Showing papers on "Cataract surgery published in 2017"

Accuracy of 3 new methods for intraocular lens power selection.

Abstract: Purpose To evaluate the accuracy of 3 new methods for intraocular lens (IOL) power selection (Hill-Radial Basis Function [Hill-RBF] method, FullMonte method, and the Ladas Super Formula) compared with that of the Holladay 1 and Barrett Universal II formulas. Setting Ophthalmology Department, Alfred Hospital, Melbourne, Australia. Design Retrospective case series. Methods Patients who had uneventful cataract surgery with insertion of the Acrysof IQ SN60WF IOL over 5 years were included in the study. Data obtained from the electronic medical record and the IOLMaster device were entered into the respective calculators using self-designed computer programs. Using optimized lens constants, the predicted refractive outcome using each of the 5 methods/formulas was calculated and compared with the actual refractive outcome to give the prediction error. Eyes were separated into subgroups based on axial length as follows: short (≤22.0 mm), medium (>22.0 to Results The study comprised 3122 eyes of 3122 patients. A statistically significant difference in the mean absolute prediction error (MAE) between the 5 methods for IOL power calculation was found ( P Conclusion New methods for predicting the postoperative refraction failed to yield more accurate results than current formulas.

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

Abstract: Endophthalmitis (inflammation of the inside of the eyeball due to infection or trauma) is a rare but potentially blinding complication of cataract surgery. It typically is caused by bacteria that enter the eye during surgery or in the first few days after surgery. Multiple preventive measures are used to try to prevent infection after surgery. Several studies have investigated different modes of prevention such as the types of antibiotics used, how the antibiotics are applied or taken, and when the antibiotics are given in the surgical process. The authors searched the literature for randomized controlled trials of cataract surgery that evaluated giving antibiotics shortly prior to, during, or immediately after surgery to prevent acute endophthalmitis. Four trials with a total of 100,876 adults and 131 endophthalmitis cases met the inclusion criteria. Of these four trials, two reported reduced rates of endophthalmitis when comparing antibiotics injected into the eye versus antibiotics given in eye drops. In one study, penicillin injected into the eye resulted in a 67% reduction in endophthalmitis after surgery. In the more recent ESCRS study, cefuroxime injected into the eye reduced the risk of endophthalmitis by 80% to 90%, depending on whether antibiotic drops were also utilized. This study provides the best available current evidence for antibiotic prevention of endophthalmitis. Cefuroxime is used widely in Europe but on a limited basis in the United States, where some physicians have expressed concerns regarding risk of contamination or dilution errors during the compounding process (preparing drugs for ocular use) that could cause ocular toxicity (harms). Given that clinical trials with rare outcomes need to enroll a large number of participants and are costly to conduct, it is unlikely that additional clinical trials will be conducted to assess how well perioperative antibiotic prophylaxis works to prevent acute endophthalmitis after cataract surgery. Practitioners should consider the evidence shown by the ESCRS study, that antibiotics injected into the eye are likely to reduce the risk of endophthalmitis after cataract surgery when they can be sterilely obtained and delivered.

Non‐steroidal anti‐inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery

Abstract: Background Cataract is a leading cause of blindness worldwide. Cataract surgery is commonly performed but can result in postoperative inflammation of the eye. Inadequately controlled inflammation increases the risk of complications. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are used to prevent and reduce inflammation following cataract surgery, but these two drug classes work by different mechanisms. Corticosteroids are effective, but NSAIDs may provide an additional benefit to reduce inflammation when given in combination with corticosteroids. A comparison of NSAIDs to corticosteroids alone or combination therapy with these two anti-inflammatory agents will help to determine the role of NSAIDs in controlling inflammation after routine cataract surgery. Objectives To evaluate the comparative effectiveness of topical NSAIDs (alone or in combination with topical corticosteroids) versus topical corticosteroids alone in controlling intraocular inflammation after uncomplicated phacoemulsification. To assess postoperative best-corrected visual acuity (BCVA), patient-reported discomfort, symptoms, or complications (such as elevation of IOP), and cost-effectiveness with the use of postoperative NSAIDs or corticosteroids. Search methods To identify studies relevant to this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register (2016, Issue 12), MEDLINE Ovid (1946 to December 2016), Embase Ovid (1947 to 16 December 2016), PubMed (1948 to December 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 16 December 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com; last searched 17 June 2013), ClinicalTrials.gov (www.clinicaltrials.gov; searched December 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en; searched December 2016). Selection criteria We included randomized controlled trials (RCTs) in which participants were undergoing phacoemulsification for uncomplicated cataract extraction. We included both trials in which topical NSAIDs were compared with topical corticosteroids and trials in which combination therapy (topical NSAIDs and corticosteroids) was compared with topical corticosteroids alone. The primary outcomes for this review were inflammation and best-corrected visual acuity (BCVA). Data collection and analysis Two review authors independently screened the full-text articles, extracted data from included trials, and assessed included trials for risk of bias according to Cochrane standards. The two review authors resolved any disagreements by discussion. We graded the certainty of the evidence using GRADE. Main results This review included 48 RCTs conducted in 17 different countries and two ongoing studies. Ten included studies had a trial registry record. Fifteen studies compared an NSAID with a corticosteroid alone, and 19 studies compared a combination of an NSAID plus a corticosteroid with a corticosteroid alone. Fourteen other studies had more than two study arms. Overall, we judged the studies to be at unclear risk of bias. NSAIDs alone versus corticosteroids alone None of the included studies reported postoperative intraocular inflammation in terms of cells and flare as a dichotomous variable. Inflammation was reported as a continuous variable in seven studies. There was moderate-certainty evidence of no difference in mean cell value in the participants receiving an NSAID compared with the participants receiving a corticosteroid (mean difference (MD) -0.60, 95% confidence interval (CI) -2.19 to 0.99), and there was low-certainty evidence that the mean flare value was lower in the group receiving NSAIDs (MD -13.74, 95% CI -21.45 to -6.04). Only one study reported on corneal edema at one week postoperatively and there was uncertainty as to whether the risk of edema was higher or lower in the group that received NSAIDs (risk ratio (RR) 0.77, 95% CI 0.26 to 2.29). No included studies reported BCVA as a dichotomous outcome and no study reported time to cessation of treatment. None of the included studies reported the proportion of eyes with cystoid macular edema (CME) at one week postoperatively. Based on four RCTs that reported CME at one month, we found low-certainty evidence that participants treated with an NSAID alone had a lower risk of developing CME compared with those treated with a corticosteroid alone (RR 0.26, 95% CI 0.17 to 0.41). No studies reported on other adverse events or economic outcomes. NSAIDs plus corticosteroids versus corticosteroids alone No study described intraocular inflammation in terms of cells and flare as a dichotomous variable and there was not enough continuous data for anterior chamber cell and flare to perform a meta-analysis. One study reported presence of corneal edema at various times. Postoperative treatment with neither a combination treatment with a NSAID plus corticosteroid or with corticosteroid alone was favored (RR 1.07, 95% CI 0.98 to 1.16). We judged this study to have high risk of reporting bias, and the certainty of the evidence was downgraded to moderate. No included study reported the proportion of participants with BCVA better than 20/40 at one week postoperatively or reported time to cessation of treatment. Only one included study reported on the presence of CME at one week after surgery and one study reported on CME at two weeks after surgery. After combining findings from these two studies, we estimated with low-certainty evidence that there was a lower risk of CME in the group that received NSAIDs plus corticosteroids (RR 0.17, 95% CI 0.03 to 0.97). Seven RCTs reported the proportion of participants with CME at one month postoperatively; however there was low-certainty evidence of a lower risk of CME in participants receiving an NSAID plus a corticosteroid compared with those receiving a corticosteroid alone (RR 0.50, 95% CI 0.23 to 1.06). The few adverse events reported were due to phacoemulsification rather than the eye drops. Authors' conclusions We found insufficient evidence from this review to inform practice for treatment of postoperative inflammation after uncomplicated phacoemulsification. Based on the RCTs included in this review, we could not conclude the equivalence or superiority of NSAIDs with or without corticosteroids versus corticosteroids alone. There may be some risk reduction of CME in the NSAID-alone group and the combination of NSAID plus corticosteroid group. Future RCTs on these interventions should standardize the type of medication used, dosing, and treatment regimen; data should be collected and presented using the Standardization of Uveitis Nomenclature (SUN) outcome measures so that dichotomous outcomes can be analyzed.

Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma.

Abstract: Recently, many new devices and procedures have been developed to lower intraocular pressure in a less invasive and purportedly safer manner than traditional glaucoma surgery. These new devices might encourage an earlier transition to surgery and reduce the long-term commitment to topical glaucoma medications with their associated compliance and intolerance issues. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. New studies have shown that primary ab interno trabeculectomy (Trabectome, NeoMedix Inc., Tustin, CA, USA), trabecular micro-bypass stent insertion (iStent and iStent Inject, Glaukos Corporation, Laguna Hills, CA, USA), canalicular scaffolding (Hydrus, Invantis Inc., Irvine CA, USA), the ab interno gel Implant (XEN, Allergan, Dublin, Ireland) or supraciliary stenting (CyPass Micro-Stent, Alcon, Fort Worth, TX, USA) may lower the lowering intraocular pressure and/or topical medication burden in phakic or pseudophakic patients with glaucoma. This effect seems to last at least 12 months but reliable cost-effectiveness and quality of life indicators have not yet been established by investigator-initiated randomized trials of sufficient size and duration.

Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo

Abstract: Define the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study. Eyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use. PCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk. Pseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors. NIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945 .

Short term visual outcomes of a new trifocal intraocular lens.

Abstract: Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™). Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery. One hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at −1.00D and peaked again at −2.00D. Visual acuities better than 0.2 LogMAR were maintained between −2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction. The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution. ISRCTN60143265 , retrospectively registered on the 24th of April 2017.

Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents.

Abstract: Introduction This retrospective consecutive case series examined whether training on a surgical simulator reduces intraoperative complication rates among novice ophthalmology residents learning cataract surgery. Methods Beginning July 2014, training on the Eyesi simulator became mandatory for novice postgraduate year 3 ophthalmology residents before live cataract surgery at our institution. Complication rates of the 11 simulator-trained residents (study group) were compared with their immediate 11 simulator-naive predecessors (comparison group). Only straightforward cataract cases (according to standardized preoperative criteria) where postgraduate year 3 residents served as the primary surgeon were included. Complication data were obtained from Morbidity and Mortality records and compared using Fisher exact test. A survey was administered to the residents to gauge the perceived utility of simulation training. Results The simulator-trained group (n = 501 cataract cases) and the simulator-naive comparison group (n = 454 cases) were analyzed. The complication rate in the simulator group was 2.4% compared with 5.1% in the comparison group (P = 0.037, Fisher exact test). Both the mean posterior capsule tear rate and vitreous prolapse rate in the simulator group were 2.2% compared with 4.8% in the comparison group (P = 0.032, Fisher exact test). The survey had a response rate of 100% (11/11), and 91% (10/11) of respondents felt that the training was "extremely worthwhile" and should be mandatory. Conclusions The addition of surgical simulation training was associated with a significantly reduced rate of complications, including posterior capsule tears and vitreous prolapse, among novice postgraduate year 3 residents. There is a perceived utility among residents to incorporate virtual simulation into surgical training.

Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review.

Abstract: PurposeOver 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium i

Optimizing outcomes with toric intraocular lenses

Abstract: Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery. Comprehensive literature search was performed in MEDLINE using "toric intraocular lenses," "astigmatism," and "cataract surgery" as keywords. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Realignment of the toric IOL is needed in 0.65%-3.3% cases, with more than 10° of rotation from the target axis. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations.

Ab Interno Gel Implant for the Treatment of Glaucoma Patients With or Without Prior Glaucoma Surgery: 1-Year Results.

Abstract: PURPOSE The purpose of this study is to evaluate IOP lowering effects and complication management of an ab interno gel implant for the treatment of patients refractory to antiglaucoma medication or glaucoma surgery. METHODS Retrospective analysis of the medical records of 242 consecutive eyes of 146 patients with uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy or prior surgical intervention that underwent XEN45 implantation (as sole procedure or in combination with cataract surgery) between March 2014 and June 2015. Data included IOP, number of glaucoma medications, the need for additional surgery, needling, and complications. RESULTS During the study period, mean IOP had decreased by 54.1% from 32.19 (±9.1) mm Hg to 14.24 (±4.0) mm Hg (P=0.00; Wilcoxon test). The number of antiglaucoma medications had decreased from a mean of 3.13±1.0 to 0.3±0.7 (P=0.00; Wilcoxon test). Needling was required between week 1 and months 3 in 27.7% of all eyes to enhance the outflow. Hypotony (IOP<6 mm Hg) was observed in 9 eyes (4.0%) at 1 month but normalized in all eyes at 12 months postoperatively. Two eyes experienced hypotony requiring the refill of the anterior chamber. CONCLUSIONS Our data indicate that the XEN45 gel implant has a favorable safety profile and is an effective treatment option for controlling IOP in glaucoma patients with unregulated IOP despite IOP lowering medical therapy or prior surgical intervention. It offers an effective approach, both as sole procedure and in combination with cataract surgery.

Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts.

Abstract: Purpose To compare the outcomes between femtosecond laser–assisted cataract surgery (femtosecond group) and conventional phacoemulsification cataract surgery (conventional group) in patients with hard nuclear cataract Setting Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China Design Prospective consecutive nonrandomized comparative cohort study Methods According to the Emery-Little classification, cataract patients with a grade 4 or 5 hard nuclei were assigned to 1 of the 2 groups The endothelial cell density (ECD), central corneal thickness (CCT), and uncorrected and corrected (CDVA) distance visual acuities were evaluated preoperatively and 1 day, 1 week, 1 month, and 3 months postoperatively Results The study comprised 95 eyes (47 in the femtosecond group; 48 in the conventional group) The effective phacoemulsification time, absolute phaco time, and mean ultrasound power were lower in the femtosecond group ( P P = 001, and P P P Conclusion Compared with conventional phacoemulsification, femtosecond laser–assisted cataract surgery for hard nuclear cataracts conserved phacoemulsification power, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation

Surgery for cataracts in people with age‐related macular degeneration

Abstract: Background Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. Objectives The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016. Selection criteria We included randomized controlled trials (RCTs) and quasi-randomized trials that enrolled participants whose eyes were affected by both cataract and AMD in which cataract surgery was compared with no surgery. Data collection and analysis Two review authors independently evaluated the search results against the inclusion and exclusion criteria. Two review authors independently extracted data, assessed risk of bias for included studies, and graded the certainty of evidence. We followed methods as recommended by Cochrane. Main results We included two RCTs with a total of 114 participants (114 study eyes) with visually significant cataract and AMD. We identified no ongoing trials. Participants in each RCT were randomized to immediate cataract surgery (within two weeks of enrollment) or delayed cataract surgery (six months after enrollment). The risk of bias was unclear for most domains in each study; one study was registered prospectively. In one study conducted in Australia outcomes were reported only at six months (before participants in the delayed-surgery group had cataract surgery). At six months, the immediate-surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed-surgery group (mean difference (MD) -0.15 LogMAR, 95% confidence interval (CI) -0.28 to -0.02; 56 participants; moderate-certainty evidence). In the other study, conducted in Austria, outcomes were reported only at 12 months (12 months after participants in the immediate-surgery group and six months after participants in the delayed-surgery group had cataract surgery). There was uncertainty as to which treatment group had better improvement in distance visual acuity at 12 months (unit of measure not reported; very low-certainty evidence). At 12 months, the mean change from baseline between groups in cumulated drusen or geographic atrophy area size was small and there was uncertainty which, if either, of the groups was favored (MD 0.76, 95% CI -8.49 to 10.00; 49 participants; low-certainty evidence). No participant in one study had exudative AMD develop in the study eye during 12 months of follow-up; in the other study, choroidal neovascularization developed in the study eye of 1 of 27 participants in the immediate-surgery group versus 0 of 29 participants in the delayed-surgery group at six months (risk ratio 3.21, 95% CI 0.14 to 75.68; 56 participants; very low-certainty evidence). Quality of life was measured using two different questionnaires. Scores on the Impact of Vision Impairment (IVI) questionnaire suggested that the immediate-surgery group fared better regarding vision-related quality of life than the delayed-surgery group at six months (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59; low-certainty evidence). However, we could not analyze scores from the Visual Function-14 (VF-14) questionnaire from the other study due to insufficient data. No postoperative complication was reported from either study. Authors' conclusions At this time, it is not possible to draw reliable conclusions from the available data as to whether cataract surgery is beneficial or harmful in people with AMD after 12 months. Although cataract surgery provides short-term (six months) improvement in BCVA in eyes with AMD compared with no surgery, it is unclear whether the timing of surgery has an effect on long-term outcomes. Physicians must make recommendations to their AMD patients regarding cataract surgery based on experience and clinical judgment until large controlled trials are conducted and their findings published. There is a need for prospective RCTs in which cataract surgery is compared with no surgery in people with AMD to better evaluate whether cataract surgery is beneficial or harmful in all or a subset of AMD patients. However, ethical considerations preclude withholding surgery, or delaying it for several years, if it may be a potentially beneficial treatment. Designers of future trials are encouraged to utilize existing standardized systems for grading cataract and AMD and for measuring key outcomes: visual acuity, change in visual acuity, worsening of AMD, quality of life measures, and adverse events.

The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye.

Abstract: Purpose To determine the incidence and severity of dry eye as determined by the International Task Force (ITF) scale in patients being screened for cataract surgery. Patients and methods This was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT), ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye. Results Mean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9%) had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer's score with anesthesia ≤5 mm. Conclusion The incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated.

Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage.

Abstract: Objective To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). Methods All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. Findings Datasets from 20 countries were included (2005–2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1–66.6%), CSOGood was 58.9% (IQR 53.7–67.6%) and CSOPoor was 17.7% (IQR 11.3–21.1%). Coverage and quality of cataract surgery were moderately associated—every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2–50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5–7.1%) than for CSC (median 2.3% IQR -1.5–11.6%). Conclusion eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

Contralateral eye comparison study in MICS & MIGS: Trabectome® vs. iStent inject®.

Abstract: To compare the safety and efficacy profile after combined micro-incision cataract surgery (MICS) and micro-invasive glaucoma surgery (MIGS) with the ab interno trabeculectomy (Trabectome®) in one eye versus two iStent® inject devices in the contralateral eye in patients with open-angle glaucoma (OAG) and cataract. This retrospective, intraindividual eye comparison study included 27 patients (54 eyes) who were treated with combined MICS and ab interno trabeculectomy (group I, Trabectome®) in one eye and two iStent® inject devices (group II, GTS 400) in the fellow eye. Primary outcome measures included intraocular pressure (IOP) and glaucoma medication after 6 weeks, 3, 6, and 12 months follow-up. Secondary outcome measures were number of postoperative interventions, complications, and best-corrected visual acuity (BCVA). Mean preoperative IOP decreased from 22.3 ± 3.7 mmHg in group I and 21.3 ± 4.1 mmHg in group II to 15.6 ± 3.6 mmHg for Trabectome (p 0.05). No vision-threatening complications such as choroidal effusion, choroidal hemorrhage, or infection occurred. In each group trabeculectomy had to be performed in two eyes due to insufficient IOP lowering effect. Ab interno trabeculectomy and iStent® inject were both effective in lowering IOP with a favourable and comparable safety profile in an intraindividual comparative study over a 12-months follow-up in OAG. However, longer follow-up of these patients will be necessary to determine long-term outcomes and to evaluate significant differences.

Prospective multicenter trial of a small-aperture intraocular lens in cataract surgery

Abstract: Purpose To evaluate the clinical acceptability of monocular implantation of the small-aperture (IC-8) intraocular lens (IOL) in 1 eye and an aspheric monofocal IOL in the fellow eye of bilateral cataract patients over 6 months postoperatively. Setting Twelve clinics in Austria, Belgium, Germany, Italy, Spain, and Norway. Design Prospective case series. Methods The visual acuity, depth of focus, contrast sensitivity, patient satisfaction, visual symptoms, and adverse events were assessed in patients who had bilateral cataract surgery followed by implantation of the small-aperture IOL in 1 eye and an aspheric monofocal IOL in the fellow eye. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were reported in Snellen notation. Results The study comprised 105 patients. At 6 months, the UDVA, UIVA, and UNVA in eyes with the small-aperture IOL were 20/23, 20/24, and 20/30, respectively. Ninety-nine percent, 95%, and 79% of patients achieved 20/32 or better binocular UDVA, UIVA, and UNVA, respectively. Ninety-three patients (95.9%) reported they would have the procedure again versus 4 patients (4.1%) who reported they would not have the procedure again. In eyes with the small-aperture IOL, the target-corrected defocus curve measured with 0.75 diopter (D) of myopia extended the range of functional near vision by an additional diopter without loss of distance vision compared with the distance-corrected defocus curves. The mean UIVA and UNVA remained at 20/25 and 20/32, respectively, for up to 1.5 D of residual astigmatism in eyes with the small-aperture IOL. Conclusion The small-aperture IOL showed excellent visual performance, safety, patient satisfaction, and tolerance to residual astigmatism 6 months after implantation.

Dropless Cataract Surgery: An Overview

Abstract: Risk reduction and the attainment of good outcomes in contemporary cataract surgery depend in part on patient compliance with a postoperative regimen of topical eye drops. Topical drops are expensive and challenging to instill properly for patients. The consequences of noncompliance or poor compliance can be significant for the patient (in the case of a complication) and for society (in the case of development of antibiotic resistance). For all of these reasons, new approaches that reduce the need for topical therapy are beginning to emerge, including intracameral injection, sustained or slow-release drug delivery mechanisms, and the recently introduced "Dropless cataract surgery," which involves intravitreal injection of single-use, compounded combination of antibiotics and corticosteroids. This paper is a review of the rationale for reducing topical therapy in cataract surgery prophylaxis, and what is known to date about the efficacy and safety of the dropless approach.

Image-guided system versus manual marking for toric intraocular lens alignment in cataract surgery.

Abstract: Purpose To compare the accuracy of toric intraocular lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. Results The study enrolled 36 eyes (24 patients). The mean toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P = .02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P .05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P > .05). No intraoperative complications occurred during any surgery. Conclusion The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism.

Review of manual small-incision cataract surgery

Abstract: Cataract surgery has undergone many changes with the size of incision progressively decreasing over time with an incision of 12.0 mm for intracapsular cataract extraction to 2.2-2.8 mm in phacoemulsification. However, phacoemulsification due to high cost and equipment maintenance cannot be employed widely in developing countries. Manual small-incision cataract surgery (MSICS) offers similar advantages with the merits of wider applicability, less time consuming, a shorter learning curve, and lower cost. MSICS can be performed in high-volume setups due to fast technique. Here, we review the various techniques, safety and efficacy of MSICS, and its progress and utility in developing and underdeveloped countries.

Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection

Abstract: Purpose of review After publication of the results of the European Society of Cataract and Refractive Surgery (ESCRS) study, there is a lot of enthusiasm for using intracameral antibiotics for the prevention of postcataract endophthalmitis. However, despite level 1 evidence, the practice has not been adopted universally. The aim of this review is to present a summary of the articles published in the last 18 months on this topic. Recent findings The published literature highlights that the incidence rate of endophthalmitis declined after 2007. Simultaneously, there is a rising trend for using intracameral injection of antibiotics at the conclusion of cataract surgery. Although various drugs have been used for this purpose, nearly all provide comparable protection. Industry has started manufacturing formulations for commercial availability of intracameral injection. Innovations are also ongoing to use intraocular lens for drug delivery and developing other intraocular drug delivery devices. Summary Endophthalmitis prevention is at an interesting crossroad. Although there is hesitation the intracameral injection of antibiotics is increasingly being adopted by physicians, which is likely to grow further with commercial availability of formulations. However, it will be important to be cautious and report all adverse reactions associated with this practice.

Comparison of visual outcomes, alignment accuracy, and surgical time between 2 methods of corneal marking for toric intraocular lens implantation

Abstract: Purpose: To compare the efficacy of a computer-assisted marker system for toric intraocular lenses (IOLs) (Callisto Eye System) with manual marking techniques. Setting: University Eye Hospital Munich, Ludwig-Maximilians-University, Munich, Germany. Design: Prospective case series. Methods: This study included patients having cataract surgery with implantation of a toric IOL (Torbi 709 M). They were randomly assigned to 1 of 2 groups based on the marking system used, manual or digital. Patients were included if they had age-related cataract and a regular comeal astigmatism of 1.25 diopters (D) or higher. Visual and refractive outcomes as well as rotational stability were evaluated. Vector analysis was performed to evaluate total astigmatic changes. Results: The study comprised 57 eyes of 29 patients;there were 28 eyes in the manual group and 29 eyes in the digital group. The mean toric IOL misalignment was significantly lower in the digital group than in the manual group (2.0 degrees +/- 1.86 [SD] versus 3.4 +/- 2.37 degrees;P = .026). The mean deviation from the target induced astigmatism was significantly lower in the digital group (0.10 +/- 0.08 D versus 0.22 +/- 0.14 D;P = .008). During surgery, the mean toric IOL alignment time was significantly shorter in the digital group (37.2 +/- 11.9 seconds versus 59.4 +/- 15.3 seconds;P = .003). The mean overall time required to perform the surgery was significantly shorter in the digital group (727.2 +/- 198.4 seconds versus 1110.0 +/- 382.2 seconds;P < .001). Conclusions: A digital tracking approach for toric IOL alignment was efficient and safe to improve refractive outcomes. Furthermore, image-guided surgery helped streamline the workflow in refractive cataract surgery. (C) 2017 ASCRS and ESCRS

High correlation between performance on a virtual‐reality simulator and real‐life cataract surgery

Abstract: Purpose: To investigate the correlation in performance of cataract surgery between a virtualreality simulator and real-life surgery using two validated, objective assessment tools.Methods: Cataract surgeons with varying levels of experience were included in the study. All participants performed and video-recorded three standard cataract surgeries before completing a proficiency-based test on the EyeSi virtual-reality simulator. Standard cataract surgeries were defined as: 1) surgery performed under local anaesthesia, 2) patient age > 60 years, and 3) visual acuity > 1/60 pre-operatively. A motion-tracking score was calculated by multiplying average path length and average number of movements from the three real-life surgical videos of full procedures. The EyeSi test consisted of five abstract and two procedural modules: intracapsular navigation, antitremor training, intracapsular antitremor training, forceps training, bimanual training, capsulorhexis, and phaco divide and conquer. Results: Eleven surgeons were enrolled. After a designated warm-up period, the proficiency-based test on the EyeSi simulator was strongly correlated to real-life performance measured by motion-tracking software of cataract surgical videos with a Pearson correlation coefficient of -0.70(p=0.017). Conclusion: Performance on the EyeSi simulator is significantly and highly correlated to real-life surgical performance. However, it is recommended that performance assessments are made using multiple data sources.

The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema.

Abstract: AIM To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery. METHODS Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. INCLUSION CRITERIA eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. MAIN OUTCOME MEASURE rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. RESULTS 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01). CONCLUSIONS This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.

A Global View on Output and Outcomes of Cataract Surgery With National Indices of Socioeconomic Development.

Abstract: Purpose: Cataract blindness accounts for a substantial proportion of blindness worldwide. Understanding the correlations between national levels of socioeconomic development with the quantity and quality of cataract surgery may provide insight for the prioritization and resource allocation for blindness prevention programs. Methods: The relationships between human development index (HDI), gross domestic product (GDP) per capita, and cataract surgical coverage (CSC) and visual outcome of cataract surgery were examined in a multinational study utilizing secondary data from the repository for Rapid Assessment of Avoidable Blindness (RAAB), World Health Organization, Global Burden of Disease, United Nations, and the World Bank. Results: A total of 266 RAAB studies across 73 countries/territories were retrieved. Linear regression model results revealed strong associations of HDI with prevalence of cataract blindness (β = -7.056, P < 0.001), CSC (β = 60.808, P = 0.004), proportion of intraocular lens (IOL) implantation (β = 87.040, P = 0.001), and proportion of cases with good vision outcomes among operated eyes (β = 73.351, P < 0.001) in studies performed between 1995 and 2009. Similar associations were observed for studies performed between 2010 and 2015. In addition, countries with lower GDP per capita showed a higher rate of cataract blindness (β = -0.527, P = 0.001), lower CSC (β = 9.800, P < 0.001), lower percentage of IOL implantation (β = 6.871, P = 0.001), and fewer patients with good vision outcomes after surgery (β = 7.959, P < 0.001). After controlling survey year, country, and other factors, GDP per capita and HDI were also found to be significantly associated with CSC and visual outcomes after cataract surgery (all P < 0.05). Conclusions: We documented the strong associations of socioeconomic indices with quantity and quality of cataract surgery. These socioeconomic indicators should be considered as important factors for developing strategies aimed to improve worldwide cataract surgery service delivery.

Cataract surgery in uveitis: a multicentre database study

Abstract: Background/aims Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared with non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts. Methods Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared with a reference group of 95 573 eyes from the same dataset. Results Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse preoperative visual acuity (0.87 vs 0.65 logarithm of the minimum angle of resolution (logMAR) units), were from younger patients and had shorter axial lengths and a higher incidence of ocular copathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer postoperative visual acuity at all time points measured up to 6 months (0.41 vs 0.27 logMAR units at 12–24 weeks). Conclusions This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, copathology and worse visual outcomes in this group. These data will allow more accurate preoperative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded, so that patient expectations are met. Compared with the non-uveitic population, the mean postoperative visual acuity is between one and two lines worse at all time points.

Update on congenital cataract surgery management.

Abstract: Purpose of reviewThe basic procedure of pediatric cataract surgery has not dramatically changed over the past few years. Recent multicenter study results along with technological innovations, however, have increased our understanding and armamentarium of techniques and devices used to improve outcom

Multifocal intraocular lenses: Types, outcomes, complications and how to solve them.

Abstract: The multifocal intraocular lenses (IOLs) available are often able to restore visual function and allow spectacle independence after their implantation with great levels of patient satisfaction. The factors associated with the postoperatory success include the careful selection of the patient, the knowledge about the IOLs' design, and their visual performance added to the proper surgical technique and management of possible complications as demonstrated by the evidence available.