Corneal astigmatic outcomes after femtosecond laser-assisted cataract surgery combined with surface penetrating arcuate keratotomies

AIM:To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies(FAKs)combined with femtosecond-laser assisted cataract surgery(FLACS)over 12mo follow-up.METHODS:Totally 145 patients with bilateral cataracts and no ocular co-morbidities were recruited to a singlecentre,single-masked,prospective randomized controlled trial(RCT)comparing two monofocal hydrophobic acrylic intraocular lenses.Eyes with corneal astigmatism(CA)of>0.8 dioptres(D)received unpaired,unopened,surface penetrating FAKs at the time of FLACS.Visual acuity,subjective refraction and Scheimpflug tomography were recorded at 1,6,and 12mo.Alpins vectoral analyses were performed.RESULTS:Fifty-one patients(61 eyes),mean age 68.2±9.6y[standard deviation(SD)],received FAKs.Sixty eyes were available for analysis,except at 12mo when 59 attended.There were no complications due to FAKs.Mean pre-operative CA was 1.13±0.20 D.There was a reduction of astigmatism at all post-operative visits(residual CA 1mo:0.85±0.42 D,P=0.0001;6mo:0.86±0.35 D,P=0001;and 12mo:0.90±0.39,P=0.0001).Alpins indices remained stable over 12mo.Overall,the cohort was under-corrected at all time points.At 12mo,61%of eyes were within±15 degrees of pre-operative astigmatic meridian.CONCLUSION:Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective.CA is largely under-corrected in this cohort using an existing unmodified nomogram.The effect of arcuate keratotomies on CA remained stable over 12mo.

Are there sex-based disparities in cataract surgery?

AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.

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.

Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor Eye Gel Combined with Tobramycin Dexamethasone Eye Drops in the Treatment of Dry Eye Syndrome in Patients after Cataract Surgery

Objective:To evaluate the therapeutic effect of recombinant bovine basic fibroblast growth factor(rbFGF)eye gel combined with tobramycin-dexamethasone(TOB-Dex)eye drops on dry eye syndrome(DES)after cataract surgery.Methods:86 patients with DES after cataract surgery,admitted from November 2021 to November 2023,were randomly divided into groups.The observation group included 43 patients treated with rbFGF eye gel combined with TOB-Dex eye drops.The reference group included 43 patients treated with TOB-Dex eye drops alone.Multiple indicators,including total effective rate and clinical symptom scores,were compared between the two groups.Results:The total effective rate in the observation group was higher than in the reference group(P<0.05).Before treatment,there were no differences in clinical symptom scores,serum factors,or disease severity scores between the two groups(P>0.05).Three weeks after treatment,the observation group had lower clinical symptom scores,serum factors,and disease severity scores compared to the reference group(P<0.05).The adverse reaction rate in the observation group was lower than in the reference group(P<0.05).Conclusion:rbFGF eye gel combined with TOB-Dex eye drops can improve the clinical efficacy for patients with DES after cataract surgery,alleviate disease symptoms,reduce inflammatory responses,and have fewer adverse reactions.

Bibliometric analysis of research relating to refractive cataract surgery over a 20-year period:from 2003 to 2022

AIM:To investigate the research trend on refractive cataract surgery,compare the contributions of different countries,institutions,journals,and authors in the past 20y,and explore its potential research hotspots.METHODS:All publications were extracted relating to refractive cataract surgery from 2003 to 2022 from Web of Science.Document types were limited to original articles and reviews,and the language was limited to English.Quantitatively and qualitatively of the publications were analyzed through Microsoft Excel and GraphPad Prism.VOSviewer and CiteSpace were used for bibliometric and visualized analysis.RESULTS:A total of 2090 publications were enrolled.The United States contributed the most publications(434,20.8%),followed by China(345,16.5%)and England(163,7.80%).Publications from the United States were cited more frequently(9552 citations)with the highest H-index of 48.China ranked second in the total number of publications,the papers were not cited that frequently(3237 citations),and the H-index ranked sixth(H-index=29).Journal of Cataract and Refractive Surgery published the most papers(333,15.9%),and the University of London had the highest number of publications(75,3.59%).Dick HB from Germany published the most papers.Corneal astigmatism-related research,cataract surgery methodrelated research,postoperative visual-quality relate to research,and postoperative complications-relate research are the hotspots in this field.The most significant limitation was that the database was updated frequently and the latest publications were not included.CONCLUSION:The bibliometric analysis shows a brief summarization of the contribution of the authors,institutions,countries,and journals.Corneal astigmatism,cataract surgery method,postoperative visual-quality and postoperative complications related researches have become the emerging hotspots,which can give a direction in the future researches.

Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).

Comparison of visual performance with iTrace analyzer following femtosecond laser-assisted cataract surgery with bilateral implantation of two different trifocal intraocular lenses

AIM:To compare the postoperative binocular visual performance with an iTrace analyzer following femtosecond laser-assisted cataract surgery(FLACS)combined with bilateral implantation of two different types of diffractive trifocal intraocular lenses(IOL).METHODS:During this retrospective observational study,patients who received bilateral FLACS combined with implantation of two different types of diffractive trifocal IOLs were evaluated.According to the IOLs’different types and design,the patients were divided into AT LISA tri839MP group(tri839 group)and AcrySof PanOptix TFNT00 group(TFNT group).Study parameters included preoperative and postoperative uncorrected distance visual acuity(UDVA)at 5 m,uncorrected near visual acuity(UNVA)at 30 cm and 40 cm,uncorrected intermediate visual acuity(UIVA)at 60 cm and 80 cm,postoperative refractive status,objective visual qualities and total high order aberrations(HOAs)postoperatively.The postoperative complications were also recorded.RESULTS:Totally 56 eyes of 28 patients(tri839 group,n=26;TFNT group,n=30)were included.Preoperative baseline characteristics between groups were not statistically significantly different.UDVA was not significantly different between groups except for 1wk follow-up due to the postoperative corneal edema.TFNT group showed statistically significant better UNIA at 60 cm than tri839 group at the 1wk(0.05±0.19 vs 0.15±0.10 logMAR,P=0.013),1mo(0.05±0.12 vs 0.15±0.09 logMAR,P=0.001)and 3mo(0.04±0.12 vs 0.15±0.11 logMAR,P=0.001)follow-up,while tri839 group showed statistically significant better UNIA at 80 cm than TFNT group at the 1d(0.14±0.15 vs 0.20±0.14 logMAR,P=0.041)and 1mo(0.09±0.07 vs 0.14±0.10 logMAR,P=0.042)follow-up.Postoperative refractive status showed stable at every visit.Modulated transfer function(MTF)values and strehl ratio(SR)values were improved and HOAs were lower significantly after surgery.CONCLUSION:FLACS with bilateral implantations of both tri839 and TFNT00 can achieve satisfactory natural whole-course vision,high postoperative refractive stability and good visual quality but without significantly difference.iTrace aberration instrument can accurately evaluate the visual quality under different status.

Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery

Dear Editor,We read with interest the Meta-analysis conducted by Chen et al[1]on the clinical outcomes and complication rates between femtosecond laser-assisted cataract surgery(FLACS)and conventional phacoemulsification cataract surgery(CPCS).The authors reported no statistical difference between both methods for all measured complications except posterior capsular tear,with CPCS displaying a higher rate of posterior capsular tear.Since its inception in 2011[2].

Secondary in-the-bag intraocular lens implantation combined with 120-and 360-degree goniotomy in glaucoma following congenital cataract surgery:a case report

Dear Editor,Glaucoma following cataract surgery(GFCS)is one of the most sight-threatening postoperative complications of pediatric cataract surgery,and often becomes refractory to medical treatment[1].Goniotomy has been an increasingly popular procedure for primary open angle glaucoma and primary angle-closure glaucoma with 120-.

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Background: Cataract surgery is the most frequently performed surgery worldwide. Posterior capsule rupture (PCR) remains one of the most common complications of cataract surgery and a major risk factor for poor visual outcomes. Cataract surgeries complicated by PCR and vitreous loss are managed with anterior vitrectomy at the time of surgery. However, the situation can be further complicated by dropping lens particles into the vitreous cavity necessitating a secondary pars plana vitrectomy (PPV). Purpose: To compare the visual outcomes and risk of rhegmatogenous retinal detachment (RRD) between eyes that required anterior vitrectomy (AV) alone for the management of vitreous loss and eyes that required AV and subsequent PPV for the management of dropped nuclear lens fragments (DNLF) following cataract surgery complicated by PCR in a tertiary care teaching hospital in Saudi Arabia. Methods: Medical records of patients in whom PCR occurred during phacoemulsification cataract surgery requiring AV or subsequent PPV for DNLF were retrospectively reviewed over a 6-year period from January 2016 to December 2021. Results: PCR occurred in 183 (2.3%) of 7757 consecutive eyes that underwent phacoemulsification cataract surgery during the study period. Seven eyes were excluded from analysis for missing data or short follow-up. Of the 176 eyes, 147 eyes (83.5%) were managed with AV alone, and the remaining 29 eyes (16.5%) underwent a secondary PPV for DNLF. After excluding eyes with pre-existing ocular pathology, final best-corrected visual acuity (BCVA) was similar in both groups with a mean of 0.32 logMAR (P = 0.99). Two of 147 eyes (1.4%) in the AV group developed RRD with poor final BCVA whereas none of the eyes in DNLF group developed RRD. Conclusion: The risk of RRD is lower in eyes that required PPV for DNLF than in eyes that were managed with AV alone following PCR during cataract surgery. The poor visual outcomes in eyes that suffered RRD underscore the importance of postoperative retinal examination and early detection of retinal breaks.

Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus

BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS Patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery,and TIMP-2 Levels remained stable in both groups.IL-20 content started to increase in the third week after surgery.CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation,which indicated more severe postoperative inflammation in the first two weeks.

Combination of cataract surgery with intravitreal injection of dexamethasone intravitreal implant(Ozurdex)for uveitis-induced cataract

AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHODS:The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),anterior chamber reaction,central macular thickness(CMT),intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively.RESULTS:A successful surgery was performed in all patients.The average follow-up period was 12mo.The female/male ratio was 13/13.Mean age was 45.65±3.83y(range 26 to 65y).Etiologically,rheumatic arthritis occurred in 6 patients(18.75%),ankylosing spondylitis in 4(12.50%),HLA-B27 associated uveitis in 3(9.38%),Vogt-KoyanagiHarada-associated uveitis in 4(12.50%),Behcet’s disease in 2(6.25%),and 7(21.88%)suffered from unknown diseases.All 32 eyes had varying degrees of improvement at 12mo after surgery,with 2 eyes showing BCVA of 0.1 or below(6.25%),6 having 0.1-0.5(18.75%),18 of 0.5-1.0(56.25%),and 6 of 1.0 or above(18.75%).No cases with increased IOP were observed.The values of mean CMT was increased at day 1,decreased at 1,3mo after surgery and increased at 6,12mo after surgery.No severe uveitis reactions,such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL,were observed after surgery.CONCLUSION:The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.

Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials

AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery

AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

Application Experience of Eyesi Operation Simulation Training System in the Teaching of Cataract Surgery for Ophthalmology Masters

Objective:To explore the application effect of the Eyesi surgical simulator in the teaching of cataract surgery for professional ophthalmology postgraduate students.Methods:The professional postgraduate students who were trained in the third year of ophthalmology at the First Affiliated Hospital of Xi’an Medical University were selected as the research objects.After passing the theoretical examination,they were randomly divided into the pig eyeball group,Eyesi group,and pig eye+Eyesi group,with 5 students in each group.The pig eyeball,Eyesi surgery simulator,and pig eye+Eyesi surgery simulator were used for microscopic technique operation and cataract surgery steps training,respectively.After the training,the overall training effects of the three groups of postgraduates were scored,and questionnaires were used to objectively evaluate the three training methods.Results:The scores of the students in the pig eye+Eyesi group were better than those in the Eyesi group,and the students in the Eyesi group were better than those in the pig eyeball group.Conclusion:The Eyesi surgical simulation training system can evaluate the microsurgical skills of professional masters and improve their surgical skills.This system is of great significance for the training of the cataract surgery skills of professional masters.

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs’endothelial dystrophy patients:a randomized pilot study with 6mo follow up

AIM:To compare the corneal outcome in Fuchs’endothelial dystrophy(FED)patients between femtosecond laser-assisted cataract surgery(FLACS)and conventional phaco surgery(CPS).METHODS:This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS(stop and chop technique)in FED patients.Central corneal thickness,corneal light backscatter,corneal densitometry,and central corneal endothelial cell count and hexagonality(noncontact endothelial cell microscope),and corrected distance visual acuity(CDVA)were assessed preoperatively and at day 1,40,and 180 postoperatively.RESULTS:Totally 31 patients(16 women)were included.At day 40 postoperatively,the mean endothelial cell loss(ECL)was 23.67%by FLACS and 17.30%by CPS(P=0.53).At day 180 postoperatively,ECL was 25.58%in FLACS and 21.32%in CPS(P=0.69).Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2,2-6,6-10 and 10-12,total densitometry with all layers and all annuli was performed.A significant difference was found in 6-10(posterior layer)at day 1 with-1.42 grayscale units(GSU;95%CI:-2.66 to-0.19,P=0.02).In 10-12(anterior layer,central layer and all layers)at day 40 were significant different with 7.7(95%CI:1.89 to 13.50,P=0.009),3.97(95%CI:0.23 to 7.71,P=0.03),4.73 GSU(95%CI:0.71 to 8.75,P=0.02),respectively.In the remaining parameters we found no difference between the two groups(P>0.05).Three CPS eyes suffered from corneal decompensation.CONCLUSION:There is no significant difference in corneal outcome between FLACS and CPS.Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

Assessment of visual outcomes of cataract surgery in Tujia nationality in Xianfeng County, China

AIM: To evaluate the visual outcome and factors influencing visual outcome of manual small incision cataract surgery(MSICS) in the rural area in the Xianfeng County.METHODS: Eighty-two eyes of 82 patients who underwent cataract surgery performed by using MSICS technique were identified. Data collected included each patient’s age, gender, the level of education. Uncorrected and corrected distance visual acuity(UDVA and CDVA) at presentation and at 1, 6, 8wk postoperatively, pre-existing eye disease, operative findings and complications, the risk factors were evaluated.RESULTS: In 82 patients, the average age was 69.6±0.6y, illiterate were 52(63.4%). Of 82 eyes, pseudophakia was present in 77 eyes(93.9%). At 1wk postoperatively,47 eyes(57.3%) had the UDVA of ≥6/18, and 52 eyes(63.4%) had the CDVA of ≥6/18. At 6 to 8wk postoperatively, 50 eyes(61.0%) had UDVA of ≥6/18, and57 eyes(69.5%) had the CDVA of ≥6/18. Postoperative visual status was significantly related to the co-morbidities, such as corneal pathology, glaucoma(P 【0.001).Operative complications, such as posterior capsule opacity and cystoid macular edema were main operative cause for the poor visual outcome.CONCLUSION: MSICS provides a good visual recovery in our study but the vision outcome did not fulfill the standards proposed by WHO, which highlights the need for an improvement in local socioeconomic understanding, population education and surgery quality.

Efficacy of recombinant human epidermal growth factor plus sodium hyaluronate eye drops in diabetic dry eye post-cataract surgery

BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.