Underwent Cataract Extraction Research Articles

Accuracy comparison of total keratometry and standard keratometry in intraocular lens power calculations for post-corneal refractive surgery cataract patients

Objective: To compare the accuracy of intraocular lens (IOL) power calculations using total keratometry (TK) versus standard keratometry (K) in post-corneal refractive surgery cataract patients. Methods: This retrospective case series study included 30 patients (36 eyes) with a history of laser corneal refractive surgery who underwent cataract extraction and IOL implantation at Qingdao Eye Hospital, Affiliated to Shandong First Medical University, from September 2022 to December 2023. The cohort comprised 16 males and 14 females, with an average age of (53.6±8.1) years. IOL power was calculated using the K-based Haigis-L and Barrett True-K formulas, as well as the TK-based Haigis and Barrett Universal Ⅱ formulas. Postoperative objective refraction was performed to obtain the actual refractive status of the operated eyes. The refractive prediction error (RPE) was defined as the difference between the actual spherical equivalent and the predicted refraction. The absolute value of the RPE was taken as the refractive absolute error (RAE). Differences in errors calculated by the four formulas were compared. Results: TK showed good consistency with K, with TK being on average 0.50 D lower than K. Analysis of variance revealed statistically significant differences in RPE among the four formulas (P<0.001). The RPE for the TK-based Haigis formula was (0.17±0.09) D, and for the Barrett Universal Ⅱ formula, it was (0.21±0.11) D, both significantly better than the K-based Haigis-L formula (-0.61±0.12) D and Barrett True-K formula (-0.57±0.11) D (all P<0.001). The percentage of eyes with postoperative RPE<±1.00 D was higher for the TK-based Haigis (92%, 33 eyes) and Barrett Universal Ⅱ (86%, 31 eyes) formulas compared to the TK-based Barrett True-K (75%, 27 eyes) and Haigis-L formulas (67%, 24 eyes), with statistically significant differences (P<0.05). Conclusions: Compared with K, TK improves the accuracy of IOL power calculation in post-corneal refractive surgery patients. Both the TK-based Barrett Universal Ⅱ and Haigis formulas demonstrate high accuracy.

Visual Outcomes of Cataract Surgery in Patients with Previous History of Implantable Collamer Lens

Background/Objectives: This retrospective case series analyzed visual outcomes in patients with a prior history of implantable collamer lens (ICL) implantation who underwent cataract extraction (CE). A secondary aim was to investigate the relationship between vault height and the rate of cataract development. Methods: Visual acuity and refraction measurements were collected after CE at one week, one month and six months. Vault height measurements were correlated to the time until symptomatic cataracts were removed. Results: A total of 44 eyes were analyzed at six months after CE with efficacy and safety indexes of 1.20 ± 1.11 and 1.50 ± 1.06, respectively. In addition, 70% of eyes had a post-operative uncorrected distance visual acuity (UDVA) within one line of pre-operative corrected distance visual acuity (CDVA). Refractive predictability at six months demonstrated that 43% and 69% of eyes were within ±0.25 D and ±0.50 D of SEQ target, respectively. Astigmatism measured by refractive cylinder was ≤0.25 D in 17% and ≤0.50 D in 34% of eyes pre-operatively compared to 40% and 60% of eyes, respectively, at six months post-operatively. Vault heights one week after ICL (p &lt; 0.0081) and one week before CE (p &lt; 0.0154) demonstrated a positive linear regression with the time until CE. Conclusions: This sample population achieved favorable visual outcomes six months after CE, similar to six months after ICL implantation. Patients with a history of ICL implantation will similarly have a good visual prognosis after CE.

Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery

To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion. Retrospective cohort study. Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified. Refraction data were analyzed at post-operative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D. The primary outcome was mean refraction at POM1 and POM6 across the three surgical groups. Secondary outcomes were comparisons of refraction and visual acuity among different goniotomy and SCS devices, as well as incidence of anisometropia. A total of 8,360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7,815 CE alone) from 6,059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36±0.91D, -0.31±0.85D, and -0.39±0.88D respectively (p=0.019). Mean logMAR VA was 0.10±0.20, 0.08±0.19, and 0.14±0.26 respectively (p=0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (p=0.217). At POM6, mean SEs were -0.38±0.97D (CE/goniotomy), -0.35±0.81D (CE/SCS), and -0.40±0.91D (CE alone; p=0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma (POAG) / normal-tension glaucoma (NTG) eyes, mean SE at POM1 was -0.36±0.73D (CE/goniotomy), -0.24±0.84D (CE/SCS), and -0.45±0.81D (CE alone; p<0.001). Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and visual acuity, although these small magnitude differences were unlikely to be clinically meaningful.

Impact of dexmedetomidine as an adjuvant to peribulbar anesthesia on the retinal vasculature in glaucoma patients: an optical coherence tomography angiography study

Objectives To assess Dexmedetomidine’s effect as an adjuvant to peribulbar anesthesia on the retinal vasculature in patients with glaucoma undergoing cataract extraction surgery via optical coherence tomography angiography (OCT-A). Participants Thirty-nine glaucoma participants planned for phacoemulsification were allocated into two groups. A 10 ml mixture of peribulbar anesthesia was administered to group I. This anesthetic mixture consisted of 4.5 ml of lidocaine 2% mixed with 4.5 ml of bupivacaine 0.5%,1 ml of dexmedetomidine (50 µg), and 150 IU hyaluronidase. Group II was administered a peribulbar anesthetic mixture consisting of 4.5 ml of lidocaine 2% combined with 4.5 ml of bupivacaine 0.5%,150 IU of hyaluronidase, and 1 ml of normal saline, totaling 10 ml. Optical coherence tomography angiography was used 10 mi before and 10 min after injection to scan optic disc total vessel density, foveal superficial deep capillary plexuses (DCP) density, radial peripapillary capillary network density, and total vessel density plus foveal avascular zone (FAZ) diameter. We also checked the intraocular pressure (IOP) before and 10 min after the anesthetic injection. Results After the administration of the peribulbar anesthetic, group II demonstrated a notably higher significance in the DCP fovea median percent change (–43.7%) compared with group I (-2%) (P&lt;0.001). Additionally, group II experienced a considerably greater median percent change in DCP total density (–22.4%) postinjection compared to group I (–0.8%) (P value &lt; 0.001). The postinjection median percent changes in foveal total vessel density and superficial vessel density were −16.2% and −56.8% in group II, and −1% and −2.4% in group I, respectively, with a P value less than 0.001. Moreover, following the injection, the median percentage change in the diameter of the foveal avascular zone was significantly higher in group II (–40.6%) than in group I (–2.3%) (P value &lt; 0.001). Additionally, there was a noteworthy increase in the optic disc’s total vessel density and the median percentage shift in radial peripapillary capillary network density in group II (–13.1 and −13.7%, respectively) compared with group I (–1.2 and −1%, respectively, P value &lt; 0.001). IOP before and after injecting the anesthesia was insignificantly different between the studied groups (P =0.198 and 0.069, respectively). Conclusion The addition of dexmedetomidine to the peribulbar anesthesia demonstrates a protective effect on the retinal microvasculature against the ischemic impact of anesthetic drugs with no significant effect on the IOP. This effect holds significant implications for glaucoma patients.

Effect of femtosecond laser-assisted phacoemulsification on corneal endothelium and prognosis of diabetic patients with cataract with different nuclear hardness

Objective: To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts, considering varying nuclear hardness. Methods: This non-randomized controlled trial involved 161 patients (161 eyes) with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022. The cohort comprised 73 males and 88 females, with an average age of (65.9±5.23) years. Based on patient preference, 101 individuals underwent conventional phacoemulsification (group A), while 60 chose femtosecond laser-assisted phacoemulsification (group B). Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1 (grade Ⅰ and Ⅱ), A2/B2 (grade Ⅲ), and A3/B3 (grade Ⅳ) subgroups. The study compared effective phacoemulsification time (EPT), cumulative energy release of phacoemulsification (CDE), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagon cell ratio (HEX) before and after surgery at 1 day, 1 week, 1 month, and 3 months. Results: The intraoperative EPT of patients in groups A and B were (6.52±4.93) and (5.63±4.31)s, respectively, and the CDE were 11.57%±5.21% and 10.68%±6.02%, respectively. The differences between them were not statistically significant (all P>0.05).There were no significant differences in EPT and CDE between groups A1 and B1 (all P>0.05), and there were statistically significant differences between groups A2 and B2, A3 and B3 (all P<0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery (all P>0.05), and there were statistically significant differences in CCT between A2 and B2, A3 and B3 groups at 1 day and 1 week after surgery (all P<0.05), and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery (P>0.05).ECD was reduced in both groups.There was no statistically significant difference in ECD at different time of operation between A1 and B1 groups (all P>0.05), while there was statistically significant difference in ECD at 1 day, 1 week, 1 month and 3 months after operation in A2 and B2, A3 and B3 groups (all P<0.05). Group B was significantly better than group A. There was no significant difference in coefficient of variation and HEX between the two groups at different time after surgery (P>0.05). Conclusion: Femtosecond laser-assisted phacoemulsification demonstrates benefits in preserving corneal endothelial cells, reducing early postoperative corneal edema, and minimizing corneal injury in type 2 diabetes patients with cataracts of high nuclear hardness.

Postoperative myopic shift and visual acuity rehabilitation in patients with bilateral congenital cataracts.

This study aimed to explore the postoperative myopic shift and its relationship to visual acuity rehabilitation in patients with bilateral congenital cataracts (CCs). Bilateral CC patients who underwent cataract extraction and primary intraocular lens implantations before 6 years old were included and divided into five groups according to surgical ages (<2, 2-3, 3-4, 4-5, and 5-6 years). The postoperative myopic shift rates, spherical equivalents (SEs), and the best corrected visual acuity (BCVA) were measured and analyzed. A total of 1,137 refractive measurements from 234 patients were included, with a mean follow-up period of 34 months. The postoperative mean SEs at each follow-up in the five groups were linearly fitted with a mean R2 = 0.93 ± 0.03, which showed a downtrend of SE with age (linear regression). Among patients with a follow-up of 4 years, the mean postoperative myopic shift rate was 0.84, 0.81, 0.68, 0.24, and 0.28 diopters per year (D/y) in the five age groups (from young to old), respectively. The BCVA of those with a surgical age of <2 years at the 4-year visit was 0.26 (LogMAR), and the mean postoperative myopic shift rate was 0.84 D/y. For patients with a surgical age of 2-6 years, a poorer BCVA at the 4-year visit was found in those with higher postoperative myopic shift rates (r = 0.974, p = 0.026, Pearson's correlation test). Performing cataract surgery for patients before 2 years old and decreasing the postoperative myopic shift rates for those with a surgical age of 2-6 years may benefit visual acuity rehabilitation.

The Prevalence and Risk Factors of Post-Operative Corneal Decompensation after Cataract Extract among Patients in Khartoum Eye Hospital - Sudan June 2021 - January 2022

 Background: Corneal decompensation is a medical condition characterized by opacity of the cornea. This condition arises as a result of mechanical injury caused by inadvertent contact of intraocular instruments with the cornea during surgery. Cataract extraction involves a surgical procedure to remove a clouded lens from the eye that has developed over, which can impede vision in the affected eye.  Objectives: To determine the prevalence and risk factors of post-operative corneal decompensation after cataract extraction according to the type of surgical procedure  Methodology: This is a Descriptive, retrospective, Cross sectional, hospital-based study, was conducted in Khartoum eye hospital, from June 2021 to January 2022. Patients who underwent cataract extraction between June 2021 - January 2022 Patients who were diagnosed with corneal decompensation were included. Data collection was conducted from medical record by using data sheet. The data will be analyzed via SPSS program (Statistical Package for The Social Sciences) and Microsoft Excel program. using chi square, t-test and correlation then be presented in the form of tables, bar charts and pie charts.  Results: About patient’s gender, males were 53(48.2%), females were 57(51.8%), patients from 70 – 79 years were 42(38.2%), 60 – 69 years were 33(30%), 50 – 59 years were 20(18.2%), and 40 – 49 years were 15(13.6%). About Diagnosed with symptoms of corneal Decompensation, yes 17(15.5%), No 93(84.5%), ; Extracapsular surgery was done in 55(50%) of patients, Phaco was done in 35(31.8%) of patients, and small incision cataract surgery was done in 20(18.2%) of patients, Glaucoma 7(15.5%) was the most common other contributing factors in followed by Trauma 4(36.4) and previous steroid use was 1(25%) respectively, About experience any intra-operative complications, no 108(98.2%) patients, yes 2(1.8%) patients.  Conclusion: Most of patients were females, between 70-79 years old, Extracapsular surgery was the most occuring type of surgery. Extracapsular surgery had the largest percentage of corneal decompensation. There was a notable correlation (significant association) that was observed between between gender, age and corneal decompensation.  Recommendations: Further research involving a larger sample size is necessary to validate the results of this study, Education programs should be developed to raise the awareness of patients.

T1D and T2D predispose to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases

PurposeTo assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery. DesignA retrospective cohort study. MethodsAll patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies. ResultsIncluded were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. ConclusionIn our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.

Short-term Visual Outcome Following Anterior Chamber Intraocular Lens Implantation—The Experience of a Rural Teaching Hospital

Purpose: To report the indications, frequency and short-term visual outcome of anterior chamber intraocular lens implantation (ACIOL) in a rural tertiary hospital; as well as to describe the reasons for poor visual outcome following ACIOL implantation. Methods: This was a retrospective descriptive study of all patients aged at least 18 years who underwent cataract extraction and implantation of ACIOL between January 2004 and May 2023. Information retrieved from the case records included preoperative visual acuity, indication for ACIOL implantation, first-day postoperative visual acuity, and 6 weeks postoperative visual acuity. Results: A total of 133 eyes of 126 patients were reviewed in this study. The mean age was 60.9 years, with a male-to-female ratio of 1.7:1. The most common indication for ACIOL use was a posterior capsular rent (70.7%). The first-day postoperative visual acuity was 6/18 or better in 7 (5.3%) patients, and by the sixth postoperative week, this proportion had increased to 28.6% (38 patients). The most common complication on the first day post-op was striate keratopathy (72.9%), while the most common at 6 weeks was pseudophakic bullous keratopathy (21.1%). Conclusion: Although complications were noted with the use of ACIOLs, improvement in visual acuity was observed at 6 weeks. ACIOLs may still be relevant in settings where automated vitrectomy equipment is not readily available, but the availability of expertize is required for its implantation and the complication profile of ACIOLs must always be taken into consideration.

Prediction of MIGS outcomes on second eyes using first eyes' response.

To evaluate how well outcomes following cataract extraction and microinvasive glaucoma surgery in one eye predict outcomes in sequential second eye. Retrospective study of 78 patients who underwent cataract extraction and microinvasive glaucoma surgery in both eyes. Linear regressions using Pearson correlation coefficients were used to evaluate correlations in intraocular pressure and glaucoma medication change between eyes. Multivariable logistic regression models were used to evaluate the associations between first-eye variables and the likelihood of second-eye surgical success at 6 months. Surgical success was defined as meeting target intraocular pressure without additional medications compared to baseline or secondary surgical interventions. Baseline ocular characteristics were comparable between fellow eyes, with the majority having mild glaucoma. Intraocular pressure changes between fellow eyes at 6 months were modestly correlated between eyes (R = 0.48; P < .001). Changes in glaucoma medications were strongly correlated between eyes at all time points, and month 6 demonstrated the most significant correlation (R = 0.80; P < .001). First and second eye cohorts achieved 82% and 83% surgical success. Multivariate analysis for predictive factors of successful second eye surgery showed patients with successful first eye surgery at 6 months were significantly more likely to have successful second eye surgery (odds ratio, 20.67; P < .001). Reductions in intraocular pressure and glaucoma medications at 6 months following surgery in first eyes are correlated to second eye reductions. Successful surgical outcomes at 6 months following first eye surgeries are strongly associated with successful sequential second eye outcomes.

Management of aphakia with low corneal endothelial cell count after complicated cataract surgery in a middle-age patient

Background: secondary intraocular lens implantation becomes more challenging due to pre-existing conditions. Objective: To report the outcome of retropubic iris-claw intraocular lens (RP-ICIOL) to corrects aphakia with low corneal endothelial cell count following previous complicated cataract surgery. Case: A 32-year-old male was referred to Undaan Eye Hospital with a chief complaint of blurred vision in his left eye (LE). Previously, the patient was diagnosed with a mature subluxated cataract and has undergone cataract extraction on the LE. Visual acuity of LE was 1/60 with raised intraocular pressure (31,8 mmHg with Schiotz Tonometry). On anterior segment examination, there was a clear cornea with an oval pupil and aphakia. The examination of the posterior segment was within normal limits. Specular microscopy of LE was 1140 cells/mm2. After IOP was controlled by medication, the patient then underwent retropubic iris-claw intraocular lens implantation. Post-operatively, the visual acuity of the LE was 2/10 and the IOP was 11 mmHg using non-contact tonometry. Six weeks post-op, the best visual acuity (BCVA) was 9/10 and the IOP was 15 mmHg and the CECD was 1110 cells/mm2 on the LE. Discussion: The RP-ICIOL was maintaining the physiological condition of the IOL location posteriorly, thus minimizing the risk of corneal decompensation and increased postoperative intraocular pressure, while at the same time trying to achieve a good refractive outcome. Conclusion: The implantation of RP-ICIOL is safe and effective management of aphakia with a low corneal endothelial cell coun secondary intraocular lens implantation becomes more challenging.

Lens-induced glaucoma - In a Tertiary Eye Care Center, Ethiopia

Background: Lens-induced glaucoma after untreated mature cataract is the commonest cause of secondary glaucoma in the developing world. The purpose of this study was to determine the common clinical features of lensinduced glaucoma, its management, and its outcome at Menelik II tertiary hospital, in Ethiopia.Methods and Materials: This was a retrospective study of cases that were seen at the hospital from January to December 2020. Lens-induced glaucoma patients who undergo cataract extraction were included in the study. Medical charts review was performed, and analysis was done using SPSS version 24.0 Software.Results: Forty-four lens-induced glaucoma patients were included in this study. Female participants were 65.9%. The mean age was 63.3(±Standard deviation (SD) 8.7) years. Phacomorphic glaucoma 88.6% was the leading cause. The common clinical symptoms identified were eye pain (100%), visual reduction (97.7%), and redness (38.8%). Visual acuity (3/60) or worse was reported in all patients with mean intraocular pressure of 37.3mmHg. After cataract surgery, the mean intraocular pressure reduced to 14.5± 6.55 mmHg while vision improved to better than 6/60 in 28 (63.6%) of patients. Of these, 21 (75%) patients seek medical treatment in the first two weeks of initial symptom.Conclusion: This study has identified the main cause of LIG was phacomorphic with the common clinical findings of pain, redness, and visual reduction. Early cataract extraction was associated with better final visual recovery and intraocular pressure control. An intraoperative complication was often observed in those with delayed presentation. Therefore, creating awareness among the general population and healthcare givers is key to the timely management of lens-induced glaucoma.

Endoscopy-assisted pars plana vitrectomy in retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes

BackgroundProliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes.MethodsRetrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients’ demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance.ResultsEighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year.ConclusionE-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

Presence of a soft contact lens during biometry

A case of an intraocular lens (IOL) power calculation error due to the presence of a soft contact lens (CL) is described. During preparation of a routine cataract surgery for a patient in the operating room, a soft CL was discovered on the patient’s surgical eye by the scrub nurse. Further, questioning revealed that the patient was a regular CL wearer and had possibly worn them during pre-operative biometric measurement, suggesting a potential error in his IOL calculation. Surgery was not performed, and the patient was given a CL holiday. Examination of the pre-operative B-scan ultrasound by the IOL Master700 confirmed the presence of the soft CL. Four weeks after the CL holiday, re-measurement of the surgical eye with the same biometric formula, lens factor and post-operative visual target revealed a +6.00 dioptre difference in the recommended lens implant. The patient underwent cataract extraction and IOL implantation with the correct IOL implant, with a good visual outcome. Presence of a CL during biometry causes a significant error in the IOL power calculation and should be identified preoperatively for this very common surgery.

Comparison of intraocular lens power prediction accuracy of formulas in American Society of Cataract and Refractive Surgery post-refractive surgery calculator in eyes with prior radial keratotomy.

To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive calculator in eyes with prior radial keratotomy (RK) for myopia. This retrospective study included 25 eyes of 18 patients whose status was post-RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post-refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True-K no-history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post-refractive calculator. Median absolute errors were the least for Barrett True-K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True-K, ASCRS Average (0.86 [-0.17, 1.61], 0.14 [-0.22 to 0.54], and 0.23 [-0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (-0.02 [-0.46 to 0.38] and - 0.48 [-1.06 to - 0.22] D, respectively). Multiple comparison analysis of Friedman's test revealed that Atlas formula was significantly different from IOLMaster/Lenstar, Barrett True-K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001). In post-RK eyes, Barrett True-K no-history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others.

Hyperacute Cutibacterium acnes Endophthalmitis Following Cataract Surgery.

Postoperative endophthalmitis is a relatively uncommon, but potentially visually devastating, complication associated with cataract surgery. Specific microbial causes of endophthalmitis are characteristically associated with particular disease time courses. Though Cutibacterium acnes is typically associated with an indolent course of inflammation, we report a case of C. acnes endophthalmitis with onset on postoperative day (POD) 1 and a positive culture from POD 2. Case report. A 56-year-old man underwent cataract extraction and posterior chamber intraocular lens placement in his left eye. On POD 1, he presented with severe discomfort, reduced visual acuity, and significant inflammation. On POD 2, his anterior chamber was tapped and injected with broad-spectrum antibiotics and steroids. The inflammation ultimately resolved, and his visual acuity improved to 20/20. C. acnes is a rare cause of hyperacute onset postoperative endophthalmitis. Maintaining a high clinical suspicion and initiating prompt treatment can help to optimize long-term visual outcomes.

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Effectiveness of the Preoperative Educational Guidelines for Patients Undergoing Cataract Extraction Surgery and Intraocular Lens Implantation

Is Demodex Blepharitis Connected With Cataract Surgery?

To determine whether there is an increased incidence of Demodex of the eyelashes among patients after cataract extraction surgery. Prospective, noncomparative clinical study. A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively that were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated 3 weeks after surgery. During several postoperative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. A total of 62 patients were included in the study (31 men and 31 women), with a mean age of 71.04 years (range, 47-87). In the group positive for Demodex, the male-to-female ratio was 2:3 (P=.2772). Demodex colonization was observed in 22.58% of samples before cataract surgery and in 32.26% after cataract surgery and topical postoperative steroid therapy (P=.0143). There is a statistically significant increase in Demodex colonization of eyelashes after cataract surgery and postoperative topical steroid treatment. Although Demodex colonization does not necessarily cause blepharitis, our findings of increased colonization should raise the possibility of Demodex blepharitis being considered by ophthalmologists in patients with chronic postoperative eye discomfort after cataract surgery. This study was carried out at the Emek Medical Center.

Posterior Capsular Contraction after Cataract Surgery: A Posterior Capsular Phimosis?

A 56-year-old female underwent cataract extraction in his right eye by phacoemulsification through a continuous curvilinear capsulorhexis, complicated by a posterior rupture, managed and followed by in-the bag lens implantation without complications.

Outcomes of cataract surgery in children who present with cataract at uveitis diagnosis

To describe the clinical and demographic characteristics of patients presenting with cataract at uveitis diagnosis treated at a single institution between 2005 and 2019 and to analyze postoperative outcomes following cataract surgery. We retrospectively reviewed the medical records of children (<18 years of age) diagnosed with cataract at their initial uveitis presentation who subsequently underwent cataract extraction. Outcome measures were best-corrected visual acuity, number of uveitis flare-ups (cells ≥1+), and postoperative complications. A total of 14 children (17 eyes) were included. Mean patient age was 7.2 ± 3.9 years. Methotrexate was initiated preoperatively in 11 patients; adalimumab, in 3. Primary intraocular lens was implanted in 4 eyes. Best-corrected visual acuity improved from a mean of 0.90 ± 0.40 logMAR preoperatively to 0.50 ± 0.35 logMAR at 1 year and 0.57 ± 0.40 logMAR at mean of 6.3 ± 3.4 years postoperatively. Four eyes (24%) had a single episode of uveitis flare-up during the first postoperative year. Macular and/or disk edema was discovered in 6 eyes following cataract removal. Only 3 eyes (18%) had ocular hypertension in the first year, but glaucoma developed in subsequent years in 7 eyes (41%), 5 of which required surgery. In our study cohort, surgery for preexisting cataract at uveitis diagnosis resulted in improved visual acuity. Postoperative uveitis flare-ups were relatively uncommon, occurring in 4 of 17 eyes. Glaucoma was the main long-term complication.