Cataract Surgery Research Articles

Artificial intelligence applications in cataract and refractive surgeries.

This review highlights the recent advancements in the applications of artificial intelligence within the field of cataract and refractive surgeries. Given the rapid evolution of artificial intelligence technologies, it is essential to provide an updated overview of the significant strides and emerging trends in this field. Key themes include artificial intelligence-assisted diagnostics and intraoperative support, image analysis for anterior segment surgeries, development of artificial intelligence-based diagnostic scores and calculators for early disease detection and treatment planning, and integration of generative artificial intelligence for patient education and postoperative monitoring. The impact of artificial intelligence on cataract and refractive surgeries is becoming increasingly evident through improved diagnostic accuracy, enhanced patient education, and streamlined clinical workflows. These advancements hold significant implications for clinical practice, promising more personalized patient care and facilitating early disease detection and intervention. Equally, the review also highlights the fact that only some of this work reaches the clinical stage, successful integration of which may benefit from our focus.

Acute intraoperative fluid misdirection managed with anterior approach irido-zonulo-hyaloido-vitrectomy.

To evaluate the causes of acute fluid misdirection (AFM) and the role of irido-zonulo-hyaloido-vitrectomy (IZHV) in the management of AFM. Among the 95,712 cataract surgeries performed between April 2017 and August 2022 at a tertiary center, six eyes of six patients developed intraoperative AFM and underwent IZHV through the anterior approach. AFM was diagnosed intraoperatively when there was sudden shallowing of the anterior chamber with markedly elevated intraocular pressures (IOPs) not attributable to external causes or choroidal effusion/hemorrhage. The condition resolved with deepening of AC following IZHV. Five eyes had angle closure disease (one of them also had pseudoexfoliation), and one eye had open-angle glaucoma. The mean preop IOP was 25.8 ± 7.3 mmHg, with an IOP range of 18-36. The mean number of preop AGM was 3 ± 1.7. Four eyes developed AFM during combined cataract and trabeculectomy, and two eyes during cataract surgery. Four eyes had aqueous misdirection during or after cortical aspiration, and two eyes after creation of internal trabeculectomy ostium. IZHV was performed for all eyes through an anterior approach using a 23G vitrector, which resulted in instant resolution and deepening of the anterior chamber. The mean follow-up was 8.75 months (1-48 months), the mean postoperative IOP was 16.1 ± 2.6 mmHg, and the mean number of AGM at the last follow-up was 2.8 ± 2.2. The anterior chamber was deep, and IOP was under control in all eyes with four eyes needing AGM. One eye developed postoperative aqueous misdirection due to blockade of the IZHV opening. IZHV can be an effective solution for acute intraoperative AFM, which can be performed via an anterior approach by the anterior segment surgeon.

Is Floppy Eyelid Syndrome predictive of Intraoperative Floppy Iris Syndrome? A prospective and translational study

Intraoperative floppy iris syndrome (IFIS) is defined as an excessive billowing of the iris during cataract surgery. Floppy eyelid syndrome is defined as an excessive hyperlaxity of the eyelids. Based in our daily experience, we suspected FES to be associated with IFIS. This association has been investigated. The goal of the study was to explore whether FES was predictive of IFIS. We conducted a prospective observational single-center study at the University Hospital of Nice. IFIS and FES were investigated in patients undergoing cataract surgery from November 2019 to May 2021. In addition, tarsus and iris samples were harvested in 2 fresh cadavers, and Verhoeff staining was used to identify elastin fibers. We included 452 eyes (n=312 patients, 50.9% male) with a mean age of 71.7years (±11.4). IFIS was diagnosed in 88 (19.5%) patients, including 20 (4.4%) grade 1, 34 (7.5%) grade 2, and 33 (7.3%) grade 3. FES was diagnosed in 35 (7.7%) patients. PEX was found in 23 (5.1%) patients. On multivariate analysis, FES (P<0.001), pseudo exfoliation (P=0.017), intracameral dilatation (P<0.004), senior surgeons (P=0.009) and α1-ARA (P<0.001) were associated with IFIS. Elastin fibers were identified in small amounts in the tarsus samples but not in the iris samples. FES is predictive of IFIS. Surgeons should be aware of this association to prevent intraoperative complications.

Global review of publicly available image datasets for the anterior segment of the eye.

This study comprehensively reviewed publicly available image datasets for the anterior segment, with a focus on cataract, refractive, and corneal surgeries. The goal was to assess characteristics of existing datasets and identify areas for improvement. PubMED and Google searches were performed using the search terms "refractive surgery," "anterior segment," "cornea," "corneal," "cataract" AND "database," with the related word of "imaging." Results of each of these searches were collated, identifying 26 publicly available anterior segment image datasets. Imaging modalities included optical coherence tomography, photography, and confocal microscopy. Most datasets were small, 80% originated in the U.S., China, or Europe. Over 50% of images were from normal eyes. Disease states represented included keratoconus, corneal ulcers, and Fuchs dystrophy. Most of the datasets were incompletely described. To promote accessibility going forward to 2030, the ESCRS Digital Health Special Interest Group will annually update a list of available image datasets for anterior segment at www.escrs.org .

Ophthalmic Surgeries at a Nigerian Teaching Hospital from the Perspectives of Undergraduate Medical Education

BackgroundAn appraisal of the profile of ophthalmic surgeries performed at Ladoke Akintola University of Technology Teaching Hospital (LAUTECHTH), Ogbomosho, Nigeria over a seven-year period with a view to harnessing their potentials for maximising ophthalmic experiences of medical students. MethodsA retrospective review of ophthalmic surgery records over a seven-year period (2013 – 2019) at LAUTECHTH. ResultsThere were 386 eye surgeries, mean ophthalmic surgeries: 4 - 5/month or 55/year. Most (329, 85.2%) surgeries were performed on individuals aged at least 45 (range 10 - 95) years with slight male dominance (1.1:1). The most common indication for surgery was cataract (307, 79.6%). Most surgeries were elective (362, 93.8%) and performed under local anaesthesia (367, 95.1%). Despite the highest number of surgeries being performed in the months of April and September; and lowest during the months of May and October; there was fair distribution across and over the years. Small incision cataract surgery with or without intraocular lens implant (307, 79.6%) was the most common surgery followed by pterygium excision with adjuvant therapy (37, 9.6%). ConclusionThe study showed a broad spectrum of eye surgeries, including cataract and pterygium, performed at the teaching hospital, encompassing common conditions that lead to visual impairment or blindness. This exposure provides valuable training opportunities for undergraduate medical students to become physicians especially those aspiring to become ophthalmologists. However, there is a need to increase the overall volume of eye surgeries to enhance the learning experience and potentially influence career choices.

Discriminant prediction equation using an optical biometer for identifying postmyopic laser vision correction eyes.

To create an equation for identifying postmyopic laser vision correction (M-LVC) eyes by using corneal shape parameters in a swept-source optical coherence tomography (SS-OCT) biometer and verify its accuracy. Nagoya Eye Clinic, Nagoya, Japan. Retrospective evaluation of a screening approach. Control participants were selected retrospectively from patients who visited the clinic for cataract surgery or refractive surgery. M-LVC patients were selected retrospectively from patients who visited the clinic for cataract surgery or M-LVC postoperative checkups. The control and post-M-LVC patients with keratometric values between 39 diopters (D) and 43 D were included in the final analysis. Patients were randomly assigned to equation-creation and validation groups in a 2:1 ratio. To discriminate post-M-LVC patients from control participants, multiple logistic regression analysis was performed with the corneal shape parameters from the optical biometer as independent variables. The M-LVC and control groups consisted of 90 eyes from 90 patients and 97 eyes from 97 patients, respectively. The average keratometry (Ave-K) values did not differ significantly between the control and M-LVC groups ( P = .187). The multiple logistic analysis identified the asymmetry component (regression coefficient, 5.357; odds ratio, 212.158) and corneal eccentricity index (regression coefficient, -5.088; odds ratio, 0.006) as explanatory variables. The area under the receiver operating characteristic curve in the predictive equation-creation group was 0.946. The sensitivity and specificity in the validation group were 93.3% and 87.5%, respectively. The M-LVC discriminant prediction equation with the topography-equipped SS-OCT biometer was effective in detecting post-M-LVC eyes with high accuracy.

Multimodal corneal imaging before refractive cataract surgery.

To prospectively review the advances in diagnostics for refractive cataract surgery, focusing on multimodal corneal analysis. The article explores the considerations related to planning refractive cataract surgery, emphasizing its potential to enhance patients' vision performance and quality of life. This review explores preoperative analysis in cataract surgery, focusing on assessing the cornea and ocular surface using multimodal diagnostics, including Placido disk-based corneal topography, Scheimpflug tomography OCT (optical coherence tomography), and biomechanical assessment. Wavefront technology, gene therapy, and artificial intelligence are also relevant in enhancing surgical precision and outcomes. It highlights the importance of preoperative thorough evaluations and technological advancements in ophthalmology. The rapid evolution and advancement of technology enable excellent refractive outcomes in most cases following cataract surgery. Consideration of appropriate preoperative factors is essential for achieving the desired postoperative outcome.

Trends in glaucoma surgery in a tertiary hospital in Spain: 2010-2022.

This study aims to conduct an analysis glaucoma surgeries performed over a 13-year period at a tertiary hospital affiliated with the Spanish National Health System, with the goal of assessing temporal trends. This retrospective observational study scrutinized surgeries undertaken in the glaucoma unit of a tertiary center in Spain between 2010 and 2022. Data collected included surgical dates, procedure performed, whether it was standalone or combined, as well as patient demographics including age, sex, and type of underlying glaucoma. Surgeries on individuals under 18 years of age were excluded. An annual comparative analysis was performed to ascertain the evolving trends in glaucoma surgical interventions. A total of 12,944 surgeries were included in the analysis, comprising 9428 isolated cataract surgeries and 2975 glaucoma procedures. Trabeculectomy, glaucoma drainage devices (GDD), and cyclodestruction, collectively referred to as traditional surgery, demonstrated a decline from 93.2% to 23.6% over the study duration. Minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb surgery (MIBS) demonstrated a significant increase from 3.8% in 2010 to 74.7% in 2022, relative to the total glaucoma surgeries. Furthermore, combined surgeries manifested a noteworthy increase from 39.0% in 2010 to 44.2% in 2022, with 86.4% of combined procedures in 2022 being MIGS or MIBS. In recent years, there has been a noticeable change in the trend of glaucoma surgeries, with MIGS and MIBS procedures experiencing a significant increase and becoming the most commonly performed glaucoma procedures. Consequently, traditional glaucoma surgeries have decreased in frequency.

Patients’ perceptions on reluctance to undergo cataract surgery in Sedibeng district hospital, Gauteng province

Background: Over 50 million people are blind, and 135 million people suffer from severe visual impairments, with cataracts contributing to 51% of global blindness cases. Despite efforts to promote cataract surgery (CS), many patients remain hesitant, underscoring the importance of understanding their perspectives.Aim: This study aimed to explore and describe patients’ perceptions regarding reluctance to undergo CS to improve awareness and increase surgery uptake.Setting: The research was conducted in the Sedibeng District, Gauteng province, South Africa.Methods: A qualitative descriptive phenomenological design was employed to capture the lived experiences of patients through face-to-face, individual semi-structured interviews with 15 patients aged 38 – 72 years prior to their CS. Purposive sampling was used to select participants, and Colaizzi’s seven-step analysis was used for data analysis.Results: The findings highlight several barriers perceived by participants, including long waiting times; fear; lack of knowledge; limited financial, material and human resources; power outages; uncontrolled blood sugar levels; and coronavirus disease 2019 (COVID-19) pandemic restrictions. Nevertheless, some view it positively as a means to avert blindness and enhance vision.Conclusion: To address the challenges, the study recommends boosting the number of eye health care professionals, prioritising budget allocation, addressing electricity interruptions and conducting community outreach educational programmes to improve access to CS in the district.Contribution: The insights gained from this study can help health care providers and policymakers optimise care and support for CS patients through policy formulation and education. Addressing these knowledge gaps will likely increase surgery uptake and improve patients’ quality of life.

Diagnostic utility of tear meniscus height measurement using anterior segment optical coherence tomography for lacrimal passage disorder before cataract surgery

To evaluate diagnostic utility of tear meniscus height (TMH) measurement using anterior segment optical coherence tomography (AS-OCT) for lacrimal passage disorder (LPD) in patients scheduled for cataract surgery. Patients with cataracts were enrolled. Lacrimal irrigation test was used to diagnose LPD. TMH measurement was performed using prior to cataract surgery. A receiver operating characteristic curve analysis was performed to calculate the cutoff value of TMH to detect LPD. Correlation between TMH and age, sex, LPD, use of glaucoma eyedrops, and use of dry eye drops in patients with and without LPD was evaluated. Sixty-six patients (127 eyes) were included, of which 12 (9.4%) eyes had LPD. The mean TMH was significantly higher in the LPD group than in the non-LPD group (P = 0.007). Multiple regression analysis revealed a significant association of TMH with LPD (P = 0.000). With an area under the curve of 0.740, the optimal cut-off TMH value was 401.0 μm. The sensitivity and specificity of this cutoff value were 58.3% and 83.0%, respectively. These findings demonstrate the diagnostic utility of TMH, measured using AS-OCT, for LPD. This suggests that AS-OCT is useful for preoperative exclusion of LPD.

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BackgroundTo evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.MethodsThis was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.ResultsThere were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.ConclusionsLess surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Long‐Term Monitoring of ApoE4 within Aqueous Humor Using Intraocular Lenses Containing Target‐Responsive Inverse Opal Hydrogel

Neurodegenerative diseases, including Alzheimer's disease (AD), pose significant challenges to global healthcare because of their irreversible postsymptomatic progression. Conventional radiographic techniques have limitations in early detection, owing to the time lapse between symptom recognition by individuals and precise inspection using medical instruments. Current research explores ophthalmic approaches to address this gap, investigating the physiological link between ocular health and brain diseases. Intraocular lenses (IOLs), widely used in cataract and refractive surgeries, provide a safe and minimally invasive platform for the continuous monitoring of neurodegenerative disease biomarkers, including those associated with AD. By integrating biomolecule‐responsive sensors with IOLs, it becomes feasible to achieve early diagnosis and long‐term, noninvasive monitoring postimplantation. Herein, a fluorescently labeled inverse opal hydrogel (FIOH) is merged with IOLs for ApoE4 detection, a key risk factor for AD. The permeability and inherent photonic properties of FIOH facilitate the cumulative enhancement of the fluorescence signal. In a simulation of the aqueous humor circulation, the detection limit for ApoE4 is determined to be 0.1 nM. Therefore, FIOH‐integrated IOLs hold promise not only for early detection but also for providing a reliable platform for the continuous, noninvasive monitoring of neurodegenerative diseases after the initial, minimally invasive implantation.

Does Laser Iridotomy Cause Secondary Epiretinal Membrane?

This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT). This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not. After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045). LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery.

Association of cataract surgery with risk of dementia: a meta-analysis and systematic review of cohort studies with 720,075 participants

Association of cataract surgery with risk of dementia: a meta-analysis and systematic review of cohort studies with 720,075 participants

Clinical Evaluation of Violet Light Filtration and High-Resolution Lathing on a Diffractive Extended Depth of Focus IOL.

This study is a prospective, randomized, subject/evaluator-masked clinical trial in a single-center clinical setting. The purpose of the study is to compare the clinical performance of Tecnis Symfony Optiblue IOL (models ZXR00V and ZXW150) with violet light filter (VLF) and manufacturing improvements versus Tecnis Symfony IOL (models ZXR00 and ZXT150) with ultraviolet light filter (UVF) in patients undergoing cataract surgery. Patients with cataracts aged ≥ 22years were randomly assigned 1:1 to bilateral implantation with ZXR00V/ZXW150 (VLF group) or ZXR00/ZXT150 (UVF group). Key endpoints at 6months postoperative included patient reported nighttime dysphotopsia symptoms, 25% low contrast visual acuity with glare, and patient satisfaction. Sixty patients were implanted with ZXR00V/ZXW150 (30) or ZXR00/ZXT150 (30). At 6months, the VLF group did not show a statistically significant differences in mean monocular photopic uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA) (40cm), or distance-corrected near visual acuity (DCNVA) (40cm) compared to the UVF group. At 1month, patients in the VLF group reported significantly less difficulty due to halo (p = 0.016) and starburst (p = 0.028) symptoms. By the 6months, dysphotopsia complaints were no longer significantly different between the groups. Although the VLF group trended toward better low contrast visual acuity and patient satisfaction, statistical significance was not reached. Managing the patients' expectations is key to achieving success. At the 1-month visit the patients who reported dysphotopsia complaints in the VLF group had significantly less difficulty with starbursts and halos as compared to the UVF group. By the 6-month visit, there was no significant difference between the two groups in the difficulty with starbursts and halos. ClinicalTrials.gov identifier, NCT06567834.

Development of a prognostic model for predicting long-term visual acuity after cataract surgery in children with bilateral congenital cataracts: a single centre retrospective, observational study

BackgroundTo evaluate factors influencing best corrected visual acuity (BCVA) in paediatric patients with bilateral congenital cataracts (CC) after cataract extraction and intraocular lens (IOL) implantation, as well as develop a robust model for predicting long-term visual acuity.MethodsThis retrospective study followed 194 paediatric patients with bilateral CC from January 2008 to December 2021. The endpoint event was defined as a final BCVA < 0.22 Log MAR at the last follow-up, which indicated good outcome. The probability of reaching this endpoint event was modelled using Cox proportional hazards regression analysis and internally validated through 200 iteration of 5-fold cross-validation.ResultsA prognostic model for long-term visual acuity in bilateral CC after surgical treatment was established as follows: ln h(t) = −0.009 × “age at cataract extraction” − 0.015 × “age at IOL implantation” − 2.934 × “without nystagmus at last follow − up” + ln h0(0), in which h0(t) represents the baseline risk equation that can be any non-negative equation for time (t); h(t) represents the probability of the endpoint event occurring at time (t) without any endpoint event occurring before it. The model was visualized using a nomogram and contour plot to facilitate clinical practice. The model demonstrated reasonably accurate discrimination with an area under the receiver operating characteristic curve of 0.712 (95% confidence interval [CI]: 0.589–0.835) and a C-index of 0.797 (95% CI: 0.683–0.911). According to the model, children with bilateral CC had a higher likelihood of achieving a good outcome (BCVA < 0.22 Log MAR) if they underwent cataract extraction before the age of six months (hazard ratio [HR] 1.80, 95% CI: 0.92–3.70), received IOL implantation before the age of thirty-one months (HR 3.70, 95% CI: 1.77–7.80), and presented without nystagmus during their last follow-up visit (HR 11.20, 95% CI: 3.96–31.80).ConclusionsThis long-term visual acuity prognostic model demonstrates adequate performance for individualized prediction and assists in clinical decision-making. The risk stratification index guides optimal timing for surgery.

Pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management. Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement. PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.

Cataracts Associated With Fibroblast Growth Factor Receptor Inhibitors for Cholangiocarcinoma

Since fibroblast growth factor receptor inhibitors (FGFRi) are used for treatment of intrahepatic cholangiocarcinoma (iCCA), understanding potential complications following longer-term use in clinical practice settings is warranted. This study describes cataract formation or progression as a complication of FGFRi use for the treatment of iCCA, even after treatment discontinuation. To describe cases of cataract formation or worsening in patients with iCCA treated with FGFRi and to characterize the ophthalmologic features, risk factors, and outcomes for FGFRi-associated cataracts. This retrospective case series study used data from patients with iCCA harboring FGFR2 aberrations who received FGFRi in clinical trials or as standard therapy from the University of California, San Francisco, Hepatobiliary Tissue Bank and Registry. Data were collected from patient visits between February 2015 and October 2021, and this retrospective investigation was conducted from September 6, 2022, to May 4, 2023. Data analysis was conducted from May 5, 2023, to September 6, 2023. Use of an FGFRi for the treatment of iCCA. The primary outcome was designated as development of a new or worsening cataract after FGFRi initiation. Statistical analysis for the association between cataract formation and clinical covariates was performed using unpaired t tests and Fisher exact tests. A single bivariate logistic regression model was used to examine total duration of FGFRi therapy and age at the conclusion of FGFRi therapy as predictors of cataract development. A total of 18 patients were included in the study; median (range) patient age was 54 (27-81) years, and 13 patients (72%) were female. Nine patients (50%) developed a cataract or had cataract progression in at least 1 eye after initiation of FGFRi. Of 17 eyes with cataract, 8 eyes (47%) required cataract surgery. One patient rapidly developed a cataract associated with phacomorphic glaucoma, which required urgent surgery. The median (range) time to cataract onset or worsening from initiation of FGFRi was approximately 18 (1-23) months. Five of 9 patients (56%) who developed cataracts or had cataract progression were diagnosed with new or worsening cataracts after discontinuation of FGFRi. Patients who developed cataracts had longer median (range) duration of FGFRi treatment compared with patients who did not develop cataracts (13 months [2-26] vs 5 months [1-11]; odds ratio, 1.01; 95% CI, 1.00-1.02; P = .02). While this retrospective case series study cannot prove cause and effect conclusively due to the study design, study results highlight cataract formation or progression as a potential adverse effect of FGFRi therapy, supporting consideration of periodic eye examinations in patients who have received this treatment.

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report

BackgroundPosterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.Case presentationA 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.ConclusionsThis case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

Should test for dry eyes be done before age-related cataract surgery?

Objectives: This study aimed to determine if tests for dry eyes should be done routinely before age-related cataract surgery. Materials and Methods: This was a hospital-based observational prospective study. Patients 50 years and above with age-related cataracts that met the inclusion criteria scheduled for manual small incision cataract surgery (MSICS) were assessed for dry eye disease (DED) before and after surgery. Numerical variables were described using the mean and standard deviation (SD) with a 95% confidence interval and P &lt; 0.05. Results: A total of 81 patients were studied: 60.5% (49) males and 39.5% (32) females. The mean pre-operative Schirmer’s test value was 14.09 mm (SD = 10.7 mm). Post-operative schirmer’s test values were 18.12mm (SD = 11.81mm) at 1 week, 14.98mm (SD = 11.26mm) at 4 weeks and 16.20 mm (SD = 11.06 mm) at 6 weeks. Pre-operative mean tear break-up time (TBUT) was 10.05 (SD = 5.13 s), 9.46 s (SD = 4.18 s) at 1 week, 10.13 s (SD = 4.29 s) at 4 weeks and 9.80 s (SD = 4.33 s) at 6 weeks postoperatively. Lissamine green staining score (LGSS) Grade 0 was 80% at 1 week post-operative, Grade 0 increased to 85%, 90% at 4 weeks and 91% at post-operative 6 weeks. Conclusion: This study showed that DED is not associated with MSICS, and it is not associated with objective worsening of previously diagnosed DED. Testing for DED preoperatively plays a significant role in the pre-operative evaluation of patients and symptomatic expectations, but its testing before MSICS might not always be necessary.