Descemet Membrane Detachment Due to Laser Application in Femtosecond Laser-Assisted Cataract Surgery: Incidence and Risk Factors.

PURPOSE: To assess the incidence and risk factors of Descemet membrane detachment due to laser application in femtosecond laser-assisted cataract surgery (FLACS). METHODS: In this retrospective case series, all patients who underwent FLACS with the LenSx system (Alcon Laboratories, Inc) were eligible to participate. The medical records were reviewed to collect data regarding potential risk factors related to Descemet membrane detachment, including patients' demographics, laser parameters, and ocular measurements. The eyes were separated into two groups based on the clinical diagnosis of Descemet membrane detachment as the femto-second laser was performing the corneal incisions. RESULTS: Five hundred ten eyes (304 patients) were included. Descemet membrane detachment occurred in 20 (3.9%) eyes of 16 (5.3%) patients. Four (1.3%) patients had a detachment in both eyes. In 16 (3.1%) eyes, the Descemet membrane detachment occurred in the secondary incision site. The eyes that had a detachment had a statistically lower mean endothelial cell density (2,193.40 ± 313.37 versus 2,385.08 ± 357.80 cells/ mm2; P = .019), and a statistically higher prevalence of corneal guttata (25.0% versus 8.8%; P = .015). None of the other analyzed variables statistically differed between the groups (P > .05). The risk of having Descemet membrane detachment was statistically higher among eyes with guttata (odds ratio = 3.47; P = .015) and in those with an endothelial cell density of less than 2,000 cells/mm2 (odds ratio = 3.26; P = .014). CONCLUSIONS: The incidence of Descemet membrane detachment due to laser application in FLACS was 3.9%, with the associated risk factors being endothelial cell density of less than 2,000 cells/mm2 and corneal guttata. [J Refract Surg. 2021;37(7):466-471.].

Prevalence of macular abnormalities identified only by optical coherence tomography in Brazilian patients with cataract.

PURPOSE: To assess the prevalence of macular abnormalities not suspected by the biomicroscopic fundus examination and identified only by macular optical coherence tomography (OCT) in the preoperative evaluation for cataract surgery in a large series of Brazilian patients. SETTING: Private practice, Recife, Brazil. DESIGN: Retrospective case series. METHODS: All eyes that had cataract surgery by the same physician between August 2014 and July 2016 were eligible. Excluded were eyes with a previous diagnosis of macular abnormalities, with a suspicious biomicroscopic fundus examination, and without OCT results. Based on the preoperative macular OCT, patients were divided into the following 2 groups: those with a normal OCT and those with an abnormal OCT. RESULTS: Nine hundred fifty-two eyes (614 patients) were included in the study. Macular OCT identified abnormalities in 47 eyes (4.9%) of 44 patients (7.2%). Thirty-one eyes (3.3%) had epiretinal membrane, 7 (0.7%) had age-related macular degeneration, 4 (0.4%) had intraretinal cysts, 4 (0.4%) had a lamellar hole, and 1 (0.1%) had a macular hole. Patients with an abnormal OCT had a statistically significant higher mean age (P = .004). CONCLUSION: In the preoperative evaluation for cataract surgery in Brazilian patients, 7.2% of those with a normal biomicroscopic fundus examination had macular abnormalities that were identified only by OCT.

Comparison of biometry and intraocular lens power calculation performed by a new optical biometry device and a reference biometer.

PURPOSE: To compare biometry measurements and intraocular lens (IOL) power calculations obtained by a new optical A-scan interferometer biometer (Galilei G6) (new biometer) and a partial coherence interferometer biometer (IOLMaster 500) (reference biometer). SETTING: Private practice, Recife, Brazil. DESIGN: Retrospective comparative study. METHODS: Cataract patients who had biometric measurements with the new biometer and the reference biometer were included in the study. Comparisons were performed for axial length (AL), keratometry (K), anterior chamber depth (ACD), and IOL power calculation to reach emmetropia with an Acrysof SN60WF IOL using the Haigis formula. The Pearson correlation coefficient and the 95% limits of agreement (LoA) were calculated. The paired Student t test and the Wilcoxon test were used to assess differences between devices. RESULTS: Eighty-eight eyes (88 patients) were studied. Both biometers provided statistically similar mean IOL power to reach emmetropia, AL, keratometry, and ACD measurements (P > .05). The differences in these variables did not vary as their mean values increased, and there was a strong positive correlation between the values obtained by both devices for each variable. The 95% LoA values for AL, mean keratometry, ACD, and IOL power were 0.27 mm, 1.08 diopters (D), 0.66 mm, and 1.56 D, respectively. CONCLUSIONS: The 2 devices were comparable with regard to mean IOL power, mean AL, K, and ACD measurements. However, the wide range of differences between the devices suggests they should not be used interchangeably.

Use of the Delphi process in paediatric cataract management.

PURPOSE: To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. DESIGN: A modified Delphi method. PARTICIPANTS: International paediatric cataract experts with a publishing record in paediatric cataract management. METHODS: The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. MAIN OUTCOME MEASURE: Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. RESULTS: Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. CONCLUSIONS: Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions.

Global challenges in the management of congenital cataract: proceedings of the 4th International Congenital Cataract Symposium held on March 7, 2014, New York, New York.

Childhood cataracts have become a leading cause of preventable childhood blindness in many areas of the world. Here we summarize regional focus group discussions from the 4th Annual International Congenital Cataract Symposium on the current situation, challenges, and recommendations for the management of congenital cataracts in sub-Saharan Africa, the Middle East and North Africa, South Asia, Central America, South America, and developed nations. Strategies for managing congenital cataracts must be adapted and developed according to regional conditions. A basic framework for acceptable outcomes must focus on developing systems to address the critical components of education, access, quality care, and good follow-up.

Outcomes of congenital cataract surgery: intraoperative intracameral triamcinolone injection versus postoperative oral prednisolone.

PURPOSE: To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation. SETTING: Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil. DESIGN: Randomized clinical trial. METHODS: Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively. RESULTS: The mean patient age at surgery was 10.45 months±6.22 (SD) in the study group (31 eyes) and 10.0±6.15 months in the control group (29 eyes) (P=.779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P=.922 and P=.149, respectively; control group P=.483 and P=.416, respectively). The groups had similar incidences of cell deposits (P=.517) and posterior synechiae (P=.247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL. CONCLUSION: One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.