Navigating the intersection of psychiatry and ophthalmology:A comprehensive review of depression and anxiety management in glaucoma patients

Glaucoma,a prevalent and debilitating eye disease,has long been associated with vision impairment and blindness.However,recent research has shed light on the often-underestimated psychological dimensions of this condition.Anxiety and depression,two pervasive psychiatric comorbidities,have been increasingly recognized among glaucoma patients.This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology,in the context of managing depression and anxiety in glaucoma patients.By meticulously examining peer-reviewed literature,we synthesize current knowledge on the prevalence,risk factors,and underlying mechanisms of anxiety and depression in glaucoma.The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders.Factors such as progressive vision loss,complex medication regimens,and the fear of further visual deterioration contribute to their vulnerability.Moreover,we delve into the bidirectional relationship between glaucoma and mood disorders,shedding light on the complex interplay between ocular and emotional health.Our review investigates the implications of anxiety and depression on glaucoma management,including their potential impact on treatment adherence,disease progression,and overall quality of life.We also explore the neurobiological pathways linking glaucoma and mood disorders,providing a foundation for future research and potential therapeutic interventions.In conclusion,recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care.This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma.By addressing anxiety and depression in glaucoma care,healthcare providers can enhance the overall quality of life for these patients,ultimately leading to improved outcomes and a brighter future for those affected by this condition.This review offers valuable insight for healthcare practitioners and researchers,providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND During anesthesia administration for cataract surgery,low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing,with the use of additional drops intraoperatively increasing the risk of complications.Accordingly,there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study.Patients were divided into the proparacaine surface anesthesia(SA)group(65 cases)and the compound acupuncture-medicine anesthesia group(CAMA group,65 cases).Patients in the CAMA group were provided acupuncture analgesia in addition to SA.Preoperative anxiety[Self-Rating Anxiety Scale(SAS)score and state anxiety inventory(SAI)score],intraoperative stress,vital signs,analgesia,and cooperation,as well as postoperative adverse events,were compared between groups.RESULTS More marked reductions in anxiety were observed among patients in the CAMA group,with corresponding reductions in SAS and SAI scores.During the operation,no change in the secretion of E,NE,or Cor group compared to the preoperative period was observed in the CAMA,which was markedly lower than that in the SA group.Heart rate,blood pressure,and respiratory rate were more stable intraoperatively in the CAMA group.In addition,the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group.Accordingly,patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery.Furthermore,marked reductions in intraoperative adverse effects were observed in the CAMA group,indicating greater overall safety.CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Intraocular lens exchange or explantation post cataract surgery

AIM:To report incidence,indications,and visual outcomes of intraocular lens(IOL)exchange/explantation surgery.METHODS:Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1^(st) January 2017 and 31^(st) December 2022.The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.RESULTS:Out of 39778 cataract surgeries(with no preexisting ocular co-morbidities)during a six-year period(2017-2022),60(0.15%)needed IOL exchange/explantation.Surgeons-under-training performed 36/60 cases(60%)while 24/60(40%)were by experienced surgeons.The commonest indication was subluxated IOL in 26(43.3%),followed by dislocated IOL in 20(33.3%),postoperative refractive surprise in 7(11.6%),IOL induced uveitis in five and broken haptic in two eyes.Twenty-four(40%)eyes had intraoperative complications during primary surgery.Posterior chamber IOL(PCIOL)was the commonest secondary IOL in 21(35%)eyes,scleral fixated in 20(31.6%),anterior chamber IOL(ACIOL)in 13(21.6%),iris fixated IOL in three(5%)and three eyes(5%)were left aphakic.The mean time between primary and secondary surgery was 168d(168±338.8).Best corrected visual acuity(BCVA)of>20/60 was obtained in 43 eyes(71.66%),20/80-20/200 in 14(23.33%),20/250 in two and hand movements in one.No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons(UCVA 0.45±0.29 vs 0.53±0.32,P=0.20,BCVA 0.34±0.25 vs 0.37±0.26,P=0.69).CONCLUSION:IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor.This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

Different concentrations of hyaluronic acid eye drops for dry eye syndrome: a systematic review and Meta-analysis

AIM:To compare high or low concentration of hyaluronic acid eye drops(HY)for dry eye syndromes(DES).METHODS:Randomized controlled trials(RCTs)comparing various concentrations of HY were searched in PubMed,Embase,Web of Science,Cochrane,SinoMed,CNKI,Wanfang Database,CQVIP,and Chinese journals databases between inception and July 2023.Pooled standardized mean differences(SMD)or weighted mean difference(WMD)with 95%confidence intervals(CI)from RCTs evaluating Schirmer’s I test(SIT),corneal fluorescein staining score(CFS),tear breakup time(TBUT),DES score(DESS),and Ocular Surface Disease Index(OSDI)were calculated.Sensitivity analysis,Egger’s test and Meta-regression analysis were performed for all indicators.RESULTS:We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria,involving 1796 cases.High-concentrations group significantly improved the outcome of CFS according to random effects modelling(SMD,-3.37;95%CI,-5.25 to-1.48;P=0.0005).The rest of the results were not statistically significant,including indicators such as SIT,TBUT,DESS and OSDI.CONCLUSION:For dry eyes with positive corneal staining,a high concentration of HY is recommended,whereas in other cases,a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.

Real-World Study on the Treatment of Macular Edema in Central Retinal Vein Occlusion Using Traditional Chinese Medicine(TCM)and Its Medication Guidelines

Object:The aim is to evaluate how effective Traditional Chinese Medicine(TCM)is in treating patients who have central retinal vein occlusion with macular edema(CRVO-ME)in a real-world study.Furthermore,the objective of the research was to examine the TCM prescription trends in the management of CRVO-ME.Method:A single-center real-world study(RWS)was carried out over a span of 19 years,following the established design.The study encompassed 113 patients diagnosed with CRVO-ME.Out of these,74 patients received TCM treatment,while the remaining individuals underwent a combined therapy involving TCM and anti-VEGF drugs through intravitreal injection.The patients were matched using propensity score matching(PSM).The result measured in the RWS was BCVA.The oral prescriptions for CRVO-ME that led to observable and effective outcomes were collected.Excel and the TCM Inheritance Auxiliary Platform V2.5 were utilized to optimize mutual information,hierarchical clustering based on entropy,and other techniques to extract medication regulations and features.Result:After applying PSM,each group comprised 29 cases.Both groups exhibited improved BCVA following treatment;however,there was no statistically significant distinction in BCVA or effectiveness between the two groups(all P>0.05).Apart from the analysis of oral prescriptions for CRVO-ME,the investigation pinpointed the most frequently used TCMs,namely Flos Carthami,Semen Persicae,Radix Angelica sinensis,Radix Rehmanniae,and Radix et Rhizoma Notoginseng.Frequently utilized medications tended to possess cold,warm,or mild attributes and exhibited a taste profile that was either bitter or sweet.The primary meridians associated with the medicines employed in treating CRVO-ME were liver,spleen,stomach,heart,and lung.Through the application of association rule analysis,it was discerned that there were 195 commonly employed combinations of medicines.Additionally,a complex system entropy cluster analysis unveiled 13 key combinations of medicines.By employing an unsupervised entropy hierarchical clustering analysis,a novel prescription was formulated.Conclusion:Within a real-world population of CRVO-ME patients,TCM exhibited its effectiveness.The treatment approach for CRVO-ME predominantly involved the regulation of qi(Qi is an exceedingly subtle substance within the human body,brimming with vitality and ceaseless motion.It constitutes the fundamental element that shapes and sustains the various processes of human life.)and blood as well as the resolution of dampness.The oral prescriptions frequently targeted the meridians of liver,spleen,stomach,heart,and lungs.

Unveiling the silent link:Normal-tension glaucoma's enigmatic bond with cardiac blood flow

This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.

Comparison of two types of visual quality analyzer for the measurement of high order aberrations

AIM： To compare the difference and agreement of KR- lW and iTrace for measurement of high order aberrations.METHODS： KR-1W and iTrace were respectively used in a group of healthy people （40 volunteers, 32 eyes） to measure the high order aberration （HOA） of corneal, internal and total ocular. The clinical difference and agreement of two instruments were respectively evaluated by paired-samples 1-test and Bland-Altman analysis. RESULTS： The paired-samples t-test showed that the corneal HOA measured by the two instruments had no statistical differences （P〉0.05）; but the internal and total ocular HOA had significant statistical differences （P〈 0.05）, and the mean results measured by iTrace were higher than that of KR-1W. However, Bland-Altman analysis revealed that the HOA of corneal and internal were all in 95% limits of agreement; and just one point of total ocular HOA was beyond the 95% limits of agreement. CONCLUSION： KR-1W and iTrace were consistent well in the measurement of corneal, internal and total ocular HOA, especially for the cornea.

Comparison of measurements of anterior chamber angle via anterior segment optical coherence tomography and ultrasound biomicroscopy

BACKGROUND Glaucoma is an irreversible optic neuropathy with the loss of visual field and decrease of vision.The variable clinical manifestations may result in differential diagnostic difficulties.The early screening and diagnosis of glaucoma are currently experiencing a demand for anterior segment analysis tools that can gather more information with one short measurement.Therefore,we analyzed the agreement,difference,and correlation of chamber angle parameters such as angel opening distance at 500μm(AOD500)and trabeculo-iris space area at 500μm^2(TISA500)measured by anterior segment optical coherence tomography(ASOCT)and ultrasound biomicroscopy(UBM).AIM To compare the differences,correlation,and agreement in measuring AOD500 and TISA500 by AS-OCT and UBM.METHODS Both AS-OCT and UBM were performed to measure AOD500 and TISA500 in 45 subjects(72 eyes).All subjects without glaucoma were collected from October 2015 to August 2016 at the Ophthalmology Department of the Fourth Affiliated Hospital of China Medical University.Data of the two groups(AOD500 and TISA500)were compared by nonparametric tests.Pearson correlative analysis and Bland-Altman analysis were used to compare the correlation and agreement.RESULTS There were no significant differences between AS-OCT and UBM in measuring AOD500(P1=0.110,P2=0.633,P3=0.078,and P4=0.474)and TISA500(P1=0.584,P2=0.889,P3=0.297,and P4=0.550)of the four quadrants of the anterior chamber angle.There was a high correlation in measuring AOD500(r1=0.562,r2=0.671,r3=0.635,and r4=0.720;P<0.001)and TISA500(r1=0.584,r2=0.889,r3=0.297,and r4=0.550;P<0.001).There was a good agreement in measuring AOD500 and TISA500 by the two modalities.CONCLUSION There is a high correlation and agreement between AOD500 and TISA500 measurements by AS-OCT and UBM.They are interchangeable under some circumstances.AS-OCT proves to be a better early screening tool for glaucoma.

Autophagy activation and the mechanism of retinal microvascular endothelial cells in hypoxia

AIM： To explore the state of autophagy and related mechanisms in the murine retinal microvascular endothelial cells（RMECs） under hypoxia stimulation.METHODS： The murine RMECs were primarily cultured and randomly divided into three groups： hypoxia group（cultured in 1% O_2 environment）, hypoxia＋autophagy inhibition group [pretreated with 5 mmol/L 3-methyladenine（3-MA） for 4 h followed by incubation in 1% O_2] and control group（cultured under normoxic condition）. The state of autophagy in RMECs was examined by assaying the turnover of light chain 3 B（LC3BB） and expression of Beclin-1, Atg3 and Atg5 proteins with Western blotting, by detecting formation of autophagosomes with transmission electron microscopy（TEM） and by counting the number of GFP＋ puncta in RMECs. The protein levels of AMPK, P-AMPK, Akt, P-Akt, m-TOR and P-m TOR were also assayed by Western blotting.RESULTS： Primary murine RMECs were successfully cultured. Under hypoxic conditions, the ratio of LC3BB-Ⅱ/Ⅰ and the expression of Beclin-1, Atg3 and Atg5 proteins were increased when compared with the control group. In addition, the numbers of autophagosome and the GFP＋ puncta were also increased under hypoxia. However, pretreatment with 3-MA obviously attenuated these changes in autophagy in RMECs under hypoxia. Protein expression of P-Akt and P-AMPK was increased but P-m TOR level was decreased in cells exposed to hypoxia. CONCLUSION： In murine RMECs autophagy is activated under hypoxia possibly through activation of the AMPK/mTOR signaling pathway.

The binocular intraocular lens power difference in eyes with different axial lengths

AIM:To investigate the binocular intraocular lens(IOL)power difference in eyes with short,normal,and long axial lengths(AL)using Lenstar LS 900 optical biometry.METHODS:A total of 716(1432 eyes)participants were included.The groups were categorized into short(group A:AL<22 mm),normal(group B:22 mm≤AL≤25 mm),and long AL groups(group C:AL>25 mm).The central corneal thickness(CCT),anterior chamber depth(ACD),lens thickness(LT),AL,anterior corneal keratometry,whiteto-white(WTW),pupil diameter(PD),as well as IOL power calculated using embedded Barrett formula were assessed.Bland-Altman plots were used to test the agreement of the binocular parameters.RESULTS:In group A,the CCT of the right eye was significantly thinner than that of the left eye(P=0.044)with a difference of-2±8μm[95%limits of agreement(LoA),-17.8 to 13.2μm].For group B,the PD and IOL power in the right eye were significantly lower than those of the left eye(P=0.001,<0.001)with a difference of-0.05±0.32 mm(95%LoA,-0.68 to 0.58 mm)and-0.18±1.01 D(95%LoA,-2.2 to 1.8 D).The AL of right eye was longer than that of the left eye(P=0.002)with a difference of 0.04±0.25 mm(95%Lo A,-0.45 to 0.52 mm).No significant difference was observed for all the binocular parameters in group C.The percentage of participants with binocular IOL power difference within±0.5 D were 62%(31/50),68.3%(339/496),and 38.8%(66/170)in groups A,B,and C,respectively.CONCLUSION:The binocular parameters related to IOL power are in good agreement,but the binocular IOL power difference of more than half of participants with long AL is more than 0.50 D.

A Femur-Implant Model for the Prediction of Bone Remodeling Behavior Induced by Cementless Stem

Bone remodeling simulation is an effective tool for the prediction of long-term effect of implant on the bone tissue, as well as the selection of an appropriate implant in terms of architecture and material. In this paper, a finite element model of proximal femur was developed to simulate the structures of internal trabecular and cortical bones by incorporating quantitative bone functional adaptation theory with finite element analysis. Cementless stems made of titanium, two types of Functionally Graded Material （FGM） and flexible ＇iso-elastic＇ material as comparison were implanted in the structure of proximal femur respectively to simulate the bone remodeling behaviors of host bone. The distributions of bone density, von Mises stress, and interface shear stress were obtained. All the prosthetic stems had effects on the bone remodeling behaviors of proximal femur, but the degrees of stress shielding were different. The amount of bone loss caused by titanium implant was in agreement with the clinical obser- vation. The FGM stems caused less bone loss than that of the titanium stem, in which FGM I stem （titanium richer at the top to more HAP/Col towards the bottom） could relieve stress shielding effectively, and the interface shear stresses were more evenly distributed in the model with FGM 1 stem in comparison with those in the models with FGM II （titanium and bioglass） and titanium stems. The numerical simulations in the present study provided theoretical basis for FGM as an appropriate material of femoral implant from a biomechanical point of view. The next steps are to fabricate FGM stern and to conduct animal experiments to investigate the effects of FGM stem on the remodeling behaviors using animal model.

Effects of Materials of Cementless Femoral Stem on the Functional Adaptation of Bone

The objective of this paper is to identify the effects of materials of cementless femoral stem on the functional adaptive behaviors of bone. The remodeling behaviors of a two-dimensional simplified model of cementless hip prosthesis with stiff stem, flexible ＇iso-elastic＇ stem, one-dimensional Functionally Graded Material （FGM） stern and two-dimensional FGM stem for the period of four years after prosthesis replacement were quantified by incorporating the bone remodeling algorithm with finite element analysis. The distributions of bone density, von Mises stress, and interface shear stress were obtained. The results show that two-dimensional FGM stem may produce more mechanical stimuli and more uniform interface shear stress compared with the stems made of other materials, thus the host bone is well preserved. Accordingly, the two-dimensional FGM stem is an appropriate femoral implant from a biomechanical point of view. The numerical simulation in this paper can provide a quantitative computational paradigm for the changes of bone morphology caused by implants, which can help to improve the design of implant to reduce stress shielding and the risk of bone-prosthesis interface failure.

Regional Variations in Trabecular Morphological Features of Femoral Head of Patients with Proximal Femoral Fractures

The regional microstructural variations in femoral head from proximal femoral fracture patients were investigated. Mi- cro-CT scanning was performed on seven femoral heads from proximal femoral fracture patients. Each femoral head was divided into three regions according to the trabecular orientation from the fovea of femoral head to the femoral neck. Eight three-dimensional trabecular cube models were reconstructed from each region. A total of 154 trabecular cubic models were reconstructed because the corresponding areas for 14 cubic models were damaged during the surgeries. Eight trabecular mor- phological parameters were measured and analyzed, namely, trabecular thickness （Tb.Th）, trabecular separation （Tb.Sp）, spe- cific bone surface （BS/BV）, bone volum在不 fraction （BV/TV）, structural model index （SMI）, degree of anisotropy （DA）, trabecular pattern factor （Tb.Pf）, and trabecular number （Tb.N）. Bivariate correlation analyses were performed for all mor- phological parameters. One-way ANOVA tests were performed to analyze the differences of each parameter among three re- gions. Post-hoc multiple comparisons （Student-Newman-Keuls method） were performed to analyze the morphological differ- ence between two regions. Trabecular bone of proximal femoral fracture patients significantly degenerated in all regions of femoral heads. BV/TV was statistically correlated with Tb.Th, Tb.Sp, BS/BV, Tb.Pf, and Tb.N （p 〈 0.05）. Statistical differences in morphological parameters were observed between regions （p 〈 0.05）. The trabecular strength in the middle regions was significantly higher than that in other regions because of the relationships between morphological parameters and mechanical parameters. Trabeculae in the medial region were more uniform and stable along each direction than those in the lateral region. Most trabeculae in the lateral region only grew along the weight-bearing direction, and those along the other directions de- generated significantly. This study provides detailed trabecular morphological information on fractured femoral heads, as well as references for the prevention of high fracture risk in the elderly.

Out-of-the-bag intraocular lens dislocation： outcomes of posterior chamber intraocular lens exchange, risk factors, and prevention

Background Dislocation of posterior chamber intraocular lens is one of the most common complications of intraocular lens implantation. Lens exchange is an effective solution to this unsatisfactory status. This study was conducted to analyze the possible predisposing factors for out-of-the-bag posterior chamber intraocular lens dislocation and to study the outcomes of lens exchange surgery. Methods Thirty-six consecutive patients （36 eyes） with out-of-the-bag intraocular lens dislocation who underwent posterior chamber intraocular lens exchange in Zhongshan Ophthalmic Center of Sun Yat-sen University （Guangdong, China） from January 2003 to October 2009 were included. A 6-month follow-up was completed. The causes for out-of-the-bag intraocular lens dislocation and visual outcomes of posterior chamber intraocular lens exchange were analyzed. The out-of-the-bag intraocular lens dislocation was diagnosed on the basis of the findings from slit-lamp microscope and B-ultrasound. The dislocated intraocular lens was explanted. Reimplantation of a new posterior chamber intraocular lens was performed in each case using standardized surgical procedures. Results In this study, a total of thirty-six consecutive patients （36 eyes） with out-of-the-bag intraocular lens dislocation underwent posterior chamber intraocular lens exchange surgery. Causes for out-of-the-bag intraocular lens dislocation included posterior capsule rupture during the initial cataract extraction procedure （23 eyes, 63.8%）, trauma （5 eyes, 13.9%）, neodymium-doped yttrium aluminium garnet （Nd：YAG） laser-induced dislocation （2 eyes, 5.6%）, the status after vitrectomy （2 eyes, 5.6%） and unidentifiable etiology （4 eyes, 11.1%）. Symptoms of these patients mainly included decrease in visual acuity （17 cases, 47.2%）, blurred vision （16 cases, 44.4%）, glare （1 case, 2.8%）, diplopia （1 case, 2.8%）, and halo （1 case, 2.8%）. Intraocular lens dislocation into the posterior vitreous cavity （29 eyes, 80.5%）, anterior chamber （1 eye, 2.8%） and anterior vitreous cavity （6 eyes, 16.7%） was found in this series. The foldable intraocular lenses （acrylic or silicone） were explanted from 27 eyes （75%） and rigid intraocular lenses （poly methyl methacrylate, PMMA） from 9 eyes （25%）. The most common explanted intraocular lens material was single-piece acrylic （13 pieces, 36.1%）, followed by 3-piece acrylic （9 pieces, 25%）, single-piece PMMA （9 pieces, 25%）, and 3-piece silicone （5 pieces, 13.9%）. Uncorrected visual acuity postoperatively improved in 29 eyes （81%）, unchanged in 4 eyes （11%）, and worsened in 3 eyes （8%） in comparison to that before exchange operation （P=0.006）. Best corrected visual acuity tended to improve, but the improvement was not significant （P=0.206）. Complications related to lens exchange surgery were mainly intraocular lens redislocation （1 eye）, retinal detachment （1 eye）, vitreous hemorrhage （1 eye）, and cystoid macular edema （1 eye）. Conclusions Out-of-the-bag intraocular lens dislocation was mainly caused by posterior capsule rupture during the initial cataract extraction procedure and the foldable lens was the most common dislocated intraocular lens. In most cases, posterior chamber intraocular lens exchange surgery could provide satisfied final visual outcomes.

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia

Purpose:To evaluate the impact of video and verbal counselling on patients'undergoing phacoemulsification under topical anaesthesia.Methods:This is a prospective randomized controlled trial conducted at Aravind Eye Care System,Pondicherry,India.All patients had a 15 min one-on-one verbal counselling covering surgical technique,implant options,anaesthesia and payment options one day prior to surgery.On the day of surgery,patients were randomized into two groups;in the first group,patients were provided with video counselling and in the second group,patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia.Measurements of blood pressure,heart rate,respiration rate,and the Likert-scale anxiety rating were collected at preoperative,perioperative,and postoperative time points.Results:A group of 186 patients(aged 45–70 years)were provided video counselling via portable iPad before firsttime phacoemulsification,and a second group of 186 patients underwent surgery with verbal counselling.Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point.Furthermore,during the intraoperative period,123(66.1%)video counselled patients felt relaxed compared to 119(64%)patients who were provided verbal counselling(P?0.6636).Patient cooperation during surgery was excellent in 76(40.9%)video counselled patients and 67(36%)verbally counselled patients(P?0.3374).25.8%and 21%(P?0.2703)of patients experienced no pain during surgery in the video and verbal counselled groups respectively.Conclusions:Although measures such as pulse rate,respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling,patients marked cooperation during surgery and furthermore,the level of anxiety is most reassuring.