Received Cataract Surgery Research Articles

Characteristics Associated With Receiving Cataract Surgery in the US Medicare and Veterans Health Administration Populations

Considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States. To identify patient characteristics associated with receiving cataract surgery within the US Medicare and Veterans Health Administration (VHA) populations. In this population-based retrospective cohort study of 3 073 465 patients, Medicare and VHA patients with a cataract diagnosis between January 1, 2002, and January 1, 2012, were identified from the 2002-2012 Medicare Part B files (5% sample) and the VHA National Patient Care Database. Patient age, sex, race/ethnicity, region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were recorded. Cataract surgery at 1 and 5 years after diagnosis was identified. Data analysis was performed from July 1, 2016, to July 1, 2017. Odds ratios (ORs) of cataract surgery for selected patient characteristics. The study sample included 1 156 211 Medicare patients (mean [SD] age, 73.7 [7.0] years) and 1 917 254 VHA patients (mean [SD] age, 66.8 [10.2] years) with a cataract diagnosis. Of the 1 156 211 Medicare patients, 407 103 (35.2%) were 65 to 69 years old, 683 036 (59.1%) were female, and 1 012 670 (87.6%) were white. Of the 1 917 254 VHA patients, 905 455 (47.2%) were younger than 65 years, 1 852 158 (96.6%) were male, and 539 569 (28.1%) were white. A greater proportion of Medicare patients underwent cataract surgery at 1 year (Medicare: 213 589 [18.5%]; VHA: 120 196 [6.3%]) and 5 years (Medicare: 414 586 [35.9%]; VHA: 240 884 [12.6%]) after diagnosis. Factors associated with the greatest odds of surgery at 5 years were older age per 5-year increase (Medicare: OR, 1.24 [95% CI, 1.23-1.24]; VHA: OR, 1.18 [95% CI, 1.17-1.18]), residence in the southern United States vs eastern United States (Medicare: OR, 1.38 [95% CI, 1.36-1.40]; VHA: OR, 1.40 [95% CI, 1.38-1.41]), and presence of chronic pulmonary disease (Medicare: OR, 1.26 [95% CI, 1.24-1.27]; VHA: OR, 1.40 [95% CI, 1.38-1.41]). Within Medicare, female sex was associated with greater odds of surgery at 5 years (OR, 1.14; 95% CI, 1.13-1.15). Higher CCI scores (CCI score ≥3 vs 0-2) were associated with increased odds of surgery among VHA but not Medicare patients at 5 years (Medicare: OR, 0.94 [95% CI, 0.92-0.95]; VHA: OR, 1.24 [95% CI, 1.23-1.36]). Black race vs white race was associated with decreased odds of cataract surgery 5 years after diagnosis (Medicare: OR, 0.79 [95% CI, 0.78-0.81]; VHA: OR, 0.75 [95% CI, 0.73-0.76]). Within both groups, older age, residence in the southern United States, and presence of chronic pulmonary disease were associated with increased odds of cataract surgery. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the VHA, although it is possible that a smaller proportion of VHA patients receive surgery compared with Medicare patients.

General analysis of factors influencing cataract surgery practice in Shanghai residents

BackgroundIt was reported that lack of knowledge, less confidence of medical services, commute difficulties, and poor economic conditions would be the main barriers for cataract surgery practice. The influencing factors could have changed in cities with high developing speed. Shanghai is one of the biggest cities in China and the world. The purpose of the study was to explore the factors influencing cataract surgery practice in Shanghai.MethodsThis was a population-based, cross-sectional study. A total of 2342 cataract patients older than 50 years old with cataract-induced visual impairment or who had undergone cataract surgery were recruited from rural and urban areas of Shanghai. Participants accepted a face-to-face structured questionnaire. Data were collected on patient demographics, education, work, income, health insurance, awareness about cataracts disease, treatment and related medical resources and deration policy, transportation and degree of satisfaction with hospitals.ResultsThere were 417 patients who had received cataract surgery, 404 of them supplied complete information in the questionnaire. More female subjects (64.6%) than male subjects (35.4%) accepted cataract surgery among the 404 patients. Of the patients with cataract history, 36.4% of surgery patients were equal or older than 80. More people with urban medical insurance received surgery (p = 0.036). Patients who received surgery were more satisfied with local medical service (p = 0.032). In urban area, Lower income and difficulties with commutes were related to a higher rate of surgery.ConclusionsCataract patients with the following features were more inclined to receive surgery: female, old age, better awareness. In urban areas low income and difficult commutes did not represent barriers for cataract surgery, probably because of appropriate cataract surgery promotion policies recent years in Shanghai. In rural areas, better healthcare reimbursement policies would likely lead to a higher uptake of cataract surgery. Further cohort studies with more controls could supply stronger evidence for our viewpoint.

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification.

PurposeTo assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure.MethodsRetrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma.ResultsEighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001).ConclusionsThe attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.

First Rapid Assessment of Avoidable Blindness Survey in the Maldives: Prevalence and Causes of Blindness and Cataract Surgery.

A nationwide rapid assessment of avoidable blindness survey was undertaken in the Maldives among people aged 50 years or more to assess the prevalence and causes of blindness and visual impairment, cataract surgical coverage, cataract surgery outcome, and barriers to uptake of cataract surgical services. Prospective population-based study. In the cluster sampling probability proportionate to size method, 3100 participants in 62 clusters across all 20 atolls were enrolled through house-to-house visits. They were examined in clusters by an ophthalmologist-led team. Data was recorded in mRAAB version 1.25 software on a smartphone. The age-sex standardized prevalence of blindness was 2.0% [95% confidence interval (CI), 1.5-2.6]. Cataract was the leading cause of blindness (51.4%) and uncorrected refractive error was the leading cause of visual impairment (50.9%). Blindness was more prevalent in higher age groups and women (16.3%). Cataract surgical coverage was 86% in cataract blind eyes and 93.5% in cataract blind persons. Good visual outcome in cataract operated eyes was 67.9% (presenting) and 76.6% (best corrected visual acuity). In this study, 48.1% of people had received cataract surgery in neighboring countries. Important barriers for not using the services were "did not feel the need" (29.7%) and "treatment deferred" (33.3%). Cataract surgical coverage is good, though nearly half the people received surgery outside the Maldives. Cataract surgery outcomes are below World Health Organization standards. Some barriers could be overcome with additional human resources and training to improve cataract surgical outcomes, which could encourage greater uptake of services within the country.

THE IMPACT OF CATARACT SURGERY ON DEPRESSION AMONG OLDER ADULTS: A PROPENSITY SCORE ANALYSIS

Cataracts is an eye disorder that is the leading cause of vision loss in the United States. Although individuals with cataracts typically undergo cataract surgery, the impact of this treatment on depression remains inconclusive. The purpose of this study was to examine the impact of cataract surgery on depression among older adults through a propensity score analysis. Data was retrieved from the Health and Retirement Study (HRS), which surveys a nationally representative sample of older adults over age 50. The sample was restricted to individuals with cataracts, but have not previously undergone cataract surgery (n=182) in 2010. Depression was measured by the seven-item Composite International Diagnostic Interview-Short Form (CIDI-SF) scale in 2012. Greedy matching and propensity score weighting were both conducted as a sensitivity analysis to estimate the effect of cataract surgery on depression. Through Poisson regression, both approaches were consistent in suggesting a statistically significant increase in depression scores following cataract surgery. Greedy matching indicated individuals who received cataract surgery were expected to have an incidence rate for depression scores 4.81 times that of individuals without surgery (p<.05). Propensity score weighting indicated an average treatment effect (ATE) incidence rate ratio (IRR) of 2.65 (p<.05) and an average treatment effect for the treated (ATT) IRR of 3.00 (p<.05) for individuals with cataract surgery. Our findings support previous studies in suggesting cataract surgery may exacerbate depressive symptoms in older adults. Therefore, further research is needed to understand factors contributing to increased depression following cataract surgery and how this can be prevented.

Long-term outcomes after cataract surgery in infants with congenital cataract

Objective: To observe the long-term outcomes after congenital cataract surgery performed prior to 36 months of age. Methods: A retrospective case study was conducted. Thirty-two cases (57 eyes) of congenital cataract were included from January 2004 to January 2012. All patients received intraocular lens (IOL) implantation with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction and were followed up. At the last visit, the best corrected visual acuity (BCVA) was determined and postoperative complications were evaluated during follow-up with a longest time of 13 years. Non-normal distribution showed in median M (minimum and maximum). Data were analyzed by Kruskal Wallis single factor variance analysis and multiple comparison. The independent Mann-Witney U test was used to analyze non-normal distribution data. Results: There were thirty-two cases (57 eyes) of congenital cataract including 7 unilateral cases and 25 bilateral cases. The median age at cataract extraction was 6.0months; the median IOL implantation age was 28.0 months and the median duration of follow-up after cataract extraction was 67.0 months. The median postoperative BCVA was (LogMAR) 0.52. Unilateral and bilateral cataract postoperative BCVA difference had no statistical significance (U=107, P>0.05). Patients received cataract surgery in 2 to 4 months, the postoperative BCVA was better than in 5 to 8 months. The difference was statistical significance (H=-15.33, P<0.05). BCVA after IOL implantation before 24 months were significantly better than after 30 months. The difference had statistical significance(H=-20.61,-20.78, P<0.05). Postoperative complications were posterior capsular opacity (5 eyes; 8.77%), glaucoma (2 eyes; 3.51%), strabismus (17 eyes; 29.82%) and nystagmus (30 eyes; 52.63%). Conclusions: Most infantile cataract surgeries performed prior to 36 mouths of life together with the implantation of IOL can achieve good visual acuity. No serious complications occurred. (Chin J Ophthalmol, 2017, 53: 266-273).

Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes.

To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction. In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME. In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687). Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

Bacteriology of the conjunctiva in pre-cataract surgery patients with occluded nasolacrimal ducts and the operation outcomes in Japanese patients

BackgroundContamination of the conjunctiva in association with nasolacrimal duct obstruction is by all accounts a risk factor for infectious endophthalmitis post-cataract surgery.MethodsAll patients who underwent cataract day surgery routinely received nasolacrimal duct syringing with normal saline at the Wakayama Medical University Hospital, Japan, from 2011 to 2013. The microorganisms isolated from conjunctival swab samples of patients with occluded nasolacrimal ducts and their susceptibility to antibiotics, as well as the operation outcomes in all the patients were retrospectively investigated.ResultsNasolacrimal duct obstruction was observed in 125 eyes of 90 patients (3.3%; 42 eyes of 30 male individuals, and 83 eyes of 60 female individuals) from a total of 3754 eyes of 2384 patients by using irrigation samples of nasolacrimal ducts. The mean age of the subjects with duct obstruction was 79 ± 8.5 years.. In bacterial cultures of swabs from these 125 individuals, microbial growth was detected in 56 samples (i.e. 44.8%). Coagulase-negative Staphylococcus was detected in 28 eyes, and Corynebacterium species was detected in 17 eyes. Staphylococcus aureus, excluding methicillin-resistant S. aureus was detected in seven eyes with nasolacrimal duct obstruction. Methicillin-resistant S. aureus was isolated in two eyes with nasolacrimal duct obstruction. Each case was treated with topical antibiotics based on the results of antibiotic sensitivity tests. After culturing of cotton swab samples from the conjunctiva, and using direct micrography of bacteria every 2 or 3 days after starting treatment, and once the results were negative (consecutively tested three times), the patients received cataract surgery. In the current case series, bacteria were not detected in conjunctival swabs obtained consecutively three times for 3 weeks after starting topical antibiotics in 118 eyes from 125 eyes (94.4%), and later in the remaining patients. No patient required dacryocystorhinostomy to eliminate bacterial contamination in the conjunctiva following topical antibiotic therapy. No patient developed infectious endophthalmitis at least 1-year post-cataract surgery.ConclusionsAll the patients receiving cataract day surgery underwent the operation after the elimination of conjunctival microorganism contamination in association with nasolacrimal duct obstruction by using appropriate topical antibiotics.

Examination and analysis of diabetic optic neuropathy after cataract surgery

Objective To analyse the characteristics of diabetic optic neuropathy (DON) in cataract patients with diabetes by using fluorescein fundus angiography (FFA), optical coherence tomography (OCT), visual evoked potential (VEP) and perimetry examination. Methods A total of 235 eyes of 125 cataract patients with diabetes were included in the study. These patients received cataract surgery and performed with FFA, OCT, VEP and perimetry examination postoperatively. The examination results and clinical characteristics of diabetic retinopathy (DR) and DON were analyzed. Results Seventy eyes (29.8%) were diagnosed with DR, 75 eyes(31.9%) were diagnosed with DON. FFA in DON patients showed macular edema, optic disc edema, filling defect and optic disc neovascularization. OCT mainly showed macular edema, thickening or atrophy. VEP mainly showed prolonged P100 wave latency or decreased wave amplitude. Perimetry examination showed various kinds of insults. Conclusion DR and DON show a high occurrence rate in diabetes mellitus patient with cataract. FFA plays a key role in the early diagnosis of DR and DON. Retinal ganglion cells are damaged in patients with early DR. Key words: Optic neuropathy, diabetic; Examination, postoperative, cataract; Fundus fluorescein angiography; Optical coherence tomography; Visual evoked potential

Revision and application of Chinese version of visual function index-14 in the evaluation of life quality in cataract patients

Background Cataract is the main cause of blindness in the world.The comprehensive evaluation of the visual function of the patients with cataract should be combined with clinical examination results and subjective evaluation.Visual function index-14 (VF-14) is an assessment tool for the cataract patients in developed countries. Objective This study was to develop a Chinese version visual function index-14 (VF-12-CN) and assess its application value in the evaluation of cataract patients, quality of life (QoL) and the affecting factors. Methods A prospective cross-sectional investigation was carried out.The VF-14 was revised and developed into a VF-12-CN by translating, back-translating and cultural adaptating.The QoL questionnaires of VF-12-CN were given to 215 patients with age-related cataract or daibetic cataract who were going to receive cataract surgery in Eye Hospital of Wenzhou Medical University from February to October, 2013.Psychometric properties of the VF-12-CN, including item difficulty and discrimination, Cronbach's α coefficient, Split-Half reliability, intra-investigators reliability, content validity, and construct validity were tested, and the influence factors of the final questionnaire were analysised.Forty-eight patients who finished questionnaires were scored by 2 invistigators separately.Level 4 score method was used to assess whether VF-12-CN could reflect the psychometric properties of cataract.The Ethics Committee of the Eye Hospital of Wenzhou Medical University approved the study. Results Total 200 questionnaires were taken back with the response rate of 93.02%.Three items which involved filling of form, physical training and recreational activities were revised based on Chinese culture and life style, and 2 items that related with driving were deleted from VF-14 due to a lower response rate.The VF-12-CN showed an excellent item discrimination, with the Cronbach's α coefficient of 0.863, Split-Half reliability of 0.874, intra-investigators reliability of 0.958 and I-CVI, S-CVI/UA, and S-CVI/Ave of 1.0.Two common factors were extracted by the factor analysis, with a cumulative variance contribution rate of 59.3%.The scale scores were positively correlated with age, uncorrected distant visual acuity (UCDVA) of better eyes and UCDVA of worse eyes(r=0.277, 0.534, 0.367, all at P 0.05). The main factors affecting the QoL of cataract patients included UCDVA of better eyes, educational degree and age, with the regression equation: scores=25.045-10.927×UCDVA of better eyes-3.342×education+ 3.201×age (R=0.586, R2=0.334, F=34.247, P=0.000). Conclusions VF-12-CN is a reliable and valid tool for assessing the visual functions of Chinese cataract patients.The UCDVA of better eyes is the main factor affecting QoL in cataract patients. Key words: Quality of life/psychology; Surveys and questionnaires; Cataract/physiopathology; Visual acuity/physiology; Psychometric property; Humans; Chinese version of visual function index-14

Outcome of primary vitrectomy in phakic patients aged younger than 50years with rhegmatogenous retinal detachments.

To evaluate the visual outcome, primary anatomic success, and cataract progression of phakic eyes of patients aged younger than 50years treated for rhegmatogenous retinal detachment (RRD) with primary pars plana vitrectomy (PPV). This was a retrospective, observational, cross-sectional study. The data from 53 RRD patients undergoing PPV were analyzed. The time course changes in best-corrected visual acuity (BCVA) and cataract formation were examined. The 53 patients had a mean age of 37.8years. Forty-eight eyes (90.6%) achieved anatomic success after the primary surgery. The BCVA improved significantly after surgery (mean±SD -0.091±0.146) when compared with the baseline (mean±SD 0.214±0.597; P=0.0001). No patient aged younger than 40years (mean 32.5years; range 17-39) developed significant lens opacity or received cataract surgery within the first 3years. Of the patients aged older than 40years (mean 43.8years; range 40-49), 22% developed significant lens opacity and received cataract surgery within the first 3years. A significant difference was found in cataract progression between the two groups within the first 3years (P=0.0217), but not over the entire follow-up period (P=0.1679). We found that lens-sparing PPV for RRD in patients aged younger than 50years had a reasonable success rate, although cataract progression was evident during the follow-up period in patients aged older than 40years.

Predictors of functional vision changes after cataract surgery: the PROVISION study

ObjectiveTo ascertain whether time-to-treatment, sex, age, preoperative functional vision scores, education, and ocular comorbidities predict change in functional vision pre- to postoperatively in patients receiving cataract surgery. DesignProspective cohort study. ParticipantsThree hundred and forty-three cataract patients at the Hamilton Regional Eye Institute. MethodsParticipants 18 years or older scheduled to undergo cataract surgery completed the Catquest-9SF functional vision questionnaire on the day of their surgery and were mailed a survey 2–3 months postoperatively. Multivariate linear regression was used to determine the ability of predictors to explain variability in functional vision change between questionnaire administrations. ResultsOne hundred and sixty-six patients completed both baseline and follow-up questionnaires. Mean age of the cohort was 73.8 ± 8.1 years. Most patients were female (59.6%), had cataract surgery performed for the first time (66.9%), and had spent a mean time of 20.3 ± 20.7 weeks waiting for surgery. Functional vision improved in 83.7% of patients. The mean baseline Catquest-9SF score was the only significant predictor of functional vision improvement (adjusted R2 = 0.47; F1,159 = 144.6; p < 0.001). Controlling for other variables, functional vision improved by 0.74 logits when mean baseline survey score increased by 1 logit. ConclusionsIn most patients, functional vision improved after cataract surgery. Mean baseline Catquest-9SF score was a moderate predictor of the observed improvement.

Blindness, cataract surgery and mortality in Ethiopia

PurposeTo examine the relationships between blindness, the intervention of cataract surgery and all-cause mortality in a rural Ethiopian population.DesignPopulation-based, interventional prospective study.MethodsCommunity-based detection methods identified blind Ethiopian persons from two...

Posterior capsulorrhexis for preventing capsule contraction after intraocular lens implantation

Objective To evaluate the effect of posterior continuous curvilinear capsulorrhexis (PCCC) for preventing capsule contraction after phacoemulsification and intraocular lens implantation. Methods Fifty eyes of 25 patients were enrolled in this study. The left eyes received cataract surgery with PCCC (the PCCC group), and all the right eyes received ordinary phacoemulsification surgery without PCCC (the control group). Foldable aspherical IOLs of the same type were implanted in both groups. All patients were followed up for 3 months after the surgery. The best-corrected visual acuity (BCVA) and the depth of the anterior chamber (ACD) were observed. Results The ACD increased gradually in both two groups during the follow-up of 3 months. The ACD was increased by (0.01±0.1) mm in the PCCC group 3 months after the surgery , and the difference was not statistically significant (t=0.86, P=0.78) compared with the ACD 1 month after the surgery. But in the control group the ACD was increased by (0.13±0.19) mm three months after surgery, and the difference was statistically significant (t=3.08, P=0.02) compared with that 1 month after surgery. The difference in postoperative BCVA between the two groups was not statistically significant (t=1.09, P=0.26). Conclusion The ACD increased gradually after cataract surgery in both of the two groups. PCCC is useful to minimize postoperative ACD increase caused by capsule contraction. Key words: Cataract, age-related; Continuous curvilinear capsulorrhexis, posterior; Lens, intraocular; Anterior chamber depth; Capsule contraction

Association Between 131I Treatment for Thyroid Cancer and Risk of Receiving Cataract Surgery: A Cohort Study from Taiwan.

The risk of cataracts after (131)I therapy for cancer is unknown. The objective of this study was to evaluate the association between (131)I therapy for thyroid cancer and risk of receiving cataract surgery in Taiwan. This was a nationwide population-based cohort study of patients with thyroid cancer diagnosed during the period 1998-2008. The data were obtained from the Taiwan National Health Insurance Research dataset. The cumulative (131)I activity in each patient was calculated. Hazard ratios were calculated using a time-dependent survival analysis to estimate the effect of (131)I therapy on the risk of receiving cataract surgery. A total of 8,221 patients were eligible for the final analysis (mean age, 43.2 y; mean follow-up, 5.9 y); 69% received (131)I with a median cumulative activity of 3.7 GBq. Two hundred patients received cataract surgery. The adjusted hazard ratios were 0.77 (95% confidence interval, 0.54-1.09), 0.92 (95% CI, 0.64-1.31), and 1.06 (95% CI, 0.58-1.94) for cumulative (131)I activities of 0.1-3.6, 3.7-7.3, and 7.4 GBq or more, respectively, compared with a cumulative activity of 0. No trend was noted (P = 0.85). No interaction between (131)I activity and age or between (131)I activity and sex was noted (all P > 0.05). (131)I treatment for thyroid cancer did not increase the risk of receiving cataract surgery up to 10 y after treatment. However, further research with direct lens examination and a longer follow-up period is needed to assess subtle and late adverse effects beyond 10 y.

A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

Purpose: To report a case of fragmentation and anterior migration occurred after dexamethasone intravitreal implant (Ozurdex, Allergan, Irvine, CA, USA) injection in a branch retinal vein occlusion patient. Case summary: A 66-year-old male was referred for blurred vision. He received cataract surgery in 1986 and was diagnosed with central retinal vein obstruction in 2011 in the right eye. For treatment of macular edema, dexamethasone intravitreal implant was performed in the right eye. One week after implantation, a fragment of the dexamethasone implant migrated to the anterior chamber with corneal edema and surgical removal was performed immediately. One day after removal, the remaining fragmented implant migrated to the anterior chamber and corneal edema still existed. The fragmented implant was removed with anterior chamber irrigation. After removal, corneal edema improved and visual acuity was recovered. Conclusions: Anterior migrated dexamethasone implant could induce corneal complications, such as corneal edema and corneal decompensation and might lower the corneal endothelial cell even if immediately removed. We report a case of corneal edema, which was induced by anterior migration of a fragmented dexamethasone implant and recovered with immediate surgical removal. J Korean Ophthalmol Soc 2016;57(4):667-671

Evaluation of Objective Accommodation Power in Different Age Groups Using an Auto Accommodation Refractometer

Purpose: To evaluate the objective amplitude of accommodation in various age groups using an autorefractometer and to compare the results with subjective assessments on accommodation. Objective accommodative amplitude of artificial lenses in post-operative cataract patients was also measured. Methods: In this study, 41 patients who visited Korea University Guro Hospital from July through August 2014 were categorized into 6 different age groups. Accommodative amplitude was measured using long-distance refraction at 5 m and short-distance refraction at 20 cm. In 20 patients, subjective amplitude of accommodation was measured using the minus lens technique and was compared with the measured objective accommodative amplitude. Accommodative amplitude was also measured in 8 patients who received cataract surgery. Results: The mean accommodative ability in normal people was 2.38 D. The age groups of 10-19, 20-29, 30-39, 40-49, 50-59, and over 60 years showed accommodative amplitudes of 3.31 ± 0.99 D, 3.25 ± 0.34 D, 3.78 ± 0.68 D, 1.00 ± 0.60 D, 0.22 ± 0.23 D, 0.00 ± 0.00 D, respectively. The results showed a rapid decrease in accommodative ability of patients older than 40 years and demonstrated a correlation between objective and subjective amplitude of accommodation (Pearson’s correlation coefficient 0.838). There was a significant difference between objective and subjective accommodative amplitudes in artificial lenses (p = 0.015), with average objective and subjective measures of 0.10 ± 0.23 D and 0.59 ± 0.35 D, respectively. Conclusions: Measuring amplitude of accommodation using an autorefractometer can be useful in assessing results of presbyopia treatment. J Korean Ophthalmol Soc 2016;57(1):20-24

Predictive modeling of risk factors and complications of cataract surgery.

Cataract surgery is generally safe; however, severe complications exist. Preexisting conditions are known to predispose patients to intraoperative and postoperative complications. This study quantifies the relationship between aggregated preoperative risk factors and cataract surgery complications, and builds a model predicting outcomes on an individual level, given a constellation of patient characteristics. This study utilized a retrospective cohort of patients age 40 years or older who received cataract surgery. Risk factors, complications, and demographic information were extracted from the Electronic Health Record based on International Classification of Diseases, 9th edition codes, Current Procedural Terminology codes, drug prescription information, and text data mining. We used a bootstrapped least absolute shrinkage and selection operator model to identify highly associated variables. We built random forest classifiers for each complication to create predictive models. Our data corroborated existing literature, including the association of intraoperative complications, complex cataract surgery, black race, and/or prior eye surgery with increased risk of any postoperative complications. We also found other, less well-described risk factors, including diabetes mellitus, young age (&lt;60 years), and hyperopia, as risk factors for complex cataract surgery and intraoperative and postoperative complications. Our predictive models outperformed existing published models. The aggregated risk factors and complications described here can guide new avenues of research and provide specific, personalized risk assessment for a patient considering cataract surgery. Furthermore, the predictive capacity of our models can enable risk stratification of patients, which has utility as a teaching tool as well as informing quality/value-based reimbursements.

Prevention and control of nosocomial infection from the large number of cataract surgery at Lifeline Express

Objective To investigate the prevention measure of infections from the large number of cataract surgery at the Life-line Express. Methods From September to November 2013, a total of 1 069 cases (1 070 eyes) completed cataract surgery in Songyuan City of Jilin Province. A series of peri-operative prevention measures for nosocomial infection were established and implemented according to the characteristics of cataract surgery carried out in Life-line Express and local environment. Results The measures to prevent the nosocomial infection were fulfilled quite well, 1 069 patients had received cataract surgery successfully, no case occurred entophthalmia. Conclusions Effective prevention of the nosocomial infection can be achieved through establishing a sound system and measures, which can ensure the effect of surgery. Key words: Cataract; Cross infection; Life-line express; Prevention measures

Long-term effect of phacoemulsification on trabeculectomy function.

To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in trabeculectomized eyes and to identify the factors affecting the IOP changes. In consecutive patients with previous trabeculectomy (TE) who underwent uncomplicated clear cornea phacoemulsification we evaluated intraocular pressure, need of antiglaucomatous medical therapy or glaucoma surgery, and length of glaucoma control without therapy. Glaucoma therapy was prescribed in the presence of IOP >18 mm Hg or worsening of the visual field. A group of trabeculectomized eyes that did not receive cataract surgery was retrospectively selected as a control. Multivariate analysis was used to test factors related to final outcome of the treatment. One hundred and eight eyes with previous TE that received phacoemulsification and 108 controls were included in the study. Phacoemulsification was performed 60±21 months after TE. After a mean follow-up of 66±28 months, mean IOP was significantly increased in the cataract surgery group (by 1.7±4.3 mm Hg) and in the control group (by 2.3±4.3 mm Hg)(both P<0.001); in two groups, respectively, 31 eyes (28.7%) and 17 eyes (15.7%) had received glaucoma therapy (chi-square P=0.030). Factors related to success (no need of therapy) were use of mitomycin-C (MMC) in previous TE (P<0.001), longer time from TE to cataract surgery (P=0.007), higher preoperative bleb score (P=0.021), and lower baseline IOP (P=0.042). Cataract surgery reduces the function of filtering bleb in some eyes. Factors related to low rate of failure are the previous use of MMC during TE, longer time from TE to cataract surgery, and good preoperative aspect of the bleb.