Initial Cataract Research Articles

Histopathological Characteristics of Zonular Fibers and Lens Capsule and Their Relationship to Clinical Features in Intraocular Lens Dislocation

Purpose: To identify the histopathologic changes in the lens capsule of eyes with in-the-bag intraocular lens (IOL) dislocation. Design: Pathological analysis and correlation with clinical findings. Setting: Hayashi Eye Hospital (Fukuoka, Japan). Methods: Specimens of twenty-five IOL-lens capsule complexes obtained during surgery were processed for scanning electron microscopy (SEM). Backscattered electron images of cross-sections of the lens capsule were obtained using SEM. Ultrastructural changes in the lens capsule were examined and analyzed based on preoperative clinical findings. Results: The mean age was 70.0±18.0 years. The mean time from initial cataract surgery to IOL removal was 12.5±7.0 years. Of these, nine eyes had exfoliation syndrome (XFS), seven had high myopia, five underwent vitrectomy, and three had atopic dermatitis. The mean age of the XFS cases was 86.6±4.3 years. All XFS specimens demonstrated highly associated ruptured zonular fibers (p <.01). In the 16 non-XFS cases, the mean age was 61.2±17.5 years, significantly younger than in the XFS cases (p <.01); 14 of the 16 specimens had a detachment of zonular lamella (ZL), which was highly associated (p <.01). Four non-XFS eyes exhibited clear capsules, demonstrating significant associations with capsular delamination (p < .01) and the absence of lens epithelial cells (p < .01), resembling dead-bag syndrome. Conclusions: Structural changes in the lens capsule associated with IOL dislocation are mainly of three types: ruptured zonular fibers in XFS, detachment of the ZL, and capsular delamination. They vary according to the associated diseases, suggesting that prevention and treatment should consider the underlying pathophysiology.

Factors associated with the time of glaucoma-related adverse events onset after pediatric cataract surgery and the preferred anti-glaucomatous surgical selection

PurposeTo describe the clinical characteristics of glaucoma-related adverse events (GRAE) after pediatric cataract surgery. More importantly, to identify the factors associated with the time of GRAE onset and the preferred anti-glaucomatous surgical procedure for this disease.MethodsHospitalized medical records of patients who developed GRAE, which include glaucoma and glaucoma suspect, after pediatric cataract surgery (surgical age ≤ 14 years) between 1994 and 2021 were retrospectively reviewed. If the interval between cataract surgery and GRAE diagnosis was less than one year, early-onset GRAE was diagnosed, otherwise it was late-onset type. Multivariate logistic regression analysis was performed to investigate the possible associated factors for the type of GRAE onset. Chi-square test was used to evaluate the differences of the re-operation rate between the two surgical groups of glaucoma valve implantation and trabeculectomy for controlling elevated intraocular pressure (IOP).Results125 eyes in 94 patients with GRAE following pediatric cataract surgery were included in the study. Among them, 25 patients had unilateral cataracts and 100 eyes in 69 patients were bilateral. Of the 125 eyes, 63 (50.4%) had initial cataract surgery under 6 months of age, and 97 (77.6%) under 2 years of age. 76 eyes (60.8%) were aphakic, and 21 (16.8%) were with primary intraocular lens (IOL) implantation and the remaining 28 (22.4%) with secondary IOL implantation. More than half of the eyes (69/104, 66.3%) belonged to the group of late-onset GRAE. Multivariate analysis showed that a younger age at cataract surgery was associated with early-onset GRAE (P = 0.041). Closed angles were found in 72.1% (44/61) of eyes before the first anti-glaucomatous surgeries. 50% eyes (9/18) after trabeculectomy needed re-operation to control IOP compared with 12.1% (4/33) after glaucoma valve implantation (P = 0.003).ConclusionsAn earlier age at pediatric cataract surgery is more likely to develop early-onset GRAE. Glaucoma valve implantation seemed to be a preferred surgical intervention for patients with GRAE.

Features of hematological indices in cataract in the dynamics of surgical treatment

BACKGROUND: Cataract is one of the most common ophthalmologic diseases leading to blindness. AIM: To study the features of hematological indices in men over 40 years old with different types of cataract before and after surgical treatment. MATERIAL AND METHODS: The examination groups included 25 patients (25 eyes) with opacities localized in the cortical substance of the lens, 19 (19 eyes) with total opacities, 26 (26 eyes) with nuclear opacities, 30 (30 eyes) with subcapsular opacities; of these, 43 patients (43 eyes) had initial cataract, 39 (39 eyes) — immature, 18 (18 eyes) — mature cataract. The control group consisted of 30 people. All study participants underwent a complete ophthalmologic examination and assessment of hematological indices. The following integral hematological indices were calculated using generally accepted formulas: lymphocyte index (lymphocytes/neutrophils); leukocyte intoxication index; neutrophil/lymphocyte ratio index; neutrophil/monocyte ratio index; lymphocyte/monocyte ratio index; lymphocyte/eosinophil ratio index; leukocyte ratio and erythrocyte sedimentation rate index. Statistical analysis was performed using the Statistica 10 package. The Kruskal–Wallis and Mann–Whitney nonparametric tests were used to assess differences in the groups. The critical level of statistical significance when testing scientific hypotheses was p 0.05. RESULTS: At all stages of cataract maturity, before and after surgery, unidirectional changes in the hematological indices were revealed: the lymphocyte and eosinophil ratio decreased (1.4–2.0; p=0.01), the neutrophils and monocytes (1.3–2.1; p=0.04), lymphocytes and monocytes (1.4–2.5; p=0.02) ratios, leukocytes and erythrocyte sedimentation rate (2.9–6.8; p=0.01) increased. In immature cataract, the intoxication index according to the hematological indices increased by 2 times in the dynamics of surgical treatment. At the same time, multidirectional changes in the hematological indices were revealed in cortical and subcapsular opacities of the lens, unidirectional changes — in nuclear and total opacities. CONCLUSION: Patients with nuclear and total cataracts have the greatest number of disturbances in the ratio of cell populations according to hematological indices, therefore they constitute a risk group for the development of complications.

A NOVEL FOUR-POINT SCLERAL FIXATION TECHNIQUE WITH A HYDROPHOBIC INTRAOCULAR LENS: The Loop to Optic and Trailing end to Outside Technique.

To describe a new surgical technique that combines four-point, flanged polypropylene scleral fixation with a hydrophobic intraocular lens (IOL). Using the Envista MX60 and 6.0 polypropylene, scleral four-point fixation was achieved using a flanged-suture technique five times in a model eye and in a case series of eight patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration Loop to Optic and Trailing ends to Outside. Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy at fracture sites were studied. Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the Loop to Optic and Trailing end to Outside and the simple-pass technique (1.08 ± 0.52 N vs. 1.09 ± 0.32 N), suggesting no safety compromise. Scanning electron microscopy did not disclose the cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3-19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity of 20/25 to 20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9° (range: 0-9.6; median: 2.9°). Two patients developed postoperative cystoid macular edema treated topically. The first case developed flange extrusion that was readily repaired in the clinic. This novel technique adds two main advantages to previously described flanged-suture techniques: 1) four-point fixation of a hydrophobic IOL; 2) immediate application at the time of initial complicated cataract surgery because it requires no additional supply, IOL, or instrumentation.

Metabolic changes in the eye lens in the progression of cataract

Background. Cataract is one of the main causes of decreased visual acuity in the world, and therefore scientists are continuing researches on the mechanisms of development of this ophthalmic pathology.The aim. To study metabolic changes in a cloudy lens using an experimental model.Materials and methods. The study was carried out on adult male Wistar rats (n = 60), which were divided into control (n = 30) and experimental (n = 30) groups. Experimental cataract were simulated by daily ultraviolet irradiation (λ = 300–350 nm) during 6 months for 20 minutes. At the months 2, 4 and 6 of the study, we carried out a biomicroscopic examination of the anterior eye of animals using a slit lamp to monitor the development of cataract. Lenses were collected to determine the content of stearoyl-coenzyme-A desaturases and melatonin using enzyme immunoassay.Results. At the stage of initial cataract, the content of the stearoyl-coenzyme A desaturase was statistically significantly lower than the control values by 38 %; at the stage of immature cataract – by 30 %; at the stage of mature cataract – by 15.4 %. It was revealed that at the month 6 of the study, the concentration of melatonin in lens homogenates was 17 % lower when compared with the control. A statistically significant correlation was established between stearoyl-coenzyme A desaturase and melatonin (r = 0.32).Conclusion. Melatonin and stearoyl-coenzyme A desaturase play an important role in a number of biochemical processes that ensure the proper functioning of the visual analyzer. Changes in the concentration of these biological molecules can play a key role in the pathogenesis of cataract and a number of other ophthalmic diseases

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine & quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients & Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery & had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary & secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye & PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size & percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

Отдаленные результаты этапного хирургического лечения осложненной начальной катаракты у пациентов с далекозашедшей диабетической ретинопатией

Purpose. To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). Material and methods. 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the group I patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step — PE+IOL implantation + silicone oil removal. In the group II PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the group III patients were subjected to a two-step surgical procedure: VRS with gas tamponade performed as the first step in their treatment; followed by the second step, PE and the IOL implantation. In the group IV PE performed simultaneously with VRS with gas tamponade. Results. Patients in subgroup I and group III had better functional results than those in subgroup II and group IV, respectively (p < 0,001). The subgroup IIa (n = 9; 14.5 %) showed higher incidence of NVG than the subgroup Ia (n = 2; 3.2 %), p = 0.027. There also was a higher rate of NVG in group IV (n = 6; 19,3 %) compared to group III (n = 1; 3,1 %), p = 0,04. Conclusion. Phacoemulsification of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications. Keywords: proliferative diabetic retinopathy; vitreoretinal surgery; phacoemulsification

Возможности использования интраокулярной коррекции со сложной оптикой у пациентов с эпимакулярным фиброзом

Еpimacular fibrosis (EMF) occupies one of the leading positions in the structure of retinal surgical diseases. Vitreoretinal surgeons often face the necessity to perform combined surgical intervention in patients with native lens. Multifocal IOLs and IOLs with complex optics are strongly contraindicated for implantation in patients with macular pathology. However, not so long ago the ophthalmologic world was presented with an innovative method of presbyopia correction using EDOF IOLs (Extended depth-of-focus). Purpose. To study the use of intraocular correction with complex optics in patients with epimacular fibrosis. Material and methods. 14 patients of different genders with clinically significant EMF and initial cataract were included in the study. Patients underwent combined surgery including phacoemulsification (PEK) with implantation of EDOF IOL (Synthesis+ (Cutting Edge), France) and subsequent standard vitrectomy surgery. All patients underwent standard ophthalmologic examination before surgery and one month after surgical treatment. Results and discussion. We found that the distance vision after one month had a significant increase. Determination of IEP at the middle distance also recorded an increase. We recorded a statistically significant increase in the RPE at close distance visometry, which is probably explained by the elimination of central opacity of the own crystalline lens, preventing the ability of clear focusing of vision in the presence of presbyopic refraction. Keywords: epimacular fibrosis, facovitrectomy, EDOF, presbyopia, cataract, IOL

Современные подходы к хирургии катаракт с высокой остротой зрения на основании анализа волнового фронта

Relevance. Until recently, visual acuity was the main criterion for determining the timing of surgery, but already in the early stages of cataract development, patients may suffer from reduced image quality, which affects the quality of life (“night” myopia, light scattering, blurring). Deterioration in visual function in these patients may be explained by refractive errors. Analysis of internal higher-order aberrations resulting from slight opacification of the lens is important for determining the effect of media opacity on wavefront aberrations (WF) and for determining the indications and timing of surgical treatment, especially in patients with high visual acuity. Purpose. Evaluate the optical system of the eye with initial cataracts and high visual acuity. Evaluate the wavefront and its aberrations, contrast sensitivity and Shtrel coefficient. Material and methods. The study included 111 eyes with cataracts and 42 eyes without signs of cataracts (control group). Patients aged on average 57±5.3 years. Wavefront analysis was performed using an iTrace ray tracing aberrometer (Tracey Tech., USA) in a dark room under maximum drug-induced mydriasis. In each group, total, corneal, and internal wavefront aberrations were measured at a pupil diameter of 6.0 mm. Higher order aberrations were analyzed using Zernike polynomials (3rd to 5th order). The modulation transfer function (MTF) at different spatial frequencies (0–30 c/deg) and the Strehl coefficient in patients in the study groups were also assessed. Results. Total and internal higher-order wavefront aberrations were significant in different cataract groups compared with control patients, while higher-order corneal aberrations were not statistically different. We noted a higher level of total and internal aberrations in the group of patients with posterior subcapsular cataract. In this regard, patients with posterior subcapsular cataract require surgical treatment at an earlier stage, despite high visual acuity. Conclusion. We recommend assessing the optical quality of vision and wavefront aberrations when observing early cataracts in order to decide whether to perform surgery at an earlier date. Key words: initial cataract, quality of vision, higher order aberrations, internal wavefront aberrations

Phacoemulsification with IOL implantation at a critical level of corneal endothelial cells

BACKGROUND: Cataract phacoemulsification is one of the most frequently performed surgical procedures, and a decrease in the corneal endothelial cell density (ECD) is the main postoperative complication leading to visual impairment. The average cell loss after phacoemulsification is 4.0112.94% within a year, and within 2 months 5.29.1%. The use of viscoelastics helps to reduce this loss, but it is impossible to completely prevent it.
 AIM: Сomparison of ECD in the pre- and postoperative period of phacoemulsification using viscoelastic of different percentages at a critical level of corneal endothelial cells.
 MATERIALS AND METHODS: The study included 60 eyes with emmetropic refraction: in the first group: 30 eyes with initial cataract and low ECD level (1694/1218 cells/mm2), an apyrogenic moderately cohesive viscoelastic 1.6% sodium hyaluronate solution (Kogevisk, Solopharm) was used, in the second group: 30 eyes with mature cataract and ECD level (1646/1183 cells/mm2) an apyrogenic, highly purified viscoelastic was used, consisting of medium-molecular fractions of chondroitin sodium sulfate 4% and sodium hyaluronate 3% (Adhevisk, Solopharm). Before surgery and a month after surgery, patients were tested for uncorrected visual acuity in the distance, ECD measurements, and intraocular pressure measurement.
 RESULTS: In phacoemulsification with IOL implantation, the use of viscoelastics of different percentages shows that the condition of the cornea remained stable a month after surgery. Postoperative ECD loss in all clinical cases, regardless of the stage of cataract, was less than 3%.
 CONCLUSIONS: Viscoelastics allow to solve the tasks set: in the case of cohesive maintaining the depth of the anterior chamber and the width of the pupil, adhesive protecting the corneal endothelium, good visualization. Rational consistent use of adhesive and cohesive components facilitates basic manipulations during phacoemulsification and IOL implantation. To do this, it is necessary to correctly use and select viscoelastic for a particular operation based on the number of endothelial cells.

Clinical experience in rehabilitation of patients with Fuchs corneal dystrophy and cataract by ultrasonic phacoemulsification and descemetorhexis

BACKGROUND: The potential for peripheral corneal endothelial capabilities is a novel, poorly understood direction. The comprehensive development of various modifications of endothelial keratoplasty goes hand in hand with a lack of donor material. This explains the continuous search for safe tissue-preserving techniques.
 AIM: The aim of this study is to evaluate the clinical and functional results of treatment of patients with Fuchs corneal dystrophy and cataract using a combination of cataract ultrasound phacoemulsification and descemetorhexis.
 MATERIALS AND METHODS: The study included 3 patients (3 eyes), 3 women aged 65 to 78 (on average 73.6 7.5 years). The follow-up period in the postoperative period was 36 months. The inclusion criteria were: patient complaints about glare, blurred vision and cloudy vision in the morning; the location of the guttae in the central 5 mm zone, central corneal stromal edema less than 610 microns, the inability to count endothelial cells in the center, endothelial cells density on the periphery in the upper quadrant more than 1400 cells/mm2. All patients underwent phacoemulsification of cataract with IOL implantation and subsequent descemetorhexis in the 4 mm zone.
 RESULTS: At 1 month an increase in the central corneal thickness and a slight increase in uncorrected visual acuity (UCVA) and in best corrected visual acuity (BCVA). By the 3rd month, positive dynamics was present: an increase in UCVA and BCVA in all cases, a decrease in the central corneal thickness (559 20 m), resorption of stromal edema, increase in corneal transparency, possibility to calculate the endothelial cells density in the center (866 46 cells/mm2). At 36 months, the BCVA was 0.6, 0.4 and 0.5, respectively.
 CONCLUSIONS: Restoration of corneal transparency was achieved in 100% of cases (3 out of 3). An analysis of the clinical results of the descemetorhexis + phacoemulsification + IOL operation demonstrated an increase in visual acuity, an increase in corneal transparency and a decrease in stromal edema in patients with initial Fuchs corneal dystrophy and cataract. The possibility of not using donor material for the treatment of Fuchs corneal dystrophy is a promising trend. Further accumulation of material is required.

Некоторые биохимические изменения хрусталика в процессе старения.

The goal is to study some biochemical changes in the lens of rats and humans during aging. Materials and methods. Experiments were carried out on 25 rats. We also examined 84 patients with initial nuclear cataract. Results. diverse dynamics of the content of total lipids in the lenses of rats was revealed. There is a noticeable decrease in the content of products of oxidative modification of lipids in the lens tissue between 12 and 24 months and a slight increase in the period from 24 to 36 months. A 2-fold decrease in the content of the total protein level was revealed when comparing groups of 5 months and 36 months and an increase in total protein content with age. When comparing the parameters of oxidative degradation, cl in the lens tissue of rats and humans with age, similar indicators of dynamics were obtained. Conclusion. The data obtained indicate changes in the parameters of lipids and proteins in the lens tissue of rats during postnatal ontogenesis. The fact that there is a balance between damage and protection of proteins in the transparent lens was revealed. When comparing data on protein oxidation in the lens tissue of rats and humans with age, similar indicators were obtained. Keywords: lens, aging, biochemical changes

Advancements in Cataract Detection: The Systematic Development of LeNet-Convolutional Neural Network Models.

Regular screening and timely treatment play a crucial role in addressing the progression and visual impairment caused by cataracts, the leading cause of blindness in Thailand and many other countries. Despite the potential for prevention and successful treatment, patients often delay seeking medical attention due to the gradual and relatively asymptomatic nature of cataracts. To address this challenge, this research focuses on the identification of cataract abnormalities using image processing techniques and machine learning for preliminary assessment. The LeNet-convolutional neural network (LeNet-CNN) model is employed to train a dataset of digital camera images, and its performance is compared to the support vector machine (SVM) model in categorizing cataract abnormalities. The evaluation demonstrates that the LeNet-CNN model achieves impressive results in the testing phase. It attains an accuracy rate of 96%, exhibiting a sensitivity of 95% for detecting positive cases and a specificity of 96% for accurately identifying negative cases. These outcomes surpass the performance of previous studies in this field. This highlights the accuracy and effectiveness of the proposed approach, particularly the superior performance of LeNet-CNN. By utilizing image processing technology and convolutional neural networks, this research provides an effective tool for initial cataract screening. Patients can independently assess their eye health by capturing self-images, facilitating early intervention and medical consultations. The proposed method holds promise in enhancing the preliminary assessment of cataracts, enabling early detection and timely access to appropriate care.

Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy.

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Изменение концентрации мелатонина при прогрессировании катаракты

Purpose. To establish the relationship between melatonin level in the blood serum and the lens in patients with different degrees of cataract progression. Material and methods During the study, the following groups of patients were formed: group 1 – initial cataract, group 2 – immature cataract, group 3 – mature cataract and group 4 – complicated initial cataract with type 2 diabetes mellitus. All patients were surveyed. Considering the fact that melatonin secretion depends on a daily rhythm, the sampling of biomaterial for analysis was carried out at the same time during a planned surgical intervention. Melatonin content was determined by enzyme immunoassay using the commercial Human MT (Melatonin) ELISA Kit. Results. The study did not reveal statistically significant changes in the level of melatonin in the blood serum of patients with different levels of cataract progression. However, there was a trend towards lower melatonin values in the group of patients with immature and mature cataract, relative to patients with initial cataract. When comparing the group of patients with mature cataract relative to patients with initial cataract, there was a decrease in melatonin levels by 45 % (p ≤ 0.05). The level of melatonin in the lens of patients with cataract complicated by diabetes mellitus was lower by 63 % (p ≤ 0.01) compared to patients with uncomplicated initial cataract. Conclusion. It was found that the level of melatonin in the lens significantly depends on the degree of cataract progression. Cataracts complicated by diabetes mellitus were characterized by minimal values of melatonin in the lens. The obtained data show the relevance of further research to assess the role of melatonin in various ophthalmic pathologies. Keywords: melatonin, cataract, eye lens

Timing of the Initial Postoperative Care After Cataract Surgery: A Patient's Perspective.

To evaluate patient preferences in regards to the timing of the initial postoperative examination after undergoing cataract surgery. A retrospective, consecutive case series analysis from a single private practice institution was performed using a standardized phone survey on patients who underwent cataract surgery. Subjects were classified into one of two possible study groups according to the timing of their initial postoperative cataract surgery examination: Group A received the initial postoperative cataract surgery examination on the same day as the surgery, whereas Group B received the initial postoperative cataract surgery examination on the day following the operation. There were 80 subjects contacted for the phone survey of which 70 (35 in each study group) completed the survey and therefore were included in the analysis. Group A subjects responded favorably in regards to preference and realizing reduced time and cost savings compared to Group B (p < 0.0001 for both). There were no subjects in Group A who would have preferred next-day initial postoperative care, whereas 31.4% of subjects in Group B would have preferred same-day care if given the opportunity. Patients undergoing cataract surgery both prefer and report time and cost savings with same-day initial postoperative care compared to next-day initial postoperative care. Patient preferences regarding their postoperative care should be one of the many factors that a surgeon ought to take into consideration when providing follow-up care after cataract surgery.

Clinical Case of Cataract Phacoemulsification with Implantation of a Multifocal Intraocular Lens in a Patient with Posterior Keratoconus

Purpose: to provide a clinical case of cataract phacoemulsification with implantation of a multifocal intraocular lens (IOL) in a patient with posterior keratoconus.Clinical case. A 58-year-old patient came to the clinic with complaints of decreased visual acuity in both eyes over the past 2 years. A series of standard instrumental examinations and Scheimpflug keratotopography were performed. An initial age-related cataract, moderate hyperopia, complex hyperopic astigmatism, posterior keratoconus, and peripheral chorioretinal dystrophy was diagnosed.Results and discussion. To achieve high visual functions and correct presbyopia, the patient was offered phacoemulsification surgery with implantation of a multifocal intraocular lens (IOL) Oculentis in the right eye and a multifocal toric one in the left one.Conclusion. The result of our surgical treatment showed the multipurpose of the multifocal IOL Oculentis in some nonstandard cases and conditions of the cornea.

Современные подходы к хирургии катаракты на основании анализа волнового фронта

Relevance. Cataract is the leading cause of visual impairment worldwide. Even in the early stages of cataract development, when the maximum visual acuity often remains high, patients complain of a decrease in image quality (light scattering, diplopia), which is expressed in the difficulty of performing daily and professional activities. The cause of this condition in most cases is internal aberrations of a higher order. One of the topical issues of modern ophthalmology is the definition of indications for surgery of primary cataracts with high visual acuity. Purpose. The purpose of this literature review was to describe the current state of the problem of wavefront changes in patients with various types of initial lens opacity. Material and methods. A systematic analysis of scientific publications of domestic and foreign authors on the resources PubMed, Medline from 2000 to 2022, devoted to the currently existing methods for assessing the quality of vision of patients with initial opacification of the lens, was carried out. Results. Our literature review showed the great importance of assessing wavefront aberrations in patients with initial cataracts and high visual acuity. With the advent of modern diagnostic systems – aberrometers with the possibility of an isolated assessment of internal aberrations, doctors have the opportunity to interpret data on the effect of lens changes on the quality of vision. Conclusion. Visual acuity in patients with initial cataract is not a unique evaluation criterion for determining the timing of surgical intervention. Analysis of wavefront aberrations to a greater extent describe visual impairments and can be used as objective criteria for prescribing surgical treatment. The study of aberrations of the human eye makes it possible to give an objective and quantitative assessment of the optical functions of the eye, which expands the possibilities for diagnosis and for the formation of surgical approaches for initial lens opacities in patients with high visual acuity. Key words: higher-order wavefront aberrations, cataract

Tecnics Eyhance Iol as a Solution for Anisometropic Amblyopia Cataract Patient: a Case Report

Background: Amblyopia affects 1-3% of the population, leading to irreversible vision loss in children and adults. Treatment options include refractive correction, occlusion therapy, and atropine penalization. Anisometropic amblyopia, caused by a difference in refractive status between the eyes, can be treated using contact lenses, glasses, ICL implantation, or cataract surgery with intraocular lens implantation. Tecnis Eyhance IOL is a superior solution, improving vision after eye surgery with a low incidence of halo, glare, or starburst. Objective: The aim is to present the case of a patient with anisometropic amblyopia, in whom Eyhance IOL was implanted in both eyes as a solution to refractive error and initial cataract due to intolerance for contact lenses. Case report: A 58-year-old female patient presented to our clinic complaining of blurry vision in her left eye that had persisted for a year. The patient reported intolerance to contact lenses and a history of amblyopia in her right eye. CDVA was 0.20 with -9.00/-1.50 x 25◦ in her right and 0.80 with +4.00 sphere correction in her left eye, while her CNVA was J9 with +2.50 and J1 with +2.50. Slit-lamp examination revealed early cataracts in both eyes, with otherwise normal findings. A dilated fundus examination showed vitreous liquefaction and myopic macula in the right eye but normal results in both eyes‘ posterior segments. The IOP was within normal limits, and the eye‘s axial length was measured. Considering the patient‘s intolerance to contact lenses, cataract surgery with intraocular lens implantation was deemed appropriate. Given the anisometropic amblyopia, the Eyhance lens was selected to optimize the patient‘s visual acuity. Following the procedure, the patient‘s visual acuity improved significantly, with her best CDVA at 0.35 in the right eye and 0.95 in the left eye. With +1.50 sphere correction, the CNVA was also enhanced, with the patient reading at J4 and J1 for her right and left eye, respectively. These improvements may have positively impacted the patient‘s quality of life and ability to perform daily activities. Conclusion: Anisometropic amblyopia in 58-year-old women was treated successfully with cataract surgery and implantation of Eyhance IOL.

Синдром токсического поражения переднего сегмента глаза (tass) после факоэмульсификации катаракты и имплантации иол. (клинический случай)

Purpose.To present a clinical case of TASS at the IRTСEye Microsurgery Ekaterinburg center. Clinical case. Patient C, born in 1955 came to the Center in 2016 with complaints of low vision in the left eye. After a standard ophthalmologic exa mination, she was diagnosed with mature cataract with elements of swelling in the left eye, initial cataract, 1st degree hyperopia in the right eye. Phacoemulsification of cataract with IOL implantation was suggested for the left eye. The patient developed TASS-syndrome the next day after the surgery. Results. We have analyzed possible causes of TASS development in the patient. The peculiarity of the operative treatment was the use of Rhex-ID capsule dye in the volume of 1 ml. We assumed that the use of this dye was the cause of the syndrome. Conclusion. The problem of postoperative inflammatory reaction remains rather urgent despite of rare occurrence of toxic anterior segment syndrome. The syndrome appears suddenly and unpredictably, can take the form of an outbreak in an individual institution. TASS is a condition similar to infectious bacterial postoperative complications in its clinical manifestations and presence of pathognomonic symptoms, which complicates diagnosis and determination of tactic. Key words: TASS; toxic anterior segment syndrome; postoperative endophthalmitis.