Showing papers on "Cataract surgery published in 2012"
TL;DR: Patients with combined single trabecular micro‐bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataracts surgery alone.
Abstract: Purpose To assess the long-term safety and efficacy of a single trabecular micro-bypass stent with concomitant cataract surgery versus cataract surgery alone for mild to moderate open-angle glaucoma. Setting Twenty-nine investigational sites, United States. Design Prospective randomized controlled multicenter clinical trial. Methods Eyes with mild to moderate glaucoma with an unmedicated intraocular pressure (IOP) of 22 mm Hg or higher and 36 mm Hg or lower were randomly assigned to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). Patients were followed for 24 months postoperatively. Results The incidence of adverse events was low in both groups through 24 months of follow-up. At 24 months, the proportion of patients with an IOP of 21 mm Hg or lower without ocular hypotensive medications was significantly higher in the stent group than in the control group ( P =.036). Overall, the mean IOP was stable between 12 months and 24 months (17.0 mm Hg ± 2.8 [SD] and 17.1 ± 2.9 mm Hg, respectively) in the stent group but increased (17.0 ± 3.1 mm Hg to 17.8 ± 3.3 mm Hg, respectively) in the control group. Ocular hypotensive medication was statistically significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant. Conclusions Patients with combined single trabecular micro-bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataract surgery alone. Both groups had a similar favorable long-term safety profile. Financial Disclosure Dr. Craven was an investigator in the clinical trial of the iStent. Dr. Katz is a consultant to Glaukos and was the medical monitor for the clinical trial of the iStent. Dr. Katz is a stockholder in Glaukos. Mr. Wells and Ms. Giamporcaro are employees of Glaukos.
286 citations
TL;DR: Cataract surgery decreases intraocular pressure after cataract extraction in patients with ocular hypertension over a long period of time.
250 citations
TL;DR: In this case series, there was a clear learning curve associated with the use of femtosecond lasers for cataract surgery and adjustment to surgical technique and prior experience with a femTosecond laser seemed to flatten the learning curve.
205 citations
TL;DR: The present guidelines are based on data entered from January 1, 2009, to August 28, 2011 (523,921 cataract extractions) and include only those steps in theCataract surgery process that can be analyzed by the database.
Abstract: In March 2008, the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) commenced. This 3-year project was cofunded by the European Union (EU) and the European Society of Cataract & Refractive Surgeons (ESCRS). The ESCRS became the lead partner in the project with 11 national societies as associated partners. The aims of the project were to improve treatment and standards of care for cataract and refractive surgery and to develop evidence-based guidelines for cataract and refractive surgery across Europe. Surgeons from all participating societies contributed to the database, which contained data on 820,000 cataract surgeries in November 2011. The present guidelines are based on data entered from January 1, 2009, to August 28, 2011 (523,921 cataract extractions). The guidelines include only those steps in the cataract surgery process that can be analyzed by the database.
191 citations
TL;DR: In a cohort of US Medicare beneficiaries aged 65 years and older with a diagnosis of cataract, patients who hadCataract surgery had lower odds of hip fracture within 1 year after surgery compared with patients whoHad not undergone cataracts surgery.
Abstract: Results There were 1113640 US Medicare beneficiaries 65 years and older with a diagnosis of cataract between 2002 and 2009 in the 5% random sample; of these patients, 410809 (36.9%) received cataract surgery during the study period. There were 13976 patients (1.3%) who sustained a hip fracture during the study period. The most common fracture-related comorbidity was osteoporosis (n=134335; 12.1%). The most common ocular comorbidity was glaucoma (n=212382; 19.1%). Compared with 1-year hip fracture incidence in patients with cataract who did not have cataract surgery, adjusted OR of hip fracture within 1 year after cataract surgery was 0.84 (95% CI, 0.81-0.87) with an absolute risk difference of 0.20%. Compared with matched subgroups of patients who did not receive cataract surgery, patient subgroups that experienced lower odds of hip fracture after cataract surgery included patients with severe cataract, patients most likely to receive cataract surgery based on propensity score, patients 75 years and older, and patients with a CCI score of 3 or greater. Conclusion In a cohort of US Medicare beneficiaries aged 65 years and older with a diagnosis of cataract, patients who had cataract surgery had lower odds of hip fracture within 1 year after surgery compared with patients who had not undergone cataract surgery.
168 citations
TL;DR: Femtosecond laser-assisted cataract surgery causes less corneal swelling in the early postoperative period and may cause less trauma to cornea endothelial cells than manual phacoemulsification.
Abstract: PURPOSE: To compare the effect of conventional phacoemulsifi cation and femtosecond laser–assisted cataract surgery on the cornea using Scheimpfl ug imaging and noncontact specular microscopy. METHODS: In each group, 38 eyes (38 patients) underwent cataract surgery using either femtosecond laser–assisted (Alcon LenSx laser) (femtolaser group) or conventional phacoemulsifi cation (phaco group). Central corneal thickness, 3-mm corneal volume, and Pentacam Nucleus Staging (PNS) were determined by a rotating Scheimpfl ug camera (Pentacam HR, Oculus Optikgerate GmbH), and the volume stress index was calculated at 1 day and 1 month postoperatively. Endothelial cell count was measured by noncontact specular microscopy preoperatively, 1 day, 1 week, and 1 month postoperatively. RESULTS: Central corneal thickness was signifi cantly higher in the phaco group (60791 µm) than in the femtolaser group (58042 µm) on day 1, but did not differ signifi cantly preoperatively and at 1 week and 1 month. Volume stress index at day 1 was signifi cantly lower in the femtolaser group than in the phaco group (P.05) but did not differ signifi cantly at 1 month. Multivariate regression analysis showed that the type of surgery had a signifi cant effect on central corneal thickness.
167 citations
TL;DR: Using multiple micro‐bypass stents with concurrent cataract surgery led to a mean postoperative intraocular pressure (IOP) of less than 15 mm Hg and allowed patients to achieve target pressure control with significantly fewer medications through 1 year.
Abstract: Purpose To evaluate the efficacy of multiple trabecular micro-bypass stents combined with cataract surgery in patients with open-angle glaucoma (OAG) and cataract. Setting Private practice, Mississauga, Ontario, Canada. Design Comparative case series. Methods Eyes with OAG had implantation of 2 or 3 micro-bypass stents with concurrent cataract surgery and follow-up through 1 year. Efficacy measures were intraocular pressure (IOP) and topical ocular hypotensive medication use. Safety assessment included complications and corrected distance visual acuity (CDVA). Results The study comprised 53 eyes (47 patients); 28 had implantation of 2 stents and 25 had implantation of 3 stents. The overall mean 1-year postoperative IOP was 14.3 mm Hg, which was significantly lower than preoperative IOP overall and in each group (P Conclusions Using multiple micro-bypass stents with concurrent cataract surgery led to a mean postoperative IOP of less than 15 mm Hg and allowed patients to achieve target pressure control with significantly fewer medications through 1 year. Financial Disclosure Dr. Ahmed is a consultant to Glaukos Corp. No other author has a financial or proprietary interest in any material or method mentioned.
166 citations
TL;DR: Combined cataract surgery and Glaukos iStent implantation seems to be an effective and safe procedure to treat coexistent open-angle glaucoma and cataracts.
Abstract: Aims To evaluate the long-term efficacy and safety of combined cataract surgery and Glaukos iStent implantation for coexistent open-angle glaucoma and cataract. Methods Prospective, non-comparative, uncontrolled, non-randomised, interventional case series study. Subjects older than 18 years with coexistent uncontrolled mild or moderate open-angle glaucoma (including pseudoexfoliative and pigmentary) and cataract underwent phacoemulsification and intraocular lens implantation along with ab-interno gonioscopically guided implantation of one Glaukos iStent. The variables recorded during a minimum of 3 years of follow-up were: intraocular pressure (IOP), number of antiglaucoma medications and best-corrected visual acuity. Results The 19 patients enrolled were 58–88 years old (mean age 74.6±8.44 years). Mean follow-up was 53.68±9.26 months. Mean IOP was reduced from 19.42±1.89 mm Hg to 16.26±4.23 mm Hg (p=0.002) at the end of follow up, indicating a 16.33% decrease in IOP. The mean number of pressure-lowering medications used by the patients fell from 1.32±0.48 to 0.84±0.89 (p=0.046). In 42% of patients, no antiglaucoma medications were used at the end of follow-up. Mean best-corrected visual acuity significantly improved from 0.29±0.13 to 0.62±0.3 (p Conclusion Combined cataract surgery and Glaukos iStent implantation seems to be an effective and safe procedure to treat coexistent open-angle glaucoma and cataract.
150 citations
TL;DR: The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure, suggesting capsulotomy and lens fragmentation in the treatment of patients with senile cataracts should be performed.
Abstract: Purpose To compare the effect of femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT) with standard cataract surgery. Methods This prospective clinical trial evaluated the feasibility of using a femtosecond laser system (Catalys Precision Laser System, OptiMedica) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Fifty-two patients underwent standard cataract surgery and 57 patients underwent femtosecond laser-assisted cataract surgery in December 2011. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. Results Preoperative LOCS III grades were 3.4±0.9 in the femtosecond laser-assisted cataract surgery group and 3.1±0.9 in the standard group. In the femtosecond laser-assisted cataract surgery group, mean laser treatment time was 54.9 seconds and EPT was 0.16±0.21 seconds compared to 4.07±3.14 seconds in the standard group. Conclusions The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure.
144 citations
TL;DR: For staff surgeons experienced with both phacoemulsification and manual SICS, intraoperative complication rates were comparably low, but for trainee surgeons, the complication rate was significantly higher with phacoamulsification, suggesting that manuals SICS may be a safer initial procedure to learn for inexperienced cataract surgeons in the developing world.
Abstract: Purpose To analyze the rate of intraoperative complications, reoperations, and endophthalmitis with phacoemulsification, manual small-incision cataract surgery (SICS), and large-incision extracapsular cataract extraction (ECCE). Setting Aravind Eye Hospital, Madurai, India. Design Retrospective cohort study. Methods This study comprised consecutive cataract surgeries performed during a 12-month period. All surgical complications and endophthalmitis cases were tabulated and analyzed for each of 4 surgeon groups (staff, fellows, residents, visiting trainees). Within each surgeon group, complication rates with phacoemulsification, manual SICS, and ECCE were compared. Results The surgical distribution was 20 438 (26%) phacoemulsification, 53 603 (67%) manual SICS, and 5736 (7%) ECCE. The overall intraoperative complication rate was 0.79% for staff, 1.19% for fellows, 2.06% for residents, and 5% for visiting trainees. Extracapsular cataract extraction had the highest overall rate of surgical complications (2.6%). The overall complication rate was 1.01% for manual SICS and 1.11% for phacoemulsification. However, the combined complication rate for trainees was significantly higher with phacoemulsification (4.8%) than with manual SICS (1.46%) ( P P Conclusions For staff surgeons experienced with both phacoemulsification and manual SICS, intraoperative complication rates were comparably low. However, for trainee surgeons, the complication rate was significantly higher with phacoemulsification, suggesting that manual SICS may be a safer initial procedure to learn for inexperienced cataract surgeons in the developing world. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
141 citations
TL;DR: The decrease in GCD, which was correlated with operative time, had not recovered at 3 months after cataract surgery, and microscopic ocular surface damage during cataracts surgery seems to be one of the pathogenic factors that cause ocular discomfort and dry eye syndrome after catARact surgery.
TL;DR: Ab interno trabeculectomy using this new incisional procedure safely lowered intraocular pressure to the mid teens, with an overall greater reduction in exfoliation glaucoma and improved success when combined with cataract surgery.
Abstract: Purpose To compare outcomes in exfoliation glaucoma versus primary open-angle glaucoma (POAG) after ab interno trabeculectomy alone (Trabectome) or in combination with cataract surgery and intraocular lens (IOL) implantation. Setting Trabectome Study Group institutions. Design Prospective nonrandomized cohort study. Methods Outcomes included intraocular pressure (IOP), glaucoma medications, complications, secondary procedures, and success, defined as no secondary surgery and IOP less than 21 mm Hg and a greater than 20% reduction from baseline. Results In the ab interno trabeculectomy–alone group, the mean preoperative IOP was 29.0 mm Hg ± 7.5 (SD) in exfoliation glaucoma cases and 25.5 ± 7.9 mm Hg in POAG cases ( P P P =.02); and the cumulative probability of success was 79.1% and 62.9%, respectively ( P =.004). In the combined ab interno trabeculectomy–IOL group, the mean preoperative IOP was 21.7 ± 8.4 in exfoliation glaucoma cases and 19.9 ± 5.4 mm Hg in POAG cases ( P =.06). At 1 year, the mean decrease in IOP was −7.2 ± 7.7 and −4.1 ± 4.6, respectively ( P P =.88); and the cumulative probability of success was 86.7% and 91.0% ( P =.73), respectively. Conclusion Ab interno trabeculectomy using this new incisional procedure safely lowered IOP to the mid teens, with an overall greater reduction in exfoliation glaucoma and improved success when combined with cataract surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: DMEK combined with cataract surgery (triple procedure) can routinely be performed in cases of endothelial dystrophy andCataract and had no adverse effect on endothelial function or graft adhesion and did not increase the likelihood of postoperative complications.
TL;DR: Emmetropia is the goal in most cataract cases but was reached in only 55% of eyes planned for emmetropia, and remaining corneal astigmatism and biometry prediction errors in astigmatic and ametropic eyes were high.
Abstract: PURPOSE: To assess and analyze refractive outcome after cataract surgery in Sweden from 2008 though 2010. SETTING: Swedish cataract surgery units participating in outcome registration of National Cataract Register. DESIGN: Cohort study. METHODS: Planned and actual postoperative refractions were analyzed for cataract procedures and preoperative and postoperative corneal astigmatism for procedures performed in 2008 though 2010. Induced astigmatism was calculated with Naeser and Behrens polar coordinates. RESULTS: Postoperative refraction was analyzed for 17 056 procedures and corneal astigmatism for 7448 procedures. Emmetropia was targeted in 78.1% of eyes and achieved in 52.7%; 43.0% had less than 1.00 diopter (D) of astigmatism. "Reading myopia" of -3.5 to -1.6 D was targeted in 7.0% of eyes and achieved in 7.8%. Planned hyperopia greater than 1.0 D or myopia greater than -3.5 D was rare. The mean absolute biometry prediction error was 0.402 D +/- 0.338 (SD) in all eyes; however, astigmatic eyes and eyes planned for myopia or hyperopia had higher biometry prediction errors. Younger patients were more often astigmatic and planned for a more myopic outcome. Preoperatively, one third of eyes had more than 1.0 D of corneal astigmatism; postoperatively this figure was largely unaltered. The mean induced astigmatism was 0.525 +/- 0.804 D in all eyes. CONCLUSIONS: Emmetropia (spherical equivalent -0.5 to + 0.5 D and <1.0 D astigmatism) is the goal in most cataract cases but was reached in only 55% of eyes planned for emmetropia. Factors precluding emmetropia included remaining corneal astigmatism and biometry prediction errors in astigmatic and ametropic eyes.
TL;DR: Laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery, possibly due to a more precise capsulorrhexis, resulting in a more stable IOL position.
Abstract: PURPOSE: To compare intraocular lens (IOL) power calculation and refractive outcome between patients who underwent laser refractive cataract surgery with a femtosecond laser and those with conventional cataract surgery. METHODS: In this prospective study, 77 eyes from 77 patients underwent laser refractive cataract surgery (laser group; Alcon LenSx femtosecond laser), and conventional cataract surgery with phacoemulsification was performed in 57 eyes from 57 patients (conventional group). Biometry was done with optical low coherence reflectometry (Lenstar LS900, Haag-Streit AG), and IOL calculation was performed with third-generation IOL formulas (SRK/T, Hoffer Q, and Holladay). The refractive outcome was analyzed using the mean absolute error (MAE; difference between predicted and achieved postoperative spherical equivalent refraction), and multivariable regression analysis was performed to compare the two groups. RESULTS: No significant differences were found between age, axial length, keratometry, and preoperative corrected visual acuity in the laser and conventional groups (P>.05; Mann-Whitney U test). At least 6 weeks after surgery, MAE was significantly lower in the laser group (0.38±0.28 diopters [D]) than in the conventional group (0.50±0.38 D) (P=.04). The difference was the greatest in short (axial length 26.0 mm, 0.33±0.24 vs 0.63±0.42) eyes. CONCLUSIONS: Laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery. This difference is possibly due to a more precise capsulorrhexis, resulting in a more stable IOL position.
TL;DR: Endophthalmitis rates are lower than previous yearly US estimates, but remain higher than rates reported from a series of studies from Sweden; patient factors or methodologic differences may contribute to differences across countries.
TL;DR: It is shown that routine preoperative medical testing does not increase the safety of cataract surgery, and the average cost of performing routine medical testing is estimated to be 2.55 times higher in those with preoperativeMedical testing compared to those without preoperativemedical testing.
Abstract: Background
Cataract surgery is practiced widely and substantial resources are committed to an increasing cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to optimize the safety and cost-effectiveness of this procedure. Most cataracts are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that routine preoperative medical testing will detect medical conditions, but it is questionable whether these conditions should preclude individuals from cataract surgery or change their perioperative management.
TL;DR: The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, sex, age, and by certain provider characteristics.
Abstract: Purpose: To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States.Setting: Cataract surgery performed on Medicare beneficiaries in 2003 and 2004.Methods: Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003–2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, sex, race and state; surgical volume by facility type and surgeon characteristics; time interval between first- and second-eye cataract surgery.Results: The national cataract surgery rate for 2003–2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those aged 75–84 years. After adjustment for age and sex, blacks had approximately a 30% lower rate of surgery than whites. While only 5% o...
TL;DR: The use of the femtosecond laser–assisted system in cataract surgery with 350 μmGrid softening led to a statistically significant lower EPT than the 500 μm grid.
Abstract: Purpose To compare the effect of different fragmentation softening grids in femtosecond laser–assisted cataract surgery on effective phacoemulsification time (EPT). Setting Ruhr University Eye Clinic, Bochum, Germany. Design Prospective randomized clinical trial. Methods The study evaluated the feasibility of using a femtosecond laser ( Catalys Precision Laser System) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Patients had laser refractive cataract surgery with 350 μm fragmentation grids or with 500 μm fragmentation grids. Both groups had phacoemulsification using pulsed ultrasound energy, and the EPT was evaluated. Results Eighty patients were treated with 350 μm fragmentation grids and 80 patients with 500 μm fragmentation grids. The mean preoperative LOCS III grade was 3.7 ± 0.8 (SD) in the 350 μm group and 3.5 ± 0.8 in the 500 μm group. The mean laser treatment time was 66.4 ± 14.4 seconds in the 350 μm group and 52.8 ± 11.9 seconds in the 500 μm grid group and the mean EPT, 0.03 ± 0.05 seconds and 0.21 ± 0.26 seconds, respectively. Conclusion The use of the femtosecond laser–assisted system in cataract surgery with 350 μm grid softening led to a statistically significant lower EPT than the 500 μm grid. Financial Disclosure Dr. Dick is a member of the medical advisory board of Optimedica Corp. No other author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Endophthalmitis following IVI is associated with an increased incidence of Streptococcus spp.
Abstract: We thank Drs Shoaib and Hing for their interest in our article and welcome the opportunity to respond to their comments. Our article1 compares patients presenting to a tertiary referral centre with acute endophthalmitis following either cataract surgery or …
TL;DR: Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a child with persistent fetal vasculature.
Abstract: Glaucoma is an important complication of pediatric cataract surgery, with a wide range of reported frequencies, depending on the definition used and the length of follow-up 1-3. Two large, retrospective series reported 15-21% frequency of glaucoma diagnosed 5 years after cataract surgery 4-5. Numerous risk factors for the development of glaucoma have been noted, including cataract surgery in the first year of life, postoperative complications such as secondary membrane surgery, small corneal diameters, type of cataract, a family history of aphakic glaucoma, and primary posterior capsulotomy/anterior vitrectomy performed at the time of cataract surgery 2-10. Cataract surgery in the first year of life, and small corneal diameters have been the most consistent risk factors for glaucoma development in reported studies 3,5-10. The effect of the placement of an intraocular lens (IOL) at the time of cataract surgery on the risk of developing glaucoma is unknown, although one retrospective review suggested a decreased incidence of glaucoma in patients who received an IOL 11. However the eyes which received an IOL in that report were older at the time of surgery (mean age 5.1 years for pseudophakia versus 2.7 years for aphakia) and children with corneal diameters less than or equal to 10 mm were excluded from analysis. Other studies have noted similar rates of glaucoma in aphakic and pseudophakic children who had cataract surgery performed in the first year of life 9,10.
The Infant Aphakia Treatment Study (IATS) is a multi-center, randomized, controlled clinical trial sponsored by the National Eye Institute. The objective of the study is to compare the use of primary IOL implantation to surgery without IOL implantation in infants with a unilateral congenital cataract removed between 1 and 6 months of age. The results of IATS during the first year after cataract surgery including visual acuity, adverse events, and additional surgery have been previously reported 12. In this paper we report the development of glaucoma-related adverse events in IATS subjects through 1 year of follow-up.
TL;DR: Nepafenac demonstrated statistically significant and clinically relevant advantages compared with vehicle in preventing macular edema and maintaining visual acuity in diabetic patients following cataract surgery and the risk/benefit to the diabetic patient undergoing cataracts surgery appears to be positive.
Abstract: Background
The purpose of this study was to evaluate nepafenac ophthalmic suspension 0.1% (Nevanac®; Alcon Research Ltd) in the prevention of macular edema following cataract surgery in diabetic retinopathy patients.
TL;DR: Intracameral cefuroxime injection at the end of cataract surgery was safe and significantly decreased the incidence of endophthalmitis.
Abstract: Purpose To determine whether an intracameral injection of cefuroxime at the end of cataract surgery decreases the incidence of postoperative endophthalmitis. Setting Dupuytren Hospital, Ophthalmology Department, Limoges, France. Design Clinical trials. Methods Patients having cataract surgery between April 2003 and June 2008 were included in a survey of operative-site infection. Intracameral cefuroxime injections started in June 2006. Preoperative data (beta-lactam allergy, a history of endophthalmitis, age, sex), intraoperative data (use of trypan blue, use of capsular ring or iris retractors, surgical time, senior or junior surgeon, corticosteroid injection, iris retractors), and the incidence of postoperative infections at 8 days and 1 month were prospectively collected. Results During the inclusion period, 5115 patients had cataract surgery; 2289 received cefuroxime and 2826 did not. The incidence of endophthalmitis was 35 (1.238%) of 2826 patients without intracameral cefuroxime and 1 (0.044%) of 2289 patients with intracameral cefuroxime; the difference was statistically significant (P Conclusion Intracameral cefuroxime injection at the end of cataract surgery was safe and significantly decreased the incidence of endophthalmitis. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The trifocal intraocular lens provides good far, intermediate, and near visual acuity and is maintained in mesopic conditions.
Abstract: BACKGROUND The purpose of this study was to record the visual outcomes of patients treated by six surgeons after implantation of a trifocal lens. METHODS The setting for this study comprised six ophthalmology units and eye clinics in Belgium and France, with a coordinating center in France, and data management and statistical analysis in France and Belgium. Ninety-four eyes from 47 patients were implanted with a trifocal FineVision(®) intraocular lens by six surgeons. Monocular and binocular, uncorrected and best distance-corrected, and photopic and mesopic visual acuity was measured, as well as the defocus curve between +4 D and -4 D with best distance correction. RESULTS Near and far monocular visual acuities were similar to the data published after bifocal intraocular lens implantation. Intermediate vision was improved, and was demonstrated by scores of near visual acuity as well as far visual acuity with defocus -1.5 D-add lens. Far vision is maintained in mesopic conditions. CONCLUSION The trifocal intraocular lens provides good far, intermediate, and near visual acuity.
TL;DR: The case of a 68-year-old male diagnosed with macular edema following branch retinal vein occlusion in his left eye and an intravitreous injection of Ozurdex (Allergan Inc., Irvine, CA, USA) was performed without remarkable complications, where the patient finally underwent corneal transplantation.
Abstract: Dear Editor, Ozurdex® (Allergan Inc., Irvine, CA, USA) is an intravitreal implant containing the dexamethasone. It uses NOVADUR® drug delivery technology, in which a biodegradable material is combined with the active drug dexamethasone to form a small rod-shaped implant of 0.46 mm in diameter and 6 mm in length. Inside the eye, the implant is progressively dissolved in the vitreous gel, as it slowly releases dexamethasone (0.7 mg). This biodegradable device is indicated for the treatment of macular edema following branch or central retinal vein occlusions. In large clinical trials, Ozurdex® has also proved effective in the treatment of posterior non-infectious uveitis, and diabetic and macular edema to and pseudophakic macular edema [1, 2]. Herein we report the case of a 68-year-old male diagnosed with macular edema following branch retinal vein occlusion in his left eye. Visual acuity was 0.6 logMAR. The patient had undergone cataract surgery years before, with intraoperative violation of the lens posterior capsula, anterior vitrectomy assisted with triamcinolone and iris-claw intraocular lens implantation. An intravitreous injection of Ozurdex® (Allergan Inc., Irvine, CA, USA) was performed without remarkable complications. Three weeks later, the patient attended our emergency department complaining of blurred vision in his left eye. Slit-lamp examination revealed the presence of diffuse corneal edema, and anterior migration of the implant (Fig. 1). The intraocular pressure measured 18 mmHg. The implant was surgically removed from the anterior chamber 48 hours later. However, corneal edema did not resolve, and the patient finally underwent corneal transplantation. The anterior chamber transit has been previously described for triamcinolone acetonide, resulting in pseudohypopion [3, 4]. Probably due to a similar mechanism, the dexamethasone implant may also migrate into the anterior chamber, with secondary corneal descompensation due to the contact of the implant with the endothelium. This may be more frequent in pseudophakic cases with Nd-YAG capsulotomy, or posterior capsule violation during phacoemulsification. Nevertheless, pseudohypopion after intravitreal triamcinolone injection has been described in both phakic or pseudophakic patients with posterior capsule integrity, it being presupposed then that the zonula is not complete or that the crystals are capable of crossing through it [3, 4]. In this particular case, the lack of anterior hyaloid may facilitate the penetration of Ozurdex into the anterior chamber too. In our opinion, the state of anterior hyaloid can be assessed by slit-lamp examination only. However, ecography could be useful in cases of uncertain anterior hyaloid status. The authors certify that they have not been published or are being considered for publication elsewhere. The authors also transfer property rights (copyright) of this work to Graefe’s Archive for Clinical and Experimental Opthalmology. D. Pardo-Lopez : E. Frances-Munoz :R. Gallego-Pinazo : M. Diaz-Llopis Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
TL;DR: Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated intraocular implantation, fibrin glue was associated with fewer complications.
Abstract: Purpose To compare the visual outcomes and complications after suture-assisted and fibrin glue-assisted scleral fixated intraocular (IOL) implantation. Methods Scleral fixated IOL implantation was performed in patients with inadequate capsular support. Intraocular lens fixation was achieved using sutures or fibrin glue. Main parameters evaluated were visual outcomes and complications. Results Fifty patients were included in the study (n=25 suture, n=25 glue). The most common indication for scleral fixated IOL implantation was cataract surgery complicated with posterior capsule rupture (29/50 [58%]). No significant differences were noted between demographic characteristics, surgical indications, and preoperative corrected distance visual acuity (CDVA) in either group (P=.680). No intraoperative complications related to IOL fixation were encountered in any case. At last follow-up (6 months), CDVA was 20/40 or better in 88% and 84% of patients in the suture and glue groups, respectively. Postoperative inflammation (48% vs 16%) and glaucoma (40% vs 16%) were seen more frequently in eyes with sutures as compared to eyes with glue. Overall, a significantly higher number of complications were encountered in eyes with suture fixation (14/25 [56%]) compared to eyes with glue fixation (7/25 [28%]) (P=.045). Conclusions Although visual outcomes were similar at the end of 6 months in eyes that underwent suture- and glue-assisted scleral fixated IOL implantation, fibrin glue was associated with fewer complications.
TL;DR: Cataract surgery continues to be a very well tolerated surgical procedure with few patients experiencing serious sight-threatening adverse events, and it will be interesting in the coming years to determine whether there will be a continued reduction in complications of cataract surgery.
Abstract: Purpose of reviewOver the past several decades, there have been many advances in the equipment, instrumentation and techniques of performing cataract surgery. This review will address the impact of these advances on the safety profile of cataract surgery.Recent findingsRecent studies have demonstrat
TL;DR: Findings indicate the broad positive impact of sight restoring cataract surgery on the recipients’ as well as their families’ lives will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.
Abstract: Background
To explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status.
Methods
Participants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19).
Results
Of the 294 participants, mean age ± standard deviation (SD) 60±8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; p<0.001). At one year, more participants were engaged in income generating activities (44.7% to 77.7%; p<0.001) and the proportion of households with a monthly income <1000 Rps. decreased from 50.5% to 20.5% (p<0.05). Overall VRQoL improved (p<0.001). Participants who had successful cataract surgery were less likely to remain in the lower categories of monthly household income (OR 0.05–0.22; p<0.02) and more likely to be engaged in income earning activities one year after surgery (OR 3.28; p = 0.006). Participants widowed at baseline who had successful cataract surgery were less likely to remain widowed at one year (OR 0.02; p = 0.008).
Conclusion
These findings indicate the broad positive impact of sight restoring cataract surgery on the recipients’ as well as their families’ lives. Providing free high quality cataract surgery to marginalized rural communities will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.
TL;DR: This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors.
Abstract: Cataract surgery in uveitic eyes is often challenging and can result in intraoperative and postoperative complications. Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. With improved understanding of the disease processes, pre- and perioperative control of inflammation, modern surgical techniques, availability of biocompatible intraocular lens material and design, surgical experience in performing complicated cataract surgeries, and efficient management of postoperative complications have led to much better outcome. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation. Meticulous and careful cataract surgery in uveitic cataract is essential in optimizing the postoperative outcome. Management of postoperative complications, especially inflammation and glaucoma, earlier rather than later, has also contributed to improved outcomes. This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors.
TL;DR: Compared with previous studies, limbus-based and fornix-based trabeculectomy procedures have more symptomatic hypotony and more and earlier cataract development, and incidence of surgical complications are similar.