Postoperative Complication Of Cataract Surgery Research Articles

Pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management. Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement. PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.

CPD: Post-operative complications of cataract surgery

Christian Dutton, Simon Hardman-Lea, Kin Tam, Jasraj Bhangra and Jo-Sheetal Thethy summarise the pathophysiology and management of cataract post-operative complications as identified by the National Ophthalmology Database Audit 2023

Combinative approach of transzonular triamcinolone-moxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery.

To investigate the effectiveness of combination therapy with transzonular triamcinolone-moxifloxacin and conventional perioperative drops in reducing postoperative complications of cataract surgery. Electronic medical records of cataract surgery patients (single surgeon) were reviewed from January 2018 to September 2021. The rate of postoperative complications including prolonged and/or recurrent postoperative inflammation, endophthalmitis, cystoid macular edema (CME), and intraocular pressure (IOP) was compared between the patients receiving combinative therapy and patients receiving drops only. Totally 596 patients and 1057 eyes (Combinative-Therapy group 493 and Drop-Only group 564) were included in this study. Using combination therapy reduced the relative risk of postoperative inflammation by 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0 in Combinative-Therapy group vs 0.5% in Drop-Only group (relative risk reduction 100%), although not statistically significant (P=0.10). The incidence of severe IOP spikes was not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33). The relative risk of postoperative CME was 51.4% less in three months follow up visit in Combinative-Therapy group, although not statistically significant (P=0.07). The visual outcome 1-month postop. (best corrected visual acuity) was significantly better in Combinative-Therapy (logMAR 0.10) compared to Drop-Only (logMAR 0.14) groups (P=0.02) while the baseline visual acuity was not significantly different. The combinative approach of transzonular triamcinolone-moxifloxacin plus perioperative eyedrops is an effective method to minimize postoperative inflammation, with better visual outcomes. It could potentially reduce the risk of postoperative endophthalmitis and CME (near-significant P-values; larger studies could analyze better considering low incidence).

Visual outcome of cataract surgery in paediatric uveitis

1. To analyse the visual outcome in patients of paediatric uveitis who underwent cataract surgery; 2. To analyse the post-operative complications of cataract surgery in paediatric uveitis.Retrospective observational study was done on patients of uveitis who underwent cataract surgery. Patients who were under 18 years and co-operative for examination were included.They underwent Phacoaspiration with posterior chamber IOL implantation by a single surgeon after 3 months of activity free interval, BCVA(in Log MAR) in every follow up, anterior segment examination using slit lamp and posterior segment examination using IDO, post-operative complications and Intra ocular pressure was recorded using Noncontact tonometer.Uveitis was classified using the SUN classification of uveitis. Use of corticosteroids, biologics and immunosuppressive drug were collected at each visit. Total of 18 subjects diagnosed with cataract as a complication of uveitis & undergone cataract surgery were studied (6 were females, 12 were males) 9 had anterior uveitis, 1had intermediate uveitis and 5 had pan uveitis. JRA (66.7%) was the most common cause identified. Improvement in vision from baseline was observed post-surgery at the end of first, third and 6th month which was statistically significant (P- Value <0.05). Average duration of disease before they underwent surgery was 18 months. Most common post op complication was posterior capsular opacification (50 %), others include secondary glaucoma (38.9), exudative retinal detachment (5.6%) and Vitritis (22.2%)Unlike adult uveitic patients, the surgical management of paediatric uveitic cataract is both challenging and controversial, and the surgery itself has been associated with poor visual outcomes. However, our study had shown that with implantation of IOL, good immunosuppressants and control of the disease can give these children a good visual outcome.

Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders.

To determine the visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders (OSDs). Tertiary eyecare center in North India. Retrospective observational study. Patients with various OSDs with stabilized ocular surfaces who underwent cataract surgery during this period and had a minimum postoperative follow-up of 6 weeks were included. The primary outcome measures were postoperative corrected distance visual acuity (CDVA) at 6 weeks, best CDVA achieved, and postoperative complications. The study included 20 men and 24 women. A total of 55 eyes were evaluated: Stevens-Johnson syndrome (SJS) 35 eyes, ocular cicatricial pemphigoid (OCP) 4 eyes, 8 eyes with dry eye disease (DED), 6 eyes with chemical injury and 2 eyes with vernal keratoconjunctivitis (VKC). The mean duration of OSD was 33.9 ± 52.17 months. The median preoperative CDVA was 2.0 (interquartile range [IQR], 1.45 to 2.0). The median CDVA ever achieved was 0.50 (IQR, 0.18 to 1.45) at 2 months and the median CDVA at 6 weeks was 0.6 (IQR, 0.3 to 1.5). Maximum improvement in CDVA was noted in patients with DED and SJS and the least in OCP. Phacoemulsification was performed in 47.27% eyes with intraoperative complications noted in 9% eyes. Postoperative surface complications occurred in 12 (21.82%) eyes. Other postoperative complications occurred in 9 (16%) eyes. Cataract surgery outcome can be visually rewarding in patients with OSDs provided ocular surface integrity is adequately maintained preoperatively and postoperatively.

Knockout of TGF-β receptor II by CRISPR/Cas9 delays mesenchymal transition of Lens epithelium and posterior capsule opacification

Posterior capsule opacification (PCO) is the most common postoperative complication of cataract surgery. Transforming growth factor-β (TGF-β) is related to epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) that is proven to induce PCO formation in clinical and experimental studies. In this study, CRISPR sequences targeting exon of TGF-βRII were knocked out with lentiviral transfection in LECs. Rabbits' PCO model was established and recombinant adeno-associated virus (AAV) for transferring the gRNA of TGF βRII were intravitreally injected. SgRNA inhibited TGF-βRII expression and human LECs proliferation. In TGF-βRII knockout group, LECs motility and migration were suppressed, N-cadherin and vimentin expressions were significantly decreased, whereas E-cadherin was increased. The animal model showed that TGF-βRII knockout in vivo was effective in suppressing PCO. The current study suggested that the CRISPR/Cas9 endonuclease system could suppress TGF-βRII secretion, which participates in the EMT procedure of LECs in vitro and PCO in vivo. These findings might provide a new gene-editing approach and insight into a novel therapeutic strategy for PCO.

Indomethacin and bromfenac may be effective in the prevention of posterior capsule opacification

Posterior capsule opacification (PCO) is the most common long‐term postoperative complication of cataract surgery, leading to secondary vision loss. Optimized intraocular lens (IOL) structure and appropriate pharmacological intervention can provide physical barriers and biological inhibition, respectively, to block the migration, proliferation, and epithelial‐mesenchymal transition (EMT) of lens epithelial cells (LECs) for PCO prophylaxis. We demonstrated that non‐steroidal anti‐inflammatory drugs (NSAIDs) are effective in preventing posterior capsule opacification. Indomethacin (INDOM) not only suppresses cell migration and down‐regulates the expression of cyclooxygenase‐2 (COX‐2) and EMT markers, including alpha‐smooth muscle actin (α‐SMA) and cyclin D1, but also promotes autophagy activation in LECs. Autophagy was also verified as a potential therapeutic target for down‐regulating EMT in LECs. Bromfenac effectively inhibits cell migration, overexpression of EMT markers such as fibronectin (FN), matrix metalloproteinase 2 (MMP2), α‐smooth muscle actin (α‐SMA), and transcription factor Snail, and extracellular signal‐regulated kinase (ERK)/glycogen synthase kinase‐3β (GSK‐3β) signalling induced by transforming growth factor‐β2 (TGF‐β2) in vitro. Based on ultrasonic spray technology, we developed a drug‐eluting intraocular lens (IOL) using poly (lactic‐co‐glycolic acid) (PLGA) with sustained release ability of indomethacin/bromfenac for PCO prevention. The novel IOL, serving as a drug delivery platform, can carry an adjustable dose of drugs with sustained release ability for more than 28 days. In the rabbit PCO model, the novel IOL showed excellent anti‐inflammatory and anti‐PCO effects. In summary, indomethacin and bromfenac are effective pharmacological interventions for PCO prophylaxis, and the novel IOL we developed prevented PCO in vivo, providing a promising approach for PCO prophylaxis in clinical applications.

Prophylaxis of posterior capsule opacification through autophagy activation with indomethacin-eluting intraocular lens.

Posterior capsule opacification (PCO) is the most common long-term postoperative complication of cataract surgery, leading to secondary vision loss. Optimized intraocular lens (IOL) structure and appropriate pharmacological intervention, which provides physical barriers and biological inhibition, respectively, can block the migration, proliferation, and epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) for PCO prophylaxis. Herein, a novel indomethacin-eluting IOL (INDOM-IOL) with an optimized sharper edge and a sustained drug release behavior was developed for PCO prevention. Indomethacin (INDOM), an ophthalmic non-steroidal anti-inflammatory drug (NSAID) used for postoperative ocular inflammation, was demonstrated to not only be able to suppress cell migration and down-regulate the expression of cyclooxygenase-2 (COX-2) and EMT markers, including alpha-smooth muscle actin (α-SMA) and cyclin D1, but also promote the autophagy activation in LECs. Additionally, autophagy was also verified to be a potential therapeutic target for the down-regulation of EMT in LECs. The novel IOL, serving as a drug delivery platform, could carry an adjustable dose of hydrophobic indomethacin with sustained drug release ability for more than 28 days. In the rabbit PCO model, the indomethacin-eluting IOL showed excellent anti-inflammatory and anti-PCO effects. In summary, indomethacin is an effective pharmacological intervention in PCO prophylaxis, and the novel IOL we developed prevented PCO in vivo under its sustained indomethacin release property, which provided a promising approach for PCO prophylaxis in clinical application.

Endophthalmitis After Cataract Surgery: A Postoperative Complication.

Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to a permanent loss of light perception. It is generally an inflammation of the fluids present in the anterior and posterior chamber of the eye, consisting of vitreous and aqueous fluid. The inflammation is due to the infection of these fluids after their exposure during or after the cataract surgery. In today's situation, patient surgery is the most frequently preferredfor the correction or treatment of the cataract.There are various factors causing endophthalmitis in cataract surgery. This condition occurs mostly by the entry of infective bacteria such as staphylococcus, gram-negative organisms, and streptococcus species. As well as fungi like aspergillus and candida. Cataract surgery has many risk factors that can be divided into preoperative, intraoperative, and postoperative phases. The most common symptom of this condition is pain in the eyes and redness, which sometimes leads to purulent discharge, causing decreased vision or loss of eyesight. The increasing inflammation of the vitreous fluid is the main identification of the condition. There is a surge of inflammatory cells in the space of the vitreous fluid. The condition can be classified into two types which are exogenous and endogenous. In these types, subtypes explain the postoperative complications of the disease. It is a rare condition, and the percentage of it occurring as a postoperative complication is very low. It generally targets the old age group of people. This narrative review article explainsendophthalmitis as a postoperative complication of cataract surgery and its treatment modalities. The terms endophthalmitis, postoperative, cataract surgery, complications, and vitreous humor were used for the review article in PubMed.

Late-onset Capsular Block Syndrome: A Rare Complication and Its Surgical Management

Purpose: Capsular block syndrome of late onset is one of rare post-operative complications of cataract surgery. Here we report the diagnosis and successful surgical management of this case. Case report: A 70 year aged person presented with gradual decrease of right eye vision for 4 years with a history of phacoemulsification surgery which was done 8 years back. Patient’s presenting vision was 6/60 in right eye with a whitish fluid filled like space just behind the intraocular lens (IOL). Patient managed surgically by removal of the ‘IOL-capsule-complex’ with anterior vitrectomy. The microbiological culture report of ‘IOL-capsule-complex’ showed no bacterial growth. Visual rehabilitation was restored by implanting an anterior chamber lens 2 months afterwards.Conclusion: Though rare but delayed presentation of capsular block syndrome has reported but conventional treatment with Nd:YAG laser capsulotomy may have risk of intraocular infection spread. Extraction of ‘ IOL-capsulecomplex’ with anterior vitrectomy followed by late implanting an anterior chamber lens can restore the visual function and can lessen the risk of intraocular infection.

Predisposing Factors for Severe Complications after Cataract Surgery: A Nationwide Population-Based Study.

We conducted a retrospective group study to evaluate the potential systemic risk factors for major postoperative complications of cataract surgery. Individuals diagnosed with (n = 2046) and without (n = 8184) serious complications after cataract surgery were matched 1:4 for age, sex, and index date obtained using Taiwan’s National Health Insurance Research Database. The outcome was defined as at least one new inpatient or outpatient diagnosis of systemic disease one year before the index date. The effect of demographic data on postoperative complications was also analyzed in the multivariable model. Data were analyzed using univariate and multivariate conditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals of the risk of developing serious complications. After the entire study interval, the major postoperative complications of cataract surgery were associated with the following systemic diseases: hypertension (adjusted OR (aOR) = 2.329, p < 0.001), diabetes mellitus (aOR = 2.818, p < 0.001), hyperlipidemia (aOR = 1.702, p < 0.001), congestive heart failure (aOR = 2.891, p < 0.001), rheumatic disease (aOR = 1.965, p < 0.001), and kidney disease needing hemodialysis (aOR = 2.942, p < 0.001). Additionally, demographic data including old age, higher urbanization level, higher level of care, and more frequent inpatient department visits were associated with a higher rate of postoperative complications. In conclusion, metabolic syndrome, chronic heart failure, end-stage renal disease, rheumatic disease, older age, and frequent inpatient department visits are correlated with the development of severe postoperative complications of cataract surgery. Therefore, cataract surgery patients should be informed about a higher possibility of postoperative complications.

Early postoperative complications of cataract surgery in diabetic patients

Background: Progressions in technology and expertise has made cataract surgery a common and safe procedure now but this might be associated with early postoperative complications in diabetics. The objective of this study was to determine the occurrence of early postoperative complications after cataract surgery among diagnosed cases of diabetes mellitus. Methods: This clinical observational analytical study was carried at Department of Ophthalmology, Liaquat University Eye Hospital, Jamshoro from May to Oct 2018. Diagnosed diabetic patients who underwent cataract surgery, were enrolled for this study. The patients with early senile cataract and diagnosed cases of diabetes mellitus with normal arterial pressure and better macular function were included. Patients were enquired for early postoperative findings after cataract surgery. Data was analysed using SPSS-22. Mean±SD for quantitative variables and frequency (%) for qualitative were calculated. Results: Total 91 diabetic patients were included in the study. Early postoperative complications of cataract surgery in diabetic patients were compared according to duration of diabetes mellitus. Visual acuity of most patients remained between 6/6 and 6/24. Diabetics for &gt;5 years were more prone to early postoperative complications as compared to those with &lt;5 years. Statistically significant differences between early postoperative complications in the two groups were observed (p=0.01). Conclusion: Though frequency of complications after cataract surgery has decreased due to advances in surgical techniques, better preoperative assessment, and understanding of diabetes control, still early postoperative complications are common in individuals with longer duration of diabetes. Pak J Physiol 2021;17(1):12–4

Intra-Operative and Immediate Post-Operative Complications of Cataract Surgery in an Eye Camp

Purpose: To analyze the intra-operative and immediate post-operative complications in patients after cataractsurgery in an eye camp.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was conducted in a village of Nawabshah, Sindh, Pakistan from 7th to9th of February 2020.Material and Methods: Fifteen hundred patients were screened for visual disabilities of which 150 were selectedfor the study. They had a visual acuity of less than 6/9 in one or both eyes and had a cataract. The selectedpatients were operated using either phacoemulsification, extracapsular cataract extraction ECCE), intracapsularcataract extraction (ICCE) or small incision cataract surgery (SICS). The immediate intra-operative as well aspost-operative complications on day 1 after surgery were observed.Results: One hundred and fifty patients were operated. Age ranged from 14 years to 90 years, males were58.7% and females were 41.3%. The most common procedure performed was phacoemulsification 51.3%,followed by ECCE 30.0%, then SICS 18.0% and ICCE 0.7%. The most common intra-operative complication wasposterior capsule rent and the most common post-operative complication was striate keratopathy which was seenin 14.0% individuals. There was a significant association found for post-operative complications with gender withfemales having more post-operative complications as compared to males (P-value = 0.001 &lt; 0.001).Conclusion: Camp surgeries when performed with strict sterilization and in experienced hands can play animportant role in treating cataract, which is the commonest cause of preventable blindness in developingcountries

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.

Evaluation of programmed cell death processes on the lens epithelium of older dogs with diabetic and hypermature cataracts

It is well known that posterior capsule opacification (PCO), one of the most common late postoperative complications of cataract surgery, is mainly caused by proliferation and differentiation of remaining lens epithelial cells (LECs) on the posterior lens capsule. Many authors suggest that alterations induced by the pathophysiology of cataracts, its metabolism and the use of 0.1% trypan blue (TB) must cause some degree of cellular damage on these cells, wicht would help to prevent and/or reduce the incidence of PCO after cataract surgery in humans. Therefore, the aim of this study was to evaluate the expression of cell death markers on LECs of older dogs with diabetic and hypermature cataracts, after capsulorhexis, both using 0.1% TB. Twenty samples collected from 13 dogs of different breeds, with ages varying from 8 to 12 years-old, with diabetic and hypermature cataracts, which had been subjected to phacoemulsification surgery (Phaco) using 0.1% TB for staining were studied. Animals were classified as dogs with diabetic (DC) and hypermature cataracts (HC), and expression of molecular markers for apoptosis and autophagy (caspase-3 and beclin-1) on LECs were obtained by immunofluorescence technique. The expression of caspase-3 and beclin-1 was observed in every studied sample and did not differ between groups. In conclusion, our findings suggest that apoptosis and autophagy processes occur to LECs in older dogs presenting diabetic and hypermature cataracts after Phaco utilizing 0.1% TB. Our results may be helpful to future studies of PCO in post-phacoemulsification surgery patients.

Dickkopf-1 inhibits Wnt3a-induced migration and epithelial-mesenchymal transition of human lens epithelial cells

Posterior capsular opacification (PCO) is a major post-operative complication of cataract surgery. Epithelial-mesenchymal transition (EMT) contributes to PCO. We previously indicated that Wnt3a induces the EMT of human lens epithelial cells (LECs) and plays an important role in the development of PCO. The present study aimed to test the potential effect of Dickkopf-1 (Dkk1) on Wnt3a-induced cell migration and the EMT of LECs and to explore possible cellular mechanisms. The secretion of Dkk1 was reduced in the rabbit PCO model, and Dkk1 injected into the eyes post-surgical manipulation prevented PCO formation. Cultured HLE-B3 cells were then transfected with Wnt3a in the presence or absence of Dkk1. Dkk1 treatment restored the epithelial phenotype and reversed the expression of EMT-associated proteins induced by Wnt3a. Dkk1 suppressed LEC migration and the expression of matrix metalloproteinase-1 (MMP-1), and the activity of MMP-2 and MMP-9. Dkk1 inhibited the nuclear accumulation of β-catenin, which is the key regulator of the canonical Wnt signaling. Our results indicate that Dkk1 inhibits Wnt3a-induced migration and the EMT of human LECs.The results contribute to the prevention of PCO formation and development.

Visual outcomes and complications of cataract surgery with primary implantation in infants

To describe the visual results and postoperative complications of cataract surgery with primary intraocular lens (IOL) implantation performed in infants and to determine possible predictive factors related to poor visual outcome. A retrospective consecutive case series of cataract surgeries with primary IOL implantation in infants was performed. Visual outcome and postoperative complications were recorded. A final visual acuity>0.5 logMAR was considered as a poor visual outcome. Sixty-one consecutive procedures were evaluated in 43infants. Eighteen infants (42%) had bilateral cataract surgery and 25(58%) had monocular surgery. The median age at primary surgery was 5.7months (range: 4weeks-24months). The median follow-up was 47months (range: 14-60months). The median best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) at the last follow-up examination was 1.00 in the case of unilateral surgery and 0.40 in the case of bilateral surgery. The overall visual result in all eyes was 0.50logMAR. A better visual result was achieved when the infants were younger than 6months or older than 12months of age when surgery was performed. Opacification in the visual axis requiring secondary surgery occurred in 54% of the eyes (33/61). Postoperative inflammation occurred in 41% of the eyes (25/61) but was not associated with poor visual outcome (P=0.39). Glaucoma affected 11.5% of the eyes (7/61) and was significantly associated with poorer visual function (OR: 15.36, 95% CI 1.02-230.35, P=0.05). Compared with the unilateral cataract group, the OR of poor visual acuity was 0.06 (95% CI 0.01-0.35, P<0.01) in the bilateral cataract group. No statistical association was observed between final visual acuity>0.5 logMAR and leukocoria at time of diagnosis, IOL-related complications and postoperative strabismus. Primary IOL implantation is associated with an overall satisfactory visual outcome, especially when surgery is performed before 6months or after 12months of age and in bilateral cases. Glaucoma is the main complication associated with poor visual outcome.

Efficacy and cost-effectiveness of intracameral vancomycin in reducing postoperative endophthalmitis incidence in Australia.

Endophthalmitis is a rare but devastating postoperative complication of cataract surgery. We aimed to describe the incidence of acute postoperative endophthalmitis in an Australian population over a 14-year period. This was a retrospective longitudinal cohort study performed at Westmead Hospital, a major tertiary hospital in Sydney, Australia. Patients who had acute postoperative endophthalmitis within 6 weeks of their cataract surgery at Westmead Hospital were included. Endophthalmitis cases from 2000 to 2014 were identified from computerized diagnostic coding. These were cross-referenced with the cataract surgery list over this time period. The routine use of intracameral vancomycin at the end of cataract surgery was introduced in Westmead Hospital in 2004. We quantified the incidence of acute postoperative endophthalmitis pre and post the routine use of intracameral vancomycin. A total of 14 805 cataract cases were performed at Westmead Hospital from 2000 to 2014. Seventeen cases of endophthalmitis were within 6 weeks post cataract surgery performed at Westmead Hospital. In the period 2000 to 2003, the incidence of postoperative endophthalmitis was 0.43% (11/2539). From 2004 to 2014, there was a dramatic decrease in the incidence of postoperative endophthalmitis to 0.049% (6/12 266, P < 0.0001). There has been a nine-fold reduction in the rate of acute postoperative endophthalmitis with the use of intracameral vancomycin in cataract surgery. Post-cataract surgery endophthalmitis is now a relatively rare cause of endophthalmitis in this Australian population. Our study supports the routine use of intracameral vancomycin as postoperative endophthalmitis prophylaxis.

Bit1—a potential positive regulator of epithelial–mesenchymal transition in lens epithelial cells

Posterior capsule opacification (PCO) is a common postoperative complication of cataract surgery. Epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) is an important initial step of PCO pathogenesis. We have previously shown that Bit1 expresses in rat LECs. In this study, we aim to investigate the role of Bit1 in the EMT of human LECs. The expression of Bit1 was firstly detected in human PCO-attached LECs and human lens cell line SRA01/04 by real-time PCR and immunofluorescence staining. The proliferation and migration of Bit1 knockdown SRA01/04 cells were evaluated by cell counting, wound-healing assay, and transwell migration assay. The EMT of LECs was triggered by TGF-β2, and then the effect of Bit1 on EMT with a key biomarker of α-smooth muscle actin (α-SMA) was analyzed by siRNA knockdown assay, and the reversal of EMT was validated by real-time PCR and western blot. Bit1 was obviously augmented in LECs derived from PCO tissues and Bit1 expressed with high levels in the cytoplasm of cultured SRA01/04 cells. Cell proliferation, invasion, and migration, as well as α-SMA expression, were significantly decreased in Bit1 knockdown SRA01/04 cells. While TGF-β2 elevated Bit1 and α-SMA expression levels in a dose-dependent manner, with peak levels at 10ng/ml of TGF-β2 treatment, suppression of Bit1 in SRA01/04 cells reversed the EMT process. TGF-β2 induced elevation of α-SMA expression level, as well as migration, and invasion abilities were all suppressed by Bit1 deficiency. These findings reveal that Bit1 promotes TGF-β2 induced α-SMA expression and acts as an positive regulator of EMT. Suppressing Bit1 inhibits the proliferation, migration, and EMT of LECs. Bit1 may be a potential novel therapeutic target for the prevention and treatment of PCO.

A Study on the Visual Outcomes and Complications of Cataract Surgery in the Rural Population of Indian Patients with Pseudo exfoliation

Aim: To analyze the visual outcomes and the intra and postoperative complications of manual small incision cataract surgery (MSICS) in patients with Pseudo exfoliation (PXF). Materials and Methods: The study included 76 eyes of 76 patients of the rural population in India with cataract and PXF who underwent MSICS surgery. The effect of the parameters like the dilatation of pupil during surgery, nuclear grading at baseline was studied with respect to the final visual outcomes and intra operative and postoperative complications of cataract surgery. The best corrected visual acuity (BCVA) at 4 weeks and 6 weeks after surgery were reported. Results: The mean age of the patients was 64.9 years and there were 44 males and 32 females. The BCVA ranging from 6/6 to 6/9 was seen in 44 (58.1%) eyes at 4 weeks and 46 (60.6%) eyes at 6 weeks. The visual outcomes were lower in patients with higher nuclear sclerosis (NS) of grade IV-V, poor pupil size (?6 mm) compared to patients with NS I-III and good pupil size (>6 mm). Iris prolapsed 8 (10.9%) and posterior capsular rent 7 (9.2%) intra operatively and corneal edema 34 (44.7%) postoperatively that subsided within 1-2 days were the most commonly reported complications. Conclusion: MSICS technique in cataract patients with PXF is cost effective and is associated with good visual outcomes. Early diagnosis, proper preoperative and postoperative planning, knowledge and surgical skills of handling the possible complications can increase the success rate of cataract surgery in patients with PXF. Keywords: Best corrected visual acuity (BCVA), Nuclear grading, Pupil size, Pseudo exfoliation