ABSTRACT
Multifocal intraocular lenses (MIOLs) have demonstrated efficacy and safety in adult cataract surgery, yet they encounter many challenges in pediatric applications. This article elaborates on the difficulties in biometric measurements in children, the unpredictability of postoperative refraction outcomes, the lack of long-term spectacle independence in children with MIOLs, the absence of significant advantages in correcting childhood amblyopia, and the potential increase in the rate of secondary surgeries. Due to the insufficient clinical evidence supporting the use of MIOLs in children at present, it is proposed that MIOLs be cautiously applied to children with congenital cataracts in clinical practice. Further research in this area is encouraged.
Subject(s)
Cataract Extraction , Cataract , Lens Implantation, Intraocular , Humans , Cataract/congenital , Cataract/therapy , Child , Lens Implantation, Intraocular/methods , Cataract Extraction/methods , Lenses, Intraocular , Multifocal Intraocular Lenses , Refraction, Ocular , Amblyopia , Visual AcuityABSTRACT
This case report details the assessment and interdisciplinary collaboration in the management of an 81-year-old patient presenting with acute visual impairment, dizziness, general weakness, gait disturbances and fear of falling. A holistic geriatric evaluation revealed orthostatic dysregulation and an underlying multifactorial gait disorder exacerbated by visual impairment. Ophthalmological findings included left central retinal artery branch occlusion and cataracts. A comprehensive geriatric assessment showed frailty, impaired mobility and decreased functional abilities. Subsequent patient-centered interdisciplinary approaches included treatment for retinal ischemia, orthostatic testing, medication reconciliation, physiotherapy and occupational therapy. This case emphasizes how interdisciplinary collaboration between ophthalmology and geriatrics enables proactive assessment and intervention to reduce the risk of functional decline and loss of autonomy in visually impaired patients, which is of particular relevance considering the increasing prevalence of visual impairment in the ageing population.
Subject(s)
Geriatric Assessment , Humans , Aged, 80 and over , Intersectoral Collaboration , Male , Vision Disorders/diagnosis , Vision Disorders/etiology , Patient Care Team , Female , Interdisciplinary Communication , Ophthalmology , Accidental Falls/prevention & control , Medication Reconciliation , Cataract/therapy , Cataract/diagnosis , Cataract/complicationsABSTRACT
Objective: The aim of this paper is to compare the refractive correction effects of rigid gas permeable contact lenses (RGPCL) and spectacle correction in children with aphakia after congenital cataract surgery. Methods: This was a prospective non-randomized controlled trial. Children with aphakic eyes after congenital cataract surgery, who underwent vision correction in the Strabismus and Pediatric Ophthalmology Clinic of Beijing Tongren Hospital affiliated with Capital Medical University from April 2012 to November 2019, were continuously collected. Those who voluntarily chose to wear RGPCL for refractive correction were included in the experimental group. Patients with monocular disease were in trial group 1, and patients with binocular disease were in trial group 2. Patients who chose to wear frame glasses for refractive correction were included in the control group. Patients with monocular disease were in control group 1, and patients with binocular disease were in control group 2. Regional origin, medical history, and family information were collected at the first diagnosis. During the follow-up, adverse reactions occurring during the process of wearing glasses were recorded. The Teller acuity card was used for visual examination to obtain the best-corrected visual acuity and convert it into the logarithm of the minimum resolution angle. The degree of nystagmus was determined according to the amplitude and frequency of nystagmus. Treatment cost, treatment compliance, and the reasons for adopting or not adopting RGPCL were analyzed through a questionnaire completed by the parents of children with RGPCL. Results: A total of 203 children (344 eyes) who underwent congenital cataract surgery were included, including 124 males (210 eyes) and 79 females (134 eyes). The age range was 3 to 36 months. There were 28 cases in the experimental group, including 19 cases in trial group 1 and 9 cases in trial group 2. There were 175 cases in the control group, including 43 cases in control group 1 and 132 cases in control group 2. Except for 6 months of age, the visual acuity of the experimental group was better than that of the control group, and the differences were statistically significant (P<0.05). The visual acuity of children in trial group 1 was better than that of children in control group 1 at the same age. Among them, at 12 months of age [1.54 (1.27, 1.97), 1.84 (0.97, 2.12)], 18 months of age [1.27 (0.97, 1.84), 1.84 (0.97, 2.12)], 24 months of age [1.54 (1.27, 1.84), 1.84 (0.97, 2.12)], and 30 months old [0.97 (0.66, 1.27), 1.54 (0.66, 2.12)], the difference was statistically significant (P<0.001). The visual acuity of children in trial group 2 was better than that in control group 2 at the same age. Among them, at 18 months old [1.27 (0.97, 1.54), 1.27 (0.66, 2.12)], 24 months old [0.97 (0.66, 1.27), 1.27 (0.66, 2.12)], and 30 months old [1.27 (0.66, 2.12)], the difference was statistically significant (P<0.05). The remission rate of nystagmus in the experimental group was 8/9 (8 cases), the remission rate of nystagmus in the control group was 34.40% (32 cases), and the exacerbation rate was 29.03% (27 cases). The average annual cost of the experimental group was 25 125 yuan, and that of the control group was 2 511 yuan. Conclusions: RGPCL is a well-tolerated, safe, and effective treatment for infants and young children. The visual acuity and degree of nystagmus were significantly improved in children who wore RGPCL for aphakia refractive correction after congenital cataract surgery compared with spectacle correction.
Subject(s)
Aphakia , Cataract Extraction , Cataract , Contact Lenses , Nystagmus, Pathologic , Ophthalmology , Child, Preschool , Female , Humans , Infant , Male , Cataract/therapy , Cataract/congenital , Eyeglasses , Prospective StudiesABSTRACT
Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.
Subject(s)
Astigmatism , Cataract , Lenses, Intraocular , Phacoemulsification , Male , Adult , Female , Humans , Middle Aged , Aged , Lens Implantation, Intraocular , Astigmatism/surgery , Retrospective Studies , Cataract/complications , Cataract/therapy , Refraction, OcularABSTRACT
PURPOSE: This study was conducted to evaluate the effects of different capsulotomy and fragmentation energy levels on the production of oxidative free radicals following femtosecond laser-assisted cataract surgery (FLACS) with a low-energy platform. METHODS: The experimental study included 60 porcine eyes (12 groups). In each group, capsulotomies with 90% or 150% energy, and fragmentations with 90%, 100%, or 150% energy or 150% with high spot density, respectively, were performed. Control samples were obtained from non-lasered eyes at the beginning (five eyes) and end (five eyes) of the experiment. In the clinical study, 104 eyes were divided into 5 groups, and they received conventional phacoemulsification (20 eyes), FLACS with 90% capsulotomy and 100% fragmentation energy levels without NSAIDs (16 eyes), FLACS with 90% (26 eyes) or 150% (22 eyes) capsulotomy energy levels, respectively, with a 100% fragmentation energy level and NSAIDs, and FLACS with 90% capsulotomy and 150% fragmentation energy levels and NSAIDs (20 eyes). Aqueous samples were analyzed for their malondialdehyde (MDA) and superoxide dismutase (SOD) levels. RESULTS: In the experimental study, there were no significant differences in the MDA and SOD levels between the groups with different capsulotomy energy levels. An increase in the fragmentation energy from 100% to 150% led to significantly higher MDA levels in the groups with both 90% (p = 0.04) and 150% capsulotomy energy levels (p = 0.03), respectively. However, increased laser spot densities did not result in significant changes in MDA or SOD levels. In the clinical study, all four of the FLACS groups showed higher MDA levels than the conventional group. Similarly, the increase in the fragmentation energy from 100% to 150% resulted in significantly elevated levels of MDA and SOD, respectively. CONCLUSIONS: Although increasing the FSL capsulotomy energy level may not have increased free radicals, higher fragmentation energy levels increased the generation of aqueous free radicals. However, fragmentation with high spot density did not generate additional oxidative stress. Increased spot density did not generate additional oxidative stress, and this can be helpful for dense cataracts.
Subject(s)
Cataract , Laser Therapy , Humans , Laser Therapy/methods , Cataract/therapy , Lasers , Oxidative Stress , Free Radicals , Anti-Inflammatory Agents, Non-Steroidal , Superoxide DismutaseABSTRACT
PURPOSE: Measurements of macular pigment optical density (MPOD) using the autofluorescence spectroscopy yield underestimations of actual values in eyes with cataracts. Previously, we proposed a correction method for this error using deep learning (DL); however, the correction performance was validated through internal cross-validation. This cross-sectional study aimed to validate this approach using an external validation dataset. METHODS: MPODs at 0.25°, 0.5°, 1°, and 2° eccentricities and macular pigment optical volume (MPOV) within 9° eccentricity were measured using SPECTRALIS (Heidelberg Engineering, Heidelberg, Germany) in 197 (training dataset inherited from our previous study) and 157 eyes (validating dataset) before and after cataract surgery. A DL model was trained to predict the corrected value from the pre-operative value using the training dataset, and we measured the discrepancy between the corrected value and the actual postoperative value. Subsequently, the prediction performance was validated using a validation dataset. RESULTS: Using the validation dataset, the mean absolute values of errors for MPOD and MPOV corrected using DL ranged from 8.2 to 12.4%, which were lower than values with no correction (P < 0.001, linear mixed model with Tukey's test). The error depended on the autofluorescence image quality used to calculate MPOD. The mean errors in high and moderate quality images ranged from 6.0 to 11.4%, which were lower than those of poor quality images. CONCLUSION: The usefulness of the DL correction method was validated. Deep learning reduced the error for a relatively good autofluorescence image quality. Poor-quality images were not corrected.
Subject(s)
Cataract , Deep Learning , Macular Pigment , Humans , Lutein , Cross-Sectional Studies , Zeaxanthins , Cataract/therapy , Spectrum AnalysisABSTRACT
With the rapid increase in the myopic population, cataract surgery in individuals with high myopia has become increasingly prevalent. For patients, the benefits of cataract surgery in highly myopic individuals are more pronounced compared to conventional cataract surgery. However, For cataract surgeons, performing cataract surgery in highly myopic individuals presents a more complex surgical procedure with elevated surgical risks and less favorable postoperative outcomes. As a result, the decision regarding the timing of cataract surgery in highly myopic individuals exhibits a clear polarization. some patients with mild cataracts strongly advocate for early surgery, while others with severe cataracts hesitate due to concerns about surgical risks. When making surgical decisions, both medical professionals and patients should thoroughly consider the benefits and risks of the surgery, allowing for an objective selection of the most appropriate timing for the procedure.
Subject(s)
Cataract Extraction , Cataract , Myopia , Humans , Visual Acuity , Cataract/complications , Cataract/therapy , Cataract/epidemiology , Refraction, Ocular , Myopia/surgery , Myopia/epidemiologyABSTRACT
Cataract is the leading cause of blindness worldwide. In recent years, the annual amount of adult cataract surgery is increasing rapidly. In order to promote the standardization of adult cataract surgery in our country, in accordance with the guiding principles and standards of clinical practice and the existing evidence-based data and expert consensus, Chinese Cataract and Refractive Surgery Society has developed the first clinical guideline in China specifically addressing the surgical treatment of adult cataracts. This guideline focuses on the major clinical issues encountered in adult cataract surgery and aims to provide guidance and reference for ophthalmologists in their clinical practice.
Subject(s)
Cataract Extraction , Cataract , Ophthalmology , Refractive Surgical Procedures , Adult , Humans , Cataract Extraction/adverse effects , Cataract/therapy , Cataract/complications , Blindness/etiology , ChinaABSTRACT
A 56-year-old male patient sought medical attention due to a gradual decline in bilateral visual acuity, which had been ongoing for a year and had rapidly worsened over the past three months. He received an initial diagnosis of bilateral concurrent cataracts and bilateral anterior megalophthalmos. Subsequently, cataract removal surgery was performed. During the surgery, it was observed that the patient had lax and fragile zonules of the crystalline lens. To address this issue, the surgical team employed reverse optic capture technique for the implantation of a three-piece intraocular lens. Following the surgery, the patient experienced a substantial improvement in uncorrected visual acuity. Remarkably, the patient remained free from adverse reactions, such as elevated intraocular pressure, during a follow-up period extending to 11 years.
Subject(s)
Cataract Extraction , Cataract , Lenses, Intraocular , Male , Humans , Middle Aged , Lens Implantation, Intraocular/methods , Cataract/complications , Cataract/therapy , Cataract Extraction/methods , Eye , Postoperative Complications , Follow-Up StudiesABSTRACT
Childhood cataract is a complex condition requiring longitudinal care, including early diagnosis, timely referral to a specialist, early surgical intervention, and dedicated postoperative care. Adherence to refractive correction and amblyopia therapy are critical for visual rehabilitation, even months to years after the cataract is removed. We review the impact of the social determinants of health on each step in the visual rehabilitation pathway for children with congenital and infantile cataracts. Children from socioeconomically marginalized backgrounds are more likely to experience delays in access to care and utilization of surgical services. They are also less likely to adhere to amblyopia therapy, with corresponding decrements in visual outcomes. Additional sociocultural factors, including parental stress, self-efficacy, and health literacy, pose barriers for these children. Standardizing clinical roles, improving health communication, managing parental stress, and implementing systemic policy changes may alleviate socioeconomic disparities in outcomes for children with cataracts.
Subject(s)
Amblyopia , Cataract Extraction , Cataract , Child , Humans , United States , Amblyopia/therapy , Lens Implantation, Intraocular , Cataract/congenital , Cataract/diagnosis , Cataract/therapy , Visual AcuityABSTRACT
INTRODUCTION: Cataract surgery continues to evolve with increasing levels of precision through the development and introduction of new technologies. Despite these advances, unexpected visual outcomes attributable to residual refractive error still occur. Additional "enhancement" procedures to the cornea can treat this residual refractive error to achieve a satisfactory outcome. Two frequently employed excimer laser enhancement procedures include laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). While both of these procedures are widely accepted as safe and effective in treating refractive error, there is a paucity of data comparing the two as enhancements in the post-cataract population. The purpose of this study was to investigate visual and refractive parameters in the pre- and post-enhancement setting on post-cataract surgery patients to compare the effectiveness of both excimer laser-enhancement treatments. METHODS: This study examined patients that underwent post-cataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 D). The setting was a private, tertiary surgery center. Refractive enhancement procedures were performed by 3 different surgeons. Post-enhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. RESULTS: This study included 822 post-cataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least six months follow up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRKenhanced patients. Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK- and PRKenhanced patients at or beyond six months, respectively. A total of 330 (67%) of LASIK-enhanced patients achieved 20/20 or better post-enhancement UDVA, compared to 142 (43%) PRK-enhanced patients. Categorized by pre-enhancement UDVA, LASIK-enhanced patients showed significantly better post-enhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean post-enhancement of 0.05 ± 0.14 UDVA compared to 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients. CONCLUSION: LASIK provides better and more predictable outcomes in UDVA than PRK in post-cataract enhancement patients, even when categorizing patients by their pre-enhancement visual acuity, prior ocular procedures, and allowing for sufficient time for healing and stabilization of the cornea.
Subject(s)
Cataract Extraction , Cataract , Keratomileusis, Laser In Situ , Photorefractive Keratectomy , Refractive Errors , Humans , Cataract/therapy , CorneaABSTRACT
PURPOSE: To assess long-time results of primary surgical treatment in children with glaucoma after congenital cataract surgery. METHODS: A retrospective study of 37 eyes from 35 children with glaucoma after congenital cataract surgery, who underwent surgery between 2011 and 2021 at the Childhood Glaucoma Center, University Medical Center Mainz, Germany. Only children, who received a primary glaucoma surgery in our clinic within the given time (n = 25) and had at least one-year follow-up (n = 21), were included in the further analysis. The mean follow-up time was 40.4±35.1 months. The primary outcome was the mean reduction in IOP (in mmHg) from baseline to follow-up visits after the surgery, measured with Perkins tonometry. RESULTS: 8 patients (38%) were treated with probe trabeculotomy (probe TO), 6 (29%) with 360° catheter-assisted trabeculotomy (360° TO) and 7 (33%) with cyclodestructive procedures. IOP was significantly reduced after probe TO and 360° TO after 2 years, from 26.9 mmHg to 17.4 mmHg (p<0.01) and 25.2 mmHg to 14.1 mmHg (p<0.02), respectively. There was no significant IOP reduction after cyclodestructive procedures after 2 years. Both, probe TO and 360° TO led descriptively to eye drops reduction after 2 years, from 2.0 to 0.7 and 3.2 to 1.1. The reduction was not significant. CONCLUSIONS: In glaucoma after congenital cataract surgery, both trabeculotomy techniques, lead to good reduction of IOP after 2 years. There is a need for a prospective study with comparison to the use of glaucoma drainage implants.
Subject(s)
Cataract , Glaucoma , Trabeculectomy , Child , Humans , Intraocular Pressure , Retrospective Studies , Treatment Outcome , Glaucoma/congenital , Trabeculectomy/methods , Cataract/therapy , Cataract/etiology , Follow-Up StudiesABSTRACT
OBJECTIVES: To assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension (OHT). METHODS: Single-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥20% from preoperative IOP, an IOP ≤ 14 mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP. RESULTS: Mean follow-up was 658 ± 64 days. Mean preoperative IOP was 17.76 ± 4.88 mmHg, it decreased to 15.35 ± 3.10 mmHg at 1 year (n = 37) (p = 0.006) and to 14.00 ± 3.78 at 3 years (n = 8) (p = 0.074). Mean number of glaucoma medication requirements decreased from 2.02 ± 1.0 preoperatively to 1.02 ± 0.96 at 1 year (n = 37) (p < 0.001) and to 1.63 ± 0.92 at 3 years (n = 8) (p = 0.197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8 years after the procedure due to uncontrolled IOP. CONCLUSIONS: Combined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or OHT and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery.
Subject(s)
Cataract , Glaucoma , Ocular Hypertension , Phacoemulsification , Humans , Lasers, Excimer/therapeutic use , Glaucoma/complications , Glaucoma/surgery , Ocular Hypertension/surgery , Ocular Hypertension/complications , Cataract/complications , Cataract/therapyABSTRACT
PURPOSE: This study evaluated the functional outcome and ocular side effects of patients receiving proton beam radiotherapy (PBR) for the treatment of iris melanoma (IM). DESIGN: This retrospective study analyzed prospectively collected data. PARTICIPANTS: Patients with IM who underwent PBR as a primary treatment. METHODS: Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98). MAIN OUTCOME MEASURES: Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development. RESULTS: A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98). CONCLUSIONS: Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Subject(s)
Cataract , Drug-Related Side Effects and Adverse Reactions , Glaucoma , Iris Neoplasms , Melanoma , Humans , Adult , Middle Aged , Aged , Protons , Treatment Outcome , Neoplasm Recurrence, Local/radiotherapy , Retrospective Studies , Iris Neoplasms/pathology , Glaucoma/complications , Cataract/etiology , Cataract/therapy , Melanoma/radiotherapy , Melanoma/pathology , Iatrogenic Disease , Iris/pathologyABSTRACT
In patients with eye surface disorders such as dry eye syndrome or Meibomian gland dysfunction (MGD) it is necessary to improve the tear film condition in order to obtain visual system measurements before cataract surgery. The aim of the project was to analyze the Thermal Pulsation System (TPS) impact on the visual system parameters used in cataract surgery qualification. The study included six patients (11 eyes) with MGD diagnosis. All patients were treated with TPS. The obtained results were compared and used to calculate the power and type of the intraocular lens (IOL). As a treatment result, the power of astigmatism has changed in 64% of the eyes. Planned surgical treatment type has changed in 27% of cases. TPS also affected the cylinder axis in three eyes, which was 27% of cases. Based on the calculations, power of the recommended IOL has changed in five eyes (46%). Stabilization of visual system parameters after TPS allowed to improve the accuracy of the results. It also ensured the proper astigmatism treating method during cataract surgery and allowed selection of the proper IOL power and type.
Subject(s)
Astigmatism , Cataract , Lenses, Intraocular , Meibomian Gland Dysfunction , Phacoemulsification , Humans , Meibomian Gland Dysfunction/surgery , Astigmatism/complications , Astigmatism/surgery , Meibomian Glands , Cataract/complications , Cataract/therapyABSTRACT
Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these disorders correlates with disease duration and quality of metabolic control. Regular ophthalmological examinations are needed to prevent sight-threatening advanced stages of diabetic eye diseases.
Subject(s)
Cataract , Diabetes Mellitus , Diabetic Retinopathy , Macular Edema , Humans , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/therapy , Macular Edema/diagnosis , Macular Edema/therapy , Cataract/therapy , Laser Coagulation , Diabetes Mellitus/therapyABSTRACT
BACKGROUND: Trabeculotomy with the Kahook knife is a new ab interno minimally invasive glaucoma surgery (MIGS) procedure. The MIGS are usually performed in early to intermediate glaucoma eyes. In this retrospective study we analyzed the intraocular pressure (IOP) and topical glaucoma eye drop therapy (Meds) reduction achieved by the Kahook trabeculotomy (TO) without (nâ¯= 19) or with (nâ¯= 18) combined cataract operation (Cat-TO) as initial treatment before or to avoid filtering surgery. MATERIAL AND METHODS: A total of 37 eyes of 37 patients were examined when IOP was >â¯21â¯mmâ¯Hg in at least 2 examinations despite the maximum tolerable Meds applied. Cat-TO was performed in 18 phakic eyes (primary open-angle glaucoma, POAGâ¯= 11, pseudoexfoliation glaucoma, PEXâ¯= 5, ocular hypertension, OHTâ¯= 2). In 19 pseudophakic eyes (POAGâ¯= 12, PEXâ¯= 6, OHTâ¯= 1) an isolated TO was executed. Complete success (no Meds) and relative success (irrespective of Meds) for IOP ≤â¯21â¯mmâ¯Hg, ≤â¯18â¯mmâ¯Hg, ≤â¯16â¯mmâ¯Hg were evaluated 2, 6 and 12 months postoperatively. RESULTS: The IOP was significantly reduced from preoperatively to 2 months after Cat-TO as well as after TO (Cat-TO: 26.8⯱ 5.9â¯mmâ¯Hg to 16.0⯱ 2.9â¯mmâ¯Hg, pâ¯< 0.001; TO: IOD 28.2⯱ 5.6â¯mmâ¯Hg to 16.3⯱ 3.5â¯mmâ¯Hg, pâ¯< 0.001). Meds reduction after Cat-TO as well as after TO was not significant (Cat-TO: 2.1⯱ 1.3 to 1.3⯱ 1.3, pâ¯= 0.11; TO: Meds 2.7⯱ 1.1 to 2.2⯱ 1.3, pâ¯= 0.23); however, Meds reduction after 6 and 12 months was significantly greater in the Cat-TO group compared to the TO group (pâ¯= 0.02). The IOP and Meds did not change significantly from 2 to 6 months. After Cat-TO, qualified success after 12 months for IOP ≤â¯18â¯mmâ¯Hg was 61% (11/18) and for IOP ≤â¯16â¯mmâ¯Hg 28% (5/18). After TO, qualified success after 12 months for TO was 47% (9/19) for IOP ≤â¯18â¯mmâ¯Hg and 26% (5/19) for IOP ≤â¯16â¯mmâ¯Hg. The intervention was not sufficient for 7 patients after TO and 2 patients after Cat-TO (IOP two times >â¯21â¯mmâ¯Hg). CONCLUSION: The first year results show that TO as well as Cat-TO are effective minimally invasive interventions to delay or even avoid a filtrating operation. In case of Meds intolerance and target IOP ≤â¯16â¯mmâ¯Hg Cat-TO is not sufficient.
Subject(s)
Cataract , Glaucoma, Open-Angle , Glaucoma , Trabeculectomy , Humans , Trabeculectomy/methods , Intraocular Pressure , Glaucoma, Open-Angle/surgery , Retrospective Studies , Treatment Outcome , Glaucoma/surgery , Cataract/therapyABSTRACT
Cataracts often develop early and rapidly in patients with high myopia, which is one of the common causes of vision loss in these patients. Cataract surgery is usually required to treat this condition. However, patients with high myopia have specific anatomies and pathological changes, and eye balance needs to be considered. Based on the domestic and international research literature, this article discusses related hot issues, including the use of a monofocal or multifocal intraocular lens, the design of the postoperative refractive state for both eyes, and the lens size and material selection.
Subject(s)
Cataract Extraction , Cataract , Lenses, Intraocular , Myopia , Humans , Visual Acuity , Cataract/therapy , Myopia/surgeryABSTRACT
Objective: To compare the clinical effects of and visual quality after correction of low-degree against-the-rule (ATR) corneal astigmatism by implantation of an astigmatism-corrected intraocular lens (IOL), femtosecond laser release and manual release in cataract surgery. Methods: It was a prospective cohort study. A total of 120 patients (120 eyes) with cataract combined with low-degree ATR corneal astigmatism diagnosed in Chongqing Aier Mega Eye Hospital from December 2017 to October 2020 were included and divided into 3 groups, each with 40 patients, according to their own selections of astigmatism correction methods during cataract surgery. In the astigmatism-corrected IOL group, phacoemulsification for cataract extraction combined with toric IOL implantation was performed. In the femtosecond laser release group, astigmatic keratotomy using a femtosecond laser was combined. In the manual release group, a limbal relaxing incision was made. Uncorrected distance visual acuity (UDVA) and corneal astigmatism were measured before surgery. At 3 months and 1 year after surgery, UDVA and best-corrected distance visual acuity were examined, as well as whole eye residual astigmatism by ARK-1, corneal astigmatism by the IOLMaster 500, whole eye high order aberration (HOA) and modulation transfer function (MTF) by the iTrace visual function analyzer. Analysis of variance was used for the comparison of data in a normal distribution. Repeated measures were used for the comparison within groups. The rank sum test was used for the comparison of data that were not normally distributed. Results: Of the 120 patients, 100 patients (100 eyes), including 44 males and 56 females, with an age of (66.48±6.20) years, completed the follow-up. Among the three groups, the differences were not statistically significant in terms of gender distribution, age, preoperative corneal astigmatism, UDVA and spherical equivalent of the IOL (all P>0.05). At 3 months and 1 year after surgery, the UDVA was significantly better than that before surgery in each group (Z=5.18, 5.04, 4.98, 4.99, 4.90, 4.89; all P<0.001). At the two time points, the differences in the whole eye residual astigmatism among the three groups were statistically significant (H=30.69, 31.23; both P<0.001). At 3 months, the whole eye residual astigmatism in the astigmatism-corrected IOL group was lower than that in the other two groups. At 1 year, the residual astigmatism in the astigmatism-corrected IOL group [0.25(0.00, 0.50) D] was also lower compared to that in the femtosecond laser release group [0.50(0.50, 0.75) D] and the manual release group [0.75(0.50, 0.75) D] (Z=-3.71, -5.18, -3.94, -5.15; all P<0.001). The differences in the HOA at 3 months and 1 year among the three groups were statistically significant (H=36.30, 34.38; both P<0.001). The HOA in the astigmatism-corrected IOL group was significantly higher than that in the other two groups at the two time points (Z=5.01, 4.73, 5.31, 5.27; all P<0.001). At 3 months and 1 year, the differences in the MTF value among the three groups were also statistically significant (H=30.02, 29.92; both P<0.001), and the MTF value in the femtosecond laser release group was significantly higher than that in the other two groups (Z=4.61, 4.67, 4.66, 4.69; all P<0.001). Conclusions: All the three astigmatism correction methods used at the time of cataract surgery can effectively correct low-degree ATR corneal astigmatism. The residual astigmatism in the whole eye after astigmatism-corrected IOL implantation is small and stable, while the HOA after release using the femtosecond laser is low with good visual quality.