Cataract Surgery In Eyes Research Articles

Commentary: Cataract surgery in small eyes: Choosing between complications.

Commentary: Cataract surgery in small eyes: Choosing between complications.

Venting incision of cornea and intracameral air repairs Descemet membrane detachment three months after phacoemulsification surgery

Introduction: Cataract surgery is one of the most commonly performed operations in the world. Descemet membrane detachment (DMD) is a potentially blinding complication of this operation. Aim: To describe the successful treatment of DMD three months after initial surgery. Case study: Retrospective case review. Results and discussion: A 69-year-old bilateral pseudophakic man presented with persistent blurring of vision in his left eye despite having undergone left eye cataract surgery for phacomorphic glaucoma 10 weeks previously. Examination and anterior segment optical coherence tomography (AS-OCT) showed left descemet detachment involving the visual axis. Despite the long duration, he underwent left cornea venting incision combined with intracameral air injection which successfully improved the cornea clarity and reattached the descemet on AS-OCT. When this was combined with treatment for cystoid macula oedema, he was able to attain best corrected visual acuity of 6/6-2, N5 3 months after the cornea venting procedure. Conclusions: Treatment with cornea venting incision combined with air injection is an effective method of reattaching the descemet membrane in late presentation of DMD.

Outcome of cataract surgery in eyes with uveitis.

To assess the outcome of cataract surgery in patients with uveitis without the use of prophylactic high dose (> 5-10 mg/day) systemic steroid. A hospital based prospective study enrolling 64 eyes of 60 patients with uveitis and cataract from May 2013 to April 2014 having intraocular inflammation under control for at least 3 months preoperatively and underwent phacoemulsification with in bag placement of foldable acrylic intraocular lens (IOL). Twenty six male and 34 female were included with mean age of 47.23 ± 16.85SD (16-85) years. In 43.75 % of eyes the uveitis was idiopathic followed by sarcoiduveitis (18.7%), Herpetic uveitis (15.6%), Tubercular uveitis (6.2%), VKH (4.6%), HLAB 27(4.6%), Behcet's, endogenous endophthalmitis, Wegener's granulomatosis and lepromatous uveitis (1.5% each). Anterior chamber cell count was grade 1+ in 33 eyes (51.56%) on 1st post-operative day and in 29 eyes (45.31%) on second follow up. Out of total 11 eyes (17.18%) that developed fibrin, 7 eyes were treated with subconjunctival injection of dexamethasone with half hourly topical steroid drops. Other 4 eyes that developed fibrin responded to half hourly topical steroid. Dose of oralprednisolone increased in 6 patients in early post operative duration. At the final follow up, 50 eyes (92.58% ) had improvement in best corrected visual acuity and cystoidmacular edema (CME) in 5% (n=3) eyes. Even without the use of preoperative high dose of oral steroid, inflammation was under control with significant improvement in visual acuity 3 months postoperatively.

Anti-inflammatory Medication of Cataract Surgery in Pseudoexfoliation Syndrome – NSAID Is Needed

ABSTRACT Background To optimize the anti-inflammatory treatment of cataract surgery in pseudoexfoliation syndrome (PXF) eyes. Methods A prospective randomized double-masked trial. Sixty eyes of 60 patients with PXF undergoing routine cataract surgery were randomized for potent topical postoperative anti-inflammatory medication either with prednisolone acetate (10mg/ml), nepafenac (1mg/ml) or their combination. Clinical outcome parameters were recorded at 28 days and 3 months. Recovery from surgery was recorded by a structured home questionnaire. Results Patient age and gender distribution, and all baseline ophthalmic and surgical parameters were comparable between the study groups. At 28 days, change in central subfield macular thickness was +11.4 ± 11.9 µm in prednisolone acetate group compared to +1.7 ± 16.8 µm in nepafenac (P = .017), and −0.3 ± 8.7 µm in combination therapy (P = .010) groups. At 3 months, the values were +11.8 ± 18.1 µm, +1.8 ± 17.5 µm (P = .055), and −1.3 ± 6.4 µm (P = .055), respectively. Pseudophakic cystoid macular edema (PCME) was reported in two eyes, both with prednisolone acetate monotherapy. After surgery, conjunctival injection lasted 6.5 ± 5.0 days and irritation of the eye 9.5 ± 8.5 days in prednisolone acetate group compared with nepafenac (2.6 ± 2.2 days; P = .037 and 4.3 ± 5.2 days; P = NS, respectively) and combination therapy (3.3 ± 1.9 days; P = NS and 3.0 ± 4.0 days; P = .025, respectively). Conclusions Routine cataract surgery of PXF eyes with nonsteroidal anti-inflammatory drugs (NSAID) alone, or in combination with steroids resulted in faster recovery from surgery and avoidance of PCME compared to steroids alone. Abbreviations BAB: blood–aqueous barrier; CDVA: corrected distance visual acuity; CDE: cumulative dissipated energy; CSMT: central subfield macular thickness; HRQoL: Health-related quality of life; IOP: intraocular pressure; logMAR: log of the minimum angle of resolution; NSAID: nonsteroidal anti-inflammatory drug; PCME: pseudophakic cystoid macular edema; PXF: pseudoexfoliation syndrome; OCT: optical coherence tomography; t.i.d.: three times a day; VA: visual acuity

The Outcomes of Cataract Surgery in Small and Normal Pupillary Eyes with Pseudoexfoliation

The Outcomes of Cataract Surgery in Small and Normal Pupillary Eyes with Pseudoexfoliation

Corneal perforation associated with the use of ketorolac tromethamine after cataract surgery

# Purpose To report a case of corneal ulceration and perforation after cataract surgery associated with normal doses of ketorolac tromethamine (Elipa®). # Case-Report An eighty-year-old man with a 15-days history of right eye (RE) cataract surgery presented to our emergency department with complaints of pain and blurred vision. He was on a treatment regimen with a combination of dexamethasone plus gentacmicin given 5 times daily and ketorolac tromethamine given 3 times daily. The patient’s visual acuity was light perception. Slit-lamp examination of the right eye revealed central corneal perforation with iris prolapse and a shrunken eye. The drug was discontinued, a bandage soft contact lens was placed and topical antibiotics and preservative-free tears were added, with a slow improvement during the following weeks. Laboratory tests, including corneal cultures, were negative or normal. # Conclusions Patients treated with topical NSAIDs drugs after ocular surgery should be monitored closely. The duration of treatment and frequency of administration should be minimized, and as needed, should be discouraged. Corneal melting or perforation is a rare complication that may occur in patients receiving topical NSAIDs. Even in patients without any such history of previous ocular surface disease, severe and unexpected complications may happen.

Refractive surprise after phacoemulsification in a post-laser in situ keratomileusis case: December consultation #1

To evaluate the outcomes of femtosecond laser–assisted arcuate keratotomy combined with cataract surgery in eyes with low-to-moderate corneal astigmatism.Eyes of York Private Practice Ophthalmology Clinic, York, Pennsylvania, USA.Retrospective case series.This retrospective analysis included case records of patients with preexisting corneal astigmatism ranging from 0.5 to 2.0 diopter (D). Study parameters included corneal astigmatism, refractive astigmatism, and uncorrected (UDVA) and corrected (CDVA) distance visual acuities. The results, which were analyzed at 3 months postoperatively, included frequency distribution histograms, vector analysis, and single-angle polar plots.The study comprised case records of 189 eyes of 143 patients (56 men and 87 women). The postoperative refractive astigmatism was reduced significantly compared with preoperative corneal astigmatism to 0.14 D ± 0.23 (SD) from 0.92 ± 0.34 D (P < .001). One hundred eighty-one eyes (95.8%) demonstrated postoperative refractive astigmatism of 0.5 D or less. The mean surgically induced change along the preoperative steep axis was −0.59 ± 0.56 D, and the change along the orthogonal axis was 0.01 ± 0.35 D. Postoperatively, 171 eyes (90.5%) had astigmatism angle of error of 15 degrees or less. The postoperative mean UDVA and CDVA were 0.09 ± 0.16 logarithm of the minimum angle of resolution (logMAR) and 0.02 ± 0.05 logMAR, respectively. One hundred seventy eyes (90%) had a postoperative UDVA of 20/30 or better. The results demonstrated stability at 12 months postoperatively. No intraoperative or postoperative arcuate keratotomy-related events were observed.The results suggest that femtosecond laser–assisted arcuate keratotomy represents a safe and effective method for astigmatism correction at the time of cataract surgery with demonstrated stability of correction for at least 1 year postoperatively.

Femtosecond laser–assisted arcuate keratotomy at the time of cataract surgery for the management of preexisting astigmatism

To evaluate the outcomes of femtosecond laser-assisted arcuate keratotomy combined with cataract surgery in eyes with low-to-moderate corneal astigmatism. Eyes of York Private Practice Ophthalmology Clinic, York, Pennsylvania, USA. Retrospective case series. This retrospective analysis included case records of patients with preexisting corneal astigmatism ranging from 0.5 to 2.0 diopter (D). Study parameters included corneal astigmatism, refractive astigmatism, and uncorrected (UDVA) and corrected (CDVA) distance visual acuities. The results, which were analyzed at 3months postoperatively, included frequency distribution histograms, vector analysis, and single-angle polar plots. The study comprised case records of 189 eyes of 143 patients (56 men and 87 women). The postoperative refractive astigmatism was reduced significantly compared with preoperative corneal astigmatism to 0.14 D±0.23 (SD) from 0.92±0.34 D (P<.001). One hundred eighty-one eyes (95.8%) demonstrated postoperative refractive astigmatism of 0.5 D or less. The mean surgically induced change along the preoperative steep axis was -0.59±0.56 D, and the change along the orthogonal axis was 0.01±0.35 D. Postoperatively, 171 eyes (90.5%) had astigmatism angle of error of 15 degrees or less. The postoperative mean UDVA and CDVA were 0.09±0.16 logarithm of the minimum angle of resolution (logMAR) and 0.02±0.05 logMAR, respectively. One hundred seventy eyes (90%) had a postoperative UDVA of 20/30 or better. The results demonstrated stability at 12months postoperatively. No intraoperative or postoperative arcuate keratotomy-related events were observed. The results suggest that femtosecond laser-assisted arcuate keratotomy represents a safe and effective method for astigmatism correction at the time of cataract surgery with demonstrated stability of correction for at least 1year postoperatively.

Role of interferon alpha 2b (IFN‐α2b) in the treatment of conjunctive squamous neoplasia

AbstractPurposeIFN‐α2b has been postulated as an effective treatment to treat ocular surface tumors since the mid‐1990s. It could be used as a neoadjuvant agent, adjuvant therapy if there are positive margins after resection or as a primary agent for small tumors. It causes anti‐angiogenic, anti‐proliferative, cytotoxic and immunomodulatory effects. Consequently, it reduces the number of recurrences with few and mild side effects.MethodsWe present the case of a 77‐year‐old man with history of right eye cataract surgery who was seen in our Ophthalmology Department, due to a new appearance of a conjunctival tumor in the upper and lower temporal sectors, arriving at the bulbar conjunctiva with corneal invasion in the right eye. After performing a biopsy, squamous cell carcinoma with mild dysplasia was diagnosed. Ultrasonography and MRI were requested, ruling out infiltration. Surgical excision and amniotic membrane implantation were decided. Despite starting treatment with mitomycin C (MMC) 4 times a day, he suffered from a temporary recurrence. A second excision was performed 3 months later. This time, treatment with IFN‐α2b was started 4 times a day.ResultsIFN‐α2b is consolidating as a postoperative adjuvant treatment. In our case, it has managed to avoid new recurrences. We observed an asymmetric rise of the intraocular pressure (IOP) which could be associated with IFN‐α2b and need antihypertensive ocular topic treatment.ConclusionNowadays, surgery remains the gold standard in the treatment of these tumors. Nevertheless, the high rate of recurrences and the appearance of different treatments makes search for an optimized treatment of these patients possible and necessary. IFN‐α2b stands out in terms of cost‐effectiveness and must be present among the therapeutic arsenal of any ophthalmologist who faces this carcinoma but it side effects should be studied.

Intraindividual study of anxiety and pain in sequential cataract surgery

Purpose: An understanding of the patient’s anxiety and pain and differences if any between the first and second cataract surgery can help patients, paramedics and surgeons to plan and execute a surgical procedure which is tailor made to the individual patient’s expectations, capabilities and weaknesses and ensure a happy patient and an even happier surgeon. This study was therefore proposed to compare bilateral cataract patient’s evaluation of pain and anxiety between first and second phacoemulsification surgery under topical anaesthesia. Materials and Methods: A prospective observational study was carried out, recruiting 60 patients of bilateral cataract scheduled for sequential phacoemulsification surgery under topical anaesthesia. The patients were assessed for anxiety in the preoperative room and for operative pain in the postoperative room by a numbered Visual Analog Scale (VAS) and modifiedWong-Baker faces scale. Peroperative assessment of surgeon’s comfort and patient satisfaction and comfort were recorded by a questionnaire, administered by a trained investigator. Results: Mean anxiety score was 3.151.21 (MeanSD) for first eye surgery and 1.580.89 for second eye surgery and was statistically significant (p first eye surgery. Mean pain score was 0.730.86 for first and 2.170.90 for second eye surgery and was statistically significant (p significant difference was observed in the surgeon’s grading of operative comfort and satisfaction between the two procedures. Conclusions: Higher visual disability, expectation from surgery and higher psychological stress lead to higher anxiety and lower pain score in first eye surgery, while previous successful surgery and operative experience lead to lower anxiety scores in second surgery. A relaxed mental state with consequent attention to operative process leads to higher pain score during the second surgery. Contrary to popular reasoning, patients undergoing second eye cataract surgery need a more detailed exp

Early transient intraocular pressure spike after cataract surgery in highly myopic cataract eyes and associated risk factors

PurposeTo investigate the incidence of the early transient intraocular pressure (IOP) spike after cataract surgery in eyes with highly myopic cataract (HMC) and associated risk factors.MethodsConsecutive patients treated with phacoemulsification...

Case Series of Combined XEN Implantation and Phacoemulsification in Chinese Eyes: One-Year Outcomes.

The outcome of XEN implantation in Chinese eyes has not been previously reported. The purpose of our study is to evaluate the efficacy and safety of combined cataract surgery and XEN implantation in Chinese eyes with glaucoma. We conducted a prospective study of 31 consecutive Chinese patients who underwent combined phacoemulsification and XEN implantation at the National University Hospital (Singapore) in this study. Patients were assessed preoperatively and postoperatively on days1 and 7, and months1, 3, 6, and 12. The intraocular pressure (IOP), glaucoma medication use, Snellen visual acuity (VA), and complications were assessed at each visit. The Wilcoxon signed rank test for non-parametric data was used for the analysis of IOP and glaucoma medications at baseline versus 12months after the procedure. The mean age of the patients was 70 ± 7.9years and 48.4% were male. Twelve patients (38.7%) were diagnosed with primary open angle glaucoma and 19 patients (61.3%) were diagnosed with primary angle closure glaucoma. There was a significant decrease in IOP at 12months (12.1 ± 2.6mmHg) compared with preoperative medicated (15.6 ± 2.7mmHg, p < 0.0001) and unmedicated IOP (22.1 ± 3.6mmHg, p < 0.001). as well as a significant reduction in the number of glaucoma medications (1.4 ± 0.6 vs 0.1 ± 0.4, p < 0.0001). The most common complications were transient hypotony (12.9%) and ptosis (12.9%) and there were no sight-threatening intraoperative or postoperative complications. One patient required additional glaucoma surgery for uncontrolled IOP at 8months after combined phacoemulsification and XEN implantation. Combined XEN implantation with cataract surgery was effective in lowering the IOP and the number of glaucoma medications in Chinese eyes for at least 12months, with a favorable safety profile.

Management of cataract in keratoconus: early visual outcomes of different treatment modalities.

A review of 31 eyes with keratoconus who developed cataract and underwent phacoemulsification. Visual acuities were measured 1mo postoperatively. Six eyes with a history of good corrected distance visual acuity (CDVA) and a similar refractive and topographic astigmatic axis were implanted with toric intraocular lenses (IOLs). The mean postoperative uncorrected distance visual acuity (UDVA) was 0.2 logMAR with a spherical equivalent (SE): 0.75D. Eleven eyes with a history of good CDVA and different refractive and topographic axis were implanted with monofocal IOL+/-Toric implantable collamer lenses to treat anisometropia and ametropia; mean UDVA was 0.25 logMAR with a mean SE: -0.51 D postoperatively. Six eyes with poor CDVA were first treated with intra-corneal ring segments, followed by phacoemulsification, the mean postoperative UDVA was 0.82 logMAR with an SE: 0.22 D. Eight eyes had advanced ectesia and received combined phacoemulsification and penetrating keratoplasty. Our approach is efficient in addressing ametropia after cataract surgery in keratoconic eyes.

Intraoperative Aberrometry Versus Preoperative Biometry for IOL Power Selection After Radial Keratotomy: A Prospective Study

To compare the accuracy of Optiwave Refractive Analysis (ORA) intraoperative aberrometry (Alcon Laboratories, Inc., Fort Worth, TX) with preoperative biometry in predicting residual refractive error after cataract surgery in eyes that underwent radial keratotomy. This was a prospective consecutive case series of patients with cataract and prior radial keratotomy. Each patient underwent a preoperative intraocular lens (IOL) power calculation using partial coherence interferometry (IOLMaster version 5; Carl Zeiss Meditec, Jena, Germany). For each eye, the Barrett True-K formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Hoffer Q, Haigis, and Holladay formulas 1 and 2, and the ORA intraoperatively. Between 8 and 12 weeks after cataract extraction with IOL implantation, the postoperative refraction was compared with the preoperative and intraoperative predictions. The study comprised 52 eyes of 34 patients. The median absolute errors associated with each method were as follows: Barrett True-K formula (0.34), ORA aberrometer (0.53), and SRK/T (0.54), Hoffer Q (0.51), Haigis (0.54), SRK/T (0.57), and Holladay formulas 1 and 2 (0.44) (P = .08). The proportion of patients within ±0.50 diopters of the predicted error was 63.5%, 48.1%, 44.2%, 48.1%, 53.8%, 36.5%, and 57.7%, respectively (P = .03). No statistically significant difference was observed in the number of eyes with hyperopic outcomes (P = .68). In eyes with prior radial keratotomy surgery, the ORA aberrometer performance was similar to the Barrett True-K formula and all of the other established formulas, with no significant difference between median absolute error and mean absolute error. The Barrett True-K formula produced significantly more eyes within ±0.50 diopters than the SRK/T, Hoffer Q, and Holladay 1 formulas. [J Refract Surg. 2019;35(10):656-661.].

The Influence of Diabetes Status on the Rate of Cataract Surgery Following Pars Plana Vitrectomy

We aimed to evaluate the association between diabetic status and the rates of cataract extraction (CE) following pars plana vitrectomy (PPV). Retrospective cohort, multicenter database study. Patients were selected from an insurance claims database (PharMetrics LifeLink) that included persons who had filed claims between 2006 and 2015 in the United States. We analyzed the records of 22 146 patients who underwent PPV performed by 2705 retina physicians. The vitrectomy group included patients ≥18 years of age who had undergone PPV. The control group included patients who were matched to the vitrectomy group 1:2 based on sex, diabetes mellitus (DM) status, region of the United States, and Charleston Comorbidity Index. Hazard ratios (HRs) and rates of cataract surgery in patients with and without diabetes who had undergone prior PPV. The hazard ratio for post-PPV CE was lower among patients with diabetes (3.307; 95% confidence interval [CI], 3.051-3.583) than among patients without diabetes (4.889; 95% CI, 4.670-5.119). This association was significant for all subgroups of patients with diabetes except in patients with diabetes and without retinopathy (4.086; 95% CI, 3.511-4.754). There was a significantly longer time between PPV and CE in patients with diabetes (537 days; 95% CI, 459-677 days) compared with those without diabetes (295 days; 95% CI, 278-312 days). The type of DM (type 1 vs. type 2) did not influence the rate of post-PPV cataract surgery. In persons with diabetes who underwent PPV, we observed a trend for a lower HR of cataract surgery in eyes with proliferative retinopathy (0.903; 95% CI, 0.725-1.124), and nonproliferative retinopathy (0.965; 95% CI, 0.721-1.290) compared with eyes with no retinopathy. Eyes of patients with diabetes had a significantly decreased risk of undergoing CE after PPV surgery compared with eyes of patients without diabetes.

Phacoemulsification vs Manual Small Incision Cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III Cataracts

PurposeTo compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II & III) with pseudoexfoliation syndrome (PXF). MethodsIt is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. ResultsThe mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (p < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (p < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (p < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (p 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. ConclusionIn moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

Role of B scan ultrasonography before cataract surgery in eyes with dense cataracts

Role of B scan ultrasonography before cataract surgery in eyes with dense cataracts

Incidence and Risk Factors for Glaucoma Development After Bilateral Congenital Cataract Surgery in Microphthalmic Eyes

To evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes. Retrospective, observational case series. Subjects: Children with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6months of birth and been followed up for at least 5 years. Review of medical records at our institution. Probability of an eye's developing glaucoma after bilateral congenital cataract surgery and associated risk factors. Thirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ±1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye's developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio= 0.364, P= .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P > .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P= .049). The long-term cumulative risk of postoperative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.

This Issue of Acta

This Issue of Acta

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery.

To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists' National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017. Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England. The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access. We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.