Cataract Surgery Eyes Research Articles

Leaving trusted paths: Estimating corneal keratometric index in cataract surgery eyes with zero-power implants

PurposeThis study aimed to estimate the corneal keratometric index in the eyes of cataract surgery patients who received zero-power intraocular lenses (IOLs).MethodologyThis retrospective study analyzed postoperative equivalent spherical refraction and axial length, mean anterior curvature radius and aqueous humor refractive index to calculate the theoretical corneal keratometric index value (nk). Data was collected from 2 centers located in France and Germany.ResultsThirty-six eyes were analyzed. The results revealed a mean corneal keratometric index of 1.329 ± 0.005 for traditional axial length (AL) and 1.331 ± 0.005 for Cooke modified axial length (CMAL). Results ranged from minimum values of 1.318/1.320 to maximum values of 1.340/1.340.ConclusionThe corneal keratometric index is a crucial parameter for ophthalmic procedures and calculations, particularly for IOL power calculation. Notably, the estimated corneal keratometric index value of 1.329/1.331 in this study is lower than the commonly used 1.3375 index. These findings align with recent research demonstrating that the theoretical corneal keratometric index should be approximately 1.329 using traditional AL and 1.331 using CMAL, based on the ratio between the mean anterior and posterior corneal curvature radii (1.22).

Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes.

Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted.Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p < 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p < 0.05) compared to FD eyes. The only factor showing a significant correlation (p < 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p < 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus.Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.

Anterior chamber tap cytology in acute postoperative endophthalmitis: a case–control study

AimsTo determine anterior chamber tap cytology characteristics in acute postoperative bacterial endophthalmitis.Methods488 eyes of 488 patients were included in this retrospective case–control study. The study group included 93 eyes with...

Outcomes of toric intraocular lens implantation after femtosecond laser and traditional cataract surgery

ABSTRACT Clinical relevance Having an understanding of the refractive outcomes of different forms of cataract surgery will assist optometrists in explaining the implication of such procedures to patients being referred for such procedures. Background The purpose of this study was to compare the refractive outcomes after toric intraocular lens implantation between femtosecond laser‐assisted cataract surgery and traditional phacoemulsification. Methods This retrospective non‐randomised case series included 114 eyes of 92 consecutive patients (59 male and 55 female) aged 71.65 ± 10.46-years (range 57 to 92-years), who underwent either femtosecond laser‐assisted cataract surgery (using two laser platforms) (group 1) or traditional phacoemulsification (group 2) between August 2013 and September 2015. Pre‐operative keratometric values, the attempted refraction from the biometry platform and the toric intraocular lens web‐based calculator, and the one month post‐operative manifest refraction were assessed to evaluate the refractive outcomes of the two groups. Results Mean pre‐operative topographic corneal astigmatism was −1.94 ± 0.73 D (range 0.91 to 4.61 D) and −1.98 ± 0.60 D (range 1.07 to 3.43 D) for groups 1 and 2, respectively (p > 0.05). Mean axial length was 24.22 ± 0.73-mm (range 21.78 to 29.30-mm) and 24.60 ± 1.09-mm (range 21.82 to 25.95-mm) for groups 1 and 2, respectively (p > 0.05). Multivariate vector analysis of the remaining refractive error between the two groups (desired refraction minus achieved refraction) revealed no statistically significant difference (p > 0.05). Analysis within each group demonstrated a higher accuracy of refractive outcomes for the femtosecond laser‐assisted cataract surgery eyes (p < 0.05) when compared to the traditional phacoemulsification (p > 0.05). Conclusion Femtosecond laser‐assisted cataract surgery and traditional phacoemulsification demonstrate similar refractive outcomes after toric intraocular lens implantation, while femtosecond laser‐assisted cataract surgery seems to provide a slightly higher accuracy.

Comparative Analysis of Visual Performance and Astigmatism Tolerance with Monofocal, Bifocal, and Extended Depth-of-Focus Intraocular Lenses Targeting Slight Myopia.

Purpose To compare the visual performance and astigmatism tolerance of 3 intraocular lens (IOL) groups: monofocal, bifocal, and extended depth-of-focus (EDOF) IOLs targeting slight myopia. Methods Overall, there were 60 cataract surgery eyes from 60 patients with implantation of a monofocal, bifocal, or EDOF IOL (20 eyes in each IOL group). The EDOF IOLs targeted slight myopia (−0.25 D to −0.75 D). Intragroup comparison of visual acuity, defocus curve, objective optical quality, contrast sensitivity, visual function questionnaire scores, patients' overall satisfaction, and the astigmatism tolerance was performed 3 months after surgery. Results The EDOF group provided equivalently excellent distance visual outcomes (0.06 ± 0.12) as the monofocal (0.06 ± 0.09) and bifocal (0.03 ± 0.09) groups (P=0.554), better intermediate vision than the other 2 groups (P < 0.05), and similarly satisfactory near visual outcomes (0.23 ± 0.16 at 20 cm, and 0.17 ± 0.14 at 33 cm) as the bifocal group (0.28 ± 0.14 at 20 cm and 0.08 ± 0.10 at 33 cm) (P > 0.05). The contrast sensitivity of EDOF IOL was slightly decreased compared to that of monofocal IOL, but it was better than that of bifocal IOL. The EDOF group showed significantly higher satisfaction than the bifocal group did when preoperative corneal astigmatism was 0.75 D or greater (P=0.009). A significant negative correlation between the corneal astigmatism and patient satisfaction was observed in only the bifocal group. Conclusions The EDOF IOLs targeting slight myopia offered satisfactory visual outcomes at an extended range from far to near distances. The EDOF and monofocal IOLs showed a better tolerance to astigmatism than did the bifocal IOL.

Effects of cataract surgery on symptoms and findings of dry eye in subjects with and without preexisting dry eye.

To compare dry eye symptoms and findings in post cataract surgery eyes' with and without preexisting dry eye. Prospective, observational case-control study. Sixty-seven eyes that had undergone cataract surgery were included; 48 were classified into group D (preexisting dry eye) and 19 into group N (no preexisting dry eye). No subjects received perioperative treatment for dry eye. We evaluated between-group differences in symptom scores, corrected distance visual acuity (CDVA), tear film breakup time (BUT), tear film breakup pattern (BUP), and ocular surface fluorescein staining scores, at 1week, 1month, and 3months postoperatively. Symptoms were unchanged in group N, but improved in group D (P < .001) postoperatively. CDVA was improved after surgery in both groups (P < .001). BUT was shorter preoperatively in group D than in group N although this difference was absent 1month postoperatively. Fluorescein staining scores significantly increased at 1month postoperatively in group N (P = .01), but did not change in group D. During the perioperative period, the predominant BUP was the random break pattern in both groups (≥ 85%). From 1week to 3months, dimple break patterns decreased in group D (P = .007), whereas spot break patterns increased (P = .01). Cataract surgery has an influence on tear film stability and the ocular surface. There was either a transient improvement or worsening of ocular surface wettability in some patients without preexisting dry eye.

Prescribing Patterns and Costs Associated with Postoperative Eye Drop Use in Medicare Beneficiaries Undergoing Cataract Surgery

To determine costs and prescribing patterns of postoperative eye drops for cataract surgery and estimate potential savings of generic or therapeutic drug substitutions. Retrospective, cross-sectional analysis. Medicare beneficiaries aged ≥65 years with Part D coverage who underwent cataract surgery in2016. Medicare Part D claims were used to extract information on eye drop prescriptions that were filled during the postoperative period of cataract surgery. Savings from generic or therapeutic drug substitutions were estimated for brand medications. Total cost of postoperative eye drops for cataract surgery and physician and patient factors associated with medication cost. Postoperative eye drops were prescribed in 2016 to 88% of 591 733 Medicare beneficiaries who underwent cataract surgery during that calendar year, with brand medications accounting for 57.5% of prescription volume. The overall cost totaled more than $167 million, 76.5% of which was attributable to use of brand medications. The mean costs of medications were $228 and $324 for those undergoing 1 and 2 surgeries, respectively. Topical antibiotics (89%) were the most commonly prescribed drug class by volume, followed by topical steroids (86%) and nonsteroidal anti-inflammatory drugs (66%), and accounted for 26%, 37%, and 36% of the total cataract surgery eye drop cost, respectively. Use of therapeutic and generic alternatives could have resulted in cost savings of as much as $118 million, or 70% of the total cost of postoperative eye drops. In adjusted analysis, patient factors associated with increased eye drop cost included older age, female gender, and race or ethnicity. Physician characteristics associated with increased eye drop cost included female gender, greater number of years in practice, practicing in metropolitan versus nonmetropolitan areas, and practicing in the Northeast versus the South and in the South versus the Midwest. The cost to the Centers for Medicare and Medicaid Services for eye drops prescribed for postoperative use after cataract surgery in 2016 was approximately $170 million. In the absence of evidence of clinical superiority of expensive versus less costly options, substantial opportunity exists to improve the value of care delivered to Medicare beneficiaries.

Cataract surgery in eyes with iridoschisis using the Perfect Pupil iris extension system

To evaluate the use of the Perfect Pupil system (Milvella Pty. Ltd.) in 3 eyes in cataract surgery with iridoschisis. Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Patient 1 was an 83-year-old man with a nuclear cataract, pseudoexfoliation syndrome, and iridoschisis. He was also having systemic anticoagulation therapy. Preoperative best corrected visual acuity (BCVA) was 0.05 in the right eye and 0.08 in the left eye. Patient 2 was a 73-year-old mentally retarded man with a brunescent cataract in the right eye. Preoperative BCVA was 0.1. In the first patient, cataract surgery was performed under topical anesthesia in both eyes through a clear corneal incision. Intraoperative pupil size was 3.0 mm. The Perfect Pupil device was inserted manually and fixated at the iris rim, leading to pupil dilation of 6.0 mm. Uneventful cataract surgery was performed without damage to the iris. Hydrophobic acrylic foldable intraocular lenses (IOLs) were implanted with forceps. Postoperative BCVA was 0.5 in the right eye and 0.4 in the left eye. The second patient was operated on under general anesthesia. Pupil dilation was successfully achieved. The brunescent cataract was removed and a hydrophobic acrylic IOL was implanted with an injector, resulting in postoperative uncorrected visual acuity of 0.3. In iridoschisis patients, there is risk of aspiration of iris fibers during cataract surgery. In these 2 patients, this was prevented using the Perfect Pupil system.

Zur Notwendigkeit eines Augenverbandes nach Kataraktoperation in Tropfanästhesie

Although postoperative eye patching is a common practice its background is not well known. Therefore the necessity of eye patching after cataract surgery in topical anesthesia from the medical point of view and the patients' subjective opinion was studied. In this prospective and randomized study 133 patients received after cataract surgery either no covering of the eye (group1), a transparent eye shield for four hours (group 2), an eye pad for four hours (group 3) or an eye pad until the next morning (group 4). Clinical findings were noted and local symptoms, such as pain, foreign body sensation, tearing and photophobia were documented on a visual analogue scale (0 - 10). Furthermore, a questionnaire concerning the subjective opinion was handed out to the patient. The clinical findings revealed no significant differences between the groups. The mean values for local pain were 0.94 +/- 1.56, for the foreign body sensation 1.41 +/- 2.02, for tearing 0.99 +/- 1.8 and for photophobia 1.05 +/- 1.99. Comparing the groups there was significantly more pain and foreign body sensation reported by the patients in group 3, who received eye patching for 4 hours. 91 % of the unpatched patients had no discomfort, whereas 53 % of the patients wearing an eye pad until the next morning considered it as unnecessary. After cataract surgery in topical anesthesia only mild symptoms were noted. There were no significant differences between the groups in the objective clinical findings and the subjective feeling. These results indicate that after cataract surgery eye patching could be unnecessary.

Intraocular lens calculation for cataract after previous radial keratotomy.

The purpose of this study is to discuss the major reasons for the hyperopic shift after cataract surgery following radial keratotomy (RK) and to find potential methods to improve the prediction of intraocular lens power (IOLP). The results for 18 cataract surgery eyes that had undergone RK were analysed retrospectively. The IOLP was calculated using Haigis, Hoffer Q, and SRK/II formulae with different keratometric measurements. Theoretical IOLP miscalculation ((delta)IOLP(K)) was assessed in order to define the optimal combination of different keratometric parameters and intraocular lens prediction formula. The research revealed a significant temporary hyperopic shift after cataract surgery, the maximum value of which was noted in the first week post-operatively. Standard keratometers and placido-topography systems overestimate comeal power after RK. Corneal power overestimation correlates significantly with the spherical equivalent change after RK. Theoretical formulae (Haigis, Hoffer Q) produced the lowest (delta)IOLP(K) using calculated corneal powers derived from spherical equivalent change. Standard autokeratometry significantly overestimates corneal power after RK performed for moderate and high myopia. The use of calculated corneal power and third-generation theoretical formulae seems to be the most appropriate for IOLP prediction.

Persistent vertical binocular diplopia after cataract surgery

PURPOSE: To report the incidence of, and factors associated with, persistent vertical diplopia after cataract surgery. DESIGN: Consecutive interventional case series. METHODS: Retrospectively, all adult patients examined during a five year, five month period because of new onset persistent (>3 months) vertical binocular diplopia after cataract surgery were analyzed. All patients had their cataract surgery at the same outpatient ophthalmic surgery center, and were referred to the author, enabling calculation of incidence. Trends in anesthesia type and strabismus complications therefrom were also assessed. Comparison was made between ophthalmologist-administered retrobulbar anesthesia versus anesthesia staff-administered retrobulbar anesthesia. Incidence during a period in which hyaluronidase was not incorporated in the retrobulbar anesthetic was calculated. RESULTS: Persistent vertical diplopia occurred after cataract surgery in 32 (0.18%) of 17,531 eyes that had cataract surgery. No patient whose cataract surgery was conducted with topical anesthesia (3817 eyes) had persistent vertical diplopia, whereas 32 (0.23%) of the 13714 eyes whose cataract surgery was done after retrobulbar anesthesia were affected. No cases of persistent postoperative diplopia were found among 7410 cataract surgery eyes after retrobulbar injection given by one cataract surgeon. There was a threefold greater number of left eyes involved than right eyes ( P < .005). No significant ( P > .20) increase in cases of persistent vertical diplopia was noted during a period of hyaluronidase shortage. CONCLUSIONS: In this study, persistent binocular vertical diplopia after cataract surgery occurred in 0.23% of cases in which retrobulbar anesthesia was performed. No cases were found after topical anesthesia. Occurrence may be technique-related.

The Deployment of Information Technology in an International Rural Health Care Project

SUMMARY This paper presents a case study of the utilization of Information Technology (IT) in a cataract surgery eye camp held outside a remote village in India. Detailed here are the organizational and technological context of the project, the steps taken in the development and deployment of a patient medical database, the data collection procedures employed during the eye camp, and the resultant information products of these endeavors. Discussed are the implications for the application of IT in the documentation and evaluation of time-limited health and social service delivery projects.

Accuracy and predictability of intraocular lens power calculation after photorefractive keratectomy

Purpose To investigate the accuracy and predictability of intraocular lens (IOL) power calculation in postoperative photorefractive keratectomy (PRK) eyes. Setting Gimbel Eye Centre, Calgary, Alberta, Canada. Methods The results in 5 cataract surgery eyes that had had PRK were analyzed retrospectively. Target refractions based on actual and refraction-derived keratometric values were compared with postoperative achieved refractions. The target refractions calculated using 5 IOL formulas and 2 A-constants were also compared with the achieved refractions. Results In postoperative PRK eyes, the power calculation was more accurate and predictable when the smaller of either the actual or refraction-derived keratometric value was used to calculate the IOL power. The difference between target and achieved refractions appeared smaller when the Binkhorst formula was used. No significant hyperopic shift was observed after cataract surgery. Conclusion The smaller of the actual or the refraction-derived keratometric value is recommended for calculating IOL power in post-PRK eyes.