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Han Y, Qi N. Numerical study of critical straight, frown, and chevron incisions in small incision cataract surgery. Front Bioeng Biotechnol 2023; 11:1283293. [PMID: 37929200 PMCID: PMC10623057 DOI: 10.3389/fbioe.2023.1283293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction: When an intraocular lens (IOL) injector is inserted through a pre-cut corneal incision (e.g., an empirical size of 2.2 mm) during small incision cataract surgery, uncontrollable tearing to the corneal tissue may occur, which is highly associated with the incision shape, size, and location. The goal of this numerical study was to investigate the optimal incision scheme amongst three typical shapes, i.e., straight, frown, and chevron incisions using mechanical modeling and finite element analysis. Methods: Assuming that the damage is caused by the tissue fracture at the incision tips and is governed by the classical energy release rate (ERR) theory which compares the current ERR value subject to IOL injection and the material's intrinsic parameter, critical ERR G c. Results: It was found that for chevron incisions, the incision shape with an angle of 170° was superior which induced minimal ERR value, while for frown incisions, the shape with a central angle of 6° was optimal. Both chevron and frown incisions could allow a larger size of injector to inject through than a straight pre-cut. In particular, the frown incision performed the best due to its lowest corresponding ERR and easy operation. Discussion: It was also observed that regions where the embedded fibrils are more dispersed and exhibit high isotropy were more favorable. If necessary, the chevron incision was recommended to be more aligned with the direction exhibiting a larger modulus, for example, along the circumferential direction near the limbus. This study provides useful knowledge in operation design and a deep insight into mechanical damage to corneal wounds in small incision cataract surgery.
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Affiliation(s)
- Yang Han
- Research Center for Mathematics and Interdisciplinary Sciences, Shandong University, Qingdao, Shandong, China
- Institute of Marine Science and Technology, Shandong University, Qingdao, China
| | - Nan Qi
- Research Center for Mathematics and Interdisciplinary Sciences, Shandong University, Qingdao, Shandong, China
- Frontiers Science Center for Nonlinear Expectations, Shandong University, Qingdao, Shandong, China
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Chen XY, Wu QR, Xie MY, Zhang D, Zhang C. Bibliometric analysis of research relating to refractive cataract surgery over a 20-year period: from 2003 to 2022. Int J Ophthalmol 2023; 16:1692-1701. [PMID: 37854386 PMCID: PMC10559026 DOI: 10.18240/ijo.2023.10.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/01/2023] [Indexed: 10/20/2023] Open
Abstract
AIM To investigate the research trend on refractive cataract surgery, compare the contributions of different countries, institutions, journals, and authors in the past 20y, and explore its potential research hotspots. METHODS All publications were extracted relating to refractive cataract surgery from 2003 to 2022 from Web of Science. Document types were limited to original articles and reviews, and the language was limited to English. Quantitatively and qualitatively of the publications were analyzed through Microsoft Excel and GraphPad Prism. VOSviewer and CiteSpace were used for bibliometric and visualized analysis. RESULTS A total of 2090 publications were enrolled. The United States contributed the most publications (434, 20.8%), followed by China (345, 16.5%) and England (163, 7.80%). Publications from the United States were cited more frequently (9552 citations) with the highest H-index of 48. China ranked second in the total number of publications, the papers were not cited that frequently (3237 citations), and the H-index ranked sixth (H-index=29). Journal of Cataract and Refractive Surgery published the most papers (333, 15.9%), and the University of London had the highest number of publications (75, 3.59%). Dick HB from Germany published the most papers. Corneal astigmatism-related research, cataract surgery method-related research, postoperative visual-quality relate to research, and postoperative complications-relate research are the hotspots in this field. The most significant limitation was that the database was updated frequently and the latest publications were not included. CONCLUSION The bibliometric analysis shows a brief summarization of the contribution of the authors, institutions, countries, and journals. Corneal astigmatism, cataract surgery method, postoperative visual-quality and postoperative complications related researches have become the emerging hotspots, which can give a direction in the future researches.
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Affiliation(s)
- Xiao-Yong Chen
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Qian-Ru Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing 100730, China
| | - Min-Yue Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing 100730, China
| | - Di Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Chun Zhang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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Borkenstein AF, Packard R, Dhubhghaill SN, Lockington D, Donnenfeld ED, Borkenstein EM. Clear corneal incision, an important step in modern cataract surgery: a review. Eye (Lond) 2023; 37:2864-2876. [PMID: 36788364 PMCID: PMC10516977 DOI: 10.1038/s41433-023-02440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria.
| | | | | | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria
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Gurnani B, Mishra D, Kaur K, Heda A, Sahu A. Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review. Indian J Ophthalmol 2022; 70:3773-3778. [PMID: 36308095 PMCID: PMC9907246 DOI: 10.4103/ijo.ijo_1567_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.
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Affiliation(s)
- Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Amritsar, Punjab, India
| | - Deepak Mishra
- Associate Professor, Department of Ophthalmology, Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India,Correspondence to: Dr. Deepak Mishra, Associate Professor, Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail:
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Strabismus Services, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Aarti Heda
- Consultant Glaucoma, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Amulya Sahu
- Department of Ophthalmology, Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
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González-Cruces T, Cano-Ortiz A, Villarrubia A, Sánchez-González MC, Sánchez-González JM. Comparison of wound architecture in implantable collamer lens surgery: Self-sealing single-plane opposite clear corneal incision versus main surgical incision. Eur J Ophthalmol 2022; 33:11206721221121439. [PMID: 36036354 DOI: 10.1177/11206721221121439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Incision architecture can play an important role in corneal astigmatism management through peripheral corneal relaxing incisions. The aim of this study was to compare the incision architecture of single-plane opposite clear corneal incisions (OCCIs) and main surgical incisions (MSIs) in patients undergoing implantable collamer lens (ICL) surgery. METHODS A retrospective cross-sectional tomographic analysis of MSI and OCCI architectures was performed 6 months after ICL surgery. Image acquisition was performed using spectral-domain anterior segment optical coherence tomography. RESULTS A total of 31 OCCIs and 24 MSIs were evaluated. The mean incision angle was 42.83 ± 5.69 degrees for MSIs and 48.26 ± 6.07 degrees for OCCIs (p < 0.01), and the mean MSI and OCCI length was 1146.70 ± 150.48 µm and 976.68 ± 140.19 µm, respectively (p < 0.01). The mean increase in epithelium depth in the wound was 37.63 ± 11.91 µm in the MSI group and 47.64 ± 15.45 µm in the OCCI group (p = 0.02). Endothelial misalignment was observed in both types of incisions. However, the misalignment with MSI was greater than with OCCI, 106.67 ± 31.84 µm versus 83.75 ± 23.39 µm (p = 0.01), respectively. CONCLUSION Both types of incisions, OCCI and MSI, were shown to be safe with complete wound sealing and healing 6 months postoperatively. The MSIs performed in the temporal position were more angled and longer, with greater endothelial retraction and minor epithelial thickening in the wound area compared with astigmatic incisions without manipulation.
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Affiliation(s)
- Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, 221798Hospital La Arruzafa, Cordoba, Spain
- Department of Physics of Condensed Matter, Optics Area, 16778University of Seville, Seville, Spain
| | - Antonio Cano-Ortiz
- Department of Anterior Segment, Cornea and Refractive Surgery, 221798Hospital La Arruzafa, Cordoba, Spain
| | - Alberto Villarrubia
- Department of Anterior Segment, Cornea and Refractive Surgery, 221798Hospital La Arruzafa, Cordoba, Spain
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González-Cruces T, Cano-Ortiz A, Sánchez-González MC, Sánchez-González JM. Cataract surgery astigmatism incisional management. Manual relaxing incision versus femtosecond laser-assisted arcuate keratotomy. A systematic review. Graefes Arch Clin Exp Ophthalmol 2022; 260:3437-3452. [PMID: 35713710 DOI: 10.1007/s00417-022-05728-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/16/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This systematic review aims to compare corneal astigmatism correction in cataract surgery through corneal relaxing incision, manually and femtosecond laser assisted. METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We used PubMed, Scopus, and Web of Science (WOS) as databases from January 2010 to March 30, 2021. Patients with keratoconus, corneal ectasia, and a previous history of eye surgery were excluded because our aim was to analyze only healthy eyes. RESULTS A total of 1025 eyes were evaluated from 946 patients (mean age was 68.90 ± 5.12) in manual incision group articles, while 1905 eyes of 1483 patients (mean age was 65.05 ± 4.57) were evaluated in femtosecond laser arcuate keratotomy (FLAK) articles. The mean uncorrected distance visual acuity (UDVA) was 0.19 ± 0.12 and 0.15 ± 0.05 logMAR for manual incision and FLAK articles, respectively (p = 0.39). The mean correction index (CI) was similar in both groups: 0.77 ± 0.18 in manual incision and 0.79 ± 0.17 in femtosecond laser assisted incision (p = 0.70). Refractive stability was found after 3 months and no serious complications were reported during the follow-up in any group. CONCLUSION Both techniques are safe and moderately effective in corneal astigmatism correction in cataract surgery. FLAK represents a more precise and predictable approach. However, since visual and refractive outcomes appear to be similar in both cases, the cost-benefit analysis is controversial.
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Affiliation(s)
- Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, Cordoba, Spain.,Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - Antonio Cano-Ortiz
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, Cordoba, Spain
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
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Qi N, Lockington D, Wang L, Ramaesh K, Luo X. Estimations of Critical Clear Corneal Incisions Required for Lens Insertion in Cataract Surgery: A Mathematical Aspect. Front Physiol 2022; 13:834214. [PMID: 35464073 PMCID: PMC9023857 DOI: 10.3389/fphys.2022.834214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
In a routine cataract operation cornea tissue may be damaged when an intra-ocular lens (IOL) injector of diameter between 1.467 and 2.011 mm is inserted through an empirically designed 2.2 mm corneal incision. We aimed to model and estimate the minimal length of the incision required to avoid wound tear. It was assumed that the damage was caused by tissue fracture at the tips of the incision, and this fracture could be studied using damage and fracture mechanics. The criterion of the damage was caused by a tear governed by the critical energy release rate (ERR) Gc, which is tissue dependent. Analytical and numerical studies were both conducted indicating the possibility of a safe and effective incision in cataract surgery. Six commonly used IOL injection systems were examined. Our results suggested that the recommended 2.2 mm incision cannot be treated as a universal threshold. Quicker IOL insertion may reduce wound damage. It was also recommended to advance IOL injector via its minor axis, and to cut the tear preferably along the circumferential direction due to tissue orthotropy. This study provides useful information and a deeper insight into the potential for mechanical damage to the corneal wound in cataract surgery.
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Affiliation(s)
- Nan Qi
- Institute of Marine Science and Technology, Shandong University, Qingdao, China
- *Correspondence: Nan Qi,
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Lei Wang
- Beijing National Center for Applied Mathematics, Academy for Multidisciplinary Studies, Capital Normal University Beijing, Beijing, China
| | - Kanna Ramaesh
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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A Randomized Study of the Impact of a Corneal Pre-Cut During Cataract Surgery on Wound Architecture and Corneal Astigmatism. Ophthalmol Ther 2021; 10:313-320. [PMID: 33709325 PMCID: PMC8079538 DOI: 10.1007/s40123-021-00339-0] [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: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The aim of the current study was to assess the effect of a 600-µm corneal pre-cut on wound architecture and its impact on surgically induced astigmatism. The images were acquired intraoperatively and postoperatively with high-resolution spectral-domain optical coherence tomography (SD-OCT). METHODS This study included patients scheduled for cataract surgery. Preoperatively, optical biometry and corneal topography were performed (IOL Master 500 and Atlas 9000, both Carl Zeiss Meditec AG, Germany). The first eye randomly received a 600-µm corneal pre-cut during cataract surgery, or a single-plane stab-incision and the second eye received the other incision technique. Incision architecture was assessed intraoperatively using a continuous intraoperative optical coherence tomography (iOCT) device (ReScan 700, Carl Zeiss Meditec AG, Germany) at three time points: after the incision, after irrigation/aspiration and after intraocular lens (IOL) implantation. Additionally, OCT (Spectralis, Heidelberg Engineering, Germany) measurements were performed 1 h, 1 week and 1 month postoperatively. RESULTS Forty eight eyes of 24 patients were analysed. The pre-cut group and the stab-incision group had a significant decrease in wound thickness from the 1-h to the 1-week measurement (p = 0.022 and p = 0.001). Corneal astigmatism showed a vector difference from preoperatively to the 1-week measurement of 0.48 D (SD, ± 0.27) in the stab incision group and 0.49 D (SD, ± 0.24) in the stab incision group. No significant differences were found between the groups. CONCLUSION To our knowledge, this was the first study which compared the wound alterations in pre-cut and stab-incision groups. TRIAL REGISTRATION NCT02155270.
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Müller-Kassner A, Arad T, Schmack I, Kohnen T. [Conjunctival pigmentation-Tumor or trauma?]. Ophthalmologe 2021; 118:1150-1152. [PMID: 33630148 PMCID: PMC8568869 DOI: 10.1007/s00347-021-01337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Annika Müller-Kassner
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Tschingis Arad
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Schmack
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Thomas Kohnen
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Sen P, Chandra K, Jain E, Sen A, Kumar A, Mohan A, Shah C. Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age. Indian J Ophthalmol 2021; 68:460-465. [PMID: 32057003 PMCID: PMC7043184 DOI: 10.4103/ijo.ijo_1138_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.
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Affiliation(s)
- Pradhnya Sen
- Children Eye Care Center, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Kriti Chandra
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Alok Sen
- Department of Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Amit Kumar
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Amit Mohan
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
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Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1609-1615. [PMID: 33502628 DOI: 10.1007/s00417-021-05071-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To show that an immediate vitrectomy with an intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections. METHODS We reviewed all cases of clinical endophthalmitis caused by an intravitreal injection that were treated in our department between March 2012 and November 2019. Only patients that underwent a vitrectomy within 6 h after presentation to the clinic and with a documented visual acuity shortly before the causative event were included. Baseline best-corrected visual acuity (BCVA) before the causative event was compared to BCVA measured within a follow-up period of 8 months (up to 14 months). RESULTS In total, 30 eyes of 30 patients were included. The BCVA before the intraocular infection was a mean value of 0.55 logMAR, and the BCVA on the day of the endophthalmitis decreased significantly to 1.66 logMAR. Within 2 months following the pars plana vitrectomy (PPV), the mean BCVA improved to 0.83 logMAR. Eight months following PPV (mean value, 8.20 months; SD, 3.59 months), the mean BCVA was 0.63 logMAR. In the last follow-up interval most of the eyes recovered, and the BCVA did not differ significantly from baseline. Two eyes underwent further pars plana surgery during the follow-up period. No enucleation was required. CONCLUSION In this study, we have shown that an immediate vitrectomy with subsequent intravitreal injection of antibiotics is an effective option for treating post-injection endophthalmitis and frequently results in recovery of vision; thus, it should be performed as early as possible, where available.
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Meyer BI, Berry DE, Cribbs BE, Hendrick A, Jain N, Hubbard GB, O'Keefe G, Patel PS, Shantha JG, Yan J, Yeh S, Rao P. Outcomes of Infectious Endophthalmitis in Patients with Systemic Antibiotic Allergies to Penicillins, Cephalosporins, or Vancomycin. Ophthalmol Retina 2020; 5:901-909. [PMID: 33271346 DOI: 10.1016/j.oret.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The mainstay empiric treatments of bacterial endophthalmitis are intravitreal vancomycin and ceftazidime. In the United States, up to 10% of the general population has a reported penicillin (PCN) allergy. Despite low cross-reactivity between PCN and later-generation cephalosporins, some providers alter the intravitreal antibiotic choice for endophthalmitis because of concern for allergic reactions. We evaluated the management strategies of infectious endophthalmitis in the setting of self-reported systemic antibiotic allergies and the association with adverse reactions after standard intravitreal antibiotic administration. DESIGN Single-center, retrospective cohort study. PARTICIPANTS All patients with endophthalmitis between 2005 and 2019 and documented PCN, PCN-analog, cephalosporin, or vancomycin allergy who received intravitreal antibiotics on the basis of International Classification of Diseases 9th and 10th Revisions, and Current Procedural Terminology codes. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Any allergic reaction after intravitreal injection, additional surgical interventions required for treatment, and visual function at last recorded visit. RESULTS Of the 65 patients included in this cohort, the most common causes of endophthalmitis were postcataract extraction surgery (n = 23, 35.4%) and postintravitreal injection (n = 11, 16.9%). All patients (65/65) received intravitreal vancomycin, and 81.5% (53/65) received intravitreal ceftazidime. Of the 53 patients who received intravitreal ceftazidime, 46 (86.8%) had allergies to PCNs alone, 5 (9.4%) had a cephalosporin allergy alone, and 2 (3.8%) had reported allergies to both PCN and cephalosporin antibiotics. Two patients (3.1%) with a documented vancomycin allergy received intravitreal vancomycin without complication. No patients exhibited any systemic or local allergic reactions or complications after intravitreal injection. CONCLUSIONS There were no documented allergic reactions in this cohort of patients with systemic antibiotic allergies who were treated for infectious endophthalmitis. Our findings are consistent with previous reports of a low allergic cross-reactivity between PCN and later-generation cephalosporins. Ophthalmologists should use evidence-based practices and a careful informed consent process when choosing intravitreal antibiotics for patients with specific antibiotic allergies. In the routine patient with suspected bacterial endophthalmitis, PCN allergy may not be an absolute contraindication to intravitreal cephalosporin use.
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Affiliation(s)
| | - Duncan E Berry
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Blaine E Cribbs
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Andrew Hendrick
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Nieraj Jain
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - G Baker Hubbard
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Ghazala O'Keefe
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Purnima S Patel
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | | | - Jiong Yan
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia
| | - Prethy Rao
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia.
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Kaur M, Bhai N, Titiyal JS. Risk factors for complications during phacoemulsification cataract surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1806715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Manpreet Kaur
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nithya Bhai
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S. Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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14
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Lu LJ, Chen X, Adelman RA. Clinical Etiologies, Microbial Spectrum, Antibiotic Susceptibilities, and Visual Acuity Outcomes of Acute Endophthalmitis. J Ocul Pharmacol Ther 2020; 36:534-539. [PMID: 32609038 DOI: 10.1089/jop.2018.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose of this study was to report the clinical etiologies, microbial spectrum, antibiotic resistance, and visual acuity (VA) outcomes associated with acute endophthalmitis. Methods: A retrospective chart review of patients with International Classification of Diseases (ICD)-9 and ICD-10 codes for endophthalmitis over a 6-year period (2011-2016) at a tertiary referral center was performed. The clinical records were reviewed to evaluate clinical etiologies, microbial spectrum, antibiotic susceptibilities and resistance, and visual outcomes. Results: Medical records of 94 patients treated for culture-proven endophthalmitis were reviewed. The etiologies of endophthalmitis were exogenous in 68.8% of cases and endogenous in 31.2% of cases. The most common inciting factors for exogenous endophthalmitis were progression of corneal ulcer and postoperative infection after cataract extraction. The microbial spectrum of causative organisms was dominated by coagulase-negative Staphylococcus (30.9%), followed by Staphylococcus aureus (23.4%). The most frequent fungal isolates were Candida species. Antibiotic susceptibilities of gram-positive bacteria ranged from 96.7% for vancomycin to 28.8% for penicillin G. Antibiotic susceptibilities of gram-negative bacteria were overall very high, with >90% susceptibility among isolated culture samples. Final VA outcomes of 20/400 or better were reported in 62.5% of patients. Conclusions: The study demonstrates that the most frequent clinical etiology of endophthalmitis was exogenous due to progression of corneal ulcer and postoperative infection after cataract extraction. The spectrum of pathogens causing endophthalmitis is composed of mainly Gram-positive organisms (particularly coagulase-negative Staphylococcus). VA was improved in the majority of patients after treatment for endophthalmitis.
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Affiliation(s)
- Louise J Lu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xuejing Chen
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA.,Retina Department, Ophthalmic Consultants of Boston, Boston, Massachusetts, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
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15
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Fayyaz A, Ranta VP, Toropainen E, Vellonen KS, Ricci GD, Reinisalo M, Heikkinen EM, Gardner I, Urtti A, Jamei M, Del Amo EM. Ocular Intracameral Pharmacokinetics for a Cocktail of Timolol, Betaxolol, and Atenolol in Rabbits. Mol Pharm 2020; 17:588-594. [PMID: 31794668 DOI: 10.1021/acs.molpharmaceut.9b01024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The mechanisms of drug clearance from the aqueous humor are poorly defined. In this study, a cocktail approach was used to simultaneously determine the pharmacokinetics of three β-blocker agents after intracameral (ic) injection into the rabbit eyes. Aqueous humor samples were collected and analyzed using LC-MS/MS to determine drug concentrations. Pharmacokinetic parameters were obtained using a compartmental fitting approach, and the estimated clearance, volume of distribution, and half-life values were the following: atenolol (6.44 μL/min, 687 μL, and 73.87 min), timolol (19.30 μL/min, 937 μL, and 33.64 min), and betaxolol (32.20 μL/min, 1421 μL, and 30.58 min). Increased compound lipophilicity (atenolol < timolol < betaxolol) resulted in higher clearance and volume of distributions in the aqueous humor. Clearance of timolol and betaxolol is about 10 times higher than the aqueous humor outflow, demonstrating the importance of other elimination routes (e.g., uptake to iris and ciliary body and subsequent elimination via blood flow).
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Affiliation(s)
- Anam Fayyaz
- Certara UK, Simcyp Division , Level 2-Acero, 1 Concourse Way , Sheffield S1 2BJ , U.K.,University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Veli-Pekka Ranta
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Elisa Toropainen
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Kati-Sisko Vellonen
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Giuseppe D'Amico Ricci
- University of Sassari , Department of Biomedical Sciences , Sassari , Italy.,Asl Città di Torino, Ospedale Oftalmico di Torino , U.O.C Oculistica 2, Ospedale San Giovanni Bosco di Torino , Torino , Italy
| | - Mika Reinisalo
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland.,Institute of Clinical Medicine, Department of Ophthalmology, Faculty of Health Sciences , University of Eastern Finland , 70210 Kuopio , Finland
| | - Emma M Heikkinen
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Iain Gardner
- Certara UK, Simcyp Division , Level 2-Acero, 1 Concourse Way , Sheffield S1 2BJ , U.K
| | - Arto Urtti
- University of Eastern Finland , School of Pharmacy, Biopharmaceutics , Yliopistonranta 1 , 70210 Kuopio , Finland
| | - Masoud Jamei
- Certara UK, Simcyp Division , Level 2-Acero, 1 Concourse Way , Sheffield S1 2BJ , U.K
| | - Eva M Del Amo
- University of Manchester , Division of Pharmacy & Optometry , Oxford Road , Manchester M13 9PL , U.K
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Kim SH, Yu MH, Lee JH, Kim SW, Rah SH. Endophthalmitis after Cataract Surgery in Korea: A Nationwide Study Evaluating Incidence and Risk Factors in a Korean Population. Yonsei Med J 2019; 60:467-473. [PMID: 31016909 PMCID: PMC6479122 DOI: 10.3349/ymj.2019.60.5.467] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/01/2019] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25-1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13-3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71-11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03-2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18-1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31-1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01-1.62; p=0.039) were found to be related to APE development. CONCLUSION The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.
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Affiliation(s)
- Soo Han Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Heui Yu
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joung Hyuck Lee
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Hoon Rah
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Pederson SL, Cleymaet AM, Hess AM, Wotman KL, Freeman KS. Surgically induced astigmatism in canines following sutured dorsonasal vs dorsotemporal clear corneal incisions. Vet Ophthalmol 2019; 22:799-806. [PMID: 30884062 DOI: 10.1111/vop.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate use of the Pentacam® HR for evaluation of surgically induced corneal astigmatism (SIA) in canines undergoing bilateral phacoemulsification and determine differences between dorsonasal and dorsotemporal clear corneal incisions. ANIMALS Client-owned canines undergoing bilateral phacoemulsification. PROCEDURES Patients received anterior segment imaging pre-operatively, immediately post-operatively, and 2-4 months post-operatively (follow-up). Total corneal refractive power was used to determine SIA. Surgically induced astigmatism was compared between right and left eyes, representing dorsotemporal and dorsonasal incisions, respectively. Repeated measures analyses were used between time points and paired t test compared SIA between eyes. RESULTS Complete imaging series were obtained for seven patients. Follow-up imaging occurred at a median of 112 days (range 60-132 days) post-operatively. For repeated measures analyses, significant differences were found between pre- and immediate post-operative values (P < 0.01), and between immediate post-operative and follow-up values (P < 0.01). There was no significant difference between pre-operative and follow-up values. Surgically induced astigmatism was significantly different between right and left eyes, with values of 2.01 ± 1.24 D and 3.05 ± 1.58 D at 3 mm radius (P < 0.05), and 2.04 ± 1.18 D and 3.06 ± 1.27 D at 4 mm radius (P < 0.05) for dorsotemporal and dorsonasal incisions, respectively. CONCLUSIONS Preliminary investigation revealed improvement of corneal SIA 2-4 months post-operatively, but development of significantly more SIA in dorsonasal vs dorsotemporal incisions. This prompts consideration of patient or microscope rotation to create a more dorsotemporal incision when possible.
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Affiliation(s)
- Samantha L Pederson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Allison M Cleymaet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Ann M Hess
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, Colorado
| | - Kathryn L Wotman
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kate S Freeman
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Yoo JH, Lee SJ. The effect of suture by absorbable material on corneal astigmatism after phacoemulsification. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives To investigate the effect of absorbable suture on surgically-induced corneal astigmatism in 3.0-mm sclera tunnel cataract surgeries. Methods Medical records of patients who underwent phacoemulsification cataract surgery using a 3.0-mm sclera tunnel incision made by a single surgeon were reviewed. Uncorrected distant visual acuity, corneal astigmatism and surgically-induced astigmatism were measured in 56 patients' eyes that underwent sclera tunnel cataract surgery with absorbable sutures (sutured group) and in 23 patients' eyes without sutures (unsutured group). Uncorrected visual acuity, intraocular pressure, slit lamp examination, and automated keratometry were evaluated preoperatively and at 3 days, 2 weeks, 4 weeks, and 8 weeks after cataract operation. Results There were no significant differences in preoperative average uncorrected distant visual acuity of the two groups (sutured group: 0.79 ± 0.64, unsutured group: 0.68 ± 0.72, P = 0.145). Corneal astigmatism measured using keratometry in the sutured and unsutured group at postoperative day 3 were 2.27 ± 2.12 D versus 0.83 ± 0.55 D at ( P < 0.001), a difference which had disappeared after 4 weeks. Surgically induced astigmatism using the Holladay and Vector methods showed similar outcomes, suggesting that the sutured group exhibited higher astigmatism compared with the unsutured group until 2 weeks post-surgery. Conclusions TPatients undergoing scleral tunnel cataract surgery with absorbable sutures have greater surgically induced astigmatism, especially in the early postoperative period, compared with those without sutures. However, this surgically induced astigmatism due to absorbable sutures in scleral tunnel cataract surgery is temporary and disappears at 4 weeks post-surgery.
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George NK, Stewart MW. The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence? Ophthalmol Ther 2018; 7:233-245. [PMID: 29974362 PMCID: PMC6258587 DOI: 10.1007/s40123-018-0138-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 02/06/2023] Open
Abstract
Post-operative endophthalmitis (POE) following cataract surgery is an uncommon, vision-threatening complication that has been reported to occur at rates of between approximately 0.03% and 0.2%. Prompt diagnosis and treatment of endophthalmitis is critical for minimizing vision loss, but most recent efforts have focused on the prophylactic administration of antibiotics to prevent the development of endophthalmitis. Surgeons from around the world have different topical and intracameral antibiotic usage patterns to prevent endophthalmitis, and to date no general consensus regarding best practice has emerged. Several studies have reported on the routine use of intracameral cefuroxime, moxifloxacin, and vancomycin, including a single randomized clinical trial by the European Society of Cataract and Refractive Surgery (ESCRS) in 2007. These studies have notable shortcomings, but many authors suggest that intracameral cefuroxime together with topical antibiotics probably decreases the risk of endophthalmitis. However, the deleterious effects of routine prophylactic antibiotics, which include toxicity, cost, and increasing antimicrobial resistance, among others, are noteworthy. In contrast, aseptic technique with pre-operative instillation of povidone-iodine remains the only technique supported by level I evidence to reduce the incidence of endophthalmitis. Although the routine use of intracameral antibiotics continues to increase throughout the world, data from multicenter, randomized, prospective trials is needed to provide better guidance regarding the prophylactic use of antibiotics.
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20
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Uy HS, Shah S, Packer M. Comparison of Wound Sealability Between Femtosecond Laser-Constructed and Manual Clear Corneal Incisions in Patients Undergoing Cataract Surgery: A Pilot Study. J Refract Surg 2018; 33:744-748. [PMID: 29117413 DOI: 10.3928/1081597x-20170921-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 08/25/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the sealability of femtosecond laser-constructed and manual clear corneal incisions (CCIs) in patients undergoing cataract surgery. METHODS This prospective, randomized study included 62 eyes of 62 patients with cataract grade 1 to 2 (LOCS scale). The patients were randomly assigned (1:1) for creation of either manual CCI (with a 2.4-mm keratome) or femtosecond laser-assisted CCI (LENSAR, Inc., Orlando, FL) (31 eyes in each group) before undergoing femtosecond laser-assisted cataract surgery. Wound sealability was assessed as grade 1, 2, or 3 (1: need to reform anterior chamber and hydrate wound at end of surgery; 2: need to reform anterior chamber only; 3: formed anterior chamber, no hydration or anterior chamber reformation necessary). RESULTS The nuclear sclerosis grade, cumulative dissipated energy and phacoemulsification time were comparable between the two groups. No complications were experienced in any of the patients. The mean wound sealability for the femtosecond laser group (2.35 ± 0.84) was statistically significantly better in comparison to the manual group (1.32 ± 0.65) (P < .001). At the end of the surgery, 22.6% (n = 7) of eyes in the femtosecond laser group needed reformation of the anterior chamber and hydration of the wound compared to 77.4% (n = 24) of eyes in the manual group. Conversely, 58.1% (n = 18) of eyes in the femtosecond laser group compared to 9.7% (n = 3) of eyes in the manual group were observed to have a formed anterior chamber. CONCLUSIONS Femtosecond laser-created CCIs had significantly better wound sealability compared to those created with a metal keratome. [J Refract Surg. 2017;33(11):744-748.].
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Dhoble P, Khodifad A. Combined Cataract Extraction With Pars Plana Vitrectomy and Metallic Intraocular Foreign Body Removal Through Sclerocorneal Tunnel Using a Novel "Magnet Handshake" Technique. Asia Pac J Ophthalmol (Phila) 2018; 7:114-118. [PMID: 28868832 DOI: 10.22608/apo.2017207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To study the outcomes of combined cataract extraction with pars plana vitrectomy (PPV) and metallic intraocular foreign body (IOFB) removal through a sclerocorneal tunnel using the "magnetic handshake" technique. DESIGN A retrospective review. METHODS Retrospective review of case records of 14 patients from 2010 to 2016 with metallic IOFB and traumatic cataract was performed. Cataract extraction was combined with PPV. Two intraocular magnets (IOMs) introduced through 20-gauge vitrectomy port and sclerocorneal tunnel helped achieve safe delivery of IOFB outside the globe by the "magnetic handshake" technique. RESULTS All patients were males with a mean age of 33.04 years. A final best corrected visual acuity (BCVA) of 20/60 or better was noted in 10 (71.42%) of 14 patients. Final reattachment with more than 1 surgery was achieved in 13 (92.85%) patients. Postoperative complications included retinal detachment (RD) and phthisis bulbi in 1 (14.28%) patient each. CONCLUSIONS Combined cataract extraction with PPV and metallic IOFB removal through sclerocorneal tunnel using the "magnet handshake" technique gives good visual and surgical outcomes.
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Affiliation(s)
- Pankaja Dhoble
- Retina Services, Aravind Eye Hospital, Pondicherry, India
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22
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Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Prediction of surgically induced astigmatism in manual and femtosecond laser-assisted clear corneal incisions. Eur J Ophthalmol 2018; 28:398-405. [DOI: 10.1177/1120672117747017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess the surgically induced astigmatism with femtosecond laser-assisted and manual temporal clear corneal incisions and to evaluate the performance of a model for prediction of the surgically induced astigmatism based on the preoperative corneal astigmatism. Methods: Clinical data of 104 right eyes and 104 left eyes undergoing cataract surgery, 52 with manual incisions and 52 with femtosecond laser-assisted incisions in each eye group, were extracted and revised retrospectively. In all cases, manual incisions were 2.2 mm width and femtosecond incisions were 2.5 mm width, both at temporal location. A predictive model of the surgically induced astigmatism was obtained by means of simple linear regression analyses. Results: Mean surgically induced astigmatisms for right eyes were 0.14D@65° (manual) and 0.24D@92° (femtosecond) (p > 0.05) and for left eyes, 0.15D@101° (manual) and 0.19D@104° (femtosecond) (p > 0.05). The orthogonal components of the surgically induced astigmatism (XSIA, YSIA) were significantly correlated (p < 0.05) with the preoperative orthogonal components of corneal astigmatism (Xpreop, Ypreop) (r = −0.29 for X and r = −0.1 for Y). The preoperative astigmatism explained 8% of the variability of the XSIA and 3% of the variability of YSIA. The postoperative corneal astigmatism prediction was not improved by the surgically induced astigmatism obtained from the model in comparison with the simple vector subtraction of the mean surgically induced astigmatism. Conclusion: Temporal incisions induce similar astigmatism either for manual or for femtosecond procedures. This can be clinically negligible for being considered for toric intraocular lens calculation due to the great standard deviation in comparison with the mean. The usefulness of the prediction model should be confirmed in patients with high preoperative corneal astigmatism.
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Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
- Department of Ophthalmology, Torrecárdenas Hospital Complex, Almería, Spain
| | | | - Javier Martínez
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
| | - Ana Tauste
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Department of Ophthalmology (OFTALMAR), Vithas Medimar International Hospital, Alicante, Spain
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Nikose AS, Saha D, Laddha PM, Patil M. Surgically induced astigmatism after phacoemulsification by temporal clear corneal and superior clear corneal approach: a comparison. Clin Ophthalmol 2018; 12:65-70. [PMID: 29379266 PMCID: PMC5757199 DOI: 10.2147/opth.s149709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Cataract surgery has undergone various advances since it was evolved from ancient couching to the modern phacoemulsification cataract surgery. Surgically induced astigmatism (SIA) remains one of the most common complications. The introduction of sutureless clear corneal incision has gained increasing popularity worldwide because it offers several advantages over the traditional sutured limbal incision and scleral tunnel. A clear corneal incision has the benefit of being bloodless and having an easy approach, but SIA is still a concern. PURPOSE In this study, we evaluated the SIA in clear corneal incisions with temporal approach and superior approach phacoemulsification. Comparisons between the two incisions were done using keratometric readings of preoperative and postoperative refractive status. METHODOLOGY It was a hospital-based prospective interventional comparative randomized control trial of 261 patients conducted in a rural-based tertiary care center from September 2012 to August 2014. The visual acuity and detailed anterior segment and posterior segment examinations were done and the cataract was graded according to Lens Opacification Classification System II. Patients were divided for phacoemulsification into two groups, group A and group B, who underwent temporal and superior clear corneal approach, respectively. The patients were followed up on day 1, 7, 30, and 90 postoperatively. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. The mean difference of SIA between 30th and 90th day was statistically evaluated using paired t-test, and all the analyses were performed using SPSS 18.0 (SPSS Inc.) software. RESULTS The mean postoperative SIA in group A was 0.998 D on the 30th day, which reduced to 0.768 D after 90 days, and in group B the SIA after 30 days was 1.651 D, whereas it reduced to 1.293 D after 90 days. CONCLUSION Temporal clear corneal incision is evidently better than superior clear corneal incision as far as SIA is concerned.
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Affiliation(s)
- Archana Sunil Nikose
- Department of Ophthalmology, N.K.P. Salve Institute and LMH, Nagpur, Maharashtra, India
| | - Dhrubojyoti Saha
- Department of Ophthalmology, N.K.P. Salve Institute and LMH, Nagpur, Maharashtra, India
| | - Pradnya Mukesh Laddha
- Department of Ophthalmology, N.K.P. Salve Institute and LMH, Nagpur, Maharashtra, India
| | - Mayuri Patil
- Department of Ophthalmology, N.K.P. Salve Institute and LMH, Nagpur, Maharashtra, India
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Cavallini GM, Verdina T, De Maria M, Fornasari E, Torlai G, Volante V, Donati S, Cagini C. Bimanual microincision cataract surgery with implantation of the new Incise ® MJ14 intraocular lens through a 1.4 mm incision. Int J Ophthalmol 2017; 10:1710-1715. [PMID: 29181315 DOI: 10.18240/ijo.2017.11.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the visual outcomes and the posterior capsule opacification (PCO) with the new Incise® MJ14 intraocular lens (IOL) implanted through a 1.4 mm clear corneal incision (CCI) in patients who underwent bimanual microincision cataract surgery (B-MICS). METHODS Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study: 40 eyes were implanted with an Incise® MJ14 IOL through a 1.4 mm CCI (group A) without enlargement of the main CCI, while 40 eyes were implanted with an Akreos® MI60 IOL with enlargement of the main CCI to 1.8 mm (group B). Best corrected visual acuity (BCVA), astigmatism and endothelial cell loss were evaluated before and after surgery at 7, 30d and 6mo. Anterior segment-optical coherence tomography (AS-OCT) of CCI was performed at 1, 3, 7, 30d, 6 and 18mo. PCO incidence was evaluated at 18mo using EPCO 2000 Software. RESULTS Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups; no statistically significant difference in surgically induced astigmatism (SIA) was noticed in the two groups. At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet's membrane at 1 and 7d after surgery; no statistically significant alterations were found at 1, 6 and 18mo. PCO score at 18mo was 0.03±0.07 for group A and 0.08±0.18 for group B (P=0.11) with no sign of central optic plate invasion in both groups. CONCLUSION The implant of the new Incise® MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery. PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.
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Affiliation(s)
| | - Tommaso Verdina
- Institute of Ophthalmology, University of Modena, Modena 41100, Italy
| | - Michele De Maria
- Institute of Ophthalmology, University of Modena, Modena 41100, Italy
| | - Elisa Fornasari
- Institute of Ophthalmology, University of Modena, Modena 41100, Italy
| | - Giulio Torlai
- Institute of Ophthalmology, University of Modena, Modena 41100, Italy
| | - Veronica Volante
- Institute of Ophthalmology, University of Modena, Modena 41100, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, University of Insubria, Varese-Como 21100, Italy
| | - Carlo Cagini
- Department of Surgical and Biomedical Sciences, University of Perugia, S. Maria della Misericordia Hospital, Perugia 06123, Italy
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Pujari A, Swamy DR, Selvan H, Chawla R. Limbal cyst following blunt trauma in an operated case of congenital cataract: a rare scenario. BMJ Case Rep 2017; 2017:bcr-2017-221210. [PMID: 28775091 DOI: 10.1136/bcr-2017-221210] [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: 11/04/2022] Open
Abstract
A 15-year-old male patient with the history of bilateral operated congenital cataract surgery 5 years back now presents with gradual painless diminution of visual acuity in left eye following a blunt trauma with a fist. Ocular examination showed a well-defined slightly bluish-tinged limbal-based conjunctival cyst without any irregularities in the anterior chamber/pupil. Intraocular pressures were 16 mm Hg in the right eye and 10 mm Hg in the left eye; retinal examination showed findings consistent with hypotonic maculopathy. Anterior segment ultrasound biomicroscopy revealed a well-defined limbal cyst with anterior chamber communication. Under local anaesthesia, the cyst was completely excised with the reconstruction of the sclerocorneal defect. At the end of 6 months, the patient is symptom-free with pretraumatic visual acuity.
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Affiliation(s)
- Amar Pujari
- Department of Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, New Delhi, India
| | - Deepa R Swamy
- Department of Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, New Delhi, India
| | - Harathy Selvan
- Department of Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, New Delhi, India
| | - Rohan Chawla
- Department of Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, New Delhi, India
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Sivley MD, Wallace EL, Warnock DG, Benjamin WJ. Conjunctival lymphangiectasia associated with classic Fabry disease. Br J Ophthalmol 2017; 102:54-58. [DOI: 10.1136/bjophthalmol-2016-310088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/16/2017] [Accepted: 03/25/2017] [Indexed: 11/03/2022]
Abstract
BackgroundFabry disease (FD) is a treatable multisystem disease caused by a defect in the alpha-galactosidase gene. Ocular signs of FD, including corneal verticillata, are among the earliest diagnostic findings. Conjunctival lymphangiectasia (CL) has not previously been associated with FD.MethodsWe examined the eyes of a cohort of 13 adult patients, eight men and five women, with documented classic FD, all treated with enzyme replacement therapy (ERT) at the University of Alabama at Birmingham between February 2014 and April 2015. The average age was 48 years with a range of 35–55 years for men and 21–71 years for women. The mean duration of ERT was 8.4 years (men 8.9 years, women 7.6 years) with a range of 4–14 years. Classical Fabry mutations included Q283X, R227X, W236X and W277X. A high resolution Haag-Streit BQ-900 slit lamp with EyeCap imaging system was used to record conjunctival images.ResultsCL was observed in 11 of the 13 patients (85%) despite long-term ERT. Clinical presentations included single cysts, beaded dilatations and areas of conjunctival oedema. Lesions were located within 6 mm of the corneal limbus. Ten of the 13 subjects (77%) had Fabry-related cataracts and all 13 demonstrated bilateral corneal verticillata. Twelve of the 13 patients had evidence of dry eye, 9 of whom were symptomatic, and 10 had peripheral lymphoedema.ConclusionCL represents a common but under-recognised ocular manifestation of FD, which persists despite ERT, and is often accompanied by peripheral lymphoedema and dry eye syndrome.
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Nejat F, Sarahati S, Nobari SM, Jadidi K, Naderi M, Nejat MA. Preliminary Results of Femtosecond Laser-assisted Cataract Surgery in a Private Clinic in Iran. J Ophthalmic Vis Res 2017; 12:39-43. [PMID: 28299005 PMCID: PMC5340062 DOI: 10.4103/jovr.jovr_70_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To report the preliminary results of femtosecond laser-assisted cataract surgery in Iranian patients. Methods: This prospective case series included 21 eyes of 21 patients with cataract. Mean patient age was 66.7 ± 10 years. The patients underwent femtosecond-laser assisted cataract surgery (VICTUS Femtosecond Laser Platform: Bausch + Lomb) and intraocular lens (IOL) implementation in Bina Eye Hospital, Tehran, Iran between May and October, 2014. Visual outcomes, intraocular pressure (IOP), and complications were evaluated three months after surgery. Results: Mean preoperative best-spectacle corrected visual acuity (BSCVA) was 0.40 ± 0.21 logMAR which significantly improved to 0.02 ± 0.03 logMAR three months postoperatively (P < 0.001). Mean preoperative IOP was 17.88 ± 2.70 mmHg which significantly decreased to 12.5 ± 1.51 mmHg three months after operation (P < 0.001). Mean duration of operation for these patients was 29.30 ± 8 minutes and mean femtosecond laser process time was 4.20 ± 2 minutes. In terms of complications, 9 patients developed fine subconjunctival hemorrhage and eye redness and 2 patients had mild corneal edema which all subsided within less than 7 days. Serious complications such as anterior or posterior capsule tears were not encountered. Conclusion: Femtosecond laser-assisted cataract surgery is a relatively new method of cataract
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Affiliation(s)
- Farhad Nejat
- Vision Health Research Center, Bina Eye Hospital, Tehran, Iran
| | - Sara Sarahati
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sahar Mojaled Nobari
- Department of Optic II (Optometry and Vision), Complutense University, Madrid, Spain
| | - Khosrow Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Naderi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Nejat
- Department of Bioelectronics Engineering, Islamic Azad University, Science and Research Branch, Tehran, Iran
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The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology. Sci Rep 2017; 7:40776. [PMID: 28094301 PMCID: PMC5240098 DOI: 10.1038/srep40776] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022] Open
Abstract
Endophthalmitis can be a devastating complication after cataract surgery. Therefore, this study sought to better understand the occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small and medium-scale departments of ophthalmology, as well as identify its risk factors and assess the treatment options. This investigation revealed 52 postoperative endophthalmitis cases in 46,185 operations at 30 hospitals from 2011 to 2013, at an occurrence rate of 0.11%. A small cataract surgery volume of less than 500 cases per year (OR 2.21; p = 0.006), the absence of 0.5% povidone iodine (PVP-I) irrigation (OR 1.73; p = 0.046), and intraoperative posterior capsular rupture (PCR) with vitreous loss (OR 4.40; p = 0.034) showed statistically significant associations with endophthalmitis in the multivariate analysis. The rate of culture positivity was 44.2%, with Staphylococcus epidermidis being the most common organism isolated in China. More than 40% of the endophthalmitis cases were treated with a nonstandard antibiotics regimen, and only 32.7% of these had a visual acuity of better than 20/40. We concluded that the occurrence rate of acute-onset endophthalmitis following cataract surgery in Chinese small and medium-scale departments of ophthalmology lags behind the level of developed countries, as well as Chinese top eye centers. Overall, the use of 0.5% PVP-I irrigation seemed to be an effective measure to reduce the risk of the development of postoperative endophthalmitis.
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Mah FS. Effect on Gel Formation Time of Adding Topical Ophthalmic Medications to ReSure Sealant, an In Situ Hydrogel. J Ocul Pharmacol Ther 2016; 32:396-9. [DOI: 10.1089/jop.2015.0112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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