Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery

Efficacy of intracameral antibiotics following manual small incision cataract surgery in reducing the rates of endophthalmitis: A meta-analysis

BACKGROUND

Manual small incision cataract surgery (MSICS) is a widely used technique for cataract surgery in the developing world. Higher rates of postoperative endophthalmitis have been reported with this technique compared with phaco-emulsification. The purpose of this study was to evaluate the efficacy of prophylactic intracameral (IC) antibiotics in reducing the rates of postoperative endophthalmitis following MSICS.

METHODS

Systematic review and meta-analysis of patients undergoing MSICS. A literature search in PubMed and EMBASE databases was performed to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Two authors independently assessed eligibility, extracted data and assessed the risk of bias. Heterogeneity was assessed using the I² test.

RESULTS

Twelve studies enrolling 1 494 307 eyes were included. IC antibiotics were used in 725 324 (48.5%) eyes. The risk ratio of developing endophthalmitis was 2.94 (95% CI, 1.07-8.12; P = .037) in eyes that did not receive IC antibiotics.

CONCLUSIONS

Routine use of IC antibiotics may help to reduce the rates of endophthalmitis following MSICS and significantly improve the safety of this effective form of cataract surgery.

Efficacy and Safety Outcomes of Cataract Surgery in Survivors of Ebola Virus Disease: 12-Month Results From the PREVAIL VII Study

Purpose

In survivors of Ebola virus disease (EVD), intraocular viral persistence raises questions about the timing and safety of cataract surgery. To the best of our knowledge, this is the first controlled study evaluating Ebola virus persistence and cataract surgery safety and outcomes in EVD survivors.

Methods

Seropositive EVD survivors and seronegative controls with vision worse than 20/40 from cataract and without active intraocular inflammation were enrolled. Aqueous humor from survivors was tested with reverse transcription-polymerase chain reaction for Ebola viral RNA. Participants underwent manual small-incision cataract surgery and 1 year of follow-up examinations.

Results

Twenty-two eyes of 22 survivors and 12 eyes of eight controls underwent cataract surgery. All of the aqueous samples tested negative for Ebola viral RNA. Median visual acuity improved from 20/200 at baseline to 20/25 at 1 year in survivors and from count fingers to 20/50 in controls (overall, P < 0.001; between groups, P = 0.07). After a 1-month course of topical corticosteroids, 55% of survivors and 67% of controls demonstrated at least 1+ anterior chamber cell. Twelve months after surgery, optical coherence tomography revealed a median increase in macular central subfield thickness of 42 µm compared with baseline (overall, P = 0.029; between groups, P = 0.995).

Conclusions

EVD survivors and controls demonstrated significant visual improvement from cataract surgery. The persistence of intraocular inflammation highlights the importance of follow-up. The absence of detectable intraocular Ebola viral RNA provides guidance regarding the safety of eye surgery in Ebola survivors.

Translational Relevance

These findings demonstrate the safety and efficacy of cataract surgery in Ebola survivors and will inform ocular surgery guidelines in this population.

[Morphological and functional condition of the macula after different types of phaco cataract surgeries]

One of the directions of advancing phaco technology is related to adoption of hybrid phacoemulsification for clinical practice. Potential postsurgical changes in the macular area, when other factors are equal, can be seen as a conditional criterion for the injury rate of phaco surgeries.

PURPOSE

To evaluate morphological and functional condition of the macular area after different types of phaco cataract surgeries.

MATERIAL AND METHODS

Two groups were formed for comparative study in accordance with criteria for standardization and maximum mitigation of the impact of other factors on the condition of the retina - with standard ultrasound and hybrid (femtolaser-assisted) phacoemulsification (30 operations in each group). Examinations were performed initially, then 7-10 days, and 2-3 month after the surgery. Optical coherence tomography (OCT) and multifocal electroretinography (mfERG) were performed for evaluation of the morphological and functional condition of the macular area.

RESULTS

There was no statistically significant dependence of linear and volumetric measures in the macular area on phaco surgery method, and the few variations were most likely related to increasing the time of ultrasound action in standard phacoemulsification. Revealed changes turned out to be significantly less marked than what is considered critical for development of macular edema. Improvement of baseline multifocal electroretinography measurements (increase of the density of retinal biopotential and decrease of latent time) just after the surgery results from the effect the lens opacification has on basic parameters, regardless of phacoemulsification technique. There were no significant differences in postsurgical measurements of multifocal electroretinography obtained in similar periods of postsurgical assessment after standard ultrasound and hybrid phacoemulsification.

CONCLUSION

The results prove the safety of phaco surgery methods and the absence of negative impact of femtolaser component of hybrid phacoemulsification on structural and functional condition of central retina.

Distinct macular thickness changes after femtosecond laser-assisted cataract surgery of age-related cataract and myopia with cataract

Cataract surgery can cause macular thickness change. We used optical coherence tomography (OCT) to assess the macular thickness of different regions after femtosecond laser–assisted cataract surgery of age-related cataracts (ARC) and myopia cases with cataract (myopia group). Fifty eyes of 50 patients in ARC group and fifty eyes of 50 patients in myopia with cataract group were included. All study underwent femtosecond laser–assisted cataract surgery and macular thickness of was measured at pre-operation and 1 week, 1 month after surgery. There are significant differences of foveal thickness (P = 0.02), foveal volume (P = 0.02) and average retinal thickness (P = 0.02) between two groups before operation. In the myopia group, statistically significant differences were not found in postoperative macular thickness as compared with ARC group. There are differences in macular thickness between pre-operation and 1 month after operation when compared with nasal outer macular ring thickness (P = 0.022), foveal volume (P = 0.005) and average retinal thickness (P = 0.012) in ARC group. The study suggest that femtosecond laser–assisted cataract extraction is safe in myopia group that did not cause significant increase of macular thickness. However, an increased post-operative local macular thickness was recoded while comparing macular thickness with the baseline in ARC group.

Comparison of efficacy between coaxial microincision and standard-incision phacoemulsification in patients with age-related cataracts: a meta-analysis

BACKGROUND

Incision size plays a critical role in the efficacy of cataract surgery, but the available evidence on ideal incision size is inconsistent. In this study, we conducted a meta-analysis to evaluate the efficacy of coaxial microincisional phacoemulsification surgery (MICS) compared with that of standard-incision phacoemulsification surgery (SICS) in patients with age-related cataracts.

METHODS

The Cochrane Library (Wiley Online Library), PubMed, Medline, National Knowledge Infrastructure (CNKI), and VIP databases were searched to identify reports of clinical randomized controlled trials (RCTs) comparing MICS to SICS for the treatment of age-related cataracts. The outcomes of interest included surgically induced astigmatism (SIA), effective phacoemulsification time (EPT), central corneal thickness (CCT), endothelial cell count (ECC), endothelial cell count loss (ECC Loss %), and average ultrasonic energy (AVE).

RESULTS

Eleven RCT studies were included in this meta-analysis. No statistically significant differences were observed in EPT (Z = 1.29, P > 0.05), CCT (1 day: Z = 1.37, P > 0.05; 7 days: Z = 0.75, P > 0.05; 30 days: Z = 0.38, P > 0.05; 90 days: Z = 0.29, P > 0.05), ECC (7 days: Z = 1.13, P > 0.05; 30 days: Z = 1.42, P > 0.05) or ECC Loss % (7 days: Z = 0.24, P > 0.05; 30 days: Z = 0.06, P > 0.05; 90 days: Z = 0.10, P > 0.05) between MICS and SICS. However, statistically significant differences were found in AVE (Z = 4.19, P < 0.0001) and SIA (1 day: Z = 10.33, P < 0.00001; 7 days: Z = 10.71, P < 0.00001; 30 days: Z = 10.95, P < 0.00001; 90 days: Z = 2.21,- P < 0.01) between MICS and SICS.

CONCLUSION

Compared with SICS, MICS can reduce short-term and long-term SIA, but it does not differ in safety outcomes or in the time required for surgery.

[Hybrid (femtosecond laser-assisted) phaco surgery and the state of the macula]

The review covers different aspects of the impact of femtosecond laser-assisted cataract surgery on the state of the macular zone of the retina. Literature search has revealed inconsistency of the published data and indicated the need for a more detailed study of this problem.

Retinal and choroidal thickness after femtosecond laser-assisted and standard phacoemulsification

Purpose

The purpose of this study was to compare the short-term changes in retina and choroidal tissue after femtosecond laser-assisted cataract surgery (FLACS) and standard phacoemulsification (PE) surgery.

Methods

In all, 25 eyes undergoing FLACS and 27 eyes undergoing PE surgery were included in this nonrandomized, retrospective, cross-sectional study. Central retinal thickness (CRT) and choroidal thickness (CT) were measured pre- and postoperatively (at day 1, 1 week later, and after 1 month) with spectral domain optical coherence tomography (OCT) in all patients and were compared. For group comparisons, chi-square test and independent t-test were used. Postoperative values were compared to the baseline using a paired t-test. The magnitude of the change from baseline to the peak was analyzed by multiple regression models in an attempt to explain possible influence variables.

Results

Pre and postoperative CRT measurements were similar in both groups. The mean subfoveal CT at day 1, after 1 week, and 1 month were significantly higher than baseline CT measurements in the PE group.

Conclusion

FLACS might have an advantage in regard to postoperative choroidal changes.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens

Purpose:

To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT).

Methods:

This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and −5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD).

Results:

The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants.

Conclusions:

The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

Changes of the Macular Ganglion Cell-Inner Plexiform Layer Thickness after Cataract Surgery in Glaucoma Patients

Purpose. To investigate the effect of uneventful cataract surgery on macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in glaucoma patients. Methods. This retrospective study included 65 eyes of 65 subjects who underwent uneventful cataract surgery, including 13 glaucoma eyes and 52 normal eyes. Using spectral domain optical coherence tomography, the mGC-IPL thickness was measured and compared between glaucoma and normal eyes preoperatively as well as 1 month and 3 months postoperatively. Linear regression analysis was used to determine the factors associated with postoperative change in mGC-IPL thickness. Results. The mean mGC-IPL significantly increased in both groups 1 month and 3 months after surgery (all P values equal to or less than 0.001). The postoperative changes between groups were not significantly different (P = 0.171). In the multivariate regression analysis, preoperative mGC-IPL thickness showed a significant association with the change of average mGC-IPL thickness 1 month and 3 months after surgery (all P values < 0.001). Conclusions. The mean mGC-IPL thickness was increased after cataract surgery, and the postoperative mGC-IPL thickness changes were associated with preoperative mGC-IPL thickness in both groups and axial length in normal eye. The effects of cataract surgery on mean mGC-IPL thickness were not different in glaucomatous and normal eyes.

Comparison of ketorolac 0.45% versus diclofenac 0.1% for macular thickness and volume after uncomplicated cataract surgery

PURPOSE

To compare the effects of ketorolac 0.45% and diclofenac 0.1% on macular thickness and volume after uncomplicated cataract surgery.

METHODS

A total of 76 eyes of 76 patients who underwent uncomplicated cataract surgery were included. Patients were treated with either diclofenac 0.1% (38 eyes) or ketorolac 0.45% (38 eyes) after surgery. The macular thickness and volume were obtained with optical coherence tomography (OCT). Central subfield thickness (CST, OCT 1 mm zone), total foveal thickness (TFT, OCT 3 mm zone), total macular thickness (TMT, OCT 6 mm zone), average macular thickness (AMT) and total macular volume (TMV) were compared between the two study groups.

RESULTS

No significant differences between groups were found in macular thickness or volume 1 month after cataract surgery. Two months after surgery, the ketorolac group had significantly lower CST, TFT, TMT and AMT than the diclofenac group (p < 0.05 for all). Additionally, 1 and 2 months after surgery, changes from preoperative values in CST (both p = 0.04), AMT (p = 0.02 and p < 0.01, respectively) and TMV (both p = 0.04) were significantly less in the ketorolac group than in the diclofenac group.

CONCLUSIONS

Following uncomplicated cataract surgery, topical ketorolac 0.45% was more effective than diclofenac 0.1% in preventing increases in macular thickness and volume.

Meta-analysis to Compare the Safety and Efficacy of Manual Small Incision Cataract Surgery and Phacoemulsification

PURPOSE

A systematic review and meta-analysis comparing the safety, efficacy, and expenses related to phacoemulsification versus manual small incision cataract surgery (SICS).

METHODS

PubMed, Cochrane, and Scopus databases were searched with key words manual SICS 6/18 and 6/60; astigmatism and endothelial cell loss postoperatively, intra- and post-operative complications, phacoemulsification, and comparison of SICS and phacoemulsification. Non-English language manuscripts and manuscripts not indexed in the three databases were also search for comparison of SICS with phacoemulsification. Data were compared between techniques for postoperative uncorrected and corrected distance visual acuity (UCVA and best corrected visual acuity [BCVA], respectively) better than 6/9, surgical cost and duration of surgery. The Oxford cataract treatment and evaluation team scores were used for grading intraoperative and postoperative complications, uncorrected near vision.

RESULT

This review analyzed, 11 comparative studies documenting 76,838 eyes that had undergone cataract surgery considered for analysis. UCVA of 6/18 UCVA and 6/18 BCVA were comparable between techniques (P = 0.373 and P = 0.567, respectively). BCVA of 6/9 was comparable between techniques (P = 0.685). UCVA of 6/60 and 6/60 BCVA aided and unaided vision were comparable (P = 0.126 and P = 0.317, respectively). There was no statistical difference in: Endothelial cell loss during surgery (P = 0.298), intraoperative (P = 0.964) complications, and postoperative complications (P = 0.362). The phacoemulsification group had statistically significantly less astigmatism (P = 0.005) and more eyes with UCVA of 6/9 (P = 0.040). UCVA at near was statistically significantly better with SICS due to astigmatism and safer during the learning phase (P = 0.003). The average time for SICS was lower than phacoemulsification and cost <½ of phacoemulsification.

CONCLUSION

The outcome of this meta-analysis indicated there is no difference between phacoemulsification and SICS for BCVA and UCVA of 6/18 and 6/60. Endothelial cell loss and intraoperative and postoperative complications were similar between procedures. SICS resulted in statistically greater astigmatism and UCVA of 6/9 or worse, however, near UCVA was better.

The use of femtosecond lasers in cataract surgery: review of the published results with the LenSx system

PURPOSE

To review the published literature describing the use of the LenSx femtosecond laser technology (Alcon Laboratories, Inc., Fort Worth, TX) in cataract surgery.

METHODS

Literature review.

RESULTS

The LenSx system has been used in more than 200,000 cataract surgery procedures to date. Pre-clinical evaluations have shown that this system produces accurate and reproducible capsulorhexes, and that both the energy required for phacoemulsification and total phacoemulsification time are less than with conventional phacoemulsification. In comparative studies, femtosecond lasers have been shown to produce more precise and reproducible capsulorhexes than manual procedures, and better intraocular lens placement; capsule overlap, circularity of capsulotomy, and centration of the intraocular lens are consistently better with femtosecond lasers than with manual procedures. The improved quality of capsulorhexis and intraocular lens positioning are reflected in favorable visual and refractive outcomes. As with any new technology, there is a significant learning curve: prospective cohort studies have shown that the incidence of intraoperative complications such as suction breaks or anterior capsular tears or tags decreases with experience. In general, the incidence of such complications is within the range (< 2%) considered in recent evidence-based guidelines to be feasible and desirable.

CONCLUSIONS

Although femtosecond laser cataract surgery is in its infancy, the technology is evolving rapidly and offers the potential for more consistent and predictable results after cataract surgery.

Influence of cataract surgery on repeatability and measurements of spectral domain optical coherence tomography

BACKGROUNDS/AIMS

To evaluate the effect of uncomplicated cataract phacoemulsification on the measurements of macular and retinal nerve fibre layer (RNFL) in healthy subjects using two spectral domain (SD) optical coherence tomography (OCT) instruments--Cirrus OCT (Zeiss) and Spectralis OCT (Heidelberg)--and to assess the reliability of the measurements obtained with these two devices before and after cataract surgery.

METHODS

The study included 60 eyes of 60 healthy subjects (22 men and 38 women, 54-88 years of age) who underwent cataract phacoemulsification. One month before and one month after surgery, three repetitions of scans were performed using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments. The differences between RNFL and macular thickness measurements obtained in the two visits were analysed. Repeatability was evaluated by calculating the coefficient of variation (COV) for each of the parameters recorded and for each visit.

RESULTS

The RNFL measurements obtained with the Cirrus and Spectralis OCT differed before and after surgery, and most of these differences were statistically significant (p<0.05). Macular thickness measurements using the Spectralis OCT were not significantly different between the two visits, whereas the differences found with the Cirrus OCT were statistically significant. The repeatability was better after surgical removal of the cataract, and the differences between COV in the two visits were significant with the Cirrus OCT.

CONCLUSIONS

The presence of cataracts affects RNFL and macular measurements performed with SD-OCT. The repeatability of the images significantly improved after cataract phacoemulsification when using the Cirrus OCT.

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract

BACKGROUND

Age-related cataract is a major cause of blindness and visual morbidity worldwide. It is therefore important to establish the optimal technique of lens removal in cataract surgery.

OBJECTIVES

To compare manual small incision cataract surgery (MSICS) and phacoemulsification techniques.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2013), EMBASE (January 1980 to July 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to July 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 23 July 2013.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) for age-related cataract that compared MSICS and phacoemulsification.

DATA COLLECTION AND ANALYSIS

Two authors independently 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). We collected data on these outcomes at three and 12 months after surgery. Complications such as posterior capsule rupture rates and other intra- and postoperative complications were also assessed. In addition, we examined cost effectiveness of the two techniques. Where appropriate, we pooled data using a random-effects model.

MAIN RESULTS

We included eight trials in this review with a total of 1708 participants. Trials were conducted in India, Nepal and South Africa. Follow-up ranged from one day to six months, but most trials reported at six to eight weeks after surgery. Overall the trials were judged to be at risk of bias due to unclear reporting of masking and follow-up. No studies reported presenting visual acuity so data were collected on both best-corrected (BCVA) and uncorrected (UCVA) visual acuity. Most studies reported visual acuity of 6/18 or better (rather than 6/12 or better) so this was used as an indicator of good functional vision. Seven studies (1223 participants) reported BCVA of 6/18 or better at six to eight weeks (pooled risk ratio (RR) 0.99 95% confidence interval (CI) 0.98 to 1.01) indicating no difference between the MSICS and phacoemulsification groups. Three studies (767 participants) reported UCVA of 6/18 or better at six to eight weeks, with a pooled RR indicating a more favourable outcome with phacoemulsification (0.90, 95% CI 0.84 to 0.96). One trial (96 participants) reported UCVA at six months with a RR of 1.07 (95% CI 0.91 to 1.26).Regarding BCVA of less than 6/60: there were only 11/1223 events reported. The pooled Peto odds ratio was 2.48 indicating a more favourable outcome using phacoemulsification but with wide confidence intervals (0.74 to 8.28) which means that we are uncertain as to the true effect.The number of complications reported were also low for both techniques. Again this means the review is underpowered to detect a difference between the two techniques with respect to these complications. One study reported on cost which was more than four times higher using phacoemulsification than MSICS.

AUTHORS' CONCLUSIONS

On the basis of this review, removing cataract by phacoemulsification may result in better UCVA in the short term (up to three months after surgery) compared to MSICS, but similar BCVA. There is a lack of data on long-term visual outcome. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. In view of the lower cost of MSICS, this may be a favourable technique in the patient populations examined in these studies, where high volume surgery is a priority. Further studies are required with longer-term follow-up to better assess visual outcomes and complications which may develop over time such as posterior capsule opacification.

Influence of cataract surgery on optical coherence tomography and neurophysiology measurements in patients with retinitis pigmentosa

PURPOSE

To evaluate the effect of uncomplicated cataract phacoemulsification on the measurements of visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) using 2 spectral-domain optical coherence tomography (OCT) instruments, the Cirrus OCT (Carl Zeiss Meditech) and Spectralis OCT (Heidelberg Engineering), in patients with retinitis pigmentosa (RP), and to assess the reliability of the OCT measurements before and after cataract surgery.

DESIGN

Observational cross-sectional study.

METHODS

Thirty-five eyes of 35 patients with RP (20 men and 15 women, 45-66 years) who underwent cataract phacoemulsification were studied. At 1 month before and 1 month after surgery, visual acuity, VEP, PERG, and 3 repetitions of scans using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments were performed. The differences in measurements between the 2 visits were analyzed. Repeatability of OCT measurements was evaluated by calculating the coefficients of variation.

RESULTS

VEP amplitude, RNFL thicknesses provided by Cirrus and Spectralis, and macular measurements provided by Cirrus OCT differed between the 2 visits. VEP latency, PERG measurements, and macular thicknesses provided by the Spectralis OCT before surgery did not differ significantly from those after surgery. The OCT repeatability was better after surgery, with lower coefficients of variation for scans performed after surgical removal of the cataract. The nuclear, cortical, and posterior subcapsular types of cataracts did not show different repeatability.

CONCLUSIONS

The presence of cataracts affects VEP amplitude, RNFL, and macular measurements performed with OCT in eyes with RP. Image repeatability significantly improves after cataract phacoemulsification.

Evaluation of macular thickness after uncomplicated cataract surgery using optical coherence tomography

PURPOSE

To evaluate central macular thickness (CMT) after cataract surgery in selected groups of patients. 


METHODS

The study comprised 4 groups-patients with epiretinal membrane, patients with high myopia, patients with diabetes without retinopathy, and healthy subjects-who underwent phacoemulsification and intraocular lens implantation. Central macular thickness was measured with spectral domain optical coherence tomography (OCT) using the 3D macular cube scan. The OCT evaluation was performed preoperatively and 1, 6, 15, 30, 60, 90, and 360 days after surgery. Visual acuity was measured preoperatively and after 6 and 360 days after surgery.


RESULTS

The study included 258 patients, 164 women and 94 men, with a mean age of 74 (SD 7.6) years. A statistically significant increase in CMT was observed from day 30 in patients with epiretinal membrane (p = 0.010) and diabetic patients (p = 0.026), reaching its maximum thickness at day 60 (p = 0.001 and p = 0.001), while it was observed only on day 360 in healthy subjects (p = 0.018) and those with high myopia (p = 0.003). The correlation between CMT and visual acuity was statistically significant only in the diabetic group (r = 0.61, p<0.01).


CONCLUSIONS

Following cataract surgery, CMT changes according to characteristic patterns in the different groups studied. These changes did not prevent an optimal recovery of visual function.

Efficacy and safety of indomethacin 0.1% eye drops compared with ketorolac 0.5% eye drops in the management of ocular inflammation after cataract surgery

PURPOSE

To determine whether indomethacin 0.1% eye drops are at least as effective as ketorolac 0.5% eye drops in treating ocular inflammation following cataract surgery.

METHODS

Prospective, multicenter, investigator-masked, parallel-group, randomized, active-controlled clinical trial. Cataract patients were randomized in a 1:1 ratio to receive indomethacin or ketorolac administered QID for 3 weeks beginning 1 day before surgery. The primary end-point was aqueous flare measured by laser flare meter at postoperative Days 1 and 7. Secondary end-points included retinal thickness, slit lamp and funduscopic examinations and postsurgical pain ratings. Safety and tolerability were also assessed.

RESULTS

A total of 86 patients were included in the per protocol population (n = 43 per treatment group). Indomethacin was found non-inferior to ketorolac for comparison of aqueous flare at postoperative Days 1 and 7 (Day 1: 95% CI: -2.37, 5.50; non-inferiority upper margin, 15 ph/ms and Day 7: 95% CI: -7.83, -0.94; non-inferiority upper margin, 8 ph/ms) and statistically better than ketorolac at Day 7 (p = 0.013). There were no significant between-group differences in aqueous flare and change from baseline in retinal thickness at postoperative Days 30 and 90. Indomethacin showed a higher subjective tolerance rating than ketorolac at postoperative Days 7 and 30 (p ≤ 0.044).

CONCLUSION

Indomethacin 0.1% was at least as effective as ketorolac 0.5% at Day 1 and more effective than ketorolac 0.5% at Day 7 in treating ocular inflammation after uncomplicated cataract surgery. Indomethacin was better tolerated than ketorolac. There were no clinically meaningful safety concerns with either treatment.

Effect of intracameral carbachol given during cataract surgery on macular thickness

To evaluate the effect of intracameral carbachol on foveal thickness in patients who underwent uneventful cataract surgery. This retrospective study included two groups: the study group patients (group 1, n = 47 eyes) had uneventful cataract surgery and received only carbachol 0.01 % for miosis; the control group patients (group 2, n = 49 eyes) had uneventful cataract surgery without carbachol or any intracameral medication(s). The groups were compared for foveal thickness after cataract surgery. All phacoemulsification plus intraocular lens implantation surgeries were performed under local anesthesia via temporal clear corneal tunnel incisions. Mean values and standard deviations were calculated for preoperative and postoperative visual acuity (VA) and foveal thickness (FT) at 1 and 4 weeks. Optical coherence tomography was used for the FT measurements, with the MM6 map program. The patients in the study and control groups had a mean age of 57.78 ± 9.07 and 59.72 ± 8.96, respectively (p = 0.355). All eyes had a significant improvement in VA. In the study group, the mean FT at the visits before and 1 and 4 weeks after surgery was 216.87 ± 21.06, 228.81 ± 30.52, and 222.94 ± 29.91 μm, respectively. For the control group, the mean FT, before and 1 and 4 weeks after surgery, was 222.53 ± 17.66, 231.67 ± 23.08, and 225.41 ± 22.59 μm, respectively. Intracameral carbachol 0.01 % had no effect on foveal thickness in patients who underwent uneventful cataract surgery.

Cataract surgery in developing countries

PURPOSE OF REVIEW

To review the previous year's literature related to cataract surgery in developing countries and to provide fast, up-to-date information to the scientific world.

RECENT FINDINGS

Cataract is the leading cause of blindness, especially in developing countries. The prevalence of cataract increases with the aging population. Although cataract surgery is the most cost-effective intervention, its delivery in developing countries has many issues and challenges. A paradigm shift has occurred in the surgical techniques used for delivering cataract services and the outcomes have been positive in some countries compared to the scenario a decade ago. However, in some parts of Africa, it still continues to be a challenge. Apart from this, the issues related to ongoing supply of consumables and human resources continue to be a challenge in these countries.

SUMMARY

Although manual small incision cataract surgery is the most cost-effective intervention, there are other issues related to the delivery of services in developing countries. We need to plan a comprehensive strategy to deliver the services in developing countries if we want to achieve our goal of VISION 2020.

Influence of Cataract Surgery on Macular Thickness — A 3-Month Follow-Up

This prospective follow-up study evaluated the longer term changes to macular thickness and volume following cataract surgery. The study included 23 patients (23 eyes) who underwent ambulatory cataract surgery with phacoemulsification and intraocular lens implantation, followed by a scheduled optical coherence tomography measurement of macular thickness and volume after 3 months. Results were compared with preoperative data and measurements taken at 1 month after surgery, which were recorded in a previous study. A comparison of preoperative macular thickness values with those at 3 months after surgery demonstrated that the latter values remained greater in all macular regions except the superior outer macula, and that the differences were significant in the fovea, nasal inner macula and inferior outer macula. When macular thickness at 3 months after surgery was compared with that measured at 1 month, decreases were observed in all perifoveal areas, suggesting the reversible nature of cataract surgery-related macular thickness changes.