Patients Undergoing Phacoemulsification Cataract Surgery Research Articles

Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study.

Implantation of multifocal intraocular lenses (IOLs) is becoming increasingly popular for the treatment of visual demands at various distances in patients undergoing phacoemulsification cataract surgery. We aimed to assess the visual performance and rates of photic phenomena, posterior capsule opacification (PCO), and spectacle independence in patients with bilateral implantation of the AcrySof® IQ PanOptix® multifocal IOL model TFNT00 at one and six months postoperatively. This prospective interventional cohort study included adult patients who underwent uneventful phacoemulsification cataract surgery with bilateral implantation of AcrySof® IQ PanOptix® IOL. Uncorrected and corrected visual acuities at far, intermediate, and near distances were measured preoperatively and at the one- and six-month postoperative follow-up examinations. The rates of photic phenomena, postoperative need for near and distance spectacles, and PCO were also recorded. We included 164 eyes of 82 patients with a male-to-female ratio of 38 (46.3%) to 44 (53.7%) and a mean (standard deviation [SD]) age of 52.37 (7.62) years. There were statistically significant improvements in the visual acuities of both eyes across all distances at the one- and six-month follow-up examinations compared to the preoperative values (all P < 0.001), except for corrected near visual acuity in the right eye (P > 0.05) at six-month. We also detected significant postoperative improvements in visual acuities of both eyes across all distances at the six-month follow-up compared to values at the one-month follow-up (all P < 0.05), except for corrected near visual acuity in the right eye (P > 0.05). The photic phenomenon was reported by 12 (14.6%) of the 82 patients at the six-month postoperative follow-up. Five (6.1%) and eight (9.8%) of the 82 patients reported using spectacles for distance and near, respectively. Additionally, PCO developed in 19 (11.6%) of the 164 included eyes, although it was not clinically significant at six months. The AcrySof® IQ PanOptix® IOL model TFNT00 is recommended for use, given its excellent performance in all ranges of vision, a high rate of spectacle independence, and a good safety profile. Future comparative studies with longer follow-up periods are warranted to verify superiority of its performance over that of other available multifocal IOLs.

Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses.

To evaluate and compare the clinical outcomes after cataract surgery with implantation of 3 types of trifocal diffractive intraocular lenses (IOLs). Hospital da Luz, Lisbon, Portugal. Prospective comparative case series. Patients undergoing phacoemulsification cataract surgery with implantation of 1 of the 3 trifocal IOLs were enrolled: TECNIS Synergy (Synergy group, 30 patients), Acrysof PanOptix (PanOptix group, 30 patients), and POD F (Finevision group, 30 patients). The outcomes of distance, intermediate, and near visual acuity (VA), refraction, defocus curve, photic phenomena, and spectacle independence were evaluated at the 3-month follow-up. 180 eyes of 90 patients were enrolled. No statistically significant differences were found between groups in monocular distance-corrected intermediate (Synergy group 0.04 ± 0.11, PanOptix group 0.05 ± 0.09, and Finevision group 0.08 ± 0.10; P = .107) and near VA (0.01 ± 0.08, 0.01 ± 0.06, and 0.04 ± 0.10, respectively; P = .186). Similarly, no statistically significant differences among groups were found in binocular uncorrected distance (P = .572), near (P = .929), and intermediate VA (P = .327). By contrast, statistically significant differences between groups were found in the visual acuity for the vergence demands of -0.50, -1.00, -2.00, -3.50, and -4.00 diopters (P ≤ .045). No statistically significant differences among groups were found in the frequency, severity, and bothersomeness of different disturbing visual symptoms, including glare and halos (P ≥ .129). More than 87 (96%) of patients in all groups did not require the use of spectacles at any distance postoperatively. The 3 trifocal IOLs evaluated provided an effective visual rehabilitation with minimal incidence of photic phenomena. A trend to obtain a wider range of functional focus was observed with the TECNIS Synergy IOL.

Stabilization of refractive error and associated factors following small incision phacoemulsification cataract surgery

BackgroundAccumulating evidence suggests that refractive stabilization occurs rapidly following small incision cataract surgery. Nonetheless, many guidelines still suggest waiting four to 6 weeks before prescribing corrective lenses. This study was undertaken to supplement the existing literature regarding refractive stabilization, and evaluate multiple contributing factors that could dissuade clinicians from confidently correcting refractive error in the early post-operative course following routine cataract surgeries.MethodsAdult patients undergoing phacoemulsification cataract surgery with uncomplicated surgeries and post-surgical courses at the Calgary Ophthalmology Centre (Calgary, Alberta, Canada) were included in this prospective observational case series. Exclusion criteria included known corneal dystrophies, infectious keratitis, complicated surgery or toric/multifocal IOLs. Data was collected at weekly intervals for a total of 6 weeks. Collected data included autorefraction, visual acuity, corneal pachymetry, and effective lens position.ResultsOne hundred six eyes of 104 patients were included in this study. Post-operative sphere, cylinder and spherical equivalent were not significantly different at any post-operative week compared with week six, and 80–86% of patients were within 0.5D of last follow-up spherical equivalent at any week. The secondary outcomes of central corneal thickness, effective lens position and visual acuity did, however, exhibit significant differences between early post-operative weeks and last follow-up values.ConclusionsThese data suggest that refractive error can be effectively measured and corrected as early as one-week post-operatively in the majority of patients, though other measures of post-operative stability including central corneal thickness, effective lens position and visual acuity can require up to 4 weeks to stabilize. Thus a conservative and pragmatic approach may be to wait until 4 weeks post-operatively prior to obtaining refractive correction following uncomplicated phacoemulsification cataract surgery.

Comparison of changes in blood pressure in phacoemulsification cataract surgery performed via topical and peribulbar anaesthesia: A cohort study

BackgroundThe purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period. MethodsIn this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure. ResultsSystolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases. ConclusionThe increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens.

To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001). This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study.

Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis. A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders. One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis. The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.

Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia.

The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.

Comparison of optical biometry based on partial coherence laser interferometry (PCLI) principle to conventional applanation ultrasonic biometry

Purpose: Our aim was to compare the accuracy of intraocular lens (IOL) power calculation with two techniques namely optical biometry based on partial coherence laser interferometry (PCLI) principle and conventional ultrasound biometry. Materials and Methods: A comparative study was done in our hospital wherein 100 eyes of 100 patients undergoing phacoemulsification cataract surgery were recruited into it. Out of them, 50 eyes underwent optical biometry and 50 eyes underwent conventional applanation ultrasound biometry. Eyes were grouped according to axial length into long (>24.50), normal (22 to Results: The MAE calculated was 0.60 +/- 0.40D and 0.20+/- 0.30D with the conventional applanation ultrasound and optical biometry respectively. It was found that the optical biometry gives more accurate values for eyeball with small and large axial length. Conclusion: The optical biometry parameters which uses the partial coherence laser interferometry (PCLI) principle happens to be the more precise method in IOL power calculation. Keywords: Axial length, Optical, Partial coherence laser interferometry, Ultrasound A scan.

Combined aspirin and clopidogrel therapy in phacoemulsification cataract surgery: a risk factor for ocular hemorrhage?

To evaluate the safety of phacoemulsification cataract surgery in the patients undergoing dual antiplatelet therapy with aspirin and clopidogrel. Consecutive patients undergoing phacoemulsification cataract surgery with a clear corneal incision under topical anesthesia were eligible for inclusion in the study. Thirty-eight eyes from 38 patients on combined aspirin and clopidogrel therapy who continued the treatment were classified into the maintenance group, a matched group of 38 eyes from 38 patients on no antiplatelet/anticoagulant therapy as the control group. The best-corrected visual acuity (BCVA) and incidences of complications were compared between the two groups. There was no significant difference in final BCVA between the maintenance group and the control group (p = 0.178). No significant difference existed in the incidences of hemorrhagic or non-hemorrhagic complications between the two groups (p = 0.529 and p = 0.589, respectively). Moreover, no surgery was postponed or cancelled due to hemorrhagic complications in either group, and no cardiovascular events occurred during the follow-up. There was no case of anterior chamber hemorrhage, vitreous hemorrhage, or suprachoroidal hemorrhage. Our outcomes indicated that phacoemulsification cataract surgery using a clear corneal incision with topical anesthesia could be safely done without stopping dual antiplatelet therapy with aspirin and clopidogrel.

Microbiology of the conjunctival sac before and after cataract surgery

Background: The aim of the study was to evaluate the bacterial flora and antibiotic susceptibility profile of bacterial isolates taken from the conjunctival sacs of patients undergoing phacoemulsification cataract surgery, and to compare them. Material and methods: In total, 200 conjunctival swabs were collected from 50 patients between June and December of 2017. Results: The most common pathogen collected from the conjunctival sacs before surgery was coagulase-negative staphylococci (CoNS) (65% of swabs); 45 of them (45%) were methicillin-sensitive staphylococci (MS-CoNS) and 25 (25%) were methicillin-resistant staphylococcus (MR-CoNS). Following the surgeries, CoNS were collected from 34 swabs (34%), 16% of which were taken from the eye on which the operation had been performed. Twenty-three swabs (23%) were MS-CoNS and 11 (11%) were MR-CoNS. The number of CoNS-positive swabs after pharmacotherapy decreased by 52%. The possibility of obtaining sterile swabs was statistically and significantly higher in eyes in which chemoprophylaxis was used [(OR = 4.58, 95% CI: 2.91–7.21), p &lt; 0.001)]. The possibility of obtaining sterile swabs was not correlated with gender (p = 0.866) or diabetes (p = 0.712), but was observed more frequently in younger patients (p = 0.001). Multi-drug resistant bacteria were detected in 34 swabs before surgery (34%) and in 26 samples after operations (26%). Conclusions: It is probably impossible to sterilise the conjunctival sac. There is a risk of multi-drug resistant bacterial flora colonising the conjunctival sac.

Comparing the safety and efficacy of three different doses of atracurium in facilitating the insertion of laryngeal mask airway in patients undergoing phacoemulsification cataract surgery: A randomized clinical trial.

Background:In this study, we aimed to evaluate the safety and efficacy of three different doses of atracurium on conditions of laryngeal mask airway (LMA) insertion, first-try success rate, and possible complications.Materials and Methods:A total of 120 patient's ≥18 years old were randomly divided into three groups of 40. The study groups received fentanyl 2 μg/kg thiopental 5 mg/kg and atracurium in doses 0.2 mg/kg, 0.4 mg/kg, and 0.6 mg/kg, respectively, based on the patient group. The conditions of LMA insertion, hemodynamic responses, and complications were evaluated and compared in the groups.Results:In the study groups, the LMA placement was difficult in 15%, 7.5%, and 2.5%, respectively (P = 0.13). There was no statistically significant difference among the groups regarding the success rate in the first attempt to the insertion of LMA. Of the three groups, 5%, 2.5%, and 2.5% had bleeding at the place of mask insertion (P = 0.77). 17.5%, 7.5%, and12.5% had sore throat, respectively (P = 0.4). No patient experienced laryngospasm during the study. Furthermore, changes in blood pressure, heart rate, and oxygen saturation were not significant in the three groups.Conclusion:All three doses of atracurium have similar effects on the condition of LMA insertion. Atracurium 0.4 mg/kg accompanied by higher success on LMA insertion in the first attempt and lower airway complications (bleeding and sore throat), increasing this dose had no significant effect on the success rate of LMA insertion.

A comparative study on early vision quality after implantation of refractive segmental and diffractive multifocal intraocular lens.

Objectives:To compare early subjective and objective vision quality of postoperative patients undergoing phacoemulsification cataract surgery combined with implantation of refractive segmental multifocal intraocular lens (MIOL) SBL-3 and apodized diffractive MIOL SN6AD1.Methods:As a prospective study, it enrolled 53 patients (53 eyes) to undergo phacoemulsification cataract surgery combined with MIOL implantation. According to differences in MIOL implanted, patients were divided into a SBL-3 group (25 eyes) and a SN6AD1 group (28 eyes). Ophthalmological evaluation included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA)visual acuities and corrected near(CNVA) visual acuity, contrast sensitivity, modulation transfer function (MTF) and high order aberration (4 mm pupil diameter) at three months postoperatively. Moreover, a questionnaire survey was carried out to assess near spectacle independence, patient satisfaction and symptoms of visual disturbance.Results:At three months after surgery, UIVA and UNVA in the SBL-3 group are statistically significantly superior to those of the SN6AD1 group (P>0.05). There was statistical difference in contrast sensitivity at four spatial frequencies (3, 6, 12, 18cycles/degree) under mesopic conditions and mesopic conditions with glare (P>0.05). The total ocular high order aberration, coma and trefoil were statistically significantly larger in the SBL-3 group than in the SN6AD1 group with 4.0 mm pupil diameters (P>0.05). Statistical differences were found in the MTF at spatial frequencies of 5, 10 and 15 cycles/degree between the groups. There were no significant differences in spectacle independence, patient satisfaction and visual disturbance between the groups (P>0.05).Conclusions:Both the two multifocal intraocular lens provided an excellent level of quality of vision three months postoperatively. However, the application effect of SBL-3 MIOL is superior to that of SN6AD1 MIOL as far as intermediate vision, near vision and contrast sensitivity are concerned.

Comparison of the Effects of Povidone-Iodine 5%, Polyhexamethylene Biguanide, and Chlorhexidine as a Preoperative Antiseptic in Endophthalmitis Prophylaxis in Patients Undergoing Phacoemulsification Cataract Surgery.

Background:This study aims to compare the efficacy and toxicity of povidone-iodine (PI) 5%, polyhexamethylene biguanide (PHMB) 0.02%, and chlorhexidine 0.02% in patients undergoing phacoemulsification cataract surgery.Materials and Methods:This single-center, randomized study was done on 330 patients who referred to Feiz hospital in Isfahan and scheduled for cataract surgery. They were assigned randomly to 1 of 3 groups of 110 eyes who received 1 drop of PI 5% in group 1, 1 drop of PHMB 0.02% in group 2 and 1 drop of chlorhexidine 0.02% in group 3. Pre-operative Cultures samples were obtained without any topical application and it was repeated 5 min after use of antiseptic solutions. Cultures were obtained from the inferior conjunctival fornix, using sterile culture swabs while avoiding contact to the eyelids and lashes.Results:The numbers of colony-forming units (CFUs) did not differ significantly among the three groups (P = 0.149 and P = 0.260, respectively). After the intervention, CFUs numbers in the three groups were decreased with a significant difference in both blood and chocolate agars (P = 0.304 and P = 0.136, respectively). Of the 317 eyes, 108 (34.1%) showed no bacterial growth in the pre-preparation period, which was similar in the three groups. Staphylococcus epidermidis was the most common isolated bacteria. Conjunctival injection was significantly different among studied groups (P = 0.0001), five patients in iodine group had severe conjunctival injection and no one in the other group. SPE was significantly fewer in chlorhexidine group than PHMB and iodine groups (P = 0.0001).Conclusion:Pretreatment with 5% Povidone-Iodine (PVI) for at least 15 min or repeated applications over 10 min is effective in the reduction of conjunctival organisms, and results in less postoperative endophthalmitis.

Application of integrated medical care in elderly patients undergoing phacoemulsification cataract surgery

Objective To explore the effect of integrated medical care in the treatment of senile patients undergoing phacoemulsification cataract surgery. Methods From March 2017 to March 2018, 826 patients who underwent phacoemulsification surgery in this hospital were randomly divided into control group and observation group, 413 cases of each group.The control group was treated with routine care, while the observation group adopted integrated nursing care.The length of hospital stay, hospitalization costs, the patients' psychological status, complications rate and satisfaction to the care service were compared between the two groups. Results The length of hospital stay and hospitalization expenses in the observation group were lower than those in the control group, and the differences were statistically significant (P 0.05). After operation, the scores of SAS and SDS in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). The incidence of complications in the observation group was 5.57%(23/413), lower than that in the control group, which was 12.11%(50/413), with statistically significant difference (P<0.05). The satisfaction rate in the observation group was 97.58%(403/413), higher than the 92.98%(384/413) in the control group, and the difference was statistically significant (P<0.05). Conclusions The application of integrated nursing intervention in elderly patients undergoing phacoemulsification cataract surgery can effectively reduce their negative emotions and postoperative complications, improve patients' satisfaction with nursing to a certain extent, and shorten the clinical treatment time, so as to promote the improvement of the disease. Key words: Cataract; Phacoemulsification; Medical and care integration; Psychological state; Satisfaction to nursing

Transzonular Triamcinolone-Moxifloxacin Versus Topical Drops for the Prophylaxis of Postoperative Inflammation After Cataract Surgery.

Purpose: To compare the safety and efficacy of an intraoperative transzonular injection of triamcinolone-moxifloxacin (Imprimis' Tri-Moxi 15 mg/1 mg/mL) to topical drops in patients undergoing cataract surgery. Methods: Between January 2017 and October 2017, patients undergoing phacoemulsification cataract surgery by a single surgeon at the Penn State Eye Center were offered a single intraoperative injection of transzonular triamcinolone-moxifloxacin in lieu of perioperative drops. Between November 2017 and July 2018, the transzonular injection was not offered, and all patients who underwent surgery by the same surgeon received a drop regimen consisting of polymyxin b/trimethoprim and prednisolone acetate 1%. Patients were seen 1 day, 1 week, and 6-9 weeks postoperatively. Outcome measures included incidence of intraoperative complications, postoperative breakthrough inflammation, cystoid macular edema, and infectious sequela. Results: Of the 198 eyes, 99 from 73 patients received the injection and 99 from 82 patients received topical drops. One (1%) intraoperative posterior capsule tear occurred in each group. Eleven (11.1%) eyes in the injection group and 3 (3%) in the drop group experienced symptomatic breakthrough inflammation necessitating treatment (P = 0.0488). One (1%) eye in the injection group and zero (0%) in the drop group developed clinically significant macular edema (P = 1.0). No instances of elevated intraocular pressure or infectious sequela occurred in either group (P = 1.0). Conclusions: Transzonular injection of triamcinolone-moxifloxacin may be associated with an increased incidence of breakthrough inflammation compared to topical drops.

Pain Perception and Acceptance of Illness in Patients Undergoing Phacoemulsification Cataract Surgery under Drip Anesthesia.

For many years, cataracts have been the main cause of vision loss and vision impairments in the world (43% and 33%, respectively). Currently, the most common surgical method for treating cataracts is phacoemulsification. The aim of this study was to assess the pain perception and acceptance of illness connected with awaiting phacoemulsification cataract surgery under intravenous drip anesthesia, as well as to determine the effect of selected sociodemographic factors on the above. Methods: The study was conducted in a group of patients of the Department of Ophthalmology, University Clinical Hospital in Białystok, Poland suffering from cataracts, who underwent phacoemulsification surgery under intravenous drip anesthesia. The study group consisted of 151 people. The study used an original short questionnaire and three standardized psychometric scales: The acceptance of illness scale (AIS), the Beliefs about Pain Control Questionnaire (BPCQ), and the Coping Strategies Questionnaire (CSQ). Results: The median overall AIS point value was 24 points, which is considered an average score in terms of disease acceptance. Respondents assessed the influence of individual factors on the level of perceived pain and the impact of individual strategies for coping with pain similarly. The level of perceived pain decreased with the patient’s age. People with a higher education level experienced a greater level of pain; however, this relationship was not statistically significant. The place of residence did not affect the level of pain experienced during the procedure. Women had a greater level of acceptance of illness. The respondents’ education level negligibly differentiated the approach to the disease. The place of residence also did not affect the assessment of illness acceptance as measured by the AIS. Whether the surgery pertained to the first or second eye did not significantly affect the approach to the disease. Conclusions: The level of acceptance of illness and pain perception were at a moderate level among the patients. The acceptance of illness was significantly influenced by the age of patients and the waiting period for phacoemulsification, and this level of acceptance decreased significantly with the increasing age of patients. The longer the waiting period for surgery, the lower the acceptance of illness. Sex significantly differentiated the level of pain experienced during the procedure. Education and place of residence did not significantly affect the acceptance of illness and the feeling of pain.

Modified Corneal Incisions for Cataract Surgery in Patients Treated with Tamsulosin: A Prospective Study

ABSTRACTPurpose: To evaluate modified anterior elongated corneal incisions as a simple technique to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS), in patients taking tamsulosin (a selective α1a-adrenergic receptor antagonist).Methods: This prospective case series was conducted at Meir Medical Center, a tertiary care facility in Israel. Included were 45 eyes of 39 male patients taking tamsulosin, and thus prone to IFIS. Patients underwent phacoemulsification cataract surgery with anterior elongated corneal incisions. The primary outcomes were the incidence and severity of IFIS, the complication rate and the need for additional IFIS management techniques. The secondary outcome was to quantify the surgically induced astigmatism, using Alpin’s vector analysis. The tamsulosin treatment period and pupil diameter during five stages of the surgery were also noted.Results: The overall rate of IFIS was 33.33% (n = 15). The IFIS severity was rated as mild in 22.22% and moderate in 11.11% of the study eyes. No IFIS was noted in 66.67% of the eyes. There were no cases of severe IFIS, and no need for other IFIS management strategies. The complications rate was 2.22% (n = 1). Patients who developed IFIS had a significantly smaller pupil at the beginning of surgery (p < 0.05). There was no significant difference in tamsulosin treatment period between patients with and without IFIS (p = 0.19). The centroid – the mean SIA vector was 0.51 D @ 18° ±1.5 D (SD).Conclusions: In tamsulosin treated patients, using modified corneal incisions may be feasible in order to reduce the incidence and severity of IFIS during cataract surgery. Future randomized studies are warranted.

The role of sex in intraoperative floppy-iris syndrome

To compare the incidence of intraoperative floppy-iris syndrome (IFIS) between male and female patients undergoing phacoemulsification cataract surgery, evaluate risk factors for its appearance in each sex, and assess any differences in the final visual outcomes. 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. Comparative retrospective case-control study. Cataract patients with recorded IFIS of any severity occurring over 4years in a tertiary care ophthalmic center during phacoemulsification surgery were identified and enrolled in a multivariate analysis. The study comprised 3811 eyes of 3213 patients. Of the 1678 female patients (1937 eyes) undergoing cataract surgery, IFIS was observed in 25 eyes (1.29%), whereas the incidence of IFIS in male eyes during the same period was statistically significantly higher (97 [5.17%] of 1874 eyes) (P<.0001). No statistically significant difference in age was found between male patients (72.92years±6.5 [SD]) and female patients (72.04±7.1years) (P=.56). An intake of α1-receptor blockers was identified in 70 (72.2%) of 97 male IFIS cases and in none of the 25 female IFIS cases (P<.0001). The posterior capsule rupture rate was significantly higher in 7 (28%) of the 25 female IFIS cases compared with 9 (9.28%) of the 97 male IFIS cases (P=.02). The posterior capsule rupture incidence and final corrected distance visual acuity (with spectacles) were shown to correlate with the IFIS severity grade only in female patients (P<.001 and P=.02, respectively). Although the incidence of IFIS is rarer in female patients, it might significantly affect an increase in the intraoperative events rate and affect the final visual outcome correlating with the severity grade of its appearance. Predisposing risk factors differ between the sexes and surgeons should always be aware of the potentially catastrophic consequences of unforeseen IFIS.

The Effectiveness of 2% Lidocaine Gel Compared to 0.5% Tetracaine Eye Drop As Topical Anesthetic Agent for Phacoemulsification Surgery.

BackgroundTopical anesthetics have become the primary choice in phacoemulsification procedures for cataract extraction. The most common topical anesthetic drug used is 0.5% tetracaine eye drops. Repeated administration of 0.5% tetracaine drops can cause corneal epithelial damage. Two percent lidocaine gel is latest option which has longer contact time with corneal epithelium.ObjectivesTo compare the effectiveness of 2% lidocaine gel with 0.5% tetracaine drops in phacoemulsification surgery.MethodsThe study was a single blinded randomized clinical trial from March to July 2017 in patients underwent phacoemulsification cataract surgery. There were 72 subjects with age ≥ 40 years old who received randomization and divided into 2 groups: 2% lidocaine gel group and 0.5% tetracaine eye drop group. Topical anesthetics were applied 5 minutes before surgery. Five minutes after surgery, pain scale perceived during surgery was assessed by using a numerical rating scale. At the end of surgery, the subject filled the satisfaction questionnaire on topical anesthetic drugs administered. The ophthalmologists were also given a satisfactory questionnaire for topical anesthetic drugs selected for the procedure.ResultsThe median pain scale for 2% lidocaine gel group pain scale was 1; meanwhile, the median pain scale for 0.5% tetracaine eye drops was 3 (P < 0.05).ConclusionsTwo percent lidocaine gel was more effective in relieving pain during phacoemulsification cataract surgery compared with 0.5% tetracaine drops.

Resident surgeon efficiency in femtosecond laser-assisted cataract surgery.

PurposeComparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification.Patients and methodsA retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.ResultsTotal room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05). Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001). There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups.ConclusionIn early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.