Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post-cataract surgery patients

AIM： To evaluate the safety of therapeutic bandage contact lens for post-cataract surgery patients and to illustrate its efficacy on post-operative comfort and tear-film stability. METHODS： A total of 40 participants were recruited and randomly divided into two groups. Group one was instructed to wear bandage contact lenses for a week and use antibiotic eye drops for a month since the first day after surgery. Group two received sub-conjunctival injection of tobramycin and was asked to wear eye pads on the first day after surgery and then were instructed to use antibiotic eye drops as the first group did. Ocular surface disease index（OSDI） questionnaire, slit-lamp microscope examination of tear break-up time（TBUT）, corneal fluorescein score（CFS）, tear meniscus height（TMH） together with anterior segment optical coherence tomography（AS-OCT） and corneal topography were evaluated preoperatively and postoperatively. RESULTS： The subjective feeling（P=0.004）, TBUT（P〈0.001） and TMH（P=0.02） post-surgery had improved in patients who used bandage contact lenses compared with those who did not at 1wk post-surgery. Until three month postoperatively, the comfort degree（P=0.004） and TMH（P=0.01） of group two were still worse than group one. Moreover, TBUT（P〈0.001） and CFS（P=0.004） of the group with eye pads got worse than the results before, whereas the group with bandage contact lenses recovered to normal. None of these patients had infections or other complications. CONCLUSION： Wearing therapeutic bandage contact lens after cataract surgery, compared with traditional eye-pads, is a safe method to improve tear-film stability and reduce post-operative discomfort without hindering corneal incision recovery.

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

The effect of lens aging and cataract surgery on circadian rhythm

Many organisms have evolved an approximately 24-hour circadian rhythm that allows them to achieve internal physiological homeostasis with external environment.Suprachiasmatic nucleus（SCN） is the central pacemaker of circadian rhythm,and its activity is entrained to the external light-dark cycle.The SCN controls circadian rhythm through regulating the synthesis of melatonin by pineal gland via a multisynaptic pathway.Light,especially shortwavelength blue light,is the most potent environmental time cue in circadian photoentrainment.Recently,the discovery of a novel type of retinal photoreceptors,intrinsically photosensitive retinal ganglion cells,sheds light on the mechanism of circadian photoentrainment and raises concerns about the effect of ocular diseases on circadian system.With age,light transmittance is significantly decreased due to the aging of crystalline lens,thus possibly resulting in progressive loss of circadian photoreception.In the current review,we summarize the circadian physiology,highlight the important role of light in circadian rhythm regulation,discuss about the correlation between age-related cataract and sleep disorders,and compare the effect of blue light-filtering intraocular lenses（lOLs） and ultraviolet only filtering lOLs on circadian rhythm.

The effect of cataract surgery on sleep quality:a systematic review and Meta-analysis

AIM： To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultravioletblocking clear intraocular lens（UVB-IOL） and blue-filtering intraocular lens（BF-IOL） implantation.METHODS： Electronic search was performed of PubM ed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index（PSQI）. A random/fixed-effects Metaanalysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS： Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3 mo [mean difference（MD） =-0.62, 95%CI：-1.14 to-0.11, P=0.02, I2=66%] and 3-12 mo（MD=-0.32, 95%CI：-0.62 to-0.02, P=0.04, I2=0）, respectively. Considering different intraocular lens（IOL） implantations, relative postoperative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION： This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.

Refractive lens exchange in modern practice: when and when not to do it?

Cataract surgery due to advances in small incision surgery evolved from a procedure concerned with the primary focus on the safe removal of cataractous lens to a procedure focused on the best possible postoperative refractive result.As the outcomes of cataract surgery became better,the use of lens surgery as a refractive modality in patients without cataracts has increased in interest and in popularity.Removal of the crystalline lens for refractive purposes or refractive lens exchange(RLE)presents several advantages over corneal refractive surgery.Patients with high degrees of myopia,hyperopia and astigmatism are still not good candidates for laser surgery.Moreover,presbyopia can currently only be corrected with monovision or reading spectacles.RLE supplemented with multifocal or accommodating intraocular lenses(IOLs)in combination with corneal astigmatic procedures might address all refractive errors including presbyopia,and eliminate the future need for cataract surgery.