Factors Associated with Quality of Life among People with Atrial Fibrillation: Jordan Atrial Fibrillation Registry Study.

Background and Objectives: Atrial fibrillation (AF) is a common arrhythmia that may adversely affect the quality of life (QoL). Several factors could be associated with the QoL among patients with AF; however, evidence regarding these factors is still limited and controversial. Therefore, this study aimed to identify the level of QoL and its associated factors among Jordanian patients with AF. Subjects and methods: A case study design was implemented. A sample of 620 participants were recruited from 28 outpatient clinics registered in the Jordan atrial fibrillation registry AF (JoFIB). Data on QoL were gathered through the self-reported Atrial Fibrillation Effect on Quality-of-life tool (AFEQT). A QoL questionnaire was validated in this population before starting this study. The cardiac nurse then provided the research assistant with data relating to patients' characteristics and associated comorbidities. Results: The overall AFEQT scores were positively skewed (median 21.3, IQR: 14.4-31.9). This pattern was reflected for the AFEQT sub-scales 'Symptoms' (20.8, 8.3-33.3), 'Daily activities' (16.7, 10.4-27.1), and 'Treatment concerns' (27.8, 19.4-41.7), whereas 'Treatment satisfaction' was negatively skewed (91.7, 83.3-91.7). Patients in the higher quartiles, indicating a better QoL, tended to be younger and were less likely to experience dyslipidemia, stroke, pulmonary hypertension, or other comorbidities. Over 90% of patients were currently experiencing AF, and patients with a better QoL tended to be less likely to be currently experiencing AF and more likely to have had their latest episode of AF more than a month ago (compared to less than a month ago). Age, BMI, dyslipidemia, heart failure, COPD, CAD, history of ablation, and the use of anticoagulants were significantly associated with the overall AFEQT score (R2 = 0.278). Conclusions: This study demonstrates that AF Jordanian patients had low levels of QoL. Patients in higher quartiles for the overall AFEQT score were younger, with fewer disease comorbidities and less experience of current AF episodes. Several modifiable and non-modifiable factors were associated with QoL in AF patients. Age, BMI, dyslipidemia, heart failure, COPD, CAD, history of ablation, and the use of oral anticoagulants were significantly associated with the overall AFEQT score. Healthcare providers should target these factors as indicators or interventions for which QoL is continuously monitored.

Comparison of experiences of nursing staff and patients before and after move to 100% single-bed room hospital in Australia: mixed methods.

BACKGROUND: There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. METHOD: Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. RESULTS: Nurses and patients highlighted single-bed rooms contributed to patients' privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. CONCLUSION: Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.

Anticipated advantages and disadvantages of a move to 100% single-room hospital in Australia: A case study.

OBJECTIVES: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. METHODS: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. RESULTS: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction. CONCLUSION: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.

Evaluation of clinical outcomes following implantation of a sub-2-mm hydrophilic acrylic MICS intraocular lens.

PURPOSE: To evaluate clinical outcomes following sub-2-mm microincision cataract surgery (MICS) and intraocular lens (IOL) implantation. SETTING: Five EU clinical sites. DESIGN: Prospective, multicenter, open-label, single-arm, non-randomized. METHODS: Preoperative assessment involved visual acuity (VA), intraocular pressure and biometry measurements. 1.4-mm wound-assisted or 1.8-mm MICS was performed. Follow-up visits were made 1 day, 1-2 weeks, 1-2 and 4-6 months after surgery. The incision size, corrected distance VA (CDVA), uncorrected distance VA, manifest refraction spherical equivalent (MRSE), refraction predictability/stability and IOL decentration were assessed. At 12-, 18-, and 24-month, long-term centration, posterior capsular opacification (PCO) and Nd:YAG capsulotomy rates were investigated. RESULTS: A total of 103 eyes were implanted with the study IOL (INCISE, Bausch & Lomb), 96 of which were included in visual outcome analysis. A mean 6-month CDVA of - 0.02 logMAR (20/20 + 1) was observed and 75 eyes (79.8%) and 93 eyes (98.3%) achieved a visual acuity of at least 20/20 or 20/40. Mean MRSE was - 0.20 ± 0.60 D. Mean absolute predictive error was 0.44 ± 0.36 D, with 90.4% within 1.00 D of target. Mean total decentration was 0.35 ± 0.36 mm at 6 months and 0.32 ± 0.14 mm at 24 months (p > 0.05). 24-month evaluation of posterior capsular opacification score was 0.03 for the central area. A Nd:YAG rate of 3.4% was observed at 24 months. CONCLUSIONS: The new MICS IOL provided excellent visual outcomes and was safe and effective for the sub-2-mm procedure. The MICS IOL demonstrated long-term centration, stability and a low rate of PCO development.

Prostaglandin release during femtosecond laser-assisted cataract surgery: main inducer.

PURPOSE: To investigate a possible correlation between intraocular prostaglandin concentrations and partial steps of laser-assisted cataract surgery. METHODS: Aqueous humor was collected from 67 patients after laser-assisted cataract surgery pretreatment (only capsulotomy, only fragmentation, or both) and at the beginning of routine cataract surgery. Total prostaglandin levels were measured in all four groups using an enzyme-linked immunoassay. RESULTS: Significantly higher levels of aqueous humor prostaglandins were detected right after the full treatment (capsulotomy and fragmentation [330.6 ± 110.6 pg/mL; P = .01] or only laser capsulotomy [362.4 ± 117.5 pg/mL; P = .01]), whereas the control group showed lower values (52.5 ± 8.1 pg/mL). By itself, laser-assisted cataract surgery fragmentation did not lead to a prostaglandin increase (186.8 ± 114.0 pg/mL; P = .14). CONCLUSIONS: This study identified the anterior capsulotomy as the main trigger for an increase of prostaglandins in the aqueous humor immediately after laser-assisted cataract surgery. Optimized energy settings in combination with nonsteroidal anti-inflammatory drugs might help reduce the phenomenon of laser-induced miosis.

Femtosecond laser-assisted cataract surgery without OVD: a prospective intraindividual comparison.

PURPOSE: To compare femtosecond laser-assisted cataract surgery without the use of ophthalmic viscosurgical device (OVD) with standard phacoemulsification using OVD. METHODS: This was a prospective, randomized, single-center trial of 37 patients (74 eyes) diagnosed as having significant cataract in both eyes. Randomly, one eye underwent standard phacoemulsification with OVD (the OVD group); this group acted as controls. The other eye was treated with the femtosecond laser; the subsequent manual part of the procedure was performed without OVD (non-OVD group). Time of surgery, amount of fluid used during phacoemulsification, central corneal thickness, intraocular pressure, endothelial cell count, and visual acuity were documented over the 6-month follow-up. RESULTS: There were no major complications and no significant difference in overall surgery time (non-OVD: 375 ± 81 seconds; OVD: 362 ± 43 seconds; P = .713) and in the quantity of fluid passing through the eye (non-OVD: 187 ± 35 mL; OVD: 186 ± 27 mL; P = .952) between groups. Endothelial cell loss after 6 months was not significantly different between groups (non-OVD: -2.4%; OVD: -2.7%; P = .880). Central corneal thickness was not different at 1 week postoperatively between groups (non-OVD: 575 ± 45 µm; OVD: 573 ± 46 µm; P = .820). Three patients in the OVD group and one patient in the non-OVD group experienced intraocular pressure greater than 25 mm Hg at 1 day postoperatively. There were no significant differences in corrected distance visual acuity between groups (logMAR non-OVD: 0.024; OVD: 0.038; P = .461). CONCLUSIONS: Femtosecond laser-assisted treatment allows the cataract surgeon to perform phacoemulsification and intraocular lens implantation without the use of OVD at no additional risk to the corneal endothelium. Furthermore, there was a tendency toward fewer increases in intraocular pressure in patients treated with the femtosecond laser.

Primary posterior laser-assisted capsulotomy.

PURPOSE: To describe new techniques for performing primary posterior laser-assisted capsulotomy (PLC) to prevent posterior capsule opacification after cataract surgery. METHODS: After lens and cortex removal, three different techniques were used to cut the posterior capsule with an image-guided (optical coherence tomography [OCT]) femtosecond laser. Technique 1: Prior to intra-ocular lens (IOL) implantation, the posterior capsule was carefully opened and elevated with ophthalmic viscosurgical device (OVD) whereas the anterior hyaloid surface remains intact. After sterile re-docking, the posterior capsule was cut and removed and followed by IOL implantation. Techniques 2 and 3: After IOL implantation, a thin layer of OVD was injected between the IOL optic and the posterior capsule. After sterile re-docking, Berger's space and the posterior capsule were identified using OCT and the capsule was cut by the laser. The posterior capsule is located close to the anterior hyaloid membrane in Technique 2 and the posterior capsule is located between the posterior optic surface of the IOL and the anterior hyaloid in Technique 3. RESULTS: Technique 1 was performed in 50 PLC cases. All capsulotomies were easy to remove and no complications were observed. Techniques 2 and 3 were performed in 53 of 55 PLC cases. In 45 of these cases (82%), the posterior capsule was localized with open space between the IOL and Berger's space. In all treated PLC cases, a 360° cut was successfully accomplished. CONCLUSION: The described techniques for PLC have the potential to prevent and solve posterior capsule opacification in routine cases.

Intraocular lens fixated in the anterior capsulotomy created in the line of sight by a femtosecond laser.

PURPOSE: To describe a new surgical technique and a new generation of foldable, hydrophilic acrylate intraocular lenses available for femtosecond laser-assisted capsulotomy. METHODS: After femtosecond laser-assisted capsulotomy (diameter: 5.2 mm) and lens fragmentation, the new intraocular lens (90F; Morcher GmbH, Stuttgart, Germany) was implanted in the capsular bag. Three-dimensional spectral-domain optical coherence tomography scanned the anterior and posterior capsules to create the position of the anterior capsulotomy. The anterior capsulotomy rim was positioned in the flank of the intraocular lens optic. Distance visual acuity, refractive outcome, and anterior chamber depth were measured at 1 week and 1 month postoperatively. RESULTS: No complications were observed at the 1-month follow-up in 6 eyes of 6 patients. No statistically significant changes in anterior chamber depth and refraction were observed at 1 week and 1 month postoperatively. CONCLUSIONS: Image-guided femtosecond lasers can perform a capsulotomy with a predictable size and position according to the line of sight. After implanting the 90F intraocular lens, the final effective lens position can be achieved sooner and may allow more predictable refractive outcomes.

Laser-assisted mini-capsulotomy: a new technique for intumescent white cataracts.

PURPOSE: To describe a new two-step femtosecond laser-assisted technique for intumescent white cataracts. METHODS: In 6 eyes with intumescent white cataracts, a laser-assisted mini-capsulotomy was performed first to release the intralenticular pressure. In the next step, the fluid milky lens material was removed from the anterior chamber before the eyes were re-docked to the laser system and a second larger anterior capsulotomy (4.5-mm diameter) was performed. Finally, the cataractous lens material was removed followed by intraocular lens implantation in the capsular bag. RESULTS: In all cases, the laser system was able to identify and cut the anterior capsule without complications. Small residual tissue bridges were recognized after laser-assisted mini-capsulotomy in 2 eyes and solved with the dimple-down maneuver. The second, larger capsulotomy demonstrated satisfactory quality and a 360° overlap on the intraocular lens' optic was achieved in all cases. CONCLUSIONS: This novel technique for intumescent white cataracts using a two-step laser-assisted mini-capsulotomy has the potential to avoid complications.

Intraindividual capsular bag shrinkage comparing standard and laser-assisted cataract surgery.

PURPOSE: To examine the dynamics of capsular bag changes over 3 months of healing after standard cataract surgery and laser-assisted cataract surgery. METHODS: One hundred six eyes of 53 patients with visually significant cataracts were treated with laser-assisted cataract surgery in one eye and standard phacoemulsification in the other. A capsular measuring ring was implanted in both eyes and effective phacoemulsification time was recorded. Capsular bag diameter was measured at six time points within 3 months of follow-up. Intraindividual capsular bag shrinkage was calculated. RESULTS: The laser group required less ultrasound energy to remove the softened nucleus than the standard group (effective phacoemulsification time: 0.03 vs 1.25 sec; P < .005). The laser group had statistically significantly less capsular bag shrinkage than the standard group at all time points from 1 to 3 months (P < .001). CONCLUSIONS: Lens position changes within 3 months postoperatively may be lessened with laser-assisted cataract surgery in comparison to standard phacoemulsification due the decreased capsular bag shrinkage during this period. A tendency toward earlier stabilization of the capsular bag diameter with laser-assisted cataract surgery provides potential for more predictable effective lens position and intraocular lens power calculations.

Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery.

PURPOSE: To compare femtosecond laser-assisted cataract surgery with standard phacoemulsification concerning the incidence of postoperative clinical or subclinical macular edema and the correlation between macular thickness and postoperative intraocular inflammation values. METHODS: One hundred four eyes of 104 patients were treated by laser-assisted cataract surgery and the fellow 104 eyes underwent phacoemulsification using pulsed ultrasound energy and intraocular lens implantation in this prospective randomized study. Laser flare photometry was measured preoperatively and at 2 hours, 3 to 4 days, 1 month, 3 months, and 6 months postoperatively. Retinal thickness was measured by spectral-domain optical coherence tomography. RESULTS: Two hundred two eyes (97%) were included and analyzed at 6 months postoperatively. The mean center thickness in the laser group was 210 ± 24 µm at 4 days postoperatively, 214 ± 22 µm at 1 month postoperatively, 219 ± 20 µm at 3 months postoperatively, and 215 ± 22 µm at 6 months postoperatively. The mean center thickness in the standard group was 211 ± 32 µm at 4 days postoperatively, 210 ± 34 µm at 1 month postoperatively, 217 ± 29 µm at 3 months postoperatively, and 209 ± 30 µm at 6 months postoperatively. Laser flare photometry showed higher levels in the standard group at the first postoperative visit 2 hours after surgery compared with the laser group. CONCLUSIONS: Femtosecond laser-assisted cataract surgery did not obviously influence the incidence of postoperative macular edema.

Cortex removal after laser cataract surgery and standard phacoemulsification: a critical analysis of 800 consecutive cases.

PURPOSE: To evaluate the ease of anterior cortex removal and hydrodissection of the lens in femtosecond laser-assisted cataract surgery compared with standard phacoemulsification. METHODS: In the femtosecond laser-assisted cataract surgery group (400 eyes), a femtosecond laser was used for capsulotomy and followed by lens fragmentation. In the standard group, the capsulorhexis was performed manually. In both groups, a normal hydrodissection was set, the nucleus was aspirated with or without ultrasound phacoemulsification energy, and residual cortex removal and posterior capsule polishing were performed using bimanual irrigation/aspiration. The primary end point was the time (in seconds) required for the removal of the cortex from instrument insertion in the eye until aspiration tip removal. Secondary end points were the effective phacoemulsification time, quality of the anterior capsule, and anterior or posterior capsule ruptures. RESULTS: Cortex removal time measured 30 ± 13 seconds (range: 10 to 76 seconds) for the standard group and 27 ± 10 seconds (range: 9 to 72 seconds) for the femtosecond laser-assisted cataract surgery group (P < .005). After laser-assisted capsulotomy, one capsule was still adherent following removal by forceps. No anterior or posterior capsular tears were observed in either group. CONCLUSIONS: In femtosecond laser-assisted cataract surgery, the biaxial cortex removal time was comparable with the time in standard phacoemulsification.

A New Small-Aperture Device Implanted on Top of the Intraocular Lens: Safety, Feasibility, and First Clinical Results.

PURPOSE: To investigate the feasibility and safety of a new small-aperture device, which is implanted on top of the intraocular lens. METHODS: Regular cataract surgery was performed in both eyes in 7 patients. In the non-dominant eye, a small-aperture device (VisionXtender; Morcher) was additionally implanted into the capsular bag at the end of the surgery. The mask had an inner diameter of 1.4 mm. Feasibility and safety were investigated 3 months and 2 years after surgery. RESULTS: In all cases, the device was successfully positioned in the capsular bag without any intraoperative complications. No inflammation was observed at the 3-month follow-up visit. All patients achieved binocular uncorrected distance visual acuity of 0 logarithm of the minimum angle of resolution (log-MAR) or better. Additionally, distance-corrected intermediate visual acuity of 0.1 logMAR or better was measured in the non-dominant eye. Two years postoperatively, Nd:YAG capsulotomy was performed in three patients in both eyes. CONCLUSIONS: This clinical feasibility trial demonstrates that the use of the new small-aperture device is both easy and safe. No intraoperative or postoperative complications were reported. All patients attained satisfactory distance, intermediate, and near visual acuity. The device shows significant potential when used in combination with different intraocular lenses (eg, toric). In the future, different opening shapes seem to be possible. [J Refract Surg. 2024;40(9):e662-e666.].

Comparison of toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking.

PURPOSE: To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. SETTING: Ruhr University Eye Clinic, Bochum, Germany. DESIGN: Prospective clinical trial. METHODS: In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. RESULTS: Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 ± 1.25 degrees vs 2.64 ± 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 ± 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 ± 0.13 logMAR, and residual astigmatism was 0.3 ± 0.23 diopter (D) with an astigmatism ≤0.5 D in 93% of eyes. CONCLUSIONS: Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.

Disease progression model in subjects with mild cognitive impairment from the Alzheimer's disease neuroimaging initiative: CSF biomarkers predict population subtypes.

AIM: The objective is to develop a semi-mechanistic disease progression model for mild cognitive impairment (MCI) subjects. The model aims to describe the longitudinal progression of ADAS-cog scores from the Alzheimer's disease neuroimaging initiative trial that had data from 198 MCI subjects with cerebrospinal fluid (CSF) information who were followed for 3 years. METHOD: Various covariates were tested on disease progression parameters and these variables fell into six categories: imaging volumetrics, biochemical, genetic, demographic, cognitive tests and CSF biomarkers. RESULTS: CSF biomarkers were associated with both baseline disease score and disease progression rate in subjects with MCI. Baseline disease score was also correlated with atrophy measured using hippocampal volume. Progression rate was also predicted by executive functioning as measured by the Trail B-test. CONCLUSION: CSF biomarkers have the ability to discriminate MCI subjects into sub-populations that exhibit markedly different rates of disease progression on the ADAS-cog scale. These biomarkers can therefore be utilized for designing clinical trials enriched with subjects that carry the underlying disease pathology.

Laser-assisted cataract surgery in small pupils using mechanical dilation devices.

PURPOSE: To describe methods for performing laser-assisted cataract surgery in small pupils. METHODS: Iris retractors or a Malyugin Ring (Microsurgical Technology, Redmond, WA) were used for mechanical pupil dilation before laser capsulotomy and lens fragmentation. The laser treatment can be performed with or without use of ophthalmic viscosurgical devices (OVD). RESULTS: In 73 eyes with small pupils, laser treatment was possible after mechanical dilation device installation. With and without an OVD, no flattening of the anterior chamber or other complications occurred during re-docking, laser treatment, or the manual part of the operation. Small adhesions of the anterior capsulotomy were more frequent when the anterior chamber was still filled with the OVD and did not occur when the OVD was removed. CONCLUSION: A small, poorly dilating pupil constitutes a major challenge in cataract surgery, particularly when performing capsulorhexis. Femtosecond laser treatment can be employed with considerable benefit for the patient, even in these difficult cases.

Femtosecond laser-assisted cataract surgery in pediatric Marfan syndrome.

PURPOSE: To report femtosecond laser-assisted cataract surgery in pediatric Marfan syndrome. METHODS: Case report. RESULTS: A 10-year-old boy with ectopia lentis due to Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Catalys Precision Laser System; OptiMedica, Sunnyvale, CA) under general anesthesia. Anterior capsulotomy was performed on the decentered lens. Routine irrigation/aspiration devices were used for lens and cortex removal. Centration of the capsular bag was achieved using a Cionni scleral fixation ring. A foldable intraocular lens was implanted. A free-positioned and precise sized capsulotomy was cut by the femtosecond laser. No intraoperative or postoperative complications were observed within the 10 weeks of follow-up. CONCLUSIONS: The use of a femtosecond laser has potential to perform a circular, well-centered capsulotomy for subsequent capsular tension ring and intraocular lens implantation without decentration in patients with Marfan syndrome.

Histological sections of corneal incisions in OCT-guided femtosecond laser cataract surgery.

PURPOSE: To investigate the quality and accuracy of three-dimensional spectral-domain optical coherence tomography (OCT)-guided corneal incisions with the Catalys precision femtosecond laser system (OptiMedica, Sunnyvale, CA) in living human tissue. METHODS: In vivo cataract and intrastromal corneal incisions were made with a femtosecond laser designed for cataract surgery with a patient scheduled for enucleation. RESULTS: An accurate correlation between the pre-incision spectral-domain OCT and the post-incision histology was demonstrated. CONCLUSIONS: The OCT-guided femtosecond laser is capable of creating accurate, precise, and histologically demonstrable incisions in preselected intrastromal locations.

Femtosecond laser-assisted cataract surgery without ophthalmic viscosurgical devices.

PURPOSE: To describe a technique for performing femtosecond laser-assisted cataract surgery without the use of ophthalmic viscosurgical devices (OVDs). METHODS: After laser pretreatment, the anterior chamber is stabilized with balanced salt solution during lens and cortex aspiration. A preloaded intraocular lens is implanted under irrigation. RESULTS: In 23 eyes undergoing surgery without the use of OVDs, no complications were observed within a 1-month follow-up period. The time for surgery and the amount of fluid that went into the eye were similar to those of a standard procedure. There was no remarkable increase in intraocular pressure or corneal thickness. All patients achieved a significant increase in corrected distance visual acuity after surgery. CONCLUSIONS: The significant reduction of phacoemulsification use after femtosecond laser application might render the use of OVDs obsolete in many cases.

Changes in prostaglandin levels in patients undergoing femtosecond laser-assisted cataract surgery.

PURPOSE: To investigate the intraocular prostaglandin concentrations after femtosecond laser treatment and the potential relationship to miosis. METHODS: Aqueous humor was collected from patients after femtosecond laser pretreatment and at the beginning of routine cataract surgery. The total prostaglandin and the prostaglandin E2 concentrations were measured in two independent studies using an enzyme-linked immunoassay. RESULTS: A significantly higher level of prostaglandins was noted in the aqueous humor of patients immediately after femtosecond laser treatment. This could be confirmed in two studies consisting of independent patient populations (study I: control = 17.3 ± 4.0 pg/mL [n = 22], femtosecond laser [femto] = 182.1 ± 38.1 pg/mL [n = 22], P = .0001, and study II: control = 17.5 ± 1.4 pg/mL [n = 37], femto: 377.1 ± 83.6 pg/ mL [n = 35], P = .00004). A significant increase of prostaglandin E2 was noted in two measurements (study III: control = 4.5 ± 1.9 pg/mL [n = 13], femto: 19.2 ± 2.5 pg/mL [n = 20], P = .0002, and study IV: control = 11.3 ± 1.6 pg/mL [n = 35], femto: 60.3 ± 16.1 pg/mL [n = 36], P = .004). No correlation was noted between age or cataract density and prostaglandin/prostaglandin E2 level or between corneal incision, suction time, or laser time in the femto groups and prostaglandin/prostaglandin E2 level. CONCLUSIONS: Prostaglandins rise immediately after femtosecond laser treatment. Future patients should perhaps be treated with non-steroidal anti-inflammatory drugs to maintain mydriasis before undergoing femto-second laser treatment for cataract surgery.