Related Cataract Research Articles

Risk of dementia after initiation of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors in adults aged 40-69 years with type 2 diabetes: population based cohort study

ObjectiveTo compare the risk of dementia associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors versus dipeptidyl peptidase-4 (DPP-4) inhibitors in adults aged 40-69 years with type 2 diabetes.DesignPopulation based cohort study.SettingKorean National...

Cyclic RGD conjugated PEG-PLGA nanoparticle enhances preventative effect of bilirubin on the development of ultraviolet-B (UVB)-induced cataract

Age related cataract (ARC) is characterized by protein conformational disorder with aging stands out as an independent risk factor. Therefore, mitigation of oxidative stress and DNA damage within the lens emerges as a potential therapeutic strategy. While topical administration remains the most common treatment modality for ocular disorder, drug bioavailability is hindered by the cornea epithelium barrier. In this study, we developed a novel cyclic Arg-Gly-Asp (cRGD)-conjugated nanoparticle encapsulating bilirubin (cRNM@BR), an endogenous antioxidant, to combat against cellular senescence and lens opacity associated with ARC. Immunofluorescence staining assay confirmed that cRGD modification significantly prolonged nanoparticle retention on the ocular surface by targeting integrin expressed on corneal epithelium. Moreover, through LC-MS/MS analysis, we demonstrated the enhanced transcorneal penetration efficacy of cRGD-modified nanodrugs both in vivo and in vitro. Our mechanistic investigations revealed that cRNM entered human corneal epithelial cells (HCECs) by clathrin and micropinocytosis-mediated pathways, with the ER/Golgi pathway facilitating its exocytosis. In a mouse model of ultraviolet B (UVB)-induced cataract, topical application of cRNM@BR effectively alleviated intracellular reactive oxygen species (ROS) levels and DNA damage in lens epithelial cells (LECs), thereby preventing cellular senescence and lens opacity. Transcriptomics analysis of LECs in UVB-exposed group and cRNM@BR pretreated group indicated significant enrichment of the cGAS/STING pathway. Further experiments determined that cRNM@BR prevented cellular senescence and lens opacity by ameliorating the cGAS/STING pathway. In conclusion, our findings underscore the therapeutic potential of cRNM@BR in ARC management and highlight the efficacy of cRGD-conjugated nanoplatform for intraocular delivery.

Safety and prognosis of phacoemulsification using active sentry and active fluidics with different IOP settings - a randomized, controlled study

PurposeTo explore the impact of different intraoperative intraocular pressure (IOP) settings on the safety and prognosis in phacoemulsification.MethodsAge related cataract patients who met the inclusion criteria and underwent phacoemulsification by using active sentry handpiece and active fluidics system. According to different intraoperative IOP settings during surgery, they were randomly divided into two groups: the 20mmHg group and the 60mmHg group. The best corrected visual acuity (BCVA), cumulative dissipated energy (CDE), total U/S time, active surge mitigation (ASM), estimated fluid usage (EFU) as well as the changes in corneal thickness (CT), corneal epithelial layer thickness (CELT) and endothelial cell density (ECD) were collected. The post-operative follow-up was only 1 day.ResultsA total of 110 cases (110 eyes) were included in the study. There were 55 eyes in each group. There was no statistically significant difference in postoperative BCVA (p = 0.839). The CDE, total U/S time and EFU during surgery were (5.22 ± 3.31), (30.60 ± 15.06), (45.07 ± 12.68) and (4.70 ± 2.83), (27.39 ± 13.75), (42.38 ± 11.93) in the 20mmHg group and 60mmHg group (p = 0.381, 0.246, 0.254). The ASM during surgery in the 20mmHg group and 60mmHg group were (0.95 ± 2.77) and (7.24 ± 6.34), respectively. The 20mmHg group showed a significant decrease in ASM (p < 0.001). There was no statistically significant difference in the changes in CT, CELT and ECD before and after surgery between the two groups (p = 0.913, 0.825, 0.624). Both groups did not experience any intraoperative complications, such as posterior capsule rupture.ConclusionA lower IOP setting of 20 mmHg can significantly reduce the occurrence of intraoperative surges during phacoemulsification. And there was no increase in rate of complications.Trial RegistrationThe trial registration number is ChiCTR2100050240. The registered date is August 24th, 2021.

Maintenance of Ocular Health by Ayurveda

There are five sense organs (Gyanendriya) in Ayurveda i.e., Eye, Ear, Nose, Tongue and Skin among them prime importance is given to eye. It says “Sarvendriyaanam Nayanam Pradhanam”. A faulty lifestyle has resulted in many eye disorders like Dry eye, Computer vision syndrome, Age related macular degeneration, Cataract, Diabetic retinopathy and many more which adversely effects quality of life. To avoid these lifestyle disorders, prevention of eye disorders and preservation of ocular health has become essential because good vision is necessary for social and intellectual development of humans. But unlikely the preventive aspects of eye health and diseases related to eye has not been given due importance in our day-to-day life. For preventing these eye disorders and for maintaining eye health much more has been described in Ayurvedic texts in the form of Dincharya (Daily regimen), Ritucharya, Sadvritta, Swasthavritta and Chakshyusya Rasayana. Many tested procedures like Anjana (Collyrium), Netraprakshalana (Eye wash), Snana (Bath), Padabhyanga (Foot massage with oil) are highly effective daily procedures for the prevention of eye disorders and maintenance of good eye health. Various Yogasana, Pranayama, Neti and Trataka are also considered beneficial for the eye health. The aim of this article is to spread awareness among society about the maintenance of eye health and prevention of eye disorders.

The Efficacy of Phacotrabeculectomy in Reducing Intraocular Pressure

Background: Primary open angle glaucoma and age related cataract are ocular comorbidities which can occur in some individuals at different times. Phacoemulsification is carried out for restoration of vision decreased by cataract while trabeculectomy is a procedure to decrease the intra ocular pressure. To save the time, money and stay in the hospital, phacotrabeculectomy is a single procedure which can fulfill both the restoration of vision and decrease intraocular pressure. Objectives: To determine the efficacy of phacotrabeculectomy in decreasing the intraocular pressure in patients having both primary open angle glaucoma and age related cataract.Materials and Methods: This study was conducted at the Eye department, Hayatabad Medical Complex, Peshawar, from 1st August, 2022 to 1st February 2023 after getting the permission from Ethical Committee to do this study. Patients both males and females, from 40-80 years of age, who had coexisting age related cataract (ARC) and Primary open angle glaucoma (POAG), whose intraocular pressures (IOP) was 21mm Hg or above, with and without using anti-glaucoma treatment.Patients who had secondary or rosette shaped cataract, past ocular trauma (including ocular surgery along with its intraoperative or post-operative complications) and trauma after phacotrabeculectomy procedure during the follow up period were excluded from this study.Results: All 121 patients underwent Phacotrabeculectomy. Follow up was done for 5 months. Preoperative mean intraocular pressure (IOP) was 23.53 ± 4.22SD which reduced to 12.90 ± 2.09SD postoperatively which was highly significant with p- value=0.001Conclusion: Phacotrabeculectomy reduced Intraocular pressure by &gt;10 mm Hg in our study which showed that this procedure is very effective in coexisting age related cataract and primary open angle glaucoma.Keywords: Age related cataract, Angle closure glaucoma, Combined phaco-trabeculectomy, Glaucoma, Intraocular pressure, Open angle glaucoma, Trabeculectomy.

Correlation of Dysfunctional Lens Index with Lens Opacification System III in Age Related Cataract

Purpose: Age-Related changes in crystalline lens opacity and lens density contribute to formation of higher order aberrations resulting in reduced quality of vision. Precise quantification of cataract is important for predicting phacodynamics and educating patient. The iTrace(a ray-tracing aberrometer) provides Dysfunctional Lens Index (DLI). This study from Pakistan investigates the relationship between LOCS III and DLI in senile cataract. Study Design: Correlational study. Place and Duration of Study: Hashmanis Hospital, Karachi from March 2021 to May 2021. Methods: This study included 44 patients with age-related cataract. Demographic characteristics and complete ophthalmic examination of eyes including Best Corrected Visual Acuity (BCVA) and slit lamp biomicroscopy were performed. Age related cataracts were graded using the Standard technique of LOCS III. I-Trace was utilized for wave front analysis to calculate DLI. Results: BCVA and LOCS III nuclear opalescence score had strongest positive linear correlation (r=0.433, P&lt;0.01). DLI displayed a strong significant negative correlation to LOCS III Cortical Cataract (C) and LOCS III Posterior Sub-Capsular Cataract (P) score (r=-0.415 and r=-0.694; respectively). Conclusion: BCVA had insignificant and small to no correlation to LOCS III C score and P score. Whereas, DLI showed the strongest significant correlation to LOCS III C score and P score. Patient's optical quality determined by visual symptoms are more closely associated to DLI parameter as compared to LOCS III classification. DLI can provide a better objective way to elevate age related cataract, monitor the progression and determine phacodynamics.

Association of serum lipid level with age related cataract in north western Rajasthan

: The aim of the study was to evaluate whether serum lipids levels are associated with incidence and type of age related cataract (ARC).: This was a analytical observational study conducted at Department of Ophthalmology of S.P. Medical College and Associated Group of Hospitals, Bikaner, Rajasthan, India. A random sample size of 200 subjects who met the inclusion criteria was recruited.: Data were analyzed and statistically evaluated using SPSS-PC-25 version.In the present study we found that mean age for control group was 50.84 years and 60.91 years for case group. In control group 69% male patients were seen while in case group 53% male patients were present. The mean Serum CHO level was found to be 204.66 ± 50.76 mg/dl in control subjects and it was found to be 226.63 ± 59.63 mg/dl in the subjects with age-related cataract (ARC). The mean Serum TG level was found to be 113.70 ± 59.92 mg/dl in control subjects and it was found to be 149.35 ± 68.12mg/dl in the subjects with age-related cataract (ARC). The mean Serum HDL level was found to be 58.65 ± 15.25 mg/dl in control subjects and it was found to be 53.12 ± 11.28 mg/dl in the subjects with age-related cataract (ARC). Our study found association between serum lipid profiles with age related cataract in the population. Our findings indicate a need for health promotional activities and health care access for controlling this modifiable factor among the ageing population of the country.

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M &amp; J Western Regional Institute of Ophthalmology (M&amp;J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M &amp; J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value &amp;#60;0.05 was taken as significant.: MSICS &amp; phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS &amp; phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Using genetics to investigate the association between lanosterol and cataract.

Background: Cataract is one of the most prevalent causes of blindness worldwide. Whilst surgery is the primary treatment for cataracts, it is not always an available option, particularly in developing countries. Non-surgical methods of treatment would increase treatment availability for more patients. Several studies have investigated how topical application of oxysterols, such as lanosterol, may break down aggregated proteins and restore lens transparency. However, the results are conflicting and inconclusive. Aim: In this study, we focus on combining genetic evidence for associations between lanosterol related genetic variation and cataract to explore whether lanosterol is a potentially suitable drug treatment option. Method: Using data from 45,449 available cataract cases from the UK Biobank, with participant ages ranging from 40-69, we conducted a genetic association study (GWAS) to assess the risk of cataract. Cataract cases were defined using diagnostic and operation codes. We focused on genetic variants in the lanosterol synthase gene region. We also compared our results with previously published genetic associations of phytosterol-to-lanosterol ratios. Finally, we performed a genetic risk score analysis to test the association between lanosterol within the cholesterol synthesis pathway and the risk of cataract. Results: No statistically significant single nucleotide polymorphisms (SNPs) associations with cataract were observed in the gene region of lanosterol synthase at a multiple testing adjusted significance threshold of p < 0.05/13. The comparison between cataract risk and genetic association of 8 phytosterol-to-lanosterol GWAS results also showed no evidence to support lanosterol's protective properties for cataract risk. No statistically significant association was found between the lanosterol within the cholesterol synthesis pathway genetic risk score and cataract outcomes (OR = 1.002 p = 0.568). Conclusion: There was no evidence observed for genetic associations between lanosterol and cataract risk. Our results do not support lanosterol's potential role in treating cataracts. Further research may be needed to address the effect of lanosterol on specific cataract subtypes.

Cataract-related variant R114C increases βA3-crystallin susceptibility to environmental stresses by disrupting the protein senior structure

Congenital cataract is a major cause of childhood blindness worldwide, with crystallin mutations accounting for over 40 % of gene-mutation-related cases. Our research focused on a novel R114C mutation in a Chinese family, resulting in bilateral coronary cataract with blue punctate opacity. Spectroscopic experiments revealed that βA3-R114C significantly altered the senior structure, exhibiting aggregation, and reduced solubility at physiological temperature. The mutant also displayed decreased resistance and stability under environmental stresses such as UV irradiation, oxidative stress, and heat. Further, cellular models confirmed its heightened sensitivity to environmental stresses. These data suggest that the R114C mutation impairs the hydrogen bond network and structural stability of βA3-crystallin, particularly at the boundary of the second Greek-key motif. This study revealed the pathological mechanism of βA3-R114C and may help in the development of potential treatment strategies for related cataracts.

Prevalence of Cataract in Relation to Socio-demographic Factors: A Population Based Cross Sectional Study of Adults in Imo State Nigeria

Cataract is among the major causes of blindness and visual impairments among adults globally. The present study was designed as a population based cross sectional study aimed at determining the prevalence of cataract in relation to factors of socio demographics among adults in Imo State South Eastern Nigeria. Subjects were examined of the presence of cataract via Slit Lamp Biomicroscopy. Lens opacity was performed using Lens Opacity Classification System (LOCS) III system. A slit lamp examination was conducted and the presence and severity of specific lens opacity were compared. Socio-demographic information was obtained using a validated study questionnaire. Data analyses were conducted through descriptive and inferential analysis. Descriptive technique was used to describe the data characteristics in a frequency distribution. Chi square test was used to test for association between class variables. Logistic regression method was used to establish significant factors to cataract and odds ratios were computed to account for size effect measures. A total of 792 adults were studied and the prevalence of cataract was 3.7% (29 out of 792) in the study area. Significant socio-demographic risk factors found include age (P=0.000, ꭔ2= 48.85), occupation (P=0.000, ꭔ2= 40.69), education (P=0.001, ꭔ2= 19.99) and household income level (P=0.004, ꭔ2= 15.55). The odds for cataracts was lower in younger age such as 45-50 years than in older age such as 60 and above (OR =0.05, 95% CI =0.01, 0.23). it was also lower among higher school education level participants (OR =0.071, 95% CI =0.009, 0.561) against the non-formal education group. The disease was high among low household income (7.1%). In conclusion, cataract prevalence in relation to socio-demographic factor remained a challenging factor to the that needed to be taking into account in any preventive measures against the burden of the disease.

A lipidomic study on the lens epithelial cells of patients with age related cataracts.

Age related cataracts (ARC) represent the main reason for blindness globally. The lens epithelial cells (LECs) participate not only in the metabolism of many substances in the lens but also in maintaining lens transparency. This study used lipidomics to investigate the metabolic differences in LECs of ARC patients with different severity, aiming at identifying potential metabolic biomarkers of ARC. Patients diagnosed with ARC and underwent cataract surgery at Shanghai Tongren Hospital were selected to participate in this study, which were classified as mild ARC group and severe ARC group. During their cataract surgery, anterior lens capsules(LCs) containing LECs were obtained. The lipidomics of LECs were analyzed using the liquid chromatography‑mass spectrometry (LC-MS). Potential pathways of lipids were searched for using databases such as the Kyoto Encyclopedia of Genes and Genomes (KEGG) and MetaboAnalyst platform. In LEC lipids, 26 lipids have been identified as potential biomarkers between mild ARC and severe ARC, with AUC values of 0.67-0.94. The pathway analysis results revealed that the Glycerophospholipid (GPL) metabolism was significantly influenced, indicating that these metabolic markers contribute significantly to regulating this pathway. The LEC metabolic spectrum demonstrates a proficient ability to differentiate between patients with varying levels of cataracts. Herein, we have successfully identified potential metabolic biomarkers and pathways that have proven to be valuable in enhancing our understanding of ARC pathogenesis. The finding has translational value for developing new cataract treatment methods in the future.

Assessment And Comparison of Bacterial Contamination in Anterior Chamber Aspirates in Small Incision Cataract Surgery (SICS) And Phaco-Emulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent now a day. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age related cataract in the department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January, 2009 to 30th June, 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly by 1:1 basis. 1 ml of anterior chamber contents were aspirated through aseptic technique by 26G needle from each patient pre-operatively, after capsulorrhexis (early per-operative) and just before wound closure by stromal hydration (late per-operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In SICS group, out of 30 samples 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative sample respectively and in Phacoemulsification group, it was 2, 3, 5 pre-operative, early per-operative and late per-operative sample respectively. The common organisms isolated were Coagulase positive Streptococcus, Corynebacterium species, Streptococcus viridans, and Staphylococcus aureus etc. Almost none of the patients showed clinical activity except few cells and flare in the anterior chamber in early post-operative period. Conclusion: The microbiological examination shows the incidence of microbial contamination of anterior chamber contents is very low after cataract surgery by both form of technique, and there was no statistically significance difference in incidence between these two techniques. J.Natl.Inst.Ophthalmol.2023;6(1): 37-41

Corneal Clarity after Phacoemulsification: Nuclear Management by Stop and Chop Method

Introduction: Restoration of effective vision is the principal aim of all modalities of cataract surgery including phacoemulsification. In this method, nuclear part of the cataractous lens is emulsified by ultrasonic power. Energy level of ultrasonic power and turbulence of fluid in the anterior chamber play an important role in corneal endothelial cell loss which inturn influences post-operative corneal clarity. Endothelial cell loss can be minimized by modification of nuclear management method. The common nuclear division techniques of phacoemulsification are stop and chop, divide and conquer and phaco chop. Purpose: To show post-operative corneal clarity after phacoemulsification by stop and chop technique of nuclear divisions. Materials and Methods: This prospective observational study was conducted at selected outdoor patients from January, 2023 to June, 2023 over 33 patients of age related cataract selected for phacoemulsification surgery. Patients were selected based on specific selection criteria. Selected patient underwent detail, ocular and systemic examinations as well as relevant investigations which included assessment of corneal endothelial cell count and central corneal thickness. Phacoemulsification were done in all patients by a single expert surgeon where technique of nuclear management by stop and chop were chosen randomly. Patients were followed up on 1 week, 4 weak and 12 weak after surgery. Corneal endothelial cell count and central corneal thickness were assessed in each visit. All the relevant data were presented by appropriate tables. Results: The mean age of the study subjects were 60.96 with standard deviation 1.75 years out of which 14 were males and 17 were females. Pre-operative value of mean endothelial cell count was 2620+-70.20/mm2. Mean value of endothelial count was 2420+-68.90/ mm2, 2345+-66.64/ mm2, 2310+-66.04/ mm2 respectively after 1 week , 4 weeks and 12 weeks after surgery. Mean value of central corneal thickness was 545+-40.50 micrometer, 535+-40.02 micrometer, 532+-39.85 micrometer respectively after 1 week, 4 weeks and 12 weeks after surgery. Conclusion: Quantitative assessment of endothelial cell count and central corneal thickness shows that at end of the study there was no significant difference in mean endothelial cell count and mean central corneal thickness . Medicine Today 2023 Vol.35(2): 118-120

Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis

Background: The comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear. Objectives: This meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting. Methods: A systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE, and EMBASE from January 2005 to May 2022. Studies that reported on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA were included. A random-effects meta-analysis was performed. Cochrane’s Risk of Bias Tool 2 was used to assess the risk of bias, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines were used to assess certainty of evidence. Results: Five RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high-dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD = −4.75 ETDRS letters, 95% CI = [−7.73, −1.78], p = 0.002) and reduction in retinal thickness (WMD = −93.02 μm, 95% CI = [−153.23, −32.82], p = 0.002) at months 4–6 compared to low-dose (1–2 mg) IVTA. However, high-dose IVTA had a higher risk of intraocular pressure-related adverse events (RR = 2.99, 95% CI = [1.05, 8.50], p = 0.04) and cataract surgery (RR = 5.67, 95% CI = [3.09, 10.41], p < 0.00001) than low-dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high-dose and low-dose IVTA were not observed in DME eyes. Conclusions: The RCT evidence in this setting is limited. High-dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low-dose IVTA at months 4–6. However, high-dose IVTA had a less favorable safety profile than low-dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.

Prevalence of Corneal Astigmatism in Age Related Cataract Patient in a Tertiary Eye Hospital

Background: To investigate the magnitude and pattern of pre-existing corneal astigmatism in age related cataract patient.&#x0D; Method: This prospective observational study was carried out in a tertiary eye hospital from January 2020 to June 2020. We examined 577 eyes of 532 patients who underwent cataract surgery. The mean age at the time of surgery was 61.2 ±7.1 (40 to 100) years. Corneal astigmatism was measured with Auto Refracto Keratometer at least two times for each patient. Astigmatism was calculated from dioptric difference of vertical reading from horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian at 900±200. Against the rule (ATR) astigmatism was considered when steep meridian at 1800±200. Astigmatism is in other direction is defined as oblique.&#x0D; Result: The pattern of astigmatism was ATR astigmatism in 237 eyes (41%), WTR astigmatism in 165 eyes (28.6%) and Oblique in 175 eyes (30.4%). Prevalence of ATR astigmatism was more than WTR astigmatism and prevalence of ATR astigmatism axis significantly increased with the increase in age. Average corneal power was 45.23D. Corneal astigmatism was 0.0D to 0.5D in 274 eyes (47.5%), 0.51D to 1.0D in 175 eyes (30.3%), 1.01D to 2.0D in 98 eyes (17.0%) and more than 2D in 30 eyes (5.2%) cases. Corneal astigmatism of most cataract surgery candidates fell between 0.50D to 1.50 D in 360 eyes (62.4%) cases.&#x0D; Conclusion: Thirty five percent (35%) pre-operative patient had 1D or more corneal astigmatism and sixty five percent (65%) had less than 1Dcorneal astigmatism.&#x0D; Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 67-70

Effect of Phacoemulsification on Sub Foveal Choroidal and Central Macular Thickness as measured by Swept Source Optical Coherence Tomography.

To study the effect of Phacoemulsification on Sub Foveal Choroidal Thickness (SFCT) and Central Macular Thickness (CMT) as measured by Swept Source Optical Coherence Tomography (OCT). This experimental study was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from April 2021 to February 2022. One hundred eyes of 100 patients with age related cataract underwent uneventful phacoemulsification surgery. Pre-operative SFCT and CMT was measured and compared with SFCT and CMT at one week, one month and three months after surgery using swept source OCT. Mean age of study population was 56.76±8.31 years. Out of 100 patients, 46 (46%) were males and 54 (54%) were females. Mean pre-operative CMT, one week, one month and three months post-operative CMT was 233.95±9.46 μm, 232.88±8.59 μm, 230.38±10.62 μm and 230.67±7.55 μm respectively. Mean pre-operative SFCT, one week, one month and three months post-operative SFCT was 337.14±8.41 μm, 339.14±9.63 μm, 339.39±11.96 μm and 351.39±9.19 μm respectively. The difference of mean change in CMT from baseline at one week, one month and three months post-operatively was not statistically significant. The difference of mean change in SFCT from baseline at one week and one month post-operatively was not statistically significant. However, the difference of mean change in SFCT from baseline at three months post-operatively was statistically significant (p<0.05). Uneventful phacoemulsification surgery does not have any effect on central macular thickness, however there is a significant increase in subfoveal choroidal thickness at three months after surgery.

Vascular endothelial cell-derived exosomal miR-1246 facilitates posterior capsule opacification development by targeting GSK-3β in diabetes mellitus

Posterior capsule opacification (PCO) is a serious complication after cataract surgery. Diabetes could increase the occurrence of PCO, but the mechanism is still unclear. The purpose of this study is to investigate the role of small extracellular vesicles (sEVs) derived from diabetic aqueous humor in PCO process. Intraoperatively-derived aqueous humor sEVs from patients with diabetic related cataract (DRC) promoted the epithelial-mesenchymal transition (EMT) and metastasis of human lens epithelial cells (LECs). Via mouse PCO surgical model and DiI labeled fluorescence detection of sEVs, the sEVs derived from vascular endothelium were discovered directly contacting with LECs. Furthermore, we demonstrated that high-glucose-cultured human umbilical vein endothelial cells (HUVEC) -derived sEVs facilitated EMT process of HLE-B3 using co-culture model in vitro. miRNA-seq data and GEO datasets analysis revealed that miR-1246 was essential in EMT process with diabetes. The miR-1246 was highly expressed in diabetic aqueous humor sEVs and high-glucose-treated vascular-endothelial-cell-derived sEVs. Moreover, miR-1246 promoted the metastasis and EMT process of HLE-B3 cells by directly targeting GSK-3β. Inhibiting miR-1246 could negatively regulated EMT. This finding might serve as a potential therapy for diabetic PCO.

Influence of anterior capsule polishing on capsular bag and IOL position after phacoemulsification

Background- Phacoemulsification is considered not only as a cataract surgery but also as a refractive surgery due to negligible astigmatism following micro incision and refractive error correcting/ presbyopia correcting IOLs. Objective- To evaluate the effect of anterior capsule polishing on capsular bag and IOL position after phacoemulsification. Methods- In this prospective randomized clinical trial comprised of 120 eyes of 60 consecutive patients with bilateral age related cataract who undergoes phacoemulsification in VMKVMCH, Salem is evaluated. The ACD was measured 1 week, 1 month, 3 months and 6 months and1 year after surgery. The actual axial movement of IOL was defined as the root mean square (RMS) of the change in ELP at each visit. Results- A total of 120 eyes of 60 patients were included, and 60 patients (50%) were men. All the patients underwent uneventful surgeries with­out intra-operative or postoperative complica­tions, and returned on time for measurements. The mean age of them was 70.4±7.2 years (range 54 to 78 years). Mean ELP among differ­ent visits of the polished group was more stable than that of the control group.

A comparative study of subtenon’s anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery in patients with age related cataracts

To compare the safety, efficacy and ease of administration of subtenon’s anaesthesia with peribulbar anaesthesia in manual small incision cataract surgery(MSICS) and assess the surgeon and patient comfort.A prospective longitudinal study was conducted among 200 patients undergoing MSICS at a rural tertiary care hospital wherein patients were randomly divided into the two groups of peribulbar (P) and subtenon’s (ST) block.After randomization, 200 patients were assessed for various factors including pain at the time of administration of anaesthetic, time to attain akinesia, patient’s comfort and satisfaction score.200 eyes of 200 patients who underwent MSCIS were divided into Peribulbar and Subtenon’s group by random number table; of which 122 were women (61%) and 78 were men (39%). There was a significant difference in the amount of anaesthetic used, with the group P (8.37+1.19 ml) usage being more than the group ST(4.02+0.91 ml) (p&amp;#60;0.001). Group P took significantly lesser time to attain akinesia compared to group ST. Group P achieved significantly higher degree of akinesia than group ST. (p&amp;#60;0.001) Significantly greater number of eyes in the group ST required additional anaesthetic injection compared to the group P (p&amp;#60;0.001). A significantly more number of patients experienced pain in the group P. (p=0.008)Significantly greater number of eyes in group ST had mild and moderate chemosis and subconjunctival haemorrhage compared to group P(p&amp;#60;0.001).We found that subtenon’s anaesthesia was an equally effective technique for achieving analgesia and akinesia when compared to peribulbar anaesthesia in patients undergoing MSICS.