Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort

Improved analysis with spectral-domain optical coherence tomography angiography for evaluating vascular damage in exfoliation syndrome

PURPOSE

To assess microvascular damage in exfoliation syndrome (XFS) patients with spectral-domain optical coherence tomography (OCT) and the correlations between OCT angiography (OCTA) parameters and systemic blood parameters in XFS.

METHODS

Twenty-one XFS eyes and 23 healthy eyes were included in this cross-sectional study. The foveal avascular zone (FAZ) area, vessel density (VD), thickness of the layers of the ganglion cell complex (GCC), homocysteine (Hcy) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were compared between the two groups. The correlations between OCTA parameters and systemic blood parameters were analyzed. Receiver operating characteristic curve analysis was performed to evaluate the ability of the OCTA parameters to predict XFS.

RESULTS

Compared with healthy controls, XFS patients had an enlarged FAZ area and a lower VD in the superficial vascular complex (SVC). The GCL thickness map and VD map of the SVC and deep vascular complex (DVC) revealed the presence of pathological damage at the outer superior (OS) and outer inferior (OI) sectors in XFS patients. In XFS patient, the FAZ area and OS VD of the SVC were strongly correlated with the Hcy levels, and the OS VD of the SVC was significantly negatively correlated with the NLR and PLR. The areas under the receiver operating characteristic curve for the SVC FAZ area and OS VD in predicting XFS were both >0.67.

CONCLUSIONS

The pixel-level FAZ algorithm and VD map derived from OCTA can reflect microvascular damage in XFS. The fundus lesions observed in XFS are accompanied by systemic circulatory changes.

Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia

PURPOSE

To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome.

METHODS

This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes.

RESULTS

A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract.

CONCLUSIONS

All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.