Showing papers on "Cataract surgery published in 2014"
TL;DR: Disorganization of the retinal inner layers in the 1-mm foveal area is associated withVA, and change in DRIL predicts future change in VA, and DRIL warrants further study as a robust, readily obtained, and noninvasive biomarker of future VA response in eyes with DME.
Abstract: Importance Biomarkers that predict future visual acuity (VA) in eyes with baseline diabetic macular edema (DME) would substantively improve risk assessment, management decisions, and selection of eyes for clinical studies targeting DME. Objective To determine whether baseline or early change in the novel spectral domain–optical coherence tomography (SD-OCT) parameter disorganization of the retinal inner layers (DRIL) is predictive of VA in eyes with center-involved DME. Design, Setting, and Participants At a tertiary care referral center for diabetic eye disease, a retrospective, longitudinal cohort study obtained demographics, VA, and SD-OCT images from baseline, 4-month, and 8-month visits in 96 participants (120 eyes) with diabetes mellitus and baseline center-involved DME (SD-OCT central subfield thickness, ≥320 µm for men and ≥305 µm for women). Exclusion criteria included substantial media opacity, cataract surgery within 6 months, and nondiabetic retinal pathology affecting VA. On SD-OCT, the 1-mm-wide retinal area centered on the fovea was evaluated by masked graders for DRIL extent, cysts, hyperreflective foci, microaneurysms, cone outer segment tip visibility, and external limiting membrane or photoreceptor disruption and reflectivity. Main Outcomes and Measures Visual acuity and SD-OCT–derived retinal morphology. Results Greater DRIL extent at baseline correlated with worse baseline VA (point estimate, 0.04; 95% CI, 0.02-0.05 per 100 µm; P P r = 0.80). Each approximately 300-µm DRIL increase during 4 months predicted a 1-line, 8-month VA decline. When DRIL increased at least 250 µm at 4 months, no eyes had VA improvement of at least 1 line at 8 months. When DRIL decreased at least 250 µm at 4 months, no eyes had VA decline of at least 1 line at 8 months, and 77.7% had VA improvement of at least 1 line. Conclusions and Relevance Disorganization of the retinal inner layers in the 1-mm foveal area is associated with VA, and change in DRIL predicts future change in VA. Early change in DRIL prospectively identifies eyes with a high likelihood of subsequent VA improvement or decline. Therefore, DRIL warrants further study as a robust, readily obtained, and noninvasive biomarker of future VA response in eyes with DME.
362 citations
TL;DR: The preliminary results and safety profile for GATT, a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabECulotomy.
251 citations
TL;DR: High-quality evidence is found that topical NSAIDs are more effective than topical steroids in preventing PCME in patients undergoing phacoemulsification with posterior chamber intraocular lens implantation for age-related cataract.
236 citations
TL;DR: There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic, however, there were significantly more adverse events and additional intraoperative procedures in the IOL group.
Abstract: Importance The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. Objective To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. Design, Setting, and Participants The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Interventions Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. Main Outcomes and Measures HOTV optotype visual acuity at 4.5 years of age. Results The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group ( P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P Conclusions and Relevance There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. Trial Registration clinicaltrials.gov Identifier:NCT00212134
179 citations
TL;DR: Compared with sequential management of patients with concomitant cataract and endothelial dysfunction, triple DMEK is an effective strategy in rapid visual rehabilitation and offers the advantage of a 1-stage procedure, with reduced risks and costs.
175 citations
TL;DR: The femtosecond laser–assisted method was efficient and safe for cataract surgery and had a learning curve during the first 100 cases, and with cautious surgical technique the complications can be avoided.
Abstract: Purpose To analyze complications of femtosecond lasers used for cataract surgery. Setting Department of Ophthalmology Semmelweis University, Budapest, Hungary. Design Retrospective analysis. Methods Intraoperative complications of the first 100 femtosecond laser–assisted (Alcon-Lensx, Inc.) cataract surgeries were collected. Possible complications of femtosecond capsulotomies and their management were also assessed. Results The complications were as follows: suction break (2%), conjunctival redness or hemorrhage (34%), capsule tags and bridges (20%), anterior tear (4%), miosis (32%), and endothelial damage due to cut within the endothelial layer (3%). There were no cases of capsule blockage or posterior capsule tear. During the learning curve, there was no complication that would require vitrectomy. All complications occurred during the first 100 cases. Conclusions Femtosecond laser cataract surgery had a learning curve during the first 100 cases. With cautious surgical technique, the complications can be avoided. The femtosecond laser–assisted method was efficient and safe for cataract surgery. Financial Disclosure Drs. Nagy, T. Juhasz, and Slade are consultants to Alcon-Lensx, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
141 citations
TL;DR: These results may help vitreoretinal surgeons to benchmark their intraoperative complication rate and reoperation rate and to compare their surgical techniques with their peers' and suggest that the benefits of RD surgery greatly outweigh the risks.
139 citations
TL;DR: Laser anterior capsulotomy integrity seems to be compromised by postage-stamp perforations and additional aberrant pulses, possibly because of fixational eye movements, which can lead to an increased rate of anterior capsule tears, and extra care should be taken during surgery after femtosecond laser pretreatment has been performed.
137 citations
TL;DR: The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants is found to be greater than previously reported.
124 citations
TL;DR: Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients, and the response pattern was similar across anatomic locations of uveitis.
120 citations
TL;DR: The IOL power estimation in challenging eyes with prior LASIK/photorefractive keratectomy was most accurately predicted by IRB/ORA, significantly more accurate than the other preoperative methods.
TL;DR: The review suggests that preoperative control of uveitis, use of an acrylic or HSM IOL, and a diagnosis of Fuchs heterochromic cyclitis were associated with better outcomes.
TL;DR: Laser cataract surgery, irrespective of potential improvements in visual acuity outcomes and complication rates, is not cost effective at its current cost to patient when compared with cost-effectiveness benchmarks and other medical interventions, including PCS.
Patent•
11 Jun 2014
TL;DR: In this paper, the authors present a tool guidance system for cataract removal using optical coherence tomography (OCT), white-light imaging, and structured light imaging.
Abstract: Systems and processes for facilitating the removal of cataract material with a robotically assisted tool with laser, irrigation capabilities, aspiration capabilities. Tool guidance systems that make use of vision technologies, including optical coherence tomography (OCT), white light imaging, and structured light imaging. Emulsification patterns optimized to minimize risk to the patient and reduce procedure time. Robotic tools with articulation capabilities that allow for precise control during capsulorhexis and emulsification procedures. Robotic instrument drive mechanisms combined with pumps, flow meters, and valves regulate and control irrigation and aspiration functionalities during robotic ophthalmologic procedures.
TL;DR: There are sufficient data to suggest that cataract surgery provides a lowering effect on intraocular pressure in the long term, and this effect appears to be proportional to preoperative IOP.
Abstract: Purpose of review To examine the current literature covering the long-term effect of cataract extraction on intraocular pressure (IOP). Recent findings As a result of the high rate of cataract surgery, the impact on IOP continues to be the subject of multiple studies in different populations. Recent publications include those that distinguish patients with open angles from those with more narrow angles, as well as prospective analyses that address the impact of regression to the mean and other types of bias on the effect of postoperative IOP lowering. Summary There are sufficient data to suggest that cataract surgery provides a lowering effect on IOP in the long term. This effect appears to be proportional to preoperative IOP. Eyes with higher preoperative IOP have the greatest average lowering, whereas eyes with IOP in the lower range of statistically normal tend to have an IOP that is unchanged from baseline or even higher following cataract surgery. In patients with narrow angles, the IOP-lowering effect appears to also be proportional to the degree of anterior chamber deepening induced by cataract surgery.
TL;DR: The limited data from intervention trials provide some support for observational studies with regard to nuclear cataracts, and the beneficial levels of nutrients in diets or blood and the total number of participants surveyed in epidemiologic studies since a previous review in 2007 are presented.
Abstract: Lens opacification or cataract reduces vision in over 80 million people worldwide and blinds 18 million These numbers will increase dramatically as both the size of the elderly demographic and the number of those with carbohydrate metabolism-related problems increase Preventative measures for cataract are critical because the availability of cataract surgery in much of the world is insufficient Epidemiologic literature suggests that the risk of cataract can be diminished by diets that are optimized for vitamin C, lutein/zeaxanthin, B vitamins, omega-3 fatty acids, multivitamins, and carbohydrates: recommended levels of micronutrients are salutary The limited data from intervention trials provide some support for observational studies with regard to nuclear - but not other types of - cataracts Presented here are the beneficial levels of nutrients in diets or blood and the total number of participants surveyed in epidemiologic studies since a previous review in 2007
TL;DR: Femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time, which correlates positively with the preoperative lens opacity, and this gain was noticeably, but not significantly, lower in group 2.
TL;DR: The risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.
Abstract: Importance Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. Objective To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. Data Sources We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. Study Selection We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. Data Extraction and Synthesis Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. Main Outcomes and Measures Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. Results Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I 2 = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I 2 = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I 2 = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. Conclusions and Relevance Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.
01 Jan 2014
TL;DR: The purpose of this review is to look through the complications associated with Nd:YAG laser capsulotomy, and the effect of Capsulotomy size and used total energy on such complications.
Abstract: It has been revealed that posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. On the other hand, Nd:YAG laser capsulotomy is accepted as standard treatment for PCO. Although, Nd:YAG laser capsulotomy is a noninvasive and safe treatment it carries risk of some complications. Using less total energy and performing smaller capsulotomies are effective choices to decrease complications after Nd:YAG capsulotomy. The purpose of this review is to look through the complications associated with Nd:YAG laser capsulotomy, and the effect of capsulotomy size and used total energy on such complications.
TL;DR: In this paper, the effect of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on the corneal endothelium was compared.
Abstract: Purpose To compare the effect on the corneal endothelium of femtosecond laser–assisted cataract surgery and conventional phacoemulsification cataract surgery. Setting Private clinic, Tasmania, Australia. Design Prospective comparative cohort study. Methods Femtosecond laser–assisted cataract surgery (study group) or conventional phacoemulsification (control group) was performed. The central corneal thickness, central 3.0 mm corneal volume, volume stress index, and central endothelial cell density (ECD) were measured preoperatively and 1 day, 3 weeks, and 6 months postoperatively. Results The study group comprised 405 eyes and the control group, 215 eyes. Postoperative corneal edema was significantly less in the study group at 1 day and 3 weeks. However, the difference was negligible at 6 months. The study group had significant reductions in ECD loss compared with the control group at 3 weeks but not at 6 months (6-month mean −150 cells/mm 2 ± 244 [SD] versus −149 cells/mm 2 ± 233). Eyes in the study group with laser-automated corneal incisions had greater endothelial cell loss at 6 months than eyes in the study group with manual corneal incisions and eyes in the control group ( P P Conclusions Femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification; however, the difference diminished with time. Laser-automated corneal incisions seemed to adversely affect the corneal endothelial cells. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: This article highlights available intracameral antibiotics with respect to pharmacology, spectrum of activity, dosage and preparation, safety, and efficacy profiles, as well as toxic anterior segment syndrome risks to better define the potential use of these medications in the prevention of endophthalmitis.
Abstract: Endophthalmitis is a rare but potentially devastating complication of cataract surgery. This article presents an overview of endophthalmitis prophylaxis and the use of intracameral antibiotics. It highlights available intracameral antibiotics with respect to pharmacology, spectrum of activity, dosage and preparation, safety, and efficacy profiles, as well as toxic anterior segment syndrome risks to better define the potential use of these medications in the prevention of endophthalmitis. Financial Disclosure Proprietary or commercial disclosures are listed after the references.
TL;DR: Cataract surgery with the noncontact femtosecond laser system was safe and no eye lost vision because of complications, but caution should be taken during phacoemulsification and I/A to avoid radial anterior capsule tears and posterior capsule tears.
Abstract: Purpose To report the early experience and complications during cataract surgery with a noncontact femtosecond laser system. Setting Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China. Design Retrospective case series. Methods All patients had anterior capsulotomy or combined anterior capsulotomy and lens fragmentation using a noncontact femtosecond laser system (Lensar) before phacoemulsification. Chart and video reviews were performed retrospectively to determine the intraoperative complication rate. Risk factors associated with the complications were also analyzed. Results One hundred seventy eyes were included. Free-floating capsule buttons were found in 151 eyes (88.8%). No suction break occurred in any case. Radial anterior capsule tears occurred in 9 eyes (5.3%); they did not extend to the equator or posterior capsule. One eye (0.6%) had a posterior capsule tear. No capsular block syndrome developed, and no nuclei were dropped during irrigation/aspiration (I/A). Anterior capsule tags and miosis occurred in 4 eyes (2.4%) and 17 eyes (10.0%), respectively. Different severities of subconjunctival hemorrhages developed in 71 (43.8%) of 162 eyes after the laser procedure. The mean surgical time from the beginning to the end of suction was 6.72 minutes ± 4.57 (SD) (range 2 to 28 minutes). Conclusions Cataract surgery with the noncontact femtosecond laser system was safe. No eye lost vision because of complications. Caution should be taken during phacoemulsification and I/A to avoid radial anterior capsule tears and posterior capsule tears. Financial Disclosure Dr. Chang received travel expenses from Abbott Medical Optics, Inc., and Technolas Perfect Vision GmbH and lecture honoraria from Abbott Medical Optics, Inc., Technolas Perfect Vision GmbH, and Alcon Laboratories, Inc. Dr. Chang was a consultant to Abbott Medical Optics, Inc., from 2010 to 2011. No author has a financial or proprietary interest in any material or method mentioned.
01 Jan 2014
TL;DR: Femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification; however, the difference diminished with time.
Abstract: Purpose To compare the effect on the corneal endothelium of femtosecond laser–assisted cataract surgery and conventional phacoemulsification cataract surgery. Setting Private clinic, Tasmania, Australia. Design Prospective comparative cohort study. Methods Femtosecond laser–assisted cataract surgery (study group) or conventional phacoemulsification (control group) was performed. The central corneal thickness, central 3.0 mm corneal volume, volume stress index, and central endothelial cell density (ECD) were measured preoperatively and 1 day, 3 weeks, and 6 months postoperatively. Results The study group comprised 405 eyes and the control group, 215 eyes. Postoperative corneal edema was significantly less in the study group at 1 day and 3 weeks. However, the difference was negligible at 6 months. The study group had significant reductions in ECD loss compared with the control group at 3 weeks but not at 6 months (6‐month mean −150 cells/mm2 ± 244 [SD] versus −149 cells/mm2 ± 233). Eyes in the study group with laser‐automated corneal incisions had greater endothelial cell loss at 6 months than eyes in the study group with manual corneal incisions and eyes in the control group (P<.0001). Eyes in the study group with zero effective phaco time and manually created corneal incisions had statistically significantly less endothelial cell loss at 6 months than the other groups (P<.0001). Conclusions Femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification; however, the difference diminished with time. Laser‐automated corneal incisions seemed to adversely affect the corneal endothelial cells. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: In this article, the posterior capsule rupture rates and visual outcomes after phacoemulsification, analyze risk factors for poor vision, and compare results of faculty (F) and residents (R).
TL;DR: The use of the femtosecond laser–assisted system for capsulotomy in surgery for intumescent white cataract appears to be safe and technically feasible.
Abstract: Purpose To evaluate the feasibility and safety of femtosecond laser–assisted capsulotomy in eyes with intumescent white cataract. Setting Ruhr University Eye Clinic, Bochum, Germany. Design Prospective clinical trial. Methods After femtosecond laser–assisted capsulotomy (Catalys Precision system), phacoemulsification was performed using pulsed ultrasound energy and the effective phacoemulsification time was evaluated. The lenticular capsule disk was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps for further analysis of form and shape. Results Twenty-five eyes were included in this trial. Automatic optical coherence tomography detection of the anterior capsule was performed successfully in all eyes. Radial anterior tears occurred in 2 eyes, an adherent tongue-like capsule adhesion in 9 eyes, and an incomplete capsulotomy button in 3 eyes. In all cases, the intraocular lens was centered and the implantation was uneventful. The mean deviation from the target diameter of the extracted capsule disks was 60 μm ± 44 (SD). Conclusion The use of the femtosecond laser–assisted system for capsulotomy in surgery for intumescent white cataract appears to be safe and technically feasible. 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: In this article, the authors compared the effect of toric intraocular lens (IOL) and peripheral corneal relaxing incisions (PCRIs) on reducing the astigmatism of cataract patients.
Abstract: Purpose To compare the astigmatism-reducing effect of a toric intraocular lens (IOL) and peripheral corneal relaxing incisions (PCRIs). Setting Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Design Prospective masked bilateral randomized study. Methods Cataract patients with a preoperative corneal astigmatism of 1.0 to 2.5 diopters (D) were included. All patients received a toric IOL in 1 eye and a nontoric IOL plus a PCRI in the other eye. Postoperative follow-up was at 1 hour, 1 month, and 6 months. The uncorrected distance visual acuity, corrected distance visual acuity, autorefraction (Topcon RM-8800), and subjective refraction were recorded. The IOL axis was assessed using retroillumination photographs. Results The study enrolled 60 eyes of 30 patients. The mean astigmatism vector reduction was 1.74 D ± 0.64 (SD) in the toric IOL group and 1.27 ± 0.76 D in the PCRI group; the difference was statistically significant (P=.042). The mean absolute rotation of the toric IOL was 2.5 ± 1.8 degrees (maximum 6.3 degrees) in the first 6 postoperative months. Astigmatism increased in the PCRI group between the 1-month and 6-month follow-up (mean 0.38 ± 0.27 D; maximum 1.00 D) (P Conclusion Toric IOLs and PCRIs both reduced astigmatism; however, toric IOLs reduced astigmatism to a higher extent and they were more predictable. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The AL and changes in the IOP are critical for evaluating the changes in choroidal thickness and these changes negatively correlated with those in IOP early after surgery.
Abstract: Purpose To evaluate changes in choroidal thickness before and after cataract surgery and factors affecting the changes. Setting Tsukazaki Hospital, Himeji, Japan. Design Prospective interventional study. Methods Patients having cataract surgery without other eye pathology were studied. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), axial length (AL), and enhanced-depth-imaging optical coherence tomography (OCT) were measured preoperatively. The choroidal thickness was measured at 5 points (subfoveal and 1.5 mm nasal, temporal, superior, and inferior to the fovea) using the OCT device's software. Enhanced-depth-imaging OCT and IOP measurements were obtained 3 days, 1 and 3 weeks, and 3 and 6 months postoperatively and compared with the baseline values. Stepwise analysis determined which factors (ie, age, CDVA, preoperative IOP, AL, operative time, changes in IOP) were associated with changes in choroidal thickness. Results One hundred eyes were analyzed. The postoperative IOP significantly decreased at 3 weeks, 3 months, and 6 months. The postoperative choroidal thickness significantly increased at the foveal and inferior regions throughout the follow-up; at the nasal region at 3 days, 1 week, and 6 months; at the temporal region at 1 week; and at the superior region at 6 months. These changes negatively correlated with those in IOP early after surgery. The changes in choroidal thickness later negatively correlated with the AL in all regions. Conclusion Cataract surgery caused changes in choroidal thickness. The AL and changes in the IOP are critical for evaluating the changes in choroidal thickness. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The physical principle of femtolasers is discussed, together with the indications and side effects of the method in cataract surgery, and the most important clinical results are presented regarding capsulotomy, fragmentation of the crystalline lens, corneal wound creation, and refractive results.
Abstract: Femtosecond lasers represent a new frontier in cataract surgery. Since their introduction and first human treatment in 2008, a lot of new developments have been achieved. In this review article, the physical principle of femtolasers is discussed, together with the indications and side effects of the method in cataract surgery. The most important clinical results are also presented regarding capsulotomy, fragmentation of the crystalline lens, corneal wound creation, and refractive results. Safety issues such as endothelial and macular changes are also discussed. The most important advantage of femtolaser cataract technology at present is that all the important surgical steps of cataract surgery can be planned and customized, delivering unparalleled accuracy, repeatability, and consistency in surgical results. The advantages of premium lenses can be maximally used in visual and presbyopia restoration as well. The advantages of premium lenses can be maximally used, not only in visual, but in presbyopia restoration as well. Quality of vision can be improved with less posterior chamber lens (PCL) tilt, more centralized position of the PCL, possibly less endothelial damage, less macular edema, and less posterior capsule opacification (PCO) formation. This technological achievement should be followed by other technical developments in the lens industry. Hopefully this review article will help us to understand the technology and the results to demonstrate the differences between the use of femtolasers and phacoemulsification-based cataract surgery. The most important data of the literature are summarized to show ophthalmologists the benefits of the technology in order to provide the best refractive results to the patient.
27 Apr 2014
TL;DR: The integrated 3-dimensional optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy followed by mechanical anterior vitrectomy, which can enhance the quality of pediatric cataract surgery.
Abstract: We describe a technique for performing cataract surgery with a femtosecond laser in infants. Anterior capsulotomy and lens division are performed by the laser. A fluid-filled interface makes it possible to re-dock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The integrated 3-dimensional optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy followed by mechanical anterior vitrectomy. The anterior and the posterior capsule disks are removed without capsule tears. The technique has been performed in 4 infants (ages 2, 4, 7, and 9 months) with congenital cataract. It can enhance the quality of pediatric cataract surgery.
TL;DR: A critical review of the recent literature on biometry for cataract surgery is intended to be a critical review, summarising the evidence for current best practice standards and available practical strategies for improving outcomes for patients.
Abstract: Biometry has become one of the most important steps in modern cataract surgery and, according to the Royal College of Ophthalmologists Cataract Surgery Guidelines, what matters most is achieving excellent results. This paper is aimed at the NHS cataract surgeon and intends to be a critical review of the recent literature on biometry for cataract surgery, summarising the evidence for current best practice standards and available practical strategies for improving outcomes for patients. With modern optical biometry for the majority of patients, informed formula choice and intraocular lens (IOL) constant optimisation outcomes of more than 90% within ±1 D and more than 60% within ±0.5 D of target are achievable. There are a number of strategies available to surgeons wishing to exceed these outcomes, the most promising of which are the use of strict-tolerance IOLs and second eye prediction refinement.