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PURPOSE: To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States. METHODS: A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II. RESULTS: Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism. CONCLUSIONS: Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Astigmatismo , Catarata , Lentes Intraoculares , Oftalmología , Facoemulsificación , Humanos , Astigmatismo/cirugía , Implantación de Lentes Intraoculares , Diseño de Prótesis , Refracción OcularRESUMEN
PURPOSE OF REVIEW: To discuss available premium intraocular lenses (IOLs), patient selection, and important considerations for each premium IOL. RECENT FINDINGS: We review important topics and considerations for premium IOL selection: specifically, toric, extended depth of focus (EDOF), multifocal/trifocal, light adjustable lenses (LALs), and small aperture IOLs. Toric lenses are an excellent option for patients with astigmatism. However, to achieve optimal patient satisfaction, it is critical to account for the ATR astigmatism contribution from the posterior cornea and high angle alphas. Additionally, examining the ocular surface prior to placement of EDOF/multifocal IOLs is important, yet the significance of HOAs on outcomes after implantation still must be elucidated more. Finally, recent studies reveal that the small aperture lens is a good alternative for those with corneal irregularities, and second generation LALs are a great option to achieve target refractions in those with less predictable refractive outcomes, such as in Fuchs' dystrophy or in eyes with previous refractive surgery.
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Lentes Intraoculares , Selección de Paciente , Diseño de Prótesis , Humanos , Refracción Ocular/fisiología , Implantación de Lentes Intraoculares , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To evaluate current best practices for postoperative photorefractive keratectomy (PRK) pain control. METHODS: Literature searches in the PubMed database were last conducted in October 2021 and were restricted to publications in English. This search identified 219 citations, of which 84 were reviewed in full text for their relevance to the scope of this assessment. Fifty-one articles met the criteria for inclusion; 16 studies were rated level I, 33 studies were rated level II, and 2 studies were rated level III. RESULTS: Systemic opioid and nonsteroidal anti-inflammatory drugs (NSAIDs); topical NSAIDs; postoperative cold patches; bandage soft contact lenses (BCLs), notably senofilcon A contact lenses; and topical anesthetics were demonstrated to offer significantly better pain control than comparison treatments. Some other commonly reported pain mitigation interventions such as systemic gabapentinoids, chilled intraoperative balanced salt solution (BSS) irrigation, cycloplegia, and specific surface ablation technique strategies offered limited improvement in pain control over control treatments. CONCLUSIONS: Systemic NSAIDs and opioid medications, topical NSAIDs, cold patches, BCLs, and topical anesthetics have been shown to provide improved pain control over alternative strategies and allow PRK-associated pain to be more tolerable for patients.
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Lentes de Contacto Hidrofílicos , Oftalmología , Queratectomía Fotorrefractiva , Humanos , Anestésicos Locales , Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Antiinflamatorios no Esteroideos/uso terapéutico , Láseres de Excímeros/uso terapéuticoRESUMEN
PURPOSE: To characterize research productivity of ophthalmic plastic and reconstructive surgery (OPRS) fellows during residency. METHODS: A database was compiled of OPRS fellows listed on the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Annual Fall Scientific Symposium program books who began their fellowship between 2012 and 2019. PubMed was searched for all publications published between July 1st of the year they began residency and September 30th of the year they began fellowship training. Bibliometric variables captured for each fellow included: the number of publications, first-author publications, and ophthalmology-related publications. RESULTS: A total of 197 OPRS fellows who began their fellowship training between 2012 and 2019 published a mean (± SD) of 2.42 ± 2.80 publications, 1.43 ± 1.85 first-author publications, and 2.33 ± 2.74 ophthalmology-related publications during residency. Linear regression revealed that the number of publications ( P < 0.001), first-author publications ( P < 0.001), and ophthalmology-related publications ( P < 0.001) that OPRS fellows published during residency have all significantly increased over the time assessed. CONCLUSIONS: The academic productivity of OPRS fellows during residency was quantified through bibliometric analysis to establish a national benchmark for the benefit of both prospective applicants and program directors. Residency research output of OPRS fellows has significantly increased between 2012 and 2019. Since ASOPRS program requirements necessitate academic productivity and thesis completion, publication records and involvement in research become valuable considerations when evaluating fellowship applicants. The knowledge of what accepted fellows have published provides the opportunity to make historical comparisons and may prove useful in the evaluation of the competitiveness of a given year's applicant pool.
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Internado y Residencia , Oftalmología , Procedimientos de Cirugía Plástica , Cirugía Plástica , Humanos , Estados Unidos , Cirugía Plástica/educación , Educación de Postgrado en Medicina , Oftalmología/educación , BecasRESUMEN
PURPOSE: To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS). METHODS: A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies. RESULTS: No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS. CONCLUSIONS: Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.
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Extracción de Catarata , Catarata , Terapia por Láser , Oftalmología , Facoemulsificación , Extracción de Catarata/métodos , Humanos , Terapia por Láser/métodos , Rayos Láser , Facoemulsificación/métodosRESUMEN
PURPOSE: Open globe injury (OGI) is a serious form of ocular trauma that can significantly lower quality of life post-injury due to comorbidities. This study was designed to investigate how traumatic cataracts and other pre-operative variables affect visual outcomes of OGIs. METHODS: A retrospective review was conducted for OGI patient records with presence of traumatic cataracts, visual outcomes, comorbidity data and provider training. Multivariable logistic regression analysis determined if several pre-operative variables including traumatic cataracts, retinal detachment and hyphema were predictive of final visual acuity and need for retinal surgery. Ancillary multivariable analysis was conducted to evaluate if timing of traumatic cataract extraction predicted poor final visual acuity. RESULTS: Multivariable logistic regression analysis did not find traumatic cataract to be an independent predictor of final visual outcome in the open globe injury sample population (n = 102, p = 0.386), but did find retinal detachment (p = 0.008), hyphema (p = 0.035) and scleral laceration (p = 0.009) to be independent predictors of poor final visual acuity. In the subgroup of eyes with traumatic cataract (n = 64), delayed cataract extraction was not found to be an independent predictor of poor final visual acuity (p = 0.156). CONCLUSION: Our results suggest that retinal detachment, hyphema, and scleral laceration influence final visual outcome while traumatic cataract does not. Within the subpopulation of patients that received lens extraction, timing of extraction was not found to independently influence final visual acuity.
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Extracción de Catarata , Catarata , Lesiones Oculares Penetrantes , Lesiones Oculares , Laceraciones , Desprendimiento de Retina , Catarata/complicaciones , Extracción de Catarata/efectos adversos , Lesiones Oculares/complicaciones , Lesiones Oculares/diagnóstico , Lesiones Oculares/cirugía , Lesiones Oculares Penetrantes/complicaciones , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/cirugía , Humanos , Hipema/cirugía , Laceraciones/cirugía , Pronóstico , Calidad de Vida , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Estudios RetrospectivosRESUMEN
PURPOSE: The purpose of this study is to determine the correlation between subjective and optical measurements used during cataract evaluation, including the iTrace Dysfunctional Lens Index (DLI), the HD Analyzer Objective Scatter Index (OSI), Lens Opacities Classification System III (LOCS III), Visual Function-14 Questionnaire (VF-14), and the Pelli-Robson Contrast Sensitivity Chart (PRCSC). METHODS: Seventy eyes from 70 patients were enrolled, including all stages of age-related nuclear cataracts. The LOCS III-NO with a cutoff of 3.2 was chosen to divide the population into two groups. Eyes with corneal or retinal pathology were excluded. All patients were evaluated with the iTrace's DLI, HD Analyzer's OSI, LOCS III, VF-14, and the PRCSC during each follow-up visit. Correlation analyses were performed using Stata software, version 14.0, StataCorp. RESULTS: The LOCS III-NO, DLI, OSI, and VF-14 questionnaire each correlated moderately with the BCVA with a Spearman rho value of 0.37, - 0.45, 0.40, and - 0.35, respectively. The DLI correlated moderately with LOCS III-NO with a rho value of - 0.37 and with the VF-14 questionnaire with a rho value of 0.35. The OSI correlated with both the contrast sensitivity and DLI with a rho value of - 0.35 and - 0.55, respectively. CONCLUSIONS: The DLI correlated with cataract symptoms (measured by the VF-14 questionnaire) in addition to BCVA. The OSI correlated moderately with contrast sensitivity and BCVA. The highest correlation was between DLI and OSI.
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Catarata , Cristalino , Catarata/complicaciones , Catarata/diagnóstico , Sensibilidad de Contraste , Humanos , Estudios Prospectivos , Agudeza VisualRESUMEN
PURPOSE: To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK). METHODS: Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist. RESULTS: When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it. CONCLUSIONS: Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.
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Biometría/métodos , Queratomileusis por Láser In Situ/métodos , Lentes Intraoculares , Miopía/cirugía , Óptica y Fotónica , Queratectomía Fotorrefractiva/métodos , Evaluación de la Tecnología Biomédica , Academias e Institutos , Humanos , Implantación de Lentes Intraoculares , Miopía/fisiopatología , Oftalmología/organización & administración , Facoemulsificación , Refracción Ocular/fisiología , Estudios Retrospectivos , Estados UnidosRESUMEN
PURPOSE: To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal. METHODS: Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II. RESULTS: Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses. CONCLUSIONS: Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.
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Academias e Institutos , Acomodación Ocular/fisiología , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares Multifocales , Oftalmología , Presbiopía/cirugía , Refracción Ocular/fisiología , Percepción de Profundidad , Humanos , Satisfacción del Paciente , Presbiopía/fisiopatología , Diseño de Prótesis , Estados Unidos , Agudeza VisualRESUMEN
Recent research has analyzed how patients use social media, but little information exists evaluating how patients utilize social media in the perioperative period or how ophthalmologists and eye institutions integrate social media into their practices. This observational study aimed to examine (1) how patients interact on social media when undergoing LASIK and (2) how ophthalmologists and (3) eye institutions utilize social media accounts. We analyzed 2592 Instagram posts between August 2016 and April 2017 on a related hashtag (#lasiksurgery). Content was coded based on time frame of the post in relation to the procedure, references to return to work/activity, post-surgical photographs, mention of the surgical institution, tone, and complaints regarding the procedure. Twitter and Instagram accounts for 30 ophthalmologists and eye institutes were also located. The 20 most recent posts were categorized by message type and topic (physicians, patients, education, conference, etc.). Patients using the hashtag posted photographs (92%), had a positive tone (88%), referenced the clinic where they were treated (62%), and posted during the day of the procedure (44%). Ophthalmologists' personal tweets focused on research conferences (35%), personal topics (25%), and the accomplishments of other physicians (21%). Eye institutions generally posted content relating to institutional promotion (22%), physician accomplishments (20%), and research publications (19%). Similar to other medical specialties, ophthalmology has a meaningful presence on both Twitter and Instagram. While LASIK patients tend to comment on their renewed vision and return to activity, ophthalmologists post to promote their research and accomplishments.
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Conocimientos, Actitudes y Práctica en Salud , Oftalmólogos/psicología , Pacientes/psicología , Medios de Comunicación Sociales , Humanos , Queratomileusis por Láser In SituRESUMEN
PURPOSE: To use optical coherence tomography (OCT) to evaluate the femtosecond laser intrastromal incisions made during cataract surgery to reduce corneal astigmatism. DESIGN: Retrospective case series. PARTICIPANTS: Seventy-seven eyes of 77 patients. METHODS: Paired intrastromal incisions were created using the Catalys femtosecond laser (Abbott Medical Optics, Inc., Santa Ana, CA). The planned intrastromal incision parameters were 20% uncut anterior, 20% uncut posterior, midpoint depth of 50%, and 90° side cut angle. Optical coherence tomography scans were obtained 3 weeks or more after surgery to assess these 4 parameters, and actual values were compared with intended values. MAIN OUTCOME MEASURES: Percentages of uncut anterior and posterior tissue, midpoint depth, and degrees of side cut angle. RESULTS: The mean values were 17.2±5.8% (range, 7.2%-36.9%) for uncut anterior, 32.5±8.8% (range, 6.0%-57.9%) for uncut posterior, and 42.3±6.6% (range, 25.5%-65.4%) for midpoint depth, which all were significantly different from the planned parameters (all P < 0.05). The mean side cut angle was 88.5°±5.6° (range, 71°-114°) and was significantly different from the planned side cut angle of 90° (P < 0.05). In 50 eyes that had paired intrastromal incisions scanned by the OCT, there was no correlation between the paired incisions for midpoint depth and side cut angle (correlation coefficient, r = -0.063 and -0.067, respectively; P > 0.05). CONCLUSIONS: The intrastromal incision midpoint depth was significantly more anterior than the planned depth of 50%. The locations of paired intrastromal incisions in each eye were not correlated. Further improvements are needed to ensure the precise location of the intrastromal incisions made with this device.
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Astigmatismo/cirugía , Extracción de Catarata , Sustancia Propia/cirugía , Cirugía Laser de Córnea/métodos , Láseres de Excímeros/uso terapéutico , Anciano , Anciano de 80 o más Años , Astigmatismo/fisiopatología , Paquimetría Corneal , Sustancia Propia/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza VisualRESUMEN
PURPOSE: The purpose of this study was to report our first clinical experience using topical losartan for the treatment of severe corneal haze after epithelium-off corneal cross-linking (CXL). METHODS: A 20-year-old man presented with clinically significant corneal haze in the right eye 1 month following Ultraviolet-A/Riboflavin Epithelium-off Collagen CXL. Haze progressed to a deep stromal scar, and vision was 20/150 with no improvement on refraction, 60 days after CXL. After unsuccessful treatment with topical corticosteroids, the patient elected to start off-label treatment with topical losartan 0.8 mg/mL, administered 6 times per day. RESULTS: After 3 months of initiating topical losartan, the right eye vision improved to preoperative vision of 20/40-1. Corneal haze was significantly reduced as observed on slitlamp examination and on Scheimpflug corneal tomography (Pentacam; OCULUS, Inc. Arlington, WA). CONCLUSIONS: Topical losartan, a transforming growth factor-ß inhibitor, is a potential treatment in clinically significant corneal haze following epithelium-off corneal CXL. This clinical experience highlights the potential efficacy of topical losartan as a novel therapeutic option in such cases, but further clinical studies are needed.
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Colágeno , Opacidad de la Córnea , Reactivos de Enlaces Cruzados , Losartán , Fármacos Fotosensibilizantes , Riboflavina , Rayos Ultravioleta , Agudeza Visual , Humanos , Losartán/administración & dosificación , Losartán/uso terapéutico , Masculino , Riboflavina/uso terapéutico , Colágeno/metabolismo , Adulto Joven , Opacidad de la Córnea/tratamiento farmacológico , Opacidad de la Córnea/etiología , Fármacos Fotosensibilizantes/uso terapéutico , Queratocono/tratamiento farmacológico , Sustancia Propia/metabolismo , Sustancia Propia/efectos de los fármacos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Fotoquimioterapia/métodos , Soluciones Oftálmicas , Administración TópicaRESUMEN
A 15-year-old boy was referred for corneal opacity evaluation. The patient had a previous herpes zoster virus (HZV) infection-varicella-zoster virus (VZV)-with ocular manifestation 1 year ago. After the infection, he developed a central corneal scar and decreased corrected distance visual acuity (CDVA) in the right eye. The slitlamp examination showed the right eye with central corneal opacity (involving anterior stroma), lacuna area between the haze, fluorescein negative, and no vascularization near the scar (Figure 1JOURNAL/jcrs/04.03/02158034-202406000-00019/figure1/v/2024-07-10T174224Z/r/image-tiff). The patient had been treated with oral valacyclovir and topical corticosteroids without any improvement of visual acuity or changes in opacity within the 1-year follow-up. His CDVA was 20/200 (-4.50 -0.75 × 25) in the right eye and counting fingers (-4.00) in the left eye. Intraocular pressure was 12 mm Hg in both eyes. Fundoscopy was normal in the right eye, but he had a macular scar in the left eye (diagnosed when he was 7 years). The left eye had no cornea signs. The patient has no comorbidity or previous surgeries. Considering this case, a corneal central scar in a 15-year-old boy, legally single eye only, and assuming it is an opacity in the anterior stroma, would you consider surgery for this patient? If so, which would you choose: Would you consider an excimer laser treatment of his ametropia while partially removing his opacity, a phototherapeutic keratectomy (PTK), or a PTK followed by a topography-guided treatment, femtosecond laser-assisted anterior lamellar keratoplasty (FALK), or deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (depending on the scar depth)? Would you consider prophylactic acyclovir during and after surgery? Would you consider any other surgical step to prevent delayed corneal healing-persistent epithelial defect? Before the surgical approach, would you consider treating this patient with topical losartan (a transforming growth factor [TGF]-ß signaling inhibitor)? Would you first perform the surgery (which one) and then start the medication? Furthermore, if so, how long would you treat this patient? Would you consider treatment with another medication?
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Opacidad de la Córnea , Herpes Zóster Oftálmico , Agudeza Visual , Humanos , Masculino , Opacidad de la Córnea/diagnóstico , Opacidad de la Córnea/etiología , Opacidad de la Córnea/tratamiento farmacológico , Adolescente , Agudeza Visual/fisiología , Herpes Zóster Oftálmico/tratamiento farmacológico , Herpes Zóster Oftálmico/diagnóstico , Herpes Zóster Oftálmico/virología , Antivirales/uso terapéutico , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/virología , Infecciones Virales del Ojo/tratamiento farmacológico , Queratoplastia PenetranteRESUMEN
BACKGROUND: To assess the repeatability and comparability of central corneal thickness (CCT) measurements obtained from the Galilei Dual Scheimpflug Analyzer (Galilei-DSA) and from ultrasonic pachymetry (USP) in normal eyes and in eyes following laser refractive surgery. METHODS: In this prospective observational study, 77 eyes of 39 patients with normal corneas and 39 eyes of 20 patients with prior laser refractive surgery were enrolled. All 116 eyes had three repeated measurements of central CCT with the Galilei-DSA first and then with USP by the same examiner. Reliability of both devices was assessed statistically, and CCT measurements by each were compared. RESULTS: The mean CCT measurement of normal eyes was 549.2 ± 30.5 µm and 548.5 ± 33.1 µm by the Galilei-DSA and USP respectively; the difference between the two modalities was -0.7 ± 7.1 µm (P = 0.365). In post-refractive surgery eyes, the mean CCT measured by the Galilei-DSA and USP was 500.4 ± 44.8 and 494.3 ± 50.3 respectively; the difference between the two devices was -6.2 ± 9.9 µm (P < 0.001). For the three repeated measurements, the mean standard deviation was 2 µm with the Galilei-DSA and 1.8 µm with USP in normal eyes, and 2.4 µm with the Galilei-DSA and 1.9 µm with USP in post-refractive surgery eyes. CONCLUSION: The Galilei-DSA has high repeatability and excellent to moderate agreement with ultrasonic pachymetry when measuring CCT in normal and post-refractive surgery eyes.
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Córnea/patología , Paquimetría Corneal/instrumentación , Topografía de la Córnea/instrumentación , Adulto , Córnea/diagnóstico por imagen , Córnea/cirugía , Cirugía Laser de Córnea , Femenino , Humanos , Presión Intraocular , Queratomileusis por Láser In Situ , Láseres de Excímeros , Masculino , Persona de Mediana Edad , Miopía/cirugía , Tamaño de los Órganos , Queratectomía Fotorrefractiva , Estudios Prospectivos , Reproducibilidad de los Resultados , Ultrasonografía , Adulto JovenRESUMEN
An 85-year-old man with a history of type 2 diabetes, pseudoexfoliation (PXF) in both eyes, and tamsulosin use was referred for the evaluation of a dense cataract in the right eye and a subluxated intraocular lens (IOL) in the left eye. Unfortunately, his surgery in the left eye was complicated by diffuse zonulopathy. The referring surgeon placed a 3-piece IOL in the sulcus. However, the passively fixated 3-piece IOL moved inferiorly causing monocular diplopia for over a year. Because the patient was pleased with the IOL immediately postoperatively, a refixation procedure was performed in the form of sulcus placement with iris suture fixation in the left eye. Fortunately, the iris-fixated IOL in the left eye has remained well centered and stable without cystoid macular edema (CME) or chronic inflammation for over 8 months. The patient is on no ocular medications and has no family history of glaucoma. He now needs cataract surgery in the right eye and is extremely apprehensive because of his difficult course in the left eye. The corrected distance visual acuity is 20/70 in the right eye and 20/25 in the left eye. Intraocular pressures (IOPs) measure 20 mm Hg in the right eye and 14 mm Hg in the left eye by Goldmann tonometry. Pachymetry is 536 µm in the right eye and 543 µm in the left eye. Pupils are round with minimal reactivity and without a relative afferent pupillary defect. Extraocular motility is normal in both eyes, and confrontation visual fields is full in both eyes. Gonioscopy reveals an angle open to the pigmented trabecular meshwork (PTM) in the right eye and the ciliary body in the left eye with 1+ PTM and without peripheral anterior synechia in both eyes. The retinal nerve fiber layer and macular optical coherence tomography are normal in both eyes. On slitlamp examination, pertinent findings include pseudoexfoliative changes at the pupillary margin with poor dilation of 3.5 mm in both eyes; the anterior chamber (AC) is shallow but adequate in the right eye and deep and quiet with rare pigmented cells in the left eye. There is a 5+ nuclear sclerotic cataract with pseudoexfoliative changes on the anterior capsule and no obvious phacodonesis in the right eye and a 3-piece posterior chamber IOL in the sulcus fixated to the iris with 10-0 polypropylene sutures at 6 and 12 o'clock without pseudophacodonesis in the left eye. Dilated fundus examination reveals a cup-to-disc ratio of 0.4 with healthy neuroretinal rims in both eyes, posterior vitreous detachments in both eyes, and no evidence of diabetic retinopathy in both eyes. All other findings are unremarkable. How would you counsel this patient regarding his risk factors for surgery in the right eye? What surgical maneuvers would you use to remove the cataract safely? How would you stabilize the IOL if the capsule bag becomes compromised due to zonulopathy?
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Extracción de Catarata , Catarata , Diabetes Mellitus Tipo 2 , Lentes Intraoculares , Masculino , Humanos , Anciano de 80 o más Años , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares/efectos adversos , Catarata/etiologíaRESUMEN
In the absence of capsular support, it is not always possible to safely place an intraocular lens (IOL) in the capsular bag at the time of surgery. Several techniques have thus been developed to enable safe placement of a secondary IOL outside the capsular bag. These techniques include placement of anterior chamber IOLs, iris-fixated IOLs (sutured, iris-claw), and scleral-fixated IOLs (sutured, sutureless). Secondary IOL placement can take place at the time of the initial surgery or in a second surgery. Each technique has its own unique advantages, as well as its potential complications. At this time, comparison studies have found no secondary IOL technique to be superior in terms of visual acuity or rate of complications. Additional comparison studies with longer follow-up times are needed to confirm these findings. The decision on which secondary IOL technique to perform depends on numerous factors including surgeon experience and comfort, as well as patient comorbidities.
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Purpose: To determine statewide cataract surgery rates with cataract extraction with intraocular lens implantation (CEIOL) in Florida from 2005 to 2014 among Caucasians, African-Americans, Hispanics, and Asian/Pacific Islanders. Methods: This is a retrospective database study analyzing ambulatory surgical data in Florida from 2005 to 2014. Using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) and State Ambulatory Surgery and Services Databases (SASD), the authors utilized data mining algorithms to analyze and graphically represent disparities in the delivery of cataract surgery, changes in surgery volume, and demographic characteristics in patients 65 years and older in all Florida counties from 2005 to 2014. Results: Cataract surgeries performed in patients ≥65 years of age represented 1,892,132 (14.90%) of the 12,695,932 total ambulatory surgical procedures from 2005 to 2014 in the HCUP-SASD Florida database. More surgeries were performed in females versus males, P < 0.001. Caucasians, African-Americans, and Hispanics represented 82.23%, 4.95%, and 10.69% of the utilization rate of all CEIOLs, respectively. From 2005 to 2014, the average surgery volume increased by an average rate of change of 1.29%. Cataract surgery penetration in the general population observed a steady decrease from 18.82% in 2005 to 16.66% in 2014. Conclusions: Cataract surgery in Florida exhibited an unequal distribution with respect to gender and race, and select counties exhibited marked changes in surgical volume over the past 11 years. This study establishes a method for data mining and geospatial analysis to study surgical and epidemiological trends and identify disparities in delivery of healthcare.
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PURPOSE: To compare the effectiveness of penetrating vs intrastromal femtosecond laser corneal relaxing incisions (CRIs) in reducing corneal astigmatism during cataract surgery. SETTINGS: Baylor College of Medicine and Mercy Clinic Eye Specialists. DESIGN: Prospective randomized study. METHODS: 248 eyes from 248 patients were included. Patients were randomly assigned to undergo paired penetrating (8 mm optical zone [OZ] at 1 center and 9 mm OZ at the other) or intrastromal CRIs (8 mm OZ at both centers). The lengths of the CRIs were based on published nomograms but modified to take into account posterior corneal astigmatism. Vector analysis was performed, and net corneal changes along the CRI meridian were calculated. Multiple regression analysis was performed to assess factors contributing to net corneal changes. RESULTS: Preoperatively, 9% to 18% of eyes had corneal astigmatism of ≤0.5 diopters (D), and 76% to 93% of eyes had postoperative refractive astigmatism of ≤0.5 D ( P < .05). Both penetrating and intrastromal CRIs produced significant mean net corneal changes along the CRI meridian (-0.49 to -1.21 D), and 71% to 84% of eyes had postoperative astigmatism vector prediction errors of ≤0.50 D. The 8 mm penetrating CRIs induced greater net corneal changes but more eyes with overcorrection than did the intrastromal and 9 mm penetrating CRIs (all P < .05). Greater net corneal changes occurred with longer CRI length, higher preoperative corneal astigmatism magnitude, and preoperative against-the-rule corneal astigmatism. Nomograms based on anterior and total corneal astigmatism are proposed. CONCLUSIONS: Both penetrating and intrastromal CRIs were effective in reducing corneal astigmatism during cataract surgery.
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Astigmatismo , Catarata , Enfermedades de la Córnea , Sustancia Propia , Topografía de la Córnea , Humanos , Rayos Láser , Estudios Prospectivos , Refracción Ocular , Agudeza VisualRESUMEN
PURPOSE: To evaluate refractive outcomes of toric intraocular lens (IOL) implantation in eyes with previous radial keratotomy (RK). SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. DESIGN: Retrospective case series. METHODS: Consecutive cases with previous RK and had undergone cataract surgery with toric IOL implantation and met the following criteria were retrospectively reviewed: (1) regular bowtie corneal astigmatism within the central 3.0 mm zone, (2) difference in corneal regular astigmatism magnitude between the IOLMaster and Lenstar of ≤ 0.75 diopters (D), (3) difference in the regular astigmatism meridians from the 2 biometers of ≤15 degrees, and (4) available postoperative manifest refraction at ≥ 8 weeks with corrected distance visual acuity of 20/30 or better. Vector analysis was used to assess the preoperative corneal and postoperative refractive astigmatism. RESULTS: In 40 eyes of 31 patients with previous RK, preoperatively, the mean magnitude of corneal regular astigmatism was 2.10 ± 0.98 D; 1 (3%) and 2 (10%) eyes had anterior corneal regular astigmatism ≤0.5 D and ≤1.0 D, respectively; and the centroid value was 1.14 D @ 179 degrees ± 2.05 D. Postoperatively, the mean magnitude of refractive regular astigmatism was 0.46 ± 0.44 D; 29 (73%) and 35 (88%) of eyes had refractive regular astigmatism ≤0.5 D and ≤1.0 D, respectively (P < .05); and the centroid value was 0.12 D @ 173 degrees ± 0.63 D (P < .05). CONCLUSIONS: Toric IOLs can be used successfully to treat corneal regular astigmatism in eyes with previous RK.
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Astigmatismo , Queratotomía Radial , Lentes Intraoculares , Facoemulsificación , Astigmatismo/cirugía , Humanos , Implantación de Lentes Intraoculares , Refracción Ocular , Estudios RetrospectivosRESUMEN
Background: Cataracts are one of the leading causes of blindness in the world and disproportionately affect the elderly people and women. Sex- and race-related differences in cataract formation are not well understood. Furthermore, race and socioeconomic factors can play a role in developing systemic diseases. Earlier studies have supported a link between certain systemic diseases and cataract formation. Our study examined race-related differences in ocular and systemic comorbidities and analyzed differences among races and insurance types for cataract surgery visual outcomes among female patients with cataracts. Materials and Methods: Data were collected retrospectively and patients were grouped by race and insurance classifications. Female patients at a large tertiary center with an International Classification of Disease, 9th Edition (ICD-9) or ICD-10 cataract diagnosis or cataract extraction procedure code between January 2013 and June 2018 were included. A total of 909 female patients were included in the study. Frequency of systemic and ocular comorbidities was analyzed. Demographic factors were also compared among races. Finally, characteristics of cataract surgery patients, such as age at surgery, preoperative best-corrected visual acuity (BCVA), and visual outcomes among races and insurance types were analyzed. Results: There are differences among races for frequency of smoking, hemoglobin A1c, hypertension, and diabetes mellitus in female patients with cataracts and differences among races and insurance types for preoperative BCVA for patients who underwent cataract surgery (p < 0.001 for all). Conclusions: Female minority and non-minority patients with cataracts have a high frequency of systemic and ocular comorbidities at our county hospital. Patients with no insurance and white and Hispanic patients had worse preoperative BCVA.