prediction error. 80 eyes of 80 patients were included in this study. The mean centroid and the mean and median absolute prediction errors using Kane (0.25 diopters [D] ± 0.54 @ 6 degrees, 0.50 D ± 0.31 and 0.45 D, respectively) were significantly different compared with MPCA (0.12 D ± 0.52 @ 16 degrees, P < .001, .44 D ± 0.28 and 0.36 D, P = .027, respectively), PPCA (0.09 D ± 0.49 @ 12 degrees, P < .001, .41 D ± 0.27 and 0.35 D, P < .001, respectively), and AK (0.11 D ± 0.49 @ 11 degrees, P < .001, .42 D ± 0.27 and 0.35 D, P = .004, respectively). No significant differences were found between the calculators in the predictability rates within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D. The measured posterior corneal curvature in the Barrett calculator yielded comparable outcomes to its prediction by the Barrett and AK formulas. The Kane calculator showed a slight against-the-rule prediction error compared with the other methods, resulting in a small higher median absolute error with marginal clinical importance.

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Is Demodex Blepharitis Connected With Cataract Surgery?

To determine whether there is an increased incidence of Demodex of the eyelashes among patients after cataract extraction surgery. Prospective, noncomparative clinical study. A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively that were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated 3 weeks after surgery. During several postoperative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. A total of 62 patients were included in the study (31 men and 31 women), with a mean age of 71.04 years (range, 47-87). In the group positive for Demodex, the male-to-female ratio was 2:3 (P=.2772). Demodex colonization was observed in 22.58% of samples before cataract surgery and in 32.26% after cataract surgery and topical postoperative steroid therapy (P=.0143). There is a statistically significant increase in Demodex colonization of eyelashes after cataract surgery and postoperative topical steroid treatment. Although Demodex colonization does not necessarily cause blepharitis, our findings of increased colonization should raise the possibility of Demodex blepharitis being considered by ophthalmologists in patients with chronic postoperative eye discomfort after cataract surgery. This study was carried out at the Emek Medical Center.

Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery

BackgroundTo compare the clinical outcomes of patients undergoing sequential pars plana vitrectomy (PPV) followed by cataract extraction surgery (CE) [PPV/CE], simultaneous PPV and CE (PPV + CE), and sequential CE followed by PPV [CE/PPV].MethodsA retrospective observational cohort study of 427 eyes of 404 patients who underwent either sequential or simultaneous PPV and CE surgery between March 2016 and May 2021. Pre-operative and post-operative assessments (up to 2 years of follow-up visits) of uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SEQ), and refractive prediction error (RPE) was done. Main outcome measures were both visual (UCVA, CDVA) and refractive (RPE, SEQ).ResultsThere was a statistically significant difference in CDVA of the PPV/CE, PPV + CE, CE/PPV groups (logMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively) at one month postoperatively (POM1) (P < 0.001), and at the POM12 visits (logMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48; P = 0.04). In the subgroup analysis of patients with a diagnosis of either epiretinal membrane or vitreous opacities, there was no statistically significant difference in SEQ (P = 0.09) and RPE (P = 0.13) at the combined 1 month and 3 month visits.ConclusionSimultaneous PPV and cataract surgery demonstrated similar improvements in visual acuity and refractive outcomes, as well as comparable intraoperative and postoperative complication profiles to sequential surgery.

A case of bilateral corneal ulcer after left eye cataract extraction surgery

The patient is a 73-year-old female who developed bilateral corneal ulcers one month after cataract surgery in her left eye. The diagnosis is bilateral conjunctival pemphigoid. She underwent a left-eye amniotic membrane transplant and a right-eye lamellar corneal transplant, and was treated with oral immunosuppressants. The patient's condition is stable.

Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma.

To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery. Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery. Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.