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Ma M, Wang M, Zhang X, Shao Y, Li X. Effects of a fortified balanced salt solution and Ringer's lactate solution on anterior chamber inflammation after phacoemulsification in diabetes. J Cataract Refract Surg 2024; 50:352-359. [PMID: 37962173 DOI: 10.1097/j.jcrs.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To compare the effects of a fortified balanced salt solution (fSS) and Ringer's lactate solution (Ringer) on anterior chamber (AC) inflammation in patients undergoing phacoemulsification. SETTING Tianjin Medical University Eye Hospital, Tianjin, China. DESIGN Prospective masked controlled trial. METHODS 80 patients (40 patients with regular cataract and 40 cataract patients with diabetes mellitus [DM]) were randomized to receive either fSS (n = 40) or Ringer's solution (n = 40). Anterior-segment optical coherence tomography was used to evaluate AC cells and flare. Transepithelial electrical resistance (TEER) and zonula occludens-1 (ZO-1) immunofluorescence were used for tight junction examination. Monocytic leukemia cell line (Tohoku Hospital Pediatrics-1 [THP-1]) transmigration assay was performed to observe the effects of the 2 perfusates on the inflammatory response in vitro. RESULTS In patients with regular cataracts, postoperative AC cells and flare on the 1st and 7th days were not significantly different between the Ringer and fSS groups. However, in cataract patients with DM, AC cells were higher in the Ringer group than in the fSS group ( P = .003) on postoperative day 1. The AC flare was also significantly higher in the Ringer group than in the fSS group ( P < .0001). No significant differences between the groups were observed on day 7. Compared with Ringer, fSS increased the TEER value and ZO-1 content and reduced the adhesion of THP-1 cells. CONCLUSIONS The results of this study indicated that early postoperative AC inflammation is more severe in patients with cataracts and DM. In addition, fSS attenuates inflammation by protecting the blood-aqueous barrier and inhibiting the exudation of inflammatory cells.
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Affiliation(s)
- Mingming Ma
- From the Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Bajraktari G, Jukić T, Kalauz M, Oroz M, Radolović Bertetić A, Vukojević N. Early and Late Complications after Cataract Surgery in Patients with Uveitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1877. [PMID: 37893595 PMCID: PMC10608233 DOI: 10.3390/medicina59101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Uveitis, a prevalent eye disorder characterized by inflammatory processes, often leads to cataract formation and significant visual impairment. This study aimed to evaluate preoperative conditions and postoperative outcomes following cataract surgery in uveitis patients. Materials and Methods: A retrospective study was conducted at the University Hospital Center Rebro Zagreb, Croatia, involving uveitis patients who underwent cataract surgery between 2013 and 2022. Eligible patients had uveitic cataracts affecting visual acuity or posterior segment visualization in a "quiet eye" and were disease-inactive for at least three months. Patients with certain pre-existing ocular conditions were excluded. The data collected included patient demographics, uveitis type, preoperative therapy, preexisting lesions, and postoperative outcomes such as visual acuity, intraocular pressure, central macular thickness, and complications. Statistical analysis was performed to identify risk factors associated with complications. Results: This study included 105 patients. The most common uveitis types were idiopathic uveitis, HLA-B27-associated uveitis, and JIA uveitis. After cataract surgery, there was a significant improvement in visual acuity at various time points, with 90% of eyes showing improvement. Intraocular pressure decreased over time. Central macular thickness increased at three months post-surgery but remained stable thereafter. Early and late complications were observed in 52.4% and 63.8% of eyes, respectively. The most common complications were posterior capsular opacification (53.3%), macular edema (26.6%), and epiretinal membrane formation (9.52%). The factors associated with complications varied between early and late stages but included age, age at the onset of uveitis, and the uveitis type. Conclusions: In patients with quiescent uveitis undergoing cataract surgery, significant visual improvement was achieved. This study highlights the importance of careful patient selection, preoperative and postoperative inflammation management, and precise surgical techniques. Although complications were common, the risk of capsular opacification, macular edema, and epiretinal membrane formation after surgery increased. However, future investigations should address this study's limitations and further refine perioperative strategies.
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Affiliation(s)
- Gentian Bajraktari
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinic of Ophthalmology, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Tomislav Jukić
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Martin Oroz
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | | | - Nenad Vukojević
- Department of Ophthalmology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Ophthalmology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
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Talens-Estarelles C, Díez-Ajenjo MA, Pons ÁM, Peris-Martínez C, García-Lázaro S. Effects of cataract surgery on blinking. J Cataract Refract Surg 2023; 49:177-183. [PMID: 36255227 DOI: 10.1097/j.jcrs.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/10/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effects of cataract surgery on the spontaneous blinking pattern and blinking kinematics. SETTING FISABIO Oftalmología Médica Eye Hospital, Valencia, Spain. DESIGN Observational descriptive clinical study. METHOD Patients with senile cataract were evaluated before (visit 1) and at 1 month (visit 2) and 3 months (visit 3) after undergoing phacoemulsification cataract surgery. The blinking of patients was recorded for 90 seconds using an eye-tracking device. Blinks were analyzed by means of image analysis to obtain a noninvasive detailed description of blinking including blink rate, number of complete and incomplete blinks, percentage of incomplete blinks, and kinematic parameters, including amplitude, closing, contact, opening, and total durations and closing and opening speeds. RESULTS 50 patients were included in this study. The blink rate was significantly smaller at visit 3 compared with baseline ( P = .03) and visit 2 ( P = .001). Likewise, the number of complete blinks was significantly smaller, and the percentage of incomplete blinks was significantly higher at 3 months postoperatively compared with baseline ( P = .02 and P = .01, respectively), although no differences were observed at 1 month postoperatively ( P > .05). Conversely, no differences in the number of incomplete blinks or any kinematic parameter were observed between visits ( P = .12). CONCLUSIONS Cataract surgery significantly altered the blinking pattern at 3 months postoperatively, although kinematic parameters remained unvaried. Clinicians should be aware of potential alterations in blinking after phacoemulsification cataract surgery and the implications this may have on the ocular surface of patients.
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Affiliation(s)
- Cristian Talens-Estarelles
- From the Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain (Talens-Estarelles, Díez-Ajenjo, Pons, García-Lázaro); Cornea and Anterior Segment Disease Unit, FISABIO Medical Ophthalmology (FOM), Valencia, Spain (Peris-Martínez); Department of Surgery, Ophthalmology, University of Valencia, Valencia, Spain (Peris-Martínez)
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Way C, Swampillai AJ, Lim KS, Nanavaty MA. Factors influencing aqueous flare after cataract surgery and its evaluation with laser flare photometry. Ther Adv Ophthalmol 2023; 15:25158414231204111. [PMID: 38107248 PMCID: PMC10725112 DOI: 10.1177/25158414231204111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood-aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. It highlights the impact of preoperative pathological states such as uveitis and diabetes, intraoperative techniques, including efficient phacoemulsification and direct comparisons between postoperative anti-inflammatory regimes. There is a large interobserver variation in the subjective flare measurement after cataract surgery and the continued use of LFP amongst other objective, noninvasive measurements of intraocular inflammation, particularly in the further development of cataract surgery, is recommended.
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Affiliation(s)
- Christopher Way
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Andrew J. Swampillai
- Department of Ophthalmology, St. Thomas’ Hospital, London, UK
- School of Life Course & Population Sciences, King’s College London, London, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, St. Thomas’ Hospital, London, UK
- School of Life Course & Population Sciences, King’s College London, London, UK
| | - Mayank A. Nanavaty
- University Hospitals Sussex NHS Foundation Trust, Sussex Eye Hospital, Eastern Road, Brighton, BN2 5BF, UK
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
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Khair D, Daoud R, Harissi-Dagher M. Retroprosthetic Membrane Formation in Boston Keratoprosthesis Type 1: Incidence, Predisposing Factors, Complications, and Treatment. Cornea 2022; 41:751-756. [PMID: 34620769 DOI: 10.1097/ico.0000000000002883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the incidence, rate of formation, and risk factors of retroprosthetic membrane (RPM) after Boston type 1 keratoprosthesis (BKPro) as well as identify secondary complications linked to its formation and describe its treatment. METHODS This was a retrospective cohort study. One hundred thirty-three eyes of 115 patients who underwent BKPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1-year follow-up. Charts were reviewed, and data were collected, including incidence of RPM formation, preoperative and intraoperative risk factors, postoperative complications, and treatment modalities. RESULTS The mean follow-up was 5.5 years, and 39% (n = 52) of eyes developed RPM. No etiologies were found to be significantly associated with RPM development. Simultaneous lensectomy and simultaneous intraocular lens extraction were respectively positively and negatively correlated with RPM development [odds ratio (OR): 0.3590, 95% CI: 0.1629-0.7570, P = 0.0097; OR = 2.646, 95% CI: 1.273-5.585, P = 0.0086, respectively]. As for postoperative complications, the strongest correlation was between RPM and retinal detachment (OR = 6.16, 95% CI: 2.14-16.14; P = 0.0004). RPM development was also positively associated with the development of hypotony and corneal melt. Nd:YAG membranectomy was the most common treatment, performed in 83% of eyes with RPM (n = 24), with 58% resolution. CONCLUSIONS More than one third of patients who undergo BKPro will develop RPM, requiring close monitoring for retinal detachment. Simultaneous intraocular lens extraction seems protective, whereas simultaneous lens extraction increases the rate of RPM formation significantly. Nd:YAG membranectomy can be used as an initial noninvasive approach.
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Affiliation(s)
- Diana Khair
- Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada
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Garg P, Gupta A, Tandon N, Raj P. Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors. Turk J Ophthalmol 2021; 50:133-142. [PMID: 32630999 PMCID: PMC7338747 DOI: 10.4274/tjo.galenos.2019.45538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To study the incidence of dry eye and its determinants in patients undergoing cataract surgery. Materials and Methods One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery. Results Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001). Conclusion The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month.
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Affiliation(s)
- Pragati Garg
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Aditi Gupta
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Nishi Tandon
- Era's Lucknow Medical College and Hospital, Clinic of Pathology, Lucknow, India
| | - Priyanka Raj
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
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Early changes in retinal microcirculation after uncomplicated cataract surgery using an active-fluidics system. Int Ophthalmol 2021; 41:1605-1612. [PMID: 33547997 DOI: 10.1007/s10792-021-01694-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the early changes in retinal microcirculation after uncomplicated cataract surgery using an active-fluidics system. MATERIALS AND METHODS Patients underwent uncomplicated cataract surgery for both eyes were enrolled. The two eyes of the patients were randomly assigned to two groups, the active-fluidics group and the gravity-fluidics group. One eye using an active-fluidics system, and the other using a gravity-fluidics system. Optical coherence tomography angiography (OCTA) was performed at 1 day, 7 days, 30 days, and 90 days after surgery. RESULTS Fifty eyes (25 patients) were included in the final analysis. A significantly lower cumulative dissipated energy (CDE), estimated fluid usage (EFU), and total aspiration time (TAT) were observed in the active-fluidics group (all P<0.05). The superficial vessel density at parafoveal region increased at 7 days and 30 days after cataract surgery in the eyes of both the active-fluidics and gravity-fluidics groups, with the fluctuation in eyes of the gravity-fluidics group more significant. The vessel density of deep capillary plexus remained stable during the follow-up period. Significant changes of retinal thickness in macular region (fovea, parafovea) were observed in eyes of the gravity-fluidics group through the comparison of corresponding values at different time points (p = 0.008, 0.005). No significant change in retinal thickness was observed in eyes of the active-fluidics. CONCLUSIONS Retinal microcirculation and thickness were disturbed after cataract surgery using the gravity-fluidics infusion system. The active-fluidics system not only improved the surgical efficacy but also protected the retinal vasculature during cataract surgery. CLINICAL TRIALS REGISTRATION The study has been registered at www.clinicaltrials.gov with its clinical trial accession number of NCT0130500.
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Sung SM, Kim JH, Lee KW, Kang HG. Analysis of Macular Capillary Plexuses after Cataract Surgery via Optical Coherence Tomography Angiography. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim S, Ahn Y, Lee Y, Kim H. Toxicity of Povidone-iodine to the ocular surface of rabbits. BMC Ophthalmol 2020; 20:359. [PMID: 32873276 PMCID: PMC7466785 DOI: 10.1186/s12886-020-01615-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background We evaluated the toxicity of 5% (w/v) povidone-iodine (PI) applied to the ocular surface of rabbits. Methods Twenty-three white rabbits were divided into four groups; these were a control group and three study groups in which the ocular surface was exposed to PI for different times. In control group, one drop of phosphate-buffered saline (PBS) was applied once for 10 min. In study groups, one drop of 5% (w/v) PI was topically applied once for 1 min, 3 min, and 10 min, and then the animals were observed for 7 days. The Schirmer test, Rose Bengal staining, corneal fluorescein staining and conjunctival impression cytology were performed on day 0, 3, and 7. After 7 days, the rabbits were sacrificed and conjunctiva and cornea were collected and evaluated by light and electron microscope. Immunofluorescence staining was also performed to detect mucin 5 subtype AC (MUC5AC). Results The decrease in goblet cell density, reductions in MUC5AC level and histopathological and ultrastructural changes of conjunctiva and cornea were more prominent in the 5% (w/v) PI groups than the control group (p < 0.05). Moreover, these changes were more prominent when PI was applied for 3 and 10 min rather than 1 min (both p values < 0.05). Conclusions 5% (w/v) povidone-iodine caused damages to the ocular surface in a time-dependent manner. Therefore, we should be aware of that excessive PI exposure during ophthalmic procedures could be a pathogenic factor of dry eye syndrome after surgery.
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Affiliation(s)
- Sunyoung Kim
- Healing Eye Center, Seoul, Korea.,College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Yongsun Ahn
- College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.,Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yeojin Lee
- College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.,Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyunseung Kim
- College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea. .,Department of Ophthalmology, Seoul St. Mary's Hospital, Seoul, Korea.
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Fondi K, Miháltz K, Vécsei-Marlovits PV. Keratokonjunktivitis sicca und Katarakt-Chirurgie – eine Übersicht der Problematik. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ting DSJ, Rees J, Ng JY, Allen D, Steel DHW. Effect of high-vacuum setting on phacoemulsification efficiency. J Cataract Refract Surg 2019; 43:1135-1139. [PMID: 28991608 DOI: 10.1016/j.jcrs.2017.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effect of a high-vacuum setting versus a low-vacuum setting on the efficiency of phacoemulsification. SETTING Sunderland Eye Infirmary, Sunderland, United Kingdom. DESIGN Prospective clinical trial. METHODS Consecutive patients having cataract surgery in 2014 were recruited. Cataract surgery was performed by 2 experienced surgeons using a phacoemulsification machine with monitored forced infusion. The cataractous lens was split into 2 heminuclei using the stop-and-chop technique; in 1 heminucleus, phacoemulsification and aspiration used a high-vacuum setting (600 mm Hg; treatment group) and in the other heminucleus, a low-vacuum setting (350 mm Hg; control group). The high and low settings were alternated by case per the operating list to reduce surgeon bias. The main outcome measures were cumulative dissipated energy (CDE) and active heminucleus removal time. RESULTS One hundred sixty patients (160 eyes) were enrolled in the study, and 158 were included in the analysis. The CDE per heminucleus was significantly lower with the high-vacuum setting than with the low-vacuum setting (mean 2.81 percent-seconds; 95% confidence interval (CI), 2.44-3.21 versus 3.81 percent-seconds; 95% CI, 3.38-4.20; P < .001). The active heminucleus removal time was significantly shorter in the high-vacuum group than the low-vacuum group (mean 27.77 seconds; 95% CI, 25.26-30.19 versus 33.59 seconds; 95% CI, 31.07-35.92; P < .001). The observed differences were independent of the surgeon, patient age and sex, incision size, and nucleus density. No intraoperative complications were observed in either group. CONCLUSION A high-vacuum setting improved phacoemulsification efficiency using an active fluidics system and torsional phacoemulsification.
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Affiliation(s)
- Darren Shu Jeng Ting
- From the Sunderland Eye Infirmary (Ting, Ng, Allen, Steel), the School of Psychology (Rees), University of Sunderland, Sunderland, and the Institute of Genetic Medicine (Steel), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jon Rees
- From the Sunderland Eye Infirmary (Ting, Ng, Allen, Steel), the School of Psychology (Rees), University of Sunderland, Sunderland, and the Institute of Genetic Medicine (Steel), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jia Yu Ng
- From the Sunderland Eye Infirmary (Ting, Ng, Allen, Steel), the School of Psychology (Rees), University of Sunderland, Sunderland, and the Institute of Genetic Medicine (Steel), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Allen
- From the Sunderland Eye Infirmary (Ting, Ng, Allen, Steel), the School of Psychology (Rees), University of Sunderland, Sunderland, and the Institute of Genetic Medicine (Steel), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David H W Steel
- From the Sunderland Eye Infirmary (Ting, Ng, Allen, Steel), the School of Psychology (Rees), University of Sunderland, Sunderland, and the Institute of Genetic Medicine (Steel), Newcastle University, Newcastle upon Tyne, United Kingdom.
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Ch'ng TW, Gillmann K, Hoskens K, Rao HL, Mermoud A, Mansouri K. Effect of surgical intraocular pressure lowering on retinal structures - nerve fibre layer, foveal avascular zone, peripapillary and macular vessel density: 1 year results. Eye (Lond) 2019; 34:562-571. [PMID: 31409906 DOI: 10.1038/s41433-019-0560-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/16/2019] [Accepted: 07/11/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine the effect of surgical intraocular pressure (IOP) lowering on peripapillary retinal nerve fibre layer thickness (RNFL), fovea avascular zone (FAZ), peripapillary and macular vessel density (VD) in glaucoma using with optical coherence tomography angiography (OCT-A). METHODS This was a prospective observational study performed at the Glaucoma Research Centre, Montchoisi Clinic, Lausanne. In total 40 eyes with open-angle glaucoma were included. OCT-A scans were performed before glaucoma surgery, and at 1-month, 3-month, 6-month, and 12-month post-operatively. AngioVue AngioAnalytic (Optovue Inc, Fremont, CA) software was used to analyse the RNFL, FAZ, peripapillary and macular VD. Changes were analysed using analysis of variance (ANOVA) models. RESULTS Mean IOP dropped from 19.4 (±7.0) mmHg pre-surgery and stabilized at 13.0 (±3.1) mmHg at 12 months (p < 0.001). The number of topical medications reduced from 2.2 (±1.2) preoperatively to 0.4 (±0.8) at 1 year (p < 0.001). Peripapillary RNFL thickness was transiently increased at 1-month postoperatively (p = 0.03). Peripapillary VD fluctuated throughout the follow-up. Foveal VD showed increased perfusion at 3 and 6 months post-operatively with minimal changes at 1 month (p < 0.01). Glaucoma surgery had a significant effect initially on FAZ area (p = 0.03), FAZ perimeter (p = 0.02) and Acircularity Index (AI) (p = 0.04). By 12-months FAZ measurements had reversed to baseline values. CONCLUSIONS Peripapillary and macular microcirculations responded differently to surgically induced IOP reduction. Peripapillary microcirculation was IOP-independent within the studied range of surgically-controlled IOP. Macular microcirculation, however, exhibited a "delayed response" followed by near-normal reperfusion after glaucoma surgery. FAZ parameters could be potentially useful modalities to assess vascular reperfusion after glaucoma surgery as, amongst all studied parameters, the area was the most sensitive to surgically induced IOP changes.
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Affiliation(s)
- Tun Wang Ch'ng
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland.,Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - Kirsten Hoskens
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | | | - André Mermoud
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland. .,Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA.
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Epidemiology and clinical features of viral anterior uveitis in southern Taiwan-diagnosis with polymerase chain reaction. BMC Ophthalmol 2019; 19:87. [PMID: 30943921 PMCID: PMC6448235 DOI: 10.1186/s12886-019-1093-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/26/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To report the epidemiology and clinical features of viral anterior uveitis in patients in southern Taiwan. METHODS A retrospective, case series study. HLA-B27 negative anterior uveitis patients with increased intraocular pressure or corneal edema seen at Kaohsiung Chang Gung Memorial Hospital from January 1, 2007 to January 31, 2018 had their aqueous sent for polymerase chain reaction analysis. Their records were reviewed for demographic data, ocular findings, and laboratory results. RESULTS In the aqueous samples obtained from 102 eligible eyes, 42 eyes were herpesviridae-positive, which included 9 with herpes simplex virus (8.8%), 5 with varicella-zoster virus (4.9%), 27 with cytomegalovirus (26.5%), and 1 with Epstein-Barr virus (1%). Herpesviridae-positive patients were more likely to be male, and have glaucoma. Glaucoma and pseudophakic eyes were significantly associated with CMV-positive eyes. CONCLUSION PCR analysis of the anterior chamber fluid is important for the confirmation of the diagnosis of viral anterior uveitis. Cytomegalovirus anterior uveitis is not uncommon in patients in southern Taiwan, and it may follow an uneventful cataract extraction in immunocompetent patients.
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Sun DF, Wang YL, Wang B, Xu CL, Zhang G, Li J, Zhang XM. Predictive risk factors for exudative retinal detachment after vitrectomy for proliferative diabetic retinopathy. Medicine (Baltimore) 2019; 98:e14603. [PMID: 30813184 PMCID: PMC6408030 DOI: 10.1097/md.0000000000014603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This retrospective study investigated the risk factors of exudative retinal detachment (ERD) occurring after vitrectomy performed to treat proliferative diabetic retinopathy (PDR).All patients were treated with vitrectomy for PDR. Patients with history(s) of the following were excluded: ocular surgery (except phacoemulsification combined with intraocular lens implantation or retinal laser photocoagulation); ocular trauma; systemic diseases; ocular diseases; uveitis; scleritis; tumor; congenital ocular disorders; or others.Included were 205 eyes of 169 patients, of whom 18 (8.78%) developed ERD with varying degrees of exudative choroidal detachment after 1 to 3 days. Binary logistic regression showed the following association with the development of ERD: lower serum albumin concentration (P = .001); without intravitreal anti-vascular endothelial growth factor (anti-VEGF) drug injection before vitrectomy (P = .044); and history of phacoemulsification combined with intraocular lens implantation (P = .046). No association was found with gender; age; systolic pressure; diastolic pressure; panretinal photocoagulation; intraocular pressure on the 1st postoperative day; intraocular pressure on the 2nd postoperative day; serum albumin concentration; or blood urea nitrogen.Risk factors for ERD after vitrectomy for PDR include low serum albumin concentration, without history of intravitreal anti-VEGF drug injection before surgery, and a history of phacoemulsification combined with intraocular lens implantation.
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Affiliation(s)
- Di-Fang Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao
| | - Yan-Li Wang
- Department of Gynecology, The First Bethune Hospital of Jilin University, Changchun
| | - Bin Wang
- Department of Orthopedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai
| | - Chun-Ling Xu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Gong Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Jia Li
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Xiao-Meng Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Avetisov SE, Erichev VP, Petrov SY, Volzhanin AV. [Influence of cataract phacoemulsification on eye hydrodynamics in patients with prior trabeculectomy]. Vestn Oftalmol 2018; 134:99-103. [PMID: 30499546 DOI: 10.17116/oftalma201813405199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
At present, phacoemulsification and trabeculectomy are the most widespread surgery methods in cataract and glaucoma treatment, generally recognized as the gold standard. Among elderly patients, comorbid glaucoma and cataract are extremely prevalent, so the order of the two surgeries and the time interval between them are pivotal choices when planning treatment strategy. The reason for it is that almost any eye surgery is considered a risk factor for long-term trabeculectomy effectiveness. In attempts to solve this problem, numerous studies have been conducted on the impact of cataract surgery on filtration bleb scarring. The problem of determining the time interval between surgeries, as well as other treatment nuances, remains relevant despite the long history of research and publications. Some results are cited as general recommendations on treatment tactics (increasing the time interval between operations, using antimetabolite and anti-inflammatory therapy, minimizing intraoperative traumatism). However, currently there are no specific recommendations for one of the most important factors - the time interval between cataract extraction and trabeculectomy.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - V P Erichev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - S Yu Petrov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A V Volzhanin
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Ishrat S, Nema N, Chandravanshi S. Incidence and pattern of dry eye after cataract surgery. Saudi J Ophthalmol 2018; 33:34-40. [PMID: 30930661 PMCID: PMC6424692 DOI: 10.1016/j.sjopt.2018.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose The objectives of the study were to identify the incidence and pattern of dry eye after phacoemulsification and manual small incision cataract surgeries. Methods The study consisted of two groups of patients - Group 1 underwent manual small incision cataract surgery (SICS) and Group 2 underwent phacoemulsification. The dry eye-related data was collected preoperatively and at 1 week, 1 month and 3 months postoperatively. Ocular Surface Disease Index questionnaire, tear break-up time (TBUT) and Schirmer test – 1 were used to record the type of dry eye. Results One hundred eyes of 96 patients, including 35 (36.5%) men and 61 (63.5%) women with the mean age of 63.1 (±8.3) years were studied. Dry eyes were found in 42% eyes (p < 0.001) of patients at 1 week follow-up. Fifteen percent and 9% of the eyes were dry at 1 month and 3 months after surgery, respectively. There were 34 (53.1%) and 8 (22.2%) dry eyes in SICS and phacoemulsification groups, respectively at one week postoperative follow-up which was a statistically significant difference. Majority of eyes (27/42, 64.3%) had mild dryness. There were significant differences in TBUT at 1 week, 1 month and 3 months postoperatively. At 1 week review, the SICS group had mean TUBT of 10.0 (±0.55) sec as compared to 13.9 (±0.70) sec in phacoemulsification group (p < 0.001). Conclusion Incidence of dry eye is higher in SICS than phacoemulsification due to tear film instability. The clinicians should be conscious about dry eye symptoms and signs in an otherwise healthy eye after cataract surgery.
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Affiliation(s)
- Saba Ishrat
- Department of Ophthalmology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Nitin Nema
- Department of Ophthalmology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
- Corresponding author at: Department of Ophthalmology, Sri Aurobindo Medical College and PG Institute, Indore Ujjain Highway, Indore, MP, India.
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Zhao Z, Wen W, Jiang C, Lu Y. Changes in macular vasculature after uncomplicated phacoemulsification surgery: Optical coherence tomography angiography study. J Cataract Refract Surg 2018; 44:453-458. [PMID: 29705010 DOI: 10.1016/j.jcrs.2018.02.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To use optical coherence tomography (OCT) angiography and a split-spectrum amplitude-decorrelation angiography algorithm to evaluate the changes in the macular vascular system after uncomplicated phacoemulsification. SETTING Department of Ophthalmology, Eye and and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China. DESIGN Prospective case series. METHODS Patients with senile cataracts were included. Retinal vessel density and thickness at the macular area were checked by OCT at baseline and at 1 week, 1 month, and 3 months after cataract surgery. RESULTS Thirty-two eyes (32 patients) were included in the final analysis. There was a significant increase in retinal vessel density, a decrease in the foveal avascular zone at the macular area after the cataract surgery (all P < .05, repeated-measures analysis of variance), and an increase in full and inner macular thickness, all of which extended to the end of the follow-up period. At 3 months postoperatively, there was a mean 6% and 3% increase in vessel density at the parafoveal and perifoveal regions, respectively, and a mean 27% reduction in the foveal avascular zone. The mean increase in inner retinal thickness was 15%, 10%, and 7% at the fovea, parafovea, and perifovea, respectively. Compared with the parafovea and perifovea, the fovea had a much higher percentage of change in retinal vasculature and inner retinal thickness (all P < .001). CONCLUSIONS Macular vessel density and thickness increased after cataract surgery. Whether these changes will persist over a longer period still needs to be studied.
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Affiliation(s)
- Zhennan Zhao
- From the Department of Ophthalmology and Vision Science (Zhao, Wen, Jiang, Lu), Eye and Ear, Nose, and Throat Hospital, Fudan University, Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai (Zhao, Wen, Jiang, Lu), and the Department of Ophthalmology (Jiang), Number 5 People's Hospital of Shanghai, Shanghai, China
| | - Wen Wen
- From the Department of Ophthalmology and Vision Science (Zhao, Wen, Jiang, Lu), Eye and Ear, Nose, and Throat Hospital, Fudan University, Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai (Zhao, Wen, Jiang, Lu), and the Department of Ophthalmology (Jiang), Number 5 People's Hospital of Shanghai, Shanghai, China
| | - Chunhui Jiang
- From the Department of Ophthalmology and Vision Science (Zhao, Wen, Jiang, Lu), Eye and Ear, Nose, and Throat Hospital, Fudan University, Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai (Zhao, Wen, Jiang, Lu), and the Department of Ophthalmology (Jiang), Number 5 People's Hospital of Shanghai, Shanghai, China.
| | - Yi Lu
- From the Department of Ophthalmology and Vision Science (Zhao, Wen, Jiang, Lu), Eye and Ear, Nose, and Throat Hospital, Fudan University, Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai (Zhao, Wen, Jiang, Lu), and the Department of Ophthalmology (Jiang), Number 5 People's Hospital of Shanghai, Shanghai, China.
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Yoeruek E, Deuter C, Gieselmann S, Saygili O, Spitzer MS, Tatar O, Bartz-Schmidt KU, Szurman P. Long-Term Visual Acuity and its Predictors after Cataract Surgery in Patients with Uveitis. Eur J Ophthalmol 2018; 20:694-701. [DOI: 10.1177/112067211002000409] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. To analyze the outcomes of phacoemulsification and posterior intraocular lens (IOL) implantation in patients with uveitis and to determine factors responsible for poor visual outcome. Methods. The records of 155 patients (180 eyes) with uveitis who had phacoemulsification and IOL implantation between August 2001 and March 2008 were examined retrospectively. Best-corrected visual acuity (BCVA) was recorded at the immediate preoperative visit and at follow-up examinations every 3 months. At each postoperative visit, a complete ophthalmologic examination was performed. The postoperative visual outcomes and complications were analyzed. Univariate regression analysis was done to determine risk factors for poor visual acuity during follow-up. Results. The mean follow-up was 31.4 months (range 3–78 months). An underlying systemic disease was present in 70 (45.2%) patients (82 eyes, 45.6%). The mean preoperative logMAR BCVA was 1.13±0.62 (95% CI: 0.85–1.02) and increased to 0.42±0.57 (95% CI: 0.32–0.59) at last medical visit (p<0.001). A total of 107 eyes (59.4%) had postoperative complications including posterior capsular opacification, newly developed macular edema, recurrence of uveitis, macular epiretinal membrane, and deposits on the IOL surface. Preoperatively observed macular lesions was the factor most strongly associated with poor visual outcome after cataract surgery (odds ratio: 5.43; 95% CI: 3.41–7.34; p<0.001). Anterior segment pathologies, age at surgery, etiology of uveitis (idiopathic, uveitis associated systemic disease), and gender did not influence visual rehabilitation after surgery (p>0.05). Conclusions. The outcomes of phacoemulsification and IOL implantation in patients with uveitis were satisfactory. Patients with observed preoperative macular lesions are at risk for poor visual outcome.
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Affiliation(s)
- Efdal Yoeruek
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Christoph Deuter
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Sylvia Gieselmann
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Oguzhan Saygili
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Martin S. Spitzer
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Olcay Tatar
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Karl U. Bartz-Schmidt
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
| | - Peter Szurman
- University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen - Germany
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Trypan Blue for the Assessment of Filtering Bleb Function During Cataract Surgery. J Glaucoma 2018; 27:246-250. [PMID: 29303877 DOI: 10.1097/ijg.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Phacoemulsification has been cited as a possible cause of bleb failure in eyes with prior trabeculectomy. No method has been developed to directly evaluate the risk of bleb failure after phacoemulsification. We investigate the use of trypan blue during cataract surgery in the setting of a preexisting trabeculectomy to evaluate the functional status of the bleb and predict postoperative bleb function. MATERIALS AND METHODS In total, 14 patients contributing 1 eye each with a history of prior trabeculectomy with mitomycin C undergoing phacoemulsification with intraocular lens implantation were enrolled in this prospective, nonrandomized clinical trial. At the time of phacoemulsification, trypan blue was instilled into the anterior chamber before capsulorhexis creation. Staining of the bleb was grouped as being mild or diffuse using intraoperative photographs. These eyes were followed for 1 year postoperatively and evaluated for intraocular pressure (IOP) control. RESULTS The change in IOP was not significantly different between the 2 groups (P=0.14). A trend towards greater need for IOP-lowering medications was noted (P<0.10) in eyes with mild bleb staining. No statistically significant difference in rates of decreased bleb function was noted at 1-year follow-up after phacoemulsification. CONCLUSION The intensity of bleb staining with trypan blue during phacoemulsification is not associated with changes in IOP postoperatively. A trend towards decreased need for IOP-lowering medications was noted in eyes with diffuse bleb staining at 1 year after cataract surgery.
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The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Hyperfiltration Following Trabeculectomy: A Prospective Study. Adv Ther 2018; 35:116-123. [PMID: 29222626 DOI: 10.1007/s12325-017-0646-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effect of visually non-significant cataract extraction in patients with hypotony maculopathy and reduced visual acuity due to over-filtering blebs after trabeculectomy. METHODS Patients with intraocular pressure (IOP) < 6 mmHg and documented hypotony maculopathy due to over-filtering blebs after trabeculectomy were prospectively recruited. Eligible patients underwent visually non-significant cataract phacoemulsification, no earlier than 12 weeks from the diagnosis of hypotony maculopathy. IOP and visual acuity before and after phacoemulsification were compared at 1 and 3 months from surgery. Correlations between age, time interval between surgeries, baseline IOP, bleb type and IOP and visual acuity changes at 3 months after phacoemulsification were investigated. RESULTS From January 2010 to September 2014, 20 consecutive adult patients met the inclusion criteria. Before phacoemulsification, mean IOP was 3.1 ± 1.6 mmHg. Following phacoemulsification, mean IOP increased to 8.6 ± 4.1 mmHg at 1 month (p < 0.01) and to 9.1 ± 4.3 mmHg at 3 months (p < 0.01). IOP elevation following phacoemulsification was observed in 16 of 20 eyes (80%). Mean visual acuity improved from Snellen 0.5 ± 0.1 to 0.6 ± 0.1 at 1 month (p < 0.01) to 0.7 ± 0.2 at 3 months (p < 0.01) after phacoemulsification. In 4 eyes in which the IOP was not elevated, surgical revision of the previous trabeculectomy was performed. No significant correlations between investigated variables, visual acuity and IOP changes at 3 months after phacoemulsification were found. CONCLUSION Phacoemulsification of visually non-significant cataract appears to be a safe and effective technique for managing chronic ocular hypotony with deep anterior chamber due to over-filtering blebs.
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Sawa M. Laser flare-cell photometer: principle and significance in clinical and basic ophthalmology. Jpn J Ophthalmol 2016; 61:21-42. [PMID: 27888376 DOI: 10.1007/s10384-016-0488-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
A slit-lamp examination is an indispensable and essential clinical evaluation method in ophthalmology, but, it is qualitative subjective. To complement its weaknesses in making a quantitative evaluation of flare intensity and number of cells in the aqueous humor in the eye, we invented the laser flare-cell photometer in 1988. The instrument enables a non-invasive quantitative evaluation of flare intensity and number of cells in the aqueous with good accuracy and repeatability as well as maneuverability equal to slit-lamp microscopy. The instrument can elucidate the pathophysiology in the blood-aqueous barrier (BAB) function in a variety of ocular disorders. The accuracy of the instrument makes it possible to investigate not only the pathophysiology of intraocular disorders but also the effects of various drugs and surgical procedures in BAB. The instrument does not only lighten the burden on patients in clinical examinations and study but it also helps minimize the sacrifice of experimental animals and improves the reliability of the results by minimizing inter-individual variations through its good repeatability. Here I shall relate how the instrument has been applied to clinical and basic studies in ophthalmology and what novel knowledge its application contributed to pathophysiology in ophthalmology.
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Affiliation(s)
- Mitsuru Sawa
- Public Interest Incorporated Foundation Isshinkai, 3-37-8 Hongo, Bunkyo, Tokyo, 113-0033, Japan. .,Emeritus Professor, Nihon University, Tokyo, Japan.
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Pawiroredjo JC, Minderhoud J, Mans DRA, Themen HCI, Bueno de Mesquita-Voigt AMT, Siban MR, Forster-Pawiroredjo CM, Moll AC, van Nispen RMA, Limburg H. The cataract situation in Suriname: an effective intervention programme to increase the cataract surgical rate in a developing country. Br J Ophthalmol 2016; 101:89-93. [PMID: 27836828 DOI: 10.1136/bjophthalmol-2016-308659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
AIMS To provide an overview of cataract data in Suriname and to describe and evaluate a programme to control cataract blindness in a developing country. DESIGN Evaluation of hospital data and findings from a population-based cross-sectional survey. METHODS The implementation of a new cataract surgical intervention programme was described and retrospectively evaluated by analysing the number of cataract operations and other related indicators at the Suriname Eye Centre (SEC) in the period 2006-2014. Findings of the recent Rapid Assessment of Avoidable Blindness (2013-2014) survey were used to evaluate the national cataract situation in Suriname in people aged ≥50 years (n=2998), including prevalence of cataract blindness, outcome and cataract surgical rate (CSR). RESULTS Since the implementation of a new cataract intervention programme, the number of cataract operations at the SEC has increased from 1150 in 2006 to 4538 in 2014, leading to an estimated national CSR of 9103 per one million inhabitants. The prevalence of bilateral cataract blindness in Suriname was 0.8% (95% CI 0.2% to 1.3%) in individuals aged ≥50 years. The proportion of eyes with a postoperative visual acuity <6/60 (poor outcome) was lowest in eyes operated at the SEC (8.5%) and highest in surgeries performed by foreign humanitarian ophthalmic missions. CONCLUSIONS The cataract situation in Suriname is well under control since the implementation of the new intervention programme. Important factors contributing to this success were the introduction of phacoemulsification, intensive training, and improvement in the affordability and accessibility of cataract surgery. The proportion of poor outcomes was still >5%.
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Affiliation(s)
| | - Janna Minderhoud
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname.,Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Dennis R A Mans
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Herman C I Themen
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Michael R Siban
- Suriname Eye Centre, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Annette C Moll
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
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Abstract
PURPOSE OF REVIEW To provide a summary of the mechanisms that may cause dry eye after cataract surgery and discuss available and upcoming treatment modalities. RECENT FINDINGS Development or worsening of dry eye symptoms after cataract surgery is multifactorial with corneal nerve transection, inflammation, goblet cell loss, and meibomian gland dysfunction commonly cited as underlying disorders. With increasing awareness of the prevalence of dry eye disease, current surgical techniques are being analyzed for their contribution to the issue. Although many classic interventions, such as artificial tears and anti-inflammatory drops, remain first-line treatment options, they may not adequately address abnormalities of the tear film. The trend has been to create new drugs and technologies that target meibomian gland deficiencies and restore goblet cell numbers. SUMMARY Therapy for postoperative dry eye symptoms should be determined based on symptom severity and which underlying cause is most prominent at a given time. Patients with high-level risk factors for dry eye should be evaluated preoperatively to determine whether they have preexisting dry eye disease or if they are susceptible to developing disease after surgery.
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Kwon JW, Chung YW, Choi JA, La TY, Jee DH, Cho YK. Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model. Int J Ophthalmol 2016; 9:218-24. [PMID: 26949638 DOI: 10.18240/ijo.2016.02.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023] Open
Abstract
AIM To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization (NV) and lymphangiogenesis (LY) between the dry eye and non-dry eye in murine cataract surgery models. METHODS We established two groups of animals, one with normal eyes (non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9(th) postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas. RESULTS Dry eye group had significantly more inflammatory infiltration (21.75%±7.17% vs 3.65%±1.49%; P=0.049). The dry eye group showed significantly more NV (48.21%±4.02% vs 26.24%±6.01%; P=0.016) and greater levels of LY (9.27%±0.48% vs 4.84%±1.15%; P=0.007). In corneas on which no surgery was performed, there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+ cells infiltration than the non-dry eye group (0.360%±0.160% vs 0.023%±0.006%; P=0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection (P=0.020 and 0.000, respectively). CONCLUSION In a murine cataract surgery model, preexisting dry eye can induce more postoperative NV, LY, and inflammation in corneal tissue.
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Affiliation(s)
- Jin Woo Kwon
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yeon Woong Chung
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Jin A Choi
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Tae Yoon La
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Dong Hyun Jee
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
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de Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev 2014; 2014:CD008812. [PMID: 24474622 PMCID: PMC11056193 DOI: 10.1002/14651858.cd008812.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Age-related cataract is one of the leading causes of blindness worldwide. Therefore, it is important to establish the most effective surgical technique for cataract surgery. OBJECTIVES The aim of this review is to examine the effects of two types of cataract surgery for age-related cataract: phacoemulsification and extracapsular cataract extraction (ECCE). SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2013), EMBASE (January 1980 to May 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the 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 13 May 2013. SELECTION CRITERIA We included randomised controlled trials of phacoemulsification compared to ECCE for age-related cataract. DATA COLLECTION AND ANALYSIS Two authors independently selected and assessed all studies. We defined two primary outcomes: 'good functional vision' (presenting visual acuity of 6/12 or better) and 'poor visual outcome' (best corrected visual acuity of less than 6/60) at three and 12 months after surgery. We also collected data on intra and postoperative complications, and the cost of the procedures. MAIN RESULTS We included 11 trials in this review with a total of 1228 participants, ranging from age 45 to 94. The studies were generally at unclear risk of bias due to poorly reported trial methods. No study reported presenting visual acuity, so we report both uncorrected (UCVA) and best corrected visual acuity (BCVA). Studies varied in visual acuity assessment methods and time frames at which outcomes were reported. Participants in the phacoemulsification group were more likely to achieve UCVA of 6/12 or more at three months (risk ratio (RR) 1.81, 95% confidence interval (CI) 1.36 to 2.41, two studies, 492 participants) and one year (RR 1.99, 95% CI 1.45 to 2.73, one study, 439 participants). People in the phacoemulsification group were also more likely to achieve BCVA of 6/12 or more at three months (RR 1.12, 95% CI 1.03 to 1.22, four studies, 645 participants) and one year (RR 1.06, 95% CI 0.99 to 1.14, one study, 439 participants), but the difference between the two groups was smaller. No trials reported BCVA less than 6/60 but three trials reported BCVA worse than 6/9 and 6/18: there were fewer events of this outcome in the phacoemulsification group than the ECCE group at both the three-month (RR 0.33, 95% CI 0.20 to 0.55, three studies, 604 participants) and 12-month time points (RR 0.62, 95% CI 0.36 to 1.05, one study, 439 participants). Three trials reported posterior capsule rupture: this occurred more commonly in the ECCE group than the phacoemulsification group but small numbers of events mean the true effect is uncertain (Peto odds ratio (OR) 0.56, 95% CI 0.26 to 1.22, three studies, 688 participants). Iris prolapse, cystoid macular oedema and posterior capsular opacification were also higher in the ECCE group than the phacoemulsification group. Phacoemulsification surgical costs were higher than ECCE in two studies. A third study reported similar costs for phacoemulsification and ECCE up to six weeks postoperatively, but following this time point ECCE incurred additional costs due to additional visits, spectacles and laser treatment to achieve a similar outcome. AUTHORS' CONCLUSIONS Removing cataract by phacoemulsification may result in a better visual acuity compared to ECCE, with a lower complication rate. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. The lower cost of ECCE may justify its use in a patient population where high-volume surgery is a priority, however, there are a lack of data comparing phacoemulsification and ECCE in lower-income settings.
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Affiliation(s)
| | | | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision Group, ICEHKeppel StreetLondonUKWC1E 7HT
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Demirci G, Karabas L, Maral H, Ozdek S, Gülkilik G. Effect of air bubble on inflammation after cataract surgery in rabbit eyes. Indian J Ophthalmol 2013; 61:343-8. [PMID: 23571264 PMCID: PMC3759105 DOI: 10.4103/0301-4738.109528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Intense inflammation after cataract surgery can cause cystoid macular edema, posterior synechia and posterior capsule opacification. This experimental study was performed to investigate the effect of air bubble on inflammation when given to anterior chamber of rabbit eyes after cataract surgery. Materials and Methods: 30 eyes of 15 rabbits were enrolled in the study. One of the two eyes was in the study group and the other eye was in the control group. After surgery air bubble was given to the anterior chamber of the study group eye and balanced salt solution (BSS; Alcon) was left in the anterior chamber of control eye. Results: On the first, second, fourth and fifth days, anterior chamber inflammations of the eyes were examined by biomicroscopy. On the sixth day anterior chamber fluid samples were taken for evaluation of nitric oxide levels as an inflammation marker. When the two groups were compared, in the air bubble group there was statistically less inflammation was seen. (1, 2, 4. days P = 0,001, and 5. day P = 0,009). Conclusions: These results have shown that when air bubble is left in anterior chamber of rabbits’ eyes after cataract surgery, it reduced inflammation. We believe that, air bubble in the anterior chamber may be more beneficial in the cataract surgery of especially pediatric age group, uveitis patients and diabetics where we see higher inflammation. However, greater and long termed experimental and clinical studies are necessary for more accurate findings.
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Affiliation(s)
- Goktug Demirci
- Department of Ophthalmology, Medical School of University of Medipol, Istanbul, Turkey
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Fesharaki H, Peyman A, Rowshandel M, Peyman M, Alizadeh P, Akhlaghi M, Ashtari A. A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length. Adv Biomed Res 2012; 1:67. [PMID: 23326797 PMCID: PMC3544086 DOI: 10.4103/2277-9175.102971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/08/2012] [Indexed: 11/22/2022] Open
Abstract
Background: This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length. Materials and Methods: A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber. Results: Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors. Conclusions: As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.
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Affiliation(s)
- Hamid Fesharaki
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Suelves AM, Kruh JN, Aznar-Peña I, Siddique SS, Foster SC. Long-term safety and visual outcomes of anterior chamber intraocular lens implantation in patients with a history of chronic uveitis. J Cataract Refract Surg 2012; 38:1777-82. [DOI: 10.1016/j.jcrs.2012.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/15/2012] [Accepted: 06/16/2012] [Indexed: 10/27/2022]
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Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol 2012; 56:113-8. [PMID: 22298313 DOI: 10.1007/s10384-012-0117-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate changes in corneal sensitivity, tear film function, and ocular surface stability in patients after cataract surgery. METHODS This hospital-based prospective randomized trial included 48 eyes from 30 patients who underwent phacoemulsification. Slit-lamp examination, Schirmer test 1 (ST1), and measurement of corneal sensitivity and tear film breakup time (BUT) were performed for all patients 1 day before and 1 day, 1 month, and 3 months after surgery. In addition, conjunctival impression cytology from the temporal region of the conjunctiva was simultaneously performed. RESULTS Corneal sensitivity at the center and temporal incision sites had decreased significantly at 1 day postoperatively (P = .021, P < .001). However, the sensitivity had returned to almost the preoperative level 1 month postoperatively. The mean postoperative ST1 results were no different from preoperative values. On the other hand, BUT results had decreased significantly at 1 day postoperatively (P = .01) but had returned to almost the preoperative level 1 month postoperatively. Mean goblet cell density (GCD) had decreased significantly at 1 day, 1 month, and 3 months postoperatively (P < .001). In addition, decrease in GCD and cataract operative time were highly correlated (r² = 0.65). CONCLUSIONS The decrease in GCD, which was correlated with operative time, had not recovered at 3 months after cataract surgery. Therefore, microscopic ocular surface damage during cataract surgery seems to be one of the pathogenic factors that cause ocular discomfort and dry eye syndrome after cataract surgery.
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Phacoemulsification in eyes with neovascular AMD treated with anti-VEGF injections. Eur J Ophthalmol 2012; 21:766-70. [PMID: 21360482 DOI: 10.5301/ejo.2011.6389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate visual results of phacoemulsification in eyes with neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF) intravitreal injections. METHODS This retrospective noncomparative interventional case-series study assessed best-corrected visual acuity (BCVA) at 4 timepoints: 1) baseline, immediately before first anti-VEGF injection; 2) preoperative, immediately before phacoemulsification; 3) postoperative, 1 month after phacoemulsification; 4) endpoint, at the last visit. Anti-VEGF retreatment regimen was based only on optical coherence tomography. The median time between anti-VEGF injections was evaluated for the time period before and after phacoemulsification. RESULTS Sixteen eyes of 16 patients were included. The median (range) baseline, preoperative, postoperative, and endpoint BCVA was 0.7 (0.3-1.3), 0.72 (0.4-1.3), 0.5 (0.05-1.0), and 0.36 (0.0-1.0) logMAR, respectively. Best-corrected visual acuity significantly improved after phacoemulsification (mean 3 logMAR lines) and remained stable during follow-up (median 14 months, range 7-28). There was no statistically significant difference in the median time interval between injections before phacoemulsification and after phacoemulsification. CONCLUSIONS Phacoemulsification significantly improved BCVA in patients with choroidal neovascular AMD. This effect persisted during follow-up with no increased need for anti-VEGF injections to keep macula dry.
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Stastna M, Behrens A, McDonnell PJ, Van Eyk JE. Analysis of protein composition of rabbit aqueous humor following two different cataract surgery incision procedures using 2-DE and LC-MS/MS. Proteome Sci 2011; 9:8. [PMID: 21306621 PMCID: PMC3045281 DOI: 10.1186/1477-5956-9-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 02/09/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The aqueous humor (AH), a liquid of the anterior and posterior chamber of the eye, comprises many proteins with various roles and important biological functions. Many of these proteins have not been identified yet and their functions in AH are still unknown. Recently, our laboratory published the protein database of AH obtained from healthy rabbits which expanded known protein identifications by 65%. Our present study extends our previous work and analyses AH following two types of cataract surgery incision procedures (clear corneal and limbal incisions) by using two dimensional gel electrophoresis (2-DE) and liquid chromatography tandem mass spectrometry (LC-MS/MS). Although both incision protocols are commonly used during cataract surgeries, the difference in protein composition and their release into AH following each surgery has never been systematically compared and remains unclear. The first step, which is the focus of this work, is to assess the scale of the protein change, at which time does maximum release occurs and when possible, to identify protein changes. RESULTS Samples of AH obtained prior to surgery and at different time points (0.5, 2, 12, 24 and 48 hours) following surgery (n = 3/protocol) underwent protein concentration determination, 2-DE and LC-MS/MS. There was a large (9.7 to 31.2 mg/mL) and rapid (~0.5 hour) influx of proteins into AH following either incision with a return to baseline quantities after 12 hours and 24 hours for clear corneal and limbal incision, respectively. We identified 80 non-redundant proteins, and compared to our previous study on healthy AH, 67.5% of proteins were found to be surgery-specific. In addition, 51% of those proteins have been found either in clear corneal (20%) or limbal incision (31%) samples. CONCLUSIONS Our results imply that a mechanism of protein release into AH after surgery is a global response to the surgery rather than increase in amount of protective proteins found in healthy AH and a mechanism of protein release for each type of incision procedure could be different. Although the total protein concentration was increased (at 0.5 and 2 hour time points and between types of surgery) many of 2-DE protein spots were similar based on 2-DE and MS analyses, and only a small number of protein spots changed with either the time points or surgical conditions (0.4 -1.9%). This suggests that the high protein content is due to an increase in the concentration of the same proteins with only a few unique proteins being altered per time point and with the different surgery type. This is the first report on the comparison of AH protein composition following two different cataract surgery procedures and it establishes the basis for better understanding of protein release into AH during events such as cataract surgery or other possible intervention to the eyes.
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Affiliation(s)
- Miroslava Stastna
- Johns Hopkins Bayview Proteomics Center, Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
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Hooper CY, Lamoureux EL, Lim L, Fraser-Bell S, Yeoh J, Harper CA, Keeffe JE, Guymer RH. Cataract surgery in high-risk age-related macular degeneration: a randomized controlled trial. Clin Exp Ophthalmol 2009; 37:570-6. [PMID: 19702706 DOI: 10.1111/j.1442-9071.2009.02095.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate if cataract surgery causes progression, from high-risk early age-related macular degeneration (AMD) to choroidal neovascularization (CNV), in the postoperative period. METHODS Randomized controlled trial. Patients, with visually significant cataract and fundus features of early AMD at high risk of progression to CNV, were randomized into two groups and were evaluated at baseline and 6 months. The study patients (n = 27) underwent immediate cataract surgery. The control group (n = 29) comprised patients who had cataract surgery deferred until after the 6-month visit. Assessment included visual acuity, quality of life (QoL) and fundus fluorescein angiography (FFA). RESULTS Of 68 eligible eyes, 60 participated and 56 completed the study. Three referred eyes (3.2%) were ineligible on the basis of a pre-existing, unsuspected occult CNV that was detected by baseline FFA. All three cases had end-stage exudative AMD in the fellow eye. Of the study eyes in the immediate surgery arm (n = 27), one (3.7%) developed CNV compared with none (0/29) in the deferred arm (chi(2); P = 1.0) at 6 months. In the operated group, there was a 2.8-line improvement in logMAR visual acuity and 2.1-fold average gain in QoL at 6 months. CONCLUSIONS No increased short-term risk of progression of AMD to CNV in high-risk fundi following uncomplicated phacoemulsification surgery was found. A low threshold for performing preoperative imaging in patients with AMD, especially in those with exudative AMD in the fellow eye, to exclude undetected CNV is recommended. Provided there is no CNV, there are distinct benefits of cataract surgery in people with early AMD.
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Affiliation(s)
- Claire Y Hooper
- Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
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Honsho C, Oriá A, Pigatto J, Laus J. Modified extracapsular extraction versus endocapsular phacoemulsification: intraoperative and immediate postoperative events. ARQ BRAS MED VET ZOO 2007. [DOI: 10.1590/s0102-09352007000100018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The clinical events and variations in intraocular pressure (IOP) that occur in endocapsular phacoemulsification technique were compared to the modified extracapsular extraction technique during the intraoperative and immediate postoperative periods. Phacoemulsification technique caused less corneal edema, less ocular discomfort and fewer postoperative complications than the modified extracapsular extraction technique. The observed increase in postoperative IOP, especially in the case of phacoemulsification, makes pressure monitoring mandatory, as well as the use of ocular hypotensive agents when the IOP exceeds acceptable limits.
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Elgohary MA, McCluskey PJ, Towler HMA, Okhravi N, Singh RP, Obikpo R, Lightman SS. Outcome of phacoemulsification in patients with uveitis. Br J Ophthalmol 2007; 91:916-21. [PMID: 17229800 PMCID: PMC1955648 DOI: 10.1136/bjo.2007.114801] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis. METHOD This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma-associated uveitis were excluded. RESULTS At the first postoperative and final visits, visual acuity was significantly better (p<0.001), and 64.4% and 71.3% of patients, respectively, had achieved >or=2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged <or=55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate-haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three-piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs. CONCLUSION Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre-existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.
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Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, Snellingen T. Surgical interventions for age-related cataract. Cochrane Database Syst Rev 2006; 2006:CD001323. [PMID: 17054134 PMCID: PMC7096771 DOI: 10.1002/14651858.cd001323.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cataract accounts for 50% of blindness globally and remains the leading cause of visual impairment in all regions of the world, despite improvements in surgical outcomes (WHO 2005). This number is expected to rise due to an aging population and increase in life expectancy. Although cataracts are not preventable, their surgical treatment is one of the most cost-effective interventions in healthcare. OBJECTIVES To compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY We searched CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists of identified trials and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA We included randomised controlled trials (RCTS). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and discrepancies were resolved by discussion. Where appropriate, risk ratios, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. MAIN RESULTS We identified 17 trials that randomised a total of 9627 people. Phacoemulsification gave a better visual outcome than extracapsular surgery but similar average cost per procedure in Europe but not in poorer countries. Extracapsular surgery with posterior chamber lens implant and ICCE with or without an anterior chamber intraocular lens (IOL) implant gave acceptable visual outcomes but extracapsular surgery had less complications. Manual small incision surgery provides better visual outcome than ECCE but slightly inferior unaided visual acuity compared to phacoemulsification. AUTHORS' CONCLUSIONS This review provides evidence from seven RCTs that phacoemulsification gives a better outcome than ECCE with sutures. We also found evidence that ECCE with a posterior chamber lens implant provides better visual outcome than ICCE with aphakic glasses. The long term effect of posterior capsular opacification (PCO) needs to be assessed in larger populations. The data also suggests that ICCE with an anterior chamber lens implant is an effective alternative to ICCE with aphakic glasses, with similar safety. Phacoemulsification provides the best visual outcomes but will only be accessible to the poorer countries if the cost of phacoemulsification and foldable IOLs decrease. Manual small incision cataract surgery provides early visual rehabilitation and comparable visual outcome to PHACO. It has better visual outcomes than ECCE and can be used in any clinic that is currently carrying out ECCE with IOL. Further research from developing regions are needed to compare the cost and longer term outcomes of these procedures e.g. PCO and corneal endothelial cell damage.
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Affiliation(s)
- Y Riaz
- Moorfields Eye Hospital, City Road, London, UK.
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Berker N, Soykan E, Elgin U, Ozkan SS. Phacoemulsification Cataract Extraction and Intraocular Lens Implantation in Patients With Behçet's Disease. Ophthalmic Surg Lasers Imaging Retina 2004. [DOI: 10.3928/1542-8877-20040501-08] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ozdal PC, Mansour M, Deschênes J. Ultrasound biomicroscopy of pseudophakic eyes with chronic postoperative inflammation. J Cataract Refract Surg 2003; 29:1185-91. [PMID: 12842688 DOI: 10.1016/s0886-3350(02)01920-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the ultrasound biomicroscopy (UBM) findings in pseudophakic eyes with chronic noninfectious postoperative inflammation and discuss the use of the technique in these cases. SETTING Uveitis Service, Department of Ophthalmology, McGill University, Montréal, Québec, Canada. METHODS Fifty-four eyes of 51 patients with chronic noninfectious postoperative inflammation were prospectively evaluated between January 1998 and September 2001. Patients with aphakia, a dislocated intraocular lens (IOL) in the posterior segment, and endophthalmitis were excluded. All patients had a UBM examination that comprised locating the IOL position, investigating the presence of lens remnants, and evaluating the anterior segment of the eye. RESULTS Ultrasound biomicroscopic examination revealed IOL misplacement in 37 eyes (68.5%). Of these, 23 (62.2%) had a sulcus-implanted posterior chamber IOL (PC IOL), 9 (24.3%) an in-the-bag PC IOL, and 5 (13.5%) an anterior chamber IOL. Haptic misplacement was significantly higher with sulcus-implanted PC IOLs than with in-the-bag PC IOLs (P<.01). Other UBM findings included edematous ciliary body processes and hypoechogenic and/or thickened ciliary bodies in 11 eyes (20.4%), peripheral anterior synechias in 8 eyes (14.8%), a significant number of lens remnants (graded as severe) in 6 eyes (11.1%), a thick cyclitic membrane in 3 eyes (5.6%), and an early cyclitic membrane in 2 eyes (3.7%). CONCLUSIONS Irritation of ocular tissues by an IOL was the main cause of chronic postoperative noninfectious inflammation in pseudophakic eyes. Therefore, detecting the IOL position and its relationships to ocular tissues is very important in planning the treatment. Ultrasound biomicroscopy is a practical method that accurately provides this information.
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Affiliation(s)
- Pinar C Ozdal
- McGill University Health Center, Department of Ophthalmology, Montréal, Québec, Canada.
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Alió JL, Chipont E, BenEzra D, Fakhry MA. Comparative performance of intraocular lenses in eyes with cataract and uveitis. J Cataract Refract Surg 2002; 28:2096-108. [PMID: 12498843 DOI: 10.1016/s0886-3350(02)01452-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the postoperative outcomes in uveitic eyes after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING Multicenter (19) international study. METHODS This prospective randomized comparative interventional case series comprised 140 eyes of 140 patients who had phacoemulsification and implantation of IOLs of various materials: hydrophobic acrylic (n = 48), silicone (n = 44), poly(methyl methacrylate) (PMMA) (n = 26), or heparin-surface-modified PMMA (HSM PMMA) (n = 22). Preoperative and postoperative grading and control of intraocular inflammation were performed. Clinically significant observations, visual outcomes, and the incidence of postoperative complications were recorded. RESULTS At the final follow-up, 64 eyes (46.3%) had a best corrected visual acuity of 20/40 or better, an improvement that was highly significant (P <.0001). One day after surgery, the acrylic group had the lowest inflammation values and the silicone group the highest (P =.02). The acrylic group continued to have the lowest inflammation grade values until the 3-month follow-up. The acrylic and HSM PMMA groups had the lowest incidence of relapses. Posterior capsule opacification developed in 48 eyes (34.2%), with the highest incidence in the silicone group. CONCLUSIONS Phacoemulsification with IOL implantation in selected uveitic eyes was safe and effective. Acrylic IOLs provided a better visual outcome and lower complication rate than IOLs of other materials.
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Affiliation(s)
- Jorge L Alió
- Department of Cataract Surgery, Instituto Oftalmológico de Alicante, Avenida Denia 111, 03015 Alicante, Spain.
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Knudsen LL. Ocular fluorophotometry in human subjects and in swine - with particular reference to long-term pharmacokinetics. ACTA ACUST UNITED AC 2002. [DOI: 10.1034/j.1600-0420.80.s235.1.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
BACKGROUND Cataract is the major cause of global blindness, accounting for 40 to 80% of all blindness in developing countries. The number of people blind from cataract is expected to rise due to the changing age distribution and increasing life expectancy. There is currently no proven intervention to prevent cataract and surgery is the only form of treatment. OBJECTIVES The objective of this review is to compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group specialised register (Cochrane Library Issue 3 2001), MEDLINE (1966 to August 2001), EMBASE (1980 to September 2001), the reference lists of identified trials, and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA We included randomised controlled trials evaluating surgical treatment for people with age-related cataract. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and discrepancies were resolved by discussion. Where appropriate, relative risks, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. We used a fixed effect model due to the low number of trials in each comparison. MAIN RESULTS We identified six trials that randomised a total of 7828 people. Phacoemulsification gave a better visual outcome than extracapsular surgery and gave a similar average cost per procedure in one trial conducted in the UK. Extracapsular surgery with posterior chamber lens implant and intracapsular surgery with or without an anterior chamber intraocular lens implant gave acceptable visual outcomes at 12 to 24 months after surgery. In three large trials in south Asia, best-corrected visual acuity of less than 6/60 ranged from 0.5 to 4%. Higher rates of poor outcome were observed in a multicentre study with 19 surgeons compared to a single-centre study with two surgeons. REVIEWER'S CONCLUSIONS This review provides evidence from one randomised controlled trial that phacoemulsification gives a better visual outcome than extracapsular extraction with sutures. However, this trial was conducted in a developed country specialised hospital setting and extrapolation to other settings must be made with caution. This review also found evidence that extracapsular cataract extraction with a posterior chamber lens implant provides better visual outcome than intracapsular extraction with aphakic glasses. This finding is also based on the results of a single trial. The long term effects of posterior capsular opacification need to be assessed in larger populations. The data in the review suggest that intracapsular extraction with an anterior chamber lens implant is an effective alternative to intracapsular extraction with aphakic glasses, with similar safety. Further data from developing regions are needed to compare all aspects of intraocular lens surgery with the three main surgical procedures - intracapsular extraction with an anterior chamber lens, extracapsular surgery with a posterior chamber lens with or without sutures.
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Affiliation(s)
- T Snellingen
- Institute of Clinical Medicine, University of Tromso, ISM UiTo, Tromso, Troms, Norway, 9037.
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Suresh PS, Jones NP. Phacoemulsification with intraocular lens implantation in patients with uveitis. Eye (Lond) 2001; 15:621-8. [PMID: 11702974 DOI: 10.1038/eye.2001.197] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of phacoemulsification with intraocular lens implantation in eyes affected by uveitis. METHODS A retrospective case series is presented including casenote review and update patient examinations. Patient data were withdrawn from the Uveitis Clinic database. All uveitis patients undergoing phacoemulsification with intraocular lens implantation from August 1995 to November 2000 were included. A pre-operative preparation protocol was used. Operative and post-operative complications, degree of postoperative inflammation, best-corrected and final visual acuity were the main outcome measures. RESULTS Eighty-six eyes of 75 patients underwent surgery, which in 11 cases was combined with trabeculectomy. Mean follow-up was 24.1 months. Eight eyes (10%) had severe or fibrinous uveitis post-operatively. The mean delay between surgery and return to baseline treatment was 8.6 weeks. Posterior capsule opacification occurred in 42% of eyes and Nd-YAG capsulotomy was required in 21%. Cystoid macular oedema was seen in 2 eyes. Seventy-two per cent of eyes retain a visual acuity of 6/9 or better, and 87% of eyes retain a post-operative improvement of 2 or more lines of Snellen acuity. CONCLUSIONS With careful patient selection, appropriate pre-operative preparation, diligent surgery and close post-operative supervision, phacoemulsification with intraocular lens implantation is safe and effective in the great majority of eyes with uveitis.
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Kruger AJ, Amon M, Abela-Formanek C, Schild G, Kolodjaschna J, Schauersberger J. Postoperative inflammation after lens epithelial cell removal: 2 year results. J Cataract Refract Surg 2001; 27:1380-5. [PMID: 11566519 DOI: 10.1016/s0886-3350(01)00795-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the influence on postoperative inflammation of lens epithelial cell (LEC) removal after phacoemulsification. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This randomized prospective single-surgeon study comprised 60 patients with senile cataract only. After a temporal clear corneal incision was made and phacoemulsification performed, no LECs were removed in Group A, LECs in the nasal half were removed in Group B, and LECs were removed from the entire anterior capsule in Group C. The LECs were removed with a Rentsch capsule curette (Geuder). In all eyes, a foldable hydrogel intraocular lens (Hydroview, Bausch & Lomb) was implanted. Anterior chamber flare was evaluated through dilated pupils in a double-masked fashion using a Kowa FC-1000 laser flare-cell meter (LFCM). Measurements were done preoperatively as well as 1, 3, 7, 14, and 28 days and 3, 6, 12, and 24 months postoperatively. RESULTS In all 3 groups, the flare and cell values increased on the first postoperative day followed by a successive decrease thereafter. One month after surgery, the blood-aqueous barrier (BAB) was nearly restored in all groups. Between the first and fourth week, the flare values in Groups B and C were slightly lower than in Group A; however, mean flare and cell values among groups were not statistically significantly different at any measurement. CONCLUSION The removal of LECs from the anterior capsule with a Rentsch curette did not influence postoperative BAB changes detected using an LFCM.
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Affiliation(s)
- A J Kruger
- Department of Ophthalmology, University of Vienna, Vienna, Austria
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Kirveskari J, Vesaluoma MH, Moilanen JA, Tervo TM, Petroll MW, Linnolahti E, Renkonen R. A novel non-invasive, in vivo technique for the quantification of leukocyte rolling and extravasation at sites of inflammation in human patients. Nat Med 2001; 7:376-9. [PMID: 11231641 DOI: 10.1038/85538] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J Kirveskari
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
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Abstract
Postoperative ocular inflammation following cataract surgery is related to the risk of complications like corneal edema, intraocular pressure spikes, cystoid macular edema, and posterior capsule opacification. The degree of postoperative inflammation following cataract surgery is linked to several surgery-dependent factors such as surgical technique, intraocular lens type, and also patient-dependent factors such as history of inflammatory disease and degree of iris pigmentation. During the past decade, major advances have occurred in cataract surgery techniques, equipment, and pharmacologic strategies that decrease the degree of postoperative inflammation following cataract surgery and reduce patients' risk for inflammation-related complications. This article reviews the most recent literature regarding the control of cataract surgery-induced intra-ocular inflammation.
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Affiliation(s)
- S M El-Harazi
- Department of Ophthalmology and Visual Science, The University of Texas Health Science Center, Houston, Texas, USA.
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Affiliation(s)
- N Okhravi
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, UK.
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