Post-cataract Surgery Research Articles

Monovision versus multifocality for presbyopia during primary phacoemulsification: systematic review and network meta-analysis.

This systematic review and network meta-analysis (NMA) focuses on comparing monovision and bilateral multifocal lenses (bMFIOL) implantation methods in treating presbyopia, a common age-related condition often seen in post-cataract surgery patients. This review focuses on evaluating the efficacy, user satisfaction and limitations of these two approaches through direct or indirect comparison. A comprehensive search was conducted in Medline, Embase, and Cochrane library, considering studies up to 15 July 2022, with direct or indirect comparisons between any monovision and bMFIOL implantation with bilateral cataract surgery. The study protocol has been published in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022340257). Thirty-two studies (3082 patients) were included in the NMA for the primary outcome, complete post-operative spectacle independence. NMA showed monovision to be inferior to bMFIOLs, as bMFIOL was more likely to provide complete spectacle independence (RR = 2.06, 95% CI = 1.34 to 3.15, p = 0.002) compared to monovision. Monovision resulted in less glare compared to bMFIOL (RR = 0.343, 95% CI = 0.181 to 0.651, p = 0.001). There was no statistically significant difference between monovision and bMFIOL for binocular unadjusted distance visual acuity (MD = 70.01, 95% CI = -19.88 to 4.60, p = 0.437) and binocular unadjusted near visual acuity (MD = 5.46, 95% CI = -5.24 to 10.94, p = 0.191). When compared to monovision, bMFIOL provided greater complete spectacle independence at the expense of greater glare. This study was limited by data heterogeneity, and further studies with standardized reporting would be useful.

The Frequency of Occurrence of Strabismus in Infants Post Lensectomy.

Purpose To identify and characterize incident cases of strabismus and interocular visual acuity among infants post lensectomy for congenital cataract. Method This was a single-centre retrospective chart review of all children aged less than 12 months who underwent lensectomy from 1st January 2014 to 1st January 2021. Cases were identified from theatre coding and electronic medical records. Cases with strabismus prior to cataract surgery were excluded. Results Seventy-five children (114 aphakic eyes) were included, 36 (48%) had unilateral cataract surgery while 39 (52%) had bilateral. The mean age at the time of cataract surgery was 3.0±2.5 months (range 1 - 10 months). The mean follow-up period was 41.2±22.8 months (range 2 -72 months). Nineteen out of 75 patients (25%) developed strabismus, most of whom (18 cases) had unilateral surgery. Out of the 19 strabismus cases recorded, esotropia was reported in 74% of the cases, followed by exotropia -16%, while esotropia associated with dissociated vertical deviation (DVD) and esotropia associated with inferior oblique each made up 5% of the population. Most children who developed strabismus [17 patients (89.5%)] had lensectomy prior to 6 months of age. A significant difference of 0.65 logMAR was recorded in the interocular visual acuity (IOVA) difference between the strabismic and non-strabismic groups, and the unilateral and bilateral lensectomy groups. Conclusion Strabismus, most commonly esotropia, is common after congenital lensectomy, particularly in those children who underwent unilateral cataract surgery, and in those less than 6 months of age.Monitoring IOVA and strabismus incidence post-cataract surgery is crucial for early intervention and amblyopia prevention.

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center.

This study aimed to describe the functional and anatomical outcomes of post-cataract surgery fungal endophthalmitis at King Khaled Eye Specialist Hospital (KKESH). A retrospective analysis of clinical data from a single institution was performed. This study included 29 patients with post-cataract surgery endophthalmitis with suspected or confirmed fungal etiology who presented between January 1, 2017, and December 31, 2022. We evaluated demographics, clinical features, microbiological assessments, and treatment strategies. The effects of various treatments on outcomes were analyzed. The need for additional treatment and functional and anatomical outcomes was also investigated. The mean time from surgery to the onset of ocular symptoms was 52.1 (SD ± 59.9; range, 3-210) days, and the mean time from surgery to the first visit to KKESH was 81.4 (SD ± 103.5; range, 2-510) days. Low culture positivity was noted in four samples, with two revealing Aspergillus sp. and two revealing Cladosporium sp. Of the 29 patients, 6 underwent pars plana vitrectomy (PPV) and received intravitreal antimicrobial/antibiotic injections. Two of the six patients also underwent simultaneous intraocular lens removal. The average number of additional treatments, regardless of visual acuity, was lower in the PPV group than in the conservative group (0.5 [SD ± 1.1; range, 0-3] and 1.48 [SD ± 1.47; range, 0-6], respectively). In the PPV group, 50% (n=3) of the eyes achieved functional success and 83.3% (n=5) of the eyes achieved anatomical success. In contrast, in the conservative group, 43.5% (n=10) of the eyes achieved functional success and 69.6% (n=16) of the eyes achieved anatomical success. For post-cataract surgery fungal endophthalmitis, a high index of suspicion and prompt PPV with empirical administration of intravitreal antifungal agents are required to achieve a favorable prognosis.

Long-Term Outcomes of Cataract Surgery: Analysis of Visual Acuity and Intraocular Pressure in a Tertiary Care Center

Abstract: Posterior capsule opacity (PCO) is a common complication following cataract surgery, caused by the proliferation of residual lens epithelial cells. This study aimed to evaluate the long-term effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP) and visual acuity in PCO patients. This was a retrospective descriptive study. Samples were 24 patients diagnosed with PCO who underwent Nd:YAG laser capsulotomy at Prof. Dr. R. D. Kandou Hospital, Manado, from January 1, 2022, to January 1, 2024. The study recorded pre- and post-procedure IOP and best-corrected visual acuity (BCVA) data. Descriptive analysis, including paired t-tests, was used to assess changes in IOP and BCVA over an average follow-up period of 19.2 months. The results showed a statistically significant improvement in BCVA (p=0.000), with mean values improving from 0.72 to 0.27 LogMAR. A significant reduction in IOP was also observed (p=0.015), with long-term IOP remaining stable. A weak correlation was found between follow-up duration and IOP variation (p=0.02). In conclusion, Nd:YAG laser capsulotomy significantly improves visual acuity and stabilizes intraocular pressure in the long term for PCO patients, suggesting its effectiveness in managing post-cataract surgery complications. Keywords: posterior capsule opacity; Nd:YAG laser capsulotomy; intraocular pressure; visual acuity; cataract surgery Methods: A retrospective descriptive study was conducted on 24 patients diagnosed with PCO who underwent Nd capsulotomy at RSUP Prof Dr. R. D. Kandou Central Hospital, Manado, from January 1, 2022, to January 1, 2024. The study recorded pre- and post-procedure IOP and Best-Corrected Visual Acuity (BCVA) data. Descriptive analysis, including paired t-tests, was used to assess changes in IOP and BCVA over an average follow-up period of 19.2 months. Results: The study revealed a statistically significant improvement in BCVA (p = 0.000), with mean values improving from 0.72 to 0.27 LogMAR. A significant reduction in IOP was also observed (p = 0.015), with long-term IOP remaining stable. A weak correlation was found between follow-up duration and IOP variation (p = 0.02). Conclusion: Nd capsulotomy significantly improves visual acuity and stabilizes IOP in the long term for PCO patients, suggesting its effectiveness in managing post-cataract surgery complications.

Cystoid macular edema after low-energy femtosecond-assisted cataract surgery.

This study aimed to evaluate the occurrence of pseudophakic cystoid macular edema (PCME) post low-energy femtosecond laser-assisted cataract surgery (FLACS) in a high-volume surgical setting. The medical records of 242 FLACS patients were retrospectively reviewed. The central subfield macular thickness (CSMT) was measured via optical coherence tomography (OCT) before and 4-6weeks after surgery, and the results were compared for PCME detection. Macular edema was defined as a 10% increase in CSMT, a new onset of intraretinal fluid, or a decrease in visual acuity (VA). VA development in PCME patients was reviewed at 2-3months and 6months. The median patient age was 72years (49-92years). Among 242 eyes, seven eyes (2.89%) developed PCME. The median preoperative CSMT in these eyes was 255μm (minimum 231μm, maximum 326μm), whereas the median CSMT at 4-6weeks after surgery was 317μm (minimum 255μm, maximum 463μm). 4- to 6-week postoperative visual acuity decreased in comparison with 1-week postoperative values in three eyes of two patients, remained stable in two patients, and improved in one patient, whereas one patient did not return for his 1-week appointment but improved from 0.4 to 0.2 logMAR 2.5months postoperatively. By 3-6months, all eyes with PCME had gained visual acuity in comparison with their preoperative values. None of the PCME patients had diabetes or used prostaglandin analogues. Three patients were receiving anticoagulation medication. A 2.89% incidence of PCME after low-energy FLACS matched published standard phacoemulsification rates. In our series of uncomplicated cases, PCME caused only a transient postoperative decrease in visual acuity. What is known Increased prostaglandin levels have been detected in the aqueous humour of cataract patients after femtosecond laser application. Prostaglandins are mediators of inflammation. Femtosecond lasers come in low energy and high energy variants. There is contrasting evidence of increased incidence of PCME after femtosecond laser assisted cataract surgery (FLACS) What is new The incidence of PCME after low-energy FLACS in our high volume surgical setting is 2.89% Low-energy FLACS does not seem to have a causative effect on PCME.

Efficacy and Safety of Nanoparticle Loteprednol Etabonate Compared to Vehicle in Post-cataract Surgery Pain and Anterior Chamber Inflammation Management: A Systematic Review and Meta-Analysis.

Cataracts are a leading cause of blindness worldwide, with phacoemulsification being the most widely used surgical method for cataract extraction due to its proven effectiveness. Managing postoperative inflammation following ocular surgery is crucial, and topical ocular corticosteroids have become an essential part of this therapeutic approach. This review aims to evaluate the efficacy and safety of nanoparticle-sized loteprednol etabonate (LE) formulations in comparison to a placebo, utilizing a systematic review and meta-analysis. We conducted a comprehensive search across Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EBSCO, and ClinicalTrials.gov. Only randomized controlled trials (RCTs) that compared nanoparticle-sized LE formulations with placebo were included. Efficacy was measured by the resolution of anterior chamber cells (ACC) and anterior chamber flare (ACF), as well as pain relief. Safety was assessed by tracking adverse events (AEs). The risk of bias was evaluated using the Cochrane risk of bias tool. Eight RCTs involving 2,375 participants met our criteria. The meta-analysis revealed that both 0.38% and 1.00% LE formulations significantly improved ACC resolution, with the 1.00% formulation showing a higher efficacy (relative risk (RR)=1.87, 95% confidence interval (CI): 1.58-2.2, P<0.01, I²=40%). Furthermore, the 1.00% LE formulation was more effective in relieving pain compared to placebo (RR=1.52, 95% CI: 1.39-1.66, P<0.01, I²=20%). Both LE formulations were associated with few adverse events, and the 1.00% LE formulation had a lower risk of such events compared to placebo. However, no significant differences were observed in terms of joint swelling, stiffness, or mortality. In conclusion, our meta-analysis supports the use of nanoparticle-sized LE for managing inflammation and pain post-cataract surgery, with the 1.00% formulation proving to be more effective than both 0.38% LE and placebo. Both formulations were found to be generally safe, though additional research is needed to further evaluate long-term outcomes and safety.

Assessing the therapeutic role of trehalose and hyaluronic acid: implications for patient care.

This Systematic review aims to assess the efficacy of trehalose and hyaluronic acid in enhancing ocular recovery post-cataract surgery, focusing on their impact on tear film stability, ocular surface integrity, and patient-reported outcomes. A comprehensive search was conducted across MEDLINE, PubMed, and Cochrane Library databases to identify randomized controlled trials investigating the efficacy of trehalose, hyaluronic acid, or their combination in post-cataract surgery care. The inclusion criteria focused on peer-reviewed studies in English, detailing outcomes relevant to ocular recovery such as tear film stability, ocular surface integrity, patient-reported discomfort, or visual acuity (VA). The quality of the included studies was assessed using the Cochrane Risk of Bias Tool and synthesized the data qualitatively. Four qualitative investigations met the inclusion criteria. The studies collectively assessed the efficacy of a 3% trehalose and 0.15% hyaluronic acid eye drop solution in reducing postoperative eye symptoms compared to various control solutions. Parameters measured included tear break-up time (TBUT), Fluorescein staining, tear production (Schirmer test), and Ocular Surface Disease Index (OSDI) scores. The results indicated significant improvements in tear film stability and ocular surface health for the treatment groups compared to controls, with a notable decrease in patient-reported discomfort. The study showed an improvement of - 18 (± 14.6) in the treatment group compared to - 7 (± 8.0) in the control group for OSDI. For TBUT, the treatment group improved by 3 (± 1.2) s, whereas the control group improved by 0.3 (± 0.71) s. VA, measured on a scale of 0-100, increased to 17 (± 0.7) in the treatment group compared to 15 (± 1.1) in the control group. Trehalose and hyaluronic acid may be beneficial in the postoperative period by enhancing tear film stability and ocular surface health. While the results are promising, further research is needed to confirm these findings, understand the mechanisms of action, and explore broader applications.

Unexpected encounter with an intracameral cilium postcataract surgery

Abstract Background: Cataract surgery, a routine and highly successful ophthalmic intervention, is not immune to unexpected challenges. While complications are infrequent, their diverse nature necessitates a thorough understanding to ensure optimal patient outcomes. Case Report: This presentation focuses on a 55-year-old female who underwent routine phacoemulsification with intraocular lens placement. Despite uneventful initial postoperative assessments, a horizontally oriented intraocular cilium was discovered on the 1st day. Prompt removal was undertaken, leading to an uneventful recovery. The case is distinguished by video evidence ruling out the presence of cilium at the surgery’s conclusion, prompting exploration into the mechanisms of delayed entry. Discussion: Delving into the intricacies of intraocular cilium postcataract surgery, this discussion emphasizes the rarity of such occurrences and explores the spectrum of ocular responses documented in the literature. Patient-specific factors, wound integrity, and the role of postoperative eye rubbing are scrutinized. The importance of patient education, vigilant postoperative monitoring, and timely interventions to mitigate complications are highlighted. The case prompts a reconsideration of preventive strategies and underscores the adaptability required in managing unexpected challenges. Conclusion: In conclusion, this case of intraocular cilium following routine cataract surgery contributes a unique perspective to the understanding of postoperative complications. The absence of cilium at the surgery’s conclusion challenges assumptions, urging a reevaluation of preventive measures. Beyond this specific case, the discussion emphasizes the broader implications for patient care and surgical practice. The adaptive approach to unforeseen challenges, coupled with comprehensive patient education, emerges as pivotal for optimal outcomes in cataract surgery.

A rare case of bilateral malignant glaucoma after cataract surgery with capsular tension ring implantation: a case report

BackgroundBilateral malignant glaucoma induced by a capsular tension ring associated with ring-shaped cysts of the ciliary body post-cataract surgery is rare. Herein, we present a case to highlight the possibility of capsular tension ring-induced malignant glaucoma.Case presentationA 59-year-old woman underwent phacoemulsification combined with capsular tension ring implantation for cataracts and zonular fibre laxity in both eyes. Upon admission, annular ciliary masses were detected in both eyes using ultrasound biomicroscopy. Two months post-surgery, the patient experienced vision deterioration, high intraocular pressure, and an axial shallowing anterior chamber in the right eye, and responded poorly to traditional anti-glaucoma medication. Ten days later, similar symptoms appeared in the left eye. Ultrasound biomicroscopy detected contact between the ciliary body and the capsular tension ring. Subsequently, malignant glaucoma was diagnosed. Anterior and posterior capsulotomies performed peripheral to intraocular lens optics using neodymium: YAG laser restored communication and alleviated the symptoms. A one-year follow-up revealed stable intraocular pressure and anterior chamber in both eyes.ConclusionsThis is the first case report of bilateral malignant glaucoma after cataract surgery induced by capsular tension ring, which is associated with bilateral ring-shaped cysts of the ciliary body. Blockage between the ciliary body and capsular tension ring was confirmed using ultrasound biomicroscopy.

Axial length acquisition success rates and agreement of two swept-source optical biometers in eyes with dense cataracts.

Swept-source optical coherence tomography-based (SS-OCT) biometers have been used in different clinical studies with the aim of assessing the accuracy of the technique, specifically in eyes with dense cataracts. Our objective is to evaluate the axial length acquisition success rates and agreement of two SS-OCT biometers when measuring axial length and biometric parameters in eyes with dense cataracts. 46 eyes (46 patients) with dense cataracts (LOCS III grade ≥ 4) were measured 3 consecutive times using the Eyestar 900 and Argos SS-OCT biometers. Keratometry (K1, flat and K2, steep), central corneal thickness (CCT), white-to-white (WTW), anterior-chamber-depth (ACD), lens-thickness (LT), and axial length were measured using both biometers. The percentage acquisition success rate and a Bland-Altman analysis to determine the agreement between the biometers were calculated. Corrected and uncorrected distance visual acuity, subjective refraction, and axial length (to assess preoperative axial length accuracy) were measured 1-month post-cataract surgery. The mean LOCS III score was 4.37 ± 0.68. The acquisition success rates for both biometers was 100%. There were statistically significant differences between the two SS-OCT biometers for all parameters evaluated (p < 0.05). The mean differences for K1, K2, CCT, WTW, ACD, LT and axial length were 0.106 D, 0.128 D, -6.347 μm, -0.054 mm, 0.095 mm, 0.110 mm, and -0.036 mm, respectively. The mean pre- and post-surgery axial length difference was -0.036 mm for the Eyestar 900 and -0.020 mm for the Argos. This difference was ≤ 0.1 mm in 97.82% of eyes with the Eyestar 900 and in 100% of eyes with the Argos. SS-OCT biometry successfully measures axial length in dense cataracts. The differences between biometers in some parameters may have a clinically significant impact but should be judged individually. The pre- and post-surgery axial length differences for each biometer can be considered clinically negligible and should not affect the IOL power calculation.

Evaluation of the Cornea by Anterior Segment Optical Coherence Tomography in Diseases of the Cornea.

The aim of the study was to determine any new findings provided by anterior segment optical coherence tomography (AS-OCT) in different corneal diseases diagnosed by slit lamp examination (SLE). This cross-sectional, observational, hospital-based study was conducted at a tertiary care centre in Western Maharashtra from September 2022 to June 2024, and it included 93 eyes of 93 patients with isolated corneal diseases.A detailed SLE of the anterior segment was done to assess corneal pathology, corneal thickness, corneal structural integrity, presence of corneal opacities, corneal vascularization, presence of other abnormalities like corneal degeneration, corneal foreign bodies, Kayser-Fleischer (KF) ring, ocular surface squamous neoplasia (OSSN). All patients underwent AS-OCT with imaging protocolstailored to each corneal condition, including assessment of focal thinning in Keratoconus patients, graft-host junction integrity in post-keratoplasty cases, Descemet's membrane integrity in post-cataract surgery patients, localization and depth of invasion of corneal foreign bodies, detection of KF rings in Wilson's disease cases, and identifying and assessing extent of corneal dystrophies, corneal degenerations, and OSSN. AS-OCT findings were compared with SLE results to identify any additional information provided by AS-OCT over SLE in the study population.For statistical analysis, data was entered into Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp; Armonk, New York, United States). Inter-rater agreements between SLE and AS-OCT were evaluated by Cohen's Kappa by using IBM SPSS Statistics for Windows, Version 26.0. AS-OCT enabled additional diagnosis of three (15.8%) more cases of keratoconus, which were declared normal on SLE.AS-OCT identified one (5.90%) case of deep-seated stromal corneal foreign body among the cases which were reported to have only superficial corneal foreign body on SLE. Two (50%) casesof suspected OSSNon SLE were ruled out on AS-OCT, whereas two (50%) casesof suspected OSSNon SLE were confirmed on AS-OCT. AS-OCT found a KF ring among two (12.5%) cases that were reported to have no KF ring on SLE. On both SLE and AS-OCT, 26 (81.2%) cases showed the same findings, whereas in 30 (49.2%) cases, AS-OCT rejected the suggested findings of the SLE. In six (18.8%) cases, SLE did not show any findings, but AS-OCT showed findings. Both SLE and AS-OCT showed no findings in 31 (50.8%) cases. This study highlights the significant role of AS-OCT in enhancing the diagnostic accuracy of various corneal diseases. Its ability to detect additional findings in various corneal conditions such as keratoconus, corneal foreign bodies, OSSN, and KF ring in Wilson's disease underscores its value in clinical practice. The utility of AS-OCT in diagnosing subclinical corneal diseases which are beyond the scope of routine SLE has been demonstrated in our study. These capabilities make AS-OCT an effective additional diagnostic toolin evaluating cornea and should be routinely incorporated along with traditional SLE in evaluating various corneal diseases.

Visual and clinical outcomes after bilateral implantation of a novel extended depth of focus lens post cataract surgery.

To assess the visual and clinical outcomes after bilateral implantation of the novel extended depth of focus (EDOF) (AcrySof IQ Vivity) intraocular lens (IOL) using a micromonovision strategy. This was a prospective interventional study at a tertiary care center. Twenty patients (40 eyes) underwent bilateral implantation of AcrySof IQ Vivity IOL. Twelve weeks postoperatively, both uncorrected vision and corrected vision were assessed. Uniocular and binocular defocus curves with and without correction were noted subjectively as well as objectively on I-trace. Contrast sensitivity was assessed with a FACT (Functional Acuity Contrast Testing) machine, and objective parameters like modulation transfer function and Strehl ratio were also measured on I-Trace. Subjective quality of vision using a subjective questionnaire was also evaluated. The mean binocular postoperative uncorrected distance visual acuity in LogMAR was -0.03 ± 0.09, the uncorrected intermediate visual acuity was 0.03 ± 0.09, and the uncorrected near visual acuity was 0.28 ± 0.18. All defocus curves were smooth and broad with the uncorrected defocus curve (with the micromonovision strategy) better than the corrected defocus curve. The subjective depth of focus (DOF = 3.73) was more than objective DOF (1.93) (P < 0.05). Photopic contrast was better than mesopic at all frequencies. All aberrations increased at 5 mm pupil size compared to 3 mm pupil size and were statistically significant, except for the total eye spherical aberration, which shows no significant difference at 3 mm and 5 mm pupil size (P = 0.27). Spectacle independence for distance, intermediate, and near was achieved in 100%, 94.7%, and 94.7% cases in this study, respectively. Using the micromonovision strategy, the visual performance of this novel EDOF IOL was outstanding both subjectively and objectively.

The Mid-Term Effect of Preservative-Free Artificial Tears Containing Hyaluronic Acid on Dry Eye Incidence after Cataract Surgery: A Retrospective Cohort Study.

The aim of this study is to survey the effectiveness of preservative-free artificial tears containing hyaluronic acid (HA) on post-cataract surgery dry eye disease (DED) prevention. A retrospective cohort study was performed, and patients that received cataract surgeries were divided into either an HA group or non-HA group depending on the artificial tear they used. A total of 37 and 74 eyes were enrolled into the HA and non-HA groups, respectively, after the selection. The primary outcomes are postoperative superficial keratitis and multiple (>3) DED symptoms. The generalized linear model was utilized to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of primary outcomes between the two groups. There were 10 and 2 episodes of superficial keratitis in the non-HA group and HA group, respectively, and the HA group demonstrated a significantly lower incidence of superficial keratitis (p < 0.001). Moreover, 13 and 5 patients developed multiple DED symptoms in the non-HA and HA groups, and the HA group illustrated fewer multiple DED symptoms (p = 0.024). The lower preoperative tear break-up time (TBUT) was correlated with superficial keratitis in the HA group (p = 0.043), while old age, low preoperative TBUT and ocular surface staining were associated with superficial keratitis in the non-HA group (all p < 0.05). Lower preoperative TBUT was correlated with multiple DED symptoms in the HA group (p = 0.020), while female sex, low preoperative TBUT and any DED symptoms were associated with multiple DED symptoms in the non-HA group (all p < 0.05). In conclusion, the usage of preservative-free artificial tears containing HA is associated with lower postoperative DED events.

Application of objective optical quality analysis system in guiding early posterior capsule opacification laser treatment: An observational study.

In the present study, we aimed to demonstrate the objective guiding role of objective scatter index (OSI) in patients with early stage posterior capsule opacification (PCO), especially in patients with multifocal intraocular lens (IOL) implantation. A prospective randomized case analysis was conducted on elderly patients experiencing PCO, exhibiting best-corrected visual acuity (BCVA) below 0.2 LogMAR. Exclusion criteria comprised patients with diabetes, glaucoma, high myopia, trauma, endothelial dystrophy, maculopathy or prior eye surgery affecting visual acuity. The main observational indicators were patient gender, age, post-cataract surgery duration, BCVA (LogMAR), and OSI values. For patients undergoing laser posterior capsulotomy, meticulous documentation of pre-laser OSI values and post-laser OSI values was undertaken. Subjective visual quality was then compared using the Chinese version visual function index-14 (VF-14-CN). The study comprised 65 eyes from 56 patients. PCO developed, on average, 2.06 ± 0.94 years (ranging from 0.5 to 4 years) after the initial surgery, with the OSI consistently exceeding 3.0. Among these cases, only 40 eyes underwent laser posterior capsulotomy using Nd:YAG laser, including 26 eyes implanted with monofocal IOLs and 14 eyes implanted with multifocal IOLs. Following laser posterior capsulotomy for early-stage secondary cataracts, there was a significant decrease in OSI values compared to the presurgery state, coupled with a notable increase in VF-14-CN scores. Among the 14 cases with multifocal IOL implantation, pre-laser VF-14-CN scores were lower compared to those with monofocal IOLs. Post-laser posterior capsulotomy, patients reported a marked improvement in self-perceived symptoms. The OQAS functioned as an objective assessment metric for the laser treatment of early stage PCO. In cases involving multifocal IOL implantation, the visual disturbance caused by PCO was more pronounced, underscoring the significance of OSI as a valuable guide for laser treatment in these patients.

Dual Role of Cutibacterium acnes: Commensal Bacterium and Pathogen in Ocular Diseases.

Microbiota present around the ocular surface, encompassing the eyelid skin, the conjunctival sac, and the meibomian glands, play a significant role in various inflammatory conditions associated with the ocular surface. Cutibacterium acnes (C. acnes), formerly, Propionibacterium acnes, is one of the most predominant commensal bacteria and its relative abundance declines with aging. However, it can act as both an infectious and an immunogenic pathogen. As an infectious pathogen, C. acnes has been reported to cause late onset endophthalmitis post-cataract surgery and infectious keratitis. On the other hand, it can trigger immune responses resulting in conditions such as phlyctenules in the cornea, chalazion in the meibomian glands, and granuloma formation in ocular sarcoidosis. This review explores the role of C. acnes in ocular inflammation, specifically highlighting its implications for diagnosis and management.

Evaluation of Two Artificial Tears Containing Hyaluronic Acid for Post Cataract Surgery Dry Eye Disease: A Randomized Controlled Trial.

This study compared the efficacy of hydroxypropyl guar (HPG)/hyaluronic acid (HA) and carboxymethylcellulose (CMC)/HA lubricant eye drops for post-cataract surgery dry eye disease (DED). This was a prospective, open-label, assessor-masked, parallel, randomized controlled study. Seventy patients with DED who underwent cataract surgery were randomized in a 1:1 ratio to receive 1-2 drops of HPG/HA or CMC/HA lubricant four times daily for 3 weeks. Efficacy assessments included changes from baseline in corneal fluorescein staining (CFS) score, Ocular Surface Disease Index score, Schirmer's test score (without anesthesia), tear break-up time, and central corneal sensitivity at weeks 1 and 3. There were 35 patients in each group. The HPG/HA group demonstrated superior improvements in CFS scores (expressed as means and standard deviations) to the CMC/HA group at week 1 ( - 1.0 [1.7] vs. - 0.1 [1.7], p = 0.039) and demonstrated comparable results at week 3 ( - 1.6 [1.8] vs. - 1.3 [1.9], p = 0.552). No statistical differences were observed in other secondary outcomes between groups at weeks 1 and 3 (p > 0.05). Only one adverse event was reported in this study, which occurred in the HPG/HA group. The AE of ocular hypertension was mild, deemed unrelated to the study treatment, and resolved within a week. The HPG/HA lubricant eye drops resulted in greater CFS scores at 1 week after treatment compared with CMC/HA drops. The HPG/HA and CMC/HA drops were safe and well tolerated. NCT06221345.

Design and Validation of Endophthalmitis Infectivity Measurement Algorithm in Post Cataract Acute Endophthalmitis: EMS Report No. 6.

We constructed a clinical clue-based algorithm to identify the microbiology-positive post-cataract surgery endophthalmitis. The Endophthalmitis Infectivity Measurement Algorithm (EIMA) was constructed using presenting Snellen vision (Letter score [LS]) and Inflammation Score (IS, from the cornea, anterior chamber, iris, and vitreous). Retrospective data (70% for training; 30% for testing) was fitted into CHAID (Chi-squared Automatic Interaction Detection). EIMA was validated with prospective data. EIMA-categorized disease severity was weighed against the symptom duration to detect infecting micro-organisms. EIMA was constructed from 1444 retrospective data. The average LS was 6.03 ± 12.11, median IS was 14 (8-24), and culture positivity was 38%. The accuracy and area under the curve of CHAID were 66.36% and 0.642, respectively. EIMA was validated with 175 prospectively collected data. Microbiology positivity (culture + sequencing) was 58.9%. EIMA sensitivity, specificity, and accuracy against microbiology-positive endophthalmitis were 73.7 (95% confidence interval [CI], 64.19-81.96), 81.9 (95% CI, 71.1-90.02), 77.1 (95% CI, 70.20-83.14), respectively. The positive and negative likelihood ratios were 4.08 (95% CI, 2.46-6.67) and 0.32 (95% CI, 0.22-0.45), respectively. There was higher microbial growth in two days or less than in three- to six-day symptom duration (69.9% vs. 28.2%; P = 0.018) endophthalmitis. Gram-negative infection was higher in two days or less (55.6% vs. 20.2%; P = 0.014), and gram-positive infection was higher in three- to six-day endophthalmitis (62.1% vs. 27.7%; P = 0.027). EIMA identified microbiology-positive endophthalmitis three-quarters of the time. EIMA suggested infectivity and the class of microbial infection could help targeted management of endophthalmitis after cataract surgery.

Lens Thickness in Infants and Children with Cataracts

PurposeThe purpose of this study was to determine the association between lens thickness and cataract in subjects aged 0-5 years. DesignThis was a prospective multi-center case-control study. ParticipantsWe enrolled 118 participants (171 eyes) age 0-5 years old, mean age 14.6 ± 17.0 months, range 0 - 60 months. MethodsLens thickness was measured on 342 ultrasound biomicroscopy (UBM) images. Main Outcome MeasuresLens thickness; feasibility of lens thickness measurement from UBM images ResultsMean lens thickness among non-cataracts was 3.60 ± 0.17 mm, compared to 3.16 ± 0.61 mm among cataracts (p<0.0001). Lens thickness less than 3.5 mm was significantly associated with increased odds of cataract, adjusted OR=5.99 [2.41,14.88] (p=0.0003) among subjects age 0-7 months. Lens thickness was significantly associated with cataract laterality among subjects age 0-7 months (p<0.0001). ConclusionsQuantitative UBM can be used to evaluate lens thickness in infants and children with congenital cataracts. The lens in congenital cataract eyes was thinner than that of controls among infants. Abnormal lens thickness was significantly associated with cataract. Future longitudinal studies will examine the association between lens thickness and post-cataract surgery outcomes.

Do Treatment Patterns for Endophthalmitis after Cataract Surgery Follow the Endophthalmitis Vitrectomy Study Recommendations?: An Academy IRIS® Registry Analysis

ObjectiveEvaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Treatment Study (EVS), which showed that patients who present with light perception vision (LP) have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP). DesignRetrospective cohort study SubjectsIRIS Registry patients undergoing cataract surgery between 2014 and 2022 (identified by CPT codes), presenting with endophthalmitis (identified by ICD 10 codes) within 42 days post-cataract surgery, and having a record of being treated with VIT or TAP on the same or one day following endophthalmitis diagnosis were identified. MethodsPotential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression. Main Outcome MeasureTreatment with VIT or TAP ResultsOf the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP – OR, 5.3 [CI: 2.9-10.5]; Counting Fingers, Hand Motion – OR 1.8 [CI: 1.0-3.6]) vs. [20/20-20/40] vision; Asian vs. White race (OR, 2.6 [CI: 1.2-5.1]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.9 [CI, 1.0-3.2]); living in the West (OR, 1.5 [CI, 1.1-2.2]) and Midwest (OR- 1.4 [CI, 1.0-2.0]) (vs. South), but not with age, sex, and insurance coverage (P>0.05). ConclusionsIn the IRIS Registry, treatment patterns for post-cataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with post-cataract surgery endophthalmitis.

Automatic segmentation and quantification of OCT images before and after cataract surgery using deep learning

Obtaining quantitative geometry of the anterior segment of the eye, generally from optical coherence tomography (OCT) images, is important to construct 3D computer eye models, used to understand the optical quality of the normal and pathological eye and to improve treatment (for example, selecting the intraocular lens to be implanted in cataract surgery or guiding refractive surgery). An important step to quantify OCT images is segmentation (i.e., finding and labeling the surfaces of interest in the images), which, for the purpose of feeding optical models, needs to be automatic, accurate, robust, and fast. In this work, we designed a segmentation algorithm based on deep learning, which we applied to OCT images from pre- and post-cataract surgery eyes obtained using anterior segment OCT commercial systems. We proposed a feature pyramid network architecture with a pre-trained encoder and trained, validated, and tested the algorithm using 1640 OCT images. We showed that the proposed method outperformed a classical image-processing-based approach in terms of accuracy (from 91.4% to 93.2% accuracy), robustness (decreasing the standard deviation of accuracy across images by a factor of 1.7), and processing time (from 0.48 to 0.34 s/image). We also described a method for the 3D models’ construction and their quantification from the segmented images and applied the proposed segmentation/quantification algorithms to quantify 136 new eye measurements (780 images) obtained from OCT commercial systems.