Postoperative Visual Outcome Research Articles

Donor Endothelial Cell Density Not Changed Immediately After Ex Vivo Corneal Cross-Linking

Purpose: The aim of this study was to evaluate the effect of corneal cross-linking on central endothelial cell density (ECD) by comparing masked measurements before and immediately after preparation of cross-linked (CXL) and non–cross-linked (non-CXL) donor corneas. Methods: Thirty donor corneas were randomized 1:1 to either CXL or non-CXL using a modified Dresden protocol. Specular microscopic images of the central corneal endothelium were obtained within 36 hours of recovery and within 3 hours of preparation completion. Images were sent to a central cornea image analysis reading center for ECD determination in a masked, dual-graded manner. Results: Before and after preparation, the mean ECD was 2567 ± 305 cells/mm2 and 2525± 339 cells/mm2 for the CXL group (n =15) and 2652 ± 365 cells/mm2 and 2572 ± 513 cells/mm2 for the non-CXL group (n =15), respectively. The mean difference in ECD before and after preparation was not statistically significant for the CXL and non-CXL groups (P = 0.36; P = 0.31, respectively). In addition, an independent sample t test showed no statistically significant difference in the ECD change between the CXL and non-CXL groups (P = 0.67). Conclusions: Our specular microscopic findings show that ex vivo cross-linking of donor corneas does not seem to produce acute decrease of central endothelial cell density. These findings are encouraging and assist in warranting a clinical trial examining its value in reducing refractive errors and improving postoperative visual outcomes in eyes with keratoconus that undergo keratoplasty.

Predictability of Astigmatism Correction by Arcuate Incisions with a Femtosecond Laser Using the Gaussian Approximation Calculation.

Planning astigmatic correction is a complex task. Biomechanical simulation models are useful for predicting the effects of the physical procedure on the cornea. Algorithms based on these models allow preoperative planning and simulate the outcome of patient-specific treatment. The objective of this study was to develop a customised optimisation algorithm and determine the predictability of astigmatism correction by femtosecond laser arcuate incisions. In this study, biomechanical models and Gaussian approximation curve calculations were used for surgical planning. Thirty-four eyes with mild astigmatism were included, and corneal topographies were evaluated before and after femtosecond laser-assisted cataract surgery with arcuate incisions. The follow-up time was up to 6 weeks. Retrospective data showed a significant reduction in postoperative astigmatism. A total of 79.4% showed a postoperative astigmatic value less than 1 D. Clinical refraction was significantly reduced from -1.39 ± 0.79 D preoperatively to -0.86 ± 0.67 D postoperatively (p 0.02). A positive reduction in topographic astigmatism was also observed (p < 0.00). The best-corrected visual acuity increased postoperatively (p < 0.001). We can conclude that customised simulations based on corneal biomechanics are a valuable tool for correcting mild astigmatism with corneal incisions in cataract surgery to improve postoperative visual outcomes.

A CLINICAL STUDY OF LENS INDUCED GLAUCOMA AND IT'S OUTCOME AFTER CATARACT SURGERY

Aim- To evaluate the characteristics, risk factors and their consequences in lens induced glaucoma on post-operative Visual outcome, Intra ocular pressure, Inammation and Optic disc changes All patients attending outpatient Methodology- and in-patient of department of ophthalmology, KIMS, Hubli, diagnosed as lens induced glaucoma during the study period of one and half years between December 2011 to April 2013. - Results The BCVA of 6/12 or better was found in 48.00% cases. It is also observed that good visual acuity achieved in cases with duration of symptoms less than 2 weeks. In cases with severe inammation, BCVA at last follow was less than 6/60 in 69.23%. There was clinically signicant reduction of mean IOP at last follow up (p=0.000) from the baseline IOP at presentation.IOP was found to be high in cases with duration of symptoms between 2 to 4 weeks (39.67 mm Hg).The ocular fundus of the affected eye suffered GDD in 36% of the total cases in which the damage was more in Phacomorphic (54.00%) than Phacolytic (28.00%).The damage was more in cases with symptoms for more than 2 weeks (26.92%), which was clinically and statistically signicant (p&lt;0.01). -Planned small incision Conclusion cataract surgery with IOL implantation, minimal tissue handling, a good follow up with efcient management of attendant complications and inammation are key factors in management

Predicting Visual Outcome Following Surgery in Patients with Idiopathic Epiretinal Membrane Using A Novel Convolutional Neural Network.

To develop a deep convolutional neural network (CNN) that enables the prediction of postoperative visual outcomes following epiretinal membrane (ERM) surgery based on preoperative optical coherence tomography (OCT) images and clinical parameters to refine surgical decision-making. A total of 529 patients with idiopathic ERM who underwent standard vitrectomy with ERM peeling surgery by two surgeons between January 1, 2014, and June 1, 2020, were enrolled. The newly developed Heterogeneous Data Fusion Net (HDF-Net) was introduced to predict postoperative visual acuity (VA) outcomes (improvement ≥ 2 lines in Snellen chart or not) 12 months after surgery based on preoperative cross-sectional OCT images and clinical factors, including age, sex, and preoperative VA. The predictive accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the CNN model were evaluated. The developed model demonstrated an overall accuracy for visual outcome prediction of 88.68% (95% CI, 79.0%-95.7%) with an AUC of 97.8% (95% CI, 86.8%-98.0%), sensitivity of 87.0% (95% CI, 67.9%-95.5%), specificity of 92.9% (95% CI, 77.4%-98.0%), precision of 0.909, recall of 0.870, and F1 score of 0.889. The heatmaps identified the critical area for prediction as the ellipsoid zone of photoreceptors and the superficial retina which was subjected to tangential traction of the proliferative membrane. The novel HDF-Net demonstrated high accuracy in the automated prediction of visual outcomes after weighing and leveraging multiple clinical parameters, including OCT images. This approach may be helpful in establishing personalized therapeutic strategies for ERM management.

Higher-order aberrations and visual quality after incision lenticule extraction surgery with intraoperative angle kappa adjustments between small and large kappa patients: A 2-year follow-up.

To evaluate the postoperative visual outcomes, that is, corneal higher-order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small-incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty-four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. At 24 months postoperatively, the mean spherical equivalent (SE) refraction was - 0.32 ± 0.40 and - 0.31 ± 0.35 in the S-kappa group (kappa <0.3 mm) and the L-kappa group (kappa ≥0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.

Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study

To compare the postoperative visual outcomes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts. Prospective, multicenter, randomized controlled trial. Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n=27) or the 839 MP (n=28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncorrected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vision and incidence of photic phenomena were surveyed using questionnaires. Visual acuity at all ranges of vision was significantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group (P=.013). Reading ability at 40 and 60 cm was similar in both groups (P ≥ .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function Index 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group. Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained impeded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in intermediate activities, with a lower photic phenomena incidence.

Incidence and Risk Factors for Poor Postoperative Visual Outcome After Excision of Orbital Cavernous Venous Malformations.

To determine the incidence and risk factors for poor postoperative visual outcome (PPVO) after removal of orbital cavernous venous malformations (OCVMs). Retrospective case-note and imaging review for patients undergoing excision of OCVMs, with estimation of odds-ratios (ORs) and relative risks (RRs) for visual loss in relation to the position of the mass, surgical approach, and patient factors. The 290 patients (179 female; 62%) presented at a mean age of 46.4 years: 243/287 (85%) OCVMs were intraconal, with 213/243 (88%) located freely in the posterior two-thirds of the orbit, and 30/243 (12%) wedged tightly in the apex. PPVO was observed in 6.9% (20/290) patients, solely after removal of intraconal lesions, Univariate analysis showed increased risk with preoperative relative afferent pupillary defect (RAPD) (14/107 [13%]; RR 2.9; P = 0.011), apical lesions (9/30 [30%]; RR 5.8; P < 0.001), situated below optic nerve (15/115 [13%]; RR 3.3; P = 0.007), fibrous masses (14/78 [18%]; RR 6.7; P = 0.005), or intraoperative diastolic blood pressure below 50mmHg (10/64 [16%]; RR 2.8; P = 0.007). Multivariate analysis found apical extension (OR 4.9; P = 0.036) and fibrous lesions (OR 10.0; P = 0.035) as strongest predictors for PPVO. The incidence of complete visual loss (no light perception) was 4.1% (12/290); half of these patients had preoperative acuity of counting fingers or worse, 8 (67%) had RAPD, 7 (58%) wedged apical lesions, and 8 (67%) were below the optic nerve. PPVO after excision of OCVMs can occur in up to 5% of "free" retrobulbar intraconal lesions and in approximately one-third of apical lesions.

Postoperative, but not preoperative, central corneal thickness correlates with the postoperative visual outcomes of Descemet membrane endothelial keratoplasty.

Descemet membrane endothelial keratoplasty (DMEK) restores visual acuity in patients with progressive corneal endothelial diseases such as Fuchs endothelial corneal dystrophy (FECD). However, patients often prefer to delay the surgery as long as possible, even though outcomes are poorer in advanced FECD. A recent study proposed that preoperative central corneal thickness (CCT) of ≥625 μm associated with worse best spectacle-corrected visual acuity (BSCVA) after DMEK for FECD. Since this threshold could signal to both surgeons and patients when to perform DMEK, we further explored the relationship between CCT and BSCVA with a retrospective cohort study. The cohort consisted of all patients with FECD who underwent DMEK in a tertiary-care hospital in 2015-2020 and were followed for 12 months. Extremely decompensated corneas were not included. Relationships between preoperative CCT and BSCVA on days 8 and 15 and months 1, 3, 6, and 12 were examined with Pearson correlation analyses. Eyes with preoperative CCT <625 or ≥625 μm were also compared in terms of postoperative BSCVA. Relationships between postoperative CCT and final BSCVA were also explored. The cohort consisted of 124 first-operated eyes. Preoperative CCT did not correlate with postoperative BSCVA at any timepoint. Eye subgroups did not differ in postoperative BSCVA. However, postoperative CCT at 1-12 months correlated significantly with 12-month BSCVA (r = 0.29-0.49, p = 0.020-0.001). Thus, postoperative, but not preoperative, CCT correlated with postoperative BSCVA. This phenomenon may reflect factors that distort preoperative CCT measurements but disappear after surgery. This observation and our analysis of the literature suggest that while there is a relationship between CCT and post-DMEK visual acuity, preoperative CCT measurements may not always adequately reflect that relationship and may therefore not be a reliable predictor of DMEK visual outcomes.

Visual outcome following clear corneal incision phacoemulsification with rigid intra-ocular lens and small incision cataract surgery in low socioeconomic group patients: A comparative analysis in a teaching hospital in South India

Background: Cataract is the most common cause of curable blindness worldwide. Aims and Objectives: A comparative analysis of clear corneal phacoemulsification with rigid intra-ocular Lens (IOL) and small incision cataract surgery (SICS) in low socioeconomic group patients in terms of post-operative visual outcome, surgically induced astigmatism (SIA), and intra-and post-operative complications. Materials and Methods: A prospective hospital-based comparative study was conducted for 8 months in 424 eyes of 400 senile cataract patients divided into PHACO and SICS groups. Each group consisted of 212 eyes of 200 patients. Detailed examinations for best corrected visual acuity (BCVA), SIA, and complications were evaluated on the 1st post-operative day, 1st week and 6 weeks postoperatively. Results: BCVA 6\18 or higher was 95.38% in the phacoemulsification group and 94.81% in the SICS group. The study revealed good visual outcome in both SICS and Phaco groups with no significant difference. The mean SIA was more in SICS group (−0.96±0.57) than in phaco group (−0.71±0.47) which was statistically significant. In terms of complications, no significant difference was noted between the groups. Conclusion: The outcome of this study indicated that though SIA is more in SICS group than Phaco group, there is no difference between the groups in terms of visual outcome. The study has proven that SICS has comparable effectiveness as phacoemulsification with rigid IOL, which should be considered in low- and middle-income countries.

Implementation and Methodology of a Pilot, Localized Video Library of Cataract Surgeries for Residency Training in a Tertiary Philippine Eye Institute

Objectives. Video-based learning of surgical skills is a useful complement in training programs. This is more evident where direct patient exposure is limited due to multiple factors. In ophthalmic surgery, access to high quality ocular surgery videos such as for cataract operations, can provide significant learning points for trainees in an institutional program. Creation therefore of a local, curated, and indexed library of cataract surgery would support alternative means to maximize training of new ophthalmic surgeons. The objective of the project was to develop a local library of cataract surgery videos as an adjunct teaching tool for resident trainees in a Philippine tertiary eye care center.Methods. A collection of cataract surgery videos from 2013-2020 were compiled into a single workstation. Videos were reviewed and catalogued using set keywords for easy searchability and labelling.Results. 256 videos of cataract surgeries were compiled into the library. 6 main headings for the keywords, with 159 total subheadings were established to provide robust tagging and search options to index the video.Conclusion. Particularly in Ophthalmic surgery, refinement of surgical technique is essential in ensuring better postoperative visual outcomes. This is achieved through repetition and careful dissection of operative technique. The use of a library with multiple videos of a similar procedure allows trainees more exposure to certain cases. This ultimately affords trainees, better experience and confidence in their own surgeries.

A Modified Technique for Preventing Lens-Iris Diaphragm Retropulsion Syndrome in Vitrectomized Eyes during Phacoemulsification.

Lens-iris diaphragm retropulsion syndrome (LIDRS) is common in vitrectomized or high myopic eyes during phacoemulsification. We evaluated the results of a modified technique for cataract treatment using phacoemulsification in vitrectomized eyes. In this retrospective study, we enrolled thirty-four vitrectomized eyes treated with modified phacoemulsification (Modified Group) and nineteen vitrectomized eyes treated with routine phacoemulsification (Control Group). The modified technique comprised irrigation with a balanced salt solution underneath the pupil before phacoemulsification instrument entry, lens implantation and stromal hydration to stabilize the anterior chamber and equilibrate the pressure between the anterior chamber and posterior cavity. We compared the incidences of intra and postoperative complications and visual outcomes between modified and routine phacoemulsification. Pain, LIDRS and difficulty in stromal hydration were significantly more common in the Control Group than in the Modified Group (p < 0.05). There were no significant differences in the rates of posterior capsular rupture, iris trauma, lens dislocation, or posterior capsular opacification between the Modified and Control Groups (p > 0.05). However, there was no significant difference in visual acuity between the groups (p > 0.05). Complications such as loss of nuclear fragments into the vitreous cavity, cystoid macular edema, retina redetachment, suprachoroidal hemorrhage and vitreous hemorrhage did not occur either intra or postoperatively in any of our patients. Our modified technique prevents LIDRS and complications arising during cataract surgery in vitrectomized eyes. Aside from this, the results of modified and routine phacoemulsification are similar in vitrectomized eyes.

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity: case series.

To report the safety, efficacy, and accuracy of small-incision lenticule extraction (SMILE) or femtosecond-assisted laser in situ keratomileusis (FS-LASIK) for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography (AS-OCT). Four patients with monocular corneal opacity (3 due to mechanical injury, 1 due to a firecracker wound) were recruited and treated with refractive surgery (3 for SMILE, 1 for FS-LASIK combined with limbal relaxing incision (LRI). Preoperative ocular manifestations, surgical details, postoperative visual outcomes, corneal opacity parameters, and corneal topography were analyzed. Preoperatively, spherical diopter ranged from -3.0 D to -4.75 D with cylinder ranging from -0.75 to -5.0 D, and corrected distance visual acuity (CDVA) ranging from 20/25 to 20/20. One eye's corneal opacity was located in the central zone and three were in the mid-peripheral optical zone. Three patients underwent uneventful SMILE in both eyes, whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye. CDVA of the eye with corneal opacity ranged from 20/22 to 20/20 one to six weeks postoperatively. Two patients achieved better CDVA and no patients lost Snellen lines. The postoperative diopter was within ±0.75 D for all eyes. Significant edema existed above the corneal opacity in one eye and dissipated soon. No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed. The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection. FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

EPIRETINAL MEMBRANE WITH FOVEAL HERNIATION: Visual and Surgical Outcomes.

Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. This study describes the visual symptoms and spectral domain optical coherence tomography findings associated with foveal herniation and evaluates the postoperative visual, anatomical, and surgical outcomes. A multicenter retrospective review of patients diagnosed with epiretinal membrane identified 59 patients with preoperative foveal herniation on spectral domain optical coherence tomography. Data regarding visual symptoms, preoperative and postoperative best-corrected visual acuity (BCVA), central retinal thickness, macular volume, and size of foveal herniation were collected, and statistical analysis was performed. A total of 58 of the 59 patients with foveal herniation underwent surgical epiretinal membrane peeling, with foveal contour restored in 53.5% of patients after surgery. Average BCVA improved from 20/80 to 20/40 Snellen equivalent at most-recent postoperative visit (P < 0.0001). The average central retinal thickness decreased from 632 µm to 432 µm (P < 0.0001) and the average macular volume decreased from 11.3 mm3 to 9.5 mm3 (P < 0.0001) at 3 months postoperatively. Preoperatively, greater herniation height was associated with worse BCVA (P = 0.008), greater central retinal thickness (P = 0.01), retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone abnormality, and external limiting membrane abnormalities (P < 0.05). Postoperatively, there was a decrease in retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone, and external limiting membrane abnormality (P < 0.05) on spectral domain optical coherence tomography. Patients with larger foveal herniation height had greater preoperative central retinal thickness, worse preoperative and postoperative BCVA, and more intraretinal abnormalities on spectral domain optical coherence tomography. Surgical epiretinal membrane peeling in patients with foveal herniation resulted in a significant improvement in patients' BCVA and microstructural abnormalities.

Visual Outcome and Complications in White Mature Cataracts after Phacoemulsification.

To identify risk factors and perioperative complications and assess postoperative visual outcome in patients of white mature cataracts undergoing phacoemulsification surgery. This cross-sectional study was conducted on 46 patients of white mature cataract undergoing phacoemulsification. Preoperatively, a detailed ocular examination was done, and anterior chamber depth (ACD) and lens thickness (LT) were measured on ultrasound biomicroscopy. Intraoperative and postoperative complications (on days 1, 7, and 30) and best-corrected visual acuity on postoperative day 30 were noted. The mean age of patients was 60.78 ± 9.001 years. The study group consisted of 41.3% of males and 58.7% of females. 8 (19.56%) cases encountered complications during phacoemulsification surgery. The intraoperative complications were capsulorhexis-related in 5 (10.86%) patients, posterior capsular rent in 2 (4.3%) patients, and 1 (2.17%) case had zonular dialysis. There was no difference in mean ACD and LT in cases who developed complications and those who underwent uneventful surgery (P > 0.05). The commonly observed postoperative complications on day 1 were corneal edema (41.3%), anterior chamber flare (45.65%), and cells (39.13%) which resolved with routine topical medications. All patients showed a significant reduction in postoperative intraocular pressure (P < 0.001). A total of 37 (80.43%) eyes regained vision between 6/6 and 6/9 postoperatively (P < 0.001). Phacoemulsification surgery is safe in white mature cataract that results in significant visual improvement. Common intraoperative complications are capsule related, while frequently encountered postoperative complications are corneal edema and anterior chamber reaction. Preoperative ACD and LT have no role in predicting intraoperative complications.

Acuity and Quality of Vision in Eyes with Epithelial Basement Membrane Dystrophy after Regular Pseudophakia.

This retrospective case-control study was conducted to quantitatively and qualitatively assess the visual impairment in eyes with Epithelial Basement Membrane Dystrophy (EBMD) after regular cataract surgery. EBMD pseudophakic eyes were compared with matched pseudophakic eyes free from surface disorders. At least 3 weeks after surgery we evaluated uncorrected and best-corrected distance visual acuity (UDVA and CDVA), objective aberrometry, Point Spread Function (PSF), Modulation Transfer Function (MTF), and patient complaints. Twenty-five EBMD eyes and 25 control eyes (13 patients per group) were included. Nine patients per group had a monofocal IOL, and four patients had a trifocal IOL. All the EBMD patients complained of postoperative blurred vision with ocular discomfort; intensive use of lubricants induced subjective improvement only in eyes with monofocal IOLs. Postoperative mean UDVA was 0.19 ± 0.16 LogMAR in the EBMD eyes and 0.11 ± 0.04 LogMAR in the control group (p = 0.016). Mean CDVA was 0.18 ± 0.15 LogMAR in the EBMD eyes and 0.06 ± 0.04 LogMAR in the control eyes (p = 0.001). The PSF curve width was significantly worse in the EBMD group (p < 0.001). The MTF cut-off value was lower in the EBMD group than in the control group (p < 0.001). After cataract removal, eyes with EBMD had significantly lower UDVA and CDVA than controls. All the aberrometric parameters were significantly worse in EBMD cases. EBMD patients complained about their postoperative visual outcome, while control patients did not.

Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre

ObjectifLa dialyse zonulaire (DZ), c'est-à-dire un déficit du soutien de la capsule lenticulaire par la zonule, peut avoir diverses origines et n’être décelée qu'au moment de la chirurgie de la cataracte. Notre étude visait donc à évaluer les caractéristiques pré-, per- et postopératoires dans des yeux dont la DZ a été découverte pendant l'intervention, sans égard à son étiologie. MéthodesIl s'agissait d'une étude d'observation de cohorte rétrospective réalisée dans un seul établissement, soit le Moorfields Eye Hospital (NHS Foundation Trust, Londres, R.-U.), auprès d'une cohorte de patients opérés pour une cataracte entre le 1er janvier 2014 et le 22 août 2019, afin de repérer ceux dont la chirurgie a été jugée compliquée par la découverte peropératoire d'une DZ. Ont été notés les caractéristiques des patients, les observations cliniques peropératoires, les résultats visuels et réfractifs de même que les complications postopératoires. RésultatsOn a découvert une DZ pendant l'opération dans 447 yeux. La plupart des patients (213 sur 223; 96,8 %), ont subi une phacoémulsification, sans conversion vers une extraction intracapsulaire ni extracapsulaire. Le taux de complications peropératoires s'est chiffré à 46,2 % (103 sur 223), sans corrélation significative avec l’étendue de la DZ. On a implanté un anneau de tension capsulaire (ATC) chez 43,4 % des patients (97 sur 223); enfin, on a pu établir une corrélation entre le recours à un ATC et l'amélioration des résultats visuels et réfractifs postopératoires. ConclusionsLa DZ est une complication grave de la chirurgie de la cataracte qui doit être diagnostiquée et prise en charge sans délai pendant l'intervention. Les résultats de la chirurgie tendent à être moins bons en présence de DZ, mais l'implantation peropératoire d'un ATC semble améliorer les résultats visuels et réfractifs postopératoires.

Proposed predictive score for visual outcome in cataracts with comorbidities following small-incision cataract surgery

Introduction: Cataract with comorbidity having poor prognosis, it is important to predict visual outcome in these eyes. Materials and Methods: This was a prospective cohort study to develop scoring system to predict visual outcome in case of cataracts with comorbidities. We enrolled all cataracts with comorbidities fulfilling inclusion criteria between August 2019 and 2020. For all enrolled cases, data were collected in pretested online format in electronic medical records. A specially designed form was used to calculate preoperative score which was categorized and compared with postoperative visual outcome. All data were exported and analyzed with SPSS 22 using descriptive, cross-tabulation, and one-sample test functions. Results: Our cohort consisted of 230 eyes of 230 patients with a mean age of 44 ± 21.22 years with 121/230 (52.6%) females and 109/230 (47.4%) males. Out of total 230 eyes Traumatic cataracts were in 64, cataract with corneal opacity in 45, postuveitic cataract in 43, neglected cataracts in 39 eyes. We found a significant difference in pre- and postoperative visual outcome. When we studied preoperative score, we found a significant difference between outcomes. Conclusion: Preoperative score for cataracts with comorbidities undergoing small-incision cataract surgery SICS is a very useful tool to predict visual outcome and universalize for comparison.

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation

ObjectiveTo study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia.DesignRetrospective, comparative, non-randomised interventional study.MethodsAll consecutive children with microspherophakia who satisfied the...

A comparative clinical study of postoperative care by teleophthalmology and in-person consultation at hospital outpatient department after an uncomplicated cataract surgery.

Teleophthalmology provides an opportunity to conduct consultations in far-flung and remote areas that have no access to specialized eye care. However, there is a paucity of studies to assess the effect of missing in-person follow-up on initial postoperative visits. The study thus aims to compare postoperative satisfaction and uncorrected distance visual activity after an uneventful phacoemulsification cataract surgery in patients with teleconsultation approach to those with hospital visit. The prospective observation study (n = 240) was conducted in patients who underwent surgery for cataract. Pre- and post-operative data were collected and divided into two groups based on the type of postoperative follow-up. All patients were scheduled for ophthalmic reviews in the hospital on day 1, day 7, and day 30-40 (hospital visit group) or through teleconsultation on days 1 and 7 followed by a hospital visit on days 30-40 (teleconsultation group). Outcomes evaluated in both groups were complications, patient satisfaction, and uncorrected distance visual acuity. Most patients in both groups were in the age group of 51-70 years. Overall satisfaction was comparable in teleconsultation and hospital visit groups (3.74 ± 0.23 vs. 3.72 ± 0.27; P = 0.22). The majority of patients had visual acuity 6/18-6/6 on postoperative day 1, day 7, and day 30-40 in both groups. Lid edema, pain, redness, watering, and congestion complications were more in the hospital visit group on postoperative day 1. The study concludes that patients with no preexisting ocular and systemic comorbidity undergoing an uneventful phacoemulsification cataract surgery teleconsultation approach can be used for follow-up without any impact on the postoperative visual outcome and patient satisfaction, thereby increasing the efficiency and productivity of health-care system.