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BMC Ophthalmology May 2024The main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens...
PURPOSE
The main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens Opacities Classification System III (LOCS-III) system, lens thickness (LT), and surgical parameters. The secondary objective is to assess the diagnostic model performance for hard nuclear cataract.
METHODS
This study included 70 eyes of 57 adults with cataract, with 49 (70%) and 21 (30%) in training and validation cohort, respectively. Correlations of the average nuclear density (AND) /maximum nuclear density (MND) with LOCS-III scores, LT, and surgical parameters were analyzed. Univariate and multivariate logistic regression analysis, receiver operating characteristic curves and calibration curves were performed for the diagnostic of hard nuclear cataract.
RESULTS
The pre-operative uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), mean axial length (AL), and LT were 1.20 ± 0.47 log MAR, 15.50 ± 2.87 mmHg, 27.34 ± 3.77 mm and 4.32 ± 0.45 mm, respectively. The average nuclear opalescence (NO) and nuclear colour (NC) scores were 3.61 ± 0.94 and 3.50 ± 0.91 (ranging from 1.00 to 6.90), respectively. The average AND and MND were 137.94 ± 17.01 and 230.01 ± 8.91, respectively. NC and NO scores both significantly correlated with the AND (rNC = 0.733, p = 0.000; rNO = 0.755, p = 0.000) and MND (rNC = 0.643, p = 0.000; rNO = 0.634, p = 0.000). In the training cohort, the area under the curve (AUC) of the model was 0.769 (P < 0.001, 95%CI 0.620-0.919), which had a good degree of differentiation (Fig. 2a). The calibration curve showed good agreement between predicted and actual probability.
CONCLUSION
The nuclear density measurement on SD-OCT images can serve as an objective and reliable indicator for quantifying nuclear density.
Topics: Humans; Female; Male; Tomography, Optical Coherence; Cataract; Aged; Middle Aged; Lens Nucleus, Crystalline; Visual Acuity; ROC Curve; Retrospective Studies; Phacoemulsification; Aged, 80 and over; Adult; Lens, Crystalline
PubMed: 38711059
DOI: 10.1186/s12886-024-03431-8 -
European Journal of Ophthalmology May 2024Fuchs uveitis syndrome (FUS) is a chronic intraocular inflammatory disease. It can lead to glaucoma which can be intractable to both medical and surgical treatment. In...
BACKGROUND
Fuchs uveitis syndrome (FUS) is a chronic intraocular inflammatory disease. It can lead to glaucoma which can be intractable to both medical and surgical treatment. In the present report, we describe our experience with GATT as a primary surgical option in the treatment of glaucoma secondary to FUS.
RESULTS
Four consecutive patients with FUS-associated glaucoma underwent GATT in a single institution. Case 1 was a 28-year-old pseudophakic male with a preoperative intraocular pressure (IOP) of 43 mmHg had unsuccessful circumferential cannulation; his IOP remained high after GATT and received trabeculectomy followed by Ahmed glaucoma valve (AGV) implantation to control IOP. Although IOP was stable following AGV, he required descemet membrane endothelial keratoplasty due to persistent corneal decompansation. He had a stable IOP of 12 mmHg over 21 months. Case 2 was a 42-year-old male with preoperative IOP of 35 mmHg and posterior subcapsular cataract had 360-degree GATT combined with phacoemulsification; his IOP reduced to 14 mmHg over 18 months. Case 3 was an 52-year-old pseudophakic male with a preoperative IOP of 28 mmHg had 360-degree GATT; his IOP remained stable at 10 mmHg over 18 months. Case 4 was an 47-year-old pseudophakic female with a preoperative IOP of 39 mmHg had 360-degree GATT; her IOP remained stable at 14 mmHg over 12 months.
CONCLUSION
GATT may be used as an initial approach in secondary glaucoma due to FUS. But, further evidence is still warranted to better ascertain the usefulness of GATT in this specific patient population.
PubMed: 38710201
DOI: 10.1177/11206721241253304 -
The Ulster Medical Journal Jan 2024The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical...
BACKGROUND
The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical capacity and the risk of nosocomial infection. This study reports on a single site experience of ISBCS in Northern Ireland.
METHODS
Data was collected prospectively between 17 November 2020 and 30 November 2021. The ISBCS surgical protocol, recommended by RCOphth and UKISCRS, was followed. Primary outcomes measures were: postoperative visual acuity (VA), refractive prediction accuracy, intraoperative and postoperative complications.
RESULTS
Of 41 patients scheduled, 39 patients completed ISBCS and two patients underwent unilateral surgery (n=80 eyes). Mean age at the time of surgery was 71.6 years (standard deviation (SD) ±11.8 years). Median preoperative VA was 0.8 logMAR (range: PL to 0.2 logMAR). Seventeen (20.9%) eyes were highly myopic and 9 (11.1%) eyes were highly hypermetropic. Median cumulative dissipated phacoemulsification energy was 15.7 sec (range: 1.8 sec to 83.4 sec). Median case time was 10.4 min (range: 4.3 min to 37.1 min).One eye (1.3%) developed iritis secondary to a retained tiny cortical fragment. Four eyes (5.0%, n=3 patients) developed cystoid macular oedema, with full resolution. On wide field imaging, an asymptomatic unilateral peripheral suprachoroidal haemorrhage was noted in two highly myopic patients (axial lengths of 27.01mm and 25.05mm respectively). The posterior pole was spared, and both resolved spontaneously without any visual impairment.
CONCLUSIONS
In our initial experience, ISBCS was found to be a safe approach to cataract surgery. Our patient cohort included eyes with dense cataracts and high ametropia. Further studies are required to assess patient reported outcome measures and the possible economic benefits of ISBCS in our local population.
Topics: Humans; Male; Middle Aged; Aged; Aged, 80 and over; COVID-19; Pandemics; Northern Ireland; Prospective Studies; Visual Acuity; Phacoemulsification; Lens Implantation, Intraocular; Cataract
PubMed: 38707980
DOI: No ID Found -
Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate the effects of retinal surgery on the ocular surface and corneal subbasal nerve plexus (SNP).
PURPOSE
To evaluate the effects of retinal surgery on the ocular surface and corneal subbasal nerve plexus (SNP).
METHODS
Ninety-eight patients undergoing 23-gauge pars plana vitrectomy for various vitreoretinal disorders were prospectively studied. We collected detailed operative and perioperative data, measuring dry eye syndrome (DED) severity and Ocular Surface Disease Index (OSDI) scores before surgery and at postoperative intervals. In vivo confocal microscopy (IVCM) quantified SNP and dendritic cell (DC) densities.
RESULTS
Fifty-three patients were analyzed. Post-surgery, OSDI scores rose from a baseline of 5.5 ± 3.5 to 12.24 ± 6.5 at one month, later reducing to 7.8 ± 4.0 after a year. DED severity increased from 0.6 ± 0.6 initially to 1.6 ± 0.6 at three months, returning to near baseline (0.9 ± 0.6) one year after surgery. DC densities increased notably by the third (58.85 ± 75.6 cells/mm²) and ninth (59.95 ± 86 cells/mm²) postoperative months, especially in patients undergoing combined phacoemulsification, vitrectomy, and C3F8 gas tamponade. SNP parameters, particularly nerve fiber density and length, showed significant declines one month post-surgery, not recovering to baseline levels within a year. Fiber density dropped from 19.06 ± 8.3 fibers/mm² preoperatively to 4.68 ± 4.8 fibers/mm² at one month, partially recovering to 10.64 ± 8.2 fibers/mm² at twelve months. Fiber length decreased from 13.31 ± 3.2 mm/mm² to 6.86 ± 3.4 mm/mm² at one month, later improving to 9.81 ± 4.5 mm/mm² at twelve months, notably in patients with silicone oil (SiO2) tamponade.
CONCLUSION
Retinal surgery, especially when combined with phacoemulsification and C3F8 or SiO2 tamponade, significantly affects ocular surface integrity and SNP density, with these changes lasting up to a year. Expanded studies with more patients and longer follow-up, using finer 25- and 27-gauge vitrectomy tools, are recommended to confirm and extend these findings.
PubMed: 38707770
DOI: 10.2147/OPTH.S456631 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems.
PURPOSE
To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems.
METHODS
Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases.
RESULTS
One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes.
CONCLUSION
The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.
PubMed: 38707769
DOI: 10.2147/OPTH.S453899 -
Photodiagnosis and Photodynamic Therapy Jun 2024
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Ophthalmology. Glaucoma Apr 2024To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients...
PURPOSE
To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery.
DESIGN
Single-center, retrospective, comparative case series.
PARTICIPANTS
A total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group.
METHODS
Eligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed.
MAIN OUTCOME MEASURES
The primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on 2 consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those who used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications.
RESULTS
The cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P = 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4-10.4 months). The IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P = 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P = 0.015). The logarithm of the minimum angle of resolution VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P = 0.82), and VFMD was -18.3 ± 9.0 dB in the phaco-tube group and -14.1 ± 7.0 dB in the phaco-trab group (P = 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P = 0.28).
CONCLUSIONS
Phaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
PubMed: 38697359
DOI: 10.1016/j.ogla.2024.04.008 -
International Ophthalmology May 2024To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery.
PURPOSE
To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery.
METHODS
The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1 week and 1 month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared.
RESULTS
A statistically significant difference was determined between the two groups at postoperative 1 month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1 month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1 month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1 week (p < 0.01) and preoperative values were reached at 1 month postoperatively.
CONCLUSION
In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium.
Topics: Humans; Hyaluronic Acid; Dry Eye Syndromes; Female; Male; Aged; Epithelium, Corneal; Middle Aged; Ophthalmic Solutions; Phacoemulsification; Viscosupplements; Prospective Studies; Tears; Postoperative Complications; Cataract Extraction
PubMed: 38696090
DOI: 10.1007/s10792-024-03128-3 -
Cornea Apr 2024To evaluate the rate of and risk factors for rhegmatogenous retinal detachment (RRD) after Descemet membrane endothelial keratoplasty (DMEK) either alone or in...
PURPOSE
To evaluate the rate of and risk factors for rhegmatogenous retinal detachment (RRD) after Descemet membrane endothelial keratoplasty (DMEK) either alone or in combination with cataract surgery.
DESIGN
Retrospective analysis of prospective database.
METHODS
Consecutive eyes with Fuchs endothelial corneal dystrophy (FECD) that received DMEK surgery with a minimum follow-up of 1 year between July 2011 and January 2021 at the Department of Ophthalmology at the University of Cologne were analyzed. Exclusion criteria were complicated history including repeat DMEK within 1-year, previous retinal or glaucoma surgery, complicated phacoemulsification, congenital cataract, history of trauma.
RESULTS
From 3858 consecutive DMEKs, 1961 patients were identified suitable for analysis. 846 (43.1%) were pseudophakic DMEK, 91 (4.6%) phakic DMEK and 1,024 (52.2%) combined with cataract surgery. RRD occurred in 13 eyes (12 patients). Within two years after DMEK RRD occurred in 0.49% and 0.47% after DMEK and DMEK with cataract surgery, respectively. Mean age of 59.24 ± 8.42 years with subsequent RRD was significantly lower than overall 68.81 ± 9.89 years (t-test two-tailed; p < 0.001). The spherical equivalent was -4.69 ± 3.98 D (range -9.00 to 0.5) in RRD after pseudophakic DMEK compared to -2.79 ± 3.54 D (range -7.5 to 0.75) in combined procedures. Re-bubbling had no influence on RRD rate.
CONCLUSIONS
DMEK alone or in combination with cataract surgery showed similar postoperative RRD rates in the first two years, generally in the range of pseudophakic RRDs. Risk factors such as myopia and younger age could be identified. Re-bubbling has no influence on RRD rates.
PubMed: 38692685
DOI: 10.1097/ICO.0000000000003554 -
Ophthalmology and Therapy Jun 2024Cataract surgery poses a risk to corneal endothelial cells. This study aimed to assess the protective effect of rho-associated kinase inhibitor eye drop (ripasudil) on...
INTRODUCTION
Cataract surgery poses a risk to corneal endothelial cells. This study aimed to assess the protective effect of rho-associated kinase inhibitor eye drop (ripasudil) on corneal endothelial cells after cataract surgery over 12 months.
METHODS
We conducted a prospective, non-randomized, non-blinded comparative study including 43 patients divided into two groups: the ripasudil group (22 patients, 23 eyes) and the control group (21 patients, 21 eyes). All patients had grade 3 nuclear cataract and underwent uneventful phacoemulsification with intraocular lens implantation. In the ripasudil group, one drop of ripasudil hydrochloride hydrate (Glanatec® ophthalmic solution 0.4%) was administered three times a day for 5 days. Outcome measures included central corneal thickness (CCT) and endothelial cell density (ECD), which were evaluated preoperatively and 12 months postoperatively.
RESULTS
In the ripasudil group, the median ECD was 2398 (interquartile range [IQR] 410, 2201-2611) cells/mm at baseline and 2262 (IQR 298, 2195-2493) cells/mm at 12 months postoperatively. In the control group, the median ECD was 2503 (IQR 390, 2340-2730) cells/mm at baseline and 2170 (IQR 324, 2049-2373) cells/mm at 12 months postoperatively. Endothelial cell loss (ECL) was 12.8% in the control group, significantly reduced to 4.5% in the ripasudil group (p = 0.001*). CCT (p = 0.042), age (p = 0.383), sex (p = 0.944), and duration of surgery (p = 0.319) were not significant factors. No adverse effects were observed in either of the groups.
CONCLUSIONS
Incorporating ripasudil into postoperative management could help maintain corneal endothelial cell integrity and reduce cell loss after cataract surgery, potentially decreasing the need for endothelial transplantation in patients who have undergone intraocular surgeries.
PubMed: 38689101
DOI: 10.1007/s40123-024-00950-x