Complication Of Cataract Surgery Research Articles

Vitreoretinal Surgery in the Treatment of Dislocations of Intraocular Lens and Nucleus-Lens Particules into the Vitreous Cavity

Drops of lens nucleus/cortex particles into the vitreous cavity or dislocations of intraocular lenses (IOLs) are one of the serious complications of cataract surgery with an increasing relative frequency with the increase in the number of cataract surgeries. In addition, spontaneous and traumatic dislocations are other common case groups that should be treated. In this article, the vitreous dislocations of nucleus/cortex residues or IOL dislocations are discussed with different vitreoretinal surgical techniques.

Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications.

Purpose “In-the-bag” placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy. Methods This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications. Results A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39–1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed. Conclusion There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.

Management of late in-the-bag IOL dislocation with exchange and scleral fixation of IOL with the transfixion technique

Introduction: Late in-the-bag intraocular lens (IOL) dislocation is a serious complication of cataract surgery. Patient and clinical findings: A 70-year-old woman with a history of left eye cataract surgery presented with progressively decreasing vision that had worsened over the past 6 months. In the left eye, the uncorrected distance visual acuity (UDVA) was counting fingers at 5 m, the corrected distance visual acuity (CDVA) was 20/25 (+12.25 −1.25 × 180), and the intraocular pressure was normal. An anterior segment examination revealed severe inferior dislocation of the IOL-capsular bag complex. Diagnosis, intervention, and outcomes: The patient was diagnosed with late in-the-bag IOL dislocation and underwent IOL–capsular bag complex explantation with sulcus-sutured IOL implantation using a new scleral fixation technique that included transfixion of a foldable acrylic IOL with polytetrafluoroethylene suture. The postoperative outcome was good; the UDVA was 20/70, and the CDVA was 20/25, and there were no postoperative complications such as infection, suture erosion, iritis, uveitis, vitreous hemorrhage, or retinal detachment. Conclusions: Late in-the-bag IOL dislocation was safely managed with IOL–capsular bag complex explantation and scleral fixation of a foldable posterior chamber IOL. This transfixion technique can be used for scleral fixation in patients with late in-the-bag IOL dislocation.

Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital.

Background: Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. Methods: The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. Results: Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. Conclusions: Artificial intelligence application may be an interesting tool in the physician’s hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.

Capsaicin attenuates TGFβ2-induced epithelial-mesenchymal-transition in lens epithelial cells in vivo and in vitro

Posterior capsule opacification (PCO), the most common complication of cataract surgery occurring in 20–50% of patients after 2–5 years of cataract surgery, is a major problem in the aging society. The epithelial-mesenchymal transition (EMT) of lens epithelial cells after cataract surgery has been proposed as a major cause of PCO. Capsaicin, widely used as a food additive and analgesic agent, is a major pungent ingredient in red pepper. Although the effect of capsaicin on EMT has been reported in cancer cells, the biological reaction of capsaicin was unique in each cell type, and there have been no reports describing its effects on EMT earlier. In this study, we demonstrated that treatment with capsaicin inhibited TGFβ2-induced EMT in vitro lens epithelial cells and ex vivo explant lens epithelial cells. Furthermore, eye drops of capsaicin inhibited the PCO model mice in vivo. Finally, we showed that capsaicin inhibited non-canonically induced Smad2/3 activation via suppression of EGFR activation and ERK phosphorylation. Our findings indicate that capsaicin and its derivatives are good candidate compounds for preventing PCO after cataract surgery.

The prophylactic effect of betaxolol 0.5% versus brimonidine 0.2% on IOP elevation after Nd:YAG laser posterior capsulotomy

ABSTRACT Clinical relevance Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). Background To evaluate the efficacy of betaxolol 0.‌5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. Methods In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.‌5% (18 eyes) or brimonidine 0.‌2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.‌ Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. Results There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was −2.39 ± 1.79 mm Hg and in the brimonidine group was −4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. Conclusion Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.

αVβ8 integrin targeting to prevent posterior capsular opacification.

Fibrotic posterior capsular opacification (PCO), a major complication of cataract surgery, is driven by transforming growth factor–β (TGF-β). Previously, αV integrins were found to be critical for the onset of TGF-β–mediated PCO in vivo; however, the functional heterodimer was unknown. Here, β8 integrin–conditional knockout (β8ITG-cKO) lens epithelial cells (LCs) attenuated their fibrotic responses, while both β5 and β6 integrin–null LCs underwent fibrotic changes similar to WT at 5 days post cataract surgery (PCS). RNA-Seq revealed that β8ITG-cKO LCs attenuated their upregulation of integrins and their ligands, as well as known targets of TGF-β–induced signaling, at 24 hours PCS. Treatment of β8ITG-cKO eyes with active TGF-β1 at the time of surgery rescued the fibrotic response. Treatment of WT mice with an anti-αVβ8 integrin function blocking antibody at the time of surgery ameliorated both canonical TGF-β signaling and LC fibrotic response PCS, and treatment at 5 days PCS, after surgically induced fibrotic responses were established, largely reversed this fibrotic response. These data suggest that αVβ8 integrin is a major regulator of TGF-β activation by LCs PCS and that therapeutics targeting αVβ8 integrin could be effective for fibrotic PCO prevention and treatment.

Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery.

Pseudoexfoliation syndrome (PES) is an age-related process associated with glaucoma and cataracts. It increases the risk of complications during cataract surgery.Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be an effective biomarker of inflammation in PES. We aimed to investigate association of NLR and pseudoexfoliation (PEX) related cataract surgery complications. A total of 210 eyes who underwent cataract surgery between January 2016 and January 2020 in our department were analyzed retrospectively. Patients were grouped with respect to developing complications and the two groups were compared. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Data obtained were analyzed using chi-square test. Receiver operating characteristics curve analysis was performed to determine cutoff, sensitivity and specificity values. p value of ≤ 0.05 was considered statistically significant. The mean age was 68.1 ± 7.2years and mean NLR was 2.11 ± 0.81. Complications were observed in 32 (15.2%) of the patients (group 1). Neutrophil counts (5.19 ± 0.64 vs. 4.43 ± 0.86, p < 0.001) and the NLR (2.68 ± 0.73 vs. 2.01 ± 0.81, p < 0.001) of group 1 were significantly higher than group 2. The ROC analysis revealed a cutoff value of 2.33 for NLR to predict cataract surgery complications with sensitivity of 87.5% and specificity of 78.1%. There is an association between NLR and increased risk of complications during cataract surgery in PES patients. NLR can be used as an easy method to help ophthalmologists in predicting the risks associated with cataract surgery in PEX eyes.

Recent developments in anterior capsulotomy for cataract surgery.

Successful anterior capsulotomy is an important step in cataract surgery. This article reviews the various anterior capsulotomy techniques available to surgeons to optimize the step, including those that have become available since the introduction of femtosecond-laser-assisted cataract surgery (FLACS). Studies comparing the relative advantages of each technique will be emphasized. Manual continuous curvilinear capsulorhexis (CCC) and FLACS remain the two most widely studied techniques for achieving anterior capsulotomy. Each technique has been shown to be effective for a wide range of patients and cataract surgery complications. Meta-analyses have shown that FLACS provides similar results to manual CCC for long-term cataract surgery outcomes. Several alternative methods for anterior capsulotomy have been described, which aim to provide some of the advantages of laser capsulotomy at a lower cost; among these, precision pulse capsulotomy (PPC) and selective laser capsulotomy (SLC) have been investigated the most in the literature so far. Cataract surgeons have an increasing number of techniques for anterior capsulotomy available. Manual CCC and FLACS remain the most widely used, and most well studied. The latest techniques, PPC and SLC, have shown promise in the few studies performed since they were introduced.

Uveitis–glaucoma–hyphema syndrome after uneventful placement of a 1-piece intraocular lens into the capsular bag

Introduction: Uveitis-glaucoma-hyphema (UGH) syndrome is an uncommon but serious complication of cataract surgery that occurs from chafing of the iris by an intraocular lens (IOL). UGH syndrome is typically associated with first-generation lenses, placement of an IOL in the ciliary sulcus, or bag-sulcus tilted positioning. UGH syndrome following placement of a modern 1-piece lens in the capsular bag is rare. Patient and clinical findings: A 55-year-old man presented with UGH syndrome 2 weeks after routine cataract surgery with in-the-bag placement of a contemporary IOL. Diagnosis, intervention, and outcomes: Correct positioning of the IOL was confirmed with ultrasound biomicroscopy and exploratory surgery, and IOL exchange achieved resolution of UGH sequelae. Conclusions: Intermittent chafing of the iris by the IOL as a result of underlying traumatic zonulopathy contributed to the development of UGH, and surgeons should be aware of this complication even with in-the-bag placement of a modern IOL.

Результаты факоэмульсификации осложненной катаракты у пациентов с неоваскулярной глаукомой на фоне пролиферативной диабетической ретинопатии или посттромботического макулярного отека

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was &lt;25 mm Hg, then phacoemulsification was performed; 2) if IOP remained &gt;25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

Применение интраоперационной ОКТ в хирургическом лечении перезрелых катаракт с фемтолазерным сопровождением

Purpose. To evaluate the capabilities of intraoperative OCT in optimizing the femtocapsulotomy technique during the surgical treatment of overripe cataracts with femtolaser support. Material and methods. The study included 20 patients (20 eyes) with overripe cataracts who underwent femtolaser-assisted cataract surgery (FACS). The patients were divided into 2 groups (10 eyes in each group). For the 1st group, femtocapsulorexis was performed taking into account the morphological changes in the anterior lens capsule and the state of the lens according to intraoperative OCT. Dosing of the laser energy depended on the condition of the anterior capsule and the underlying altered cortical masses. For prophylactic purposes, to reduce the tension of the anterior capsule and equalize the intralenticular pressure (ICP) gradient, cohesive-dispersed viscoelastics were preliminarily introduced. The anterior capsule was stained with trypan blue to improve visualization. For the 2nd group, the femtocapsulorexis technique was standard. Results. There were no cases of radialization of the anterior lens capsule in the 1st group. In all cases, a perfectly round, centrally located capsulorhexis with a diameter of 5-5.2 mm was achieved. The IOL was implanted into the capsule bag, without intra- and postoperative complications. An incomplete capsulotomy was performed with a femtolaser in 3 cases in the 2nd group. Out of these 3 cases, in two cases, radialization of the anterior capsulorhexis occurred without transition to the posterior capsule. The IOL was implanted in the capsule bag in all cases. Conclusion. The use of intraoperative OCT makes it possible to evaluate morphological changes in the lens capsule and to plan the individual parameters and femtocapsulorexis algorithm, which reduces the risk of complications of overripe cataract surgery with femtolaser support. Key words: intraoperative OCT, overripe cataract, femtolaser support.

Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey

BackgroundDemand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China.MethodsIn 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis.ResultsThe response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P < 0.0001).ConclusionsIn Shanghai, public providers dominate ophthalmic services especially for complicated cases, with almost one fifth of services provided by the EENT Hospital alone, while private sectors, though not large in number, still effectively help meet large proportions of eye care demand. Optimization of hierarchical medical system is warranted to improve the efficiency and standardization of ophthalmic services.

RETROPUPILLARY IRIS-CLAW INTRAOCULAR LENS AND PARS PLANA VITRECTOMY IN APHAKIA MANAGEMENT: A National Multicenter Audit.

To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy. Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation. The cumulative probability of the final visual acuity ≤0.3 logarithm of the minimum angle of resolution (≥20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure >21, ≥25, and ≥30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325). This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Scleral thinning with haptic exposure following intra-scleral haptic fixation of intraocular lens

In the current times, scleral-fixated intraocular lens (SFIOL) has become the treatment of choice for the management of cases of aphakia without capsular support. In this retrospective case series, we describe the risk factors and management of three cases of scleral thinning with haptic exposure following SFIOL. Medical records of cases with scleral thinning with haptic exposure following SFIOL over the last 1 year were reviewed for demographic factors, type of surgery, and outcomes. Out of 116 eyes that underwent SFIOL, 3 cases developed scleral thinning within 1 week of surgery. The indication of SFIOL was aphakia with operated penetrating keratoplasty (2 eyes) and complicated cataract surgery (1 eye). Surgical records revealed that all cases had undergone SFIOL with conjunctival closure using fibrin glue without any intraoperative complication. Post-operative day 1 findings showed conjunctival mound formation due to excessive fibrin glue in all cases. Scleral thinning was noted on follow-up (day 7, 2 cases and day 5, 1 case). Cases were managed with conjunctival advancement (n = 1) and amniotic membrane graft (n = 2). Thinning resolved within 1 week of follow-up.

20G Vitrectomy; Current Usage, Indications, and Practices

Vitreoretinal surgery is evolving to a smaller size since first described. After the first vitrectomy probe defined as 17 Gauge (G), a smaller gauge (20G, 23G, 25G, and 27G) vitrectomy probes and trocars were identified. Even though 20G vitrectomy has been used for many years, thinner and less traumatic vitrectomy systems are developed and 20G has lost popularity. Hybrid use of 20G and other systems remains current, especially in cases such as endophthalmitis, intraocular foreign body removal, and cataract surgery complications.

Cataract surgery risk stratification in phacoemulsification and manual small incision cataract surgery in a teaching hospital.

To evaluate a system that objectively assesses the risk of cataract surgery complications performed with phacoemulsification and manual small incision cataract surgery (MSICS) techniques. The study was a retrospective comparative interventional case series. Electronic medical records of consecutive eyes that underwent cataract surgery from January 2019 to December 2019 were evaluated. Patient's demographic data and preoperative risk factors were identified, and cataract was categorized as per Lens Opacities Classification System (III). Cataract eyes were grouped into normal cataract cases (G1) and complex cataract cases (G2 and G3), based on the risk factors. The rate of complications in each group and the rate of each complication were calculated and compared. The overall rate of anyone complication was 2.2% with 2.3% in G1, 1.0% in G2 and 3.9% in G3 (p < 0.001). MSICS technique, mostly used for complex cases (54.2%), reported a higher complication rate than the phacoemulsification technique (2.9% vs 1.4%, p < 0.001). However, the complication rates among the normal and complex cases were similar (2.3% vs 2.2%, p = 0.376). The total posterior capsular tear rate was 1.1% with no vitreous loss in nearly 1 in eight eyes. A preoperative risk stratification system is crucial for obtaining informed consent and better allocation of cases to surgeons based on their expertise to minimize intraoperative complications.

A Case Report of Unilateral Pediatric Cataract Surgery: Posterior Capsule Opacification and Visual Rehabilitation

Objective: To report a case of posterior capsule opacification (PCO) and severe deprivation amblyopia following unilateral pediatric cataract surgery Case Presentation: A 4-year-old girl presented with PCO of the right eye with a history of unilateral congenital cataract surgery and intraocular lens (IOL) implantation without optimal visual rehabilitation two years ago at another hospital in Jakarta. Her uncorrected right eye visual acuity was 3/60 and corrected left eye visual acuity 6/7.5. We performed secondary posterior capsulotomy and anterior vitrectomy of the right eye. Following the procedure, the patient did not regain her vision despite normal posterior segment; thus, a diagnosis of deprivation amblyopia was made. She was prescribed occlusion therapy for 6 hours a day on the left eye to decrease the degree of amblyopia of her right eye. Conclusion: Early identification and management of pediatric cataract surgery complications combined with optimal visual rehabilitation may benefit the patient in the long run. If not treated properly, especially in unilateral cataract cases, it may be too late to regain visual function.

Ectopic thyroid tissue in the iris: a case report

BackgroundEctopic thyroid tissue in the iris, also known as a thyroid glandular epithelial choristoma of the iris, has only been described twice in the literature. In both cases it remained asymptomatic.Case presentationA 67-year-old female patient presented for the first time in mid-2017 with corneal endothelial decompensation, with a history of complicated cataract surgery and IStent® implantation. Slit lamp microscopy showed endothelial decompensation, pseudophakia, anterior synechiae and a whitish iris tumour adhering to the endothelium. The latter had existed since childhood. Given these findings, reduced visual acuity of hand movement perception and an intraocular pressure of 23 mmHg, we performed a keratoplasty combined with an en bloc resection of the iris tumour at 9 o’clock and sector iridectomy at the end of 2019. Histological and immunohistological examination of the iris tumour unexpectedly revealed thyroid tissue. After the procedure described above, the patient had an increase in visual acuity while the graft stayed clear and the eye showed no evidence of tumour recurrence or other complications.ConclusionsWe report a third case of ectopic thyroid tissue in the iris. Both previous cases remained asymptomatic, whereas in our case, size and location of the ectopic thyroid tissue contributed to a more complex cataract surgery resulting in endothelial decompensation. Therefore, in such cases appropriate patient information should be provided prior to cataract surgery. Furthermore, careful histological examination and examination of the thyroid is important to exclude malignant diagnoses such as a metastasis of a follicular thyroid carcinoma.

Effect of complicated ocular surgery in stress-related parameters: A novel outlook into surgeon's health.

Purpose:To assess the stress-related physiological parameters of ophthalmic surgeons during complicated cataract surgery and compare them with uncomplicated routine cataract surgery.Methods:In this cross-sectional observational study, 110 patients of various types of cataract were divided into two groups: Group 1 included 55 patients with simple cataract (Grade ≤3) with no ocular or systemic comorbidities, whereas Group 2 included 55 patients with complicated cataracts (Grade >3) and ocular/systemic comorbidities. All patients underwent phacoemulsification with intraocular lens implantation in the right eye only. The outcome measures were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and saturation of peripheral oxygen (SpO2).Results:The average SBP, DBP, MAP, and HR were significantly higher in the surgeon operating Group 2 (complicated cataract) compared with Group 1 (uncomplicated cataract; P < 0.05). The average SBP of the surgeon while operating Group 1 patients preoperatively and postoperatively was 125.42 ± 2.49 mmHg and 122.45 ± 2.10 mmHg, respectively, whereas in Group 2, the average SBP of the surgeon taken preoperatively and postoperatively was 145.98 ± 3.80 mmHg and 137.44 ± 3.45 mmHg, respectively (P < 0.05). The surgeon’s SpO2 showed no significant difference between the two groups.Conclusion:There is a significant level of increase in stress-related parameters of operating surgeons while doing complicated cataract surgery.