Postoperative Cataract Surgery Research Articles

Prevalence of Endophthalmitis Postoperative Cataract Surgery at Takeo Eye Hospital, Cambodia

Prevalence of Endophthalmitis Postoperative Cataract Surgery at Takeo Eye Hospital, Cambodia

Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series

BackgroundThe authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time.MethodsThis retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications.ResultsLonger operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001).ConclusionThe results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.

The incidence of patients with pseudoexfoliation in two different regions of Serbia

Introduction/Objective. Pseudoexfoliation (PEX) is an age-related systemic disorder, which can affect the whole body, as well as the eye. It is characterized by abnormal production and accumulation of pseudoexfoliative material. When present in the eye, it can cause different difficulties, but most common are PEX glaucoma (XFG) and intraoperative and postoperative complications of cataract surgeries. The aim of this study was to determine an incidence of patients with PEX in two different regions of Serbia. Methods. The study included 7451 patients scheduled for cataract surgery in two regions of Serbia. It was designed as a multicentric, retrospective study with evaluation of the medical records of all patients who underwent cataract surgery. The study evaluated: incidence of PEX syndrome and PEX glaucoma, age, and sex of patients, as well as preoperative antiglaucomatous therapy and intraoperative and postoperative cataract surgery complications. Results. PEX syndrome (XFS)was recorded in 676 patients (407 females and 269 males), while 243 patients had XFS. It represented 3.26% of patients included in the study. Mean age of XFG patients was 78.1 ?} 2.1 years with a statistically significant difference (p &lt; 0.05) among incidence of XFG in females compared to males. Intraoperative and postoperative complications during cataract surgery were significantly common in patients with PEX (p &lt; 0.05) Conclusion. PEX can complicate cataract surgery, while on the other hand XFG is more difficult to treat and control than most other glaucomas. Therefore, patients with PEX require special treatment during follow-up and treatment.

Racial Disparities in Cataract Surgery Timeline and Intraocular Lens Selection: A Retrospective Study.

There is a significant amount of literature focusing on racial inequities in utilization rates and intraoperative complications of cataract surgery. Unfortunately, little is known about racial disparities regarding the timeline of cataract surgery and intraocular lens (IOL) selection. This study investigated whether black patients have a different preoperative and postoperative cataract surgery timeline and IOL selection than white patients. A total of 10,235 patients (83.47% white) were retrospectively identified from a tertiary academic center who underwent cataract surgery between 2015 and 2022. Each patient's best corrected visual acuity (BCVA), slit lamp findings, and surgical timeline were recorded. IOL selection was categorized as standard or premium. Black patients had significantly worse mean ± SD preoperative logMAR BCVA than white patients (0.47 ± 0.55 vs. 0.58 ± 0.70, respectively; P = 0.0117) and were significantly less likely to receive surgery within 120days of referral (RR, 0.71 [95% confidence interval {CI}, 0.64-0.79]; P < 0.0001). White patients were 25%, 24%, and 29% less likely to follow-up than black patients at postoperative day 1, day 7, and day 30, respectively (P < 0.0001). White patients were 6.09 (95% CI, 3.49, 10.63) times more likely to receive a premium IOL compared to black patients (P < 0.0001). Black patients experienced more delays with receiving cataract surgery but are more adherent with postoperative follow-up. Black patients were far less likely to receive a premium IOL than white patients. Increased awareness of racial inequities in cataract surgery may improve the delivery of eye care to minority groups.

Timing of the Initial Postoperative Care After Cataract Surgery: A Patient's Perspective.

To evaluate patient preferences in regards to the timing of the initial postoperative examination after undergoing cataract surgery. A retrospective, consecutive case series analysis from a single private practice institution was performed using a standardized phone survey on patients who underwent cataract surgery. Subjects were classified into one of two possible study groups according to the timing of their initial postoperative cataract surgery examination: Group A received the initial postoperative cataract surgery examination on the same day as the surgery, whereas Group B received the initial postoperative cataract surgery examination on the day following the operation. There were 80 subjects contacted for the phone survey of which 70 (35 in each study group) completed the survey and therefore were included in the analysis. Group A subjects responded favorably in regards to preference and realizing reduced time and cost savings compared to Group B (p < 0.0001 for both). There were no subjects in Group A who would have preferred next-day initial postoperative care, whereas 31.4% of subjects in Group B would have preferred same-day care if given the opportunity. Patients undergoing cataract surgery both prefer and report time and cost savings with same-day initial postoperative care compared to next-day initial postoperative care. Patient preferences regarding their postoperative care should be one of the many factors that a surgeon ought to take into consideration when providing follow-up care after cataract surgery.

The silent beast – a case of late‐onset postoperative endophalmitis

AbstractLate‐onset postoperative cataract surgery endophthalmitis remains a rare but sight‐threatening complication usually caused by slow‐growing pathogenic agents: bacterial or fungus. The delayed diagnosis and the potential irreversible ocular damage make this condition a challenging case for ophthalmologists.Herein, we present a 71‐year‐old woman with late‐onset fungal endophthalmitis after cataract surgery caused by candida parapsilopsis, a rare etiologic agent. This diagnosis should be taken into consideration in every late‐onset postoperative persistent panuveitis with no response to antibiotics and partial response to topical steroids, even after negative vitreous or tap culture. White deposits on the surface of the intraocular lens or the capsule are a crucial sign. Systemic and intraocular antifungal therapy along with vitrectomy and intraocular lens removal—if necessary—are the main therapy to ensure the best visual prognosis.

Outcomes of Cataract Surgery in Diabetic Patients in King Abdulaziz Medical City in 2019.

Background In this study, we aimed to analyze various complications following cataract surgery in diabetic patients and compare the outcomes of diabetic patients with comorbidities versus diabetic patients without comorbidities. Methodology This study was conducted in the adult ophthalmology department at a tertiary teaching care center. A retrospective cross-sectional chart review was conducted from January 1, 2019, to December 31, 2019. The selection was made using a non-probability consecutive sampling technique with a data collection sheet to include all male and female Saudi diabetic patients 40-80 years old who underwent cataract surgery in 2019. The data were divided into diabetic patients with comorbidities and diabetic patients without comorbidities to assess the postoperative complications in both groups. SPSS version 26 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results This study analyzed 290 diabetic patients; the most common age group was more than 65 years old (150, 51.7%), with slightly more females (147, 50.7%). A total of 181 (62.7%) patients had complications after surgery, and 255 (87.9%) patients had comorbidities. The most reported complication was corneal edema (181, 62.4%). Additionally, hypertension was the most frequently reported comorbidity (206, 71%). We also found that complications after cataract surgery were more common among females (p = 0.025). Conclusions The most prevalent postoperative cataract surgery complication was corneal edema in 181 (62.4%) patients. Despite comorbidities, no changes were reported in the prevalence of postoperative complications.

Quality by Design of Pranoprofen Loaded Nanostructured Lipid Carriers and Their Ex Vivo Evaluation in Different Mucosae and Ocular Tissues.

Transmucosal delivery is commonly used to prevent or treat local diseases. Pranoprofen is an anti-inflammatory drug prescribed in postoperative cataract surgery, intraocular lens implantation, chorioretinopathy, uveitis, age-related macular degeneration or cystoid macular edema. Pranoprofen can also be used for acute and chronic management of osteoarthritis and rheumatoid arthritis. Quality by Design (QbD) provides a systematic approach to drug development and maps the influence of the formulation components. The aim of this work was to develop and optimize a nanostructured lipid carrier by means of the QbD and factorial design suitable for the topical management of inflammatory processes on mucosal tissues. To this end, the nanoparticles loading pranoprofen were prepared by a high-pressure homogenization technique with Tween 80 as stabilizer and Lanette® 18 as the solid lipid. From, the factorial design results, the PF-NLCs-N6 formulation showed the most suitable characteristics, which was selected for further studies. The permeability capacity of pranoprofen loaded in the lipid-based nanoparticles was evaluated by ex vivo transmucosal permeation tests, including buccal, sublingual, nasal, vaginal, corneal and scleral mucosae. The results revealed high permeation and retention of pranoprofen in all the tissues tested. According to the predicted plasma concentration at the steady-state, no systemic effects would be expected, any neither were any signs of ocular irritancy observed from the optimized formulation when tested by the HET-CAM technique. Hence, the optimized formulation (PF-NLCs-N6) may offer a safe and attractive nanotechnological tool in topical treatment of local inflammation on mucosal diseases.

Intracameral dexamethasone 9% vs prednisolone acetate 1% in controlling postoperative pain and inflammation in patients undergoing cataract surgery.

To compare patient preferences of postoperative cataract surgery topical medication use between a 1-drop and a 3-drop regimen. Two private cataract surgery centers. Open-label randomized self-controlled prospective study. This study included 30 patients (60 eyes) undergoing routine cataract surgery in both eyes. In this contralateral eye study, 1 eye of each patient was randomized to the 1-drop regimen of intracameral delivery of moxifloxacin and dexamethasone suspension and topical bromfenac for 30 days. The other eye, randomized to the 3-drop regimen, received topical moxifloxacin 0.5% 4 times a day for 7 days and bromfenac 0.07% daily for 30 days postoperatively, along with prednisolone acetate 1% 4 times a day for 30 days. Patients reported their preferred regimen 2 weeks after the second surgery with a validated questionnaire. Secondary outcomes included subjective ocular pain, inflammation score, and out-of-pocket cost. Intraocular pressure (IOP) and macular thickness were also measured. Of the 29 patients, 28 (96.6%) significantly more preferred the eye treated with a 1-drop regimen. Self-reported pain, activity interference, and out-of-pocket cost were significantly less in the 1-drop group. Inflammation and 1-day uncorrected distance visual acuity were also significantly better in the 1-drop group. Macular thickness and mean IOP were similar between groups. Intracameral delivery of steroid and antibiotics was preferred by most of the patients undergoing cataract surgery. These eyes had significantly less pain, inflammation, activity interference, and out-of-pocket cost and significantly better uncorrected distance visual acuity at 1 day postoperatively. IOP and macular thickness were similar between groups.

Safety and Acceptability of a Natural Language Artificial Intelligence Assistant to Deliver Clinical Follow-up to Cataract Surgery Patients: Proposal.

BackgroundDue to an aging population, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence (AI), in the form of conversational agents, presents a possible opportunity to enable efficiency in the delivery of care.ObjectiveThis study aims to evaluate the effectiveness, usability, and acceptability of Dora agent: Ufonia’s autonomous voice conversational agent, an AI-enabled autonomous telemedicine call for the detection of postoperative cataract surgery patients who require further assessment. The objectives of this study are to establish Dora’s efficacy in comparison with an expert clinician, determine baseline sensitivity and specificity for the detection of true complications, evaluate patient acceptability, collect evidence for cost-effectiveness, and capture data to support further development and evaluation.MethodsUsing an implementation science construct, the interdisciplinary study will be a mixed methods phase 1 pilot establishing interobserver reliability of the system, usability, and acceptability. This will be done using the following scales and frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire; and the Non-Adoption, Abandonment, and Challenges to the Scale-up, Spread and Suitability framework.ResultsThe evaluation is expected to show that conversational technology can be used to conduct an accurate assessment and that it is acceptable to different populations with different backgrounds. In addition, the results will demonstrate how successfully the system can be delivered in organizations with different clinical pathways and how it can be integrated with their existing platforms.ConclusionsThe project’s key contributions will be evidence of the effectiveness of AI voice conversational agents and their associated usability and acceptability.International Registered Report Identifier (IRRID)PRR1-10.2196/27227

Risk Factors for Presence of Cystoid Macular Edema following Rhegmatogenous Retinal Detachment Surgery

ABSTRACT Purpose: Cystoid macular edema (CME) following cataract surgery is a well-known entity. Less is known regarding the risk factors of developing CME following repair of rhegmatogenous retinal detachments (RRD). Methods: This was a multi-institutional study of primary RRD surgeries from 1/1/2015 through 12/31/2015. The primary outcome was the development of postoperative CME following RRD surgery. Post-operative optical coherence tomography imaging and 3 months of follow-up following RRD repair were required. Results: There were 1,466 eyes that met the inclusion criteria, and 140 (9.6%) developed postoperative CME following primary RRD repair. On multivariate analysis, the statistically significant metrics were older patient age (OR 1.03 per year, 95% CI 1.01 to 1.05), pre-operative proliferative vitreoretinopathy (PVR, OR 1.74, 95% 1.03 to 2.95), and cataract surgery following RRD repair (OR 2.18, 95% CI 1.47 to 3.25). Single surgery success was protective against CME (OR 0.20 (95% CI 0.14–0.30). Seventy-six (9.0%) of the phakic eyes and 60 (9.9%) of the pseudophakic eyes developed post-operative CME. Multivariate analysis showed that cataract surgery following RRD repair (p < .0001) for phakic eyes and older age (p = .0075) for pseudophakic eyes were risk factors. In eyes that underwent successful retinal reattachment with one surgery, post-operative cataract surgery (p = .0005) and pre-operative PVR (p = .0011) were risk factors for CME in this subgroup. Conclusion: CME occurred in nearly 10% of the eyes following RRD repair. The biggest risk factors were recurrent RRD, preexisting PVR, older age, and cataract surgery following RRD repair.

Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange.

To observe the efficacy and safety of pars plana vitrectomy (PPV) with eye position guided fluid-air exchange (FAX) and air tamponade in the treatment of rhegmatogenous retinal detachment (RRD). RRD patients without severe proliferative vitreoretinopathy (PVR) C1 or more were enrolled. All patients underwent PPV combining with air tamponade. During operation, the primary retinal break(s) were placed at lower site and subretinal fluid was aspirated through the break(s) at the same time when eye position guided FAX was proceeding. Sufficient laser spots were made to seal the retinal break(s) after FAX, and filtered air was left in vitreous cavity as tamponade agent finally. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure. A total of 37 eyes (20 males and 17 females) with a follow-up time of ≥6mo were included. The range of RRD was 5.6±1.8h, and the number of retinal breaks was 1.9±1.2. The breaks located at inferior quadrants (between 3:00 and 9:00) in 5 cases (13.5%), and both superior and inferior breaks were found in 3 cases (8.1%). A total of 25 cases (67.6%) with macular detached involvement, 9 cases (24.3%) with intraocular lens, and 8 patients (21.6%) were treated with phacoemulsification and intraocular lens implantation together. The success rate of primary retinal reattachment was 100% (37/37). At 6mo postoperatively, BCVA (logMAR) was increased from 1.13±1.07 to 0.23±0.15 (P<0.001). Phacoemulsification combined with intraocular lens implantation was performed in 2 patients (5.4%), and one of them underwent macular epiretinal membrane peeling in addition (2.7%). Furthermore, high intraocular pressure was found in 4 cases (10.8%). PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD, and it has the advantages of short postoperative prone time and fewer operative complications.

Intraoperative and postoperative complications of cataract surgery in eyes with pseudoexfoliation - An 8-year analysis.

INTRODUCTION:Pseudoexfoliation (PXM) is a fibrillar material deposited in the anterior chamber of the eye and can cause disintegration of zonules and make pupillary dilatation difficult. This can make surgery difficult and result in intraoperative and postoperative complications. The aim of this study was to learn about whether the presence of pseudoexfoliation caused significant complications during cataract surgery.MATERIALS AND METHODS:We did a secondary data analysis of 12,992 eyes from 2007 to 2014 using the National Eye Database of Melaka Hospital Malaysia on intraoperative and postoperative cataract surgery complications of patients with PXM.RESULTS:Patients with PXM were 2.68 times more likely to get intraoperative complications (P < 0.001). They had a higher incidence of lens subluxation, zonular dehiscence, and vitreous loss (P < 0.001). Although posterior capsule rupture (PCR) was the most common intraoperative complication during cataract surgery (4.8%), the presence of pseudoexfoliation was not associated with PCR (P > 0.05). We did not observe any association between patients with pseudoexfoliation and any of the postoperative complications such as corneal decompensation, raised intraocular pressure, and intraocular lens decentration (P > 0.05). Pseudoexfoliation did not cause corneal decompensation (P > 0.05) although corneal decompensation was the highest postoperative complication of cataract surgeries (0.18%).CONCLUSIONS:Patients with PXM had a higher rate of intraoperative complications which were mainly vitreous loss and zonular dehiscence and also lens subluxation/dislocation. We observed poorer visual outcomes in those with PXM following cataract surgery. Patients with pseudoexfoliation should be identified and precautions taken to minimize these complications to get better visual outcomes.

Rebound Tonometry in Cataract Surgery: Comparison with Goldmann Applanation Tonometry

Purpose: to compare the rebound tonometer ICare® (RT) with the Goldmann applanation tonometer (GAT) in cataract surgery and to assess the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements. Design: retrospective, comparative study. Methods: a total of 472 patients underwent IOP measurement using RT (time 0 = RTa). GAT IOP measurement was performed 5 minutes later, followed by a second RT IOP measurement after other 5 minutes (RTa + 10 min = RTb). CCT was obtained by ultrasound pachymetry. In 106 patients IOP was measured by means of RT and GAT before clear corneal cataract surgery (RT1 and GAT1) and at one day postoperatively (RT2 and GAT2). Results: RT IOP values > 5 mmHg were overestimated, while RT IOP values < 15 mmHg were underestimated. Every 100 μm of CCT an increase of 0.97 mmHg and 0.33 mmHg was found for RT and GAT respectively. The difference between RT1 and RT2, GAT1 and GAT2, RT1 and GAT1 was not statistically significant; while the difference between RT2 and GAT2 was statistically significant (p < 0.04). The difference between RTa and RTb was not statistically significant whereas the difference between RTa and GAT and RTb and GAT was statistically significant (p < 0.001). Conclusion: our results showed a good agreement between measurements obtained with RT and GAT in pre and postoperative cataract surgery, although a significant statistically difference was found between RT and GAT measurements performed postoperatively. Moreover, CCT is a parameter to be considered for the IOP measurement, especially for values obtained with RT.

Pars plana vitrectomy with partial tamponade of filtered air in Rhegmatogenous retinal detachment caused by superior retinal breaks

BackgroundTo investigate the anatomic and functional outcomes of pars plana vitrectomy (PPV) with partial tamponade of filtered air for rhegmatogenous retinal detachment (RRD) caused by superior retinal breaks.MethodsRetrospective, comparative, consecutive case series study. Patients with RRD caused by superior retinal breaks undergone PPV with partial tamponade (Group A) and whole tamponade (Group B) of filtered air were included. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and rate of postoperative cataract surgery.ResultsForty-one patients (41 eyes) were included in Group A and 36 patients (36 eyes) were included in Group B. There were no significant differences in primary or final success rates between Groups A and B (P = 0.618 and P = 1.000, respectively). The patients in Group A experienced quicker postoperative vision improvement (from the Week 1 follow-up) than the patients in Group B (from the Month 3 follow-up). The postoperative cataract surgery rate of Group A (7/31) was lower than that of Group B (13/26) (P = 0.031).ConclusionsPPV with partial tamponade of air is effective in achieving a high anatomic success rate, quicker postoperative vision improvement, and lower rate of postoperative cataract surgery in RRD caused by superior retinal breaks.

DEVELOPING POSTOPERATIVE SELF CARE GUIDELINE FOR PATIENT UNDERGOING CATARACT SURGERY

Cataract is considered a significant global health problem and is the most frequent cause of visual impairment. Aim: this study aimed to develop postoperative self- care guideline for patients undergoing cataract surgery through the following: (1) Assessment of post operative self- care knowledge for patient undergoing cataract surgery. (2) Developing postoperative self-care guidelines for patients undergoing cataract surgery. (3) Validating the developed guideline through reviewing by experts. Design: A descriptive design. Subjects: 150 adult patients undergoing cataract surgery were included in the study. Tools for data collection: I- Patient's postoperative cataract surgery self- care knowledge assessment questionnaire. II- Patient's observational checklist for eye medication administration. Results: The present study found that, more than half of the studied patients had unsatisfactory knowledge about self care after cataract surgery. 78.0 % of the studied sample had inadequate practice regarding eye medication administration. The conclusion: Information about eye hygiene and activities of the daily living are the most prevalent needed information. Moreover, most of the studied subjects need information about administration of eye ointment and eye drop. The postoperative self–care guideline for patients undergoing cataract surgery was developed by the researcher according to patients' need. Recommendations: Health education program should be prepared for the patients undergoing cataract surgery and their families about disease management, postoperative care and prevention of cataract surgery complications.

Endothelial cells loss to the hyperopic pacients during phacoemulsification

The phacoemulsification cataract surgery is the most frequently performed surgery and it generally improves vision in over 90% of the patients. Hyperopic patients are a challenge during phacoemulsification especially because of their short eyeball and shallow anterior chamber. A shallow anterior chamber is associated with overall reduction of the safe zone, which may lead to difficulty in creating the corneal incisions, harder capsulorhexis performing, or endothelial complications. The aim of the study was to present the endothelial cells loss after the phacoemulsification procedure in the hyperopic patients. A number of 1775 patients operated in the Ophthalmology Department of the Clinical Hospital Sibiu from January 11, 2011 to December 20, 2013 have been included in our study; 595 cases with emmetropia and the rest of the 1180 patients had the following refraction errors: 216 - myopia and 964 - hypermetropia. From the total cases of the hypermetropia, we selected 72 patients to measure the endothelial cells density and the corneal thickness by using specular microscopy, one day before and 7-14 days after surgery. The preexisting hypermetropia might modify the intraoperative and postoperative cataract surgery evolution. Endothelial cell loss is potentially higher from surgical trauma so that the endothelium must be protected with viscoelastics. The loss of endothelial cells in hyperopic eyes occurred with an average of 267 cell/ mm² and the thickness of the cornea increased by 13 µm. The phacoemulsification surgery in the presence of hypermetropia requires more attention. The biometry and the specular microscopy are very important tasks for the preoperative assessment, surgery, and postoperative care. The protection of the corneal endothelium with viscoelastics leads to an insignificant modification of the endothelial cells in hyperopic patients compared to an anterior study of the patients with all ametropies.

Pathologic evidence of pseudoexfoliation in cases of in-the-bag intraocular lens subluxation or dislocation

To provide complete histopathologic evaluation of explanted capsular bags that spontaneously dislocated in the late postoperative period, with the main objective being to assess the presence of pseudoexfoliation (PXF) material. Goethe-University Frankfurt, Frankfurt, Germany, and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Retrospective case series. Standard gross and light microscopy and complete histopathology were performed on explanted subluxated and dislocated capsular bags containing an intraocular lens (IOL) or a capsular tension ring (CTR) and an IOL. Questionnaires were sent to explanting surgeons, and a patient chart review was performed, when available. The specimens were represented by capsular bags containing an IOL (n = 37) or an IOL-CTR (n = 3). The IOLs included 3-piece hydrophobic acrylic (n = 13), 1-piece hydrophobic acrylic (n = 7), 3-piece silicone (n = 6), 1-piece hydrophilic acrylic (n = 6), 3-piece hydrophilic acrylic (n = 2), and 1-piece poly(methyl methacrylate) (PMMA) (n = 6) designs; all CTRs were PMMA. Soemmering ring formation was mild in 8 specimens, moderate in 18 specimens, and severe in 14 specimens. Excessive contraction of the capsular bag with capsulorhexis phimosis was observed in 24 specimens. Twenty-six specimens had histopathologic evidence of PXF; 13 had a clinical history or evidence of PXF. Pseudoexfoliation might be implicated in a larger proportion of late in-the-bag IOL subluxations and dislocations than previously thought as a result of significant clinical underdiagnosis. This might indicate a need for new considerations during the preoperative and postoperative cataract surgery assessments and follow-up.

Surgical Outcomes of Combined Trabeculectomy-Cyclodialysis for Glaucoma

To determine the performance of combined trabeculectomy-cyclodialysis surgery over a 25-year period. A retrospective cohort study of 55 eyes (39 patients) treated between 1987 and 2012 was performed.The following data were collected: age, sex, glaucoma etiology, preoperative and postoperative number of topical medications, preoperative and postoperative laser trabeculoplasty, intraoperative and postoperative 5-fluorouracil application, lens status at the time of surgery, postoperative cataract surgery, duration of follow-up, and complications. Best-corrected LogMAR visual acuity was assessed preoperatively, at 1 year, and then at 2-yearly intervals for the duration of follow-up. Intraocular pressure (IOP) was assessed preoperatively and then at 1 week, 4 weeks, 1 year, and then at 2-yearly intervals for the duration of follow-up. Visual field indices were collected at baseline and at the completion of follow-up.Failure was defined as reoperation for glaucoma, progression to legal blindness, IOP≤5 mm Hg, >21 mm Hg, or <20% reduction below baseline. All others were a "complete success" if no additional topical medication was required and a "qualified success" if medication was required. Analyses using 18 and 15 mm Hg as upper limits for success were also performed. Mean IOP fell from 25.2 to 11.9 mm Hg over a mean 11.2 years. At completion of follow-up 32 eyes (58.2%) achieved an unqualified success, 18 (32.7%) a qualified success, and 5 (9.1%) a failure. No patient progressed to legal blindness. Cases with greater preoperative IOP had a greater reduction in IOP (P<0.0001). On univariate analysis no intraoperative application of antimetabolite (OR, 0.74; 95% CI, 0.49-0.94; P=0.022) and a longer follow-up (OR, 1.16; 95% CI, 1.02-1.33; P=0.025) predicted a higher final IOP; these were not significant on multivariate analysis. Thirty-six of 47 phakic eyes developed cataract; the majority occurred in the first 4 years. Combined trabeculectomy-cyclodialysis produces sustained lowering of IOP for long periods of time, despite a cataractogenic effect.

Evaluation of the use of a nurse-administered telephone questionnaire for post-operative cataract surgery review.

The purpose of this paper is to determine the safety of substituting the first day post-operative review after routine cataract surgery (phacoemulsification) with a telephone survey. Prospective non-randomised cohort study. A standardised questionnaire of five common ocular symptoms (general condition, vision, eye pain, headache, nausea or vomiting) was administered by a trained nurse on the first post-operative day. The patients were reviewed in clinic two to 14 days later. Patient charts were retrospectively reviewed for complications (endophthalmitis, raised intra-ocular pressure, wound leaks and uveitis) requiring deviation from standard treatment. Over 13 months, 256 eyes of 238 patients underwent uncomplicated phacoemulsification by four consultant surgeons. Only one patient reported poor general condition, blurred vision and eye pain. She was subsequently found to have corneal oedema and raised intra-ocular pressure when recalled for an earlier review. Best corrected visual acuity better than 20/40 was achieved in 80.5 per cent of patients. There were no other post-operative complications noted from medical records review. Non-randomised nature, skewed surgical expertise, lack of a control group and patient experience data. In all, 22 patients (9.2 per cent) were also uncontactable for the telephone interview. A nurse-administered telephone survey seemed to be a safe and effective alternative to first day post-operative review after routine phacoemulsification. The survey also enabled the detection of serious post-operative complications. The first day post-operative hospital visit may be safely substituted in a selected patient population with greater patient convenience achieved and liberation of clinic resources. This is the first study which utilises a standardised questionnaire as a form of post-operative review in an Asian population.