Showing papers on "Cataract surgery published in 2020"
TL;DR: Big data from clinical registries like the IRIS Registry has great potential for evaluating rare conditions such as endophthalmitis, including developing benchmarks, longer-term time trend investigation, and comprehensive analysis of risk factors and prophylaxis.
103 citations
TL;DR: A participant-masked randomised superiority clinical trial comparing FLACS and PCS in two parallel groups found that femtosecond laser was not superior to phacoemulsification in cataract surgery and, with higher costs, did not provide an additional benefit over phacoEMulsification for patients or health-care systems.
69 citations
TL;DR: AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years, compared with other single-piece monofocal intraocular lens models.
Abstract: To evaluate the 3- and 5-year incidence of posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy in patients following cataract surgery, comparing results for different single-piece acrylic hydrophilic and hydrophobic monofocal intraocular lens (IOL) models and other patient factors. Electronic medical record data collected from seven United Kingdom (UK) National Health Service (NHS) ophthalmology clinics for routine, age-related (≥65 years) cataract surgeries that implanted single-piece acrylic monofocal IOLs during 2010–2013 were used to calculate 3- and 5-year incidence of Nd:YAG and PCO. IOL models of Alcon Acrysof, AMO Tecnis, Bausch & Lomb (B & L) Akreos, LenStec Softec, and Rayner Flex were analyzed. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were conducted adjusting for known confounders. The incidence of Nd:YAG capsulotomy ranged between 2.4–12.6% at 3 years and 5.8–19.3% at 5 years post-cataract surgery. Similarly, the incidence of PCO ranged between 4.7–18.6% at 3 years and 7.1–22.6% at 5 years. When comparing all of the single-piece IOLs, AcrySof demonstrated the lowest incidence rates for both PCO and Nd:YAG (P < 0.001 for each comparison). From adjusted logistic regression analysis, AcrySof were associated with lower 3- and 5-year odds of Nd:YAG and PCO incidence. Following cataract surgery with single-piece monofocal IOLs different incidence rates of PCO were observed with different IOLs. AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years.
62 citations
TL;DR: The PPRD risk after phacoemulsification is approximately ten times the general population’s RRD risk, and the interplay of a hierarchy of risk factors, of which intraoperative vitreous loss, myopia, age and sex have the biggest effect.
Abstract: A link between cataract surgery and rhegmatogenous retinal detachment (RRD) has long been considered. Indeed, pseudophakic retinal detachment (PPRD) forms a substantial and increasing proportion of RRD. We reviewed the literature to answer the following questions: what is the incidence of PPRD in eyes following phacoemulsification cataract surgery and how does its risk change over time following surgery? We also sought to assess how the risk is modified by intraoperative factors (operative complications, surgeon grade, subsequent laser capsulotomy), intrinsic eye-related factors (laterality, myopia, previous RRD, previous trauma, previous PVD) and patient factors (sex, age, ethnicity, affluence, systemic comorbidities). Secondarily we asked how the incidence of PPRD after phacoemulsification compares with the RRD incidence in the general population and how identified risk factors contribute to the pathophysiology of PPRD. A search of the Medline and Ovid databases was conducted for relevant publications from 1990 onwards using defined search terms with pre planned inclusion and exclusion criteria. The 10-year PPRD incidence after phacoemulsification was identified as being between 0.36 and 2.9%. This decreases over time to 0.1–0.2% annually but remains above the general population. The PPRD risk is further elevated by (in order of decreasing effect) intraoperative vitreous loss, increasing axial length, younger age, male sex and trainee operating surgeons. The PPRD risk after phacoemulsification is approximately ten times the general population’s RRD risk. This risk is modified by the interplay of a hierarchy of risk factors, of which intraoperative vitreous loss, myopia, age and sex have the biggest effect.
57 citations
TL;DR: Improvements in imaging technology make it possible to non-invasively detect CME even prior to a clinically significant decrease in central vision, and the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME is summarized.
52 citations
10 Jan 2020
TL;DR: The insertion of iStent inject with cataract surgery effectively provides a sustained reduction in intraocular pressure with a markedly improved medication burden up to 24 months postoperatively, and a high safety profile was observed with no significant postoperative complications.
Abstract: The study aimed to investigate the 24-month safety and efficacy of implantation of two second-generation iStent inject trabecular micro-bypass stents with concomitant cataract surgery. This consecutive case series included 164 eyes of 109 patients implanted with the iStent inject® device with concomitant cataract surgery. The series was comprised of eyes with primary open-angle glaucoma (n = 84), pseudoexfoliation glaucoma (n = 42), normal-tension glaucoma (n = 18), and ocular hypertension (n = 20). All 164 eyes reached 9–14 months of follow-up (“12-month consistent cohort”), with a subset of 88 eyes reaching 21–26 months of follow-up (“24-month consistent cohort”). Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intra- or postoperative complications, the need for secondary procedures and corrected distance visual acuity. Comparisons of change in continuous (e.g., IOP) and categorical (e.g., proportions of eyes on zero medications) measures between baseline and postoperative times were made with the paired t-test and McNemar’s chi-squared test, respectively. At 12 months postoperatively, IOP was reduced by 25.5% (from 20.0 ± 5.5 mmHg to 14.9 ± 2.0 mmHg; p < 0.001); at 24 months postoperatively, IOP was reduced by 26.6% (from 20.3 ± 6.1 mmHg to 14.9 ± 1.9 mmHg; p < 0.001). At 12 months postoperatively, mean number of glaucoma medications was reduced by 85.0% (from 2.0 ± 1.0 to 0.3 ± 0.8 medications; p < 0.001); at 24 months postoperatively, mean number of medications was reduced by 81.0% (from 2.1 ± 1.1 to 0.4 ± 0.8 medications; p < 0.001). After 12 months, 96.3% of eyes had an IOP ≤ 18 mmHg and 58.5% of eyes had an IOP ≤ 15 mmHg, with 81.1% of eyes free of any medication, compared to 1.8% of eyes medication-free in the 12-month cohort at baseline. After 24 months, 98.9% of eyes had an IOP ≤ 18 mmHg and 53.4% of eyes had an IOP ≤ 15 mmHg, with 72.7% free of medication compared to 1.1% of eyes medication-free in the 24-month cohort at baseline. Overall, a high safety profile was observed with no significant postoperative complications. The insertion of iStent inject (comprised of two second-generation trabecular micro-bypass stents) with cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden up to 24 months postoperatively.
45 citations
TL;DR: DED is common and can be exacerbated by cataract surgery and ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.
Abstract: AimTo review published literature concerning cataract surgery and dry eye disease (DED).MethodsA search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDL...
45 citations
TL;DR: Visual acuity outcomes were highly variable with only 27 children achieving excellent visual acuity in their treated eye and 50 children having poor vision in the treated eye, and Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome.
Abstract: Importance Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. Objective To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. Design, Setting, and Participants This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Interventions Intraocular lens implantation at the time of cataract surgery. Main Outcomes and Measures Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Results Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46;P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was −0.54 to 0.47). Conclusions and Relevance As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. Trial Registration ClinicalTrials.gov Identifier:NCT00212134
43 citations
TL;DR: The EYEMATE-IO sensor was safely implanted in 22 patients and performed reliably until the end of follow-up, allowing for continual and long-term measurements of IOP.
42 citations
TL;DR: Accuracy of IOL power calculations in post-laser eyes can be improved by the addition of posterior corneal values as measured by the IOLMaster 700.
Abstract: Importance Intraocular lens (IOL) calculations in post-refractive cases remain a concern. Our study identifies improved options for surgeons. Background To evaluate and compare the prediction accuracy of IOL power calculation methods after previous laser refractive surgery using standard keratometry (SK), measured posterior corneal astigmatism (PCA) and total keratometry (TK). Design Retrospective consecutive cohort. Participants A total of 50 consecutive patients (72 eyes) at a private institution who underwent cataract surgery with prior laser refractive procedures. Methods Methods using SK included ASCRS mean, Barrett True-K no history, Haigis-L and Shammas IOL formulae. Barrett True-K using posterior values (True K TK), Haigis and Holladay 1 Double-K methods using TK were also assessed. Post-surgery refraction was undertaken at minimum 3 weeks following surgery. Main outcome measures Arithmetic and absolute IOL refractive prediction errors, variances in mean arithmetic IOL prediction error, and percentage of eyes within ±0.25D, ±0.50D, ±0.75D and ±1.00D of refractive prediction errors were compared. Results The Barrett True-K (TK) provided the lowest mean refractive prediction error (RPE) and variance for both prior myopes and hyperopes undergoing cataract surgery. The Barrett True-K (TK) exhibited the highest percentages of eyes within ±0.50D, ±0.75D and ±1.00D of the RPE compared to other formulae for prior myopic patients. Conclusions and relevance Accuracy of IOL power calculations in post-laser eyes can be improved by the addition of posterior corneal values as measured by the IOLMaster 700. The use of total keratometry may supplement outcomes when no prior refraction history is known.
39 citations
TL;DR: Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in intraocular pressure and number of medications.
Abstract: PURPOSE To investigate the efficacy and safety of a cross-linked gel stent (XEN45) with or without cataract surgery in the treatment of glaucoma patients. SETTING Five university hospitals. DESIGN Prospective multicenter clinical trial. METHODS Patients with glaucoma inadequately controlled by treatment or poor compliance or intolerance to topical therapy were included. Patients were divided into those who had an implant only (Solo Group; phakic and pseudophakic patients) and those who had an implant combined with cataract surgery (Combo Group). Differences in mean intraocular pressure (IOP) and number of medications between the baseline preoperative visit and study end (12 months), and the rate of qualified and complete success, were evaluated. RESULTS The Solo Group comprised 115 glaucoma patients (43 phakic and 72 pseudophakic) and the Combo Group comprised 56 patients. Compared with baseline, mean IOP (23.9 ± 7.6 to 15.5 ± 3.9) and number of medications (3.0 ± 1.1 to 0.5 ± 1.0) decreased significantly at 12-month follow-up (P 20% and >30% reduction in IOP from baseline was achieved by 72.3% and 52.6% of patients, respectively. IOP at 1 week postoperatively was a predictor of success, and the needling rate was inversely correlated with early postoperative IOP. The number of preoperative medications and patient age were not significantly associated with failure. CONCLUSIONS Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in IOP and number of medications.
TL;DR: In this article, the 3-month results of a randomized trial (Femtosecond laser-assisted cataract trial [FACT]) were compared with standard phacoemulsification catarach surgery (PCS).
02 Dec 2020
TL;DR: The aim of this review is to highlight the impact of such a “de-prioritization” of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataracts pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond.
Abstract: The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a "de-prioritization" of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.
TL;DR: To detect any choroidal thickness (CT) change in patients after alpha-lytic drugs withdrawal that could help in the cataract surgery timing decision, data normality with Kolmogorov-Smirnov test was checked and statistical evaluation with Wilcoxon-signed rank test was performed.
Abstract: To detect any choroidal thickness (CT) change in patients after alpha-lytic drugs withdrawal that could help in the cataract surgery timing decision. Twenty-five eyes of 25 patients (mean age: 76 ± 7 years) under alpha-lytic therapy, and 25 eyes of 25 control subjects (CS) (mean age: 75 ± 7 years) without alpha-lytic therapy, both scheduled for cataract surgery in the fellow eye, were included in this observational, prospective, non-randomized study. All patients underwent EDI-OCT during the first preoperative visit and approximately 1 month (range 28–31 days) after alpha-lytic withdrawal. In the CS group, the OCT during preoperative visit and approximately 1 month after (range 28–31 days) the first examination was performed. Data normality with Kolmogorov-Smirnov test was checked and statistical evaluation with the Wilcoxon-signed rank test was performed. The mean subfoveal CT was 224 ± 79.7 μm during therapy and 217 ± 70.4 μm after withdrawal; 1.5 mm nasally from the fovea CT was 198 ± 83.8 μm and 194 ± 82.8 μm, respectively; and 1.5 mm temporally from the fovea CT was 217 ± 55.9 μm and 205 ± 54.4 μm, respectively. A statistically significant reduction (p 0.05). No severe floppy iris syndrome was detected at the time of surgery. In these patients, CT decrease could be an important sign for cataract surgery timing decision.
TL;DR: Femtosecond laser -assisted cataracts surgery was a safe and precise procedure but enhanced visual outcomes only minimally when compared to conventional cataract surgery in experienced hands.
Abstract: To compare the visual and refractive outcomes of femtosecond laser assisted cataract surgery (FLACS) using Victus platform (Technolas Bausch and Lomb (B&L), Munich, Germany) and conventional phacoemulsification cataract surgery (CPCS). A retrospective study of 100 eyes operated for cataract. FLACS was performed in 50 eyes and CPCS was done in another 50 eyes. Preoperative and 6 months postoperative visual and refractive evaluation (efficacy, safety, predictability, and surgically induced astigmatism) as well as higher-order aberrations were analyzed. Efficacy index which equals post-operative mean of uncorrected distance visual acuity (UDVA) divided by preoperative mean corrected distance visual acuity (CDVA) was calculated in both groups. Safety index equals post-operative mean of corrected distance visual acuity (CDVA) divided by preoperative mean CDVA. Logarithm of the Minimum Angle of Resolution (LogMAR), UDVA improved in both groups after surgery (p < 0.05). It was 0.23 ± 0.20 and 0.291 ± 0.311 log MAR in FLACS and CPCS groups respectively. Safety index was 1.777 in FLACS group and 1.744 in CPCS groups showing high degree of safety of both measures. Mean surgically induced astigmatism (SIA) was 0.35 ± 0.67 D and 0.901 ± 0.882 D in FLACS and CPCS groups respectively (p = 0.015). The post-operative comparison between both groups was in favor of CPCS group vs. FLACS group regarding total aberrations (0.563 ± 0.386 vs. 0.91 ± 1.20) (p = 0.03), while low order aberrations were significantly less in FLACS group vs. CPCS group (0.64 + 0.63 vs. 2.07 + 3.15) (p = 0.027). RMS high order aberration was higher in FLACS group vs. CPCS group but of no statistical significance 0.54 ± 0.96 vs. 0.328 ± 0.360 (p = 0.082). Femtosecond laser -assisted cataract surgery was a safe and precise procedure but enhanced visual outcomes only minimally when compared to conventional cataract surgery in experienced hands. Both FLACS and manual surgeries can achieve a high efficacy, predictability and safety with slight superior outcomes in FLACS. PACTR201804003256258 (date: 27 Mar 2018) Available at: https://pactr.samrc.ac.za/
TL;DR: Postoperative corneal ECD and CCT were comparable between FLACS and CPS during the 3 months’ follow-up period and no significant difference was observed in the mean CCT values between the two groups over the follow- up period.
Abstract: Background/Aim To identify changes in endothelial cell density (ECD) and central corneal thickness (CCT) in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification surgery (CPS). Methods This is an intraindividual randomised, controlled clinical trial. One eye was randomised to receive FLACS, while the contralateral eye of the same patient received CPS. The femtosecond laser pretreatment included creating main and side-port corneal incisions, capsulotomy and lens fragmentation. Non-contact endothelial cell microscopy and pachymetry were performed preoperatively and at postoperative day 1, week 1, month 1 and month 3. Results A total of 134 paired eyes from 67 patients were included in the analysis. ECD was not significantly different between the two groups at either postoperative month 1 (2370±580 cells/mm2 and 2467±564 cells/mm2 in FLACS and CPS groups, respectively; p=0.18) or at postoperative month 3 (2374±527 cells/mm2 and 2433±526 cells/mm2 in FLACS and CPS groups, respectively; p=0.19). No significant difference was observed in the mean CCT values between the two groups over the follow-up period (p>0.05). Conclusion Postoperative corneal ECD and CCT were comparable between FLACS and CPS during the 3 months’ follow-up period.
TL;DR: In elderly people, visual impairment is associated with depressive symptoms and cognitive decline, and the impact of cataract surgery on depression and cognitive impairment is still controversial.
Abstract: IMPORTANCE In elderly people, visual impairment is associated with depressive symptoms and cognitive decline. However, the impact of cataract surgery on depression and cognitive impairment is still controversial. BACKGROUND To evaluate the effect of cataract surgery on depression and cognitive status in the elderly. DESIGN This study was a meta-analysis. PARTICIPANTS Patients with age-related cataract who underwent cataract surgery were recruited for this study. METHODS A literature search was performed on PubMed, Scopus and Web of Science. Data were extracted from selected studies by two independent reviewers. The pooled standardized mean difference (SDM) was estimated using a random-effects model. Heterogeneity was evaluated using the Q and I2 tests. Multiple sensitivity analyses and assessment of publication bias were performed. MAIN OUTCOME MEASURES The main outcome was a report of a measure of depression or cognitive impairment before and after surgery. RESULTS Sixteen studies were included: 14 of them reported data on depression and 9 of them on cognitive function. Depression significantly decreased after surgery (SDM = 0.460; 95% CI: 0.223-0.697; P < .001). In six controlled studies, the reduction of depression was higher in the surgery group than in the control group (SDM = 0.161; 95% CI: 0.027-0.295; P = .019). Cognitive function significantly improved after surgery (SDM = 0.254; 95% CI: 0.120-0.388; P < .001). In four controlled studies, the improvement of cognitive function was higher in the surgery group than in the control group (SDM = 0.188; 95% CI: 0.002-0.374; P = .048). Results were stable after sensitivity analyses. CONCLUSIONS AND RELEVANCE This meta-analysis provides evidence that cataract surgery has a positive effect on depression and cognitive function in the elderly.
University of Minnesota1, Mayo Clinic2, Medical University of South Carolina3, Harvard University4, Indiana University5, Duke University6, Cleveland Clinic7, Oregon Health & Science University8, Baylor College of Medicine9, Emory University10, Vanderbilt University Medical Center11, Stanford University12
TL;DR: Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification, and visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities.
TL;DR: The anticipated duration of intraocular lens in the eye has significantly increased, and physico-chemical characteristics and endurance should allow the lens to keep its’ optical properties for up to three decades.
Abstract: Cataract surgery is the most common surgical procedure performed in medicine. In the 2015 over 20 million surgeries were carried out worldwide, of which 3.6 million in the United States of America and 4.2 million in the European Union. The progress in technology enabled cataract surgery to be the safest and most predictable eye surgery. On the other hand, the increase in life expectancy and quality of life result in higher surmises regarding the outcomes. Currently, individuals over 70 years of age might be declared inactive or retired, however, still wish to maintain an active lifestyle, including driving a car and performing sports. Subsequently, there is a demand for techniques that are even more perfect. New encounters include surgeries performed on patients with dementia and other comorbidities related with ageing. The anticipated duration of intraocular lens in the eye has significantly increased. Thus physico-chemical characteristics and endurance should allow the lens to keep its’ optical properties for up to three decades. The most significant advances in cataract surgery will be briefly discussed within this chapter.
TL;DR: Both FLACS and CCS are effective and safe, however, mid-term visual acuity did not show any difference between both methods.
Abstract: PURPOSE To compare the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) with conventional cataract surgery (CCS). SETTING Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. DESIGN Meta-analysis. METHODS PubMed, Cochrane Library, and EMBASE were systematically searched for studies comparing FLACS and CCS. Outcomes were efficacy and safety parameters. The effect measures were weighted mean differences or odds ratios with 95% CIs. RESULTS A total of 73 studies (25 randomized controlled, 48 observational) were reviewed with a total of 12 769 eyes treated with FLACS and 12 274 eyes treated with CCS. In eyes treated with FLACS, uncorrected and corrected distance visual acuities and spherical equivalent after 1 month to 3 months (P = .04, P = .005, and P = .007, respectively) were better, total and effective phacoemulsification times were shorter (P < .001 each), cumulative dissipated energy was less (P < .001), circularity was more accurate (P < .001), central corneal thickness after 1 day and 1 month to 3 months was less (P < .001 and P = .004, respectively), and endothelial cell loss after 3 to 6 weeks and 3 months was less (P = .002 and P < .001, respectively) compared with CCS. Anterior capsule ruptures occurred more often with FLACS. No significant differences among groups were found in visual acuity at 1 week and after 6 months or in posterior capsule rupture rates and endothelial cell loss after 6 months. CONCLUSIONS Both FLACS and CCS are effective and safe. FLACS required less ultrasound energy and a more precise treatment. However, mid-term visual acuity did not show any difference between both methods.
TL;DR: ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.
Abstract: Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. Data were analysed from the Royal College of Ophthalmologists’ National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.
TL;DR: The elevated additive risks associated with low-dose radiation, if confirmed elsewhere, have important public health and clinical implications for radiation workers as well as regulatory measures.
Abstract: Objectives Previous analyses of cataract in radiation-exposed populations have assessed relative risk; radiogenic excess additive risk (EAR), arguably of more public health importance, has not been estimated. Previous analysis of a large prospective cohort of US radiologic technologists (USRT) quantified excess relative risk of cataract in relation to occupational radiation dose. We aim to assess EARs of cataract. Methods We estimated EARs of cataract/cataract surgery in the USRT cohort using generalised additive models in relation to occupational radiation exposure, and assessed risk modification by a priori-selected cataract risk factors (diabetes, body mass index, smoking, race, sex, birth-year, ultraviolet B (UVB) radiation exposure). Results There were 11 345 cataract diagnoses and 5440 of cataract surgery during 832 462 and 888 402 person-years of follow-up, respectively. Cumulative occupational radiation exposure was associated with self-reported cataract, but not with cataract surgery, with EAR/104 person-year Gy=94 (95% CI: 47 to 143, p Conclusions The elevated additive risks associated with low-dose radiation, if confirmed elsewhere, have important public health and clinical implications for radiation workers as well as regulatory measures.
TL;DR: Cataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke and its association with cataract and subtypes was similar in males and females.
Abstract: Purpose To determine the prevalence of cataract and its association with sun exposure and other environmental risk factors in three different geographically diverse populations of India. Design Population based cross sectional study during 2010–2016 Participants People aged ≥ 40 years residing in randomly sampled villages were enumerated (12021) and 9735 (81%) underwent ophthalmic evaluation from plains, hilly and coastal regions (3595, 3231, 2909 respectively) Methods A detailed questionnaire-based interview about outdoor activity in present, past and remote past, usage of sun protective measures, exposure to smoke, and detailed ophthalmic examination including assessment of uncorrected and best corrected visual acuity, measurement of intraocular pressure, slit lamp examination, lens opacities categorization using LOCS III and posterior segment evaluation was done. Lifetime effective sun exposure was calculated using Melbourne formula and expressed as quintiles. These were supplemented with physical environmental measurements. Main outcome measures Lifetime sun exposure hours, smoking, indoor kitchen smoke exposure and their association with cataract and subtypes. Prevalence of cataract calculated based on lens opacities or evidence of cataract surgery. Results Cataract was identified in 3231 (33.3%) participants. Prevalence of cataract in males (32.3%) and females (34.1%) was similar. Nuclear cataract was the commonest sub-type identified in 94.7% of affected eyes. Sun exposure had a significant association with cataract with odds ratio (OR) increasing from 1.6 (95% Confidence Intervals [CI]: 1.4, 1.9) in 3rd quintile, to 2.6 (CI: 2.2, 3.1) in 4th quintile and 9.4 (CI: 7.9, 11.2) in 5th quintile (p<0.0001). Cataract also showed a significant association with smoking (OR: 1.4, CI: 1.2, 1.6) and indoor kitchen smoke exposure (OR: 1.2, CI: 1.0–1.4). Nuclear cataract showed a positive association with increasing sun exposure in 3rd (β coefficient 0.5, CI:0.2–0.7), 4th (β: 0.9, CI: 0.7–1.1) and 5th (β: 2.1, CI:1.8–2.4) quintiles of sun exposure, smoking (β: 0.4, CI: 0.2–0.6) and indoor kitchen smoke exposure (β: 0.3, CI: 01–0.5) while cortical cataract showed a positive association with sun exposure only in 5th quintile (β: 2.6, CI:1.0–4.2). Posterior subcapsular cataract was not associated with any of the risk factors. Conclusion Cataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke.
TL;DR: To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery.
Abstract: Purpose To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. Methods This prospective non-randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. Results Central retinal thickness (CRT) increased in DEX but not in TA-treated eyes at 7 days (+1.2 ± 20.1 μm and -9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and -3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and -5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and -0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. Conclusions Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery.
TL;DR: The prevalence ofCataract and cataract-related MSVI and blindness were relatively high; subsequently, the prevalence of previous cataracts surgery was relatively low in this population from Russia.
Abstract: To assess the prevalence of cataract and cataract surgery in a population from Russia, we conducted the population-based Ural Eye and Medical Study with 5899 participants (80.5% out of 7328 eligible individuals), with an age of 40 + years as the eligibility criterion. In the phakic population, the prevalence of nuclear, cortical, subcapsular cataract and any cataract was 38.0% [95% confidence interval (CI) 36.6, 39.3], 14.5% (95% CI 13.5, 15.5), 0.6% (95% CI 0.4, 0.8) and 44.6% (95% CI 43.2, 46.0), respectively. A higher prevalence of nuclear cataract was associated with older age [odds ratio (OR) 1.10; 95% CI 1.10, 1.11], the female sex (OR 1.27; 95% CI 1.08, 1.50), urban region (OR 2.00; 95% CI 1.71, 2.33), a low educational level (OR 0.93; 95% CI 0.88, 0.98), a high diastolic blood pressure (OR 1.01; 95% CI 1.001, 1.02), a low serum concentration of high-density lipoproteins (OR 0.91; 95% CI 0.84, 0.98), more smoking package years (OR 1.01; 95% CI 1.01, 1.02), chronic kidney disease (OR 1.02; 95% CI 1.10, 1.03), a short axial length (OR 0.93; 95% CI 0.86, 0.99), and a low prevalence of age-related macular degeneration (OR 0.72; 95% CI 0.57, 0.92). The prevalence of previous cataract surgery conducted in 354/5885 individuals (6.0%; 95% CI 5.4, 6.6) increased from 0.4% (95% CI 0.0, 1.0) in the age group of 40–45 years to 37.6% (95% CI 30.9, 44.4) in the age group of 80 + years. Cataract was the cause of moderate-to-severe vision impairment in 109 (1.8%) individuals and of blindness in three (0.05%) individuals. The prevalence of cataract and cataract-related MSVI and blindness were relatively high; subsequently, the prevalence of previous cataract surgery was relatively low in this population from Russia.
TL;DR: Progress has been made towards the understanding of lens physiology and the mechanisms involved in the delivery and uptake of antioxidants to the lens which may guide future studies aimed at addressing some of the inconsistencies seen in previous animal and human studies.
Abstract: Cataracts or clouding of the lens is the leading cause of blindness in the world. Age and diabetes are major risk factors, and with an increasing aging and diabetic population, the burden of cataracts will grow. Cataract surgery is an effective way to restore vision; however, alternatives to cataract surgery are required to reduce the looming cataract epidemic. Since it is well established that oxidative damage plays a major role in the etiology of cataracts, antioxidants have been promoted as therapies to delay and/or prevent cataracts. However, many antioxidant interventions including vitamin C have produced mixed results as anti-cataract therapies. Progress has been made towards our understanding of lens physiology and the mechanisms involved in the delivery and uptake of antioxidants to the lens which may guide future studies aimed at addressing some of the inconsistencies seen in previous animal and human studies. Of interest is the potential for vitamin C based supplements in delaying the onset of cataracts post vitrectomy which occurs in up to 80% of patients within two years. These targeted approaches are required to reduce the burden of cataract on hospitals and improve the quality of life of our aging and diabetic population.
TL;DR: Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation, and topical drop-associated corneal issues.
Abstract: Purpose of reviewRoutine prophylaxis for adverse events following cataract surgery is evolving. Prior reliance on topical eyedrop instillation by patients is giving way to surgeon directed injections at the time of cataract surgery. The benefit of this new approach is assured delivery of drugs in st
TL;DR: The OMNI system provides effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative for mild-to-moderate open-angle glaucoma.
Abstract: PURPOSE To provide safety and effectiveness outcomes 12 months postsurgically for sequential canaloplasty and trabeculotomy with the OMNI system combined with cataract surgery in mild-to-moderate open-angle glaucoma (OAG). SETTING Eleven ophthalmology practices and surgery centers located in 8 U.S. states. DESIGN Retrospective, multicenter, single arm. METHODS Twelve surgeons contributed 81 patients meeting eligibility criteria: OAG, 12-month follow-up, and medicated intraocular pressure (IOP) 36 mm Hg or less on 4 or less medications preoperatively. Analysis was stratified by baseline IOP: more than 18 mm Hg (Group 1) and 18 mm Hg (Group 2) or less. Success was defined as proportion with 20% reduction or greater in IOP or IOP between 6 and 18 mm Hg (inclusive) and on the same or fewer medications without secondary surgical intervention (SSI). Other endpoints included mean IOP and medications at 12 months. Safety included corrected distance visual acuity and adverse events (AEs). RESULTS Of the 81 patients included, primary success was met by 79% in Group 1 and 81% in Group 2. The mean IOP was reduced in Group 1 (21.9 to 15.1 mm Hg, P < .0001) and remained controlled in Group 2 (14.1 to 13.4 mm Hg, P = .3177). Medications went from 2.0 ± 1.3 to 1.1 ± 1.1 in Group 1 and from 1.6 ± 1.3 to 0.9 ± 1.2 in Group 2. AEs were typical for cataract or angle surgery: mild inflammation (11%), IOP spikes (5%), and hyphema (4%). Four patients (5%) required an SSI. CONCLUSIONS The OMNI system provided effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative.
TL;DR: Favorable visual outcome was achieved in a fifth of the Eyes and globe was salvaged in two-thirds of the eyes and early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis.
Abstract: Purpose The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. Design Retrospective, interventional, multicentric case series. Methods The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed. Results The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3-76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5-40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02). Conclusions Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.
TL;DR: Combined phacovitrectomy may result in greater postoperative refractive prediction error compared to phacoemulsification alone following vitrectomy, and patients with worse vision, greater central macular thickness, and shallow anterior chambers require more caution since they are prone to inaccurate preoperative biometry.
Abstract: To investigate the accuracy of preoperative biometry in eyes undergoing combined phacovitrectomy and to compare it with eyes having cataract surgery at a later point in time following vitrectomy. Patients with epiretinal membrane or macular hole who underwent combined phacovitrectomy (group 1) or phacoemulsification following pars plana vitrectomy (PPV) (group 2) were included in this retrospective, comparative, interventional case series. The primary outcome measures were the intraocular lens power prediction error (PE) and the percentage of eyes with PE > ± 0.5D in the two groups. Secondary outcome measures included the correlation between epidemiological, clinical, or surgical factors and dioptric shift. In addition, the influence of optical coherence tomography characteristics to the PE was investigated. Group 1 and 2 consisted of 55 and 54 eyes, respectively, for a total of 109 eyes included in the study. The mean absolute PE was 0.59 D (range + 1.4 to − 2.5D) in group 1 and 0.35 (range + 1.0 to − 1.45D) in group 2 (p = 0.01). PE greater than 0.5D was observed in 47% of eyes in group 1 as opposed to 16.6% of eyes in group 2 (p = 0.027). The PE was associated with shallower anterior chamber depth (ACD), increased central macular thickness (> 300 μ), and worse baseline best-corrected visual acuity. Photoreceptor ellipsoid zone or external limiting membrane disruption was not associated with significantly greater postoperative refractive deviations. Combined phacovitrectomy may result in greater postoperative refractive prediction error compared to phacoemulsification alone following vitrectomy. Patients with worse vision, greater central macular thickness, and shallow anterior chambers require more caution since they are prone to inaccurate preoperative biometry.