Quality assurance via telephone interviews after cataract surgery: An explorative study.

INTRODUCTION: Cataract surgery is a relatively safe procedure with satisfactory postoperative results in most patients. However, in rare cases severe complications can occur shortly after the intervention. Therefore, patients are advised to undergo an ophthalmological examination postoperatively, which should be performed as soon as possible in case of emergencies. However, exactly when these follow-up visits should take place is still discussed. A time- and cost-saving alternative to this could be short-term postoperative telemedical approaches. The aim of this study was to analyze patient complaints as well as satisfaction with and the best timepoint to perform telephone calls after cataract surgery. METHODS: Patients scheduled for cataract surgery received a telephone call on the surgery day or the day after (study group) during which they were asked about complaints or additional examination visits. Patients without telephone calls served as control group. All patients had a follow-up visit one week after the intervention during which a questionnaire was filled out and the study group was asked about their satisfaction with the telephone calls. RESULTS: 181 patients were recruited in this study. Ocular surface problems were the most common postoperative symptom. More than 80% of the patients were very satisfied with the telephone calls, with patients being contacted on the day of surgery being more calmed than those called on the next day. No difference in additional and planned follow-up visits was found between the study and the control group (P > .40). Postoperative patient complaints (Phi 0.372, P < .001) and additional prescribed therapy (Phi 0.480, P < .001) were moderately associated with additional visits. CONCLUSION: Satisfaction with telephone reviews shortly after cataract surgery was very high and contacting patients on the evening of the day of the procedure could be a time- and cost-saving alternative to short-term in-house follow-up visits.

Influence of Sutureless Scleral Fixation Techniques With 3-Piece Intraocular Lenses on Dislocation Force.

PURPOSE: To compare 4 different secondary intraocular lens (IOL) fixation techniques regarding the least required force to dislocate a scleral fixated 3-piece IOL in human corneoscleral donor tissue. DESIGN: Experimental laboratory investigation. METHODS: The least required dislocation force (LRDF) of 4 different secondary IOL fixation techniques, namely, the techniques using transscleral tunnels (TTs; as described by Scharioth), glued haptics (GHs; Agarwal), flanged haptics (FHs; Yamane), and bent haptic ends (BH; Behera/Bolz), were investigated using 40 three-piece IOLs (Sensar AR40) fixated to human scleral tissue. The main outcome of the study, dislocation force between different techniques, was measured with a tensiometer. RESULTS: The force needed to dislocate the haptics was highest with the FH technique and was significantly higher than with all the other techniques (GH vs FH: -1.02±0.02 N, P < .001; TT vs FH: -1.08±0.21 N, P < .001; BH vs FH: -1.00±0.25 N, P = .044). There was no significant difference regarding the dislocation force between the other techniques: GH vs TT (-0.06±0.100 N, P = .988), GH vs BH (-0.02±0.03 N, P = .60), TT vs BH (-0.08±0.04 N, P > .99). CONCLUSIONS: The FH technique as described by Yamane proved to be the strongest form of secondary IOL fixation regarding dislocation force in this in vitro study. The other fixation techniques showed significantly less resistance to axial traction.

Attaining the optimal flange technique for transscleral capsular bag stabilization using iris hooks.

PURPOSE: To investigate the flange properties of different iris hooks. SETTING: Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria. DESIGN: Laboratory study. METHODS: The flanging properties of 4 different iris hooks made from polypropylene (PP), elastic polymer (EP), and nylon were investigated with different heating distances and both with and without forceps gripping. The maximum diameter of the flanges was measured, and the shape of the flanges was evaluated. RESULTS: Although both nylon and EP iris hooks had too small flange diameters for intrascleral fixation, PP iris hooks had a sufficient flange diameter (>330 µm) and mushroom-like shape. Furthermore, in PP hooks, heating distance was directly proportional to flange diameter. CONCLUSIONS: The findings of this study suggest that only PP iris hooks are suitable for flanged intrascleral fixation, which is off-label, to secure adequate fixation.

Sources of Error in Toric Intraocular Lens Power Calculation.

PURPOSE: To evaluate the influencing factors on remaining astigmatism after implanting a toric intraocular lens (IOL) during cataract surgery. METHODS: This retrospective study included parameters that were considered to have an influence on toric IOL power calculation. Therefore, data from the literature and the authors' own data were used. This included axial eye length, anterior chamber depth, central corneal thickness, corneal radii (anterior and posterior), diurnal changes of the cornea, inter-device differences, rotational misalignment of the IOL, tilt and decentration of the IOL, pupil size, angle kappa, and surgically induced astigmatism. Ray-tracing and Gaussian error propagation analysis was performed to quantify the sources of error. RESULTS: In total, 4,949 eyes (4,365 eyes of 42 studies and 584 eyes of retrospectively analyzed study data) were included in the study and the difference vector between aimed and calculated remaining astigmatism was 0.81 diopters (D). The main source of error was the preoperative measurement of the cornea (27%), followed by IOL misalignment (14.4%) and IOL tilt (11.3%). Other factors, such as angle kappa (10.9%), pupil size (8.1%), surgically induced astigmatism (7.8%), anterior chamber depth (7.5%), axial eye length (7.5%), and decentration (5.6%), also contributed to the refractive astigmatic error. CONCLUSIONS: The main source of error in toric IOL power calculation is the preoperative corneal measurement followed by IOL misalignment and tilt. [J Refract Surg. 2020;36(10):646-652.].

Comparison of intraocular lens decentration and tilt measurements using 2 Purkinje meter systems.

PURPOSE: To evaluate the difference in intraocular lens tilt and decentration measurements with 2 Purkinje meters. SETTING: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective evaluation of diagnostic test. METHODS: This single-center study included pseudophakic patients in 2 substudies in which 3 consecutive measurements were performed with 2 Purkinje meters (Spanish and German). In substudy 1, an inexperienced examiner performed all measurements after a short learning period. In substudy 2, all measurements were taken by experienced examiners under direct supervision of the inventors of the devices. RESULTS: Substudy 1 included 53 pseudophakic eyes in which all 53 scans were successful with the Spanish device; however, only 35 measurements (66%) were successful with the German Purkinje meter. The mean tilt measured with the Spanish Purkinje meter was 4.35 degrees ± 2.50 (SD) and 9.20 ± 6.96 degrees with the German Purkinje meter. The mean decentration was 0.44 ± 0.19 mm and 0.74 ± 0.91 mm, (P = .44), respectively. In substudy 2 (29 pseudophakic eyes), the number of successful scans was 29 (100%) and 18 (62%) for the Spanish meter and German Purkinje meter, respectively. The mean horizontal and vertical tilt difference vector between the 2 systems was 4.89 ± 3.24 degrees and 7.57 ± 3.82 degrees, respectively. CONCLUSIONS: Concerning clinical feasibility, the Spanish Purkinje meter had a greater percentage of successful scans than the German device. In addition, this device measured significantly higher tilt values than the Spanish Purkinje meter.