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Indian Journal of Ophthalmology Apr 2024This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative... (Review)
Review
This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.
Topics: Humans; Keratoconus; Lens Implantation, Intraocular; Visual Acuity; Lenses, Intraocular; Cataract; Astigmatism; Refraction, Ocular
PubMed: 38389251
DOI: 10.4103/IJO.IJO_1241_23 -
JAMA Ophthalmology Sep 2023
Topics: Child; Humans; Cataract Extraction; Lens, Crystalline; Glaucoma; Ophthalmology; Cataract
PubMed: 37590009
DOI: 10.1001/jamaophthalmol.2023.3804 -
Archivos de La Sociedad Espanola de... Dec 2023Nanophthalmos is a rare congenital condition of the eyeball that is characterised by a smaller size of the anterior and posterior segments without associated ocular... (Review)
Review
Nanophthalmos is a rare congenital condition of the eyeball that is characterised by a smaller size of the anterior and posterior segments without associated ocular malformations. Typical features that have traditionally been described in these eyes are short axial length, thickened sclera, cornea with a smaller diameter, narrow anterior chamber, and an increased lens to globe volume ratio. However, at present, there is still a lack of recognised diagnostic criteria for nanophthalmos and a classification of its severity. Its clinical relevance stems from the increased risk of multiple ocular conditions, such as high hyperopia, amblyopia, angle-closure glaucoma, retinal detachment, and cataracts. Likewise, in relation to surgery in these eyes, there are particularities in cataract and glaucoma surgery and with a greater risk of associated intra- and postoperative complications. In this way, the treatment of nanophthalmos focuses on controlling the associated eye conditions and reducing and controlling surgical complications. This review aims to update what has been published in recent years regarding nanophthalmos.
Topics: Humans; Microphthalmos; Glaucoma, Angle-Closure; Lens, Crystalline; Hyperopia; Vision, Ocular; Cataract
PubMed: 37813187
DOI: 10.1016/j.oftale.2023.10.003 -
Indian Journal of Ophthalmology Jul 2023Cataract surgery requires a well-dilated and stable pupil for a good outcome. Unexpected pupillary constriction during surgery increases the risk of complication. This... (Review)
Review
Cataract surgery requires a well-dilated and stable pupil for a good outcome. Unexpected pupillary constriction during surgery increases the risk of complication. This problem is more pronounced in children. There are now pharmacological interventions that help tackle this unforeseen happening. Our review discusses the simple and quick options available to a cataract surgeon when faced with this dilemma. As cataract surgical techniques continue to improvise and get faster, an adequate pupil size is of paramount importance. Various topical and intra-cameral drugs are used in combination to achieve mydriasis. Despite good pre-operative dilation, the pupil can be quite unpredictable during surgery. Intra-operative miosis limits the field of surgery and increases the risk of complications. For example, if the pupil size decreases from 7 mm to 6 mm, this 1 mm change in pupil diameter will lead to a decrease of 10.2 mm in the area of surgical field. Making a good capsulorhexis with a small pupil can be a challenge, even for an experienced surgeon. Repeated touching of the iris increases the risk of fibrinous complications. Removal of cataract and the cortical matter becomes increasingly difficult. Intra-ocular lens implantation in the bag also requires adequate dilation. When dealing with challenging cases like lens subluxation, pseudo-exfoliation, and zonular dehiscence, a small pupil further increases the risk and adversely affects the surgical outcome. Hence, achieving and maintaining adequate mydriasis throughout surgery is essential. This review highlights the risk factors for small pupils during surgery and current management strategies.
Topics: Child; Humans; Mydriasis; Cataract Extraction; Miosis; Pupil; Cataract; Phacoemulsification
PubMed: 37417103
DOI: 10.4103/IJO.IJO_3384_22 -
Journal of the College of Physicians... Jan 2024To measure preoperative corneal astigmatism in cataract patients.
OBJECTIVE
To measure preoperative corneal astigmatism in cataract patients.
STUDY DESIGN
Descriptive study. Place and Duration of the Study: Mughal Eye Hospital, Lahore, from 2018 to 2022.
METHODOLOGY
The amount of preoperative corneal astigmatism was noted in cataract patients. Inclusion criteria included cataract patients above 16 years of age. Exclusion criteria included any preexisting corneal pathology (including corneal scar, corneal oedema, pterygium, etc.) and any previous ocular surgery, e.g. trabeculectomy, pterygium excision. SPSS version 25 was used for recording the data.
RESULTS
Descriptive statistics were determined for demographic data and keratometry variables. Range of corneal astigmatism was zero to 5.75 dioptre with a mean of 1.05 dioptre (D) and standard deviation of 0.83. Corneal astigmatism of one or less than one diopter was recorded in 468 eyes (66.7%). Corneal astigmatism of 1.1 to 2 D was noted in 166 eyes (23.6%). Forty-nine eyes (7%) had corneal astigmatism of 2.1 to 3.0 D. Corneal astigmatism of 3.1 to 4.0 D, 4.1 to 5.0 D and 5.1 to 6 D was encountered in 11 (1.6%), 5 (0.7%) and 3 (0.4%) eyes respectively.
CONCLUSION
A marked proportion of patients undergoing cataract operation have corneal astigmatism, so the phacoemulsification surgeon should consider difference of keratometry findings preoperatively.
KEY WORDS
Corneal curvature, Corneal astigmatism, Phacoemulsification, Incision, Keratometry.
Topics: Humans; Astigmatism; Pterygium; Cataract; Cornea; Corneal Edema
PubMed: 38185969
DOI: 10.29271/jcpsp.2024.01.97 -
Behavioural Brain Research Jul 2023Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between cataract and the incidence of cognitive impairment in older adults.
METHODS
A comprehensive search of electronic databases from inception to January 2023 was performed to identify relevant studies. Data were extracted from eligible studies and a meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (CI).
RESULTS
We included 13 studies with 25 study arms involving a total of 798,694 participants. Compared with participants without cataract, those with cataract had a higher risk of developing all-cause dementia (pooled HR: 1.22; 95 % CI: 1.08-1.38; I =86 %; 9 studies), Alzheimer's disease dementia (pooled HR: 1.18; 95 % CI: 1.07-1.30; I =0 %; 9 studies), vascular dementia (pooled HR: 1.21; 95 % CI: 1.02-1.43; I =77 %;3 studies) and mild cognitive impairment (pooled HR: 1.30; 95% CI: 1.13-1.50; I =0%;2 studies). There was no significant association between cataract and mixed dementia (pooled HR: 1.03; 95 % CI: 0.52-2.04; I =78 %;2 studies). We assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale and found that most of them had a low or moderate risk of bias. The number of studies in each meta-analysis ranged from two to nine, with more studies available for all-cause dementia and Alzheimer's disease dementia than for vascular dementia and mixed dementia.
CONCLUSIONS
The findings suggest that cataract may be associated with cognitive impairment in older adults. However, the causal relationship between cataract and cognition remains unclear and requires further investigation.
Topics: Humans; Aged; Alzheimer Disease; Dementia, Vascular; Incidence; Cognitive Dysfunction; Cataract
PubMed: 37148915
DOI: 10.1016/j.bbr.2023.114455 -
Journal of Cataract and Refractive... Nov 2023The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS)... (Meta-Analysis)
Meta-Analysis
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
Topics: Humans; Phacoemulsification; Cataract Extraction; Cataract; Visual Acuity; Ophthalmology
PubMed: 37276258
DOI: 10.1097/j.jcrs.0000000000001230 -
Aging Clinical and Experimental Research Aug 2023Age-related eye diseases and cognitive frailty (CF) are both important predictors of adverse health outcomes in older adults, however, little is known about their...
BACKGROUND
Age-related eye diseases and cognitive frailty (CF) are both important predictors of adverse health outcomes in older adults, however, little is known about their association.
AIMS
To demonstrate the association between age-related eye diseases and cognitive frailty in a population of Iranian older adults.
METHODS
In this cross-sectional, population-based study, we included 1136 individuals (female n = 514) aged 60 years and older (mean 68.8 ± 6.7 years) who participated in the second cycle of the Amirkola Health and Aging Project (AHAP) between 2016 and 2017. Cognitive function and frailty were evaluated based on Mini-Mental State Examination (MMSE) and the FRAIL scale respectively. Cognitive frailty was defined as coexistence of cognitive impairment (CI) and physical frailty (PF), excluding confirmed cases of dementia such as Alzheimer's disease. Cataract, diabetic retinopathy (DR), age-related macular degeneration (AMD), elevated intraocular pressure (IOP ≥ 21 mmHg) and glaucoma suspects (vertical cup to disc ratio (VCDR) ≥ 0.6) were diagnosed based on standardized grading protocols. Associations between eye diseases and cognitive frailty were evaluated through binary logistic regression analysis.
RESULTS
Overall, CI, PF and CF were observed in 257 (22.6%), 319 (28.1%) and 114 (10.0%) participants respectively. After adjusting for confounders and ophthalmic conditions, individuals with cataract were more likely to have CF (OR 1.66; p-value 0.043), while DR, AMD, elevated IOP and glaucoma suspects (OR 1.32, 1.62, 1.42, 1.36, respectively) were not significantly associated with CF. Furthermore, cataract was significantly associated with CI (OR 1.50; p-value 0.022), but not with frailty (OR 1.18; p-value 0.313).
CONCLUSION
Older adults with cataract were more likely to have cognitive frailty and cognitive impairment. This association demonstrates the implications of age-related eye diseases beyond ophthalmology and substantiates the need for further research involving cognitive frailty in the context of eye diseases and visual impairment.
Topics: Humans; Female; Middle Aged; Aged; Male; Frailty; Cross-Sectional Studies; Iran; Cataract; Glaucoma; Cognitive Dysfunction; Cognition; Frail Elderly
PubMed: 37269465
DOI: 10.1007/s40520-023-02458-z -
Food & Function May 2024Age-related eye diseases (AREDs), including age-related cataracts (ARCs), age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma, are a leading...
Age-related eye diseases (AREDs), including age-related cataracts (ARCs), age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma, are a leading cause of visual loss globally. This study aimed to explore the effects of dietary water intake on AREDs using Mendelian randomization. In the European population, genome-wide association study (GWAS) summary statistics of water intake and AREDs were obtained from the UK Biobank database and the FinnGen Consortium, respectively. The causal associations between water intake and ARED risks were explored by univariable and multivariable MR analyses, followed by sensitivity analyses to test the robustness of the results and detect potential pleiotropy bias. Water intake was associated with reduced risks of ARCs (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.46-0.83; = 1.44 × 10) and DR (OR: 0.52; 95% CI: 0.36-0.76; = 5.47 × 10), and a suggestive reduced risk of AMD (OR: 0.42; 95% CI: 0.20-0.88; = 2.18 × 10). Water intake had no effect on glaucoma (OR: 1.16; 95% CI: 0.72-1.88; = 0.549). After adjusting confounders, the causal effects of water intake on ARCs and DR persisted. Our study provides evidence of the preventive role of water intake in ARCs and DR from a genetic perspective.
Topics: Humans; Mendelian Randomization Analysis; Drinking; Macular Degeneration; Genome-Wide Association Study; Male; Female; Aged; Eye Diseases; Cataract; Glaucoma; Middle Aged; Diabetic Retinopathy; Polymorphism, Single Nucleotide
PubMed: 38682722
DOI: 10.1039/d4fo01559b -
Zhonghua Nei Ke Za Zhi Oct 2023
Topics: Humans; Cardiomyopathies; Cataract
PubMed: 37766448
DOI: 10.3760/cma.j.cn112138-20221029-00801