Management Of Cataract Research Articles

Surgery for idiopathic epiretinal membrane.

Epiretinal membrane is an abnormal sheet of avascular fibrocellular tissue that develops on the inner surface of the retina. Epiretinal membrane can cause impairment of sight as a consequence of progressive distortion of retinal architecture. To determine the effects of surgery compared to no intervention for epiretinal membrane. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, EmbaseOvid, ISRCTN registry, US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). There were no restrictions to language or year of publication. The databases were last searched on 20 May 2020. We included randomised controlled trials (RCTs) assessing surgical removal of idiopathic epiretinal membrane compared to placebo, no treatment or shamtreatment. Paired or within-person studies were included, as well as those where both eyes of a single participant were treated. We used standard methods expected by Cochrane, and assessed certainty using the GRADE system. We considered the following five outcome measures: mean change in best corrected visual acuity (BCVA) in the study eye between baseline (before randomisation), 6 months and 12 months later; proportion of people with a gain of 0.3 logMAR or more of visual acuity in the study eye as measured by a logMAR chart at a starting distance of 4 m at 6 months and 12 months after randomisation; proportion of people with a loss of 0.3 logMAR or moreof visual acuity in the study eye as measured by a logMAR chart at a starting distance of 4 m at 6 months and 12 months after randomisation; mean quality of life score at 6 months and 12 months following surgery, measured using a validated questionnaire; and any harm identified during follow-up. We included one study in the review. This was a RCT including 53 eyes of 53 participants with mild symptomatic epiretinal membraneand BCVA of 65 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Participants were randomly allocated to immediate surgery or to watchful waiting with deferred surgery if indicated by evidence of disease progression. The study was limited by imprecision owing to the small number of participants and was at some risk of bias owing to inconsistencies in the time points for outcome assessment and in the management of lens opacity. At 12 months, the visual acuity in the immediate surgery group was higher by a mean of 2.1 (95% confidence interval (CI) -2.0 to 6.2 ETDRS letters; 53 participants; low-certainty evidence) than the watchful waiting/deferred surgery group. The evidence of the effect of immediate surgery on gains of 0.3 logMAR or more of visual acuity is very uncertain (risk ratio (RR) 0.55, 95% CI 0.06 to 4.93; 53 participants; very low-certainty evidence). At 12 months, no participant in either group sustained a loss of 0.3 logMAR or more of visual acuity(53 participants; low-certainty evidence). The included study did not measure quality of life. At 12 months, no serious adverse event was identified in any participant. One participant developed chronic minimal cystoid macular oedema following immediate surgery (53 participants; low-certainty evidence). We found no RCT that directly investigated the effect of surgery compared to no intervention. For severe disabling epiretinal membrane, the lack of a RCT comparing surgery to no intervention may reflect evidence from non-randomised studies in favour of surgery; a RCT may be considered unnecessary and ethically unacceptable because a superior effect of surgery is widely accepted. For mild symptomatic epiretinal membrane, however, the value of surgery is uncertain. Low-certainty evidence from this review suggests that watchful waiting or deferred surgery may offer outcomes as favourable as immediate surgery. However, this finding needs to be confirmed in further RCTs with appropriate statistical power, masking of treatment allocation, consistent management of cataract, and measurement of outcomes including patient-reported quality of life over a more extended time frame.

Clinical Characteristics of Presenile Cataract: Change over 10 Years in Southern Taiwan.

Purpose The purpose of this study is to investigate the clinical characteristics of presenile cataract and compare that to ten years ago in southern Taiwan. Methods The subjects who received cataract surgeries aged 30 to 54 years were recruited in Kaohsiung Chang Gung Memorial Hospital during September 2015 and August 2016. Patients with uveitis or those who received combined cataract surgeries were excluded. Retrospective chart review was performed in this study. Results A total number of 2439 cataract surgeries were performed, and 302 (12.38%) eyes were having presenile cataract. Mean age was 47.55 ± 5.64 years old, and mean axial length was 26.00 ± 2.89 mm. Among 302 presenile cataract eyes, the leading cause was high myopia (defined as mean axial length ≥ 26 mm, 47.02%), followed by diabetes mellitus (26.82%). In types of lens opacity analysis, 67.55% of the patients were nuclear sclerosis dominant. Compared to the previous study 10 years ago, the leading cause of presenile cataract changed from idiopathy to high myopia, whereas the lens opacity types changed from posterior subcapsular opacity dominant to nuclear sclerosis dominant. Conclusions High myopia has become the most important clinical characteristic associated with presenile cataract in a myopia epidemic area, and the most common type of lens opacity was nuclear sclerosis. With the increasing prevalence of high myopia, we should pay more attention to the management of presenile cataracts in high myopes to avoid complications.

Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.

The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.

Management of Cataracts in Pediatric Patients with Developmental Delay at a Tertiary Care Pediatric Hospital

Background: Childhood cataract causing visual impairment can compound developmental delay (DD) if left untreated. Current literature in children with DD is limited; thus, we evaluated cataract etiology, challenges, and treatment compliance in this group. Purpose: To report the presentation and challenges associated with cataract management in children with developmental delay (DD) at a tertiary care pediatric hospital. Methods: Retrospective review of 100 patients (173 eyes) presenting with cataracts and DD from February 2014 to December 2017. Results: 100 patients (173 eyes) were included. 27 patients had unilateral cataracts and 73 bilateral. The average age was 120.55 months (SD 63.77, range 5.87 - 243.16); the average follow-up period was 57.7 months (SD 139.14, range 1.03 - 1412.30). 61% of patients (55% eyes) underwent medical management for cataracts due to: cataract was not visually significant (66% eyes), parent deferred surgery (11% eyes), self-abusive behavior (14% eyes), and medical conditions that limited visual recovery (9% eyes). 32% of patients were unable to perform objective visual acuity by age 5. Patients with self-abusive behavior were more likely to present with or develop retinal detachment (RD) (35%) compared to those without self-abusive behavior (6%) (p = 0.0028). A statistically significant difference in the difficulty of examination (p < 0.0001) and poor compliance of glasses wear (p < 0.0001) was found in nonverbal patients. Surgical complications occurred in 39% of eyes. Those with intraocular lens placement after cataract extraction were more likely to develop visual axis opacification (27% eyes) than those who remained aphakic (9% eyes) (p = 0.0313). Conclusion: Cataract extraction in pediatric patients with DD can be associated with success, however, providers should prepare for limitations in managing these patients.

Recommendations for the management of childhood juvenile idiopathic arthritis-type chronic anterior uveitis.

Australian- and New Zealand-based, uveitis-specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)-type chronic anterior uveitis. Historically, the visual prognosis of JIA-type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. This work involved a consensus survey and a panel meeting. The Australian and New Zealand JIA-Uveitis Working Group (29 ophthalmologists) participated in the work. The Delphi technique was used to achieve consensus. This work yielded consensus statements. The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non-corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA-type uveitis. Recommendations of the Australian and New Zealand JIA-Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.

Surgical management of bilateral cataracts in a patient with congenital iris coloboma

Surgical management of bilateral cataracts in a patient with congenital iris coloboma

Prevalence and Causes of Visual Impairment and Blindness in Three Ecological Regions of Nepal.

Visual impairment and blindness are significant public health issues worldwide. The objective of this study was to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal. A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Number of participants from each region was distributed as per the prevalence findings of pilot study, with 2815 participants enrolled in Dolakha, 1509 in Dhading and 910 in Sarlahi. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using standard software. For categorical data, frequency, percentage and 95% CI were calculated and statistical tests were done using Chi-square/Fisher exact test. Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (495). It was 4.7% (133) in the mountainous region, 11.2% (169) in the Hill and 21.2% (193) in the Tarai. In those aged 15-49 years, MSVI prevalence was 1.5% (52) and 25.1% (433) in ≥50 years. The overall prevalence of blindness was 0.9% (47). It was 0.2% (6) in 15-49 and 2.3% (41) in ≥50 age groups. More than 95% visual impairment and blindness were due to cataract and uncorrected refractive error. Cataract was the leading cause of visual impairment and blindness (290, 53.5%), followed by uncorrected refractive error. The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The management of uncorrected refractive error and operable cataract would reduce nine in ten cases of moderate to severe visual impairment and blindness.

Nasolacrimal obstruction concomitant to cataract: diagnosis and management in the preoperative period of cataract surgery.

Concomitant nasolacrimal duct obstruction can occur in cataract carriers, which increases the risk of postoperative endophthalmitis. The primary aim of this study is to evaluate the knowledge of Brazilian cataract surgeons on the diagnosis and management of cataracts associated with nasolacrimal duct obstruction. This survey was based on a questionnaire involving Brazilian cataract surgeons that was conducted from March to April 2018. Data were collected on the participant's profile, time and experience in ophthalmic practice, previous training in diagnosis and management of nasolacrimal duct obstruction, and background with endophthalmitis after cataract surgery in patients with nasolacrimal duct obstruction. All data were entered into an Excel spreadsheet and analyzed according to the frequency of occurrence. Ninety-one ophthalmologists answered the questionnaire. Most (63.7%) had been performing cataract surgery for >10 years, and most (84.6%) received training to diagnose and handle nasolacrimal duct obstruction during their medical residence training. Nasolacrimal duct obstruction was investigated in the preoperative period of the cataract by lacrimal sac expression test (53.8%) or by irrigation of the tear pathways (23.1%). Nasolacrimal duct obstruction was treated with antibiotic eye drops by 47.2% of respondents. Seventy-eight percent of surgeons indicate usually performing lacrimal surgery prior to the intraocular surgery, waiting for 4 to 6 weeks to proceed with the cataract surgery. The procedure of choice for treating nasolacrimal duct obstruction prior to cataract surgery was dacryocystorhinostomy (88.4%). Most participants recognized the need for a protocol to assist in the detection and management of nasolacrimal duct obstruction in cataract carriers. Improvement in the diagnosis and management of nasolacrimal duct obstruction concomitant to cataract is needed, as this is a risk factor for endophthalmitis.

Commentary: Pediatric cataract management during the COVID-19 era.

Commentary: Pediatric cataract management during the COVID-19 era.

Evaluation of the Relationship between Corneal Diameter and Lens Diameter in Children

Primary intraocular lens (IOL) implantation has gained acceptance for management of infantile cataracts because of the advantage of reduced amblyopia risk. The aim of the study was to investigate the association between corneal diameter as measured from the white-to-white distance and natural lens diameter in children. This association may aid intraocular lens selection following cataract removal in infants and young children. A cross-sectional study was performed on forty eyes from 40 children less than 4 years, who needed to be examined, were planned for a procedure or operation under general anaesthesia. Subjects were recruited from Eye Clinic,Kuala Lumpur General Hospital from January 2010 to September 2011. Corneal diameter was measured with Holladay-Godwin corneal gauge while lens diameter was measured with ultrasound biomicroscope (UBM) during surgery. For the results, mean age of subjects was 24.7 + 12.1 months. Mean corneal diameter was 11.62 + 0.50 mm horizontally and 11.20 + 0.58 mm vertically. Mean horizontal lens diameter was 7.94 + 0.47 mm. A medium positive correlation was found between mean horizontal corneal diameter and lens diameter (r=0.479, p=0.002). Lens diameter had a strong correlation with patient’s age (r=0.718, p&lt;0.001). Lens diameter can be calculated by using this model of equation: [Lens diameter (mm) = 7.010 + 0.021 Corneal Diameter (mm) + 0.028 Age (months)] (r2=0.52). In conclusion, there was a moderate positive correlation between corneal and lens diameter. UBM can be used to measure lens capsular bag size directly preoperatively.

Incidence, management, and outcome of complex cataracts in a tertiary eye set up

Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.

Incidence, management, and outcome of complex cataracts in a tertiary eye set up

Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.

Impact of Rashtriya Bal Swasthya Karyakram, in management of childhood cataract, at a tertiary eye care center of Eastern Uttar Pradesh

Background: Cataracts in children are rare, accounting 7.4-15.3% of pediatric blindness. Pediatric cataract is a treatable leading cause of childhood blindness. Rashtriya bal swasthya karyakram (RBSK) is an important initiative aiming at early identification and early intervention for children from birth to 18 years. The objective of our study was to know the impact of RBSK, in management of childhood cataract, at a tertiary eye care center.Methods: This was a hospital based retrospective study, done from December 2018 to December 2019. This study included all patients of congenital and developmental cataract during this study period. The patients aged less than or equal to 18 years were included. All statistical analyses were done at 5% (p&lt;0.05) significance using Graph Pad instat version 3.0 and Microsoft excel 2019.Results: During a study period of thirteen months, 357 eyes of 210 patients with congenital or development cataract were included. There were 142 (67.61%) male patients and 68 (32.38%) were female. The maximum number of patients were seen in the age group of 4-6 years 52 (24.7%), followed by the age group of 7-9 years 48 (22.8%). Bilateral cataracts were seen in 148 (70.4%) patients and unilateral cataract in 61 (29.0%) patients. The most common type of cataract was lamellar cataract seen in 150 (42%) eyes.Conclusions: RBSK is changing the lives of children and their families by reducing the burden of childhood blindness due to cataract and improving the quality of the life, especially in financially underprivileged families.

Repression of Polyol Pathway Activity by Hemidesmus indicus var. pubescens R.Br. Linn Root Extract, an Aldose Reductase Inhibitor: An In Silico and Ex Vivo Study

Development of diabetic cataract is mainly associated with the accumulation of sorbitol via the polyol pathway through the action of Aldose reductase (AR). Hence, AR inhibitors are considered as potential agents in the management of diabetic cataract. This study explored the AR inhibition potential of Hemidesmus indicus var. pubescens root extract by in silico and ex vivo methods. Molecular docking studies (Auto Dock tool) between β-sitosterol, hemidesminine, hemidesmin-1, hemidesmin-2, and AR showed that β-sitosterol (− 10.2 kcal/mol) and hemidesmin-2 (− 8.07 kcal/mol) had the strongest affinity to AR enzyme. Ex vivo studies were performed by incubating isolated goat lenses in artificial aqueous humor using galactose (55 mM) as cataract inducing agent at room temperature (pH 7.8) for 72 h. After treatment with Vitamin E acetate − 100 µg/mL (standard) and test extract (500 and 1000 µg/mL) separately, the estimation of biochemical markers showed inhibition of lens AR activity and decreased sorbitol levels. Additionally, extract also normalized the levels of antioxidant markers like SOD, CAT, GSH. Our results showed evidence that H. indicus var. pubescens root was able to prevent cataract by prevention of opacification and formation of polyols that underlines its potential as a possible therapeutic agent against diabetic complications.Graphic

Cataract surgery barriers, cataract surgical coverage and outcome among rural population of Dhule district in Maharashtra

Background: In India the coverage and outcome of cataract management are through camps and hospital undertaking rural cataract surgical services. There are varied outcomes of cataract surgery in population based studies within our country while cataract surgical outcomes have inbuilt dependency on various factors. National program for control of blindness and visual impairment aims in improvement of vision of the cataract patients. Thus evaluating cataract outcome would help top strengthen the national program.Methods: The study was part of population based blindness survey carried out among 40 years and above rural population in Dhule district of Maharashtra during 2019. In the survey 2370 villagers, 40 years and above were surveyed for blindness prevalence by 30 Cluster sampling technique having 79 peoples from each cluster. Collection of baseline data with information of eye care services and ophthalmic examination was done.Results: Prevalence of cataract in 40 year and above population in study was 20.78%. In present study predominant barrier in cataract operation in 71.1% participants for not having consultation was belief it to be destiny or God’s will. 20.3% cataract patients with visual impairment had visual acuity of 6/60 and 18.4% had less than 3/60 visual acuity. Maximum participants had cataract operated in government hospital 61.7%. In the study cataract surgical coverage was 72.7% by eyes and 81.7% by person for visual acuity &lt;3/60.Conclusions: Efforts to increase cataract surgical coverage would help to reduce the prevalence of visual impairment due to cataract.

Clinical Outcomes of Management of Traumatic Cataract in a Tertiary Care Centre

Background and Objectives : Ocular trauma can lead to development of cataract when natural lens is damaged by either blunt or penetrating injury. The management of traumatic cataract follows the same principle as for senile cataract but associated damage to ocular tissues and several post-operative complications may lead to suboptimal visual outcome. This study was conceptualized to evaluate the visual outcomes following management of traumatic cataracts. Material and Methods : This prospective, longitudinal study was conducted on 80 patients with traumatic cataract in tertiary care centre. Patients were managed surgically and were followed up for a period of six months. Visual acuity was measured at every follow-up visit and any post-operative complications were noted and managed, accordingly. Final visual acuity was assessed at the end of six months. Results: Maximum cases of traumatic cataract (53.75%) were observed in age group of &lt;20 years with male to female ratio of 2.63:1. Maximum patients (92.15%) were implanted posterior chamber intraocular lens, either as a primary or secondary procedure. Uveitis and posterior capsular opacification were most common post-operative complications (30%) and 68.75% cases achieved a final visual acuity of 6/6-6/ 18 at the end of six months. Conclusions Traumatic cataract is an important cause of ocular morbidity specially in young patients. Surgery in cases of traumatic cataract can yield good visual outcomes if posterior segment is not involved and if post-operative complications are managed efficiently.

Recent developments in the management of congenital cataract.

Congenital cataract is a rare eye disease, one of the leading treatable causes of low vision in children worldwide. Hereditary cataracts can be divided in syndromic and non-syndromic cataracts. Early diagnosis in congenital cataracts is key to reach good visual function. Current surgical techniques, that combine microincision cataract extraction and primary intraocular lens (IOL) implantation, have improved childhood cataract outcome. Complications include posterior capsule opacification (PCO), aphakic or pseudophakic glaucoma, uveitis, pupil displacement and IOL decentration. A recent study using a modified Delphi approach identified areas of consensus and disagreement in the management of pediatric cataract. A consensus or near consensus was achieved for 79% of the questions, however 21% of the questions remained controversial, as for IOL implantation strategy. Congenital cataracts show a highly variable phenotype and genotype, and can be related to different mutations, genetic variance, and other risk factors. Congenital cataracts can be associated with other ocular developmental abnormalities, including microphthalmia, microcornea, or aniridia and with systemic findings. Next-generation sequencing (NGS) and forthcoming new ultra-high-throughput sequencing represent excellent tools to investigate the genetic causes of congenital cataracts. A better recognition of different clinical presentations and underlying etiologies of congenital cataracts may lead to the development of new approaches to improve visual outcome after cataract surgery and promote early detection of systemic associated syndromes.

Role of No Hydro Phacoemulsification Technique in Management of Posterior Polar Cataract

Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications in cataract surgery have been suggested to enhance safety and reduce the percentage of posterior capsule rupture rates in these posterior polar cataracts. This retrospective study tries to present the role and complications of no hydro phacoemulsification technique in management of posterior polar cataract.&#x0D; Aim: To evaluate the role of prehydro phacoemulsification and partial depth phacoemulsification with hydrodelineation in posterior polar cataract (PPC).&#x0D; Method: Medical records of 100 patients with clinical diagnosis of PPC, who underwent pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation, were retrospectively reviewed.&#x0D; Results: The incidence of posterior capsule rupture (PCR) was 8% (8/100): 4 cases occurred during epinucleus removal, 3 cases occurred during IOL implantation, and 1 occurred during OVD removal after the implantation of the intraocular lens into the bag. No nucleus piece or lens materials dropped into the vitreous during cataract surgery, and no obvious postoperative complications were found during follow-up. All patients had improved best-corrected visual acuity (BCVA) 1 month postoperatively.&#x0D; Conclusion: Pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation help to reduce the incidence of PCR and achieve satisfactory postoperative outcomes.

Post-surgical management of cataract: Light and dark in the 2020s

Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.

Lamellar Dissection Technique for Traumatic Cataract With Corneal Incarceration.

To describe a technique for traumatic cataract management for cases in which part of the anterior capsule has been incarcerated into a healed corneal laceration. This is a single-center retrospective chart review of 3 patients with capsular/corneal incarceration after penetrating injury. Each patient underwent primary globe repair, followed by subsequent cataract surgery with intraocular lens (IOL) and iris prosthesis placement. The main outcome measure was corrected distance visual acuity. At a mean of 19-month postoperative follow-up (range 12-26 mo), corrected distance visual acuity ranged from 20/25 to 20/80 and all patients had improved vision compared with before cataract surgery. At the final follow-up, all IOLs and iris prostheses were in stable position and no eyes required corneal transplantation. Traumatic cataracts may be complicated by incarceration of the anterior capsule into the cornea. Incorporating the posterior aspect of the cornea into the anterior capsulotomy enables cataract removal and IOL placement in a stable capsular bag complex.