Phacoemulsification versus small incision cataract surgery in patients with uveitis

AIMTo compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract.METHODSIn a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of <0.05 was considered statistically significant.RESULTSOne hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P<0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86±0.34 dioptres (D) in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (P<0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups.CONCLUSIONManual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

Presbyopic correction on the cornea

Purpose:The aim of this systematic review was to synthesize and appraise the evidence of the benefits of presbyopic correction on the cornea for visual function.Summary:Comprehensive search was conducted in MEDLINE using keywords like“presbylasik”,“presbyopic refractive surgery”,“corneal pseudoaccommodation”and“corneal multifocality”.We reviewed corrected and uncorrected visual acuities for distance and near(uncorrected distance visual acuity(UDVA),uncorrected near visual acuity(UNVA),corrected distance visual acuity(CDVA),distance corrected near visual acuity(DCNVA),corrected near visual acuity(CNVA)),along with the refractive outcomes in spherical equivalent(SE)and astigmatism comparing the differences observed between preoperative myopic and hyperopic patients,as well as among techniques.Thirty-one studies met the inclusion and quality criteria.Monovision provides excellent distance and near uncorrected acuities,but with a 17%retreatment and a 5%reversal rate.Initial multifocal ablations result in 12%loss of 2 or more lines of CDVA,and a 21%retreatment rate.Laser Blended Vision provides excellent UDVA,but with a 19%retreatment rate.Initial experiences with Supracor show moderate predictability and a 22%retreatment rate.Intracor results in 9%loss of 2 or more lines of CDVA.KAMRA provides excellent UDVA,with only a 1%retreatment rate,but a 6%reversal rate.Initial experiences with PresbyMAX provided excellent UNVA and DCNVA,showing excellent predictability and a 1%reversal rate.Conclusions:The findings have implications for clinicians and policymakers in the health-care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure.