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BMJ Case Reports May 2024A female in her 20s presented with a diminution of vision in the right eye (RE) following an open globe injury (scleral penetration) and repair a year back. At the...
A female in her 20s presented with a diminution of vision in the right eye (RE) following an open globe injury (scleral penetration) and repair a year back. At the presentation, she had low intraocular pressure (IOP) of 7 mm Hg, posterior subcapsular cataract (PSC), retrolental vitreous bands incarcerated at the penetration site, disc oedema, tortuous vessels and choroidal folds. Inferotemporal and superonasal cyclodialysis clefts were detected on CASIA 2 optical coherence tomography (OCT). The diagnosis of RE repaired scleral penetration, PSC and cyclodialysis cleft with hypotony maculopathy was made. The case was managed by phacoemulsification with an intraocular lens in the bag and a capsular tension ring in the sulcus, as a tamponading agent to close the cleft. Intraoperatively on endoscopic visualisation, vitreous membrane was noticed encasing the ciliary processes causing a tractional cyclodialysis and hence single port 23G pars plana vitrectomy was performed to relieve the traction. Postsurgery, IOP was 14 mm Hg, and the repaired cleft was visualised on anterior segment OCT.
Topics: Adult; Female; Humans; Cyclodialysis Clefts; Endotamponade; Eye Injuries, Penetrating; Intraocular Pressure; Phacoemulsification; Sclera; Tomography, Optical Coherence; Vitrectomy
PubMed: 38802253
DOI: 10.1136/bcr-2022-252123 -
Asia-Pacific Journal of Ophthalmology... 2024
Topics: Humans; Glaucoma, Angle-Closure; Phacoemulsification; Trabeculectomy; Cataract; Randomized Controlled Trials as Topic; Intraocular Pressure
PubMed: 38795868
DOI: 10.1016/j.apjo.2024.100076 -
Acta Ophthalmologica May 2024To investigate changes in the incidence rate of primary rhegmatogenous retinal detachment (RRD) surgery over time and to determine to what extent these changes can be...
PURPOSE
To investigate changes in the incidence rate of primary rhegmatogenous retinal detachment (RRD) surgery over time and to determine to what extent these changes can be attributed to pseudophakia.
METHODS
This nationwide cohort study was based on national patient registries. The study population comprised individuals at risk of RRD aged 40 years and above from 2006 to 2021 in Denmark. The primary outcome was RRD incidence, and the exposure was phacoemulsification surgery. A chart review was conducted to validate and examine the lens status of the outcome.
RESULTS
The crude and age-adjusted incidence rate of RRD in the Danish population increased significantly during the study period. The largest increase in RRD was seen in phakic RRD (phRRD) (65%), whereas pseudophakic RRD (pRRD) accounted for 35% of the total increase. A chart review revealed that 17% of phRRDs were misclassified as pseudophakic, resulting in pRRD accounting for a total of 45% of the increase in RRD. The prevalence of pseudophakia in Denmark grew significantly for all age groups and for both sexes (p = 10) from 2006 to 2021, but the 1-year incidence of pRRD in the pseudophakic population was constant throughout the entire period.
CONCLUSION
The incidence rate of RRD is continuing to increase in Denmark. The increase in phRRD remains undetermined, and while the risk of pRRD seemed to be constant during the study period, 45% of the overall increase in RRD could be attributed to the rise of a growing pseudophakic population.
PubMed: 38785299
DOI: 10.1111/aos.16723 -
Frontiers in Veterinary Science 2024This study investigates the relationship between ciliary muscle dynamics, thickness, and the regulation of intraocular pressure (IOP), focusing on the progression of...
INTRODUCTION
This study investigates the relationship between ciliary muscle dynamics, thickness, and the regulation of intraocular pressure (IOP), focusing on the progression of cataracts and changes post-phacoemulsification. It explores how these factors impact canine ocular health, particularly in the context of cataract development and subsequent surgical intervention.
MATERIALS AND METHODS
Data was collected using Ultrasound Biomicroscopy (UBM) from dogs at the Veterinary Medical Teaching Hospital of Chungbuk National University, Korea. The study involved 57 eyes from 35 dogs, categorized into five groups: 13 normal eyes, 14 with incipient cataracts, 12 with immature cataracts, 6 with mature cataracts, and 12 post-phacoemulsification. UBM measurements assessed various ciliary muscle parameters including ciliary body axial length (CBAXL), ciliary process-sclera angle (CPSA), longitudinal fibers of ciliary muscle thickness (Lf-CMT), and longitudinal and radial fibers of ciliary muscle thickness (LRf-CMT).
RESULTS
Findings indicated a decrease in CBAXL and an increase in Lf-CMT as cataracts progressed in severity. Post-phacoemulsification, there was a notable increase in CBAXL and a decrease in CPSA, Lf-CMT, and LRf-CMT, compared to both cataractous and normal eyes. Regression analysis revealed a significant positive association between CBAXL and IOP, alongside a negative association between Lf-CMT and IOP. These findings suggest that variations in ciliary muscle dynamics and thickness, as influenced by cataract progression and phacoemulsification, have distinct impacts on intraocular pressure.
DISCUSSION
The study proposes that phacoemulsification leads to ciliary muscle contraction, causing an inward and anterior movement of the ciliary muscle. This movement results in the narrowing of the ciliary cleft and constriction of the unconventional outflow pathway, potentially causing an increased risk of glaucoma post-surgery. Our research contributes to understanding the anatomical and physiological changes in the canine eye following cataract surgery and underscores the importance of monitoring IOP and ciliary muscle dynamics in these patients.
PubMed: 38784657
DOI: 10.3389/fvets.2024.1366997 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA), hereafter referred to as DEX, after...
PURPOSE
To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops.
PATIENTS AND METHODS
This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents.
RESULTS
Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications.
CONCLUSION
Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.
PubMed: 38784434
DOI: 10.2147/OPTH.S448973 -
Journal of Cataract and Refractive... May 2024To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) to...
PURPOSE
To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) to those with standalone phacoemulsification.
SETTING
A multicenter database study across 8 ophthalmology departments in the United Kingdom.
DESIGN
Retrospective, nonrandomized, multicenter comparative study.
METHODS
We extracted data for patients who underwent Phaco-PPV and standalone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME after surgery.
RESULTS
The study included 2222 eyes in the combined Phaco-PPV group and 112689 in the standalone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs. 1.7%), dropped lens fragments (0.5% vs. 0.2%), suprachoroidal hemorrhage (0.4% vs. 0.1%), and cystoid macular edema (3.6 vs. 1.1%) (P<0.001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs. 20/100) in the standalone phacoemulsification group (P<0.001). Visual acuity at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs. 0.22 logMAR (Snellen ∼20/100 vs. 20/32), P<0.001).
CONCLUSION
Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative visual acuity when compared to standalone phacoemulsification surgery.
PubMed: 38780417
DOI: 10.1097/j.jcrs.0000000000001493 -
Indian Journal of Ophthalmology May 2024To compare the visual outcomes and efficacy of opposite clear corneal incision (OCCI) and toric intraocular lens (IOL) implantation in correcting preexisting astigmatism...
PURPOSE
To compare the visual outcomes and efficacy of opposite clear corneal incision (OCCI) and toric intraocular lens (IOL) implantation in correcting preexisting astigmatism (PEA) in patients undergoing phacoemulsification.
METHODS
This prospective interventional comparative study was conducted between June 2022 and January 2023 in patients having cataract with PEA undergoing phacoemulsification. Patients were divided into two groups - group A underwent phacoemulsification with OCCI and group B underwent phacoemulsification with toric IOL implantation. Uncorrected distance visual acuity (UDVA), manifest refractive cylinder, and corneal astigmatism using corneal tomography were measured preoperatively and at 6 weeks postoperatively. The eyes were categorized into three groups with PEA ranging from 1 to 1.5 D, 1.6 to 2 D, and 2.1 to 3 D. Depending upon the white-to-white corneal diameter, the eyes were also categorized into four groups with corneal diameter ranging from 10.5 to 10.9 mm, 11 to 11.4 mm, 11.5 to 11.9 mm, and 12 to 12.4 mm.
RESULTS
Sixty eyes of 60 patients were studied. At postoperative 6 weeks, 83.3% (25 eyes) in the OCCI group and 96.7% (29 eyes) in the toric IOL group achieved UDVA of 6/9 or better. No statistically significant difference was noted between the groups (P = 0.37). The reduction in mean corneal astigmatism was 0.63 ± 0.37 D in the OCCI group and 0.15 ± 0.12 D in the toric IOL group (P < 0.001). The residual mean refractive cylinder was 0.60 ± 0.38 D in the OCCI group and 0.05 ± 0.15 D in the toric IOL group at 6 weeks (P = 0.007).
CONCLUSION
Both OCCI and toric IOL are effective in correcting PEA. However, in a resource-limited setting, OCCI is a better alternative surgical option for correcting astigmatism of 1-1.5 D during phacoemulsification without requiring additional skills or instruments.
PubMed: 38773910
DOI: 10.4103/IJO.IJO_3191_23 -
Indian Journal of Ophthalmology May 2024The quest of every dedicated phaco surgeon is to develop skills to emulsify all forms of hard nuclei efficiently with minimal damage to the endothelium and reducing the...
The quest of every dedicated phaco surgeon is to develop skills to emulsify all forms of hard nuclei efficiently with minimal damage to the endothelium and reducing the risk of wound burn. Obtaining a pristine cornea the very next day in a hard cataract is a dream far from reality. Prechop means nuclear division without the use of phaco energy. In this article, we describe a prechopping technique using a new sickle-shaped (saber tooth curvature and tip) novel prechopper that has a slender, sleek, and elegant design well suited for nuclear disassembly. The novel prechopper has proved to be a wonder device for hard, soft, white, posterior polar, and exfoliation cataracts. All maneuvers of prechop are performed in the bag away from the endothelium to be easily emulsified, subsequently making phacoemulsification easier, faster, and safer.
PubMed: 38773834
DOI: 10.4103/IJO.IJO_2792_23 -
Irish Journal of Medical Science May 2024Manual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by...
BACKGROUND
Manual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.
AIMS
This study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.
METHODS
An electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.
RESULTS
Nineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1-3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.
CONCLUSIONS
There is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.
PubMed: 38771463
DOI: 10.1007/s11845-024-03712-7 -
Indian Journal of Ophthalmology May 2024To evaluate the effect of phacoemulsification on intraocular pressure (IOP) and anterior chamber angle (ACA) morphology in primary angle-closure glaucoma (PACG).
PURPOSE
To evaluate the effect of phacoemulsification on intraocular pressure (IOP) and anterior chamber angle (ACA) morphology in primary angle-closure glaucoma (PACG).
SETTING AND DESIGN
A hospital-based, prospective pre- and post-interventional study was carried out in 40 PAC and PACG eyes post patent PI with visually significant cataracts.
METHODS
All patients underwent phacoemulsification and were evaluated for IOP control, ACA widening, and disease progression for a minimum of 6 months. Failure was defined as an IOP of >21 mmHg necessitating another intervention, including trabeculectomy and/or an increase in the required number of antiglaucoma medications (AGMs) by >1.
RESULTS
A highly statistically significant reduction of IOP (P < 0.0001) was seen with an overall reduction of 42.2% over 6 months and a mean reduction of 8.9 ± 3.59 mmHg, with the requirement of AGMs reducing from 39/40 patients preoperatively to 1/38 postoperatively. Success was seen in 95% of cases, with two patients not achieving target IOP and requiring trabeculectomy. Angle widening was documented in all cases by both gonioscopy and AS-OCT, and none of the patients showed any progression in disc damage and visual field changes.
CONCLUSION
Early cataract surgery in ACG not only helps to control IOP and disease progression by widening angles and improving aqueous outflow but also improves visual acuity and reduces the economic burden of AGMs. It also helps in better evaluation of disease progression by both structural and functional analysis, as was documented by the improved and more reliable visual field indices.
PubMed: 38770614
DOI: 10.4103/IJO.IJO_1701_23