Vision and patient-reported outcomes with nondiffractive EDOF or neutral aspheric monofocal intraocular lenses.

PURPOSE: To compare outcomes in patients who underwent cataract extraction with implantation of nondiffractive extended depth-of-focus (ND-EDOF; Alcon AcrySof Vivity) or neutral aspheric monofocal (Bausch & Lomb enVista) intraocular lenses (IOLs). SETTING: Academic medical center. DESIGN: Prospective single-center double-arm patient- and assessor-masked randomized controlled trial. METHODS: Patients were randomized to receive either a ND-EDOF or monofocal IOL in both eyes, targeted for emmetropia. Uncorrected and corrected (CDVA) distance visual acuities, distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), level of spectacle independence, and severity of photic phenomena were assessed at 3 months postoperatively. RESULTS: 56 patients were enrolled, of which 24 in the ND-EDOF group and 27 in the monofocal group completed follow-up. The binocular mean CDVA, DCIVA, and DCNVA were 20/20, 20/19, and 20/21 for the ND-EDOF IOL and 20/18 ( P = .188), 20/31 ( P < .001), and 20/30 ( P = .004) for the monofocal IOL, respectively. At intermediate, 88% of the ND-EDOF vs 30% of the monofocal patients had a binocular DCIVA of 20/25 or better ( P < .001). Moderate or severe glare occurred in 20.8% of ND-EDOF vs 7.4% of monofocal patients ( P = .228), whereas moderate or severe halos occurred in 16.7% of ND-EDOF vs 11.1% of monofocal patients ( P = .697). CONCLUSIONS: The ND-EDOF and monofocal IOLs provided similarly excellent distance vision. Patients implanted with the ND-EDOF IOL had 2 more lines of vision at both intermediate and near, and a greater proportion reported spectacle independence. Most patients in both groups reported low severity of photic phenomena.

Safety and efficacy of topical vs intracanalicular corticosteroids for the prevention of postoperative inflammation after cataract surgery.

PURPOSE: To compare the safety and efficacy of topical prednisolone and intracanalicular dexamethasone ophthalmic insert for the prevention of postoperative inflammation after cataract surgery. SETTING: Penn State College of Medicine, Hershey, Pennsylvania. DESIGN: Retrospective consecutive case series. METHODS: Patients scheduled for elective phacoemulsification cataract surgery with a plan to receive inflammation prophylaxis with topical prednisolone (prednisolone acetate 1 mg/1 mL) between January 2018 and November 2019 or intracanalicular dexamethasone (Dextenza, 0.4 mg) between December 2019 and March 2021 were screened. Patients were seen 1 day, 1 week, and 4 to 16 weeks postoperatively. Medical records were also reviewed for any urgent messages between visits. Primary end points were proportion of eyes with (1) breakthrough inflammation requiring escalation of anti-inflammatory therapy and (2) intraocular pressure (IOP) increase ≥10 mm Hg at 4 to 16 weeks of follow-up. Secondary end points included incidence of intraoperative complications, cystoid macular edema, and infectious sequelae. RESULTS: 358 patient charts (358 eyes) were screened. Of these, 262 eyes of 262 patients met the criteria for inclusion in the study; 131 eyes received topical drops, and 131 eyes received the intracanalicular insert. Among eyes that completed follow-up, 9 eyes (6.9%) in the drops group and 12 eyes (9.2%) in the insert group experienced breakthrough inflammation necessitating treatment ( P = .50). 2 eyes in the drops group and 1 eye in the insert group had elevated IOP. CONCLUSIONS: Postoperative inflammation prophylaxis with the intracanalicular insert may be associated with similar rates of breakthrough inflammation and IOP elevation as topical drops.

Transzonular Triamcinolone-Moxifloxacin Versus Topical Drops for the Prophylaxis of Postoperative Inflammation After Cataract Surgery.

Purpose: To compare the safety and efficacy of an intraoperative transzonular injection of triamcinolone-moxifloxacin (Imprimis' Tri-Moxi 15 mg/1 mg/mL) to topical drops in patients undergoing cataract surgery. Methods: Between January 2017 and October 2017, patients undergoing phacoemulsification cataract surgery by a single surgeon at the Penn State Eye Center were offered a single intraoperative injection of transzonular triamcinolone-moxifloxacin in lieu of perioperative drops. Between November 2017 and July 2018, the transzonular injection was not offered, and all patients who underwent surgery by the same surgeon received a drop regimen consisting of polymyxin b/trimethoprim and prednisolone acetate 1%. Patients were seen 1 day, 1 week, and 6-9 weeks postoperatively. Outcome measures included incidence of intraoperative complications, postoperative breakthrough inflammation, cystoid macular edema, and infectious sequela. Results: Of the 198 eyes, 99 from 73 patients received the injection and 99 from 82 patients received topical drops. One (1%) intraoperative posterior capsule tear occurred in each group. Eleven (11.1%) eyes in the injection group and 3 (3%) in the drop group experienced symptomatic breakthrough inflammation necessitating treatment (P = 0.0488). One (1%) eye in the injection group and zero (0%) in the drop group developed clinically significant macular edema (P = 1.0). No instances of elevated intraocular pressure or infectious sequela occurred in either group (P = 1.0). Conclusions: Transzonular injection of triamcinolone-moxifloxacin may be associated with an increased incidence of breakthrough inflammation compared to topical drops.

Papilloedema associated with dural venous sinus thrombosis.

Papilloedema is a diagnostic term used exclusively to describe optic disc oedema associated with increased intracranial pressure. Septic cerebral venous sinus thrombosis has become an increasingly rare cause of papilloedema because of the widespread availability of antimicrobial agents; however, it is imperative for optometrists to maintain vigilance for this pathologic process. Presented is a case of a 77-year-old Caucasian male with a complaint of blurred vision and non-specific, diffuse headache. He had a right sixth cranial nerve palsy and bilateral disc oedema. Raised intracranial pressure was confirmed by lumbar puncture. Neuroimaging, including magnetic resonance imaging and magnetic resonance venography in conjunction with cytological assessment of the cerebral spinal fluid led to a probable diagnosis of mastoiditis causing multiple dural venous sinus thrombi of the superior sagittal and right transverse sinuses. Sequential evaluation of this complex case is displayed along with pertinent differential diagnoses for optic disc oedema and a review of current standards for diagnosis and management of papilloedema from dural sinus thrombosis.