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Journal Francais D'ophtalmologie Jun 2024Explore the visual outcome and complications of iris fixation intraocular lenses (IFIOL) and sutureless scleral-fixated intraocular lenses (SSFIOL) in the surgical...
PURPOSE
Explore the visual outcome and complications of iris fixation intraocular lenses (IFIOL) and sutureless scleral-fixated intraocular lenses (SSFIOL) in the surgical management of patients without exchanging dislocated posterior chamber intraocular lenses (PCIOLs) in the vitreous.
METHODS
Retrospectively, 14 IFIOL and 15 SSFIOL reimplantations for dislocated PCIOLs were analyzed. Mean follow-up of reIFIOL group and reSSFIOL group: 11.3±2.0 (range: 9-15) months and 11.8±2.2 (range: 9-16) months, respectively. Preoperative and postoperative outcomes, operative indications, and complications were evaluated.
RESULTS
Primary surgical indications were pseudoexfoliation (PXE) (21.4%), post-cataract surgery (PCS) (35.7%), trauma (42.8%) in the reIFIOL group, and PXE (26.6%), PCS (40%) trauma (33.3%) in reSSFIOL group, respectively. At the latest follow-up, there was an improvement in best-corrected visual acuity (BCVA) (0.053±0.051 to 0.53±0.13, P<0.0001) in reIFIOL group and (0.05±0.02 to 0.64±0.16, P<0.0001) in reSSFIOL group. Postoperative complications of reIFIOL group and reSSFIOL group included corneal edema (14.2%; nil), IOP elevation (21.4%; 7.1%), bullous keratopathy (14.2%; nil), anterior uveitis (35.7%; 13.3%), cystoid macular edema (CME) (21.4%; 7.1%), pupil ovalization (21.4%; nil), broken haptic (none; 13.3%), IOL exchange (nil; 13.3%), and vitreous hemorrhage (nil; 14.2%).
CONCLUSIONS
Self-dislocated IOL reimplantation may enable much earlier visual rehabilitation in the reSSFIOL group than in the reIFIOL group. Moreover, the 27G trocar-assisted reSSFIOL technique takes a shorter operation time and relatively lower complication rates. However, further prospective studies with larger series and longer follow-up periods are required.
PubMed: 38917616
DOI: 10.1016/j.jfo.2024.104237 -
BMC Ophthalmology Jun 2024To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with...
BACKGROUND
To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia.
METHODS
In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months.
RESULTS
Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR.
CONCLUSION
The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high.
PubMed: 38918765
DOI: 10.1186/s12886-024-03521-7 -
Cornea Jun 2024To analyze the feasibility and outcome of Descemet membrane endothelial keratoplasty (DMEK) for treatment of endothelial failure in primary angle closure suspect (PACS)...
PURPOSE
To analyze the feasibility and outcome of Descemet membrane endothelial keratoplasty (DMEK) for treatment of endothelial failure in primary angle closure suspect (PACS) eyes.
METHODS
Retrospective, single-center case series of eyes treated by DMEK for endothelial failure caused by PACS. Main study parameters were success rate of DMEK, best-corrected visual acuity, anterior chamber depth, central corneal thickness, and endothelial cell density. Mean follow-up time was 16 ± 13 months.
RESULTS
Ten eyes of 9 patients receiving DMEK for the treatment of corneal endothelial failure because of PACS were included. Except for 2 eyes that had undergone cataract surgery, none of the eyes had previous ocular surgery. DMEK combined with cataract surgery was performed in 5 eyes, DMEK alone with second-step cataract surgery in 2 eyes. The eyes with corneal edema after cataract surgery received DMEK only. DMEK surgery was successful in nine out of 10 eyes, 1 patient required repeat DMEK because of primary graft failure. In the group of phakic eyes, mean preoperative internal anterior chamber depth was 1.74 ± 0.18 mm. In eyes with corneal edema, central corneal thickness was 849 ± 205 μm before DMEK surgery, and 517 ± 24 μm at the final postoperative visit (P = 0.002).
CONCLUSIONS
DMEK is a feasible option in eyes with endothelial failure because of primary angle closure. In case of advanced corneal edema, a second-step procedure (first DMEK, second cataract surgery) is a possible approach if visibility of the lens is too poor for simultaneous cataract surgery.
PubMed: 38917481
DOI: 10.1097/ICO.0000000000003603 -
Ocular Immunology and Inflammation Jun 2024To report an atypical presentation of severe toxicity, anterior chamber (AC) inflammation, and transient parafoveal formation of subretinal fluid induced by the...
PURPOSE
To report an atypical presentation of severe toxicity, anterior chamber (AC) inflammation, and transient parafoveal formation of subretinal fluid induced by the subconjunctival injection of 5-fluorouracil (5-FU).
METHODS
Case presentation.
RESULTS
Seven weeks after trabeculectomy, a 40-year-old white male had a subconjunctival injection of 5-FU. Within minutes after the injection, the lens turned grey and then total white. Initially, AC was clear, and 20 min later, a severe AC reaction was detected. The patient was prescribed hourly dexamethasone eye drops and tropicamide eye drops twice daily. Two days post-injection, vision improved, AC reaction was minimal, and there was whitish fibrinous material on the anterior surface of the lens, extending up to the pupillary margin. Minimal posterior synechiae were observed, and upon dilation, the remainder of the anterior surface of the lens appeared completely clear, indicating that only the portion of the lens not covered by the iris exhibited fibrinous material and deposits. One week post-injection, vision worsened due to severe corneal toxicity. The dimensions of the whitish fibrinous material on the anterior lens capsule decreased, and macular scans revealed parafoveal subretinal fluid. Two weeks later, vision significantly improved, and the dimensions of the whitish fibrinous material on the anterior lens capsule were further decreased. The subretinal fluid had completely resolved.
CONCLUSION
We describe a rare case of severe toxicity, AC inflammation, and transient parafoveal subretinal fluid formation caused by the 5-FU. This was treated with topical steroid treatment, and eventually some level of lens opacification persisted despite significant clearance of the AC inflammation.
PubMed: 38916626
DOI: 10.1080/09273948.2024.2369661 -
Cureus May 2024Congenital toxoplasmosis is caused by transplacental infection of during pregnancy. We present a case of a congenital toxoplasma with intracranial calcifications,...
Congenital toxoplasmosis is caused by transplacental infection of during pregnancy. We present a case of a congenital toxoplasma with intracranial calcifications, microcephaly, growth restriction, a unilateral cataract that developed in the third trimester, and a coincidental post-axial-polydactyly. Antenatal imaging findings are important to guide further testing and confirmation of diagnosis, it is important to know all possible associations and prognoses for timely counseling, testing, and intervention. To our knowledge, no case has been published with findings of unilateral cataract in congenital toxoplasmosis and associated coincidental polydactyly. Therefore, we wish to add this case to the current scientific literature.
PubMed: 38915958
DOI: 10.7759/cureus.61058 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To compare the accuracy of modern intraocular lens (IOL) power calculation formulas with that of older formulas, such as SRK/T and Hoffer Q, in pediatric cataract...
PURPOSE
To compare the accuracy of modern intraocular lens (IOL) power calculation formulas with that of older formulas, such as SRK/T and Hoffer Q, in pediatric cataract surgery.
METHODS
This retrospective study included 100 eyes of 100 children who underwent routine cataract surgery with primary IOL implantation in a bag. This study used four IOLMaster 700 integrated formulas: SRK/T, Hoffer Q, Haigis, and Barrett Universal II (BUII). In addition, the following formulas were used: EVO 2.0, Hill RBF 3.0, Hoffer QST, Kane, and PEARL DGS, which are available online.
RESULTS
There was a statistically significant difference between SRK/T and most other formulas, except for Hoffer Q, Hoffer QST, and BUII (p < 0.05). SRK/T yielded the lowest median absolute error (MedAE) of 0.63 D. This was followed by the BUII (0.66 D), Hoffer Q, and Hoffer QST (0.68 D). SRK/T also yielded the highest percentage of cases within ± 0.50 D (43% of the cases). For patients aged 2 to 5 years, SRK/T formula yielded statistically significantly better results than all other included formulas (p < 0.05) with MedAE = 0.44 D, 58.33% and 87.50% of the cases were within ± 0.50 D and ± 1.0 D of intended refraction, respectively.
CONCLUSION
The SRK/T formula showed the best IOL power calculation results in pediatric cataract surgery, followed by BUII, Hoffer Q, and Hoffer QST. In children aged 2-5 years, the SRK/T formula outperformed all other formulas, followed by the BUII and Hoffer QST formulas. In children older than 5 years, there was no statistically significant difference between the different formulas (p > 0.05); Hoffer Q and SRK/T showed slightly better MedAE in this age group (5-10 years).
PubMed: 38915745
DOI: 10.2147/OPTH.S468294 -
BioRxiv : the Preprint Server For... Jun 2024Variability in physical resilience to aging prompts a comprehensive examination of underlying mechanisms across organs and individuals. We conducted a detailed...
Variability in physical resilience to aging prompts a comprehensive examination of underlying mechanisms across organs and individuals. We conducted a detailed exploration of behavioral and physiological differences between C57BL/6 and CB6F1 mice across various age groups. In behavioral assays, B6 mice displayed superior performance in rotarod tasks but higher anxiety while CB6F1 mice exhibited a decline in short-term memory with age. Grip strength, long-term memory, and voluntary wheel running declined similarly with age in both strains. Examining physiological phenotypes, B6 mice exhibited lower body fat percentages across ages compared to CB6F1 mice, though cataract severity worsened with age in both strains. Analysis of cardiac functions revealed differences between strains, with worsening left ventricular hypertrophy and structural heart abnormalities with age in CB6F1 mice along with higher blood pressure than B6. Lesion scores showed an age-related increase in heart, kidney, and liver lesions in both strains, while lung lesions worsened with age only in CB6F1 mice. This study underscores the validity of behavioral assays and geropathology assessment in reflecting age-related decline and emphasizes the importance of considering strain specificity when using mouse models to study human aging.
PubMed: 38915625
DOI: 10.1101/2024.06.14.599036 -
Journal of Cataract and Refractive... Jun 2024To assess the cost-effectiveness of the treatment of low corneal astigmatism (≤1.5 D) at the moment of the cataract surgery.
PURPOSE
To assess the cost-effectiveness of the treatment of low corneal astigmatism (≤1.5 D) at the moment of the cataract surgery.
SETTING
("Masked by journal requirement").
DESIGN
Economic Evaluation.
METHODS
A decision tree was used to assess the cost-effectiveness of implanting spherical versus toric intraocular lenses (IOLs) or the spherical lens combined with the following corneal incisions: limbal relaxing incisions conducted manually (M-LRI) or assisted by femtosecond laser (F-LRI), arcuate keratotomies conducted manually (M-AK) or assisted by femtosecond (F-AK), and intrastromal arcuate keratotomies (F-iAK). Outcomes of cost were selected from a patient's perspective considering the gross cost of each one of the surgeries at European centers, and the effectiveness variable was the probability of achieving a visual acuity of 20/20 after surgery. A sensitivity analysis was conducted to assess the uncertainty considering the evidence retrieved from the transition probabilities of the model, the effectiveness, and the cost.
RESULTS
F-AK or Toric IOLs were the most effective treatments, increasing an 16% or 9%, respectively, in the percentage of eyes attaining 20/20 vision. The M-LRI, F-iAK, and F-LRI procedures were strongly dominated, while the M-AK and toric IOL were weakly dominated by the F-AK. A patient with low corneal astigmatism would need to be willing to pay 360€ [CI 95%: 231-1224] with F-AK and 472€ [CI 95%: 149-4490] with toric IOLs for a 10% increase in the probability of achieving 20/20 vision.
CONCLUSIONS
From the patient's perspective, F-AK was generally the most cost-effective treatment, even though toric IOLs can dominate in some countries.
PubMed: 38915158
DOI: 10.1097/j.jcrs.0000000000001507 -
Journal of Cataract and Refractive... Jun 2024To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases.
PURPOSE
To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases.
SETTING
Aravind Eye Hospital, Pondicherry, Tamil Nadu, India.
DESIGN
Prospective cohort study.
METHODS
Samples from multiple surgical instruments and products that were reused for consecutive cataract surgeries underwent bacterial and fungal cultures and were monitored alongside positive controls for 7 days. This included instruments that were processed using immediate use steam sterilization (IUSS) between cases (e.g., surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation and aspiration (IA) tips, phacoemulsification and IA sleeves) (Group 1), instruments that were used without sterilization between cases (e.g., phacoemulsification tubing/handpieces, coaxial IA handpieces) (Group 2) and the residual (unused) fluid from balanced salt solution bags after being used for multiple patients (Group 3).
RESULTS
3,333 discrete samples were collected from all 3 product groups that were reused across multiple patients. In all collected samples, no bacterial or fungal growth was observed. Of the 3,241 cataract surgeries that utilized reused and IUSS-sterilized instruments alongside instrument sets cultured on the same day and balanced salt solution bags shared across multiple patients, no eyes developed endophthalmitis over a 6-week follow-up period.
CONCLUSION
Bacterial or fungal growth was not found in extensive microbiological cultures of IUSS-sterilized ophthalmic surgical instruments, and cataract surgical products that were reused in multiple patients. This microbiological data complements clinical endophthalmitis data from 2 million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care.
PubMed: 38915155
DOI: 10.1097/j.jcrs.0000000000001509 -
International Journal of Retina and... Jun 2024The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for...
BACKGROUND
The EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety.
METHODS
In total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system.
RESULTS
The average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports.
CONCLUSIONS
The EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery. TRIAL REGISTRATION NUMBER CLINICALTRIALS.GOV: : NCT05229094 Data 22/5/2021.
PubMed: 38915097
DOI: 10.1186/s40942-024-00563-3