Immature Cataract Research Articles

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery

To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery (MSICS). The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. The mean age of the participants at the time of surgery was 68.42±2.05y. Of the 490 patients, 250 patients were male, and 240 patients were female (P=0.23). A total of 215 (43.9%) eyes had mature white cataract, 185 (37.8%) eyes had brown cataract, and 90 (18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2% (10/490). Vitreous loss occurred during hydrodissection [1/10 (10%)], nucleus delivery [3/10 (30%)], irrigation and aspiration [5/10 (50%)], and intraocular lens insertion [1/10 (10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio (OR)=3.99; P=0.02], irrigation and aspiration of cortical material (OR=3.07; P=0.03), and anterior capsular extension (OR=3.22, P=0.03) as independent risk factors for vitreous loss. Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

POST-OPERATIVE VISUAL PROGNOSIS IN SENILE CATARACT IN TOBACCO CONSUMERS: COMMUNITY BASED STUDY IN LUCKNOW, UTTAR PRADESH

Tobacco use is a leading cause of chronic diseases in India. It kills almost 1.3 million people every year. The country is the second largest producer and consumer of cigarettes. The use of tobacco is very easy to start and is available at very low prices. One of the biggest threats to public health is tobacco use. It leads to the deaths of thousands of people and has a heavy social and economic cost. There are around 267 million tobacco users in India. The most common type of tobacco used by Indians is smokeless tobacco. Khaini, which is a tobacco mixture used by almost every ninth adult, is followed by bidi smoking and gutkha tobacco. According to the Global Adult tobacco Survey, around 11% of Indian adults smoke cigarettes. This is a community-based study involving 626 patients having Immature cataracts with H/O chronic tobacco use from rural population of central Uttar Pradesh in North India coming from low Socio-economic strata with no major Ocular pathology who underwent Cataract surgery (Manual Small incision cataract surgery/Phacoemulsification) with best input in form of surgical techniques & skills, equipment’s material used and uncomplicated surgeries. Serum Vitamin B6, Folic acid and B12 levels were checked to assess nutritional status of these patients. Best corrected visual acuity (BCVA) preoperatively as well as postoperatively was disproportionate to the grade of cataract and best surgical input. The visual outcome in these patients was not very good. BCVA (Best corrected visual acuity) is 70% poor and only 30% is good. There was color vision deficiency and Visual field defects in most of the patients.

Karakteritik Pasien Dan Kategori Gangguan Penglihatan Pra Operasi Dan Pasca Operasi Katarak Berbasis Komunitas Pusat Mata Nasional Rumah Sakit Mata Cicendo

Introduction : The main causes of blindness in the world are cataract. Community-based cataract surgery plays an important role in reducing the burden of cataract blindness. Objective : To describe patient’s characteristic and visual impairment before and after community-based cataract surgery. Methods : This is a retrospective descriptive study with secondary data from community-based cataract surgery by the Community Ophthalmology Installation of National Eye Center Cicendo Eye Hospital from January 2019 to December 2020. Visual impairment is divided into four categories based on WHO classification. Result : There were 3890 patients included. Most of patients were aged 60 to 69 years in 1533 people (39,41%). The most common diagnosis was immature senile cataract in 1826 people (46,94%). Most of patients underwent unilateral cataract surgery using Manual Small Incision Cataract Surgery method and implantation of intraocular lens. The most common category of visual impairment in one eye before surgery was blind, in 3714 eyes (95,48%) and one day after surgery was poor outcome, in 2466 eyes (63,39%). The two-eye blindness before surgery were 1492 people (38,35%) and after surgery were 652 people (16,76%). Sight restoration rate was 26,8%. Conclusion : Most of the patients were aged 60-69 years. The most common diagnosis is immature senile cataract. The category of one eye visual impairment before surgery was mostly blind, after surgery was moderate visual impairment. There number of blind patients was decrease from 38,35% before surgery to 16,76% after surgery.

Fulminant Orbital Myiasis - A Rare Case Report from Central India

A 42 year old male farmer presented to eye OPD with a history of painful, foul smelling discharging wound over the lower lid along the inferior orbital margin since two weeks and crawling sensation over the wound with diminution of vision right eye since three days. He gave history of trauma to right eye after falling on sharp edge of stone one month back when he was in a drunken state due to which he had a lacerated wound of about 5cm x 2 cm x 2cm along inferior orbital margin.
 The wound was cleaned and dressed only once at a local hospital, however, he neglected the wound and didn’t open the dressing for about next 15 days until he noticed a crawling sensation and maggots teeming from the wound. He denied a history of diabetes mellitus, hypertension or any other chronic systemic disease or any prolonged use of medications, progressive loss of weight or appetite. However, he was a chronic alcoholic. He belonged to low socioeconomic strata with poor personal hygiene and was residing in a rural area.
 On presentation, the patient was in agony due to pain. On examination of the right eye, the eyelids were severely oedematous and indurated with severe mechanical ptosis. The lower lid along the inferior orbital rim had a deep open, macerated wound of size about 5cm x 2cm x 2cm, filled with necrotic tissue (slough), discharge and around 5-6 maggots were seen teeming from the wound [Fig. 1]. The skin around the wound was red and friable. On separating the lids gently and mechanically, the conjunctiva was severely congested and chemosed. Unaided visual acuity was 3/60; best-corrected visual acuity could not be assessed as the patient was in agony due to pain. The cornea, anterior chamber and iris were normal. The pupil was normal-sized reacting to light. The eyeball had deviated inwards and ocular movements were painful and restricted in all directions. Lens had immature senile cataract. Intraocular pressure and nasolacrimal passage could not be assessed because of gross lid oedema. Fundus examination of the right eye was within normal limits. On examination of the left eye, unaided visual acuity was 6/18 and best-corrected visual acuity was 6/9. Anterior segment was within normal limits with pupil normally reacting to light and fundus examination was normal.
 Five to six superficially lying maggots were removed with the help of turpentine oil and forceps after adequate local anaesthesia. Many more deep-seated maggots were seen but were difficult to remove.

Management and visual outcome in patients of phacolytic glaucoma at a tertiary eye care hospital

Phacolytic glaucoma is one of the commonest cause of secondary glaucoma due to senile cataracts. This study was conducted to evaluate the visual outcome of phacolytic glaucoma. 1. To study the management of phacolytic glaucoma; 2. To study the visual outcome after planned manual SICS. Participants were 30 patients in a tertiary eye care hospital for both urban and rural population diagnosed as phacolytic glaucoma. Demographic data, duration of the symptoms, IOP of the patients before presenting to the hospital were noted. Patient underwent Manual SICS with PCIOL implantation after the control of intraocular pressure and inflammation. The data was analyzed by simple statistical methods. Mean age of the patients was 61.63 yrs. Female to male ratio was 1.8:1. Duration of the presenting symptoms before reporting to the hospital was <1 week in 16 (53%), 1-2 week in 11 (37%) and >2 week in 3 (10%). Mean IOP was 40.7mmHg preoperatively. Visual Acuity was perception of light in 16 (53.33%) and hand movements in 14 (46.66%) preoperatively. Postoperative visual acuity at 6 weeks was 6/6-6/12 in 19(63.33),6/18-6/60 in 8 (27%), <6/60 in 3 (10). Following surgery 28 of 30 eyes (93.33%) had IOP less than 21 mmHg at discharge. Fellow eye showed pseudophakia in 18 (60%), immature cataract in 12 (40%). Cataract surgery proves to be effective in lowering the intraocular pressure and visual recovery in phacolytic glaucoma.

Changes in macular thickness post uncomplicated MSICS & phacoemulsification surgery

To evaluate changes in macular thickness via-a-vis visual acuity post uncomplicated manual small incision cataract surgery (MSICS) & phacoemulsification surgery Prospective clinical study on 160 patients of uncomplicated immature senile cataract, aged 40-70yrs, patients were randomised into two groups, MSICS & phacoemulsification, by simple 1:1 randomization, who underwent uncomplicated cataract surgery with posterior chamber intraocular lens (PCIOL). Post-operatively, the patients were evaluated for best corrected visual acuity (BCVA) and changes in macular thickness by optical coherence tomography (OCT) at post-op Day 1, 7, 21, 48, and 12 weeks. Paired t-test was used for comparison across follow up. : At 12 weeks post-operative, mean logMAR BCVA was 0.01±0.02 for MSICS group and 0±0.02 for Phacoemulsification group. Macular thickness was not statistically significant (p=0.342) between MSICS group (219.19±17.88µm) and Phacoemlusification group (215.61±16.21µm), at the end of 12 weeks post-operative. Clinically significant macular oedema was not diagnosed in any of the patients at the follow-ups.: Both procedures achieved good post-operative Best Corrected visual acuity without significant differences in BCVA between both the groups at the end of 12 weeks.

COMPARISION OF SERUM AND AQUEOUS GLUCOSE AND ELECTROLYTES CONCENTRATION IN VARIOUS STAGES OF CATARACT

Background: Raised serum sodium, low levels of serum calcium and increased serum glucose has been implicated in the development of cataract. Our study compares the aqueous levels of sodium, calcium and glucose among patients with different stages of cataract. Aims and Objective: - To compare the aqueous levels of sodium, calcium and glucose among patients with different stages of cataract – Immature cataract, Mature cataract and Nuclear Cataract. - To compare the serum levels of sodium, calcium and glucose among patients with different stages of cataract – Immature cataract, Mature cataract and Nuclear Cataract. Methods : Patients were divided into 3 groups. Group 1 –Immature cataract, Group 2- Mature Cataract, Group 3- Nuclear Cataract. Serum and Aqueous humour was collected intra-operatively and was sent for biochemical analysis Results: In immature cataracts: -The sodium concentration in aqueous humour was slightly higher than normal ie, 147.8 mEq/L. -The calcium level were also in normal limits was 5.6 mg/dl. -The mean glucose concentration in aqueous humour was 60.4 mg/dl which was higher than the normal limits. In mature cataracts: The mean aqueous concentration of sodium was higher than normal limits. The mean aqueous concentration of calcium levels were also in normal limits. But the glucose level was less than normal. In nuclear cataracts: -The mean aqueous concentration of sodium and calcium was in normal limits. -The glucose level were much higher than normal-86.5 mg/dl. Conclusion: - With respect to aqueous, the level of sodium and glucose were higher than normal in immature cataract and the mean aqueous concentration of calcium was higher in mature cataract. -The mean aqueous levels of sodium calcium and glucose were all raised in nuclear cataract.

Effect of oral antioxidants on the progression of canine senile cataracts: a retrospective study.

BackgroundCataracts are the leading cause of impaired vision or blindness in dogs. There are many antioxidants that can prevent cataract progression, but whether they are clinically effective in dogs has not been established.ObjectivesTo analyze the delaying or preventing effect of oral antioxidants on canine senile cataracts through retrospective analysis.MethodsMedical records of dogs from January 1, 2015 to July 10, 2020 were reviewed. Dogs that were 8 yr of age or older with senile cataracts were included in this study. The dogs were divided into two treatment groups (dogs administered with Ocu-GLO supplement and dogs administered with Meni-One Eye R/C supplement) and a control group (dogs that were not administered any supplement). Dogs with incipient and immature cataracts were included in this study. Altogether, 112 dogs (156 eyes) with incipient cataracts and 60 dogs (77 eyes) with immature cataracts were included. The period of time that cataracts progressed from incipient to immature, and from immature to mature was recorded for each dog.ResultsThere was no significant delaying effect on the progression of incipient cataracts. However, both Ocu-GLO (hazard ratio = 0.265, p = 0.026) and Meni-One (hazard ratio = 0.246, p = 0.005) significantly delayed the progression of immature cataracts compared to the control group.ConclusionsAlthough there was no significant delaying effect of oral antioxidants on incipient cataract progression, antioxidants could be used to delay the progression of senile immature cataract.

Impact of Phacoemulsification Cataract Surgery to Number of Corneal Endothelial Cells: A Descriptive Study

The main optical structure of the eyes is the lens and corneal because lens with the cornea, focuses image of the visual world onto the retina. Both of the main optical structure is affected by age, it affects the corneal endothelial cells and transparency of the lens. By aging the corneal endothelial cells decrease and the lens loses its transparency then the cataract appears [1,2]. it is known that cataract surgery effecting the corneal endothelial cells number. The surgery will be decreasing the corneal endothelial cells number. The severity to which endothelium is affected depends on many factors, such as phacoemulsification time and energy, surgical technique, anterior chamber depth, and use of ophthalmic viscoelastic devices (OVDs) [3]. A total of 52 people with cataracts were enrolled in this descriptive investigation. The study is included 52 eyes. Ages ranged from 43-77 years, with a mean age of 57,7 years. From this study 59,6% were men and the rest are women, which 79% were diagnosed with immature cataract, and 21% were diagnosed with mature cataract. It was found that 86,5% of eyes experienced a decrease in the number of corneal endothelial cells after cataract phacoemulsification surgery. The mean of corneal endothelial density pre surgery is 3126 cells/mm2 ± 246,1 and the mean of corneal endothelial density post-surgery is 3029 cells/mm2. The range of surgery time is 6-30 minutes. With the mean time of surgery 13,7 ± 5,8 minutes. From 52 eyes there are 45 eyes with corneal endothelial cells loss 7 days after surgery, with the mean of corneal endothelial cells loss after cataract phacoemulsification surgery are 152,3 ± 68 cells/mm2, the percentage mean was 6%, and we found decreasing in central corneal thickness, corneal endothelium density, hexagonality and increasing coefficient of variety.

Comparative study of surgically induced astigmatism in superior and temporal scleral incisions in manual small-incision cataract surgery patients

Background: The purpose of the study is to evaluate surgically induced corneal astigmatism and visual outcome in patients undergoing small-incision cataract surgery (SICS) by modifying incision site on the basis of type of regular astigmatism. Material and Methods: This is a prospective study including 100 patients, having senile immature cataract, divided in two groups of 50 patients each according to the type of preoperative corneal astigmatism over a period of January 2018 to June 2019. A detailed preoperative evaluation was done including automated refractokeratometry, on the basis of which patients having steeper vertical axis (90° ±30°), i.e., “with the rule” astigmatism placed in Group A and subjected to superior SICS, and those having horizontal steeper axis (150°–180° and 0°–30°), i.e., “against the rule” astigmatism, were placed in Group B and subjected to temporal SICS. All surgeries were performed by a single ophthalmic surgeon with a similar technique of a 6.00 mm superior or temporal scleral straight incision. Surgically induced astigmatism (SIA) was calculated by a computer application SIA calculator version 2.0 on the 45th postoperative day and compared. Results: Present study showed mean SIA was significantly less in the temporal group (1.09 ± 0.42 D) as compared to the superior group (1.38 ± 0.62 D). Conclusion: Modification of incision site in SICS as per preoperative astigmatism produces comparable results to other sophisticated techniques such as phacoemulsification, and hence, it provides an alternative path to attain better visual outcome and reduced SIA with limited resources available in most of the developing countries.

Why are patients with mature cataract admitted to hospital? Challenges for cataract surgery

BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period.
 AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients.
 MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts.
 RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was absence of an ophthalmologist in the outpatient polyclinic. The patients lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm 37.2%; pseudoexfoliation syndrome 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber 44.8%; lens subluxation 24.1%; atrophy of the pupillary margin 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 0.27, on Day 7 0.73 0.22, after 3 months 0.76 0.25.
 CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.

Ophthalmic disorders in a referral population of seven breeds of brachycephalic dogs: 970 cases (2008-2017).

To evaluate the frequency of ophthalmic disorders in 7 brachycephalic dog breeds referred to an academic veterinary ophthalmology service. 970 client-owned dogs of 7 brachycephalic breeds that were evaluated by the ophthalmology service in a veterinary teaching hospital from January 2008 through December 2017. Medical records of 7 brachycephalic breeds (ie, Boston Terriers, English Bulldogs, French Bulldogs, Lhasa Apsos, Pekingese, Pugs, and Shih Tzus) were reviewed to collect data regarding patient signalment, ophthalmic diagnoses, affected eyes, and number and dates of visits. Median age at the first examination was 7 years (range, 23 days to 22 years). The number of dogs seen for a first examination increased with age. Corneal ulcers, keratoconjunctivitis sicca, corneal pigmentation, immature cataracts, and uveitis were each diagnosed in ≥ 100 dogs and represented 40.4% (1,161/2,873) of all diagnoses. On the basis of anatomic location, 66.3% (1,905/2,873) of all disorders were located in either the cornea (1,014/2,873 [35.2%]) or adnexa (891/2,873 [31%]). There was a significant difference in breed proportion in the study population; of the 7 breeds studied, Shih Tzus (34.3% [333/970]), Pugs (20.8% [202/970]), and Boston Terriers (16.6% [161/970]) were the most prevalent breeds. The frequency of some diseases within the referral population was associated with breed. Findings suggested that the most prevalent disorders for the brachycephalic breeds in this ophthalmic referral population were corneal ulcers, keratoconjunctivitis sicca, corneal pigmentation, immature cataracts, and uveitis. Although all dogs shared brachycephalic features, the frequency of specific ophthalmic diseases varied between breeds.

HYDROGEL INSERT MISMATCH - A RARE CAUSE OF FAILED FEMTOSECOND LASER Assisted CATARACT SURGERY

Background: Femtosecond laser-assisted cataract surgery (FLACS) offers high level of precision and automates the three major steps of cataract surgery - corneal incisions, anterior capsulotomy and lens fragmentation. An ideal dock is required for optimal outcomes in FLACS. However dock failure can occur due to various factors. Here, we report a case of failed FLACS due to mismatch of hydrogel insert. Case description: FLACS with toric intraocular lens (IOL) implantation was planned in right eye for a 57 year old male who was diagnosed with immature cataract in that eye. Due to mismatch between the corneal curvature and the hydrogel insert, multiple attempts were required to achieve dock which resulted in folds on the hydrogel insert, causing incomplete anterior capsulotomy and nuclear fragmentation. During surgery, capsulorhexis and nuclear fragmentation was completed manually. Rest of the surgery was uneventful. Conclusion: The choice of hydrogel insert should depend on the corneal curvature. Appropriate usage of hydrogel insert based on the keratometry readings will result in enhanced outcomes.

Факоэмульсификация катаракты на пониженных интраоперационных показателях

Purpose. To evaluate the clinical and functional results after cataract phacoemulsification with implantation of an intraocular lens at reduced intraoperative intraocular pressure, adapted vacuum and aspiration. Material and methods. 12 patients (24 eyes) with immature cataracts without concomitant eye pathology were included in the study. The age of patients was from 62 to 68 years. Patients were divided into 2 groups depending on intraoperative pressure parameters. The main group included 12 eyes with immature cataracts, which underwent phacoemulsification of the cataract with a reduced intraoperative intraocular pressure. 12 paired eyes, which underwent phacoemulsification of the cataract with IOL implantation with standard settings were included in the second (retrospective) group. Postoperative examination included checking visual acuity, tonometry, endothelial microscopy. The observation period was 1 day, 1 and 6 months. Results. Phacoemulsification of the cataract in both groups was performed without complications; operations were completed with intracapsular IOL implantation. It was noted that CDE of the main group was 2.79±0.64, and it was 2.9±0.82 in the control group during analyzing intraoperative indicators. The main differences were noted in indicators of the volume of fluid aspiration: 65.4±1.21 cm3 of the main group and 74.9±2.45 cm3 of the control group. The indicator of the volume of fluid aspiration of the control group was 14% more than that of the main group. After 6 months, the number of endothelial cells of the main group ranged from 1625 to 1935 cells/mm2, in the control group the number of endothelial cells ranged from 938 to 1745 cells/mm2. Conclusions. Performing phacoemulsification of cataract at close to normotonus values of intraoperative pressure parameters, as well as adapted indicators of irrigation-aspiration and vacuum, allows to reduce the negative effect on the corneal endothelium, reducing the percentage of complications and the postoperative period of rehabilitation of patients. Key words: cataract phacoemulsification, intraoperative intraocular pressure, reduced indicators.

Изучение особенностей интра- и послеоперационного состояния интерфейса «интраокулярная линза – задняя капсула хрусталика» при факоэмульсификации возрастной катаракты

Presence of full contact of interface «intraocular lens (IOL) – posterior capsule (PC)» ensures the transparency of the latter in the early period after phacoemulsification (PE) of senile cataract (SC). The main reasons for absence of full contact of IOL with PC are: the presence of residuals of viscoelastic (VE) in the capsular bag, uneven tension of the capsule by the haptic elements of the IOL, and the incommensurability of the size of the IOL with the capsule. Purpose. To study the features of the intra- and postoperative state of interface «IOL – PC» during PE SC. Material and methods. Dynamic observation of 42 patients (42 eyes), who operated on immature senile cataracts, was carried out. All operations were performed using OPMI LUMERA 700 surgical microscope (Carl Zeiss Meditec AG, Jena, Germany) with integrated intra-operative OCT, state of interface «IOL – PC» was examined. 2 hours after and on the 1st day after the operation state of interface «IOL – PC» was studied in all eyes by OCT on Optovue RTVue-100 (Optovue, Inc., US) with module for anterior segment examining to protocols «Cornea Line» and «Cornea Cross Line». Results. During the operation, the presence of contact between IOL and PC was observed only in 9 eyes (21.4%). 2 hours after surgery, 40 eyes (95.2%) had absence of contact between lens and capsule. On the 1st day after surgery, the optimal interface between IOL and PC was observed in 32 eyes (76.2%). Conclusion. Studies have shown that state of interface «IOL – PC» on the 1st day does not depend on its characteristics revealed intraoperative and 2 hours after the operation. The main reason for absence of contact between IOL and PC is residues of VE, and the using «impulse-irrigation» technique allows completely removing VE from the central zone of the capsule in all cases. Key words: cataract, phacoemulsification, intraocular lens, lens capsule, viscoelastic, interface «IOL – PC».

MACULAR OCT OUTCOMES OF PHACOEMULSIFICATION CATARACT SURGERY IN DIABETIC VERSUS NON DIABETIC PATIENTS

Background: Cataract surgery with phacoemulsification is one of the most common surgical procedures performed today .Compared to people without diabetes, diabetic patients have been shown to have an elevated risk of developing cataracts. Cataract surgery in diabetics is indicated not only to improve visual acuity, but also to allow assessment and treatment of fundus changes. Even in the absence of diabetic retinopathy, diabetes mellitus has been found to have about twice the occurrence rate of pseudophakic CME. Objectives: This study was done to document any subsequent post-phacoemulsification macular edema (PPME) as postoperative sequelae in the diabetic versus non-diabetic nuclear senile cataract patients. Methods: This study was conducted on patients complained from visually significant immature senile cataract in ophthalmology department at Sohag university hospital between January 2018 and December 2020.Corrected distance visual acuity, Keratomerty, refraction, slit-lamp examination, macular optical coherence tomography (OCT) and biometry. Phacoemulsification was performed to all patients by stop and shop technique. The macular OCT changes were documented preoperatively and at postoperative month 1, 3, 6. Results: 64 eyes of 64 patients with visually significant senile cataract were included 32eye of them were diabetics, (33 males, and 31 females), our study documented four cases of the entire 64 eyes (6%) complicated with PPME in groups A and B at the postoperative month 1. Both A and B groups exhibited the same incidence of postoperative macular edema i.e. two (6%) cases in each group. Conclusion: Our outcomes confirmed that there was a similar probability of PPME occurrence in both non-diabetic and diabetic patients as this probability was mostly related to the surgical procedure itself. Meanwhile, the non-diabetic PPME exhibited rapid and complete recovery within one month in comparison to the diabetic PPME that exhibited gradual and incomplete recovery during the postoperative six months follow-up period.

Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study

Background: Cataract surgery in patients with diabetes is indicated either to improve visual acuity or to allow assessment and treatment of fundus changes. We aimed to document the effects of phacoemulsification on the corneal endothelium in patients with or without diabetes.
 Methods: This comparative, prospective, non-randomized controlled interventional study was conducted in patients with visually significant immature senile cataracts in the ophthalmology department at Sohag University Hospital between January 2018 and December 2020. The following data were recorded: corrected distance visual acuity, keratometry readings, refraction, slit lamp examination results, and biometry data. Changes in corneal parameters were documented preoperatively and at 1, 3, and 6 months postoperatively using specular microscopy.
 Results: Sixty-four eyes of 64 patients with visually significant senile cataracts were included (32 eyes in the diabetic group and 32 eyes in the non-diabetic control group). We found greater mean endothelial cell loss in the non-diabetic group (179 cells/mm2; 6.4%) than in the diabetic group (134 cells/mm2; 4.8%) at 3 months postoperatively, yet the difference was not significant. The difference could be explained by the higher mean cumulative dissipated energy (CDE) used in the non-diabetic group (5.37 J) than in the diabetic group (4.68 J), although the difference was also not significant. Moreover, we found significantly higher coefficient of variation (CV) in the non-diabetic group than in the diabetic group at 1, 3, and 6 months postoperatively (P = 0.03, P = 0.02, and P = 0.008, respectively).
 Conclusions: Endothelial cell density was directly related to the CDE of phacoemulsification and not to diabetes. CV was significantly higher in the non-diabetic group than in the diabetic group. Future studies with a larger sample size, longer follow-up, and more diabetic subgroups with different levels of glycemic control are warranted to verify our conclusions.
 
 How to cite this article: Mahmoud A, Moussa I, Abozaid M, Iqbal M. Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study. Med Hypothesis Discov Innov Optom. 2021 Spring; 2(1): 1-7. DOI: https://doi.org/10.51329/mehdioptometry119

Состояние эндотелиальных клеток роговицы в динамике хирургического лечения возрастной и диабетической катаракты

Purpose. To assess the state of the corneal endothelium in patients with diabetic and immature age - related cataracts before and in the long term after phacoemulsification. Material and methods. There were 25 patients (43 eyes) under observation in total. The average age is 66.4±10.1 years. There were 12 men and 13 women among the surveyed. The average time after cataract phacoemulsification was 5.6±1.7 years. There were 2 groups of patients: group I (main) included 10 patients (16 eyes) with diabetic cataract, group 2 (control) consisted of 15 patients (27 eyes) with immature senile cataract (ISC) without diabetes. Before and after phacoemulsification the central corneal thickness (CCT), as well as polymegatism, pleomorphism, and corneal endothelial cell density (ECD) were studied using an EM-2000 endothelial microscope (Nidek, Japan). Results. In the long-term period after cataract phacoemulsification there was decreasing trend in the corneal endothelial cell density (ECD) as in patients operated on for immature senile and especially diabetic cataracts (by 1.5 times). The initial data of ECD in patients with diabetic cataract in comparison with ISC were lower although not significantly. There was also a decreasing trend in the percentage of hexaganality and the number of normal endothelial cells, as well as an increase in the coefficient of their polymegatism after phacoemulsification in patients with DM in comparison with patients without it. Conclusion. The study showed that phacoemulsification of diabetic cataracts is associated with more pronounced damage to the corneal endothelium when compared with the ISC group. During phacoemulsification with IOL implantation, especially in patients with diabetic cataracts, you should pay attention to the initially possible smaller ECD and take this circumstance into account when performing phacoemulsification. Key words: diabetic cataract, surgical treatment, phacoemulsification, endothelial microscopy, corneal endothelial cells.

Open-angle glaucoma in a case of cornea plana with unilateral microcornea

Cornea plana is a rare congenital condition, usually occurring bilaterally, characterized by flat cornea and low refractive power. Glaucoma due to angle closure is a more common association owing to the shallow anterior chamber. We report a case of an elderly lady with bilateral cornea plana with immature cataract and open-angle glaucoma, and unilateral microcornea. The patient is visually rehabilitated. Her glaucoma is stable, maintained on a single anti-glaucoma medication. In conclusion, IOP measurement in these patients can be biased due to varied corneal morphology. However, with proper evaluation, these challenging cases can be well managed.

Intra-ocular Lens Master V4 versus LenStar LS900 in Intra-ocular Lens Power Calculation and Postoperative Refraction Prediction

Background: The non-contact optical methods are preferable in Intra-ocular Lens (IOL) power calculation as they have higher resolution, better patient tolerance and greater acceptability. Aim: to compare between LENSTAR LS900 and IOL Master V4 in IOL power calculation. Material and Methods: This prospective comparative study included 60 eyes of 40 cataract patients. Patients with immature cataract of any age and both genders were included while those with dense cataract, media opacities, previous ocular diseases or surgeries or intraoperative complications were excluded. Patients were assessed by a complete comprehensive ophthalmic evaluation. Each patient was evaluated twice, one by the IOL Master and the other by the LENSTAR LS900. Outcome measures were axial length (AL), vertical keratometric dioptric power (K1), horizontal keratometric dioptric power (K2), and IOL power measurements. Results: The mean age of the patients was 67.08 ± 5.34 years. Thirty-five patients were males and 25 were females. The IOL master and LENSTAR were similar (p>0.05) in terms of the AL (24.82 ± 2.21and 24.80 ± 2.20), K1 (43.13 ± 1.66 and 43.14 ± 1.68), K2 (44.14 ± 1.56 and 44.27 ± 1.52) and IOL power (16.86 ± 5.24 and 16.84 ± 5.26). The target refraction on IOL master was -0.01 ± 0.06 compared with 0.04 ± 0.10 on LenStar. The actual refraction was 0.00 ± 0.33. There were non-significant differences between target and actual refractions on both devices (p>0.05). Conclusion: Both the optical biometers, IOL Master and LENSTAR provide similarly precise biometry and IOL power calculation in cataract patients.