Risk factors for corneal endothelial cell loss after phacoemulsification.

PURPOSE: The purpose of this study was to evaluate the changes in corneal endothelial cell density (CECD) occurring after cataract phacoemulsification surgery and identify factors associated with cell loss. MATERIALS AND METHODS: This was a retrospective study involving patients who underwent cataract phacoemulsification surgery between January 1, 2018, and December 31, 2018, at two private hospitals. Demographic data and biometric parameters were obtained preoperatively. Ultrasound metrics were recorded for each operation, including total on time (TOT), total equivalent power in position 3, and cumulative dissipated energy (CDE). Using corneal specular microscopy, CECD was measured preoperatively and postoperatively at 12, 24, and 36 months. Factors associated with decreased CECD were identified. RESULTS: This study included 223 eyes of 133 patients. The mean CECD was 2530.03 ± 285.42 cells/mm2 preoperatively and significantly decreased to 2364.22 ± 386.98 cells/mm2 at 12 months (P < 0.001), 2292.32 ± 319.72 cells/mm2 at 24 months (P < 0.001), and 2242.85 ± 363.65 cells/mm2 at 36 months (P < 0.001). The amount of cell loss was associated with age, gender, preoperative CECD, preoperative anterior chamber depth, lens thickness, TOT, and CDE. Using multivariate analysis, age, preoperative CECD, and TOT were identified as independent predictors for CECD loss 12 months after surgery. CONCLUSION: The greatest decrease in CECD occurred during the first year after cataract surgery, and the amount of cell loss was influenced by both baseline patient characteristics and ultrasound metrics. Longer-term prospective studies in a larger cohort may yield more information.

Acute angle closure glaucoma misdiagnosed as sinusitis.

A 69-year-old woman developed severe right suprabulbar pain with blurred right-sided vision. There were no haloes around lights, photophobia, nausea or vomiting. Investigations in the emergency department excluded a posterior communicating/internal carotid artery aneurysm. However, she did not have an ophthalmological assessment and the initial diagnosis was of sinusitis-related headache. An urgent ear, nose and throat assessment found no abnormality, but a local ophthalmologist subsequently diagnosed and managed the patient's acute angle closure crisis. Periocular pain always deserves detailed assessment with an accurate history, visual acuity assessment and intraocular pressure measurement.

Temporal arteritis presenting with facial swelling and a negative temporal artery biopsy.

A man in his 60s presented to the emergency department with marked bilateral preauricular swelling, associated with jaw claudication, temporal tenderness and blurred vision. He was immediately treated for temporal arteritis by commencing systemic corticosteroids. A temporal artery biopsy showed no evidence of vasculitis. However, positron emission tomography-CT demonstrated increased uptake in the medium-large vessels, including the left superficial temporal artery and aorta. This case illustrates that facial swelling may be an under-recognised presenting feature of temporal arteritis, and that a negative temporal artery biopsy does not always rule out a diagnosis of temporal arteritis, and should not delay treatment.

Changes in corneal endothelial cell density after trabeculectomy.

BACKGROUND: Glaucoma is a leading cause of blindness worldwide for which trabeculectomy is the most effective surgical intervention for advanced disease. However, trabeculectomy has been associated with alterations to corneal endothelium, including a decrease in corneal endothelial cell density (CECD). The purpose of this study was to investigate changes in CECD after trabeculectomy, and identify factors contributing to cell loss, such as pre-operative biometry and lens status. METHODS: This retrospective study included 72 eyes of 60 patients who underwent trabeculectomy between January 2018 and June 2021 at two private hospitals. Demographic and clinical data were obtained at baseline. Corneal specular microscopy was performed pre-operatively and at 6 months after surgery. CECD was evaluated and compared between groups to quantify changes to corneal endothelium and identify significant factors affecting decreases in cell density. RESULTS: Mean CECD was 2284.66 ± 375.59 pre-operatively and 2129.52 ± 401.96 after 6 months (p < 0.001). A greater decrease in CECD (p = 0.005) was observed in phakic eyes (235.45 ± 118.32) compared to pseudophakic eyes (137.82 ± 107.30). The amount of cell loss was negatively correlated with pre-operative central corneal thickness (p = 0.009) and anterior chamber (AC) depth (p = 0.033). There were no significant correlations between changes to CECD and patient age, gender, number of pre-operative glaucoma medications and number of post-operative antifibrotic agents. CONCLUSIONS: Significant decreases in CECD occurred after trabeculectomy. Less corneal endothelial cell loss occurred in pseudophakic eyes. Hence, if patients need trabeculectomy and cataract surgery, it may be better to perform cataract surgery first. Longer term studies should derive more information.

Factors contributing to long-term refractive error after cataract surgery.

PURPOSE: To evaluate factors that may influence the direction and extent of long-term refractive error after cataract surgery. METHODS: This was a retrospective observational study conducted across two private practices in Sydney, NSW, Australia. The study population consisted of patients who underwent cataract phacoemulsification surgery between January 1 and December 31, 2018. Patients who received cataract surgery combined with another procedure were excluded. Demographic and biometric data including anterior chamber depth (ACD), keratometry, central corneal thickness, axial length (AL) and lens thickness were obtained pre-operatively. Spherical equivalent (SEQ) refraction was measured at 2 months and 3 years after surgery and compared with target refraction. Factors associated with refractive error were analyzed. RESULTS: This study included 221 eyes of 122 patients. A refractive error within 1.00 D was achieved in 217 eyes (98.2%) at 3 years post-operatively. Mean prediction error decreased significantly between 2 months and 3 years after surgery irrespective of whether eyes were more myopic (p < 0.001) or more hypermetropic than predicted (p < .0001). Pre-operative ACD and ACD-to-AL ratio were significantly associated with SEQ prediction error. CONCLUSION: After cataract surgery, refractive outcomes may be influenced by ACD and ACD-to-AL ratio. The pre-operative assessment of these risk factors may better inform IOL selection in individual patients. Prospective studies in a larger cohort are required.

Changes in refraction after cataract phacoemulsification surgery.

PURPOSE: After cataract phacoemulsification surgery, spherical equivalent refraction (SER) may be affected by factors including corneal curvature, effective lens position and axial length. While refractive outcomes have been assessed in the immediate post-operative period, longer-term changes in refraction have not been reported. The purpose of this study was to investigate the timeline changes in refraction after cataract surgery over a period of 3 years. METHODS: This was a retrospective observational study that included 344 eyes of 204 patients who underwent cataract emulsification surgery between 1 January and 31 December 2018 at two private hospitals. Keratometry, anterior chamber depth (ACD), central corneal thickness (CCT) and axial length were measured at baseline and post-operatively at 1 month, 1 year, 2 years and 3 years. Changes in SER and ocular parameters were assessed at each post-operative timepoint. RESULTS: Between 1 month and 3 years post-operatively, an overall myopic shift (0.32 ± 0.21 D, p < 0.001) occurred in 33.6% of eyes and a hypermetropic shift in 45.2% of eyes (0.35 ± 0.22 D, p < 0.001). In 21.2% of eyes, there was no reported change in SER between 1 month and 3 years. Significant changes in ACD (p = 0.04) and CCT (p < 0.001) occurred during the first year after surgery. CONCLUSION: The 3-year timeline changes in SER after cataract surgery were evaluated. As hypermetropic shift was the most common refractive change observed, it may be beneficial to aim for a more myopic post-operative refraction target. Patients should be advised of the potential for refractive changes after surgery.

Predicting 2-year survival in stage I-III non-small cell lung cancer: the development and validation of a scoring system from an Australian cohort.

BACKGROUND: There are limited data on survival prediction models in contemporary inoperable non-small cell lung cancer (NSCLC) patients. The objective of this study was to develop and validate a survival prediction model in a cohort of inoperable stage I-III NSCLC patients treated with radiotherapy. METHODS: Data from inoperable stage I-III NSCLC patients diagnosed from 1/1/2016 to 31/12/2017 were collected from three radiation oncology clinics. Patient, tumour and treatment-related variables were selected for model inclusion using univariate and multivariate analysis. Cox proportional hazards regression was used to develop a 2-year overall survival prediction model, the South West Sydney Model (SWSM) in one clinic (n = 117) and validated in the other clinics (n = 144). Model performance, assessed internally and on one independent dataset, was expressed as Harrell's concordance index (c-index). RESULTS: The SWSM contained five variables: Eastern Cooperative Oncology Group performance status, diffusing capacity of the lung for carbon monoxide, histological diagnosis, tumour lobe and equivalent dose in 2 Gy fractions. The SWSM yielded a c-index of 0.70 on internal validation and 0.72 on external validation. Survival probability could be stratified into three groups using a risk score derived from the model. CONCLUSIONS: A 2-year survival model with good discrimination was developed. The model included tumour lobe as a novel variable and has the potential to guide treatment decisions. Further validation is needed in a larger patient cohort.