Routine Cataract Surgery Research Articles

Spectacle use after routine cataract surgery and vision-related activity limitation.

To explore the relationship between acquisition of new spectacles after routine cataract surgery and vision-related activity limitation (VRAL) postoperatively. This cohort study with intervention (survey) included 1329 patients in Sweden who had undergone a second-eye cataract surgery during March 2013. Data from the Swedish National Cataract Register were used, including evaluations of VRAL through the Catquest-9SF questionnaire before and 3months after cataract surgery. Five months after the second-eye surgery, patients completed another five-item questionnaire about spectacle use preoperatively and postoperatively including an item on surgeons' advice about the need for spectacles. These responses were linked to the Rasch-analysed Catquest-9SF data to identify correlations with VRAL. A total of 1239 patients finally participated in the study after excluding those who did not fulfil the inclusion criteria. Patients who were advised about the need for spectacles postoperatively (n=387) had a greater (p=0.039) improvement in the postoperative VRAL compared to patients who were not advised (n=691). Patients who obtained new spectacles postoperatively (n=512) also had greater improvement (p=0.032) compared to those who did not (n=724). The average improvements in the VRAL after surgery were significantly higher for patients who obtained new distance spectacles postoperatively and for patients who were informed about the need for spectacles by their practitioners.

Anti-inflammatory medication following cataract surgery: a randomized trial between preservative-free dexamethasone, diclofenac and their combination.

To examine the anti-inflammatory efficacy and tolerance between preservative-free dexamethasone (DEX) and diclofenac (DICL) eye drops, and their combination following cataract surgery. A randomized, double-blind, prospective single-centre study with 189 eyes of 180 patients undergoing routine cataract surgery. Laser flare meter measurement and spectral-domain optical coherence tomography imaging were conducted before surgery and at the 28-day postoperative visit. Clinical characteristics, surgical parameters and assessment of postoperative symptoms were recorded. Preoperative flare was 9.0±0.6pu/ms and central retinal thickness (CRT) 269.6±1.9μm (mean±SEM). On day 28, flare was 22.1±2.9 pu/ms for DEX, 17.4±2.5pu/ms for DICL and 13.0±1.6pu/ms (p<0.05) for their combination. Central retinal thickness (CRT) increase was 31.5±8.8μm for DEX, 6.0±0.8μm (p=0.001) for DICL, and 3.5±0.5μm (p<0.001) for their combination. The incidence of ocular symptoms related to the eye drops was 11% for DEX, 37% for DICL and 34% for their combination (p<0.001). Clinically significant pseudophakic cystoid macular oedema (PCME) was observed in seven eyes which were all treated with DEX (p<0.001). Diclofenac (DICL), as well as the combination of DEX and DICL, were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME. Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.

Tripolymeric Corneal Coating Gel Versus Balanced Salt Solution Irrigation During Cataract Surgery: A Retrospective Analysis.

Purpose:To compare the protective properties and ease of manipulation during cataract surgery of corneal coating with a gel (eyeDRO; AL.CHI.MI.A. S.R.L, Italy) and corneal irrigation with balanced salt solution (BSS).Methods:We analyzed the data of 51 patients receiving either eyeDRO or BSS during routine cataract surgery performed within a 20-day period in 2016. The selected parameters were intraoperative clarity and ease of manipulation; postoperative epithelial integrity; and patient discomfort.Results:Compared with BSS irrigation, eyeDRO coating significantly increased intraoperative clarity and ease of manipulation (P < 0.01). Single application was required in eyeDRO-treated eyes, whereas BSS was applied 5.3 ± 0.4 times on average (P < 0.01). Two hours postoperatively, a normal epithelium was observed in 90.0% and 60.0% of eyeDRO-coated and BSS-irrigated eyes, respectively; punctate epithelial damage was observed in 9.7% and 40.0% (P < 0.05) of eyeDRO-coated and BSS-irrigated eyes, respectively; eye irritation and foreign body sensation were experienced by 13.0% and 37.0% of eyeDRO-treated patients and by 65.0% and 100% of BSS-treated patients, respectively (P < 0.01). Twenty-four hours postoperatively, 80.0% of BSS-treated patients versus 19.0% of eyeDRO-treated patients still experienced foreign body sensation (P < 0.01).Conclusions:EyeDRO coating was shown to be a safer and more effective option than BSS irrigation in cataract surgery because single application provided optimal hydration and intraoperative clarity during the entire surgery, better preserved the corneal epithelium, and offered postoperative comfort to the patient.

Comparison of Two Different Ophthalmic Operating Microscopes on Speed, Consistency and Time Savings in the Operating Room: A Mini Review

Purpose: To evaluate the operating times and surgical efficiencies of to two different operating microscopes Leica Stativ S3B, Leica Microsystems, Wetzlar, Germany of OPMI Lumera T with Callisto software (Carl Zeiss Meditec, Inc., Dublin, CA) for uncomplicated cataract surgery at a single center. Both systems contain apochromatic optics, Schott-style glass and focused beams aligned with the microscope oculars. Lumera provides a xenon illumination source while Leica utilizes halogen as its illumination source. Xenon illumination sources generally provide greater brightness of illumination. Clinical method and review: This was a prospective review of surgical charts by two experienced high-volume surgeons looking at total surgical times recorded in the chart. Previously identified traumatic and complicated cataract cases were excluded. Two focused beam microscopes were assessed. Discussion: Fifty cases for each microscope were reported. Mean surgery time with the Leica microscope was 14.18 minutes (standard deviation 8.672) and 11.15 minutes (standard deviation of 2.421) with the OPMI Lumera T Zeiss microscope. ANOVA analysis revealed that the difference in surgery time between the two groups was significant at a level of p=0.16. Conclusion: The newer model microscope with xenon lighting consistently produced significantly shorter operating room times with a time savings of 3.03 minutes per case with cataracts of similar density and complexity. Additionally, more variability within the surgical times was noted in the Leica groups compared with the Zeiss group (standard deviation 8672 versus 2.421, respectively). Enhanced illumination produced sharper imaging, easier visualization of structures that appears to provide an efficiency advantage in the operating room when performing routine cataract surgery. Translational relevance: As baby boomers age, more and more strain is being put on the healthcare system including declining reimbursements. Surgical and clinical efficiencies are essential to meet growing healthcare needs in the safest, most efficient methods possible.

DISTRIBUTION OF AXIAL LENGTH READINGS IN PATIENTS UNDERGOING CATARACT SURGERY

Purpose: To find the axial length distribution in patients undergoing cataract surgery with the comparison between genders and age groups.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Lahore General Hospital &amp; Yaqin Vision Eye Center, Lahore from February 2000 to May 2018.&#x0D; Material and Methods: All patients undergoing routine cataract surgery who were more than 20 years of age were included in the study. Patients with corneal scars were excluded. Biometry readings included K reading, axial length and IOL number in diopters aimed for emmetropia using the SRK-T Formula. The patients were divided into 4 groups according to age, Group V (20-39 years), Group X (40-59 years), Group Y (60-79 years) and Group Z (80-99 years). Moreover the patients were also divided into 6 groups according to Axial length, Group A (20.7-21.5 mm), Group B (21.6-22.5 mm), Group C (22.6-23.5 mm), Group D (23.6-24.5 mm), Group E (24.6-25.5 mm) and Group F (25.6-27.6 mm). Cross tabulation between age groups versus axial length and axial length versus gender was done using SPSS version 20.&#x0D; Results: There were 2146 patients included in the study out of which 1073 were male and 1073 were female patients. The mean axial length of all the patients was 23.36 ± 1 mm. The most common axial length seen in 40.7% of the patients was in the range of 22.6 to 23.5 mm. This was followed by 23.6-24.5 mm and was seen in 26.7% patients. The least common axial length seen in 2.3% patients was in the range of 20.7-21.5 mm. High Hypermetropia (20.721.5 mm) was more common in females and was seen in 80% of the patients. However, High Myopia (25.6-27.6 mm) was more common in males and was seen in 74.6% the patients.&#x0D; Conclusion: In our population High Hypermetropia is common in females while High myopia is common in males. The most common axial length seen is between 22.6-23.5 mm.

Comparison of the Efficacy of Dexamethasone, Nepafenac, and Bromfenac for Preventing Pseudophakic Cystoid Macular Edema: an Open-label, Prospective, Randomized Controlled Trial

ABSTRACTPurpose: To evaluate the incidence of pseudophakic cystoid macular edema (PCMO) in patients treated with corticosteroids alone or in combination with bromfenac or nepafenac eyedrops after uneventful cataract surgery.Materials and Methods: Prospective, randomized, open-label, placebo-controlled clinical trial. Patients who underwent routine cataract surgery with intraocular lens (IOL) implant were randomly divided into three groups receiving either bromfenac or nepafenac in association with dexamethasone or dexamethasone alone (control group) postoperatively. Best-corrected visual acuity (BCVA) measurement, slit lamp and fundus examination and optical coherence tomography (OCT) were performed preoperatively, 1 and 5 weeks after surgery. Primary outcome was defined as patients (%) in whom macular edema developed within 5 weeks after cataract surgery; secondary end points were patients (%) with BCVA improvement from pre-op through 5 weeks after surgery and corneal toxicity.Results: A total of 144 patients completed the study, 48 for each group. In all groups, mean central subfield thickness at OCT increased significantly 5 weeks after surgery (p < 0.01). However, at this time point, four patients (8.3%) of the control group and none in nepafenac and bromfenac groups developed PCMO (p = 0.016). Compared with baseline, mean BCVA significantly improved both at 1 and 5 weeks in all groups (p < 0.01). At 1 week, the nepafenac group showed a mean BCVA significantly lower compared with both the control (p = 0.038) and bromfenac group (p = 0.002).Conclusions: Co-administration of nepafenac or bromfenac and steroids in patients who underwent routine cataract surgery is associated with a lower incidence of PCMO compared with steroid monotherapy.

Poor glycemic control as a risk factor for pseudophakic cystoid macular edema in patients with diabetes

To specify the risk factors for pseudophakic cystoid macular edema (CME) in patients with diabetes. Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotka, Finland. Prospective case series. Patients with type 1 or type 2 diabetes having routine cataract surgery were evaluated. Spectral-domain optical coherence tomography imaging was performed before surgery and 1month postoperatively. The study comprised 93 patients (95 eyes). The central retinal thickness increase was 9.7μm±1.7 (SEM) in diabetic patients with no retinopathy, 22.7±8.6μm in those who had nonproliferative retinopathy, and 73.8±37.4μm in those who had proliferative retinopathy (P<.001). The central retinal thickness increase was greater in the eyes of diabetic patients with insulin dependence than in eyes of patients using noninsulin medication (21.9±5.9μm versus 8.3±1.8μm, P=.017). Serum hemoglobin A1c concentration and inversely, patient age, were associated with central retinal thickness increase, even after adjustment for confounding factors (r=0.607, P<.001 and r=0.417, P=.001, respectively). The central retinal thickness change was smaller in the eyes of patients who had a nonsteroidal antiinflammatory drug (NSAID) as their postoperative antiinflammatory medication than in eyes of patients who were not prescribed NSAID medication when retinopathy was analyzed as a covariant (8.2±3.6μm versus 13.6±2.9μm, P=.016). Young patient age and poor glycemic control were risk factors for postoperative central retinal thickness increase. This study showed it is necessary to identify, effectively treat, and follow-up with patients with diabetes who are at a greater risk for pseudophakic CME.

Ultrastructural Integrity of Human Capsulotomies Created by a Thermal Device

To investigate the ultrastructural features of anterior capsulotomy performed with a thermal device, the precision pulse capsulotomy (PPC). Prospective, multicenter case series. Consecutive patients undergoing capsulotomy with the PPC device. Prospective study of patients undergoing capsulotomy with the PPC by 2 surgeons, followed up by routine phacoemulsification cataract surgery, was undertaken. All capsulotomy specimens were collected for scanning electron microscopy (SEM). Observations were made regarding uniformity of the capsular edge and the presence of irregularities that may compromise integrity. Comparisons were made with manual continuous curvilinear capsulorrhexis. Ultrastructural features of PPC and presence of irregularities. Frayed appearance of the anterior capsule edge was noted in postoperative visits under slit-lamp examination. Scanning electron microscopy sampling showed a generally uniform rolled capsular edge, but interspersed with areas of irregularity with frayed appearance at the capsule margin. The PPC device is capable of creating reproducible, central, and precise circular capsulotomy. The ultrastructural features in exvivo human capsulotomy specimens generally show eversion of the capsulotomy edge, but in some cases, this was accompanied by areas of irregular capsule margin with frayed edges, likely caused by dissipated thermal energy. The postoperative appearance and SEM features warrant further assessment of the PPC integrity and clinical correlation.

Outcomes and Prognostic Factors of Cataract Surgery in Adult Extreme Microphthalmos With Axial Length

To study the long-term visual outcomes, complications, and prognostic factors for cataract surgery in extreme microphthalmos. Prospective cohort study. Thirty eyes with simple microphthalmos (11 eyes, axial length [AL] <18mm), complex microphthalmos (8 eyes, AL <18mm), and relative anterior microphthalmos (RAM; 11 eyes, corneal diameter [CD] <8mm) who underwent cataract surgery (phacoemulsification) in our hospital were followed for a mean of 25.3months with at least 3 visits at early (1day to 1week), mid (1-3months), and late (>6months) stages after surgery. The main outcome measures included the best-corrected visual acuity (BCVA), intraocular pressure (IOP), and complications. Significant improvements of BCVA were observed at the mid and late postoperative visits in the entire cohort when compared with preoperative value (P < .05). When eyes were divided into 3 groups, a statistically significant improvement in late-stage BCVA was observed in the simple microphthalmos and RAM groups. The AL, preoperative anterior chamber depth (ACD), and preoperative BCVA were significant prognostic factors for late-stage BCVA after surgery. The most common complications were early corneal edema (73%), glaucoma (33%), and posterior capsular opacification (23%). Preoperative ACD was significantly associated with the incidence of glaucoma after surgery (P < .05). Severe complications included suprachoroidal hemorrhage (3%), endothelial dysfunction (7%), and retinal detachment (7%). Cataract surgery provided visual improvement in extreme microphthalmos (simple microphthalmos and RAM), with higher risks of complications than with routine cataract surgeries. Extreme microphthalmos with preoperative characteristics of relatively longer AL, deeper ACD, and better BCVA may benefit more from cataract surgery.

Choroidal thickness changes following cataract surgery using swept source optical coherence tomography

ObjectiveThe aim of this study was to assess changes in subfoveal choroidal thickness (SFCT), measured using swept-source optical coherence tomography (SS-OCT), after routine phacoemulsification cataract surgery. DesignThis is a prospective, interventional, controlled study that took place at Shahzad Eye Hospital, Karachi, Pakistan, between February 2015 and January 2016. ParticipantsOne hundred and one patients who were undergoing routine cataract surgery were recruited. One eye per patient was included. The unoperated fellow eyes acted as controls. MethodsSwept-source optical coherence tomography scans were performed preoperatively, 1 week postoperatively, and 1 month postoperatively. Two independent graders evaluated the scans to measure the SFCT. The SFCT was measured and recorded for OCT scans from each visit. The general linear model repeated analysis technique was used to assess data from the 3 different time intervals, and paired t tests were used to assess a statistically significant difference between mean preoperative and postoperative SFCT. Probability values of less than 0.05 were considered to be statistically significant. ResultsThe mean preoperative SFCT in the study eye was 272.9 ± 96.2; SFCT was 278.9 ± 101.4 (p = 0.051) and 281.5 ± 105.2 (p = 0.01) at week 1 and month 1, respectively. In the control eyes, the mean measurement of preoperative SFCT was 274.2 ± 98.5; measurements were 273.8 ± 100.7 (p = 0.875) and 277.9 ± 103.1 (p = 0.063) at week 1 and month 1, respectively. ConclusionsThere was a gradual increase in SFCT at 1 month after cataract removal in the study eyes. The effect was more pronounced in younger individuals and nondiabetic individuals.

An evaluation of intracameral mydriasis for routine cataract surgery

BackgroundIntracameral Mydrane might facilitate a more streamlined cataract service and improve the patient experience. There is limited ‘real-world’ evidence of its use in a UK setting.MethodsAs part of a local...

Performing Reliable Lens Capsulotomy in the Presence of Corneal Edema With a Femtosecond Laser.

To determine the effects of the Ziemer LDV Z8 liquid interface femtosecond laser platform during capsulotomy under different energy settings in the presence of corneal edema. Cadaveric porcine eyes (n = 36) employed at less than 6 and greater than 24 post enucleation hours to simulate clear/edematous corneas, underwent capsulotomy with the Ziemer LDV Z8 femtosecond laser (5-mm diameter, energy 90%, 130%, or 150%). Lens capsules were removed for evaluation by scanning electron microscopy and rupture strengths determined by the single column universal testing system. Following ethical approval, 23 patients had lens capsules removed during routine cataract surgery following manual or Z8 capsulotomy and subjected to TUNEL assay. There was no difference in edge morphology or rupture strength (120, 113, and 118 mN at increasing energy, P = 0.42) in the clear cornea. Only 50% of capsulotomies succeeded at 90% energy in an edematous cornea, improving with increased energy (75% completion at 130%, 100% at 150%). Rupture strength in edematous corneas was not significantly different at 112, 133, and 114 mN for 90%, 130%, and 150%, respectively (P = 0.3). In human samples, increased TUNEL-positive cells were seen at 130% energy, but not at 150% (0.0 manual vs. 0.2 [90%] vs. 2.1 [130%] vs. 0.6 [150%], P < 0.05). Because of the low energy delivered by a femtosecond nanojoule platform, even incremental increases in energy appeared to have minimal effect on lens capsule morphology and strength and negligible influence on cell death. Furthermore, increasing energy appeared to enhance consistency and the ability to complete a capsulotomy in an edematous cornea.

Safety of femtosecond laser–assisted primary posterior capsulotomy immediately after cataract surgery

To evaluate the safety and feasibility of a new femtosecond laser-assisted method for posterior capsule opacification (PCO) prevention. University Eye Hospital Bochum, Bochum, Germany. Prospective randomized intraindividual case series. Eyes scheduled for bilateral cataract surgery between April 2015 and January 2016 were enrolled in the study. In 1 eye, routine manual cataract surgery with intraocular lens (IOL) implantation was performed with a primary posterior laser capsulotomy as the last step in the procedure. For the laser treatment, the posterior capsule between the anterior hyaloid surface and the posterior optic surface of the IOL was identified with integrated 3-dimensional spectral-domain optical coherence tomography. In the fellow eye, routine manual cataract surgery without posterior capsulotomy was performed. Follow-up examinations were done 1week, 2months, and 6months after surgery. The main outcome measures were feasibility of the procedure and between-group difference in visual acuity, macular thickness, laser flare, intraocular pressure (IOP), and PCO. Fifty-six eyes were included. No differences in cataract density (P=.2), axial length (P=.8), or amount of ultrasound energyused (P=.55) were found between the groups. In all cases, it was possible to identify and target the posterior capsule. In1case, a minimal attachment of a half-hour length was seen. No significant between-group differences in visual acuity, macular thickness, laser flare, or IOP were seen. The described off-label use of primary posterior laser capsulotomy was a safe, feasible technique in preventing PCO over a 6-month follow-up.

ECP ‐ limbal &amp; pars plana techniques

SummaryCyclo‐photocoagulation is a well‐recognised and powerful therapeutic modality for the reduction of intraocular pressure. Externally applied laser treatment (TransScleral Cyclo‐Photocoagulation, TSCP) may cause collateral destruction of local tissue and can induce considerable inflammation so until recently the use of diode laser cyclo‐photocoagulation was restricted to poorly sighted eyes.Endoscopically applied diode laser (Endoscopic Cyclo‐Photocoagulation, ECP) is a newer, more controlled, titratable, minimally destructive treatment that treats only the target tissue. One of the first MIGS procedures, ECP allows for a quick and simple additional step to be added to routine cataract surgery (Phaco‐ECP), offering the potential to treat cataract and glaucoma simultaneously.In addition, ECP is of considerable value in treating cases of advanced, refractory glaucoma; this area will be discussed in detail during this part of the symposium, via both limbal and pars plana approaches. ECP may be used before or instead of drainage device surgery, or afterward to further augment IOP control.

Spectacle use after routine cataract surgery: a study from the Swedish National Cataract Register.

To explore patients' obtaining and use of spectacles after routine cataract surgery. The study included 1329 patients who underwent bilateral surgery with the second eye operated during March 2013 at 38 different clinics in Sweden. Five months after the second-eye surgery, patients completed a five-item questionnaire about their spectacle use preoperatively and postoperatively. The responses were linked to data from the registry on multiple variables including postoperative refraction, age and gender. Of the 387 patients who were advised by their surgeons to obtain distance spectacles postoperatively, most did so (77.3%, n=299), while of the 691 patients who were not so advised, most did not obtain spectacles (78.9%, n=545). Nevertheless, almost 50% of patients with both spherical and cylindrical errors exceeding 1 dioptre (D) did not obtain new distance spectacles postoperatively, while about 25% of patients with bilateral emmetropia (spherical error <0.5D, cylinder <1D) obtained new distance spectacles postoperatively. Patients' choices regarding obtaining and using new spectacles postoperatively are strongly correlated with advice given by the surgeon about the need for distance correction. The large difference between groups who were and were not advised to obtain spectacles for distance correction was only partially reflected in the postoperative refractive errors. Similarly, the patterns of preoperative spectacle use and gender or age differences did not explain this difference.

The Impact of Lens Opacity on SD-OCT Retinal Nerve Fiber Layer and Bruch's Membrane Opening Measurements Using the Anatomical Positioning System (APS).

To evaluate the impact of lens opacity on retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening (BMO) measurements. Fifty-nine randomly selected patients without any other relevant ocular pathology undergoing elective routine cataract surgery in two specialized eye clinics were enrolled. RNFLT, BMO area, and BMO minimum rim width (BMO-MRW) were assessed with the Heidelberg Engineering Spectralis OCT using the anatomical positioning system (APS) prior to and 1 day after cataract surgery using a ring scan at different eccentricities of the disc (3.5, 4.1 and 4.7 mm). Lens opacity was quantified using densitometry based on Scheimpflug images (Oculus Pentacam AXL). RNFLT, BMO area, and BMO-MRW were virtually identical before and following removal of the cataractous lens. This held when assessed overall, within the six sectors for the 3.5-mm scan, or at any other eccentricity. Baseline RNFLT was not associated with lens opacity. Using the APS, RNFLT remained unchanged following cataract surgery, contrary to results reported by previous studies. Our results imply that the APS may have contributed to more precise spectral-domain optical coherence measurements, minimizing the influence of cataract on RNFLT and BMO assessments in our cohort.

Intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis

The aim of this study was to evaluate the rates of post-cataract-surgery endophthalmitis after prophylactic intracameral moxifloxacin administration. In this retrospective descriptive study, 1013 uncomplicated cataract surgeries with intraocular lens implantation were performed between March 2009 and November 2013 by one surgeon (AP). Each patient received an intracameral injection of 0.05 ml undiluted 0.5% moxifloxacin for prophylaxis of postoperative infection. The mean follow-up of patients was 1 year (range: 2 months to 4 years), and the mean age of the patients was 64.2 years (range: 38–99 years). Of the 1013 patients, 617 (58.6%) were women. No case of endophthalmitis occurred. No postoperative endophthalmitis was observed after the intracameral injection of 0.5% moxifloxacin ophthalmic solution during routine cataract surgery.

Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery.

Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery.

Comparison of the frequency of use of a pupil expansion device with and without an intracameral phenylephrine and ketorolac injection 1%/0.3% at the time of routine cataract surgery.

PurposeThe objective of this study is to evaluate whether a phenylephrine and ketorolac injection 1%/0.3% (phenyl/keto injection) (Omidria®) prior to capsulotomy decreases the need for the Malyugin Ring® to manage small pupils.SettingBucci Laser Vision Institute, Wilkes-Barre, PA, USA.DesignRetrospective analysis of cataract surgeries performed by a single surgeon at a single center.MethodsA historical control group of 1,004 consecutive cases (December 2013 to February 2015) did not receive a phenyl/keto intracameral injection prior to capsulotomy and were compared with 915 consecutive cases in the treatment group (June 2015 to April 2016) for the rate of use of the Malyugin Ring. Epinephrine injections were selectively used in the control group as per surgeon judgment. Use of the femtosecond laser was recorded for both groups. The incidence of alpha-1 blocker patients and the use of the femtosecond laser were recorded for both groups.ResultsIn the 1,004 cases performed in the historical control group without a phenyl/keto injection, the surgeon chose to use the Malyugin Ring 79 times (7.87%). In the 915 cases performed in the treatment group, the surgeon chose to use the Malyugin Ring 27 times (2.95%). The surgeon selectively used intracameral injections of epinephrine in the control group 64 times (6.47%). There was no significant difference in the use of the femtosecond laser in the control group (15.04%) versus the treatment group (16.28%); however, 4 (2.65%) femtosecond patients in the control group required a Malyugin Ring, while zero patients needed the ring in the femtosecond treatment group. The incidence of Malyugin Ring use in alpha-1 blocker patients was 12/49 (24.49%) in the control group and 6/49 (12.74%) in the treatment group (P=0.05).ConclusionThe frequency of use of the Malyugin Ring was significantly reduced (P<0.001) from 7.87% to 2.95% with this treatment. These results strongly suggest that the antimiotic/anti-inflammatory effects of this phenyl/keto injection reduced facility costs, surgical time, and other complexities related to the use of the Malyugin Ring during phacoemulsification.

The effect of intravitreal Ranibizumab for refractory cystoid macular edema after cataract surgery

Objective To evaluate the effect of intravitreal Ranibizumab for refractory pseudophakic cystoid macular edema (CME) after routine senile cataract surgery. Methods From April 2013 to May 2015, 5 patients with refractory pseudophakic CME were treated with intravitreal Ranibizumab injection. Followed up for 3-6 months, visual acuity, retinal morphology and thickness of macula were compared before and after treatment to evaluate the effect. Results After once treatment of intravitreal Ranibizumab, all patients showed better visual acuity and less macular edema without recurrence or complication. Conclusion Intravitreal Ranibizumab is safe and effective for refractory pseudophakic cystoid macular edema. Key words: Ranibizumab, intravitreal; Cataract , age-related; Cystoid macular edema, refractory, pseudophakic