Second-eye Surgery Research Articles

Pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries under topical anesthesia.

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients' intraoperative experience in second-eye cataract surgeries.

Pain perception, aqueous humour cytokines, and miosis response following first and second eye femtosecond laser-assisted cataract surgery: A randomised, prospective, intraindividual study.

To compare pain perception, pupil behaviours, and cytokine levels during first-eye and second-eye femtosecond laser-assisted cataract surgery (FLACS) and determine which is better regarding a short or long interval for bilateral FLACS. Notably, 96 eyes of 48 patients with bilateral cataracts underwent the first surgeries in the left or right eye, according to a random sequence. They were further randomised into 2- and 6-week subgroups based on surgery intervals. Pupil size was measured from captured images, and pain perception was assessed using a visual analog scale (VAS). Aqueous humour prostaglandin E2 (PGE2), monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6, and IL-8 levels were also quantitatively analysed. All patients were followed for 1 week to evaluate changes in endothelial cell density (ECD), central corneal thickness (CCT), and macular central subfield thickness (CST). Ocular pain was significantly higher in patients who underwent second-eye FLACS. First tear break-up time was negatively correlated with VAS score. MCP-1 levels were significantly higher in patients who underwent second-eye FLACS, and VAS scores were positively correlated with MCP-1 levels across all patients. There were no differences between sequential FLACS in miosis, PGE2, IL-6, IL-8 levels and changes in postoperative ECD, CCT, and CST. Patients who underwent second-eye FLACS after 6 weeks showed more CCT, CST, and MCP-1 changes than baseline. Second-eye FLACS causes more pain and upregulated MCP-1. There was no difference between sequential FLACS in PGE2 levels, miosis, and postoperative inflammation. Furthermore, first-eye FLACS triggered a sympathetic irritation, particularly after a 6-week interval.

Combination of Iris Vessel Area Density and Surgery Interval as the Predictor of Perceived Pain during Consecutive Second Eye Cataract Surgery.

To explore clinical indicators to predict perceived pain during second-eye phacoemulsification surgery in patients with bilateral cataracts. Shanghai General Hospital, China. A case‒control study and a prospective cohort study. Age-related cataract patients who underwent first or second eye uneventful phacoemulsification surgery were enrolled. Before surgery, ocular examination results, including vessel area density (VAD) and vessel skeleton density (VSD) obtained by OCTA examination of the iris were performed. Patients completed a visual-analog-scale pain survey three times after surgery: 1 hour, 3 hours, and 24 hours after surgery. Seventy patients were enrolled in the case‒control study, and the pain scores of the second-eye surgery group under local anesthesia were significantly greater than those of the first-eye surgery group (p=0.0005). Preoperative iris VAD in the second-eye group affected perioperative pain scores (p=0.0047). The optimal cutoff value of VAD was 0.2167 with a specificity of 76% and a sensitivity of 62%. In the prospective cohort study, 124 patients were included in the second-eye group. Preoperative iris VAD (p=0.0361) and the time interval (p=0.0221) were independent factors for second-eye surgery pain. Combined with preoperative iris VAD and surgical interval, the negative predictive value and positive predictive value were 0.95 and 0.29 for predicting moderate pain or above, the sensitivity and specificity were 0.97 and 0.23 respectively. The combination of iris VAD and the time interval between both eye surgeries can be an effective method to predict the timing of the second-eye cataract surgery and to avoid intraoperative pain.

Perception of Canadian ophthalmologists on immediately sequential bilateral cataract surgery: insights and implications

ObjectifÉvaluer la perception des ophtalmologistes canadiens en ce qui a trait à la chirurgie de la cataracte bilatérale immédiatement séquentielle (CCBIS). NatureSondage anonyme envoyé à tous les membres actifs de la Société canadienne d'ophtalmologie. MéthodesOn a ainsi obtenu de l'information sur les aspects suivants : données démographiques de base, types de pratique professionnelle en lien avec la chirurgie de la cataracte, avantages, inconvénients et préoccupations en lien avec la CCBIS. RésultatsAu total, 352 ophtalmologistes ont répondu au sondage. De ce nombre, 94 répondants (27 %) réalisent régulièrement des CCBIS, 123 (35 %) réalisent des CCBIS à titre exceptionnel et 131 (37 %) ne réalisent jamais de CCBIS. Les ophtalmologistes qui réalisent des CCBIS sont significativement plus jeunes que ceux qui n'en réalisent jamais (p < 0,001) et sont actifs depuis moins longtemps (p < 0,001). La prévalence des ophtalmologistes qui réalisent des CCBIS varie significativement en fonction de la province (p < 0,001) : la plupart des ophtalmologistes qui réalisent couramment des CCBIS proviennent du Québec (n = 44; 48 %), endroit où les mesures de dissuasion financière sont les moins corsées au pays. Les CCBIS sont le plus souvent réalisées dans des centres universitaires (n = 39; 42 %), plutôt que dans des cliniques privées ou communautaires (p < 0,001). Le principal motif justifiant le recours à la CCBIS tient à une utilisation plus efficace des blocs opératoires (n = 142; 65 %). Le risque de complications bilatérales (n = 193; 57 %) et l'absence de résultats réfractifs dans le premier œil au moment de réaliser l'intervention dans le deuxième œil (n = 184; 52 %) constituent les préoccupations principales en lien avec la CCBIS. La pandémie de COVID-19 a eu un effet positif sur la perception de 152 répondants (43 %) à cet égard; il s'agit surtout des ophtalmologistes qui réalisaient déjà régulièrement des CCBIS (n = 77; 84 %). ConclusionsLes ophtalmologistes qui réalisent des CCBIS sont susceptibles d’être plus jeunes et de travailler dans des centres universitaires. Le Québec a la prévalence la plus élevée d'ophtalmologistes qui réalisent des CCBIS. En raison de la pandémie de COVID-19, les ophtalmologistes qui réalisaient déjà des CCBIS se sont mis à en réaliser encore plus, comparativement à ceux qui n'en réalisaient jamais.

Association of clear vs blue-light filtering intraocular lenses with mental and behavioral disorders and diseases of the nervous system among patients receiving bilateral cataract surgery.

To analyze new-onset mental and behavioral disorders and nervous system diseases in patients with cataract implanted with either non-blue-light filtering (BLF) or BLF intraocular lenses (IOLs) in both eyes. Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. A retrospective registry-based cohort study of patients operated between September 2007 and December 2018 who were followed until December 2021. We included 4986 patients who underwent bilateral cataract surgery. Patients were implanted with either non-BLF IOLs (N = 2609) or BLF IOLs (N = 2377) in both eyes. Follow-up before the first-eye surgery and between the first-eye and the second-eye surgery was performed to acknowledge the preexisting disorders and diseases. After the second-eye surgery, the groups were analyzed for the new-onset mental and behavioral disorders and diseases of the nervous system subcategorized by the International Classification of Diseases codes. 1707 male and 3279 female patients, aged 73.2 ± 8.6 years at the first-eye surgery and 74.3 ± 8.8 years at the second-eye surgery, were identified. In univariate log-rank tests, the use of BLF IOLs showed no association in overall new-onset disorders or diseases over non-BLF IOLs, in any subtype diagnosis codes except for sleep disorders, which favored BLF IOLs ( P = .003). A multivariate analysis adjusted for age and sex identified no associations in any new-onset disorders or diseases. Multivariate analysis of sleep disorders showed a nonsignificant advantage for BLF-IOLs (hazard ratio 0.756, 95% CI 0.534-1.070, P = .114). BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.

Study on the inflammatory response in the contralateral eye after phacoemulsification combined with intraocular lens implantation in the first eye

AIM: To explore whether there is an inflammatory response in the contralateral eye after cataract surgery in the first eye, and try to explore the development of the inflammatory response. METHODS: In this paired-sample study, aqueous humor samples from 37 bilateral age-related cataract patients were collected just before each cataract surgery. Samples collected during the first-eye cataract surgery were marked as Group A, samples collected during the second-eye cataract surgery were marked as Group B. In addition, the samples were classified into five groups according to different operation intervals between the first and the second cataract surgery. Finally, the concentration of 13 selected cytokines (including TNF-α, IL-6, IL-8, CCL2/MCP-1, IL-6 Rα, IL-1 ra, MIP-1α, MIP-1d, CCL4, IL-2, CXCL9, TIMP-1, CCL11) in aqueous humor samples was detected by Luminex-200 (RnD) simultaneously in accordance with the manufacturer’s instructions. RESULTS: Among the 13 selected cytokines, there was statistically difference between the first and the second eyes in concentration of IL-6, MIP-1α, CCL2/MCP-1, TNF-α, MIP-1d, IL-2 and TIMP-1 (P&lt;0.05), and the expression levels of all these seven cytokines in the second eyes were higher than those in the first eyes, and the concentration of IL-6 and MIP-1a in the second eyes was significantly higher than that in the first eyes (P&lt;0.001). Compared with the first eyes, the concentration of CCL4, CCL11, IL-6Rα, CXCL9, and IL-1ra in the second eyes only showed slightly increase, while IL-8 showed a slight decrease, all with no statistically difference (all P&gt;0.05). The concentration differences of IL-6, MCP-1/CCL2, IL-2, MIP-1d between the first eyes and the second eyes were most obvious at the third week after phacoemulsification combined with intraocular lens implantation (PHACO+IOL) in the first eye. CONCLUSION: This study revealed that there may be an inflammatory response in the contralateral eye after cataract surgery in the first eye, and the inflammatory response in the second eye appears to be most significant at the third week after phacoemulsification combined with intraocular lens implantation (PHACO+IOL) in the first eye.

Endophthalmitis Rate in Immediately Sequential versus Delayed Sequential Bilateral Cataract Surgery within the Intelligent Research in Sight (IRIS®) Registry Data

To compare the rate of postoperative endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database. Retrospective cohort study. Patients in the IRIS Registry who underwent cataract surgery from 2013 through2018. Patients who underwent cataract surgery were divided into 2 groups: (1) ISBCS and (2) DSBCS (second-eye surgery ≥1 day after the first-eye surgery) or unilateral surgery. Postoperative endophthalmitis was defined as endophthalmitis occurring within 4 weeks of surgery by International Classification of Diseases (ICD) code and ICD code with additional clinical criteria. Rate of postoperative endophthalmitis. Of 5 573 639 IRIS Registry patients who underwent cataract extraction, 165 609 underwent ISBCS, and 5 408 030 underwent DSBCS or unilateral surgery (3 695 440 DSBCS, 1 712 590 unilateral surgery only). A total of 3102 participants (0.056%) met study criteria of postoperative endophthalmitis with supporting clinical findings. The rates of endophthalmitis in either surgery eye between the 2 surgery groups were similar (0.059% in the ISBCS group vs. 0.056% in the DSBCS or unilateral group; P= 0.53). Although the incidence of endophthalmitis was slightly higher in the ISBCS group compared with the DSBCS or unilateral group, the odds ratio did not reach statistical significance (1.08; 95% confidence interval, 0.87-1.31; P= 0.47) after adjusting for age, sex, race, insurance status, and comorbid eye disease. Seven cases of bilateral endophthalmitis with supporting clinical data in the DSBCS group and no cases in the ISBCS group were identified. Risk of postoperative endophthalmitis was not statistically significantly different between patients who underwent ISBCS and DSBCS or unilateral cataract surgery.

Dynamic monocyte chemoattractant protein-1 level as predictors of perceived pain during first and second phacoemulsification eye surgeries in patients with bilateral cataract

BackgroundThe purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract.MethodsConsecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups.Resultspain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries.ConclusionsMCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.

Bilateral implantation of a supplementary intraocular pinhole.

To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism. Private practice. Retrospective consecutive case series. Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery. Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH. Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.

Small-Gauge Pars Plana Vitrectomy for Visually Significant Vitreous Floaters.

This article evaluates our experience at a retina-only private practice with small-gauge pars plana vitrectomy (PPV) for visually significant vitreous floaters. We review the surgical outcomes, complication rates, and percentage of second-eye surgery for the same indication. A retrospective, interventional case series was conducted of consecutive patients undergoing PPV for significant vitreous floaters from September 2014 to December 2018 at a high-volume vitreoretinal surgery practice. Preoperative visual acuity (VA), complication rates, and visual outcome following surgery were evaluated. A total of 104 eyes in 81 patients underwent PPV for visually significant floaters; 35 (43.2%) patients had PPV in both eyes. Mean preoperative VA was 0.16 ± 0.17 logMAR (∼20/29 Snellen equivalent) and improved to 0.12 ± 0.15 logMAR (∼20/26 Snellen; Wilcoxon test, P = .008) at the last follow-up after PPV. All patients had improvement in VA at the final postoperative visit, with a VA of 20/40 or better achieved in 93.3% of cases. The complication rate of vitreous hemorrhage postoperatively was 0.96%. There were no cases of postoperative retinal tears, breaks, or endophthalmitis. Small-gauge PPV in the carefully selected patient is an effective and safe procedure to eliminate symptoms. VA following PPV for vitreous floaters significantly improved. Nearly half of the patients studied (43.2%) underwent PPV in the other eye.

Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia

To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia. Retrospective claims-based cohort study. A 20% representative sample of Medicare beneficiaries, 2006-2015. Dementia was identified from diagnosis codes on or prior to each beneficiary's first-eye cataract surgery. For each surgery, we identified setting, routine vs complex coding, anesthesia provider type, duration, and any postoperative hospitalization. We evaluated 30- and 90-day complication rates-return to operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment-and used adjusted regression models to evaluate likelihood of surgical characteristics and complications. Complication analyses were stratified by second-eye cataract surgery within 90days postoperatively. We identified 457,128 beneficiaries undergoing first-eye cataract surgery, 23,332 (5.1%) with dementia. None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries. There was also no difference in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization. Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases vs 8.8%, P < .0001), and surgeries exceeding 30minutes (OR= 1.21, 95% CI= 1.17-1.25). Among US Medicare beneficiaries undergoing cataract surgery, those with dementia are more likely to have "complex" surgery" lasting more than 30minutes. However, they do not have greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care, or postoperative hospitalization. This may be influenced by case selection and may suggest missed opportunities to improve vision. Future research is needed to identify dementia patients likely to benefit from cataract surgery.

Substance P induces sympathetic immune response in the contralateral eye after the first eye cataract surgery in type 2 diabetic patients

BackgroundSubstance P (SP) is a nociceptive tachykinin which regulates the immune inflammatory reactions including monocyte chemoattractant protein 1 (MCP-1) production. Sequential second-eye cataract surgery patients often suffer more pain than the first one partly because of the MCP-1 increase in aqueous humor (AH). This study aims to illustrate whether SP is involved in sympathetic inflammatory responses in the contralateral eye in patients with or without type 2 diabetes.MethodsThis prospective randomized clinical study included 51 cataract patients (22 with diabetes and 29 without). Bilateral sequential cataract surgeries were conducted with 1-day or 1-week interval randomly. More than 100 μl of AH were obtained before surgery and stored for later analysis using magnetic Luminex assays to detect interleukin (IL)-1β, IL-1ra,IL-6, IL-8, IL-10, MCP-1, vascular endothelial growth factor, spinal macrophage inflammatory protein (MIP-1a), interferon-inducible protein 10 (IP-10), regulated on activation, normal T expressed and secreted (RANTES), as well as the enzyme-linked immunosorbent assay for SP.ResultsAmong the 4 groups, no significant differences were found in age, sex distribution, the R/L ration of the first surgery eye, or the lens nucleus hardness (P ≥ 0.802). Over 100 μl of AH samples were collected safely in all cases without intraoperative complications. SP and MCP-1 levels were both increased significantly in the second eye of the diabetic patients with 1-day and 1-week interval (P ≤ 0.040). The SP increase in the second eye of the diabetic patients were significantly higher than that of the patients without diabetes (P ≤ 0.030) both in the groups with 1-day and 1-week interval. Similarly, the MCP-1 increase was significantly higher in the diabetic patients in the group with 1-week interval (P = 0.042).ConclusionsSubstance P and MCP-1 productions elevated in the AH of the contralateral eye after the first-eye cataract surgery in diabetic patients, indicating that SP and MCP-1 were involved in the sympathetic inflammatory responses. Diabetic patients are susceptible to noninfectious inflammation after cataract surgery, and perceive more pain in the second-eye phacoemulsification.Trial registrationChinese Clinical Trial Registry, ChiCTR1900028374, retrospectively registered on 20th December, 2019.

Experiences following cataract surgery - patient perspectives.

Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. Qualitative methods were used to explore patients' experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age=68.2±11.4years), and the data were analysed using thematic analysis. We identified three themes. 'Changes to Vision' explores participants' adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. 'Prescription Restrictions' describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. 'Information Needs' describes participant's responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery.

Cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (the BICAT-NL study): study design of a prospective multicenter randomised controlled trial

BackgroundCataract surgery is one of the most frequently performed types of surgery. Most patients suffer from bilateral cataract and while cataract surgery of only one eye is effective in restoring functional vision, second-eye surgery leads to further improvements in health-related quality of life, and is cost-effective. At present, most patients undergo cataract surgery in both eyes on separate days as recommended in national guidelines, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating both eyes on the same day, but as separate procedures, known as immediately sequential bilateral cataract surgery (ISBCS). The aim of this study is to evaluate the effectiveness and costs of ISBCS compared to DSBCS, in order to test the hypothesis that ISBCS is non-inferior to DSBCS in terms of effectiveness and superior to ISBCS in terms of cost-effectiveness.Methods/designMulticenter non-inferiority randomised controlled clinical trial. Patients (18 years or older) with bilateral cataract and an indication for bilateral cataract surgery with an expected uncomplicated intraoperative and postoperative course are included in the study. Patients are randomly assigned to either ISBCS or DSBCS. The primary endpoint is the proportion of patients with a refractive outcome in the second eye within 1.0 dioptre from the target refraction, at 4 weeks after surgery. Secondary outcomes include corrected and uncorrected distance visual acuity, complications, patient reported outcomes (PROMs), cost-effectiveness, and budget impact. Follow-up visits are planned at 1 week after first-eye surgery and 4 weeks after second-eye surgery. At 3 months after first-eye surgery, the occurrence of complications is checked and patients fill in a final questionnaire.DiscussionThis study protocol describes the design of a multicenter non-inferiority randomised controlled trial. Current studies on ISBCS often lack information on safety regarding refractive outcomes. In addition, there is a lack of well-designed cost-effectiveness studies using established methods. The BICAT-NL study will provide more insight in refractive and cost-effectiveness outcomes for ISBCS compared to DSBCS.Trial registrationThis study was prospectively registered at Clinicaltrials.gov on January 17th 2018. (Identifier: NCT03400124.

Full-field Electroretinography in Age-related Macular Degeneration: can retinal electrophysiology predict the subjective visual outcome of cataract surgery?

Predicting the visual gain from cataract surgery when the main cause of vision loss is age-related macular degeneration may be difficult and warrants the need for an objective predictor of subjective outcome. Full-field electroretinography is an objective measure of overall retinal function. We therefore wanted to study if full-field electroretinography can predict subjective visual outcome using visual function questionnaire. Thirty-one patients with age-related macular degeneration operated for bilateral cataract underwent full-field electroretinography preoperatively. Full-field electroretinography was performed according to International Society for the Clinical Electrophysiology of Vision standards using a Ganzfeld bowl (RETI-port/scan 21, Roland, Berlin) and Dawson-Trick-Litzkow fibre electrodes. Vision-related quality of life was measured using the National Eye Institute Visual Function Questionnaire-39 before first-eye surgery and 4.12±2.11months after second-eye surgery. Mean change in composite visual function questionnaire score after cataract surgery was 9.2±11.9. The patients were divided into three groups: visual function questionnaire composite score increase >10 (n=17); no change (n=8); and decrease (n=6). In the dark-adapted full-field electroretinography responses, we found a significant difference between the three groups in the 0.01 b-wave amplitude (p=0.05), the 10.0 b-wave amplitude (p=0.04) and a near-significant difference in 3.0 a-wave amplitude (p=0.09). Other dark-adapted responses (the 3.0 b-wave and 10.0 a-wave) did not show any significant differences between the three groups, and neither did the light-adapted responses. Patients with low dark-adapted responses on full-field electroretinography preoperatively experience a decrease in subjective vision-related quality of life, suggesting that maintained rod function before cataract surgery may be important.

Optimum Refractive Target in Patients with Bilateral Implantation of Extended Depth of Focus Intraocular Lenses.

PurposeTo determine the refractive target of extended depth of focus (EDOF) intraocular lenses in dominant and non-dominant eyes which provides the best binocular vision at all ranges after cataract surgery.Patients and MethodsThis retrospective, single-center, non-comparative study included 47 patients who had undergone bilateral cataract surgery with implantation of EDOF IOLs (Tecnis Symfony or Tecnis Symfony Toric) targeting emmetropia in both eyes. Binocular uncorrected visual acuity at distance (UDVA), near (UNVA), intermediate (UIVA), and manifest refraction spherical equivalent (MRSE) were recorded between 1 and 3 months after the second-eye cataract surgery. Scattergrams for combined binocular UDVA, UIVA, UNVA and postoperative MRSE were plotted and the points of minima of the quadratic regression curve for the dominant and non-dominant eyes were considered as the optimum MRSE corresponding to the best overall visual acuity. Subgroup analysis of patients who achieved UDVA and UIVA ≥20/20 and UNVA ≥20/30 was also performed.ResultsFor the overall group, the optimum MRSE was −0.08 D for dominant and −0.63 D for non-dominant eyes. In a subset of 17 patients who achieved excellent acuity at all distances, the mean MRSE for the dominant and non-dominant eyes was −0.07 ± 0.14 D and −0.21 ± 0.24 D, respectively.ConclusionExcellent visual acuity at all ranges can be achieved with bilateral EDOF intraocular lenses implanted after cataract surgery. Our results indicate the best results when the dominant eye is targeted at emmetropia and the nondominant eye is targeted between −0.21D and −0.63D, with excellent results shown with mild myopia of −0.21 in the non-dominant eyes. Future studies with larger sample sizes and subjective patient-reported outcomes may validate current study outcomes.

The Necessity for Second-eye Cataract Surgery in Bilateral Highly Myopic Patients with Good Visual Acuity in the Unoperated Fellow Eye

ABSTRACT Purpose To evaluate the necessity for second-eye cataract surgery in bilateral highly myopic patients with good visual acuity in the unoperated fellow eye. Materials and Methods Seventy-five bilateral highly myopic patients who underwent uneventful sequential cataract surgery (the eye with worse visual acuity operated first) were included in this prospective study. The preoperative BCVA of the eye with better visual acuity in these patients was ≤ 0.3 (logMAR, or Snellen ≥ 20/40). Binocular single vision examinations were performed 1 month after the first-eye and second-eye surgery, respectively. The VF-14 questionnaire was completed before first-eye surgery, 1 month after the first-eye and 1 month after the second-eye surgery, respectively. Results The first eye’s postoperative SE was −3.07 ± 1.10D and the second eye’s preoperative SE was −12.91 ± 5.15D. Binocular single vision functional parameters improved significantly after the second-eye cataract surgery compared with that after the first-eye surgery (all P < .001). The binocular single vision function was negatively correlated with the SE difference between the two eyes after the first-eye surgery. No difference was found between the scores of VF-14 questionnaire preoperatively and after the first-eye surgery. VF-14 score only improved significantly after the second-eye surgery compared with that after the first-eye surgery (P < .001). Conclusion In bilateral highly myopic cataract patients, binocular single vision function could improve significantly after the second-eye cataract surgery compared with after the first-eye surgery. Bilateral highly myopic patients may undergo second-eye cataract surgery earlier, even if cataract in that eye is not severe enough to affect the visual acuity.

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population-based study.

Detailed incidence data for cataract surgery in the general population are limited, yet important for determining the surgical needs of the community and formulation of healthcare policies. To report incidence rates of cataract surgery in South Korea. Nationwide, retrospective population-based study. This study involved the entire population of South Korea (n = 47 990 761); 2 236 107 eyes of 1 591 176 patients confirmed as having cataract surgery from 1 January 2011 to 31 December 2015 were included. Data for all patients who underwent primary cataract surgery in South Korea were retrieved using Korean Electronic Data Interchange and Korean Standard Classification of Diseases-7 codes. Annual incidence rates were calculated and adjusted to the national population data for the corresponding year. The average incidence of cataract surgery during the 5-year study period was estimated using population data from the 2010 Korean census. The incidence of cataract surgery increased from 8.54/1000 person-years in 2011 to 9.67/1000 person-years in 2015. The probability of second-eye surgery within 12 months after the first-eye surgery increased from 42.98% in 2011 to 48.01% in 2015. In total, 85.72% of surgeries were performed in non-rural areas: 43.18% in individuals with a higher household income and 76.65% in primary healthcare centres. The rate of vitrectomy for posterior capsular rupture was 0.72%. The incidence of cataract surgery in South Korea is increasing over time. Our findings are expected to aid in the formulation of future healthcare policies concerning cataract surgery in South Korea.

Intraindividual study of anxiety and pain in sequential cataract surgery

Purpose: An understanding of the patient’s anxiety and pain and differences if any between the first and second cataract surgery can help patients, paramedics and surgeons to plan and execute a surgical procedure which is tailor made to the individual patient’s expectations, capabilities and weaknesses and ensure a happy patient and an even happier surgeon. This study was therefore proposed to compare bilateral cataract patient’s evaluation of pain and anxiety between first and second phacoemulsification surgery under topical anaesthesia. Materials and Methods: A prospective observational study was carried out, recruiting 60 patients of bilateral cataract scheduled for sequential phacoemulsification surgery under topical anaesthesia. The patients were assessed for anxiety in the preoperative room and for operative pain in the postoperative room by a numbered Visual Analog Scale (VAS) and modifiedWong-Baker faces scale. Peroperative assessment of surgeon’s comfort and patient satisfaction and comfort were recorded by a questionnaire, administered by a trained investigator. Results: Mean anxiety score was 3.151.21 (MeanSD) for first eye surgery and 1.580.89 for second eye surgery and was statistically significant (p first eye surgery. Mean pain score was 0.730.86 for first and 2.170.90 for second eye surgery and was statistically significant (p significant difference was observed in the surgeon’s grading of operative comfort and satisfaction between the two procedures. Conclusions: Higher visual disability, expectation from surgery and higher psychological stress lead to higher anxiety and lower pain score in first eye surgery, while previous successful surgery and operative experience lead to lower anxiety scores in second surgery. A relaxed mental state with consequent attention to operative process leads to higher pain score during the second surgery. Contrary to popular reasoning, patients undergoing second eye cataract surgery need a more detailed exp

Cost-utility analysis of cataract surgery in the United States for the year 2018

To perform a cost-utility analysis of 2018 United States real dollars for cataract surgery. Center for Value-Based Medicine, Hilton Head, South Carolina, USA. Cost-utility analysis. A base-case 14-year cost-utility model using the ophthalmic cost perspective was used. Third-party insurer and societal cost perspectives were also analyzed. Patient outcomes and costs were discounted with net present value analysis at 3% a year. First-eye cataract surgery resulted in a 2.523 quality-adjusted life-year (QALY) gain, a 33.3% patient value gain, and 25.5% quality-of-life gain. Bilateral surgery yielded a 44.1% patient value gain, while second-eye cataract surgery alone conferred an 8.1% value gain. First-eye cataract surgery resulted in a gain of 2.52 QALYs, while second-eye surgery added an incremental gain of 0.81 QALYs. The ophthalmic-cost-perspective average cost-utility ratio was $2526/2.523=$1001/QALY for first-eye cataract surgery. The societal-cost-perspective average cost-utility ratio was -$370 018/2.523=-$146 629/QALY. The second-eye ophthalmic-cost-perspective cost-utility ratio was $2526/0.814=$3101/QALY, while the ophthalmic-cost-perspective cost-utility ratio for bilateral cataract surgery was $5052/3.338=$1514/QALY. The 14-year U.S. 2018 real-dollar societal-cost-perspective net return on investment for first-eye cataract surgery was $370 018 above the $2526 cost expended for cataract surgery. Cataract surgery in both the first eye and second eye, when analyzed by standard health economic methodologies, is highly cost-effective. Cataract surgery in 2018 was 73.7% more cost-effective than in2000.