Visual outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens: a single-masked prospective randomized study.

PURPOSE: To evaluate and compare the visual outcomes of an enhanced monofocal intraocular lens (IOL) with two different monofocal IOLs. SETTING: Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy. DESIGN: Prospective, single-center, single-masked, randomized controlled clinical study. METHODS: The study included patients undergoing phacoemulsification and IOL implantation. Patients were consecutively randomized by block randomization and assigned in a 1:1:1 allocation ratio to three study arms to bilaterally receive Tecnis Eyhance™ (model ICB00) or Tecnis® monofocal 1-piece (model PCB00) or Clareon® monofocal (model CNA0T0), respectively. Monocular and binocular (both corrected and uncorrected) visual acuities for far, intermediate and near were registered and compared among groups at 3 months. To track changes in patient quality of life, the Catquest-9SF questionnaire was administered to each patient before and after cataract extraction. RESULTS: Ninety patients (30 for each group) were enrolled. At 3 months follow-up, statistically significant differences for intermediate visual acuities were found between the three groups. Nonstatistically significant differences were observed for distance visual acuities and the changes in Catquest-9SF scores. CONCLUSION: Tecnis Eyhance™ provided better results in intermediate visual outcomes without adverse effects on patients' quality of life.

Phacoemulsification Wound Burn and Its Management.

Introduction: The production of ultrasonic energy during phacoemulsification is associated with heat generation that could damage ocular tissues, particularly at the corneoscleral wound site. Case Presentation: This study presents an 89-year-old patient with senile hypermature cataract and Fuchs endothelial dystrophy developing severe thermal corneoscleral injury during phacoemulsification. At presentation, visual acuity was finger count at 40 cm and there was a 1 × 2-mm area of corneal melting at the corneal tunnel with diffuse corneal oedema. After 1 month, a temporal circular corneal patch graft was applied to the corneal burn. A penetrating keratoplasty was performed 16 months after the first surgery. Conclusion: Corneal surgery, including lamellar patch grafts and full-thickness penetrating grafts, could be used, when necessary, to restore the cornea's integrity. These procedures could eliminate corneal scarring, decrease astigmatism, and improve vision in patients with phacoemulsification burns.

Hitting the refractive target in corneal endothelial transplantation triple procedures: A systematic review.

In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with phacoemulsification and intraocular lens (IOL) implantation (triple procedure). This surgery might cause a refractive shift difficult to predict. Early DMEK and DSAEK results have shown a tendency toward a hyperopic shift. Myopic postoperative refraction is typically intended to correct this postoperative refractive defect and to bring all eyes as close to emmetropia as possible. We sought to understand the mechanism underlying the hyperopization and to identify predictive factors for poorer refractive outcomes, the most suitable target refraction and IOL calculation methods in patients undergoing combined cataract extraction and lamellar endothelial corneal transplantation (DSAEK or DMEK) for endothelial dysfunctions. Of the 407 articles analyzed, only 18 were included in the analysis. A myopic target between -0.50 D and -0.75 was the most common (up to -1.50 for DSAEK triple procedures), even though no optimum target was found. Hyperopic surprises appeared more frequently in corneas that were flatter in the center than in the periphery (oblate posterior profile). Among the numerous IOL calculation formulas, there was no apparent preference.

Immediate sequential bilateral cataract surgery: Prevalence, attitudes and concerns Among Italian ophthalmologists.

PURPOSE: to investigate the existing practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in Italy and to assess ophthalmologists' attitudes towards performing ISBCS in the future for cataract treatment. METHODS: It is a multicenter cross-sectional study. From February,1st 2023 to March, 1st 2023 the Members of the Italian Society of Cataract and Refractive Surgery (AICCER) as well as the attendees of its annual national congress were invited to anonymously complete an electronic 7-item questionnaire on their current ICBCS practice. Questions included the average number of procedures per month, the main indications for ICBCS, and the main reasons for performing and not performing ISBCS. Data were analyzed using descriptive statistics. RESULTS: of the 2300 recipients, 246 (10.7%) completed the survey. Of the respondents, 156 (63.4%) replied to perform ISBCS, most of them (82%) occasionally (1 to 5 procedures per month). Fifty-three percent (130 ophthalmologists) considered adopting ISBCS as routine practice in the near future. The conditions most considered for ISBCS were age-related cataract surgery under general and topical anesthesia and congenital cataract surgery. The availability of separate instruments for the two eyes as well as patient and hospital advantages were the most important reasons for performing ISBCS. The risk of bilateral endophthalmitis and medicolegal issues were the main reasons for not performing ISBCS. CONCLUSIONS: ISBCS remains controversial among Italian surgeons, despite growing evidence of its safety and efficacy. The risk of potentially blinding complications such as bilateral endophthalmitis, together with medicolegal concerns are the principal barriers to ISBCS implementation in routine practice.

Systematic review for the development of a core outcome set for monofocal intraocular lenses for cataract surgery.

Introduction: The aim of the study was to define a core outcome set (COS) to be measured following cataract surgery for the postoperative evaluation of monofocal intraocular lenses (IOLs). Compared to current COSs, the present work provides updates considering the advances in the technology due to the development of new generation monofocal IOLs, which are characterized by a safety profile comparable to standard monofocal IOLs but with an extended range of intermediate vision. Methods: Healthcare professionals (ophthalmologist surgeons) and patients were involved in the selection of outcomes to be included in the COS, starting from a list of indicators retrieved from a systematic literature search. The search considered observational studies with both a retrospective or prospective design, case studies and classic randomized controlled trials (RCTs). A mixed methodology integrating a Delphi-driven and an expert panel approach was adopted to reach an agreement among clinicians, while patients were involved in the completion of a questionnaire. Results: The final COS included 15 outcomes. Eleven outcomes, all clinical, were considered for inclusion after a joint discussion among ophthalmologists; seven outcomes were linked to visual acuity, while the remaining to contrast sensitivity, refractive errors, aberrations and adverse events. Measurement metrics, method of aggregation and measurement time point of these outcomes were specified. The most important aspects for the patients were (1) quality of life after cataract surgery, (2) the capacity to perform activities requiring good near vision (e.g., reading), (3) spectacle independence, and (4) safety of movements without fear of getting hurt or falling (intermediate vision). Discussion: In a context with limited healthcare resources, it is important to optimize their use considering also the preferences of end-users, namely patients. The proposed COS, developed involving both ophthalmologists and patients, provides an instrument for the postoperative evaluation of different technologies in the context of monofocal IOLs, which can be used not only in clinical trials but also in clinical practice to increase the body of real-world evidence.