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BACKGROUND: To compare the difference in rebubbling rates between patients undergoing Descemet membrane endothelial keratoplasty (DMEK) with endothelium-in using a standard IOL cartridge and those with endothelium-out DMEK utilizing a no-touch technique with borosilicate glass cartridge transplantation. METHODS: This retrospective study included all eyes that underwent preloaded endothelium-in or endothelium-out DMEK transplantation from June 2019 to December 2023 at the Hanusch Hospital, Vienna, Austria. All DMEKs were harvested, prepared and preloaded at the European Eye Bank of Venice, Italy. DMEK surgeries were done by one experienced surgeon and the procedure was completed by air tamponade of the anterior chamber. RESULTS: Overall, 32 eyes each of 31 endothelium-out patients and of 29 endothelium-in patients were included. 32 preloaded endothelium-in procedures were followed by 32 preloaded endothelium-out procedures. Rebubbling rate for endothelium-in was 15/32 (47%) and for endothelium-out was 7/25 (28%) (p = 0.035, Pearson's chi-squared test). Donor age was the most important variable for rebubbling in a random forest algorithm model (ROC: 0.69). CONCLUSIONS: Rebubbling rate in endothelium-out DMEK was less than two-thirds compared to endothelium-in DMEK favoring no-touch endothelium-out DMEK as the preferred technique of DMEK transplantation.
Subject(s)
Descemet Stripping Endothelial Keratoplasty , Endothelium, Corneal , Visual Acuity , Humans , Descemet Stripping Endothelial Keratoplasty/methods , Retrospective Studies , Male , Female , Aged , Middle Aged , Endothelium, Corneal/transplantation , Graft Survival , Adult , Fuchs' Endothelial Dystrophy/surgery , Aged, 80 and over , Descemet Membrane/surgery , Tissue DonorsABSTRACT
PURPOSE: To evaluate prediction accuracy of formulas included in the ESCRS-Online-IOL-Calculator using standard keratometry (K) or total keratometry (TK). SETTING: Hospital-based academic practice. DESIGN: Retrospective case-series. METHODS: Participants: 523 cataract patients (523 eyes). Outcome Measures: trimmed-means of the spherical equivalent prediction error (SEQ-PE, trueness), precision and absolute SEQ-PE (accuracy) of all seven formulas available on the ESCRS-Online-IOL-Calculator as well as the mean (Mean-All) and median (Median-All) of the predicted SEQ refraction of all formulas. Sub-group analyses evaluated the effect of axial length on formula accuracy. RESULTS: Trimmed-mean SEQ-PE range of all formulas varied from -0.075 to +0.071D for K-based and from -0.003 to +0.147D for TK-based calculations, with TK-based being more hyperopic in all formulas (p<0.001). Precision ranged from 0.210 to 0.244D for both K-based and TK-based calculations. Absolute SEQ-PE ranged from 0.211 to 0.239D for K-based and from 0.218 to 0.255D for TK-based calculations. All formulas, including Mean-All and Median-All, showed high accuracy with 84-90% of eyes having SEQ-PEs within 0.50D.Myopic trimmed-mean SEQ-PEs significantly different from zero were observed in long eyes for Pearl DGS (-0.110D, p=0.005), Hill RBF (-0.120D, p<0.001) and Hoffer QST (-0.143D, p=0.001), and in short eyes for EVO 2.0 (-0.252D, p=0.001), Kane (-0.264D, p=0.001), Hoffer QST (-0.302D, p<0.001), Mean-All (-0.122D, p=0.038) and Median-All (-0.125D, p=0.043). CONCLUSION: Prediction accuracy of all ESCRS IOL Calculator formulas was high and globally comparable. TK-based calculations did not increase prediction accuracy and tended towards hyperopia. Observations indicating formula superiority in long and short eyes merit further evaluation.
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PURPOSE: To compare web-based, self-administered follow-up after cataract surgery to conventional face-to-face follow-up. SETTING: Eye clinics in the Netherlands, Austria, and Germany. DESIGN: Randomized controlled trial with an embedded method comparison study (ClinicalTrials.gov: NCT04809402). METHODS: Routine patients with cataract were randomized into 2 groups: The telemonitoring group undertook web-based vision self-assessments and questionnaires from home, while the usual care group received conventional care. All participants had a 4- to 6-week postoperative clinic visit for safety and validation purposes. Outcomes included, the web test's accuracy for assessing postoperative visual acuity (VA) and refractive error, adverse event rates, and patient-reported outcome measurements (PROMs). RESULTS: 94 participants (188 eyes) were enrolled. Web-based uncorrected distance VA testing demonstrated a negligible mean difference (-0.03 ± 0.14 logMAR) when compared with conventional Early Treatment Diabetic Retinopathy Study chart testing, with 95% limits of agreement ranging from -0.30 to 0.24 logMAR. The web-based refraction assessment overestimated the postoperative refractive error (mean difference in spherical equivalent 0.15 ± 0.67 diopters), resulting in a poorer corrected distance VA compared with subjective refraction (mean 0.1 vs -0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROM questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and National Eye Institute Visual Function Questionnaire-25) improved postoperatively (mean improvement -0.80 and 16.70, respectively) and did not significantly differ between the 2 groups. CONCLUSIONS: The patients with cataract in this study effectively provided postoperative outcome data using a web interface. Both conventional and web-based follow-ups yielded similar PROMs and adverse event rates. Future developments should reduce the variability in the web-based VA test and yield representative refraction outcomes.
Subject(s)
Internet , Telemedicine , Visual Acuity , Humans , Visual Acuity/physiology , Female , Male , Aged , Middle Aged , Cataract Extraction , Self Report , Surveys and Questionnaires , Pseudophakia/physiopathology , Refraction, Ocular/physiology , Patient Reported Outcome Measures , Phacoemulsification , Lens Implantation, Intraocular , Follow-Up StudiesABSTRACT
Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
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PURPOSE: To measure the dislocation forces in relation to haptic material, flange size and needle used. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Laboratory Investigation. METHODS, MAIN OUTCOME MEASURES: 30 G (gauge) thin wall and 27 G standard needles were used for a 2 mm tangential scleral tunnel in combination with different PVDF (polyvinylidene fluoride) and PMMA (polymethylmethacrylate haptics). Flanges were created by heating 1 mm of the haptic end, non-forceps assisted in PVDF and forceps assisted in PMMA haptics. The dislocation force was measured in non-preserved cadaver sclera using a tensiometer device. RESULTS: PVDF flanges achieved were of a mushroom-like shape and PMMA flanges were of a conic shape. For 30 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 1.58 ± 0.68 N (n = 10) and 0.70 ± 0.14 N (n = 9) (p = 0.003) respectively. For 27 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 0.31 ± 0.35 N (n = 3) and 0.0 N (n = 4), respectively. The flange size correlated with the occurring dislocation force in experiments with 30 G needle tunnels (r = 0.92), when flanges were bigger than 384 micrometres. CONCLUSIONS: The highest dislocation forces were found for PVDF haptic flanges and their characteristic mushroom-like shape for 30 G thin wall needle scleral tunnels. Forceps assisted flange creation in PMMA haptics did not compensate the disadvantage of PMMA haptics with their characteristic conic shape flange.
Subject(s)
Fluorocarbon Polymers , Haptic Technology , Lenses, Intraocular , Polyvinyls , Humans , Polymethyl Methacrylate , Sclera/surgeryABSTRACT
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.
Subject(s)
Cataract Extraction , Cataract , Telemedicine , Humans , Patient Satisfaction , TelephoneABSTRACT
Background: New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives: This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design: A multidimensional comprehensive systematic narrative review. Data sources and methods: A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results: Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion: The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration: The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
Keratoconus: from fundamentals to future Artificial intelligence has changed how we treat the eye disease keratoconus in recent years. This study examines the many keratoconus therapies available, including surgery and contact lens wear, and how artificial intelligence can improve the safety and accuracy of these procedures. We combed through numerous papers to locate this data. To achieve the best outcomes, several parameters and methods should be evaluated. According to the study, some elements from eye scans are more useful than others. The idea behind using artificial intelligence is to help patients see better and treat keratoconus more effectively.
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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.
Subject(s)
Artificial Lens Implant Migration , Lens Implantation, Intraocular , Lenses, Intraocular , Sclera , Suture Techniques , Humans , Sclera/surgery , Artificial Lens Implant Migration/surgery , Lens Implantation, Intraocular/methods , Sutureless Surgical Procedures/methods , Tissue Donors , Biomechanical PhenomenaABSTRACT
PURPOSE: To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months. METHODS: In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1â h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration. RESULTS: In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1â h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17â mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0. CONCLUSIONS: This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values.
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BACKGROUND: Full-thickness macular holes, defined as full-thickness defects of the fovea, lead to central scotoma and deterioration of vision. Apart from peeling of the internal limiting membrane (ILM), ILM flap techniques have been reported to have potential in improving results in macular hole surgery. In addition, foveal-sparing ILM peeling gives a high macular hole closure rate and improvement in postoperative visual acuity. The aim of this study was to examine outcomes in a cohort of patients with full-thickness macular holes that underwent vitrectomy with foveal-sparing ILM peeling and transposition of an ILM flap over the macular hole. METHODS: This retrospective study included patients scheduled for pars plana vitrectomy with foveal-sparing ILM peeling, combined with ILM flap transposition over the macular hole, for macular hole repair. All patients received a gas tamponade with 20% sulphur hexafluoride and were encouraged to undergo postoperative face-down positioning for 48 hours after surgery. Optical coherence tomography (OCT) imaging of the macula and distance-corrected visual acuity (DCVA) were performed before and 3 months after surgery. RESULTS: In total, 42 eyes of 42 patients were included in this study. Leaving a broad area of residual ILM at the foveal rim led to a high risk of failure in macular hole closure, while leaving a narrow zone of residual ILM at the foveal rim resulted in high macular hole closure rates (97% type 1 closure and 3% type 2 closure), with a median improvement of DCVA of 4 lines [interquartile range (IQR): 3 to 6] among pseudophakic and 3.5 lines (IQR: 2 to 5) among phakic patients. CONCLUSIONS: A combination of foveal-sparing ILM peeling with ILM flap techniques was shown to be a safe and effective surgical option for patients with full-thickness macular holes, resulting in a high macular hole closure rate and improvement in visual acuity in the majority of patients.
Subject(s)
Retinal Perforations , Surgical Flaps , Visual Acuity , Vitrectomy , Humans , Retinal Perforations/surgery , Male , Female , Vitrectomy/methods , Surgical Flaps/transplantation , Retrospective Studies , Aged , Middle Aged , Treatment Outcome , Fovea Centralis/diagnostic imaging , Fovea Centralis/surgery , Basement Membrane/surgery , Tomography, Optical Coherence , Organ Sparing Treatments/methodsABSTRACT
PURPOSE OF REVIEW: To showcase the majority of online intraocular lens (IOL) calculation tools and highlight some of their characteristics. RECENT FINDINGS: Online tools are available for preoperative and postoperative IOL-related calculations, including IOL power and toricity selection for standard patients, patients who underwent prior refractive surgery, keratoconus, limbal relaxing incisions for astigmatism management, realignment of a misplaced or rotated toric IOL, surgical induced astigmatism (SIA), formulae comparison, and other tools. SUMMARY: As there are new online developments and technology is advancing rapidly, we hope that this review will assist ophthalmologists in becoming acquainted with a large variety of online tools.
Subject(s)
Astigmatism , Lenses, Intraocular , Phacoemulsification , Refractive Surgical Procedures , Humans , Lens Implantation, Intraocular , Astigmatism/surgery , Refraction, Ocular , Retrospective StudiesABSTRACT
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.
Subject(s)
Lens Implantation, Intraocular , Lenses, Intraocular , Humans , Lens Implantation, Intraocular/methods , Nylons , Suture Techniques , Iris/surgery , Polymers , Sclera/surgeryABSTRACT
PURPOSE: This study aimed to explore the concept of total keratometry (TK) by analyzing extensive international datasets representing diverse ethnic backgrounds. The primary objective was to quantify the disparities between traditional keratometry (K) and TK values in normal eyes and assess their impact on intraocular lens (IOL) power calculations using various formulas. DESIGN: Retrospective multicenter intra-instrument reliability analysis. METHODS: The study involved the analysis of biometry data collected from ten international centers across Europe, the United States, and Asia. Corneal power was expressed as equivalent power and astigmatic vector components for both K and TK values. The study assessed the influence of these differences on IOL power calculations using different formulas. The results were analyzed and plotted using Bland-Altman and double angle plots. RESULTS: The study encompassed a total of 116,982 measurements from 57,862 right eyes and 59,120 left eyes. The analysis revealed a high level of agreement between K and TK values, with 93.98% of eyes exhibiting an absolute difference of 0.25 D or less. Astigmatism vector differences exceeding 0.25 D and 0.50 D were observed in 39.43% and 1.08% of eyes, respectively. CONCLUSIONS: This large-scale study underscores the similarity between mean K and TK values in healthy eyes, with rare clinical implications for IOL power calculation. Noteworthy differences were observed in astigmatism values between K and TK. Future investigations should delve into the practicality of TK values for astigmatism correction and their implications for surgical outcomes.
Subject(s)
Astigmatism , Lenses, Intraocular , Phacoemulsification , Humans , Tomography, Optical Coherence/methods , Astigmatism/diagnosis , Reproducibility of Results , Cornea , Biometry/methods , Retrospective Studies , Refraction, OcularABSTRACT
PURPOSE: To evaluate the effect of vectored thermal pulsation therapy (VTPT) on the repeatability of biometry readings of two different optical biometers in patients with meibomian gland dysfunction (MGD). METHODS: Patients affected by MGD were included in this prospective, randomized, controlled, investigator-masked study. One eye was randomized to VTPT (LipiFlow®, Johnson & Johnson), and the contralateral eye served as a control. Three visits were scheduled at baseline, 2 weeks and 3 months after the treatment. The main outcome parameter of the study was the repeatability of three calculations of emmetropic intraocular lens power (EIOLP) at the 3 months visit as compared to baseline using an optical biometer (IOLMaster® 700, Carl Zeiss Meditec AG). Repeatability of different keratometry values obtained by the optical biometer and a Placido-disc topographer (MS-39®, CSO) served as secondary outcome parameters. RESULTS: Twenty-nine patients were included in the final analysis. While tear film parameters improved in the study eyes, there were no significant differences regarding the repeatability of three EIOLP measurements between baseline and 3-months-visit in both eyes (p > 0.05) and keratometry measurements in both the optical biometer and the Placido-disc topographer. Remarkably, throughout all study visits, there were some outliers regarding the repeatability of measurements. CONCLUSION: While both devices showed high repeatability regarding EIOLP and keratometry, future studies are needed to detect high-risk patients for poor repeatability.
Subject(s)
Hyperthermia, Induced , Meibomian Gland Dysfunction , Humans , Prospective Studies , Cornea , BiometryABSTRACT
Every ophthalmic surgical supply, including intraocular lenses (IOLs), IOL cartridges, and ophthalmic viscosurgical device syringes, is packaged with instructions for use (IFU). These pamphlets are printed in multiple languages and, in the case of an IOL, significantly increase the size and weight of the packaging. To eliminate this significant and unnecessary source of waste, we recommend that manufacturers move to Quick Response codes that link to online electronic IFU (e-IFU) as a sensible alternative. In addition to reducing carbon emissions and manufacturing costs, e-IFU can be updated more easily and accessed by surgeons in the clinic, where IOL models and powers are selected. Varying and inconsistent IFU requirements between different countries are a barrier to wider adoption of e-IFU by the ophthalmic surgical industry. Regulatory agencies in every country should allow and encourage e-IFU. This position paper has been endorsed by the 3 major societies that sponsor EyeSustain, a consortium of global societies dedicated to advancing sustainability in ophthalmology.
Subject(s)
Lenses, Intraocular , Ophthalmology , Humans , Ophthalmologic Surgical ProceduresABSTRACT
INTRODUCTION: The objective of this study was to evaluate the prevalence of ocular surface damage assessed by corneal staining scores right after cataract surgery and whether it can be prevented using chitosan-N-acetylcysteine (C-NAC) eye drops. METHODS: We included patients scheduled for routine cataract surgery. Each patient was randomly assigned to one of three groups. Patients in group 1 underwent routine cataract surgery with no additional eye drops. In group 2, patients received C-NAC eye drops after cataract surgery, and in group 3, C-NAC was applied both before and after surgery. Both groups continued the treatment once daily for 4 days. Ocular surface alteration was assessed using the National Eye Institute (NEI) score, and the visual analog scale (VAS) was used to evaluate subjective complaints. RESULTS: Thirty-six patients were included in the final analyses. One hour after cataract surgery, a statistically significant increase in corneal fluorescein staining was observed in all groups, which decreased again after 1 week. There was no significant difference between the groups 1 h after cataract surgery, though a tendency toward lower NEI scores was observed during this time point in group 3. DISCUSSION: Cataract surgery induced ocular surface staining and subjective complaints after 1 h. However, the increase in VAS score was small and probably not clinically relevant. The application of perioperative C-NAC eye drops did reduce the rate of corneal staining after cataract surgery in a clinically relevant manner.
Subject(s)
Cataract Extraction , Cataract , Chitosan , Dry Eye Syndromes , Humans , Ophthalmic Solutions , Acetylcysteine/therapeutic use , Acetylcysteine/pharmacology , Cataract Extraction/adverse effectsABSTRACT
The remarkable recent advances in managing keratoconus, the most common corneal ectasia, encouraged researchers to conduct further studies on the disease. Despite the abundance of information about keratoconus, debates persist regarding the detection of mild cases. Early detection plays a crucial role in facilitating less invasive treatments. This review encompasses corneal data ranging from the basic sciences to the application of artificial intelligence in keratoconus patients. Diagnostic systems utilize automated decision trees, support vector machines, and various types of neural networks, incorporating input from various corneal imaging equipment. Although the integration of artificial intelligence techniques into corneal imaging devices may take time, their popularity in clinical practice is increasing. Most of the studies reviewed herein demonstrate a high discriminatory power between normal and keratoconus cases, with a relatively lower discriminatory power for subclinical keratoconus.
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BACKGROUND: To comprehensively evaluate the agreement of component corneal aberrations from the newly updated wavefront analysis software of a swept-source optical coherence tomographer (SS-OCT) and a referential Placido-topography combined OCT device in elderly cataract patients. METHODS: Retrospective study including 103 eyes from 103 elderly patients scheduled for cataract surgery that were measured on the same day with a SS-OCT (Heidelberg Engineering, Germany) device and a Placido-topography combined OCT device (CSO, Italy). Anterior, total, and posterior corneal wavefront aberrations were evaluated for their mean differences and limits of agreement (LoA) via Bland-Altman plots. Vector analysis was additionally employed to compare corneal astigmatism measurements in dioptric vector space. RESULTS: Mean differences of all corneal aberrometric parameters did not exceed 0.05 µm. Total corneal aberrations were not significantly different from 0 except for vertical coma (- 0.04 µm; P = 0.003), spherical aberration (- 0.01 µm, P < 0.001), and root mean square (RMS) higher-order aberration (HOA) (0.03 µm, P = 0.04). The 95% LoA for total corneal aberration parameters between both devices were - 0.46 to 0.42 µm for horizontal astigmatism, - 0.37 to 0.41 µm for oblique astigmatism, - 0.19 to 0.17 µm for oblique trefoil, - 0.33 to 0.25 µm for vertical coma, - 0.20 to 0.22 µm for horizontal coma, - 0.22 to 0.20 µm for horizontal trefoil, - 0.11 to 0.08 µm for spherical aberration, and - 0.22 to 0.28 µm for RMS HOA. Vector analysis revealed no statistically significant mean differences for anterior, total, and posterior corneal astigmatism in dioptric vector space. CONCLUSION: In eyes undergoing cataract surgery with a regular elderly cornea, corneal wavefront analysis from the SS-OCT device showed functional equivalency to the reference device. Nevertheless, clinically relevant higher order aberration parameters should be interpreted with caution for surgical decision-making.