Intraoperative OCT for the assessment of posterior capsular integrity in pediatric cataract surgery.

PURPOSE: To study the morphology of the posterior lens cortex and posterior capsules (PCs) in pediatric patients with posterior lens opacities using intraoperative optical coherence tomography (iOCT). SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Prospective observational study. METHODS: Pediatric patients with posterior lens opacities were imaged using iOCT during cataract surgery. The morphology of the posterior lens cortex and PC, along with the common patterns to indicate PC integrity, was assessed. Moreover, PC rent during surgery was observed. RESULTS: A total of 62 eyes from 53 patients were included. The mean age of patients was 3.8 years. 4 morphological variants of posterior lens opacity were observed: type I (34/62 [54.8%]) with an intact PC; type II (20/62 [32.3%]) with an intact PC, which protruded into the anterior vitreous; type III (3/62 [4.8%]) with a deficient PC and an inability to delineate the PC; and type IV (5/62 [8.1%]) with dense opacity and an inability to characterize the posterior cortex and PC. Phacoemulsification could be performed in types I and II. In types III and IV, manual nucleus removal was performed instead of phacoemulsification. 3 cases (100%) of type III PC dehiscence developed during surgery, whereas no cases developed PC dehiscence of other types. CONCLUSIONS: The morphology of the PC and posterior lens cortex in pediatric posterior lens opacities could be categorized, and PC integrity could be assessed using iOCT, which was useful to guide surgical strategies and increase safety in pre-existing PC dehiscence in pediatric cataract surgery.

Application of Surgical Decision Model for Patients With Childhood Cataract: A Study Based on Real World Data.

Reliable validated methods are necessary to verify the performance of diagnosis and therapy-assisted models in clinical practice. However, some validated results have research bias and may not reflect the results of real-world application. In addition, the conduct of clinical trials has executive risks for the indeterminate effectiveness of models and it is challenging to finish validated clinical trials of rare diseases. Real world data (RWD) can probably solve this problem. In our study, we collected RWD from 251 patients with a rare disease, childhood cataract (CC) and conducted a retrospective study to validate the CC surgical decision model. The consistency of the real surgical type and recommended surgical type was 94.16%. In the cataract extraction (CE) group, the model recommended the same surgical type for 84.48% of eyes, but the model advised conducting cataract extraction and primary intraocular lens implantation (CE + IOL) surgery in 15.52% of eyes, which was different from the real-world choices. In the CE + IOL group, the model recommended the same surgical type for 100% of eyes. The real-recommended matched rates were 94.22% in the eyes of bilateral patients and 90.38% in the eyes of unilateral patients. Our study is the first to apply RWD to complete a retrospective study evaluating a clinical model, and the results indicate the availability and feasibility of applying RWD in model validation and serve guidance for intelligent model evaluation for rare diseases.

Patient participation in free cataract surgery: a cross-sectional study of the low-income elderly in urban China.

OBJECTIVES: To explore the characteristics of the low-income elderly who underwent free cataract surgery and to determine the degree of patient satisfaction with the free cataract surgery programme in urban China. METHODS: A free cataract surgery management workflow was designed as a poverty relief project in Guangzhou. In this study, participants who underwent free cataract surgery between January and August 2014 received a telephone interview based on a structured questionnaire. Data were collected on patient demographics, resources, health conditions, reasons for undergoing the free surgery and overall evaluation of the free cataract surgery programme. RESULTS: Among the 833 participants, the mean surgical age was 76.85±7.46 years (95% CI 76.34 to 77.36), and the male to female ratio was 385:448. The majority (94.31%, 746/791) of patients resided in the main urban districts. Patients underwent surgery 61.08±60.15 months (95% CI 56.17 to 66.00) after becoming aware of the cataract, although 66.83% of them reported that their daily lives were influenced by cataracts. Only 21.5% of the respondents underwent physical examinations that included regular eye screening, and only 6.30% were highly educated patients. Financial problems were the primary reason cited by patients for participating in the free surgery programme. Those patients with a monthly family income of 1000-2999¥ (US$161-482) per capita constituted the largest patient population. The free clinics in the parks and the free cataract surgery were highly rated (9.46 and 9.11 of 10 points) by the beneficiaries. CONCLUSIONS: The telephone survey revealed a high level of patient satisfaction regarding the free cataract surgery programme. Most of the patients who participated in the programme resided in major urban districts and had poor health awareness and a low level of education. The information provided by this study is crucial for improving and expanding the management of free cataract surgery programmes. TRIAL REGISTRATION NUMBER: NCT02633865; Post-results.

[Comparative assessment of individualized multifocal intraocular lens implantation].

OBJECTIVE: To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lens (MIOLs) in both eyes (CustomMatch pattern). METHODS: Prospective, nonrandomized study. Zhongshan Ophthalmic Center, Sun yat-sen university, P.R. China. Age-related cataract patients, selected according to the inclusion criteria and divided into MIOL group and monofocal intraocular lens (SIOL) group, received phacoemulsification and were implanted with combined a ReZoom NXG1 IOL in the dominant eye and a Tecnis ZM900 IOL in the fellow eye or bilateral Sensar AR40e IOLs. Monocular and binocular testing one month after surgery included uncorrected and best-spectacle corrected visual acuity at far, intermediate and near distances under 100 cd/m(2) and 6 cd/m(2), reading visual acuity and reading speed, defocus curve, and subjective vision-related quality of life using questionnaire. RESULTS: Under 100 cd/m(2) and 6 cd/m(2), binocular mean uncorrected visual acuity at 500 cm in MIOL group was logMAR 0.013 +/- 0.149 and logMAR 0.163 +/- 0.220 and binocular mean best-spectacle corrected visual acuity was logMAR -0.027 +/- 0.092 and logMAR 0.109 +/- 0.175 respectively. The mean refraction spherical equivalent for best distance corrected visual acuity was (-0.18 +/- 0.85) D and (-0.32 +/- 0.90) D respectively. Under 100 cd/m(2), better uncorrected visual acuity (decimal 0.63) at 40 cm, 63 cm and 100 cm was achieved in MIOL group. Under 6 cd/m(2), the uncorrected visual acuities in MIOL group at 40 cm and 63 cm distance were significantly higher than those in SIOL group although there were no statistically difference at 100 cm. Uncorrected reading visual acuity and reading speed in MIOL group were better than those in SIOL group, while the results in reading ability were similar when MIOL group without correction compared with SIOL group with correction. The depth of focus was 5.5 diopter in MIOL group. No patient in both groups wore glasses for distance and 70% patients in MIOL group did not need to wear glasses for intermediate and near distances after surgery. CONCLUSION: CustomMatch pattern could provide a satisfactory vision at a full range of near, intermediate and far distance and improve the life quality to a certain extent.

[Comparative assessment of visual quality after combined implantation of multifocal intraocular lens].

OBJECTIVE: To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lenses (IOL) in both eyes. METHODS: Prospective, nonrandomized study. Age-related cataract patients were divided into multifocal IOL group (MIOL group) and monofocal IOL group (SIOL group) and received phacoemulsification. In MIOL group, a ReZoom NXG1 IOL and a Tecnis Z M900 IOL were implanted into the dominant eye and the fellow eye, respectively. In SIOL group, Sensar AR40e IOLs were implanted into both eyes. Monocular or binocular test was performed one month after surgery, including wavefront aberration, contrast sensitivity with or without glare and near stereoacuity. RESULTS: The root mean square of spherical aberration at pupil diameter of 5 mm was 0.058 +/- 0.159 microm in NXG1 eyes and 0.005 +/- 0.169 microm in ZM900 eyes, both of them were significantly lower than 0.408 +/- 0.160 microm achieved in AR40e eyes (F = 11.734; P = 0.001, 0.000). There was no significant difference in the total ocular aberration, contrast sensitivity and high-order aberration among eyes with these different IOLs. The uncorrected near stereoacuity in MIOL group was (45.60 +/- 35.04) seconds of arc, which was significantly better than (110.00 +/- 41.23) seconds of arc achieved in SIOL group (F = 2.923; P = 0.010). CONCLUSION: Combined implantation of multifocal ReZoom NXG1 IOL and Tecnis ZM900 IOL provides a good visual quality with reduced spherical aberration and satisfactory near stereoacuity.

[Quality of life assessment in children with congenital bilateral cataract].

OBJECTIVE: To study the influence of congenital bilateral cataract on visual-related quality of life (QoL) in children. METHODS: The scale of QoL for children with congenital bilateral cataract was used to evaluate the QoL of 81 children with congenital bilateral cataract and 28 healthy children with normal visual acuity. The average age of congenital bilateral cataract candidates was 9.8 years (from 8 to 15 years) and 37 patients were female. Thirty-six cataract children took part in the both preoperative and postoperative investigations. The patients' QoL were also categorized by age, gender, score, visual acuity, surgery and density of cataract. Multiple-linear regression model was applied to analyze the influence factors of QoL. RESULTS: Statistically significant difference was found at the QoL between healthy children and children with congenital bilateral cataract (P = 0.00). The QoL in children with non-dense cataract was increased after cataract surgery (P = 0.00). A high correlation was found between visual acuity and QoL (r = 0.53, P = 0.00). A statistically significant difference was found in QoL between dense and non-dense cataract (P = 0.00). Three variances enrolled in the multiple-linear regression equation included the density of cataract, surgery and visual acuity. Their partial regression coefficients were 6.14 (P = 0.00), 3.21 (P = 0.01) and 1.07 (P = 0.01) respectively. CONCLUSIONS: Compared with the healthy children, the QoL score was severely impaired in children with congenital bilateral cataract, which was influenced by the density of cataract, surgery and visual acuity. Visual acuity is the most critical factor influencing the QoL.