Simultaneous Bilateral Cataract Research Articles

Simultaneous Bilateral Phacoemulsification and Cataract Extraction - A New Operation Method

Simultaneous Bilateral Phacoemulsification and Cataract Extraction - A New Operation Method

Wybrane aspekty chirurgii zaćmy wieku dziecięcego

The authors present a selected practical problems in pediatric cataract surgery (simultaneous bilateral cataract surgery in congenital cataract, anterior and posterior capsular bag treatment, laser capsulotomy, intraocular lens calculation).

A novel two-surgeon technique of simultaneous bilateral cataract surgery with complete delinking.

Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon technique of SBCS on a 50-year-old mentally subnormal patient. Under general anesthesia, two surgeons performed phacoemulsification simultaneously, using two separate microscopes, irrigation lines, phaco machines, instruments, and assistants. Intraocular lens (IOL) implantation was performed in both eyes (OU). The patient had a visual recovery from 5/60, N36 in OU preoperatively to 6/12, N10 in OU on post-operative day 3 and 1 month, with no complications. This technique can potentially reduce the risk of endophthalmitis, repeated and prolonged anesthesia, and the number of hospital visits. To the best of our knowledge, this two-surgeon technique of SBCS has never been reported in the literature.

Extent of interocular (a)symmetry based on the metabolomic profile of human aqueous humor.

Aims: Interocular comparison of the metabolomic signature of aqueous humor (AH) was performed. The aim of the study was to quantitatively evaluate the symmetry in concentrations of various metabolites belonging to different categories. Methods: The study included AH samples from 23 patients, 74.17 ± 11.52years old, undergoing simultaneous bilateral cataract surgery at the Ophthalmology Department of the Medical University of Bialystok, Poland. Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS)-based targeted metabolomics and lipidomics analyses of AH samples were performed using the AbsoluteIDQ® p180 kit. Out of 188 metabolites available in the kit, 67 were measured in the majority (>70%) of the samples: 21/21 amino acids, 10/22 biogenic amines, 9/40 acylcarnitines, 0/14 lysophosphatidylcholines, 21/76 phosphatidylcholines, 5/15 sphingolipids, and 1/1sum of hexoses. Results: The comparison of both eyes revealed that the concentrations of metabolites did not differ significantly (p < 0.05) except for taurine (p = 0.037). There was moderate-to-strong positive interocular correlation (r > 0.5) between most metabolites regarding concentration. This was confirmed by the high intraclass correlation coefficient (ICC) values of different levels, which varied for the different metabolites. However, there were exceptions. Correlations were not significant for 2 acylcarnitines (tiglylcarnitine and decadienylcarnitine) and 3 glycerophospholipids (PC aa C32:3, PC aa C40:2, and PC aa C40:5). Conclusion: With a few exceptions, a single eye was found to be representative of the fellow eye in terms of the concentration of most of the analyzed metabolites. The degree of intraindividual variability in the AH of fellow eyes differs for particular metabolites/metabolite categories.

Management of cataract surgery in Lowe syndrome.

To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma. This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra- and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86min, whereas the total time of surgery was 153.33±22.11min. The mean extubation time and duration at recovery room was 42.33±22.60min and 130.00±64.37min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative follow-up, nystagmus (6 children) and strabismus (5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.

Impact of Three Waves of the COVID-19 Pandemic on the Rate of Elective Cataract Surgeries at a Tertiary Referral Center: A Polish Perspective.

The aim of this study was to assess the effect of three waves of the COVID-19 pandemic on the number of elective cataract surgeries. A retrospective single-center consecutive case series study was performed. We included all 12,464 patients who received cataract surgery in the period between 1 January 2016 and 31 May 2021. Monthly numbers of cataract surgeries during the pandemic were compared with monthly numbers in the reference years 2016–2019. In the pandemic the number of cataract surgeries decreased by 53.4%. The monthly numbers during the first, second and third wave of the pandemic were 77.5%, 51.5% and 29.7% lower, respectively, compared with the reference level. No rebound effect was observed once the pandemic restrictions were eased. Simultaneous bilateral cataract surgeries (SBCS) constituted 6.5% of cataract procedures performed in April and May 2021 compared with 0.77% carried out between May 2019 and March 2021. While the pandemic-affected monthly numbers of cataract surgeries tend to increase recently, they are still below the prepandemic level. Patients should be encouraged to weigh the risks of COVID-19-related morbidity and mortality against the benefits of cataract surgery. Reorganization of the logistics of cataract services is advisable with consideration of SBCS as one of the options.

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure.

Introduction Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020.

The debate on role of ‘simultaneous bilateral cataract surgery’ (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the ‘developing world’ but also in the ‘developed world.’ Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with ‘delayed bilateral cataract surgery’ (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.

Immediate Sequential Bilateral Cataract Surgery in Office Procedures at a Single Center: Retrospective Analysis of 560 Eyes of 280 Patients Undergoing Bilateral Cataract Surgery at a Single Site

Objective: Retrospective safety study of events and best-corrected visual outcomes after simultaneous bilateral cataract surgery (SBCS). Participants: patients undergoing refractive lens exchange or planned routine cataract surgery at a single site from May 2015 to February 2018. Methods: The medical records of 280 consecutive SBCS patients were analyzed included patient factors, specifically subsets of diabetics, hypertensive and current or past history of alpha adrenergic blockers. Main Outcome Measures: average change in BCVA, safety Results: 560 eyes of 280 patients underwent uncomplicated cataract surgery by two high volume cataract surgeons. The patient population was predominantly with Caucasian with a slight predominance of females. The average age of the patient was 57.6 years with a range of 18-86. 10% of eyes had diabetes although none had proliferative changes before or after surgery. Only 1% of patients were current or previous alpha adrenergic blocker users. 11% of eyes were affected by the use of blood thinners with less than 1% of eyes affected by two or more concurrent blood thinners. Fifty percent of lenses placed were multifocal, 24.6% monofocal, 21.7% toric and the small remainder evenly split between multifocal torics and crystalens. Average axial lengths were 24 mm with ranges of 18-30.5 mm. The predominant co-morbidities included hypertension. Hypercholesterolemia, thyroid disorders, depression or anxiety, allergies, osteoarthritis and gerd. The predominant ocular co-morbidities included open angle glaucoma, dry macular degeneration and dry eye. There were no intraoperative complications and less than 1% of patients experienced postoperative CME. One patient was transferred to emergency room for uncontrolled migraine from the preoperative area although she ultimately successfully underwent SBSC. No cases of endophthalmitis occurred Conclusions: Bilateral same day surgery can be safe with significant cost and time savings for surgeons, ASCs and patients with no serious adverse events and no increased complication risk, specifically for endophthalmitis.

Outcomes and complications of simultaneous bilateral cataract surgery (SBCS) in children—a 10-year review

SBCS has been viewed with caution by the ophthalmology community due to risk of devastating complications in both eyes. There is paucity of literature in children, for whom significant benefits can be derived by operating both eyes under the same anesthesia.

The Experience of Applying Simultaneous Bilateral Cataract Surgery (Sbcs) In a Patient with Deep Congenital Psychic and Somatic Pathology

The Experience of Applying Simultaneous Bilateral Cataract Surgery (Sbcs) In a Patient with Deep Congenital Psychic and Somatic Pathology

Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps.

OBJECTIVESThe aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps.METHODSThe medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications.RESULTSData from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45–80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more (P = .001). Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded.CONCLUSIONSUnder the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.

Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with 2 microincision intraocular lenses: Four-year results

To compare the development of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between 2 microincision intraocular lenses (IOLs) 4 years after surgery. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Prospective randomized clinical trial. Patients randomly received a Y-60H 3-piece hydrophobic IOL (hydrophobic group) in 1 eye and an MI60 1-piece hydrophilic IOL (hydrophilic group) in the contralateral eye during simultaneous bilateral cataract surgery. Eyes were examined 1 week, 20 months, and 4 years postoperatively. Digital retroilluminated images of each eye were evaluated using Automated Quantification of After-Cataract software. The Nd:YAG laser capsulotomy rate was recorded. Sixty patients were enrolled. Objective PCO was significantly higher in the hydrophobic group than in the hydrophilic group before capsulotomy 2 years after cataract surgery (mean score 2.1 ± 1.8 (SD) versus 1.2 ± 1.4) (P =.031). At the 4-year follow-up, the hydrophobic group had a statistically significantly higher Nd:YAG rate than the hydrophilic group (77% versus 50%) (P =.012). Comparison of 2 microincision IOLs indicated a statistically significant difference in PCO and Nd:YAG capsulotomy rates, with very high Nd:YAG rates 4 years after surgery.

Immediately Sequential Bilateral Cataract Surgery—A Global Perspective

By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.

Immediately Sequential Bilateral Cataract Surgery—A Global Perspective

By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.

Simultaneous Bilateral Cataract Surgery in Premature Babies With and Without Retinopathy of Prematurity

Background:Four premature babies (eight eyes) undergoing simultaneous bilateral cataract surgery are presented and discussed.Methods:All four babies underwent simultaneous bilateral cataract surgery. Three babies (six eyes) had primary implantation of posterior chamber intraocular lenses (IOLs) and one baby (two eyes) had primary lensectomies with secondary visual correction with contact lenses. Results: In all eight eyes, there was no endophthalmitis and no spontaneous choroidal hemorrhages. All eyes experienced large myopic shifts, as high as –15.00 D. All six eyes with IOLs required secondary membranectomies, which did not reoccur. Case 4 had Lowe’s syndrome, was bilaterally aphakic post-op, and subsequently developed glaucoma requiring bilateral glaucoma surgery. Conclusions: Simultaneous bilateral cataract surgery in severely premature babies can be successful in restoring vision over the long term. Strategies to successfully deal with the timing of surgery, IOLs, secondary membranes, secondary glaucoma, appropriate IOL powers, and IOL formulas is discussed. Successful long-term successful visual outcomes are now possible in this complex group of premature babies.

Simultaneous Bilateral Cataract Surgery in Children

Simultaneous Bilateral Cataract Surgery in Children

Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract

Long-term outcomes of intraocular lens (IOL) implantation for congenital cataract in children under 2 years old are still undetermined. We retrospectively reviewed all cases of bilateral congenital cataract who had undergone simultaneous bilateral cataract removal with posterior capsulotomy and central anterior vitrectomy between 1990 and 2010. Patients randomly underwent primary IOL implantation or secondary IOL implantation after a period of contact lens wear. The two groups were compared for visual outcome and complications during follow-up. Cataract removal and primary IOL implantation was performed in 30 eyes (15 patients; nine males, six females) at a mean age of 6.8 ± 4.2 months. After 79.31 ± 63.4 months, best-corrected visual acuity (BCVA) was 0.53 ± 0.36 EDTRS LogMAR. In 36 eyes (18 patients, 11 males, seven females) the lens was removed at a mean age of 5.42 ± 2.80 months, and after 32.0 ± 6.1 months of contact lens utilization, secondary IOL implantation was performed. After 109.0 ± 33.8 months, BCVA was 0.54 ± 0.4 ETDRS LogMAR. The association between age at surgery and final visual acuity and the difference between the two groups concerning type of cataract at baseline, BCVA and refractive error at last visit, incidence of posterior capsular opacification, glaucoma, strabismus, and nystagmus during follow-up were not significant (p > 0.05). Myopic shift was more frequent in eyes undergone primary IOL implantation (p < 0.001). Similar visual outcome and complications were observed during long-term follow-up after both primary and secondary IOL implantation following simultaneous bilateral congenital cataract removal with posterior capsulotomy and central anterior vitrectomy.

Simultaneous Bilateral Cataract Surgery With IOL Implantation in Children in Kenya

To investigate the cost implications, safety, and refractive outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation in pediatric patients in a developing world setting. Children aged 3 months to 10 years with bilateral congenital or developmental cataracts who underwent surgery between January 1, 2007, and December 31, 2009, were eligible for inclusion in this retrospective study. Cost data were compared for simultaneous and sequential cases. Postoperative complications and refraction data were analyzed. Ninety-six children (192 eyes) were included, 48 in the SBCS group and 48 in the sequential group. The mean age of the SBCS group and the sequential group was 3.4 and 4.7 years, respectively (P = .04). The total estimated surgical cost was $274 per child for SBCS and $344 for sequential surgery, a reduction of 20.3% for cases of SBCS. Fibrin formation of any amount occurred in 52 of 192 eyes (27.1%), 25 in the SBCS group and 27 in the sequential group (P = .75). Twenty-one eyes (10.9%) had additional surgery to remove visual axis obstruction, 14 in the SBCS group and 7 in the sequential group (P = .11). The incidence of early endophthalmitis in all cases of pediatric cataract surgery in an 11-year period was 0.16%. The incidence of anesthetic-related death during the same period was 0.11%. Bilateral simultaneous pediatric cataract surgery with intraocular lens implantation may be a safe alternative to sequential surgery, with advantages in cost reduction and no difference in sight-threatening complications.

Simultaneous bilateral cataract surgery: Economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2

To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned.