Phacoemulsification Surgery Research Articles

Comparison of Endothelial Cell Loss after Phacoemulsification Surgery between Patients with Diabetes Mellitus and Non-Diabetic Patients at Kariadi Hospital: A Prospective Study

Abstract
 Introduction & Objectives : To compare the endothelial cell loss after phacoemulsification surgery in patients with DM and non- DM patients
 Methods : This was a prospective study conducted at Kariadi Hospital, Semarang, Indonesia. A total of 20 eyes of 20 patients (10 DM and 10 non-DM) who underwent phacoemulsification surgery were included in this study. The central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured preoperatively and on day-7 postoperatively. The percentage of endothelial cell loss (%ECL) was calculated and compared between the two groups.
 Results : The mean pre-operative and post-operative CCT was similar in both groups (DM =546.6±44.26μm, non-DM=516.7±42.2μm, p=0.949 ;DM=562.8±46.1μm, non-DM=533.7±46.6μm, p=0.997). The mean percentage of endothelial cell loss was slightly higher in the DM group compared to the non- DM group but not significant (6.66±2.36% vs. 2.31±1.72%, p=0.566). There were no significant differences between the CV and HEX on pre-operative and day-7 after surgery
 Conclusion : Patients with DM have a slightly higher percentage of endothelial cell loss after phacoemulsification surgery compared to non-DM patients. The mean CCT, CV and HEX pre-operation and day-7 were quite similar in both groups. These findings suggest that patients with DM may require more careful monitoring and follow-up after phacoemulsification surgery.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Abstract
 Introduction & Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.
 Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Cataract Progression dan Lens Drop after Pars Plana Vitrectomy and Gas Tamponade : A Case Report

Introduction : Vitreous Hemorrhage (VH) in proliferative diabetic retinopathy (PDR) is common cause of acute vision loss.If the retina cannot be visualized and the etiology of the VH is unknown, pars plana vitrectomy (PPV) is indicated. 1Intraocular gases like SF6 or C3F8 are one of the most useful adjuncts in vitreoretinal surgery. Exposure to intraocular gases additionally increases retrolental oxygen levels, resulting in development of lens opacities.
 Case Illustration : Patient female 52 y.o, came with sudden blurry vision in the left eye since two weeks ago. History of Diabetes Mellitus 10 years with insulin treatment. From the examination left eye visual acuity 1/60, zonulysis, VH, and negative fundus reflect. On ultrasonography found vitreous opacity. The patient was diagnosed with left eye VH ec advanced PDR and scheduled PPV with C3F8 gas tamponade. Patient difficult to maintain prone position after surgery. 2 month after the surgery the patient scheduled with phacoemulsification surgery because progressive lens opacity. While prepare to the second operation, the lens found drop to the vitreous. The second surgery done with lens evacuation and Intraocular lens implantation. Last follow up, best correction visual acuity was 6/18.
 Discussion : PPV and Gas tamponade are presdisposing lens opacity progression. Lens opacity after gas tamponade include longer intraocular longevity gas and patients who fail to maintain a prone position. Risk factors for zonulysis in this patient increase the occurrence of lens drop after PPV with gas tamponade.
 Conclusion : Regular slit-lamp examination needs to be performed for early detection of cataract after PPV with gas tamponade.

Incidence of Dry Eye Syndrome After Cataract Surgery with Phacoemulsification Technique in Padang Eye Center Hospital

Introduction & Objectives : Dry eyes is one of the most common ophthalmological problems. The etiology of dry eyes is usually multifactorial, such as medication, aging, systemic disease, allergy, computer usage, environmental factors, meibomian gland dysfunction and ophthalmic surgery. Cataract is still one of the leading causes of vision impairment globally. No medical treatment is effective to remove cataract. Thus, the only option is cataract removal surgery. The most common technique of cataract surgery in Padang Eye Center Hospital is phacoemulsification. This study aims to assess the incidence of dry eye syndrome after phacoemulsification surgery without complication in patients with no previous history of dry eye syndrome.
 Methods : This study was conducted using a prospective study. The evaluation uses Ocular Surface Disease Index ( OSDI ) questionnaire and tear break-up time ( TBUT ) test performed preoperatively and three times postoperatively at one week, one month and three months follow-up after surgery.
 Results : 110 eyes of 96 patients diagnosed with cataracts who had undergone phacoemulsification surgery were enrolled in this study. The mean age of patients is 62.46 ± 6.14 years, and 59,09% were men. After one week of surgery, only 9,09% had results 0-12 on the OSDI scale, and 43,63% represented moderate dry eye disease ( OSDI score 23-32 ) and TBUT test results from 61,82% of patients had dry eyes, which improved gradually after time.
 Conclusion : The incidence of dry eye syndrome significantly increased after one-week post-surgery. But after one month postoperative, the patients’ condition gradually improved and returned to normal after three months postoperatively.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Introduction & ObjectivesIntroduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.
 Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Anatomical and Functional Outcomes of Management Pediatric Retinal Detachment with High Myopia and History of Retinopathy of Prematurity: A Case Report

Introduction : To report the anatomical and functional outcomes of management of pediatric retinal detachment in children with high myopia and a history of retinopathy of prematurity.
 Case Illustration : A 9-year-old boy had a sudden visual loss two months ago. The complaint is accompanied by photopsia and floaters. No history of trauma or infection. He had a history of myopia (S-6.00) and ROP in both eyes. The VA of the right eye was no light perception, and the left eye was 1/60. A retinal detachment with the macula off was discovered in the posterior examination. The axial length was 21 mm. He underwent a scleral buckle with vitrectomy and internal limiting membrane (ILM) peeling for his left eye. After surgery, the visual acuity was 3/60 with the retina attached. Re- detachment was found three weeks after surgery. The patient was scheduled for a second phacoemulsification and vitrectomy surgery. One month later, the best visual acuity reaches 6/48 with S -8.00 D on his left eye. The complication of high intraocular pressure (IOP) after surgery was managed successfully.
 Discussion :
 Conclusion : Management of retinal detachment cases in children is challenging. Hence, a thorough understanding is crucial in order to achieve anatomical and functional success. Myopia in ROP eyes was mainly lenticular, with an alteration in the anterior chamber that contributed to the patient's refractive status change. We encourage preterm patients to have regular follow-up not only for refractive status but also for structural changes in the anterior segment until adolescence.

Diabetes, Diabetic Retinopathy, and Intravitreal Injection as a Risk Factor of Posterior Capsular Rupture in Phacoemulsification Cataract Surgery :A Systematic Review and Meta Analysis

Abstract
 Introduction & Objectives : The risk of PCR in patients with diabetes and its sequential complication including diabetic retinopathy and Intravitreal Injection (IVI) was still under debate. This study was aimed to summarize the risk of diabetes, diabetic retinopathy, and intravitreal injection towards PCR events during phacoemulsification cataract surgery.
 Methods : A systematic literature search was performed up to March 2023 from the last 10 years publications using Medline and Cochrane library databases. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of diabetes, diabetic retinopathy, and IVI with PCR events were calculated using random-effects models. The quality of included studies was appraised using the Newcastle-Ottawa Scale.
 Results : Six studies about diabetes, six studies about diabetic retinopathy and seven studies about IVI were included in this meta-analysis. The pooled odds ratios of PCR in eyes with diabetes was 1.22 (95% CI: 1.16-1.28) I2 =0.0%, with the diabetic retinopathy patients was 1.23 (95% CI: 1.13-1.33) I2 =64.3%, and with prior IVI was 1.05 (95% CI: 1.03-1.08) I2 =51%.
 Conclusion : This meta-analysis emphasize that diabetes, diabetic retinopathy, and previous IVI significantly increase the risk of PCR on future phacoemulsification surgery. Further studies are needed to elucidate the underlying mechanism.

Successful Management of Cataract in Patient With Long Anterior Zonules and Small Pupil :A Rare Case

Introduction : Long anterior zonules (LAZ) are rare disease with prevalence was 1–2%, characterized by zonular fibers that extend centrally leading to a small zonule-free zone (ZFZ), which raises the risk of complications during zonular cutting while continuous curvilinear capsulorhexis (CCC). This leads to two options whether to perform phacoemulsification through a small CCC within the small ZFZ or an adequately sized CCC. The objective of this study was to report challenging management of phacoemulsification surgery with LAZ eyes with small pupil
 Case Illustration : A 62 y.o female had visual acuity(VA) 0.7(logMAR) due to corticonuclear cataract in left eye. She had history complicated cataract surgery with secondary sulcus fixated IOL in her fellow eye. The IOP was normal, no phacodenesis and pseudoexfoliative material observed in left eye. The posterior segment was normal. The left eye observed otherwise normal in initial examination. Intraoperatively, after viscomidriasis technique the ZFZ identified in the area of 2.0-2.5 mm from central. Five millimeter CCC can be achieved in the central area and phacoemulsification with the help of CTR (Capsular Tension Ring) safely performed and one piece IOL was implanted in the bag.
 Discussion : On the first postoperative day, VA was improves to 0.4(logMAR), IOL central and clear corneal with minimal inflammation. One week after surgery, the VA 0.3(logMAR) and no sign of IOL decenteration.
 Conclusion : Phacoemulsification in eyes with LAZs can be safely performed with CTR through an adequately sized CCC without significant complications. A combination of early recognising high-risk eye, proficient skills, and surgical instruments can improve outcome.

Management of Secondary Angle Closure Glaucoma in Nanophthalmic Eye : A Challenging Case

Introduction : Nanophthalmos is a condition characterized by short eyeball length (AXL <20.0mm), short and dense anterior segment, high eye volume or lens ratio, hypermetropia (+8.00 to +20.00) and scleral thickening (>1.7mm)
 Case Illustration : A 63-year-old man came to the Glaucoma outpatient clinic at Cicendo Hospital with complaints of blurry eyes since 3 years ago. The visual acuity in the right eye was light perception, and in the left eye was hand movement. The anterior chamber was shallow, with seclusio pupil in both eyes (Figure1). Biometry showed axial length 17.06 mm in the right eye and 16.82 mm in the left eye. The patient underwent phacoemulsification surgery + IOL + iris retractor + pupiloplasty + synechiolysis + sclerectomy for the right eye with satisfactory result (Figure3).
 Discussion : This surgical procedure for nanophthalmos has its own challenges for the operator due to the shallow anterior segment and small corneal diameter. In this case, surgery was performed first in the right eye, with consideration of a greater anterior chamber depth than the left eye. The sclerectomy procedure performed on this patient was 4 mm from the limbus and was performed full thickness only in one quadrant (Figure2).
 Conclusion : Multiple anatomic abnormalities in nanophthalmic eyes make surgery extremely challenging and are associated with a high incidence of significant intraoperative and postoperative complications. Phocoemulsification with sclerectomy can be alternative option to manage secondary glaucoma in nanophthalmic eye.

Combined Pars Plana Vitrectomy with Core Vitrectomy with 3600 Barrage Laser and Iris Claw IOL Implantation in Nuclear Drop Case: Video Presentation

Introduction : Nuclear drop is one of the numerous complications of phacoemulsification surgery. Today, the incidence of nuclear drop has been declining significantly compared to years before. Eyes with nuclear drop tend to have poorer visual and refractive outcome compared to eyes with existing risk factors but no such complication. This video presentation reports a case of nuclear drop with desirable outcome
 Case Illustration : A 46 years old male patient came with blurry vision on his right eye. Patient was undergone eventful phacoemulsification with nuclear drop complication 2 hours ago. Prior to the admission, visual acuity was 1/300, IOP (Intraocular pressure) 24 mmHg, and retinal evaluation showed there is lens nucleus on the retina. Before admission, the patient was given Methylprednisolone 1x 48mg, Ranitidine 2x150 mg, Ciprofloxacin 2x500mg , Asam mefenamat 3x500mg, Cendo LFX ED 6x1 gtt, Cendo Xytrol ed 6x1 gtt. The patient was planned to do the Pars Plana Vitrectomy followed with 360° barrage laser and Retropupil Iris Claw implantation. One day after the surgery, the visual acuity was 0.2, IOL was well implanted, and no sign of retinal detachment. Four weeks after the surgery, the visual acuity was 0.8 with well implanted IOL
 Discussion : 
 Conclusion : The outcome of nuclear drop cases is affected by several factors. Preparations before PPV are important to attain a better visual outcome. Until now the optimum time to perform PPV in nuclear drop cases remains undetermined. Meanwhile, rise in IOP indicating no luxury of waiting for PPV

TEAR FILM CHANGES FOLLOWING PHACOEMULSIFICATION SURGERY IN PRIMARY EYE CARE CENTER

Abstract
 Introduction & Objectives : Dry eye disease (DED) is one of the most commonly encountered problem in daily ophthalmology practice. One of many risk factors for DED is cataract surgery. Cataract surgery is known to modify tear film and ocular surface through corneal incision and ocular toxicity of peri- and postoperative medications. The aim of this study is to analyze tear film before and after phacoemulsification in primary eye care facility by measuring tear break-up time (TBUT), fluorescein staining, Schirmer I test (ST-I), and ocular surface disease index (OSDI) score.
 Methods : This was a longitudinal observational study with prospective cohort design, which included patients diagnosed with senile cataract and underwent uncomplicated phacoemulsification surgery at primary eye care center Sawangan Eye Clinic within period of June to December 2022. Friedman, Wilcoxon, and Cochran tests were used to analyze the data.
 Results : Thirty nine eyes from 39 patients met the inclusion criteria and were followed up to 3-month postoperatively. Mean age of the patients was 61.1±10.54 years, which consited of 53.8% males and 46.2% females. Mean preoperative OSDI score, corneal staining, TBUT, and ST-I were 24.94±10.24, 1.38±1.99, 2.94±2.17, and 15.46±8.80 respectively; while 3-month postoperative, these parameters’ means were 11.22±13.15 (p=0.0001), 1.38±2.56 (p=0.118), 3.13±1.79 (p=0.192), and 13.31±9.45 (p=0.006) respectively. OSDI was the only parameter which showed statistically significant changes from preoperative to postoperative follow ups (p<0.05).
 Conclusion : Phacoemulsification did not alter corneal staining and TBUT significantly after 3 months postoperatively, even though both of these parameters' preoperative value were already lower; yet OSDI score improved over time after surgery.

Enhanced Monofocal Intraocular Lenses in Fuchs' Endothelial Dystrophy Patients: Results from Triple Descemet Membrane Endothelial Keratoplasty Procedure.

Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery. This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes. the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL. In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.

Anterior chamber flare and choroidal vascular index as inflammatory markers after uncomplicated phacoemulsification surgery.

To determine the effect of phacoemulsification surgery, which is one of the types of cataract surgery by using ultrasonic power to break up the crystalline lens and clean it with vacuum, on anterior chamber flare (ACF) and choroidal vascular index (CVI). For this cross-sectional study, patients were included if they had cataract with nucleus hardness grade 2 or 3, no systemic inflammatory disease, and not use of anti-inflammatory drugs/prostaglandins preoperatively. ACF using a laser flare meter and CVI in patients underwent uncomplicated phacoemulsification was recorded preoperatively, on the postoperative 1st day, 1st week, and 1st month. Fifty-six eyes were included. ACF was 9.00 ± 2.90 ph/ms preoperatively. Although ACF increased significantly on postoperative day-1 (39.38 ± 23.31ph/ms) and decreased gradually until the 1st month (14.03 ± 6.03ph/ms) after the operation, it was still significantly higher at the 1st month (p < 0.001). Macular and peripapillary CVI increased significantly on postoperative day-1 (0.64 ± 0.03/0.63 ± 0.05) and week-1 (0.64 ± 0.04/0.62 ± 0.04) (p = 0.01, p < 0.001); the postoperative 1st month was similar to the preoperative one (0.59 ± 0.06/0.58 ± 0.06). The relationship between the change in ACF and the change in CVI was not significant. Phacoemulsification causes raises in ACF and CVI due to increased intraocular inflammation. The fact that ACF was significantly higher in postoperative month-1 and CVI returned to its preoperative value suggests that the effect of uncomplicated phacoemulsification surgery on the increase in inflammation in the anterior segment lasts longer than in the posterior segment. These results suggest that ACF and CVI follow-up may be clinically important in the follow-up of postoperative inflammation.

Effect of Intracameral Moxifloxacin on Endothelial Cell Count and Endophthalmitis Prophylaxis After Cataract Surgery

One of the most feared side effects of contemporary cataract surgery is still endophthalmitis. Prophylactic measures include the use of antibiotics: topical, subconjunctival, and intracameral, to avoid endophthalmitis. Moxifloxacin 0.5% has been used most frequently in preventive late-stage regimens. Objective: To ascertain how well moxifloxacin prevented endophthalmitis in patients having cataract surgery. Methods: This was a descriptive case study and was conducted at Eye Departments of Allama Iqbal Medical College, Jinnah Hospital, Lahore and Ameer-ud-Din Medical College, Lahore General Hospital, Lahore. The study was commenced after approval of the synopsis and completed in 6 months. Results: In this study, 23.75%(n=19) were between 40-50 years, 61.25%(n=49) between 51-60 years and 15%(n=12) had &gt;60 years of age, and their average was calculated as 53.99+6.22 years. 58.76%(n=47) were males and 41.25%(n=33) were females in the study. Mean endothelial cell count before cataract surgery was calculated as 2776 +177 while post-operative the average endothelial count was calculated as 2424 +72.8. while the frequency of effect of moxifloxacin, in the prevention of endophthalmitis in patients undergoing cataract surgery was recorded as 22.5%(n=18) while 77.5%(n=62) had no effect of moxifloxacin while preventing endophthalmitis in patients undergoing cataract surgery. Conclusions: We conclude that the effect of moxifloxacin, in preventing endophthalmitis in patients undergoing phacoemulsification surgery is not significantly higher and may be used in our setup for prevention of endophthalmitis, being a risk factor for blindness. Moxifloxacin does not affect the corneal endothelial cells significantly.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes.

To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.

Improvements to a GLCM-based machine-learning approach for quantifying posterior capsule opacification.

Posterior capsular opacification (PCO) is a common complication following cataract surgery that leads to visual disturbances and decreased quality of vision. The aim of our study was to employ a machine-learning methodology to characterize and validate enhancements applied to the grey-level co-occurrence matrix (GLCM) while assessing its validity in comparison to clinical evaluations for evaluating PCO. One hundred patients diagnosed with age-related cataracts who were scheduled for phacoemulsification surgery were included in the study. Following mydriasis, anterior segment photographs were captured using a high-resolution photographic system. The GLCM was utilized as the feature extractor, and a supported vector machine as the regressor. Three variations, namely, GLCM, GLCM+C (+axial information), and GLCM+V (+regional voting), were analyzed. The reference value for regression was determined by averaging clinical scores obtained through subjective analysis. The relationships between the predicted PCO outcome scores and the ground truth were assessed using Pearson correlation analysis and a Bland-Altman plot, while agreement between them was assessed through the Bland-Altman plot. Relative to the ground truth, the GLCM, GLCM+C, and GLCM+V methods exhibited correlation coefficients of 0.706, 0.768, and 0.829, respectively. The relationship between the PCO score predicted by the GLCM+V method and the ground truth was statistically significant (p<0.001). Furthermore, the GLCM+V method demonstrated competitive performance comparable to that of two experienced clinicians (r=0.825, 0.843) and superior to that of two junior clinicians (r=0.786, 0.756). Notably, a high level of agreement was observed between predictions and the ground truth, without significant evidence of proportional bias (p>0.05). Overall, our findings suggest that a machine-learning approach incorporating the GLCM, specifically the GLCM+V method, holds promise as an objective and reliable tool for assessing PCO progression. Further studies in larger patient cohorts are warranted to validate these findings and explore their potential clinical applications.

Changes in Chord Mu (µ) Length Before and After Cataract Surgery

Aim: Comparison of chord  length, a potential marker that may gain importance especially in multifocal lens implantation, before and after phacoemulsification surgery and intraocular lens (IOL) implantation in patients with cataracts. Methods: This retrospective study included 33 eyes of 33 patients who underwent phacoemulsification surgery between December 2022 and February 2023. Corneal topography (Pentacam HR, Oculus, Wetzlar, optikgerate GmbH) was performed on each patient before and after surgery. The values obtained before and at least 3 months after surgery were compared using the Student-t test. Results: There were 18 (54.5%) males and 15 (45.5%) females among the 33 patients who participated in the study. The average age was 67.27 ± 10.93 years. The postoperative mean chord μ lenght was significantly lower than the preoperative mean chord μ lenght (p=0.002). Additionally, the mean postoperative pupil size was significantly lower than the mean preoperative pupil size (p=0.000). There is a weak positive relationship between the change in chord μ length and the change in pupil size, but this relationship is not statistically significant (p&gt;0.05). No statistically significant relationship was found between any of the other binary variables. Conclusion: Centralization is crucial in refractive surgery and multifocal IOL implantation to prevent high-order aberrations and photic phenomena. Therefore, it seems useful for surgeons to be familiar with chord μ measurements, especially regarding surgical preparation. It should be considered that changes in chord mu values may influence the development of photic phenomena. A decrease in chord mu after phacoemulsification may assist the surgeon in the preoperative decision-making process in patients at risk of photic phenomena or in patients with borderline values.

Complication rates in phacoemulsification surgeries performed by trainee residents

Objectives: Phacoemulsification with a foldable intraocular lens is the gold standard of cataract treatment. Studies have shown that various risk factors affect the visual outcome of cataract surgery. One of these is the availability of well-trained surgeons. Here, we are trying to understand how to achieve good surgical outcomes even if the surgeon has low surgical experience. Materials and Methods: A hospital-based prospective study was done from August 2019 to March 2021. After a detailed examination, each patient was scored based on the risk factors associated and classified into various risk groups. A total of 286 patients were studied, out of which consultants operated on 143 patients and 143 patients were operated on by trainee residents. The intraoperative and postoperative complication rates are compared based on the complexity of cases between trainee residents and consultants. Results: About 82.5% of the patients operated by trainee residents and 78.32% of patients operated by consultants belonged to the no-risk group with complication rates of 2.50% and 1.80%, respectively, which was statistically not significant. In the case of patients with associated preoperative risk factors, 36% of patients operated on by trainee residents had complications, and 9.6% of patients operated on by consultants had statistically significant complications. Conclusion: Preoperative stratification and allocation of cases according to associated risk factors help reduce complications, help trainee residents gain essential surgical skills, and give better surgical outcomes for patients.

Comparison of Surgically-induced Astigmatism using Topography and Keratometry in Patients undergoing Phacoemulsification and Small Incision Cataract Surgery: A Prospective Interventional Study

Introduction: Topographic measurement of corneal astigmatism is the current standard of care because, in addition to measuring corneal astigmatism, it identifies irregular astigmatism, which may limit optimum surgical results. The present study focuses on the use of topography to measure Surgically Induced Astigmatism (SIA), which is not a routine practice in most institutions, and compares it with keratometry values of corneal astigmatism. The present study highlights the accuracy of topography in the measurement of astigmatism, with its additional benefits being the measurement of irregular astigmatism and assessment of tear film status. Aim: To compare SIA using topography and keratometry in patients undergoing phacoemulsification and Small Incision Cataract Surgery (SICS). Materials and Methods: The present study was a prospective, interventional study conducted in the Ophthalmology Department of Bharti Vidyapeeth (deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India for 18 months (November 2019 to April 2021). A total of 100 cases (100 eyes) with cataracts were randomly divided into Group-A (n=50) and Group-B (n=50), respectively, underwent Phacoemulsification and SICS. Before the surgery, the astigmatism of each patient was noted by both topography and keratometry. On the 45th postoperative day, patients’ Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), automated keratometry readings, and corneal topography readings were taken, based on which SIA was calculated by SIA calculator version 2.0. The mean SIA in both groups was calculated and compared. An unpaired t-test was used to compare the mean of different variables in the two groups, Group-A and Group-B. A p-value of &lt;0.05 was considered statistically significant. Results: The majority of cases were in the age group of 61- 70 years, with 23 (46%) cases in Group-A and 27 (54%) in Group-B. In the study, the mean SIA by keratometry in Group-A was 0.43±0.02D and in Group-B was 1.24±0.04D (p&lt;0.0001), and the mean SIA by topography in Group-A was 0.49±0.02D and in Group-B was 1.28±0.03D (p&lt;0.0001), indicating that phacoemulsification causes less SIA compared to SICS. Upon comparing the mean SIA calculated by keratometry and topography in both study groups, it was found that p&lt;0.02 in Group-A and p&lt;0.4 in Group-B, suggesting that both p-values are not significant. This indicates that both keratometry and topography will give similar results and can be used for determining SIA. Conclusion: The study showed that phacoemulsification produces less mean SIA compared to SICS, leading to better visual outcomes and early visual rehabilitation in contrast to the SICS group. The present study also concluded that both keratometry and corneal topography can be used for the calculation of SIA as both give similar results, although topography remains an important tool in the calculation of Intraocular Lens (IOL) power in patients with corneal pathologies and post-refractive surgeries.