Patients Undergoing Cataract Extraction Research Articles

Presence of a soft contact lens during biometry

A case of an intraocular lens (IOL) power calculation error due to the presence of a soft contact lens (CL) is described. During preparation of a routine cataract surgery for a patient in the operating room, a soft CL was discovered on the patient’s surgical eye by the scrub nurse. Further, questioning revealed that the patient was a regular CL wearer and had possibly worn them during pre-operative biometric measurement, suggesting a potential error in his IOL calculation. Surgery was not performed, and the patient was given a CL holiday. Examination of the pre-operative B-scan ultrasound by the IOL Master700 confirmed the presence of the soft CL. Four weeks after the CL holiday, re-measurement of the surgical eye with the same biometric formula, lens factor and post-operative visual target revealed a +6.00 dioptre difference in the recommended lens implant. The patient underwent cataract extraction and IOL implantation with the correct IOL implant, with a good visual outcome. Presence of a CL during biometry causes a significant error in the IOL power calculation and should be identified preoperatively for this very common surgery.

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Cataract surgery training: Report of a trainee's experience.

To report a trainee's experience gained in the cataract extraction training program after the COVID-19 pandemic. An ophthalmologist was trained in phacoemulsification and intraocular lens (IOL) implantation in the ETAPE foundation, Eye Center, Cairo for a period of 4 weeks by three expert cataract surgeons. The training was tailored to the previous trainee's experience according to his residency logbook and supervised by one expert cataract surgeon. The training included didactic lectures, clinical observations, and hands-on practical experience. In addition, the trainee was provided with a logbook to record details of patients operated on and procedures observed. The trainee performed 58 phacoemulsification surgery with IOL implantation and two extracapsular cataract extraction over the 4 weeks. Seven patients underwent intraoperative complications. Surgical time (ST) improved from 48.77 ± 9.65 min in the 1stweek to 19.34 ± 1.31 min during the last week of training (P = 0.046). Poisson regression showed that patients affected by less severe cataracts were more likely to exhibit a lower incidence of complications than patients affected by more severe cataracts. In addition, patients operated on during the 1stweek were more likely to show a higher incidence of complications than those operated on during the last week. The 4-week surgical training effectively improved surgical confidence and micro incisional skills according to ST reduction and complication rate occurrence. Ophthalmologists benefit from enhancing their cataract skills in a short time following a well-structured cataract extraction course. This could undoubtedly lead to improved surgical outcomes for patients undergoing cataract extraction.

Penetrating Ocular Injury Management in Intraocular Foreign Body (IOFB) and Traumatic Cataract

Highlight: The management of penetrating ocular injury with IOFB and traumatic cataracts needs a thorough examination of the mechanism of injury, location, size, and composition of IOFB. Endophthalmitis, retinal detachment, and development of PVR are potentially vision-threatment. Abstract: Most IOFB are metallic and found in males of productive age as a consequence of work-related accidents. A 45-year-old man complained of sudden blurred vision in the left eye (3/60 pinhole 5/12) after getting hit by a foreign body when cutting grass with a lawn mower. Anterior segment examination revealed a 10 mm long, one-plane, straight, full thickness, already sutured inferonasal corneal laceration, inferonasal traumatic iridectomy size 3x7 mm, and opaque lens. Head CT-scan revealed opacity with metallic density intraocularly. Ultrasonography revealed an echogenic lesion, particle-shaped with 100% RCS complex density, located at the inferonasal of the vitreous cavity. Focal laser photocoagulation was performed preoperatively because there was a tear at the superonasal of the retina. The patient underwent cataract extraction, intraocular lens implantation, vitrectomy, and IOFB extraction in a one-step procedure. IOFB was found at the inferonasal side of a vitreous cavity with size 3 x 1 mm, metallic, and not attached to the retina. Silicon oil tamponade was used as a precaution because there were retinal tears. Postoperatively, the left eye's visualacuity was 5/20. After 6 months, the silicon oil was evacuated and the visual acuity became 5/8.5.

Outcomes of Resident Performed Hydrus, iStent, and Kahook Glaucoma Procedures in a Predominantly African American Population.

This retrospective study characterized the efficacy and safety of 3 different microinvasive glaucoma surgery (MIGS) procedures in a predominantly African American population at the Philadelphia Veterans Affairs Hospital (Hydrus, Kahook, iStent), demonstrating no significant difference in intraocular pressure (IOP) and medication reduction between the 3 at long-term follow-up. To compare the efficacy and safety of 3 different MIGS procedures in a predominantly African American population. Retrospective cohort study of patients undergoing cataract extraction combined with 1 of 3 MIGS procedures (Hydrus, iStent, Kahook) at the Philadelphia Veterans Affairs Medical Center between January 1, 2015 and November 1, 2020. Analysis of variance and regression models were used to compare reduction in IOP and medication use among 3 MIGS types. A total of 123 eyes of 112 patients were included, including 56 (45.5%) eyes for Hydrus, 40 (32.5%) eyes for iStent, and 27 (22.0%) eyes for Kahook. Adjusted mean IOP reduction was greater for Hydrus at postoperative day 1 (-4.49 vs. -1.76 for iStent and -1.69 for Kahook, P=0.05 and greater for Kahook at postoperative week 1 (-2.53 vs. +0.70 for iStent vs. -1.41 for Hydrus, P=0.02), but did not differ significantly between MIGS types at subsequent postoperative visits (all P>0.05). In multivariable analysis, MIGS type was not significantly associated with reduction in IOP or medication use at 9 to 12 months postoperatively. There were no significant differences in complication rates across MIGS types. In this study, the difference in IOP lowering and medication reduction postoperatively between the Hydrus, iStent, and Kahook was not statistically significant after postoperative day 1. More studies are needed to evaluate outcomes of MIGS surgeries in glaucoma populations of different disease severity.

Impact of Music on the Vitals in Patients Undergoing Cataract Extraction Surgery

Background: Music is an inexpensive, easily available anxietolytic known to mankind since ages. Cataract extraction surgery is one of the widely performed surgeries under local anesthesia. India is a developing country where limited resources are spent over health infrastructure which has to cater to a large population. In our study, we have tried to utilize the anxietolytic effect of music in combating the anxiety and stress patients suffer from during surgery to essentially better the postoperative prognosis of the patients in the most inexpensive way possible. Materials and Methods: The sample size was decided taking into consideration various prevalence studies. The patients were consequently recruited for the study considering the inclusion and exclusion criteria. Patients were divided into two groups – both undergoing phacoemulsification surgery under local anesthesia by the same surgeon in the same operating room where one group was made to listen to "Classical Sitar Music," whereas the other group was not made to listen to music. Blood pressure and heart rates were measured before and after surgery and compared in all patients. Results: Blood pressure and heart rates were statistically significantly normalized (lowered) postoperatively as compared to their preoperative values in the group which were made to listen to music. Conclusion: Music can be used widely used in decreasing anxiety levels in patients undergoing cataract extraction surgery, thereby improving the postoperative prognosis in patients in a cost-effective way.

English

BACKGROUND Music is an inexpensive, easily available anxiolytic known to mankind since ages. Cataract extraction surgery is one of the widely performed surgeries under local anaesthesia. India is a developing country where limited resources are spent over health infrastructure which has to cater to a large population. In our study we have tried to utilize the anxietolytic effect of music in combating the anxiety and stress patients suffer during surgery. METHODS In this prospective, interventional study, 300 patients diagnosed with senile cataract were selected. The sample size was decided taking into consideration various prevalence studies. The patients were consequently recruited for the study considering the inclusion and exclusion criteria. Patients were divided into three groups - one undergoing phacoemulsification surgery under topical anaesthesia and two groups undergoing phacoemulsification surgery under local anaesthesia by the same surgeon in a same operating room. Two groups including the one where topical anaesthesia was used were made to listen to ‘Classical Sitar Music’ whereas one group was not made to listen to music. Blood pressure and heart rates were measured before and after surgery and compared in all patients. RESULTS Blood pressure and heart rates were statistically significantly normalized (lowered) post-operatively when compared to their pre-operative values in groups which were made to listen to music. There was a marked decrease in the anxiety levels in patients who were operated under topical anaesthesia when compared to those operated under local anaesthesia. CONCLUSIONS Music can be widely used in decreasing anxiety levels in patients undergoing cataract extraction surgery thereby improving the post-operative prognosis in patients in a cost-effective way. KEY WORDS Phacoemulsification Surgery, Classical Sitar Music, Peri-Bulbar Block, Topical Anaesthesia, Anxiety, Blood Pressure, Pulse Rate

High Agreement between Barrett Universal II Calculations with and without Utilization of Optional Biometry Parameters.

Purpose: To examine the contribution of anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW) measurements to intraocular lens (IOL) power calculations using the Barrett Universal II (BUII) formula. Methods: Measurements taken with the IOLMaster 700 (Carl Zeiss, Meditec AG, Jena, Germany) swept-source biometry of 501 right eyes of 501 consecutive patients undergoing cataract extraction surgery between January 2019 and March 2020 were reviewed. IOL power was calculated using the BUII formula, first through the inclusion of all measured variables and then by using partial biometry data. For each calculation method, the IOL power targeting emmetropia was recorded and compared for the whole cohort and stratified by axial length (AL) of the measured eye. Results: The mean IOL power calculated for the entire cohort using all available parameters was 19.50 ± 5.11 diopters (D). When comparing it to the results obtained by partial biometry data, the mean absolute difference ranged from 0.05 to 0.14 D; p < 0.001. The optional variables (ACD, LT, WTW) had the least effect in long eyes (AL ≥ 26 mm; mean absolute difference ranging from 0.02 to 0.07 D; p < 0.001), while the greatest effect in short eyes (AL ≤ 22 mm; mean absolute difference from 0.10 to 0.21 D; p < 0.001). The percentage of eyes with a mean absolute IOL dioptric power difference more than 0.25 D was the highest (32.0%) among the short AL group when using AL and keratometry values only. Conclusions: Using partial biometry data, the BUII formula in small eyes (AL ≤ 22 mm) resulted in a clinically significant difference in the calculated IOL power compared to the full biometry data. In contrast, the contribution of the optional parameters to the calculated IOL power was of little clinical importance in eyes with AL longer than 22 mm.

Congenital Cytomegalovirus Infection Initially Managed as Congenital Rubella Syndrome

Congenital cytomegalovirus (CMV) infection (cCMV) is challenging to differentiate from congenital rubella syndrome (CRS) clinically. Virus detection and serological tests are needed. However, they are often not readily available or are expensive. This is a case of a five-month-old male with bilateral cataracts. He was jaundiced at birth and started having seizure episodes at one month of age. He was also diagnosed with right inguinal hernia and had abnormal bilateral hearing tests. Both eyes were noted to have leukocoria at two months of age. There was dazzle on both eyes and sclerae were anicteric. Examination revealed dense cataracts on both eyes, but their ocular ultrasound results were essentially normal. Due to the bilateral hearing loss and bilateral cataracts, CRS was initially considered despite the absence of heart abnormality since there were reported CRS cases without the complete triad. However, possible coinfection or another disease was considered due to the presence of jaundice, seizures, and hernia, which were never seen in our previous CRS patients nor were reported in the literature. The patient underwent cataract extraction on both eyes without intraocular lens implantation (IOL) as recommended for CRS cataracts to prevent severe inflammation. TORCH (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) test was negative for rubella but positive for CMV. As such, the patient would have benefitted from early IOL implantation. The patient was then referred to a national medical center for possible treatment. However, since the patient already tested negative for CMV polymerase chain reaction (PCR) there, systemic antiviral therapy was no longer initiated. This case presented the challenge of clinically differentiating cCMV and CRS.

Cataract surgery of eyes with previous vitrectomy: risks and benefits as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

To explore the frequency and outcomes of cataract surgery in eyes with previous vitrectomy. Fifteen European countries. Retrospective cross-sectional register-based study. The European Registry of Quality Outcomes of Cataract and Refractive Surgery (EUREQUO) contains data on baseline characteristics, surgery, and follow-up for cataract surgeries. Previous vitrectomy is included as a mandatory parameter in baseline characteristics. According to the protocol for EUREQUO, consecutive cases should be reported by participating units. This study included data from units in 15 European countries from 2008 to 2018; 1 715 348 cataract extractions with follow-up data were reported to EUREQUO. Previous vitrectomy was reported in 19 416 eyes comprising 1.1% of all cases. This proportion was about the same for each study year. Most patients were men, and their mean age was 64.1 years compared with 73.7 years for the rest of the database. The preoperative visual acuity was modestly worse in postvitrectomy eyes compared with the opposite (corrected distance visual acuity [CDVA] 0.45 vs 0.25, respectively). A postoperative CDVA of 0.5 or better was achieved by 82.8% of the postvitrectomy eyes compared with 95.6% for the non-postvitrectomy eyes. The absolute mean biometry prediction error for the same groups was 0.52 diopters (D) vs 0.43 D, respectively. Patients undergoing cataract extraction after previous vitrectomy were younger and mostly men. Their visual and refractive outcomes were slightly inferior compared with the patients without vitrectomy.

Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial.

Diabetic retinopathy (DR) may progress following cataract surgery due to surgery-induced inflammation. The effect of intravitreal bevacizumab (BVB) and triamcinolone acetonide (TCA), which have differing anti-inflammatory properties, on DR progression following cataract surgery has not been reported. To report the progression of DR in diabetic patients undergoing cataract extraction treated with intravitreal BVB or TCA during the surgery. Post hoc analysis of 6-month data from a prospective, randomized, double-masked clinical trial. Diabetic patients with clinically significant cataract and fovea involving diabetic macular oedema (DME), or a recent history of DME. Participants were randomly allocated 1:1 to receive intravitreal BVB 1.25 mg or TCA 4 mg during and post-cataract surgery as needed. The rate of DR progression between groups was compared. DR progression. There were 61 eyes included. Patients receiving BVB were older than those receiving TCA (70.2 vs 64.3 years; P < .05). Three participants (10.7%) in the BVB and three (9.09%) in the TCA group had a one-step progression, while none in BVB and only one (3%) in the TCA group demonstrated two-step DR progression. In the majority of these patients, DR progression was from mild to moderate non-proliferative diabetic retinopathy. In this study, BVB and TCA groups had a similar, and lower rate of DR progression compared to previous studies where no adjunctive treatment was administered, suggesting that patients with DME may benefit from either intraoperative intravitreous BVB or TCA injection to reduce the risk of DR progression following cataract surgery.

Increased rate of ptosis following glaucoma drainage device placement and other anterior segment surgery: a prospective analysis.

To determine the degreeand rate of ptosis in patients undergoing glaucoma and cataract surgery. Patients undergoing cataract extraction (CE), trabeculectomy, or glaucoma drainage device (GDD) placement, or a combination, were consecutively enrolled by a sole surgeon. Eyelid measurements, including margin reflex distance 1 (MRD1) and levator function, were obtained preoperatively and at 1 and 3months postoperatively. Primary outcome measures were the change in MRD1 pre- vs postoperatively; percentage of patients with ptosis (defined as MRD1 < 2mm pre- vs postoperatively). Secondary measures were the absolute change in MRD1 between groups, decrease in MRD1 of ≥ 2mm, and change in levator function. In total, 104 eyes of 73 patients underwent CE, trabeculectomy, or GDD placement and completed at least 1-month follow-up; 93 eyes of 65 patients completed 3-month follow-up. MRD1 decreased significantly in trabeculectomy and GDD groups at 1 and 3months postoperatively, while it did not change in the CE group. The GDD group had a significant increase in percentage of patients with ptosis at 3months postoperatively. Patients who underwent glaucoma surgery, especially those who underwent GDDplacement, were more likely to have postoperative ptosis than patients undergoing CE alone. High ptosis rates in patients undergoing glaucoma surgery may warrant preoperative counseling and post-operative referral to oculoplastic surgeons.

Assessment of Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Changes following Cataract Surgery in Patients with Pseudoexfoliation Glaucoma.

Purpose To assess eye pressure, ganglion cell complex, and retinal nerve fiber layer changes following cataract surgery in patients with pseudoexfoliation glaucoma. Methods Eighty-five patients with pseudoexfoliation glaucoma (PEXG) were included in the study. They were divided into two groups; the first group included patients with PEXG and cataract who underwent phacoemulsification (pseudophakic group; n = 40 eyes). The second group included patients with PEXG without cataract (control group; n = 45 eyes). Both groups were on antiglaucoma treatment. IOP changes after surgery and the ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were evaluated in patients underwent cataract extraction surgery compared to controls that did not have cataract, nor underwent surgery. Both groups were followed up postoperatively for 18 months. Results There was no difference in the mean age and glaucoma stage in both groups (P=0.242 and 0.70, respectively). In the pseudophakic group, the mean IOP significantly dropped from 20.43 ± 0.90 to 17.00 ± 2.75 mmHg at the end of the follow-up period (P ≤ 0.001). Slight decrease (≈3 μm) was recorded in the mean GCC thickness of the pseudophakic patients from the baseline at the end of the follow-up period. This decrease was lower than that of the controls (≈5 μm). No significant pRNFL changes were recorded all over the postoperative visits (88.78 ± 22.55 μm at 3 months, 88.67 ± 23.14 μm at 6 months, 87.62 ± 23.04 μm at 12 months, and 87.32 ± 22.61 μm at 18 months) as compared to preoperative value (90.28 ± 22.31 μm) with P=0.335, 0.387, 0.158, and 0.110, respectively, or controls (89.69 ± 21.76 μm, 88.73 ± 21.08 μm, 87.33 ± 20.67 μm, and 87.23 ± 20.54 μm with P=0.850, 0.990, 0.951, and 0.984). Conclusion Phacoemulsification and IOL implantation may aid in managing pseudoexfoliation glaucoma by lowering IOP and slowing the rate of GCC and pRNFL losses over a short-term period.

A comparative study between topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients attending a tertiary care center in West Bengal

Background: Ocular inflammation, which is common after cataract surgery, may cause patients to have postoperative pain and photophobia. Topical nonsteroidal anti-inflammatory drugs have been shown to be clinically effective in controlling inflammation after cataract surgery. Aim: The present study aims to compare topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients. Materials and Methods: A total of 212 patients were included in the study and randomly allocated in two equal groups to receive either nepafenac (0.1%) or ketorolac (0.5%). Patients underwent cataract extraction on the scheduled date by manual small incision cataract extraction. The drug application was started on the day of operation. For both the groups, the drug was applied thrice daily. The ocular parameters were observed and noted down according to group assigned successively on day 1, day 3, day 7, day 14, and day 28. Results: There was no significant difference between the two drugs as far as visual acuity, and intraocular pressure outcome was concerned. The effect of nepafenac (0.1%) on anterior chamber cells and flare was more than ketorolac (0.5%) during 1st week (up to day 7), but at the end of the observation period (28 days), the effect was similar with both drugs. In nepafenac (0.1%) group, higher percentage of patients was free from pain and ocular discomfort than that of ketorolac (0.5%) group throughout the observation period. Conclusion: Nepafenac (0.1%) was found superior than ketorolac (0.5%) in dealing with ocular discomfort and pain and with respect to early recovery from anterior chamber inflammation.

Expression levels of aldose reductase enzyme, vascular endothelial growth factor, and intercellular adhesion molecule-1 in the anterior lens capsule of diabetic cataract patients

To compare the levels of aldose reductase (ALR) enzyme, intercellular adhesion molecule-1 (ICAM-1), and vascular endothelial growth factor (VEGF) in the anterior lens capsule of diabetic versus nondiabetic patients. Alexandria Main University Hospital, Alexandria, Egypt. Prospective case-control study. The study enrolled patients undergoing cataract extraction and divided them into 3 groups: eyes that had proliferative diabetic retinopathy (PDR), eyes that had nonproliferative diabetic retinopathy (NPDR), and nondiabetic eyes. The anterior lens capsules were obtained by performing femtosecond laser-assisted capsulorhexis. Concentrations of ALR, ICAM-1, and VEGF in the lens capsule specimens were measured using human enzyme-linked immunosorbent assay. This study comprised 200 patients (200 eyes); 51 eyes had PDR, 49 eyes had NPDR, and 100 eyes were nondiabetic. The mean ALR, ICAM-1, and VEGF levels in the anterior capsule of diabetic group were 2.84nanogram (ng)/mL±0.51 (SD), 87.73±22.84picogram (pg)/mL, and 75.53±14.95 pg/mL, respectively; whereas, in the nondiabetic group, they were 1.44±0.17ng/mL, 35.45±2.8 pg/mL, and 33.55±5.47 pg/mL, respectively. In comparing the concentrations of these mediators, both the PDR and NPDR groups had significantly higher levels compared with the nondiabetic eyes (P<.001). In addition, eyes with PDR had significantly higher levels of these mediators than eyes with NPDR (P<.001). The concentrations of ALR, ICAM-1, and VEGF in the anterior lens capsule of diabetic patients are significantly higher than those of nondiabetics. A significantly higher level of 3 mediators in eyes with PDR compared with those with NPDR might allow the use of them as a biomarker for severity of diabetic retinopathy.

Cataract surgery combined with micro-incision vitrectomy in patients with behcet\u2019s disease uveitis

BackgroundThis study sought to report the outcomes of a combined cataract extraction, intraocular lens (IOL) insertion and micro-incision vitrectomy (MIVS) procedure for the treatment of Behcet uveitis.MethodsThis investigation involved the retrospective evaluation of a case series of patients with Behcet uveitis who underwent cataract extraction, IOL insertion and MIVS in a single surgical session at the same institution between January 2013 and November 2016. Outcome measures included visual acuity, inflammatory reaction, systemic anti-inflammatory medications, intraocular pressure (IOP) and complications.ResultsSeven eyes of seven patients with a mean age of 39.00 ± 5.54 years (range, 32 to 48 years) and a mean follow-up duration of 13.57 ± 5.83 months (range, 6 to 24 months) were studied; five patients with a history of well-controlled uveitis were included. All patients underwent cataract extraction and IOL implantation combined with MIVS. All patients received postoperative steroids, which were slowly tapered during the weeks after surgery. There were no significant complications related to the surgery. Overall, best-corrected visual acuity (BCVA) was improved from log MAR (logarithm of the minimum angle of resolution) 1.67 ± 0.67 preoperatively to log MAR 0.74 ± 0.35 postoperatively; this improvement was statistically significant (p < 0.05). All eyes were deemed quiet at follow-up, and no patients required the escalation of therapy for long-term uveitis control.ConclusionsThis retrospective series indicates that a procedure that combines phacoemulsification, IOL implantation and MIVS is a feasible technique for the removal of cataracts and pathologic vitreous in eyes with Behcet uveitis. This approach can restore vision without obvious complications.

A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction.

PurposeThe aim of this study was to compare intraocular pressure (IOP) outcomes in eyes with cataract and glaucoma undergoing phacoemulsification (phaco) in combination with goniotomy using the Kahook Dual Blade (KDB) or implantation of a single iStent trabecular bypass device.MethodsRetrospective analysis of IOP and IOP-lowering medication reduction in eyes undergoing phaco-goniotomy with KDB (n=237) or phaco-iStent (n=198). Preoperative, intraoperative, and postoperative data were collected through 6 months of follow-up. Outcome measures included mean IOP reduction, mean reduction in IOP-lowering medications, and the proportion of eyes achieving ≥20% IOP reduction or ≥1 medication reduction from baseline.ResultsMean IOP in the phaco-goniotomy with KDB group decreased from 17.9±4.4 mmHg at baseline to 13.6±2.7 mmHg at Month 6 (P<0.001), with mean medication use decreasing from 1.7±0.9 to 0.6±1.0 (P<0.001). In the phaco-iStent group, mean IOP decreased from 16.7±4.4 mmHg to 13.9±2.7 mmHg (P<0.001), with mean IOP-lowering medication use decreasing from 1.9±0.9 to 1.0±1.0 (P<0.001). Mean IOP reduction from baseline was significantly greater in the phaco-goniotomy with KDB group at Month 6 (phaco-goniotomy with KDB −4.2 mmHg [23.7%] vs phaco-iStent −2.7 mmHg [16.4%]; P<0.001). IOP-lowering medication reduction was greater in the phaco-goniotomy with KDB group compared to the phaco-iStent group (1.1 vs 0.9 medications, respectively; P=0.001). The most common adverse event was IOP spikes occurring in 12.6% of phaco-iStent eyes and 6.3% of phaco-goniotomy with KDB eyes (P=0.024).ConclusionGoniotomy with the KDB combined with cataract surgery significantly lowers both IOP and the need for IOP-lowering medications compared to cataract extraction with iStent implantation in glaucomatous eyes through 6 months of postoperative follow-up.

Sural nerve graft for neurotrophic keratitis: early results

ObjectiveTo report our center’s experience in treating neurotrophic keratitis (NK) through corneal neurotization using nerve transfers and sural nerve grafts in the adult population. DesignProspective observational case series, single center study. MethodsSix consecutive patients (5 males and 1 female) with severe NK were evaluated. All patients had complete corneal anaesthesia in the neurotrophic eye. Three patients had unstable epithelial disease with recurrent breakdowns despite maximal medical and standard surgical management; three presented with dense scarring of their cornea. These patients were surgically treated using nerve transfers and sural nerve grafts for neurotization of the neurotrophic eye. Subjects were evaluated for corneal sensation, epithelial breakdown, and visual acuity. ResultsMean participant age was 57 years (SD 19) with a mean denervation time before the procedure of 23 months (SD 20). Patients were followed up for a minimum of 6 months following the procedure, with a mean follow up time 12 months (SD 4.2). All patients had improved corneal sensation within half a year following the procedure. Five patients (83%) demonstrated improved visual acuity. Of these patients, three (50%) had improved visual acuity with no further surgical intervention. One patient underwent cataract extraction 13 months after neurotization and another underwent amniotic membrane grafting 17 months after neurotization. ConclusionsOur experience suggests that corneal neurotization using nerve transfers and sural nerve grafts for patients suffering from deteriorating neurotrophic keratitis is a safe procedure in adults. It successfully restored corneal sensation in all patients and improved visual acuity in most patients.

Comparison of lignocaine 2% with adrenaline and a mixture of bupivacaine 0.5% plus lignocaine 2% with hyaluronidase for peribulbar block analgesia

Purpose: Lignocaine and bupivacaine are the most freely available local anesthetic agents which may be used alone or in combination for peribulbar block analgesia (PBA) with or without hyaluronidase and epinephrine. A prospective comparative study of two solutions was undertaken to rationalize choice of local analgesic agent for PBA. Materials and Methods: A randomized, prospective study on 100 middle-aged to elderly patients undergoing cataract extraction was undertaken to compare the efficacy of (1) 2% lidocaine plus epinephrine 1:200,000 (Group 1) or (2) a mixture of 2% lidocaine and 0.5% bupivacaine (2:3 volume per volume mix) (Group 2). A standardized deep peribulbar block technique, akinesia scoring system, analgesia scoring system, and supplemental protocol were followed. The onset of block and supplementation rates to achieve akinesia was recorded by a blinded observer. The time from 1st PBA injection to the completion of surgery (the duration of surgical access) was also recorded. Results: Significantly better results for akinesia were obtained with the combination of 2% lignocaine plus 0.5% bupivacaine mixed with 50 IU/ml of hyaluronidase at 10 min after injection and also at the end of surgery. However, with regard to analgesia, both 2% lignocaine and 2% lignocaine with 0.5% bupivacaine had a similar effect. Furthermore, the patients in Group 2 showed a significantly reduced need for the first supplemental injection and no need for a second supplemental injection. The incidence of complications was very low in this study. No serious local or systemic complication was encountered. Conclusion: The combination of 2% lignocaine with 0.5% bupivacaine results in a better quality peribulbar block than 2% lignocaine alone, while perioperative analgesia was found to be similar for both combinations. The former also required less frequent supplementary injections.

Prophylactic intracameral levofloxacin in cataract surgery - an evaluation of safety.

PurposeTo evaluate posterior and anterior segment safety of an intracameral injection of levofloxacin 0.5% ophthalmic solution as prophylaxis for patients undergoing cataract extraction and intraocular lens implantation.SettingThis study was conducted at Manila Doctors Hospital, Ermita, Manila, Philippines.DesignThis was a prospective interventional study.MethodsEyes undergoing standard phacoemulsification cataract surgery with intraocular lens implantation were treated with intracameral levofloxacin 0.5% at the conclusion of surgery. Safety parameters, including best-corrected visual acuity (BCVA), endothelial cell counts, anterior chamber cells and flare, and central foveal thickness, were evaluated preoperatively and at 1 day and 1 week postoperatively.ResultsA total of 50 eyes of 50 patients were included in the analysis. At 1 week postoperatively, all eyes demonstrated BCVA of 20/30 or better and 19 eyes (38%) achieved BCVA of 20/20 or better. On the first postoperative day, no corneal edema was observed, and trace to +2 cells and flare in the anterior chamber were noted in all eyes. After 1 week, all eyes had a quiet anterior chamber and endothelial cell counts decreased by an average of 225 cells/mm2, which was marginally significant (p=0.0525) when compared to other time points. Optical coherence tomography results showed no statistically significant differences between central foveal thickness measurements before and after surgery. There were also no statistically significant differences in preoperative and postoperative pachymetry. No study-related adverse events occurred.ConclusionThere were no safety concerns associated with intracameral injection of levofloxacin 0.5%, prophylactically, following cataract surgery. Further study is required to demonstrate effectiveness in endophthalmitis prevention.