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Showing papers on "Cataract surgery published in 2009"


Journal ArticleDOI
TL;DR: In a small series of human clinical procedures, femtosecond laser capsulotomies and phacofragmentation demonstrated similarly high levels of accuracy and effectiveness, with no operative complications.
Abstract: Purpose To evaluate femtosecond laser lens fragmentation and anterior capsulotomy in cataract surgery. Methods Anterior capsulotomy and phacofragmentation procedures performed with an intraocular femtosecond laser (LenSx Lasers Inc) were initially evaluated in ex vivo porcine eyes. These procedures were then performed in an initial series of nine patients undergoing cataract surgery. In addition to standard intraoperative assessments (including capsulotomy diameter accuracy and reproducibility), optical coherence tomography was used to evaluate human procedures. Results For an intended 5-mm capsulorrhexis in porcine eyes, average achieved diameters were 5.88+/-0.73 mm using a standard manual technique and 5.02+/-0.04 mm using the femtosecond laser. Scanning electron microscopy revealed equally smooth cut edges of the capsulotomy with the femtosecond laser and manual technique. Compared to control porcine eyes, femtosecond laser phacofragmentation resulted in a 43% reduction in phacoemulsification power and a 51% decrease in phacoemulsification time. In a small series of human clinical procedures, femtosecond laser capsulotomies and phacofragmentation demonstrated similarly high levels of accuracy and effectiveness, with no operative complications. Conclusions Initial results with an intraocular femtosecond laser demonstrate higher precision of capsulorrhexis and reduced phacoemulsification power in porcine and human eyes.

510 citations


Journal ArticleDOI
TL;DR: The 3-year outcomes of patients who participated in a randomized trial evaluating 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema were reported in this article.
Abstract: Objective To report 3-year outcomes of patients who participated in a randomized trial evaluating 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema. Methods Eyes with diabetic macular edema and visual acuities of 20/40 to 20/320 were randomly assigned to focal/grid photocoagulation or 1 mg or 4 mg of triamcinolone. At the conclusion of the trial, 3-year follow-up data were available in 306 eyes. Results Between 2 years (time of the primary outcome) and 3 years, more eyes improved than worsened in all 3 treatment groups. Change in visual acuity letter score from baseline to 3 years was +5 in the laser group and 0 in each triamcinolone group. The cumulative probability of cataract surgery by 3 years was 31%, 46%, and 83% in the laser and 1-mg and 4-mg triamcinolone groups, respectively. Intraocular pressure increased by more than 10 mm Hg at any visit in 4%, 18%, and 33% of eyes, respectively. Conclusions Results in a subset of randomized subjects who completed the 3-year follow-up are consistent with previously published 2-year results and do not indicate a long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation in patients with diabetic macular edema similar to those studied in this clinical trial. Most eyes receiving 4 mg of triamcinolone as given in this study are likely to require cataract surgery. Trial registration clinicaltrials.gov Identifier: NCT00367133.

382 citations


Journal ArticleDOI
TL;DR: Corneal astigmatism less than 1.25 D was present in most cataract surgery candidates; it was higher in about 22%, with slight differences between the various age ranges, which is useful for intraocular lens manufacturers and surgeons to evaluate which age ranges concentrate the parameters most frequently needed in sphere and cylinder powers.
Abstract: Purpose To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates. Setting University of Valencia, Valencia, Spain. Methods Refractive and keratometric values were measured before surgery in patients having cataract extraction. Descriptive statistics of refractive and keratometric cylinder data were analyzed and correlated by age ranges. Results Refractive and keratometric data from 4540 eyes of 2415 patients (mean age 60.59 years ± 9.87 [SD]; range 32 to 87 years) differed significantly when the patients were divided into 10-year subsets. There was a trend toward less negative corneal astigmatism values, except the steepest corneal radius and the J 45 vector component, in older groups (Kruskal-Wallis, P Conclusions Corneal astigmatism less than 1.25 D was present in most cataract surgery candidates; it was higher in about 22%, with slight differences between the various age ranges. This information is useful for intraocular lens (IOL) manufacturers to evaluate which age ranges concentrate the parameters most frequently needed in sphere and cylinder powers and for surgeons to evaluate which IOLs provide the most effective power range.

372 citations


Journal ArticleDOI
TL;DR: Advances and improvements in surgical techniques, intraocular lens materials, and the designs and use of therapeutic agents leading to safe, effective, and less expensive strategies to eradicate PCO are described.
Abstract: Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. Advances in surgical techniques, intraocular lens materials, and designs have reduced the PCO rate, but it is still a significant problem. The only effective treatment for PCO, Nd:YAG laser capsulotomy carries vision-related complications and risks and puts a significant financial burden on the health care system. This review contains current knowledge about the mechanisms of PCO development. Posterior capsular opacification is caused mainly by remnant lens epithelial cell proliferation and migration, epithelial-mesenchymal transition, collagen deposition, and lens fiber generation. All of these processes are influenced by cytokines, growth factors, and extracellular matrix proteins. We also describe advances and improvements in surgical techniques, intraocular lens materials, and the designs and use of therapeutic agents leading to safe, effective, and less expensive strategies to eradicate PCO.

328 citations


Journal ArticleDOI
01 Jan 2009-Eye
TL;DR: Higher-risk cases can be predicted, thus better informing the consent process and allowing surgeons to take appropriate precautions, according to risk profile of individual operations.
Abstract: To identify and quantify risk factors for posterior capsule rupture or vitreous loss or both (PCR or VL or both) during cataract surgery and provide a method of composite risk assessment for individual operations. The Cataract National Dataset was extracted on 55 567 operations from 12 National Health Service (NHS) Trusts using an electronic patient record (EPR) system between November 2001 and July 2006. Risk indicators for variations in the rate of ‘PCR or VL or both’ were identified by univariate and multivariate analyses. Adjusted odds ratios (ORs) were used to formulate a composite ‘bespoke’ risk for individual cases. Overall ‘PCR or VL or both’ rate was 1.92% (95% CI=1.81–2.04%). Risk indicators for this complication were increasing age, male gender, presence of glaucoma, diabetic retinopathy, brunescent/white cataract, no fundal view/vitreous opacities, pseudo-exfoliation/phacodonesis, reducing pupil size, axial length ⩾26.0 mm, the use of the α-blocker doxazosin, inability to lie flat and trainee surgeons performing operations. Adjusted ORs for these variables are used to estimate overall composite risk across multiple risk indicators in the form of a predicted probability of PCR or VL or both. Predicted probability for this complication ranged from less than 0.75% to more than 75%, depending on risk profile of individual operations. Higher-risk cases can be predicted, thus better informing the consent process and allowing surgeons to take appropriate precautions. Case-mix is a major determinant of the probability of an intraoperative complication. A simple composite risk estimation system has been developed.

256 citations


Journal ArticleDOI
01 Jan 2009-Eye
TL;DR: This survey confirms shifts in practice since the 1997–1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical ‘index’ benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes.
Abstract: To pilot the use of the Cataract National Dataset (CND) using multi-centre data from Electronic Patient Record (EPR) systems and to demonstrate the ability of the CND to deliver certain of its intended benefits, including detailed preoperative profiling of cataract surgery patients and updating of benchmark standards of care in the NHS and beyond. NHS departments using EPR systems to collect a minimum preoperative, anaesthetic, operative and postoperative data set, the CND, were invited to submit data, which were remotely extracted, anonymised, assessed for conformity and completeness, and analysed. Four-hundred and six surgeons from 12 NHS Trusts submitted data on 55 567 cataract operations between November 2001 and July 2006 (86% from January 2004). Mean age (SD) was 75.4 (10.4) years, 62.0% female. Surgery was for first eyes in 58.5%, under local anaesthesia in 95.5% and by phacoemulsification in 99.7%. Trainees performed 33.9% of operations. Preoperative visual acuity (VA) was 6/12 or better in 42.9% eyes overall, in 35.3% first eyes and in 55.3% second eyes. Complication rates included the following: posterior capsule rupture and/or vitreous loss of 1.92%, simple zonule dialysis of 0.46% and retained lens fragments of 0.18%. Postoperative VA of 6/12 or better (and 6/6 or better) was achieved for 91.0% (45.9%) of all eyes, 94.7% (51.0%) of eyes with no co-pathologies and 79.9% (30.2%) of eyes with one or more co-pathologies respectively. The CND is fit for purpose, is able to deliver useful benefits and can be collected as part of routine clinical care via EPR systems. This survey confirms shifts in practice since the 1997–1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical ‘index’ benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes.

253 citations


Journal ArticleDOI
TL;DR: The biological mechanisms driving PCO progression are described, the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO are discussed and the influence aqueous and vitreous humours are discussed.

242 citations


Journal ArticleDOI
01 Jan 2009-Eye
TL;DR: A benchmark standards for refractive outcome after cataract surgery in the National Health Service when implementing the 2004 biometry guidelines of the Royal College of Ophthalmologists and customising Aconstants are established.
Abstract: To establish benchmark standards for refractive outcome after cataract surgery in the National Health Service when implementing the 2004 biometry guidelines of the Royal College of Ophthalmologists and customising Aconstants. Three cycles of prospective data were collected throughout the cataract care pathway on all patients using an electronic medical record system (Medisoft Ophthalmology), between January 2003 and February 2006. The electronic medical record automatically recommends the formula to be used according to the College guidelines and allows Aconstants to be customised separately for either ultrasound or partial coherence interferometry methods of axial length measurement and for different intraocular lens models. Consultants and trainees performed routine phacoemulsification cataract surgery and new intraocular lens models were introduced during the cycles. Uncomplicated cases with‘in-the-bag fixation’, achieving 6/12 Snellen acuity or better were included. Community ophthalmic opticians performed refraction at 4 weeks. The postoperative subjective refraction was within 1 D of the predicted value in 79.7% of the 952 cases in cycle 1, 83.4% of 2406 cases in cycle 2, and 87.0% of 1448 cases in cycle 3. On the basis of our data, using College formula, optimising Aconstants and partial coherence interferometry, a benchmark standard of 85% of patients achieving a final spherical equivalent within 1 D of the predicted figure and 55% of patients within 0.5 D should be adopted.

212 citations


Journal ArticleDOI
TL;DR: The new triple-procedure DSAEK combined with cataract surgery provides rapid visual recovery and allows selection of an appropriate intraocular lens.

196 citations


Journal ArticleDOI
TL;DR: A grooved incision can aggravate the symptoms during the early postoperative period in patients without dry eye preoperatively and long microscopic light exposure times can have an adverse effect on dry eye test values.
Abstract: Purpose: To investigate changes in dry eye symptoms and diagnostic test values after cataract surgery and to address factors that might influence those symptoms and test results. Methods: Twenty-eight eyes from 14 patients with preoperative dry eye (dry eye group) and 70 eyes from 35 patients without preoperative dry eye (non-dry eye group) were studied prospectively. In each group, we measured values such as tear break-up time (tBUT), Schirmer I test (ST-I), tear meniscus height (TMH), and subjective dry eye symptoms (Sx), and evaluated the postoperative changes in these values. We also evaluated the influence of corneal incision location and shape on these values. The correlations between these values and microscopic light exposure time and phacoemulsification energy were investigated. Results: In the dry eye group, there were significant aggravations in Sx at 2 months postoperatively and in TMH at 3 days, 10 days, 1 month, and 2 months postoperatively, compared with preoperative values. All dry eye test values were significantly worse after cataract surgery in the non-dry eye group. With regard to incision location, there was no difference in tBUT, Sx, ST-I, or TMH in either the dry eye group or the non-dry eye group at any postoperative time point. Regarding incision shape, there was no difference in tBUT, Sx, ST-I or TMH at any postoperative time point in the dry eye group. In the superior incision sub-group of the non-dry eye group, tBUT and Sx were worse in the grooved incision group at day 1. In the temporal incision sub-group of the non-dry eye group, Sx were worse in the grooved incision group at 1 day, 3 days, and 10 days postoperatively. In both groups, significant correlations were noted between microscopic light exposure time and dry eye test values, but no correlation was noted between phacoemulsification energy and dry eye test values. Conclusions: Cataract surgery may lead to dry eye. A grooved incision can aggravate the symptoms during the early postoperative period in patients without dry eye preoperatively. Long microscopic light exposure times can have an adverse effect on dry eye test values.

196 citations


Journal ArticleDOI
TL;DR: Patients with any type of IOL are at risk for late in-the-bag dislocation, and Pseudoexfoliation and vitreoretinal surgery were the most common associated conditions in this series.

Journal ArticleDOI
TL;DR: The AREDS results showed no clear effect of cataract surgery on the risk of progression to advanced AMD, and the Cox proportional hazards model of right eyes showed nonsignificant hazard ratios.

Journal ArticleDOI
TL;DR: Eyes with well-controlled uveitis may obtain similar outcomes to control eyes after cataract surgery (up to 3 months).

Journal ArticleDOI
TL;DR: An Index for measuring Visual Functioning on the basis of self‐assessment is presented and evaluated clinically and statistically and the construct validity and the reliability are shown to be sufficient.
Abstract: An Index for measuring Visual Functioning on the basis of self-assessment is presented and evaluated clinically and statistically. The construct validity and the reliability are shown to be sufficient. The ‘Visual Functioning Index’ has been applied to a group of cataract patients. In bilateral cataract patients visual functioning is, of course, correlated to visual acuity in the best eye, but this correlation is not straight forward. So, for the assessment of visual impairment both visual acuity and visual functioning must be measured. Application of the Index to a group of monaphakic cataract patients indicates a good improvement of visual function obtained even by first cataract extraction. Ideally cataract surgery should be performed before the total visual functioning and social integration is severely damaged. On this basis about 20% of the patients in this study should have been operated at an earlier stage, which among other things suggests a need for additional surgical capacity.

Journal ArticleDOI
TL;DR: Toric IOL implantation achieved a slight enhanced effect over OCCIs in treating preexisting astigmatism in patients having cataract surgery.
Abstract: Purpose To compare toric intraocular lens (IOL) implantation with paired opposite clear corneal incisions (OCCIs) for astigmatism correction in patients having cataract surgery. Setting Ophthalmology Service, Donostia Hospital, San Sebastian, Spain. Methods This randomized prospective clinical study comprised eyes with more than 1.00 diopter (D) of preexisting corneal astigmatism. One group had AcrySof toric IOL implantation and the other, paired 2.75 mm/3.20 mm OCCIs in the steep axis with spherical IOL implantation. Uncorrected (UCVA) and best corrected (BCVA) visual acuity, refraction, corneal and total higher-order aberrations (HOAs), photopic and mesopic contrast sensitivity, and toric IOL axis were measured 3 months postoperatively. Results Forty eyes (40 patients) were evaluated. In the toric group, 95% of eyes achieved 20/40 or better UCVA and 70%, 20/25 or better. In the OCCI group, 80% of eyes achieved 20/40 or better UCVA and 50%, 20/25 or better. All eyes achieved 20/25 or better BCVA. Mean refractive cylinder decreased significantly from preoperatively to postoperatively (−1.75 ± 0.71 to −0.62 ± 0.46 D, toric group; −1.61 ± 0.67 to −0.97 ± 0.51 D, OCCI group) (P .1). Contrast sensitivity was similar except at the highest spatial frequency, being better in the toric group (P Conclusion Toric IOL implantation achieved a slight enhanced effect over OCCIs in treating preexisting astigmatism.

Journal ArticleDOI
TL;DR: The most important predisposing factors for an early large with the-rule-astigmatism or rapid changes in the postoperative astigmatism were large preoperative with-the-ruleAstigmatism, young age, low preoperative intraocular pressure, if an ECCE were chosen as the extraction type, anterior (corneal) location of the incision at surgery, and, finally, the surgeon.
Abstract: There has been a striking increase in the number of cataract operations in the referral region of the Lund Health Care District during 1986 through 1990, in 1990 reaching 3.6 per 1000 inhabitants. Different preoperative, intraoperative and postoperative variables and observations were registered and analysed for 5878 consecutive cataract cases operated in the period studied. Women predominate in the material and despite the increased number of operations during the period studied there was no drop in patient age. Young patients and diabetic patients show an increased standardised mortality ratio (SMR) compared to the normal population. Of the population, 78% had a preoperative astigmatism of <1.5 diopters. The amount of astigmatism was found to deviate more from the normal both in large and in small eyes. A second degree polynomial model was found to give the best description of the relation between axial length and keratometric powers. A cataract patient with glaucoma and operated on by an inexperienced surgeon runs a significantly increased risk for complications at surgery, as indicated by capsule or zonule rupture. At two years after cataract surgery we found the risk for retinal detachment to be 0.18%. The relative risk for detachment was found to be 4.9 after a YAG-laser capsulotomy. It changed by a factor of 1.3 with an increase in the axial length by one unit (=1 mm) and with 0.94 for each added patient age year. Besides age, five variables significantly influenced the risk of having postoperative YAG laser treatment. They were gender, iris sphincterotomy, operation date and the community from which the patient came from. After about four to five years, the percentage of patients not having had a YAG laser capsulotomy was reduced to around 50% for women and 60% for men. The most important predisposing factors for an early large with the-rule-astigmatism or rapid changes in the postoperative astigmatism were large preoperative with-the-rule astigmatism (polar value), young age, low preoperative intraocular pressure, if an ECCE were chosen as the extraction type, anterior (corneal) location of the incision at surgery, and, finally, the surgeon.

Journal ArticleDOI
TL;DR: The population-based analysis can be used as a benchmark for quality-improvement initiatives and can assist clinicians in educating their patients regarding the risks associated with cataract surgery.

Journal ArticleDOI
TL;DR: This review provides a comprehensive assessment of intraocular pressure (IOP), phacoemulsification techniques, and intraocular lenses (IOLs) in pseudoexfoliation (PXF) eyes having cataract surgery with recommendations for the use of adjunctive pupil and zonule support devices.
Abstract: This review provides a comprehensive assessment of intraocular pressure (IOP), phacoemulsification techniques, and intraocular lenses (IOLs) in pseudoexfoliation (PXF) eyes having cataract surgery. Pseudoexfoliation is ubiquitous and the most common cause for open-angle glaucoma worldwide. Cataracts occur with increased frequency in PXF eyes, and surgery is potentially complicated by the presence of small pupils and zonule laxity and significantly affects IOP in these eyes. Preoperative evaluation and the options for intraoperative management of cataract are presented with recommendations for the use of adjunctive pupil and zonule support devices. Postoperative complications such as capsule contraction and IOL instability are discussed and laser and surgical options to manage these special problems presented.

Journal ArticleDOI
TL;DR: Oral melatonin premedication for patients undergoing cataract surgery under topical anesthesia provided anxiolytic effects, enhanced analgesia, and decreased IOP resulting in good operating conditions.
Abstract: BACKGROUND:Melatonin has anxiolytic and potential analgesic effects. In this study, we assessed the effects of melatonin premedication on pain, anxiety, intraocular pressure (IOP), and operative conditions during cataract surgery under topical analgesia.METHODS:Forty patients undergoing cataract sur

Journal ArticleDOI
TL;DR: Surgically induced astigmatism with 2.2-mm micro-coaxial incisions and traditional 3.0-mm clear corneal incisions with intra-patient control resulted in statistically and clinically significant reduction in surgically induced cosmopolitanism with the smaller incision size.
Abstract: Purpose To evaluate the difference between 2.2-mm incision micro-coaxial phacoemulsification and traditional 3.0-mm coaxial phacoemulsification with respect to surgically induced astigmatism after temporally oriented clear corneal incision cataract surgery. Methods This prospective, randomized, intra-patient controlled study comprised 22 patients who underwent clear corneal cataract surgery in both eyes. One eye received 2.2-mm incision micro-coaxial phacoemulsification with intraocular lens (IOL) implantation and the fellow eye received traditional 3.0-mm coaxial incision phacoemulsification with IOL implantation. The 2.2-mm incisions were created with a diamond keratome after a 200-microm groove was constructed in clear cornea at the temporal limbus. The 3.0-mm incisions were created without a pre-cut groove, using a metal keratome. All cases were uncomplicated. Pre- and postoperative keratometric astigmatism at 6 weeks was measured using a hand held Nikon Retinomax K-plus 2 Autorefractor. Three methods were used to analyze the surgically induced astigmatism (SIA) data: 1) algebraic analysis of the magnitude of keratometric astigmatism induced by the surgery, 2) magnitude of SIA by vector analysis, and 3) aggregate analysis of astigmatism using vector analysis. Results The mean change in the magnitude of keratometric astigmatism was 0.10+/-0.08 diopters (D) with the 2.2-mm micro-coaxial incisions and 0.32+/-0.20 D with the 3.0-mm traditional incisions (P=.0002). Usingvector analysis, the mean magnitude of SIA was 0.35+/-0.21 D with the 2.2-mm incisions and 0.67+/-0.48 D (P=.006) with the 3.0-mm incisions. Conclusions Surgically induced astigmatism with 2.2-mm micro-coaxial incisions and traditional 3.0-mm clear corneal incisions with intra-patient control resulted in statistically and clinically significant reduction in surgically induced astigmatism with the smaller incision size.

Journal ArticleDOI
TL;DR: It is estimated that blindness and severe visual impairment from cataract could be reduced by around 11% in the low- and middle-income countries if women were to receiveCataract surgery at the same rate as men.
Abstract: Background: Cataract remains the leading cause of global blindness. Evidence from population-based surveys, carried out up to 2000, and the launch of the VISION 2020 initiative to address avoidable blindness showed that women in low- and middle-income countries had a lower cataract surgical coverage (CSC) than men. Methods: A systematic review identified population-based surveys reporting CSC in low- and middle-income countries published since 2000. Researchers extracted data on sex-specific CSC rates and estimated the overall CSC differences using meta-analyses. Results: Among the 23 surveys selected for this review, 21 showed higher CSC among men. The Peto odds ratio revealed that men were 1.71 times (95% CI 1.48 to 1.97) more likely to have cataract surgery than women. The risk difference in the rates of surgery varied from −0.025 to 0.276, and the combined average was 0.116 (95% CI 0.082 to 0.149). Discussion: Gender inequity in use of cataract surgical services persists in the low- and middle-income countries. It is estimated in this study that blindness and severe visual impairment from cataract could be reduced by around 11% in the low- and middle-income countries if women were to receive cataract surgery at the same rate as men. Additional effort globally is needed to ensure that women receive the benefits of cataract surgery at the same rate as men.

Journal ArticleDOI
TL;DR: The modified sterilization and asepsis protocol adopted to facilitate high‐volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis.
Abstract: Purpose To report the incidence of postoperative endophthalmitis at a high-volume eye hospital in southern India using a modified cost-effective sterilization protocol. Setting Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. Methods In this retrospective observational series at a single eye hospital, records of patients who had cataract surgery using a modified sterilization protocol from January 2007 through August 2008 and developed postoperative endophthalmitis within the first 3 postoperative months were drawn from a computerized database. The patient's socioeconomic status, the surgeon's experience, and the type of cataract procedure performed were analyzed as possible risk factors using the chi-square test/Fischer exact test. Results During the study period, 42 426 cataract surgeries were performed. From these, 38 cases of presumed postoperative endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases were in the manual large- and small-incision extracapsular cataract extraction (ECCE) group, which had a statistically higher rate than the phacoemulsification group (P = .016). There was no statistical difference in the endophthalmitis rates between private patients and charity patients for either surgical method (manual ECCE or phacoemulsification). Conclusions The modified sterilization and asepsis protocol adopted to facilitate high-volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis. Despite a 3:1 ratio of manual ECCE to phacoemulsification and the elimination of certain traditional sterilization practices, the rate of endophthalmitis in this generally underserved patient population with multiple risk factors for infection was comparable to that reported in other modern settings.

Journal ArticleDOI
TL;DR: In patients undergoing concurrent cataract and glaucoma surgery, the iStent was safe and efficacious for the reduction of intraocular pressure and medication therapy.
Abstract: PURPOSE. To evaluate the safety and efficacy of the iStent Trabecular Micro-bypass Stent in patients undergoing concurrent cataract and glaucoma surgery. METHODS. Prospective, 24-month, uncontrolled, multicenter, multicountry evaluation of 58 patients with uncontrolled primary open-angle glaucoma (including pseudoexfoliation and pigmentary) and cataract. Patients underwent clear cornea phacoemulsification followed by ab interno gonioscopically guided implantation of the iStent. Of the 48 per protocol population, 42 patients completed 12 months of the 24-month study, and their data are included in this interim analysis. RESULTS. At baseline, mean (±SD) intraocular pressure (IOP) was 21.7±3.98 mmHg. At 12 months, mean IOP was reduced to 17.4±2.99 mmHg, a mean IOP reduction of 4.4±4.54 mmHg (p<0.001, 18.3%). At baseline, patients were taking a mean 1.6±0.8 medications. By 12 months, the mean number of medications was reduced to 0.4±0.62 (p<0.001). Half the patients achieved an IOP ≤18 mmHg and were able to discontinue hypotensive medication by the 12-month visit. The most commonly reported device-related adverse events were the appearance of stent lumen obstruction (7 eyes) and stent malposition (6 eyes). None of the adverse events were deemed serious. CONCLUSIONS. In patients undergoing concurrent cataract and glaucoma surgery, the iStent was safe and efficacious for the reduction of IOP and medication therapy. (Eur J Ophthalmol 2009; 19: 393-9)

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TL;DR: Good uncorrected postoperative distance visual acuity can be obtained for a high percentage of cataract patients with preexisting corneal astigmatism and postoperative keratorefractive surgery is available to enhance the condition of patients who achieve less-than-optimal astigmatic results.
Abstract: Purpose of reviewThere are several options for correcting astigmatism at the time of cataract surgery. They include incision placement on the steep axis of corneal astigmatism, single or paired peripheral corneal relaxing incisions, and toric intraocular lens implantation. The aim of this review is

Journal ArticleDOI
Eva Mönestam1
TL;DR: The 10-year cumulative incidence of dislocated IOLs needing surgical attention was low in this population-based cohort with a high frequency of PEX.

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01 Jan 2009-Eye
TL;DR: Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated withA significant increase with potentially sight-threatening local anaesthetic or operative haemorrhagic complications.
Abstract: This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users. The Cataract National Dataset was remotely extracted and anonymised on 55 567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006. This report analyses 48 862 of the 55 567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48 862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (P<0.0001) or warfarin, 6.2% (P=0.0026) vsnon-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (P<0.0001) or warfarin, 3.7% (P<0.0001) vsnon-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P=0.0002) vsnon-users, 4.4%, but the haemorrhagic operative complications of choroidal/suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P=0.0057) vsnon-users, 1.77%. Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.

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TL;DR: New pattern deviation change probability maps were developed from a prospectively collected glaucoma material and designed to be sensitive to changes in localized field loss, but to be unaffected by media-induced perimetric change.
Abstract: We describe a new method for analysis of change in glaucomatous visual fields with the object to differentiate between changes caused by glaucoma from those caused by cataract. New pattern deviation change probability maps were developed from a prospectively collected glaucoma material and designed to be sensitive to changes in localized field loss, but to be unaffected by media-induced perimetric change. We compared the new change probability maps with the commercially available total deviation change probability maps in series of Humphrey perimetric tests in a glaucoma material of 43 eyes of 35 patients, who had undergone cataract surgery. When using the total deviation maps, considerable differences were seen between fields obtained before and after cataract surgery. Much smaller differences were seen when using the new change probability maps, that almost eliminated the common and disturbing effect of increasing cataract. This new tool could be of considerable help in differentiation between progressive glaucomatous visual field loss and deterioration caused by increasing media opacities.

Journal ArticleDOI
TL;DR: The use of the Ex-PRESS implant under a scleral flap was effective for lowering intraocular pressure both alone and combined with cataract surgery.
Abstract: PurposeOur purpose was to evaluate the clinical outcomes of the Ex-PRESS miniature glaucoma device placed under a partial-thickness scleral flap as a single procedure or combined with phacoemulsification cataract surgery.MethodsThis was a comparative consecutive case series of 345 eyes: 231 eyes tre

Journal ArticleDOI
TL;DR: Anterior segment noncontact OCT reveals the match between the programmed and the achieved depth of incisions after femtosecond-assisted astigmatic keratotomy for post-DSAEK astigmatism.
Abstract: 1. Hoffart L, Touzeau O, Borderie V, Laroche L. Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty. J Cataract Refract Surg 2007; 33:862–868 2. Wilkins MR, Mehta JS, Larkin DFP. Standardized arcuate keratotomy for postkeratoplasty astigmatism. J Cataract Refract Surg 2005; 31:297–301 3. Hanna KD, Hayward JM, Hagen KB, Simon G, Parel J-M, Waring GO III. Keratotomy for astigmatism using an arcuate keratome. Arch Ophthalmol 1993; 111:998–1004 4. Adrean SD, Cochrane R, Reilly CD, Mannis MJ. Infectious keratitis after astigmatic keratotomy in penetrating keratoplasty: review of three cases. Cornea 2005; 24:656–658 5. Harissi-Dagher M, Azar DT. Femtosecond laser astigmatic keratotomy for postkeratoplasty astigmatism. Can J Ophthalmol 2008; 43:367–369. Available at: http://article.pubs.nrccnrc.gc.ca/RPAS/rpv?hmZHInit&calyLangZeng&journalZcjo& volumeZ43&afpfZi08-043.pdf. Accessed July 11, 2009 Figure 2. Anterior segment noncontact OCT reveals the match between the programmed and the achieved depth (660 mm) of incisions after femtosecond-assisted astigmatic keratotomy for post-DSAEK astigmatism. Full-thickness recipient corneal incisions can be observed. 1834 CORRESPONDENCE

Journal ArticleDOI
TL;DR: Induced astigmatism, focal wound‐related flattening of the peripheral cornea, and corneal surface irregularity were signficantly less after coaxial MICS than after SICS.
Abstract: Purpose To compare changes in corneal topography and in regular and irregular astigmatism after coaxial clear corneal microincision cataract surgery (MICS) and after coaxial small-incision cataract surgery (SICS). Setting Hayashi Eye Hospital, Fukuoka, Japan. Methods Induced corneal astigmatism was determined using vector analysis. The averaged corneal shape changes and degree of irregular astigmatism were examined using videokeratography preoperatively as well as 2 days and 1, 2, 4, and 8 weeks postoperatively. Results One hundred twenty eyes of 60 patients scheduled for phacoemulsification were evaluated. Sixty eyes had MICS (2.00 mm), and the 60 contralateral eyes had SICS (2.65 mm). The mean induced corneal astigmatism was significantly less in the MICS group than in the SICS group (P≤.0495) 1 week postoperatively and subsequently. The averaged difference map on videokeratography showed focal corneal flattening corresponding to the incision and coupled steepening around the flattened area 2 days postoperatively in both groups. The flattening and steepening gradually reduced to virtually the preoperative shape by 8 weeks; the changes were significantly less in the MICS group than in the SICS group. Of the irregular astigmatic components, higher-order irregularity was significantly less in the MICS group than in the SICS group up to 2 weeks postoperatively (P≤.0470). Conclusion Induced astigmatism, focal wound-related flattening of the peripheral cornea, and corneal surface irregularity were signficantly less after coaxial MICS than after SICS.