Uncomplicated Phacoemulsification Surgery Research Articles

TEAR FILM CHANGES FOLLOWING PHACOEMULSIFICATION SURGERY IN PRIMARY EYE CARE CENTER

Abstract
 Introduction & Objectives : Dry eye disease (DED) is one of the most commonly encountered problem in daily ophthalmology practice. One of many risk factors for DED is cataract surgery. Cataract surgery is known to modify tear film and ocular surface through corneal incision and ocular toxicity of peri- and postoperative medications. The aim of this study is to analyze tear film before and after phacoemulsification in primary eye care facility by measuring tear break-up time (TBUT), fluorescein staining, Schirmer I test (ST-I), and ocular surface disease index (OSDI) score.
 Methods : This was a longitudinal observational study with prospective cohort design, which included patients diagnosed with senile cataract and underwent uncomplicated phacoemulsification surgery at primary eye care center Sawangan Eye Clinic within period of June to December 2022. Friedman, Wilcoxon, and Cochran tests were used to analyze the data.
 Results : Thirty nine eyes from 39 patients met the inclusion criteria and were followed up to 3-month postoperatively. Mean age of the patients was 61.1±10.54 years, which consited of 53.8% males and 46.2% females. Mean preoperative OSDI score, corneal staining, TBUT, and ST-I were 24.94±10.24, 1.38±1.99, 2.94±2.17, and 15.46±8.80 respectively; while 3-month postoperative, these parameters’ means were 11.22±13.15 (p=0.0001), 1.38±2.56 (p=0.118), 3.13±1.79 (p=0.192), and 13.31±9.45 (p=0.006) respectively. OSDI was the only parameter which showed statistically significant changes from preoperative to postoperative follow ups (p<0.05).
 Conclusion : Phacoemulsification did not alter corneal staining and TBUT significantly after 3 months postoperatively, even though both of these parameters' preoperative value were already lower; yet OSDI score improved over time after surgery.

Anterior chamber flare and choroidal vascular index as inflammatory markers after uncomplicated phacoemulsification surgery.

To determine the effect of phacoemulsification surgery, which is one of the types of cataract surgery by using ultrasonic power to break up the crystalline lens and clean it with vacuum, on anterior chamber flare (ACF) and choroidal vascular index (CVI). For this cross-sectional study, patients were included if they had cataract with nucleus hardness grade 2 or 3, no systemic inflammatory disease, and not use of anti-inflammatory drugs/prostaglandins preoperatively. ACF using a laser flare meter and CVI in patients underwent uncomplicated phacoemulsification was recorded preoperatively, on the postoperative 1st day, 1st week, and 1st month. Fifty-six eyes were included. ACF was 9.00 ± 2.90 ph/ms preoperatively. Although ACF increased significantly on postoperative day-1 (39.38 ± 23.31ph/ms) and decreased gradually until the 1st month (14.03 ± 6.03ph/ms) after the operation, it was still significantly higher at the 1st month (p < 0.001). Macular and peripapillary CVI increased significantly on postoperative day-1 (0.64 ± 0.03/0.63 ± 0.05) and week-1 (0.64 ± 0.04/0.62 ± 0.04) (p = 0.01, p < 0.001); the postoperative 1st month was similar to the preoperative one (0.59 ± 0.06/0.58 ± 0.06). The relationship between the change in ACF and the change in CVI was not significant. Phacoemulsification causes raises in ACF and CVI due to increased intraocular inflammation. The fact that ACF was significantly higher in postoperative month-1 and CVI returned to its preoperative value suggests that the effect of uncomplicated phacoemulsification surgery on the increase in inflammation in the anterior segment lasts longer than in the posterior segment. These results suggest that ACF and CVI follow-up may be clinically important in the follow-up of postoperative inflammation.

A comparative study of central macular thickness and endothelial cell changes in patients with diabetes mellitus undergoing phacoemulsification.

One of the most prevalent causes of blindness worldwide is cataracts. Along with the lens, Diabetes mellitus can impact all ocular structures. Diabetics have a higher incidence of cataract formation due to a variety of reasons. Diabetic people may have thicker corneas. The most frequent reason for poor vision recovery after surgery is macular edema, which is caused by cataract surgery. Therefore, after phacoemulsification, we are measuring the central macular thickness and central corneal thickness in diabetics in order to observe the post phacoemulsification macular edema and any significant changes in corneal thickness. We expect a morphological changes in endothelial cells, increase central corneal thickness and increase central macular thickness post-operatively after uncomplicated phacoemulsification surgery.

Closure of a Chronic Traumatic Macular Hole Following Phacoemulsification Surgery.

To report a case of chronic traumatic macular hole closure following an uncomplicated phacoemulsification surgery. Retrospective chart review with optical coherence tomography imaging. 42-year-old woman with a 20-year history of a traumatic macular hole and cataract in the right eye underwent an uncomplicated phacoemulsification surgery. Following surgery, the patient was prescribed prednisolone acetate 1% four times per day, which was tapered off by postoperative month 1. By postoperative month 1, the full-thickness macular hole had closed. This unique case illustrates the closure of a full-thickness macular hole following cataract surgery. We hypothesize that closure of the macular hole was aided by the use of topical steroids in the postoperative period, allowing for resolution of the cystic intraretinal fluid and hole closure.

Change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital.

To determine the change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital. This study was conducted at Department of Ophthalmology Jinnah Postgraduate Medical Centre Karachi, for 6 months from 10th Dec 2019 to 10th June 2020. Sample size calculation of 52 eyes was done by using open epi software. Patients who fulfilled the inclusion criteria that is age ranging from 50 to 75 years, either gender with senile cataract having no preexisting ocular or systemic disease and those giving consent were included in this study. Patients with any comorbidity ocular trauma, having pre-existing ocular diseases such as active ocular infection, glaucoma, maculopathy or retinopathy were excluded from study. Patients with secondary cataract also excluded from study. After complete history, all patients underwent detailed ophthalmologic examination and Pre-surgery macular thickness recorded by using swept source OCT (DRI-OCT-2 Triton; Topcon). Surgery was performed and intraocular lens was implanted in all cases. Post procedure Macular thickness was measured using swept source OCT at 1st postoperative day, 1st month and 6th month after surgery. The mean age of patients was 62.06 ± 5.1 years. Total of 52 eyes diagnosed with senile cataract were included in this study. There were 30 (57.7%) males and 22(42.3%) females. The mean preoperative central foveal thickness was 201.3±24.8μm. The postoperative central foveal thickness was 200.3±25.2μm (153-265μm) at day 1st of surgery, 224.1 ± 53.8 μm (151-458 μm) at 1st month and 212.4±28.3μm (167-255μm) 6th month after surgery. The mean preoperative BCVA was 0.70 ± 0.43 (0.1-1.7) logMAR. The postoperative mean BCVA was 0.26 ± 0.42 (0.00-3.10) logMAR at 1st day, 0.07± 0.10 (0.000.7) logMAR at 1st month and 0.05 ± 0.10 (0.00-0.3) logMAR at 6th month. In our study we found an increase in macular thickness but there was no loss of BCVA from changes of macular thickness after surgery and the mean BCVA increased progressively in postoperative period.

Comparative study of effect of phacoemulsification on central macular thickness in diabetic and nondiabetic patients assessed with spectral domain optical coherence tomography

Abstract Purpose: The aim of this work was to study the effect of uneventful phacoemulsification on central macular thickness (CMT) in diabetic and nondiabetic patients as assessed with spectral domain-optical coherence tomography. Materials and Methods: A prospective, observational, comparative, cohort study was carried out at a tertiary care center in North India from January 1, 2018 to June 30, 2019. A total of 90 diabetic patients and 95 nondiabetic controls undergoing phacoemulsification surgery were evaluated. CMT and visual acuity (VA) were noted preoperatively and postoperatively at the 6th and 12th weeks, respectively. Results: A total of 185 patients, 95 nondiabetic, and 90 diabetic patients were included in the study. The mean age (years) of the study population was 64.56 (10.38). The subclinical increase in macular thickness was maximum at 6 weeks postoperatively (P &lt; 0.001) and was more in diabetic as compared to nondiabetic patients. Final macular thickness at 12 weeks was comparable in both diabetic and nondiabetic patients (P &lt; 0.05). However, the difference in change in macular thickness (preoperative versus postoperative) between the two groups was not clinically significant at 6 weeks (0.67 µm) and 12 weeks (0.08 µm). Conclusion: Uncomplicated phacoemulsification surgery with posterior chamber implantation of an intraocular lens is associated with subclinical macular thickening. However, there is no significant increase in macular thickness after phacoemulsification, irrespective of the glycemic status.

Evaluation of Macular Thickness Changes after Uncomplicated Phacoemulsification Surgery in Healthy Subjects and Diabetic Patients without Retinopathy by Spectral Domain OCT.

To assess differences in the evolution of macular thickness after uncomplicated phacoemulsification surgery between non-diabetic subjects and patients with diabetes mellitus (DM) without diabetic retinopathy (DR), using Spectral Domain OCT (SD-OCT). We performed a unicentric prospective study including one hundred and thirty-one eyes of 70 patients divided into two groups-34 well-controlled DM patients without DR and 36 non-diabetic subjects-who underwent phacoemulsification for cataract surgery. Eyes that developed pseudophakic cystoid macular edema (PCME) were excluded from the study, leaving us with 64 patients. Macular thickness was analyzed using Cirrus HD-OCT (Macular Cube 512 × 128 protocol) preoperatively and on postoperative days 7, 30, 90, and 180. For cases with information available for both eyes, one eye was randomly selected for analysis. A total of 64 eyes from 64 patients were analyzed in this study. The mean value of HbA1c in the diabetic group was 7%. After uncomplicated cataract surgery, patients showed no increase of the foveal, parafoveal, and perifoveal retinal thickness on postoperative day 7. However, thickness values increased on days 30, 90, and 180 after surgery in both groups, and peak at 90 days. There was no difference in macular thickness before or after surgery between DM and non-diabetic patients (p = 0.540). Macular thickness increases up to 6 months after uncomplicated cataract surgery in both DM patients without DR and non-diabetic subjects, with no differences between increases in both groups.

Occurrence of cystoid macular edema after uneventful phacoemulsification in diabetic patients without retinopathy: A hospital-based comparative study

This study aims to determine the incidence of CME after uneventful phacoemulsification in diabetic patients without any signs of retinopathy and nondiabetic patients in early post-operative periods. The present study was a prospective, comparative, hospital-based study conducted from December 2019 to December 2020 in the Ophthalmology department of a tertiary care referral hospital in Eastern India. All patients aged between 50 to 80 years of either sex with cataract grade nuclear sclerosis II–III with or without cortical cataract and early posterior subcapsular cataract undergoing uncomplicated phacoemulsification surgery by a single surgeon were included in the study. The patients were divided into 2 groups. Group 1 consisted of Type 2 diabetes mellitus patients with cataracts with no retinopathy changes on funduscopy and group 2 included healthy non-diabetic patients with cataracts. Comprehensive baseline evaluation including central retinal thickness (CRT) measurement using optical coherence tomography was done in all cases. Best corrected visual acuity (BCVA) and CRT were assessed 1 week and 6 weeks following surgery. Seventy-four patients were included in the study. Both the groups consisted of 37 cases each. The mean age in group 1 and group 2 was 62.24 ± 6.36 and 63.30 ± 6.39 years respectively. One patient in each group developed clinical CME in the postoperative period. The incidence of CME in our study was 2.7%. Improvement in BCVA was comparable in both groups and statistically insignificant. An increase in CRT was found to be statistically significant (P= 0.047) in group 1 at the 6th week follow-up. Visual outcomes in diabetic patients without retinopathy are similar to normal patients following uncomplicated phacoemulsification surgery.

Systemic immune-inflammation index could be associated with pseudophakic cystoid macular edema after an uneventful phacoemulsification surgery in patients without risk factors

BackgroundTo evaluate the association between serum biomarkers and pseudophakic cystoid macular edema (PCME) in eyes without risk factors after uneventful phacoemulsification cataract surgery.MethodsThis is a case–control study. Patients without risk factors and who developed clinically significant PCME after uncomplicated phacoemulsification surgery were enrolled in the study. The age- and sex-matched control group that had normal fundus examination findings and 10/10 visual acuity in the first week, first month and following postoperative control visits was randomly recruited from the same study cohort. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were obtained from the preoperative complete blood count (CBC) test and compared between the two groups. Linear regression analysis was used to assess the relationship between central macular thickness (CMT) and biomarkers. A binary logistic regression model was generated to evaluate the significance of the biomarkers in predicting PCME. The receiver operating characteristic (ROC) curves of the significant parameters in the logistic regression model were presented to detect the area under the curve (AUC), the cut-off point, the sensitivity and the specificity.ResultsThe study cohort included 5352 patients. Of these patients, 52 (0.97%) met the inclusion criteria, and 60 age- and sex-matched patients were recruited as the control group. PLR, NLR, and SII were significantly different between the two groups (p = 0.006, p = 0.002, p < 0.001, respectively). According to the linear regression analysis, SII was found to have a significant relationship with CMT (p < 0.001). Only SII was assessed as significant in the logistic regression model (p = 0.046). In the ROC curve, the AUC of SII was 0.709. The sensitivity and specificity of SII for PCME prediction were 65.38% and 75%, respectively, and the cut-off point was 433.70.ConclusionSII is associated with the occurrence of PCME in eyes without risk factors after uneventful phacoemulsification surgery. SII could be a useful tool to predict PCME in eyes without risk factors.

Optical Coherence Tomography Angiography to Estimate Early Retinal Blood Flow Changes after Uncomplicated Cataract Surgery.

Background: To investigate macular microvascular changes after uncomplicated phacoemulsification surgery according to the cataract severity grade. Methods: Retrospective, cross-sectional study involving 23 eyes of 23 patients who underwent elective cataract extraction. All patients underwent routine ophthalmologic examination, including optical coherence tomography angiography (OCTA) at baseline (preoperative visit, T0) and seven days postoperatively (T7). OCTA scans were obtained with the spectral domain system Cirrus 5000 (Carl Zeiss Meditec, Inc., Dublin, CA, USA), and 3 mm × 3 mm raster fovea-centered scans were obtained to evaluate the superficial capillary plexus (SCP) vessel density, perfusion density, and foveal avascular zone (FAZ) parameters. Results: SCP perfusion density significantly increased from 28.3 ± 5.73% to 33.74 ± 4.13% after the surgery (p < 0.001). Similarly, SCP vessel density significantly increased from 15.14 ± 3.41 mm−1 to 18.14 ± 2.57 mm−1 after surgery (p < 0.001). The mean preoperative FAZ area significantly increased from 0.27 ± 0.12 mm to 0.24 ± 0.11 mm seven days postoperatively (p = 0.008). When comparing softer and harder cataracts, no significant variations in SCP vessel density, as well as SCP perfusion density parameters and the FAZ area, perimeter, and circularity index, were noted before and after surgery. Conclusions: Macular SPC vessel density and macular SCP perfusion density increase after uncomplicated cataract surgery regardless of the cataract severity.

The Incidence of Dry Eye Disease after Uncomplicated Phacoemulsification Surgery

The Incidence of Dry Eye Disease after Uncomplicated Phacoemulsification Surgery

Safety of Prophylactic Intracameral Moxifloxacin Injection after Uncomplicated Phacoemulsification Surgery

Safety of Prophylactic Intracameral Moxifloxacin Injection after Uncomplicated Phacoemulsification Surgery

The Incidence of Post Phacoemulsification Surgery Induced Dry Eye Disease in Upper Egypt.

BackgroundDry eye is described as a multifactorial disorder of the tear film that occurs due to excessive tear evaporation or tears insufficiency, and so leads to ocular discomfort sensation and ocular tissue damage with time.ObjectiveTo assess the incidence of dry eye disease after uncomplicated phacoemulsification surgery in patients with no pre-existed dry eye.Patients and MethodsThis hospital-based cross-sectional study was conducted to assess the incidence of dry eye at 100 eyes of 100 patients who underwent uncomplicated phacoemulsification surgery, with age more than 45 years old. It is measured by dry eye tests Schirmer 1 and tear break up time.ResultsThis study showed that 22% of the patients who underwent uncomplicated phacoemulsification surgery suffered from dry eye with significant results at 1st week post-operative that improved over time.ConclusionThere was a statistically significant drop in the results of the Schirmer test 1 and TBUT post phacoemulsification surgery, but with no clinical significance as they still at the normal range. The tear film assessment results at the 1st week post-operative were out of the normal range with TBUT and were borderline with ST1 in 22% of the patients. These results improved over time to return to the normal values within 12 weeks postoperatively.

Surgically induced astigmatism and posterior corneal curvature changes following phacoemulsification.

Purpose:To primarily compare surgically induced astigmatism (SIA), total and posterior corneal curvature, pachymetry, and their stabilization after 2.2 and 2.8 mm clear corneal incision in phacoemulsification.Methods:A randomized, prospective interventional study of 130 patients (130 eyes) of either sex having senile cataract (>40 years) divided randomly into two groups. The patients underwent uncomplicated phacoemulsification surgery with foldable intraocular lens implantation using 2.2 mm (group 1) and 2.8 mm incisions (group 2). The patients were evaluated preoperatively and followed-up at first, third, and sixth weeks.Results:Mean SIA was less in group 1 at all the follow-up visits which was not statistically significant (P value – 0.507 (at week 1), 0.626 (at week 3), and 0.312 (at week 6). Mean SIA decreased from week 1 to week 6 in both the groups. Both the groups showed an increase in SIA with the increase in the hardness of cataract. Posterior keratometry (k1 and k2) showed statistically significant steepening in the first postoperative week, followed by gradual flattening which continued till the sixth week postoperatively. Posterior astigmatism increased in both the groups at week 1 (not statistically significant). Thereafter, it decreases and does not change significantly after 3 weeks. Pachymetry increased significantly (P value < 0.001 in both the groups) in the first week in both the groups and thereafter stabilizing at 3 weeks.Conclusion:Reducing the incision size does not result in any significant reduction in SIA. We observed that the posterior corneal curvature majorly stabilized by 3 weeks, but some stabilization continued till 6 weeks.

Postoperative Acute Bilateral Irvine-Gass Syndrome following Uncomplicated Phacoemulsification Surgery with Trifocal IOL—Two Case Reports

The case studies are about atypical bilateral, postoperative Cystoid Macular Edema (CME) in two patients who underwent bilateral uncomplicated pha- coemulsification surgery with a trifocal Intraocular Lens (IOL). In postoperative follow-up, both the cases presented with complaints of bilateral blurring of vision. Irvine-Gass syndrome has been diagnosed after evaluation of the retina by fundoscopy and OCT macula. Posterior subtenon steroid injection has been prescribed and given. Regular OCT examinations indicated substantial ede- ma improvement. Subsequent improvement in visual acuity was also noted in both cases. Cystoid macular edema can happen in any case irrespective of the quality of IOL. The visual outcome is satisfactorily responsive towards steroid medication.

Correlation between corneal tomography and postphacoemulsification positive dysphotopsia

ObjectivesThe aim was to compare between patients who have positive dysphotopsia after uncomplicated phacoemulsification surgery and those who do not have regarding their corneal tomographic findings.BackgroundDysphotopsia is a disturbance of vision and includes light phenomena such as haloes, the subjective perception of a bright ring around a light source. It occurs owing to optical nonconformities in the optical path such as cataract or optical boundaries.Patients and methodsThis is a prospective interventional study that was conducted for 1 year on 20 patients with acquired cataracts. Preoperative corneal tomography and visual assessment were carried out, and then postoperative periodic follow-up for 6 months was done with clinical and visual assessment for dysphotopsia.ResultsThis study shows that 40% of eyes (eight eyes) had higher order aberration with preoperative positive dysphotopsia and 60% of eyes (12 eyes) showed no higher order aberration with no preoperative positive dysphotopsia. Postoperative assessment of positive dysphotopsia showed that patients with no higher order aberrations complained of positive dysphotopsia and patients with higher order aberrations complained of positive dysphotopsia but more severe than before.ConclusionThis study concluded that there is a correlation between corneal tomography and postphacoemulsification positive dysphotopsia, which affects visual satisfaction of patients after phacoemulsification surgery.

Assessment of Alteration in Aerobic Conjunctival and Meibomian Gland Microbial Flora after Cataract Surgery and its Association with Postoperative Meibomian Gland Dysfunction

Introduction: Combination of various commensal microorganism species is capable of protecting the ocular surface from colonization by potentially pathogenic microbes. These homeostatic microorganisms can be easily altered by environmental factors like cataract surgery. These may play a role in the development of postcataract surgery Meibomian Gland Dysfunction (MGD) whose exact pathogenesis is still unknown. Aim: To assess the change in aerobic bacterial flora of meibomian glands and conjunctiva and its association with the development of MGD after cataract surgery. Materials and Methods: This prospective study was conducted in Department of Ophthalmology at BPS Government Medical College for Women, Sonepat, Haryana, India, from June 2021 to February 2022. A total of 60 eyes of 60 patients who had undergone uncomplicated phacoemulsification surgery with intraocular lens implantation were selected. Conjunctival and Meibomian Gland (MG) secretions samples were collected preoperatively before starting antibiotics and at 6 weeks postoperatively. Aerobic bacteria isolated from the culture samples of patients before and after surgery were analysed for microbial flora change (MFC). At 6 weeks postoperative follow-up visit, the diagnosis of the MGD was made on slit lamp examination of lid margin and meibomian glands. Chi-square test was applied to assess the association between patients with MFC and patients with MGD. Results: There were 33 males and 27 females, with a mean age of 62.41 years. Preoperative conjunctival samples of 20 patients (33.33%) and MG samples of 27 patients (45%) were culture positive for aerobic bacteria. Most common microorganism isolated from preoperative samples was Coagulase Negative Staphylococci (CoNS). Isolation rate of Staphyloccus aureus increased postoperatively in both conjunctival and MG culture samples. Postoperative aerobic Microbial Flora Change (MFC) in culture samples of either conjunctival or MG or both was present in 30 patients (50%). Total 16 patients (26.6%) developed MGD out of which 13 patients (81.25%) had MFC. The association between MFC and MGD was statistically significant (p-value=0.004). Conclusion: There is alteration of ocular aerobic bacterial flora after cataract surgery and it has a statistically significant association with postcataract surgery MGD. Replenishment of ocular surface microflora can play a preventive and therapeutic role in the management of postcataract surgery MGD.

Assessment of Macular and Retinal Nerve Fiber Layer Changes after Uncomplicated Phacoemulsification Surgery in Diabetic Patients Using Optical Coherence Tomography

Background: Macular edema (ME) is a major cause of vision loss after cataract surgery in patients with diabetes. In this study we aimed to assess the macular and retinal nerve fiber layer changes after uncomplicated cataract surgery in the early postoperative period in diabetic and non-diabetic patients. Methods: This is a comparative cross-sectional study conducted on patients with cataract, included 30 patients divided into 2groups: Group 1 (Study group): Diabetes mellitus group (DM group) consists of 15 eyes with cataract (15 diabetic patients without diabetic retinopathy). Group 2 (Control group): non diabetic group consist of 15 eyes with cataract (15 nondiabetic patients). Preoperative and 30 days postoperative OCT measurements were compared. All patients were admitted for cataract surgery (phacoemulsification) and posterior chamber intraocular lens (IOL) in Ophthalmology Department Benha University Hospital. Results and conclusion: The mean (±SD) age of diabetic group was 57.7 (±6.4). They were 6 males (40%) and 9 females (60%). While the mean (±SD) age of non-diabetic group was 60.2± (9.5). They were 9 males (60%) and 6 females (40%). Both groups were matched regarding age and gender (p>0.05 for both). Our data indicated that, although in each group; there is a significant increase in MFT and peripapillary RNFL postoperatively. However, there is a significant statistical difference between both groups regarding MFT and peripapillary RNFL after 30 days postoperative. Also there is improvement in BCVA progressively postoperative in each group, but there is a statistical significant difference between both groups.

Refractive Changes After YAG laser Capsulotomy In Pseudophakic Patients

Background: The aim of our study was to evaluate the effect of Nd:YAG laser posterior capsulotomy on patient’s refractive status .Methods: a retrospective study that involved 30 eyes (of 30 patient) treated with Nd:YAG laser capsulotomy due to posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens implantation. Complete ocular examinations were done for all patients before and after YAG capsulotomy. The best corrected visual acuity , sphere and cylinder were obtained before capsulotomy ,one week and one month after capsulotomy and changes were investigated. Data was analyzed statistically. Results: It was found that The mean refractive sphere shift towards myopic changing , The mean refractive cylinder changes towards hyperopic shift , there were no statistical significance of any change in axis of the cylinder .Conclusion: Statistical significant improvement in BCVA after Nd:YAG laser capsulotomy, so Nd:YAG is an effective instrument used in non-invasive treatment of posterior capsular opacification.Keywords Refractive changes after YAG laser capsulotomy in pseudophakic patients .

To assess the role of cataract extraction in glaucoma management by its intraocular pressure lowering effect.

To measure the mean change of intraocular pressure in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with intraocular lens implanted in capsular bag. The quasi-experimental study was conducted at the Ophthalmology Department of Pakistan Institute of Medical Sciences Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from June 11 to December 10, 2018, and comprised patients who had uncomplicated cataract extraction by phacoemulsification with intraocular lens implant in the capsular bag in glaucomatous eyes of age 30-80 years. Visual acuity, intraocular pressure, slit lamp examination, fundoscopy, visual fields, details about topical medication and relevant history were recorded not more than 5 days before cataract extraction. Intraocular pressure was recorded using Goldman's applanation tonometer one day before surgery, and post-surgery 1 month and 3 months. Data was analysed using SPSS 20. Of the 40 patients, 19(47.50%) were males and 21(52.50%) were females. The overall mean age was 52.23±9.44 years. Mean pre-operation intraocular pressure was 20.42±1.69mmHg, while at 1 month post-surgery it was 18.55±0.90mmHg and at 3 months it was 17.03±1.19mmHg (p=0.0001). There was a significant change in intraocular pressure readings in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with intraocular lens implanted in capsular bag.