A Randomized, Prospective, Observer-Masked Study Comparing Dropless Treatment Regimen Using Intracanalicular Dexamethasone Insert, Intracameral Ketorolac, and Intracameral Moxifloxacin versus Conventional Topical Therapy to Control Postoperative Pain and Inflammation in Cataract Surgery.

Purpose: To evaluate clinical efficacy and patient preference for a dropless treatment regimen compared to conventional topical therapy in patients undergoing cataract surgery. Patients and Methods: In this prospective, contralateral eye study, patients with bilateral cataract were randomized to receive either intracanalicular dexamethasone insert, intracameral phenylephrine 1%/ketorolac 0.3%, and intracameral moxifloxacin (50 µg) (study group) or topical moxifloxacin 0.5%, ketorolac 0.5%, and prednisolone acetate 1.0% QID (control group). The second eye underwent cataract surgery 2 weeks later and was treated with the opposite treatment. All patients were evaluated at Days 1, 7, 14, 28, and 3 months. The primary outcome measure was postoperative ocular pain. Secondary outcomes included summed ocular inflammation score (SOIS; the sum of the mean anterior chamber cells and anterior flare score), the patient preference for medication protocol between the two eyes, and patient out-of-pocket cost of medications. Safety outcome measures included CDVA, intraocular pressure, central retinal thickness (CRT), and the incidence of reported AEs. Results: The proportion of patients with no pain was similar in both groups at all postoperative visits (p>0.05). No statistically significant difference in SOIS score was observed between the two groups at any visit. A strong majority of the patients (94.7%) preferred the study eye's dropless regimen over the control eye's conventional topical therapy regimen. No statistically significant difference in mean intraocular pressure (IOP) was observed at any postoperative visit, except at Week 1. The mean CDVA was also similar in both groups at all postoperative visits (p>0.05). The postoperative mean CRT was comparable between the two groups. Conclusion: A dropless treatment regimen is as effective as topical eyedrop administration. A higher proportion of patients who underwent bilateral cataract surgery preferred the dropless treatment regimen over the patient-administered eye drop regimen.

Radial keratotomy and cataract surgery: A quest for emmetropia.

A 75-year-old man with an ocular history of 8-cut radial keratotomy (RK) in both eyes presented for cataract surgery evaluation. He was previously correctable in spectacles in years prior despite his irregular corneas to 20/25 in the right eye and 20/30 in the left eye. He recently noticed a change in his overall visual function with significant nighttime glare and difficulty reading despite spectacle correction. Of note, he was unable to tolerate contact lenses and was resistant to refitting despite additional encouragement. Cataract surgery was delayed for many years, given he was correctable in spectacles and the concern of uncovering a highly aberrated cornea after removing his cataracts (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202308000-00021/figure1/v/2023-07-21T030437Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202308000-00021/figure2/v/2023-07-21T030437Z/r/image-tiff). Of note, the patient was interested in returning to the spectacle independence he enjoyed in the past. Ocular examination revealed a corrected distance visual acuity (CDVA) of 20/30 in the right eye and 20/60 in the left eye, with a manifest refraction of +4.50 -0.50 × 177 in the right eye and +5.75 -1.75 × 14 in the left eye. Glare testing was 20/50 in the right eye and 20/100 in the left eye, with retinal acuity meter testing of 20/25 in each eye. Pupils, confrontation visual fields, and intraocular pressures were normal. Pertinent slitlamp examination revealed corneal findings of 8-cut RK with nasal-gaping arcuate incisions in both eyes and lens findings of 2+ nuclear sclerosis with 2+ cortical changes in the right eye and 3+ nuclear sclerosis with 3+ cortical changes in the left eye. Cup-to-disc ratios of the optic nerves measured 0.5 with temporal sloping in the right eye and 0.6 with temporal sloping in the left eye. The dilated fundus examination was unremarkable. What intraocular lens (IOL) options would you offer this patient and how would you counsel regarding realistic expectations? What additional diagnostic testing would be helpful in your assessment? How would you calculate the IOLs?

Accuracy of the LaserArcs Femtosecond Cataract Surgery Arcuate Incision Nomogram in Patients Undergoing Cataract Surgery and Astigmatism Reduction.

Purpose: The purpose of this study is to evaluate the efficacy and safety of the laserarcs.com nomogram in reducing astigmatism among cataract patients that underwent astigmatism reduction with laser arcuate incisions. Methods: In this retrospective study, 50 patients who underwent uncomplicated cataract surgery with laser arc incisions for the reduction of astigmatism with a single surgeon between the dates of January 23, 2021 and February 10, 2022 were evaluated in a single eye. Preoperative astigmatism was determined on the basis of keratometry from biometry (IOLmaster, Carl Zeiss Meditec or LenStar LS900, Haag-Streit, Bern, Switzerland) and was compared to the postoperative manifest astigmatism. The percent change in the absolute magnitude of astigmatism was calculated along with the percent of patients with various levels of postoperative astigmatism. Results: Mean cylinder was 0.97 ± 0.49 D pre-op and 0.21 ± 0.28 D postop. Mean reduction in cylinder was 81.4 ± 47.7% (P < 0.00001, one-sample t-test compared to a hypothetical 60% reduction in cylinder). Residual cylinder was ≤0.5 D in 90%, 0.25 D in 72%, and 0 D in 58%. Postoperative uncorrected visual acuity was 20/30 or better in 92% and 20/20 or better in 40%. Subgroup analysis showed that residual astigmatism was not affected by patient age, magnitude of preoperative astigmatism, preoperative spherical equivalent, or corneal curvature. No adverse events related to the laser arcuate incisions were noted. Conclusion: Use of the LaserArcs nomogram yielded a significant reduction in preoperative astigmatism. Postoperative uncorrected visual acuity was substantially similar to best-corrected visual acuity, suggesting that many patients undergoing treatment will function without correction for distance tasks.

Intracameral dexamethasone 9% vs prednisolone acetate 1% in controlling postoperative pain and inflammation in patients undergoing cataract surgery.

PURPOSE: To compare patient preferences of postoperative cataract surgery topical medication use between a 1-drop and a 3-drop regimen. SETTING: Two private cataract surgery centers. DESIGN: Open-label randomized self-controlled prospective study. METHODS: This study included 30 patients (60 eyes) undergoing routine cataract surgery in both eyes. In this contralateral eye study, 1 eye of each patient was randomized to the 1-drop regimen of intracameral delivery of moxifloxacin and dexamethasone suspension and topical bromfenac for 30 days. The other eye, randomized to the 3-drop regimen, received topical moxifloxacin 0.5% 4 times a day for 7 days and bromfenac 0.07% daily for 30 days postoperatively, along with prednisolone acetate 1% 4 times a day for 30 days. Patients reported their preferred regimen 2 weeks after the second surgery with a validated questionnaire. Secondary outcomes included subjective ocular pain, inflammation score, and out-of-pocket cost. Intraocular pressure (IOP) and macular thickness were also measured. RESULTS: Of the 29 patients, 28 (96.6%) significantly more preferred the eye treated with a 1-drop regimen. Self-reported pain, activity interference, and out-of-pocket cost were significantly less in the 1-drop group. Inflammation and 1-day uncorrected distance visual acuity were also significantly better in the 1-drop group. Macular thickness and mean IOP were similar between groups. CONCLUSIONS: Intracameral delivery of steroid and antibiotics was preferred by most of the patients undergoing cataract surgery. These eyes had significantly less pain, inflammation, activity interference, and out-of-pocket cost and significantly better uncorrected distance visual acuity at 1 day postoperatively. IOP and macular thickness were similar between groups.

The Vivity Extended Range of Vision IOL vs the PanOptix Trifocal, ReStor 2.5 Active Focus and ReStor 3.0 Multifocal Lenses: A Comparison of Patient Satisfaction, Visual Disturbances, and Spectacle Independence.

PURPOSE: To compare patient-reported outcomes (PROs) after intraocular lens (IOL) implantation with the AcrySof IQ Vivity IOL or Vivity Toric IOL to those achieved with other multifocal IOLs. PATIENTS AND METHODS: Prospective, open-label, multicenter analysis of PROs, including spectacle independence, dysphotopsia, and overall satisfaction among patients who underwent cataract surgery at least 1 month previously with bilateral Vivity or Vivity Toric lenses (n=60). Results were compared to outcomes from two similar prospective studies of bilateral AcrySof IQ PanOptix or PanOptix Toric trifocal IOLs (n = 59), blended AcrySof ReSTOR 2.5/3.0 IOLs (n=72) or bilateral ReSTOR ActiveFocus 2.5 D IOLs with a mini-monovision target [n = 95]). RESULTS: Patients in the Vivity cohort were significantly less likely to notice glare and halo in dim light (85% "none" or "just a little") compared to PanOptix (69%, p<0.03), 2.5 mini-monovision (75%, p< 0.05) or 2.5/3.0 (71%, p< 0.05) patients. Complete spectacle independence for all visual activities combined (never need glasses) with Vivity was comparable to the mini-monovision and 2.5/3.0 groups (33%, 36%, and 31%, respectively) but significantly lower than in the PanOptix cohort (83%, p < 0.0001). Satisfaction was high across all groups. There were no statistically significant differences in best-corrected visual acuity, and no new safety concerns were reported. CONCLUSION: The AcrySof IQ Vivity extended depth of focus IOL offers an expanded range of vision and better spectacle independence than has typically been achieved with traditional monofocal IOLs, with high rates of satisfaction and a favorable dysphotopsia profile compared to diffractive multifocal IOLs.

Effect of Cyclosporine 0.09% Treatment on Accuracy of Preoperative Biometry and Higher Order Aberrations in Dry Eye Patients Undergoing Cataract Surgery.

PURPOSE: To determine the effect of topical cyclosporine 0.09% on ocular surface regularity and the predictive accuracy of preoperative corneal power measurements in patients undergoing cataract surgery. SETTING: Private practice. DESIGN: Open-label, multicenter, prospective study. METHODS: Seventy-five patients (75 eyes) who presented for cataract surgery evaluation with signs of dry eye disease were prescribed topical cyclosporine 0.09% for 28 days BID. Corneal curvature measurements, slit lamp exam, and Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire were evaluated at the initial and follow-up visits. Cataract surgery occurred 1 to 3 weeks after the second biometry visit. Refraction and corrected distance visual acuity measurements were performed 1-month post-surgery. The primary outcome was the difference in absolute prediction error of 1-month spherical equivalent refractive outcome before and after cyclosporine treatment. Secondary outcomes included the effect of topical cyclosporine 0.09% on ocular surface irregularity. RESULTS: Sixty-four patients completed the study. The absolute prediction error of 1-month spherical equivalent refractive outcome was 0.39 ± 0.30 D vs 0.33 ± 0.25 D (P < 0.03) before and after treatment, respectively. The proportion of eyes that achieved the target refraction was greater based on measurements after topical cyclosporine 0.09% than would have occurred using pre-treatment measurements. CONCLUSION: Cataract surgery patients with dry eye who are prescribed topical cyclosporine 0.09% BID for 28 days pre-surgery showed a statistically significant improvement in the prediction error of the spherical equivalent outcome of surgery. Other measures of dry eye severity showed significant improvements after treatment.

Comparison of Preoperative Measurements with Intraoperative Aberrometry in Predicting Need for Correction in Eyes with Low Astigmatism Undergoing Cataract Surgery.

PURPOSE: To determine whether intraoperative aberrometry during cataract surgery measures higher levels of absolute astigmatism than preoperative biometry readings and which method yields a lower, final level of astigmatism if the two do not agree. PATIENTS AND METHODS: Retrospective record review of all patients who underwent uncomplicated cataract surgery from February 2015 to May 2019 with planned intraoperative aberrometry. Data analysis included preoperative keratometry, total astigmatism as measured by intraoperative aberrometry, intraocular lens model and power used, and postoperative manifest refraction ≥1 month after surgery. The primary outcome measure was the proportion of patients requiring astigmatism correction (≥0.5 D) when measured by preoperative keratometry vs intraoperative aberrometry. Secondary outcomes included postoperative residual astigmatism, where adjusted preoperative astigmatism fell below the 0.5 D threshold for treatment but the intraoperative measurement was ≥0.5 D or ≥1.0 D. RESULTS: A total of 451 patient records were evaluated. Intraoperative aberrometry measured statistically higher levels of mean astigmatism than keratometry (0.86 D vs 0.79 D, respectively; P < 0.0001) and significantly greater astigmatism among patients with 0.5-1.5 D of adjusted preoperative astigmatism (P < 0.0001). Significantly more patients qualified for with-the-rule astigmatism correction when measured by intraoperative aberrometry (n=339; 75%) than by preoperative keratometry alone (n=314; 70%); P < 0.03. This difference did not hold for against-the-rule or oblique astigmatism. For patients whose preoperative biometry astigmatism differed from intraoperative biometry, final postoperative astigmatism was lower when corrected if the adjusted preoperative and intraoperative measurements had a vector difference of <0.5 D, but there was no additional benefit in final astigmatism reduction when the vector difference was ≥0.5 D. CONCLUSION: Using intraoperative biometry readings can produce lower postoperative astigmatism than using preoperative biometry readings, but caution should be used when interpreting intraoperative readings that disagree with preoperative measurements with a vector magnitude of >0.5 D.

The PanOptix Trifocal IOL vs the ReSTOR 2.5 Active Focus and ReSTOR 3.0-Add Multifocal Lenses: A Study of Patient Satisfaction, Visual Disturbances, and Uncorrected Visual Performance.

PURPOSE: To compare spectacle independence, patient-reported outcomes (PROs), and dysphotopsia after multifocal intraocular lens (IOL) implantation with the AcrySof PanOptix trifocal or the ReSTOR +2.5/3.0 D or ReSTOR +2.5 D mini-monovision multifocal IOL. PATIENTS AND METHODS: Prospective, open-label, multicenter analysis of PROs, spectacle independence, and satisfaction among patients undergoing cataract surgery who had been implanted at least 1 month previously with AcrySof IQ PanOptix or PanOptix Toric trifocal (n = 59) IOLs bilaterally. Results were compared to outcomes from a similar study with the AcrySof ReSTOR 2.5/3.0 or the ReSTOR ActiveFocus 2.5 mini-monovision lens [n = 191]). RESULTS: Spectacle independence was significantly higher in the PanOptix cohort, with 83% of patients "never" needing glasses for any activity versus 36% in the ReSTOR 2.5 mini-monovision and 34% in the ReSTOR 2.5/3.0 cohorts. No significant differences in patient satisfaction rates were reported between the three cohorts. Glare and halo were rated "extremely" noticeable more with the PanOptix (10%) than with the ReSTOR 2.5 mini-monovision (1%) or ReSTOR 2.5/3.0 (3%). BCVA differences were not statistically significant, and no new safety concerns were reported. CONCLUSION: The AcrySof PanOptix trifocal provides significantly greater spectacle independence across all measured activities than the AcrySof ReSTOR multifocal IOLs.

Pterygium Surgery Utilizing Limbal Conjunctival Autograft and Subconjunctival Amniotic Membrane Graft in High-Risk Populations.

OBJECTIVE: To measure the outcomes of primary pterygium excision with a limbal conjunctival autograft when combined with the adjunctive use of a prophylactic subconjunctival graft of amniotic membrane to decrease the recurrence rate after surgery in an ethnically diverse population with a statistically higher risk for recurrence (African American, Asian, Caribbean, Asian, Latin). DESIGN: This is a retrospective, non-comparative study of post-operative outcomes. PARTICIPANTS: A total of 355 patients, totaling 493 eyes, with clinically significant, primary pterygia. PATIENTS AND METHODS: Patients were enrolled into the study based on the need for pterygium surgery and if they underwent primary pterygium excision with conjunctival autograft with subconjunctival amniotic membrane placement. Patients with recurrent pterygium or those with pseudopterygium were excluded from this study. All surgeries took place at the Florida Eye Microsurgical Institute (Boynton Beach, FL) between June 2006 and October 2013 by a single surgeon (BAS). Patients were seen on post-operative day 1, 7, 30, 90, 180 and 365 to evaluate for pterygium recurrence. Pterygium recurrence is defined in this study as growth greater than 1 mm past the corneal limbus at or after 6 months. RESULTS: There were six cases of recurrent pterygium for a recurrence rate of 1.22% ± 0.97% (n=493, p=0.05). Follow-up ranged from 6 months to 6 years (mean 28 months). CONCLUSION: Primary pterygium excision with a limbal conjunctival autograft and placement of a subconjunctival amniotic membrane graft has a low recurrence rate consistent with previously published data.

Patient-Reported Outcomes/Satisfaction and Spectacle Independence with Blended or Bilateral Multifocal Intraocular Lenses in Cataract Surgery.

PURPOSE: To compare patient-reported outcomes (PROs) and satisfaction results after multifocal intraocular lens (IOL) implantation in three groups: two receiving bilateral implantation of the same IOL and another undergoing blended vision with two different multifocal IOLs. PATIENTS AND METHODS: A questionnaire was administered to patients who had undergone uncomplicated cataract surgery and 2 months of follow-up: the first group underwent bilateral implantation with Alcon's AcrySof ReSTOR 3.0 lens ("3.0/3.0," n=78); the second group underwent implantation with the ReSTOR ActiveFocus 2.5 or the ReSTOR ActiveFocus 2.5 toric lens ("2.5 mini-monovision," n=102); and the third group underwent implantation with the ReSTOR 2.5 lens in the dominant eye and the ReSTOR 3.0 lens in the non-dominant eye ("2.5/3.0," n=89). RESULTS: Overall PROs and satisfaction was similar among the groups. Refractive outcomes and accuracy were similar among the groups, but the 2.5 mini-monovision group reported better intermediate vision. Refractive outcome differences were not meaningful among the groups and were not a differentiating factor in PROs. Substantially fewer patients in the 2.5 mini-monovision group noticed glare and halo compared with the 3.0/3.0 group (P<0.0001, chi-square test). No new safety concerns were reported. CONCLUSION: The 2.5 mini-monovision results in a higher percentage of patients being satisfied with intermediate vision than bilateral ReSTOR 3.0 or blended vision with ReSTOR 2.5/3.0 implants, but overall PRO differences were not statistically significant.

Patient-reported outcomes of multifocal and accommodating intraocular lenses: analysis of 117 patients 2-10 years after surgery.

PURPOSE: The purpose of this study was to determine the satisfaction levels of patients at least 2 years after cataract surgery implantation with bilateral accommodating or bilateral multifocal intraocular lenses (IOLs) and to determine the relative rate of spectacle independence and adverse symptoms in that same time frame. DESIGN: Patient questionnaire administered in a single-center private practice at least 2 years after cataract surgery with presbyopia-correcting IOL implantation. METHODS: Patients who had undergone uncomplicated cataract surgery with an accommodating or multifocal IOL implant were eligible for inclusion. Patients with visually significant non-IOL-related postoperative morbidity were excluded. Patients with astigmatism or residual refractive error were not excluded. The main outcome measure was patient satisfaction at least 2 years after IOL implantation. RESULTS: Sixty-eight patients who received accommodating lenses and 49 patients who received multifocal lenses completed the questionnaire. The mean age of all patients was 75.7 years at the time of survey; the mean number of years since cataract surgery was 5.4 years. Overall, there were no significant differences between the two groups or within each group between the different lenses used. About 90% of patients in each group were "very satisfied" or "somewhat satisfied" with their vision at least 2 years after the initial surgery. Conversely, only one in eleven patients found his vision to be worse than expected. CONCLUSIONS: The majority of patients who received either accommodating or multifocal IOLs remain satisfied with their lens of choice more than 5 years after the original surgery. Glare and halos remain more noticeable in patients who received multifocal lenses.

Surgical techniques and adjuvants for the management of primary and recurrent pterygia.

The removal and rate of recurrence of pterygium have been discussed for years. The disorder is highly associated with environmental factors, and recurrence rates can be unacceptably high and cannot be successfully predicted. New techniques and graft preparations and postoperative management strategies are helping to reduce the recurrence rates and provide an ocular surface that is near ideal for future cataract or refractive surgery. This review discusses the advantages and disadvantages of various treatment strategies.

Pterygium excision with conjunctival autograft and subconjunctival amniotic membrane as antirecurrence agents.

OBJECTIVE: To determine the outcome of pterygium excision with a conjunctival autograft when the adjunctive use of a subconjunctival graft of amniotic membrane is employed to reduce fibrosis and recurrence after surgery. DESIGN: This is a retrospective, noncomparative study of postoperative outcomes. PARTICIPANTS: Eighty-four patients totalling 101 eyes with clinically significant pterygia that warranted surgical excision. METHODS: Surgeries were performed at South Orange County Outpatient Surgery Center (San Clemente, Calif.) between June 6, 2006, and October 23, 2013, by a single surgeon (J.A.H.). Patients were included in the study according to the need for pterygium surgery and the type of surgery performed. Exclusion criteria included patients with recurrent pterygium, those with pseudopterygium, and those whose treatment plan included prophylactic mitomycin during or after surgery. Initial pterygia measurements and postoperative findings were taken through standard slit-lamp examinations. RESULTS: Pterygium recurrence was defined as growth greater than 1 mm onto the corneal limbus at or after 6 months. There was 1 case of pterygium recurrence for a recurrence rate of 0.99% ± 1.93% (n = 101, p = 0.05). The mean extent of preoperative horizontal encroachment of pterygium on the cornea was 2.4 ± 0.87 mm. CONCLUSIONS: Pterygium excision with a conjunctival autograft and prophylactic placement of a subconjunctival amniotic membrane graft has a low recurrence rate with minimal added surgical time and minimal added risk to the patient and has merit as a surgical technique.

Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: Integrated results from 2 pivotal phase 3 studies.

PURPOSE: To evaluate the efficacy and safety of phenylephrine 1.0%-ketorolac 0.3% (Omidria) for maintenance of mydriasis during, and reduction of ocular pain after, cataract surgery. SETTING: Twenty centers in the United States and the Netherlands. DESIGN: Prospective randomized clinical trials. METHODS: Patients having cataract surgery or refractive lens exchange were enrolled in 2 clinical trials. Phenylephrine 1.0%-ketorolac 0.3% or placebo was added to irrigation solution and administered intracamerally during the procedure. Integrated analyses of primary and secondary endpoints were conducted. RESULTS: The clinical trials comprised 808 patients (403 treatment and 405 placebo). Phenylephrine 1.0%-ketorolac 0.3% was superior to placebo for the maintenance of mydriasis during, and reduction of ocular pain following, cataract surgery. The mean area under the curve (AUC) change from baseline in pupil diameter was 0.08 mm for treatment compared with -0.50 mm for placebo (P < .0001). The mean AUC of ocular pain visual analog scale scores within 12 hours postoperatively was 4.16 mm for the treatment group and 9.06 mm for the placebo group (P < .001). Results of all secondary efficacy analyses demonstrated a significant treatment effect associated with phenylephrine 1.0%-ketorolac 0.3%. Treatment-emergent adverse events were as expected for a population having cataract surgery; no clinically significant differences in safety measures were observed between treatment groups. CONCLUSION: In this integrated analysis, phenylephrine 1.0%-ketorolac 0.3% administered intracamerally with irrigation solution during cataract surgery was safe and effective for maintaining mydriasis during the procedure and reducing postoperative ocular pain. FINANCIAL DISCLOSURE: Dr. Schaaf is an employee and holds an equity interest in Omeros Corporation. Drs. Hovanesian, Sheppard, Trattler, Gayton, and Ng are consultants to Omeros Corporation. No other author has a financial or proprietary interest in any material or method mentioned.

Hydrogel sealant versus sutures to prevent fluid egress after cataract surgery.

PURPOSE: To evaluate the effectiveness of a hydrogel sealant versus a suture in preventing fluid egress after wound leakage in cataract surgery. SETTING: Twenty-four ophthalmic clinical practices in the United States. DESIGN: Prospective randomized parallel-arm controlled multicenter subject-masked study. METHODS: Healthy patients having uneventful clear corneal incision (CCI) cataract surgery were eligible for the study. Spontaneous and provoked fluid egress from wounds was evaluated at the time of surgery using a calibrated force gauge. Eyes with leakage were randomized to receive a hydrogel sealant (Resure) or a nylon suture at the main incision site. Incision leakage was reevaluated 1, 3, 7, and 28 days postoperatively. RESULTS: Of 500 eyes, 488 had leakage at the time of cataract surgery. The leak was spontaneous in 244 cases (48.8%), and 488 (97.6%) of all incisions leaked with 1.0 ounce or less of applied force. After randomization, 12 (4.1%) of 295 eyes in the sealant group and 60 (34.1%) of 176 eyes in the suture group had wound leakage with provocation (P<.0001). The overall incidence of adverse ocular events was statistically significantly lower in the sealant group than in the suture group (P<.05). CONCLUSIONS: In this study, 97.6% of CCIs leaked after cataract surgery. The hydrogel sealant was safe and effective and better than a suture for the intraoperative management of CCIs with leakage as seen on Seidel testing and for the prevention of postoperative fluid egress.

An update on the surgical management of pterygium and the role of loteprednol etabonate ointment.

Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.

Randomized comparison of postoperative use of hydrogel ocular bandage and collagen corneal shield for wound protection and patient tolerability after cataract surgery.

PURPOSE: To compare the safety and efficacy of a hydrogel bandage and a collagen corneal shield in providing wound protection and relief of pain/discomfort in the acute period after uneventful unilateral clear corneal phacoemulsification cataract surgery with foldable intraocular lens (IOL) implantation. SETTING: Seventeen investigational sites in the United States. DESIGN: Prospective randomized single-masked parallel study. METHODS: The study comprised patients scheduled to have unilateral clear corneal cataract surgery with posterior chamber intraocular lens implantation. The patients were examined preoperatively and frequently for 30 days postoperatively. The design was a noninferiority study of the 2 primary endpoints, device performance and maximum reported postoperative pain. RESULTS: The device performance success was 78.6% (228/290) for the hydrogel bandage and 26.5% (26/98) for the corneal shield (P<.0001 for noninferiority). Analyses indicated that the hydrogel bandage was superior to the corneal shield in device performance (P<.001; difference = 52.1%; 95% confidence interval, 41.6%-61.4%). The maximum postoperative pain/discomfort score of the hydrogel bandage (mean 1.3 ± 1.8 [SD]; scale 0 to 10) was noninferior to that of the corneal shield (1.1 ± 1.6) in the first 4 hours after surgery (P<.001). Adverse events in the cataract surgeries were reported in 22.2% (70/316) and 36.5% (38/104) of hydrogel bandage patients and corneal shield patients, respectively (P = .0045). CONCLUSION: The hydrogel bandage was safe and effective for ocular surface protection and relief of pain/discomfort when applied topically to clear corneal incisions used in cataract or IOL implantation surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Cataract wound closure with a polymerizing liquid hydrogel ocular bandage.

PURPOSE: To determine whether a polymerizing liquid hydrogel ocular bandage can create a watertight seal in a clear corneal cataract incision. SETTING: Laboratory. METHODS: Twenty-four clear corneal cataract wounds were made in eye-bank corneas. Twelve wounds were treated with a tissue-adherent hydrogel ocular bandage; 12 control wounds received no bandage. Each eye was tested under low-pressure conditions to detect fluid ingress of India ink on the eye's surface. Eyes were tested again with external compression to distort the wound to detect fluid egress. RESULTS: India ink did not enter the wound in any incision in the treated group but did enter 9 (75%) of 12 incisions in the control group. Fluid egress with external manipulation did not occur in any treated eyes but did occur in 11 (92%) control eyes. CONCLUSION: A tissue-adherent hydrogel ocular bandage created a watertight seal in clear corneal cataract wounds.

Watertight cataract incision closure using fibrin tissue adhesive.

PURPOSE: To determine whether a simple method for applying fibrin tissue adhesive to a clear corneal cataract incision can create a watertight seal. SETTING: Laboratory investigation. METHODS: Clear corneal cataract incisions were simulated in 8 eye-bank eyes. In 4 eyes, fibrin adhesive was applied to the incision in a simple manner; the other 4 eyes were controls with no adhesive. Each eye was tested under low pressure conditions to detect fluid ingress of India Ink on the eye's surface. The eyes were tested again with external compression to distort the incision to detect fluid egress. RESULTS: In the eyes with fibrin adhesive, there was no egress of fluid with incision distortion and no ingress of India Ink. In the 4 eyes without adhesive, there was ingress and egress of fluid. CONCLUSION: A simple method of applying fibrin adhesive to cataract incisions created a watertight seal.