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Kumar DA, Narang P, Holladay J, Sivagnanam S, Narang R, Agarwal A, Agarwal A. Optimum pinhole size determination in pinhole pupilloplasty for higher-order aberrations. J Cataract Refract Surg 2024; 50:264-269. [PMID: 37899510 PMCID: PMC10878447 DOI: 10.1097/j.jcrs.0000000000001353] [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: 01/18/2023] [Revised: 07/31/2023] [Accepted: 10/21/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE To determine optimal pinhole size (OPS) and establish a relationship with visual acuity (VA) and RMS (root mean square) values in cases with higher-order aberrations (HOAs) undergoing pinhole pupilloplasty (PPP). SETTING Private practice, India. DESIGN Prospective, interventional study. METHODS RMS value for 6-mm-diameter optical zone was determined by Scheimpflug imaging (Pentacam). Patients with RMS value >0.3 μm were included. Preoperatively, a hand-held pinhole gauge with varied apertures determined the OPS, and single-pass four-throw technique was used to perform pupilloplasty with Purkinje-1 reflex as a marker for centration. VA with OPS, correlation of RMS values with OPS and pupil size, and Strehl ratio were the main outcome measures. RESULTS 29 eyes with HOAs were analyzed; all patients chose 1.0 or 1.5 mm as OPS. The mean preoperative and postoperative pupil size was 3.25 ± 0.81 mm and 1.8 ± 0.54 mm ( P = .000), respectively. Postoperative mean pupil size when compared with OPS denoted that 14 eyes had a difference of <0.1 mm, 8 eyes ranged from 0.2 to 0.45 mm, and 7 eyes had ≥0.6 mm (range from 0.6 to 1.8 mm) difference from OPS. Eyes with higher RMS values needed smaller pupil gauge to achieve better VA. Preoperatively, vision with OPS correlated well with preoperative 6-mm RMS HOAs ( r = 0.728; P = .00). Postoperative UDVA correlated well with VA measured with OPS ( r = 0.847; P = .00). The preoperative and postoperative mean Strehl ratio was 0.109 ± 0.07 and 0.195 ± 0.11 ( P = .001), respectively. CONCLUSIONS Higher RMS values required a smaller pupil to achieve optimum VA. PPP can help achieve pinhole size in accordance with patient's optimum pinhole requirement.
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Affiliation(s)
- Dhivya Ashok Kumar
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Priya Narang
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Jack Holladay
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Soundari Sivagnanam
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Rhea Narang
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Ashvin Agarwal
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
| | - Amar Agarwal
- From the Dr. Agarwal's Eye Hospital & Research Centre, Chennai, India (Kumar, Sivagnanam, Ashvin Agarwal, Amar Agarwal); Narang Eye Care & Laser Centre, Ahmedabad, India (P. Narang, R. Narang); Department of Ophthalmology, Baylor college of Medicine, Houston, Texas (Holladay); Smt. NHL Medical College, Ahmedabad, India (R. Narang)
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Narang R, Agarwal A. Refractive cataract surgery. Curr Opin Ophthalmol 2024; 35:23-27. [PMID: 37962881 DOI: 10.1097/icu.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. RECENT FINDINGS With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism. SUMMARY Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
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Affiliation(s)
- Rhea Narang
- SMT. NHL Medical College, Ahmedabad, Gujarat
| | - Ashvin Agarwal
- Dr Agarwal's Eye Hospital & Research Centre, Chennai, Tamil Nadu, India
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Fram NR, Hovanesian JA, Narang P, Narang R, Moloney G, Lin DTC, Ferguson TJ, Thompson V, Schneider R, Yeu E, Trattler W, Zaldivar R. Radial keratotomy and cataract surgery: A quest for emmetropia. J Cataract Refract Surg 2023; 49:898-899. [PMID: 37482668 DOI: 10.1097/j.jcrs.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
A 75-year-old man with an ocular history of 8-cut radial keratotomy (RK) in both eyes presented for cataract surgery evaluation. He was previously correctable in spectacles in years prior despite his irregular corneas to 20/25 in the right eye and 20/30 in the left eye. He recently noticed a change in his overall visual function with significant nighttime glare and difficulty reading despite spectacle correction. Of note, he was unable to tolerate contact lenses and was resistant to refitting despite additional encouragement. Cataract surgery was delayed for many years, given he was correctable in spectacles and the concern of uncovering a highly aberrated cornea after removing his cataracts (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202308000-00021/figure1/v/2023-07-21T030437Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202308000-00021/figure2/v/2023-07-21T030437Z/r/image-tiff). Of note, the patient was interested in returning to the spectacle independence he enjoyed in the past. Ocular examination revealed a corrected distance visual acuity (CDVA) of 20/30 in the right eye and 20/60 in the left eye, with a manifest refraction of +4.50 -0.50 × 177 in the right eye and +5.75 -1.75 × 14 in the left eye. Glare testing was 20/50 in the right eye and 20/100 in the left eye, with retinal acuity meter testing of 20/25 in each eye. Pupils, confrontation visual fields, and intraocular pressures were normal. Pertinent slitlamp examination revealed corneal findings of 8-cut RK with nasal-gaping arcuate incisions in both eyes and lens findings of 2+ nuclear sclerosis with 2+ cortical changes in the right eye and 3+ nuclear sclerosis with 3+ cortical changes in the left eye. Cup-to-disc ratios of the optic nerves measured 0.5 with temporal sloping in the right eye and 0.6 with temporal sloping in the left eye. The dilated fundus examination was unremarkable. What intraocular lens (IOL) options would you offer this patient and how would you counsel regarding realistic expectations? What additional diagnostic testing would be helpful in your assessment? How would you calculate the IOLs?
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