Efficacy of combined cataract extraction and endoscopic cyclophotocoagulation for the reduction of intraocular pressure and medication burden

AIM： To report on the efficacy of combined endoscopic cyclophotocoagulation（ECP） and phacoemulsification cataract extraction（PCE） with intraocular lens placement for reduction of intraocular pressure（IOP） and medication burden in glaucoma.·METHODS： A retrospective case review of 91 eyes（73patients） with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded,as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits（at 1, 3, 6, or 12 mo postoperatively）,IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within12 mo after PCE/ECP.·RESULTS： Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo（P 0.0001）. Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo（P =0.0003）. At 3mo postoperatively,the success rate was 73.6%（95%CI： 63.3, 81.5）, 57.1% at6mo（95% CI： 46.3, 66.6）, and 49.7% at 12mo（95% CI：38.9, 59.6）. Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.· CONCLUSION： Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients withhigher baseline IOP levels are most likely to benefit from this procedure.

Inhibitory Effect of Short-Term Palpebral Margin Cleaning with Antibiotic Eye Drops on Ocular Surface Flora before Cataract Extraction:A New Preoperative Antibacterial Method

Objective To explore the clinical significance of the combined application of palpebral margin cleaning and antibiotic eye drops in inhibiting bacterial growth in the palpebral margin and conjunctival sacs before cataract extraction.Methods In this study,61 patients(97 eyes)with age-related cataract who underwent phacoemulsification and intraocular lens implantation were selected,and randomly grouped.In the experimental group,the combined application of palpebral margin cleaning with cotton pads and levofloxacin eye drops was given for three days before the surgery.In the control group,levofloxacin eye drops alone were applied for three consecutive days.Bacteria samples from the conjunctival sac and eyelid margins were cultivated and identified before and three days after taking antimicrobial measures,respectively.Results In the experimental group,the positive rates of the two bacteria samples were 100%(50/50)and 40%(20/50)before and 10%(5/50)and 0%(0/50)after the treatment.In the control group,the positive rates of the two bacteria samples were 97.9%(46/47)and 29.8%(14/47)before and 40.4%(19/47)and 10.6%(5/47)after the treatment.The positive rates between the two groups were not significantly different before taking antimicrobial measures(P=0.485 and 0.395),while they were significantly different after taking antimicrobial measures(P=0.001 and 0.024).Conclusion Combined application of eyelid and palpebral margin cleaning with cotton pads and antibiotic eye drops before cataract extraction imparted excellent antibacterial effects.

Liquefaction for cataract extraction

A systematic review of the recent literature regarding the implementation of the liquefaction in cataract surgery and its short-term and long-term outcomes in various parameters that affect the quality of patients＂ life, including visual rehabilitation and possible complications was performed based on the PubMed, Medline, Nature and the American Academy of Ophthalmology databases in November 2013 and data from 14 comparative studies were included in this narrative review. Liquefaction is an innovative technology for cataract extraction that uses micropulses of balanced salt solution to liquefy the lens nucleus. Most studies reported that liquefaction is a reliable technology for mild to moderate cataracts, while fragmentation difficulties may be encountered with harder nuclei.

Graft survival and visual outcome after simultaneous penetrating keratoplasty and cataract extraction

AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. ·RESULTS: The mean age of patients was 61 years. The mean overall follow -up was 27 months. The most common indications for surgery were corneal scarring (45.5% ), previous failed graft (15.8% ), corneal ulcer (12.9% ), Fuchs endothelial dystrophy (8.9% ), stromal dystrophy (2.9% ), and other conditions (14.5% ). Overall, 69 grafts (68.3% ) remained clear at final follow -up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P 】0.05). The graft rejection rate (17.8% ) was a significant risk factor for failure (P =0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P 】0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P 【0.01). ·CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.

More than 10 Years of Experience with Immediate Sequential Bilateral Cataract Extraction (ISBCE)--A Retrospective Study

Background: To evaluate the safety of immediate sequential bilateral cataract extraction (ISBCE) with respect to indications, visual outcomes, complications, benefits and disadvantages. Methods: This is a retrospective review of all ISBCEs performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 500 eyes of 250 patients were reviewed. Of these 500 eyes, 472 (94.4%) had a straight forward phacoemulsification with posterior chamber intraocular lens implantation;21 (4.2%) had a planned extracapsular cataract extraction;4 (0.8%) had an intracapsular cataract extraction and 3 (0.6%) had a combined phacoemulsification with trabeculectomy. Results: Over 66% of eyes achieved improved visual acuity (at least 3 Snellen lines) following ISBCE. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR;the interquartile range was [0.4, 1] LogMAR. At one week control the median BCVA was 0.3 LogMAR, IQR [0.1, 0.5] LogMAR. At one month the median BCVA was 0.15 LogMAR, IQR [0.05, 0.3] (p < 0.01). There were no sight-threatening intraoperative or postoperative complications observed. Conclusions: ISBCE is an effective and safe option with high degree of patient satisfaction. The relative benefits of ISBCE should be balanced against the theoretically enhanced risks.

Self-management of cataract extraction among diabetes patients

Background:Diabetes-related cataract extraction is a minor surgery required to regain full vision.One of the recognized factors that can delay or prevent full-vision recovery is poor management,and most of this management is being carried out by patients themselves.Objective:This study aimed to assess the knowledge of diabetes patients on self-management after cataract extraction in two tertiary hospitals in Osun State.Methods:A cross-sectional descriptive design was conducted among 97 diabetes patients who underwent cataract extraction and were attending clinics and follow-up visits in Osun State.A self-structured questionnaire was used for data collection.Results:Moderate knowledge was found among the participants on an appropriate diet(56.7%),prevention of injury risk(57.5%),prevention of infection risk(50.9%),and low knowledge on the technique of administration of eye drop(60.8%)after cataract extraction,whereas 74.7%of the total respondents were knowledgeable on the indication for follow-up visit after cataract extraction,these results were found to be below the expected knowledge level.Conclusion:An intensive and comprehensive educational initiative by nurses should be tailored to meet the specific needs of diabetes patients with cataract surgery.Nurses also need to implement the use of checklist which will enhance learning and improve patient understanding of self-management after cataract extraction.

Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective:To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients.Methods:96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A(ultrasonic emulsification)and group B(small-incision extracapsular cataract extraction),with 48 cases each.Results:At 1 week,1-month,and 3 months post-operation,the visual acuity of group A was higher and the astigmatism value was lower than that of group B(P<0.05);at 12h,24h,and 48h post-operation,the intraocular pressure of group A was higher than that of group B(P<0.05);the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation(P<0.05).Conclusion:Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism,improving visual acuity,and regulating macular thickness.However,due to the high energy of ultrasonic emulsification,the risk of complications such as high postoperative intraocular pressure was higher.Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts： Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty

Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. Methods： A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty （PKP） eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density （ECD）, and best-corrected visual acuity （BCVA） were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Results： Of the 54 eyes included in this study, extracapsular cataract extraction （ECCE） was performed in 34 eyes of 33 patients （ECCE group） whereas phacoemulsification was performed in 20 eyes of 20 patients （phacoemulsification group）. There was no signifcant difference in the median age （P = 0.081） or preoperative ECD （P = 0.585） between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group （P = 0.043）. In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months （P = 0.018）, 4 months （P 〈 0.001）, and 6 months （P 〈 0.001） after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group （P 〈 0.001） and phacoemulsification group （P 〈 0.001）, but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts （P 〈 0.001）. There was no signifcant difference in postoperative BCVA between the two groups （P = 0.065）. Conclusion： ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

Cataract extraction in eyes with Fuchs’endothelial dystrophy in China

It is a common belief that Fuchs' endothelial dystrophy predominantly affectsCaucasians but rarely Asians. However, in one Japanese study, primary corneal guttae (first stageof Fuchs ' dystrophy) were found in four of 107 cataract patients. With the growing popularity ofphacoemulsification in China in the past decade, the increased incidence of endothelialdecompensation may be due to learning curves among surgeons as well as that the prevalence of Fuchs'dystrophy among Chinese is higher than we thought. Low index of suspicion for Fuchs' dystrophy mayresult in missing of diagnosis and occurrence of endothelial decompensation, particularly when noextra protection is provided for endothelial cells during phacoemulsification. This study was aimedat improving our knowledge about Fuchs' dystrophy among Chinese population and reminding surgeons ofextra endothelial protection during cataract surgery for patients with Fuchs' dystrophy.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Improving refractive outcomes in cataract surgery: A global perspective

This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.

Effect of infusion pressure during cataract surgery on ganglion cells measured using isolated-check visual evoked potential

AIM： To detect the relationship between infusion pressure and postoperative ganglion cells function.METHODS： This prospective observational cohort study included sixty-one eyes that underwent uncomplicated cataract surgery. Patients were divided into two groups according to infusion time（IT） recorded using surgery equipment [Group A： IT〉IT_（mean）（27 eyes）; Group B： IT

Antibacterial effect of povidone iodine disinfectant and antibiotic eye drops before cataract surgery

Objective:Investigate the distribution of bacteria in the conjunctival sac of two groups of cataract patients with different preoperative aseptic treatments,and compare the clinical effects of 0.5%povidone-iodine(PI)and antibiotic eye drops on killing conjunctival sac bacteria.Methods:400 cases of patients(400 eyes)who underwent cataract surgery in the Department of Ophthalmology of Baogang Hospital in Inner Mongolia from October 2019 to October 2020 were selected in a randomized controlled study.They were randomly divided into the experimental group(group A)and the control group(group B),with 200 cases in each group.Group A:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drop/time)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drop/time)before the operation;0.5%PI was administered to irrigate the conjunctival sac,with 0.9%Sodium Chloride Injection washing after 3 min;0.5%PI was administered to irrigate the conjunctival sac after operation.The corneal epithelium was observed after each irrigation.Group B:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drop/time)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drop/time)2 days and 1 day before the operation;0.9%Sodium Chloride Injection was administered to irrigate the conjunctival sac before and after surgical disinfection.Conjunctival sac specimens were collected for bacterial culture 2 hours before the operation,after irrigation,and after the procedure.The positive rate and the distribution of bacteria were compared between the two groups.Results:The difference in the positive rate of bacteria in the conjunctival sac between the two groups at different time points had a statistical significance(χ^(2)=11.498,p<.022).Conjunctival sac specimens were collected on admission and 2 hours before the operation.There was no significant difference in the pathogens with positive results between the two groups(p=.955;p=.073);there was a substantial difference in the distribution of positive pathogens between the two groups before and after surgical disinfection(p<.001);there was a significant difference in the distribution of pathogens between the two groups after the operation(p=.005).For Staphylococcus epidermidis,Corynebacterium,Enterococcus faecalis,Streptococcus,and other Gram-positive bacteria,there was a significant difference in the disinfection methods between the two groups at different time points(p<.001);for Staphylococcus aureus,Gram-positive cocci,and Gram-negative bacteria,there was no significant difference in the disinfection methods between the two groups at different time points(p=.113;p=.224;p=.146).There was no significant difference between the two groups with 0-10 and 101-1000 bacterial colonies at different time points(p=.370 and.071,respectively).When there were 11-100 bacterial colonies,there was a significant difference between the two groups at different time points(p<.001).There was no significant difference in corneal epithelial injury between the two groups at other time points(χ^(2)=4.133,p=.127).Conclusions:The combination of 0.5%PI disinfectant and antibiotic eye drops can effectively reduce the bacterial load of the conjunctival sac before operation.At the same time,it is safe and effective to irrigate the conjunctival sac with 0.5%PI disinfectant before the procedure.

Clinical study of customized aspherical intraocular lens implants

AIM:To compare if there is an improvement in visual functions with age-related cataracts between patients receiving a aspherical intraocular lens(IOL) based on corneal wavefront aberration and patients randomly assigned lenses.METHODS:A total of 124 eyes of 124 patients with age-related cataracts were placed in experimental group and a group receiving randomly assigned(RA) lenses.The experimental group was undergone Pentacam corneal spherical aberration measurement before surgery; the targeted range for residual total spherical aberration after surgery was set to 0-0.3 μm. Patients with a corneal spherical aberration 【0.3 μm were implanted with a zero-spherical aberration advanced optics(AO) aspherical IOL and patients with an aberration ≥0.3 μm received a Tecnis Z9003 aspherical lens in experimental group. RA patients were randomly implanted with an AO lens or a Tecnis Z9003 lens. Three months after surgery total spherical aberration, photopic/mesopic contrast sensitivities, photopic/mesopic with glare contrast sensitivities, and logMAR vision were measured.RESULTS:Statistical analysis on logMAR vision showed no significant difference between two groups(P =0.413). The post-surgical total spherical aberration was 0.126 ±0.097 μm and 0.152 ±0.151 μm in the experimental and RA groups, respectively(P =0.12). The mesopic contrast sensitivities at spatial frequencies of 6,12 and 18 c/d in the experimental group were significantly higher than of the RA group(P =0.00; P =0.04;P =0.02). The mesopic with glare contrast sensitivity in the experimental group at a spatial frequency of 18 c/d was also significantly higher vs the RA group(P =0.01).CONCLUSION:Pre-surgical corneal spherical aberration measurement in cataract patients followed bycustomized selection of aspherical IOL implants improved mesopic contrast sensitivities at high spatial frequencies, and thus is a superior strategy compared to the random selection of aspherical intraocular lens implants.

A systematic review of pseudophakic monovision for presbyopia correction

A systematic review of the recent literature regarding pseudophakic monovision as a reliable methods for presbyopia correction was performed based on the PubMed, MEDLINE, Nature and the American Academy of Ophthalmology databases in July 2015 and data from 18 descriptive and 12 comparative studies were included in this narrative review. Pseudophakic monosvision seems to be an effective method for presbyopia with high rates of spectacles independence and minimal dysphotopsia side- effects, that should be considered by the modern cataract surgeons.

Effects of phacoemulsification surgery on ocular hemodynamics

AIM:To evaluate the possible effects of phacoemulsification cataract surgery on ocular hemodynamics.·METHODS:In this prospective study,intraocular pressure(IOP),pulsatile ocular blood flow(POBF),and ocular pulse amplitude(OPA) were measured pre-operatively(baseline) and at 1 week and 3 weeks postoperation in 52 eyes of 26 patients(mean age 63.15±10.25 years) scheduled for unilateral phacoemulsification cataract surgery with intraocular lens implantation.In all of the eyes,a blood flow analyzer(Paradigm DICON;Paradigm Medical Industries Inc.;USA) was used to obtain measurements of IOP,POBF,and OPA.The data obtained from operated eyes were compared statistically to untreated fellow phakic eyes of the patients.·RESULTS:For operated eyes,the mean baseline IOP,POBF,and OPA values were 15.9±4.64mmHg,17.41±4.84μL/s,and 2.91 ±1.12mmHg,respectively.The IOP,POBF,and OPA values were 17.19 ±4.34mmHg,17.56 ±6.46μL/s,and3.12 ±1.1mmHg,respectively,in the nonoperated control eyes.Statistically significant differences from baseline measurements were not observed 1 week and 3 weeks postoperation for the operated or nonoperated eyes.There were also no statistically significant differences in any measurements between the operated and nonoperated eyes in all the examination periods(P 】0.05for all).·CONCLUSION:Uncomplicated phacoemulsification surgery does not affect ocular hemodynamics in normotensive eyes with cataracts.

Catquest-9SF functioning over a decade–a study from the Swedish National Cataract Register

Background:The Swedish National Cataract Register(NCR)collects data on cataract surgery outcomes during March,including patient-reported outcomes using the Catquest-9SF questionnaire for over 11 years.Previous studies from NCR have shown that the preoperative visual acuity has improved over time.The main purpose of this study was to evaluate the Catquest-9SF Rasch scoring performance in this changing environment.A second purpose was to describe clinical data over the same period for those who completed the questionnaire.Methods:The performance of the Catquest-9SF was analysed by a separate Rasch analysis for each year,resulting in a preoperative and postoperative score for each participating patient in the annual cohorts.The clinical data and questionnaire scoring were analysed for each year in the period 2008-2018 inclusive.Results:Data were available for 42,023 eyes for 11 annual cohorts(2008-2018).The psychometric properties of the questionnaire were stable during the study period.Person separation(precision)for the whole period was 2.58 and varied between 2.45 and 2.72.The person reliability was 0.87 and varied between 0.86 and 0.88.The targeting of question difficulty to person ability became less accurate over time meaning that the item activities became easier to carry out without difficulty.The average targeting for the whole period was−2.06 and changed from−1.92 in 2008 to−2.31 in 2018.The person score improved both before surgery and after surgery,indicating that patients are undergoing surgery at a more able level and getting better outcomes.The average improvement by surgery decreased from 3.41 logits in 2008 to 3.21 logits in 2018(p=0.003).Over time,patient age decreased from 75 to 74 years(p<0.001)and the proportion of women decreased from 63.9 to 57.9%(p<0.001).The mean preoperative visual acuity in both the operated eye and the better eye improved over time(0.47 to 0.40 logMAR,p<0.001 and 0.22 to 0.19 logMAR,p<0.001,respectively),as did the mean postoperative visual acuity in the operated eye(0.14 to 0.09 logMAR,p<0.001).Conclusions:The Catquest-9SF retained stable psychometric properties over this 11-year period although more recent cohorts included slightly younger patients with somewhat better vision.

Anterior internal lenticonus accompanied by congenital nuclear cataract

Internal lenticonus is a very rare morphologic abnormality of crystalline lens which has been reported in only several cases in the literature. We herein reported the clinical characteristics and surgical findings of the anterior internal lenticonus accompanied by congenital nuclear cataract. Cataract extraction accompanied with intraocular lens implantation was uneventfully performed, and a good visual outcome was achieved in this case. Viral infection during embryonal and fetal period might account for the formation of the anterior internal lenticonus and congenital nuclearcataract in our case.