Combined Phacoemulsification Research Articles

Long-term surgical outcomes of combined Ahmed glaucoma valve implantation and phacoemulsification with intraocular lens implantation for patients with glaucoma secondary to iridocorneal endothelial syndrome

BackgroundTo assess the long-term outcomes of patients with glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE) who underwent Ahmed glaucoma valve (AGV) implantation combined with phacoemulsification and intraocular lens (IOL) implantation surgery.MethodsIn this non-comparative retrospective case series study, twelve patients with uncontrolled GS-ICE and cataract underwent Ahmed aqueous shunt combined with phacoemulsification and IOL implantation surgery at Beijing Tongren Eye Center between June 2014 and June 2022. Main medical records included best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications (AGM), corneal status and further surgical interventions. Surgical success was defined as a postoperative IOP ≥ 6mmHg and ≤ 21mmHg without (complete success) or with/without (qualified success) topical AGM and vision of at least light perception during the follow-up period.ResultsTwelve eyes of twelve patients were reviewed. Preoperative IOP was decreased from a mean of 38.5 ± 6.7 mmHg on 3.3 ± 0.9 AGM to a mean of 16.3 ± 4.3 mmHg (P<0.001) on 0.6 ± 1.1 medications (P<0.001) at the last follow-up (47.0 ± 24.7 months). Eight eyes (66.7%) had stable vision or at least one line improvement than that before surgery. Eight eyes (66.7%) achieved qualified success and six eyes (50.0%) achieved complete success after surgery. The surgical procedure had a qualified survival of 91.7% at 1 year, 82.5% at 3 years, 72.2% at 5 years, and 48.1% at 7 years.ConclusionAGV implantation combined with phacoemulsification and IOL implantation seems to be an effective method in IOP control and vision maintain for patients with GS-ICE. The combined surgical procedure may be a reliable option for those GS-ICE patients with coexisting cataract.

Intraocular Pressure Fluctuation as Assessed by Water Drinking Test Following iStent inject Implantation in Open Angle Glaucoma Patients.

Introduction This study investigated the intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in open-angle glaucoma (OAG) patients after combined cataract surgery with iStent implantation. Methods This was a prospective non-randomized comparative study. Eyes with OAG and cataracts that were planned for either combined phacoemulsification and iStent implantation (iStent+CS) or phacoemulsification alone (CS) were recruited. The iStent inject (Model G2-M-IS) or iStent injectW (Model G2-W) trabecular micro-bypass stent (Glaukos Corporation, San Clemente, CA, USA) was implanted in the iStent+CS group. Water drinking test (WDT) was performed before and 3 months after surgery. WDT-IOP parameters including peak IOP, IOP fluctuation, and area under curve (AUC) were compared between the two groups. Results There were 20 eyes in the iStent+CS group and 16 eyes in the CS group. Both groups had similar pre-operative baseline IOP (15.6 ± 3.7 mmHg vs 15.8 ± 1.8 mmHg in the iStent+CS and CS group, respectively, p = 0.883). The iStent+CS group experienced greater numerical reduction in peak IOP (2.6 ± 1.9 mmHg vs 1.9 ± 2.4 mmHg; p = 0.355), IOP fluctuation (1.7 ± 2.2 mmHg vs 0.8 ± 2.5 mmHg; p = 0.289), and AUC (54.8 ± 103.6 mmHg x minute vs 25.3 ± 79.0 mmHg x minute; p = 0.355) than the CS group. There was more reduction in the number of anti-glaucoma medications in the iStent+CS group (1.4 ± 1.2) than the CS group (0.3 ± 0.9; p = 0.005). Conclusion Both combined phacoemulsification with iStent inject implantation and phacoemulsification alone reduced peak IOP, IOP fluctuation, and AUC, and none of these parameters showed statistically significant difference. Greater reduction in anti-glaucoma medications was seen in the combined group.

Longitudinal outcomes of iStent inject with cataract surgery compared to cataract surgery alone: real-world data from the Fight Glaucoma Blindness registry.

To compare combined phacoemulsification and iStent inject to phacoemulsification alone. Fight Glaucoma Blindness (FGB) registry - Australia. Prospective observational registry study. Eyes that had combined phacoemulsification with iStent inject (iStent group) were compared to eyes that had phacoemulsification only (cataract alone). Primary outcome was percentage of eyes achieving >20% IOP reduction from baseline 12 months after surgery. Secondary outcomes included mean IOP and medication reduction, adverse events and secondary procedures. At 12 months the percentage of eyes achieving >20% reduction of IOP at 12 months was significantly higher in the iStent group compared to the cataract alone group (40.9% vs 30.1% p<0.001). Adverse events occurred at a low rate in both groups, and secondary IOP lowering procedures were significantly less frequent in the iStent group compared to cataract alone. Real-world outcomes from the FGB registry at 12 months show phacoemulsification combined with iStent inject has higher efficacy and a reduced need for secondary IOP lowering surgery compared to phacoemulsification alone.

Historical and practical aspects of macular buckle surgery in the treatment of myopic tractional maculopathy: case series and literature review

BackgroundUncorrected myopia is a leading cause of blindness globally, with a rising prevalence in recent decades. Pathological myopia, often seen in individuals with increased axial length (AXL), can result in severe structural changes in the posterior pole, including myopic tractional maculopathy (MTM). MTM arises from tractional forces at the vitreoretinal interface, leading to progressive macular retinoschisis, macular holes, and retinal detachment (RD). This study aims to outline preoperative evaluation and surgical indication criteria for MTM, based on the MTM staging system, and to share our Brazilian experience with three cases of macular buckle (MB) surgery, all with over a year of follow-up.MethodsWe conducted a retrospective analysis of three cases of MTM-associated RD treated with MB surgery, with or without pars plana vitrectomy. Preoperative evaluations included optical coherence tomography (OCT) and ultrasonography (USG) to assess the extent of macular involvement and retinal detachment. Surgical indications were determined based on the MTM staging system. The MB was assembled using customizable and accessible materials. Surgical procedures varied according to the specific needs of each case. An informed consent form regarding the surgical procedure was appropriately obtained for each case. The study was conducted with the proper approval of the institution’s ethics committee.ResultsAll three cases demonstrated successful retinal attachment during the mean follow-up of eighteen months. In the first case, combined phacoemulsification, vitrectomy, and MB were performed for MTM with macular hole and RD. The second case required MB and vitrectomy after two failed RD surgeries. In the third case, a macular detachment with an internal lamellar hole was treated with MB alone. These cases highlight the efficacy of MB surgery in managing MTM in highly myopic eyes.ConclusionsMB surgery is an effective treatment option for MTM-associated RD in highly myopic eyes, providing long-term retinal attachment. Our experience demonstrates that with proper preoperative evaluation and surgical planning, MB can be successfully implemented using accessible materials, offering a viable solution in resource-limited settings. Further studies with larger sample sizes are warranted to validate these findings and refine surgical techniques.

Combined Phacoemulsification and Hydrus Microstent Implantation in Asian Eyes With Moderate-to-Severe Normal Tension Glaucoma-12-Month Outcomes.

This study reports 12-month outcomes of combined phacoemulsification and Hydrus Microstent implantation in Asian eyes with moderate-to-severe normal tension glaucoma (NTG), demonstrating a significant reduction in glaucoma medications with an excellent intra and postoperative safety profile. To evaluate the 12-month safety and efficacy outcomes of combined phacoemulsification and Hydrus Microstent (Ivantis Inc.) implantation in Asian eyes with moderate to severe NTG. Retrospective study of consecutive surgeries performed from August 2019 to August 2021 in a single tertiary eye centre in Singapore. Outcome measures included a reduction in intraocular pressure (IOP), number of glaucoma medications, and intra and postoperative complications. Data from 21 eyes of 21 subjects were analyzed. All subjects were ethnic Chinese, and the majority were males (14, 66.7%). At baseline, the mean IOP was 13.3 (2.3) mm Hg, all eyes had a Humphrey visual field mean deviation of ≥-6dB [mean: -13.9 (4.3) dB], and all eyes were on at least one glaucoma medication. There was no statistically significant reduction in IOP at all time points compared with baseline (all P > 0.05). However, the median number of medications was reduced from 2 to 0 at all time points, up to postoperative month (POM) 12 (all P < 0.001). There were no intraoperative complications. No eyes underwent secondary glaucoma procedures nor lost any Snellen line of visual acuity by POM12. One (4.8%) eye experienced numerical hypotony at postoperative day 1, which resolved conservatively. Two (9.5%) eyes underwent laser iridoplasty for stent occlusion by iris. There was no deterioration in Humphrey visual field mean deviation at POM12 compared with baseline (n = 20, P > 0.05). Combined phacoemulsification and Hydrus Microstent implantation were effective in reducing medication burden in Asian eyes with moderate to severe NTG, up to 12 months postoperatively.

PUNCTATE INNER CHOROIDOPATHY FOLLOWING PARS PLANA VITRECTOMY FOR HIGH MYOPIC FULL THICKNESS MACULAR HOLE.

To describe a case of punctate inner choroidopathy (PIC) and secondary or epiphenomenon multiple evanescent white dot syndrome (EpiMEWDS) following surgery for high myopic full-thickness macular hole (FTMH). Case report. A 57-year-old high myopic female was diagnosed with cataract and FTMH in the left eye. Her initial best-corrected visual acuity (BCVA) was 20/20 in her right eye and 20/80 in the left eye. She underwent routine combined phacoemulsification and 25-gauge pars plana vitrectomy (PPV) with the inverted internal limiting membrane (ILM) technique and twice-repeated epiretinal membrane (ERM) and ILM staining in the left eye. Two weeks postoperatively, the patient reported significant visual decline and photopsia in her left eye. BCVA decreased to counting fingers. Anterior segment examination was unremarkable. Ophthalmoscopic examination showed multiple whitish-yellow lesions in the macular region compatible with PIC lesions in the left eye. Optical coherence tomography (OCT), blue-light fundus autofluorescence (BAF), fluorescein angiography, and indocyanine green angiography were performed and confirmed the diagnosis. The patient underwent oral steroid therapy for PIC treatment. One week after treatment initiation, BAF showed the occurrence of EpiMEWDS. After one month, all lesions resolved and BCVA improved to 20/100. We report a rare case of PIC and EpiMEWDS development following surgery for FTMH. We hypothesize that several causes, including individual susceptibility (high myopia and female gender), post-surgical inflammation, and/or dye toxicity due to repeated staining could have amplified this inflammatory chorioretinal response. Larger studies are needed to better understand the potential triggers of PIC development after surgery.

Evaluation of Intrascleral Lakes after Phaco-Viscocanalostomy using Anterior Segment Optical Coherence Tomography.

This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG). In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup-disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 7.22 mmHg on 2.47 1.1 medications, and the mean postoperative IOP reduced to 11.11 2.58 mmHg on 0.11 medications, which was statistically significant (P 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

Impact of Peripheral Anterior Synechiae on the Outcome of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Primary Angle Closure Glaucoma and Cataract: A Multicenter Observational Study.

The combination of phacoemulsification, goniosynechialysis and goniotomy is an effective treatment for primary angle closure glaucoma patients with cataract, and this is not linked to the extent of preoperative peripheral anterior synechiae. To evaluate the impact of the extent of peripheral anterior synechiae (PAS) on the effectiveness and safety of combined phacoemulsification (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes with primary angle closure glaucoma (PACG) and cataract. This study included patients diagnosed with PACG and cataracts who underwent combined PEI and 120 degrees GSL plus GT (PEI+GSL+GT) between April 2020 and October 2022 at 10 ophthalmic institutes. Eligible patients were divided into 3 groups based on the extent of PAS: 180°≤PAS<270°, 270°≤PAS<360°, and PAS=360°. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. The study defined complete success as postoperative IOP within the 6-18mm Hg range and a 20% reduction from baseline without the use of topical medications. Qualified success was defined in the same way as complete success, but it allowed for the use of ocular hypotensive medications. Three hundred four eyes of 283 patients were included. The mean follow-up was 12.50±1.24 months. All groups experienced a significant reduction in IOP after the surgery ( P <0.05). There were no significant differences in final IOP, number of medications, and cumulative complete and qualified success rates among the 3 groups ( P >0.05). The groups with 270°≤PAS<360°had a higher frequency of hyphema compared with 180°≤PAS<270° ( P = 0.044). PEI+GSL+GT has proven to be an effective treatment for PACG with cataracts over a 1 year period. However, the outcome was not correlated with the preoperative extent of PAS.

Lens subluxation combined with parry-romberg syndrome: case report

BackgroundParry-Romberg syndrome (PRS) is a rare progressive degenerative disorder of unknown etiology. Here we report a rare case of PRS combined with lens subluxation in Eye and ENT hospital of Fudan University, Shanghai. To our knowledge, it is the first reported case of PRS combined with lens subluxation that has been managed surgically with phacoemulsification and CTR placement and IOL implantation in Shanghai.Case presentationA 60-year-old woman was referred for “right visual blur for 2 years” and had persistent right facial paralysis of unknown etiology since the age 12. She had right facial muscle atrophy and paralysis. Eye examination also showed the right eyelid pseudoptosis, enophthalmos, age-related cataract combined with lens subluxation existed in the right eye. The patient was diagnosed as age-related cataract and lens subluxation in the right eye and progressive hemifacial atrophy (Parry-Romberg syndrome). We conducted a combined phacoemulsification, IOL and CTR implantation and pupilloplasty surgery for the patient under general anesthesia and the postoperative UCVA was 20/30 and remained for 1 year’s follow up.ConclusionsHere we reported a rare case of PHA combined with lens subluxation in China. After appropriate eye surgery, the patient achieved satisfying vision result in the right eye.

Long-term results of combined surgery in patients with cataract and glaucoma

Aim. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in combination of cataract and glaucoma in combination with NPDS in long-term follow-up.&#x0D; Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined pathology of cataract and glaucoma was carried out. The groups of patients differed according to the method of surgical intervention: 1) phacoemulsification with NPDS and implantation of the Xenoplast drainage (49 eyes, 43 patients); 2) femtolaser-assisted phacoemulsification with NPDS and Xenoplast drainage implantation (27 eyes, 23 patients).&#x0D; Results. Before surgery, the average values ​​of corneal-compensated intraocular pressure (IOP cc), pressure equated to Goldman pressure (IOP g) and corneal hysteresis (CH) in group 1 were 27.99.9 mm Hg. Art., 27.78.9 mm Hg. Art., 7.03.0 mm Hg. Art.; in group 2 - 25.98.4 mm Hg. Art., 24.77.7 mm Hg, 7.72.1 mm Hg Art. 5 years after the surgical treatment, the average values ​​of IOP cc, IOP g and CH of the 1st group were 17.13.8 mm Hg. Art., 14.52.8 mm Hg. Art., 8.52.6 mm Hg. Art.; 2nd group - 15.13.3 mm Hg. Art., 15.34.7 mm Hg, 8.31.0 mm Hg Art. In both groups, normalization of IOP and CH was noted in the late postoperative period.&#x0D; Conclusion. Combined phacoemulsification with femtolaser accompaniment and non NPDS with Xenoplast drainage implantation is an effective and safe way to improve visual functions and normalize IOP with subsequent stabilization of the glaucoma process in the late postoperative period.

Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data.

The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2years postoperatively without the need for subsequent glaucoma surgery. A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2years. Preoperatively, the mean IOP was 26.3 ± 8.9mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3-72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2years postoperatively.

Alterations in the Ocular Surface and Corneal Subbasal Nerve Plexus Following Various Retinal Surgical Procedures: A One-Year Confocal Microscopy Prospective Study.

To evaluate the effects of retinal surgery on the ocular surface and corneal subbasal nerve plexus (SNP). Ninety-eight patients undergoing 23-gauge pars plana vitrectomy for various vitreoretinal disorders were prospectively studied. We collected detailed operative and perioperative data, measuring dry eye syndrome (DED) severity and Ocular Surface Disease Index (OSDI) scores before surgery and at postoperative intervals. In vivo confocal microscopy (IVCM) quantified SNP and dendritic cell (DC) densities. Fifty-three patients were analyzed. Post-surgery, OSDI scores rose from a baseline of 5.5 ± 3.5 to 12.24 ± 6.5 at one month, later reducing to 7.8 ± 4.0 after a year. DED severity increased from 0.6 ± 0.6 initially to 1.6 ± 0.6 at three months, returning to near baseline (0.9 ± 0.6) one year after surgery. DC densities increased notably by the third (58.85 ± 75.6 cells/mm²) and ninth (59.95 ± 86 cells/mm²) postoperative months, especially in patients undergoing combined phacoemulsification, vitrectomy, and C3F8 gas tamponade. SNP parameters, particularly nerve fiber density and length, showed significant declines one month post-surgery, not recovering to baseline levels within a year. Fiber density dropped from 19.06 ± 8.3 fibers/mm² preoperatively to 4.68 ± 4.8 fibers/mm² at one month, partially recovering to 10.64 ± 8.2 fibers/mm² at twelve months. Fiber length decreased from 13.31 ± 3.2 mm/mm² to 6.86 ± 3.4 mm/mm² at one month, later improving to 9.81 ± 4.5 mm/mm² at twelve months, notably in patients with silicone oil (SiO2) tamponade. Retinal surgery, especially when combined with phacoemulsification and C3F8 or SiO2 tamponade, significantly affects ocular surface integrity and SNP density, with these changes lasting up to a year. Expanded studies with more patients and longer follow-up, using finer 25- and 27-gauge vitrectomy tools, are recommended to confirm and extend these findings.

Расчет ИОЛ при комбинированной хирургии: факоэмульсификации катаракты и витрэктомии. Собственный опыт

At the present stage of development of ophthalmic surgical technique, indications for simultaneous cataract phacoemulsification and pars plana vitrectomy are constantly expanding, however, there is a problem of predicting refractive results, which is due to the difficulty of determining the effective position of the intraocular lens (IOL) in the eye without the presence of a vitreous body. Purpose. Assessment of the accuracy of the preoperative calculation of IOL in the eyes during combined surgery — cataract phacoemulsification and vitrectomy on the state of postoperative refraction. Material and methods. Combined surgery of cataract phacoemulsification and vitrectomy of pars plana with a caliber of 25 Gage was performed in 51 people (51 eyes) aged 70.4 ± 8.4 years. The calculation of IOL before surgery was carried out according to the data of a preoperative examination on an optical biometer IOL-Master-700 (Carl Zeiss, Germany), keratopography was performed on a rotary Scheimpflug camera (Oculus, Germany). The data on SRK-T with a range of more than 22.5 mm and Hoffer-Q with a range of less than 22.5 mm were used as a basis. Results. There were no complications during the operations and in the postoperative period. Preoperative uncorrected visual acuity (UCVA) was 0.21 ± 0.2 (0.05 to 0.8) and the best-corrected visual acuity (BCVA) was 0.44 ± 0.22 (from 0.1 to 0.9). The correction is from –9.0 D to +7.75 D (–0.61 ± 2.71 D). 6 months after the operation, the UCVA was 0.67 ± 0.22 (from 0.05 to 1.0), the BCVA was 0.9 ± 0.2 (from 0.3 to 1.0), respectively, while the correction was from –1.25 D to +1.0 D (–0.17 ± 0.94 D). The deviation from the expected refraction of the target at 1 week after surgery was ± 0.5 D, at 6 months after surgery ± 0.4 D, which turned out to be statistically insignificant (p &gt; 0.05). Conclusions. 1. Combined surgery phacoemulsification and vitrectomy in combination of cataracts with pathology of the vitreomacular interface, significantly increases visual acuity after surgery (by 0.43 ± 0.03, p &lt; 0.001). 2. Changes in clinical refraction during implantation of IOL based on hydrophobic acrylic in combined surgery are not statistically significant (an average shift of ± 0,4–0,5 D, p &gt; 0.05), which allows us to apply generally accepted formulas for calculating the effective position of IOL without using correction factors. Keywords: IOL calculation, cataract phacoemulsification, vitrectomy

Outcomes of phaco-trabeculectomy versus phaco-viscocanalostomy for primary open angle glaucoma

PurposeThis study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG). MethodsIn this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT group (40 eyes) or the PVC group (41 eyes). The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6 and 20 mmHg and reduced by ≥30% without glaucoma medications or additional surgery compared to the preoperative level. A qualified success was characterized by an IOP within the range of 6−20 mmHg and a 20−30% reduction in IOP achieved through the use of glaucoma medications. ResultsThe mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in mean IOP between the groups at any time (P > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success. Nine eyes (22.50%) in the PT group and 10 eyes (24.39%) in the PVC group achieved qualified success. The other patients (9 eyes in each group) did not meet the criteria for at least a qualified success and were considered failures (P = 0.980). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (P > 0.05). ConclusionsThere was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Safety and Efficacy of Hydrus and I-Stent inject combined with Phacoemulsification in Primary Open Angle Glaucoma Patients: 2 year follow up study

Aims: To compare the safety and efficacy of phacoemulsification combined with two individual kinds of trabecular bypass micro-stent device insertion. This study compares Phacoemulsification with Hydrus stent versus phacoemulsification combined with I-Stent inject W in patients with medically uncontrolled primary open-angle glaucoma (POAG). Material and Methods: A retrospective comparative case series. Results: Eighty eyes of 75 patients with 2 years completed follow-up after combined phacoemulsification with trabecular by-pass stent (s) were included. Forty eyes of 37 patients had Hydrus stent (Hydrus Group-PH) and the other 40 eyes of 38 patients had I-stent inject W (I-stent Group-Pi) insertion combined with phacoemulsification and intraocular lens implantation. Patient demographics and preoperative characteristics of the two groups studied are comparable. A post-operative decrease of 20 percentage or more in the IOP was achieved in 33 eyes (82.5%) in PH group and 30 eyes (75%) in Pi group (p=0.57). The Hydrus group (PH) had a post-operative reduction in the mean number of medications in 22 eyes (55%) in comparison to 18 eyes (45%) in the I-stent group (Pi). Second stage trabeculectomy was avoided in 31 eyes (77.5%) in the Hydrus group and 27 eyes (67.5%). There was no significant difference in rate of complications between two groups. Conclusion: Both Hydrus stent and I-stent inject W combined with phacoemulsification and intra-ocular lens implantation, are efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). The reduction in the mean IOP and in the mean number of post-operative glaucoma medications was higher for the patients in Hydrus stent group than in I-stent inject W group.

2 Year results of combined phacoemulsification‐ iStent inject W, from a single centre

Aims/Purpose: Our aim is to review the 2 year results of combined phacoemulsification and iStent inject W implantation in a single centre in East London.Methods: Patients were listed for surgery when cataract surgery was needed and further control of glaucoma was necessary. Electronic medical records were reviewed of all the patients who underwent the procedure in the period ranging from May 2018 until February ‘21. 87 eyes of 77 patients were identified, 3 eyes were lost to follow up in year one and 2 year data were obtained for 17 eyes. Vision, iop, drop dependency was measured and complications were recorded. Further surgical treatment was considered failure and the patient was then removed from the cohort.Results: Mean vision improved from LogMAR 0,45 to 0,16 stable throughout the two years. Drop dependency dropped modestly from 2,71 to 2,49 (8%) in year one and 2,35% (13,04%) in year two. IOP dropped from 19,25mHg to 14,55 mmHg (24,43%) in year one and 12,41 mmHg (36,68%) in year two. Complications included one patient with retained lens matter, 1 with recurrent uveitis, 1 iris prolapse, 1 Irvine Gass syndrome,1 had steroid response and 2 had pressure spikes. Furthermore by year 2, 1 patient was excluded due to incomplete documentation, 2 were discharged, 4 died (6 eyes), 4 patients needed further treatment with trabeculectomy and one received micropulse cyclodiode laser.Conclusions: Overall combined phacoemulsification/iStent inject W surgery is safe, effective, does not affect the overall safety profile of phacoemulsification surgery and has a place in early and moderate glaucoma. Improvement in year 2 results in comparison to year one can be explained by the removal from the study of the patients that received further treatment; and the small number of patients seen is an effect of the reduced capacity because of the COVID‐19 pandemic restrictions during that time.

Results of Combined Phacoemulsification and Goniosynechialysis in the Management of Refractory Acute Angle Closure Glaucoma in Ratchaburi Hospital

Objective: To assess the effectiveness of combined phacoemulsification and goniosynechialysis (PE-GSL) of angle closure glaucoma in patients with uncontrolled intraocular pressure (IOP) and persistent peripheral anterior synechiae (PAS) initially presented with acute angle closure attack. Materials and Methods: The present study was a retrospective cohort study of medical records of Thai glaucoma patients comprising 19 eyes of 19 patients (13 females and 6 males) with acute angle closure attacks. All patients were performed with PE-GSL Results: There were statistically significant differences between preoperative and postoperative IOP, PAS, and the number of medications required for IOP control. Postoperative visual acuities were improved. At the final examination for each patient, IOP was 12.15±1.57 mmHg (range 10 to 16). The extent of recurrent PAS was 66.32±40.72° (range 0 to 90), and the number of antiglaucoma medications was 0 (range 0 to 2). IOP was less than 20 mmHg in 16 eyes (80%) without medications. Three eyes were controlled with medications. In the 16 eyes with successful PE-GSL, the mean time between the angle closure attack and surgery was 7.5±5.6 weeks. Conclusion: PE-GSL are effective in decreasing IOP, PAS, and medications, as well as improvement of visual acuity in eyes with uncontrolled IOP and persistent PAS in patients who initially presented with acute angle closure attacks. Keywords: Angle-closure glaucoma; Phacoemulsification; Goniosynechialysis; Cataract; IOP

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

INTRAOCULAR PRESSURE REDUCTION FOLLOWING COMBINED PHACOEMULSIFICATION AND TRABECULECTOMY SURGERY: A STUDY OF 300 CASES

Objectives: The aim of the study was to evaluate intraocular pressure (IOP) reduction following combined phacoemulsification and trabeculectomy surgery in primary glaucomapatients with cataract. Methods: A prospective, comparative study of 300 patients with primary glaucoma and cataract who underwent combined surgery phacoemulsification and trabeculectomy at our center between July 2016 and June 2019 were included in this study. Out of these, 124 patients had primary open-angle glaucoma (POAG) and 176 patients had primary angle closure glaucoma (PACG). Phacoemulsification, intraocular lens implantation, and trabeculectomy were performed in all cases. Follow-up visits were carried out at 1, 3, and 6 months after surgery. Complete ophthalmic examination was done at each follow-up visit. Results: The pre-operative mean IOP of all patients was 34.60±6.33 mmHg and mean IOP at last 6 month follow-up was 13.0±2.18 mmHg. There was a statistically significant difference between IOP at presentation and IOP at 6-month follow-up (p&lt;0.001). No significant difference in post-operative IOP in POAG and PACG patients (p&gt;0.001). Out of 300, 58 patients required anti-glaucoma medication at 1 month and this number decreased to 41 patients at 6 month follow-up. No significant intraoperative complications were noted. Conclusion: Combined phacoemulsification and trabeculectomy surgery is safe and effective in controlling IOP with minimal complications in the management of primary glaucoma patients with cataract in expert hands.