[Yearly Report of the Austrian Committee for Cataract Surgery and Intraocular Implants for 2021]. / Auswertung der Umfrage der Kommission für Kataraktchirurgie und intraokulare Implantate für 2021: Kataraktkommission der ÖOG.

Background: Every year the Austrian Committee for Cataract Surgery and Intraocular Implants, conducts a national survey of all eye surgery departments in Austria. Material and methods: The questionnaires were sent to departments of ophthalmology in Austria and were anonymously returned either in print or via an online form. Before analyzing results, it is important to consider that participation was voluntary and compared to the data of previous years. Results: The responses of 19 departments of ophthalmology with a total of 182 surgeons are presented in this publication and compared with data from previous years.The participation rate was 79.1% and a total of 66 355 cataract surgeries were reported. There was a slight increase of day clinic surgeries compared to the previous year; however, the number of surgeries is still lower than before the start of the SARS-CoV­2 pandemic.

[Evaluation of the survey of the Austrian Ophthalmic Society, Commission for Cataract Surgery and Intraocular Implants for 2020]. / Auswertung der Umfrage der ÖOG-Kommission für Kataraktchirurgie und intraokulare Implantate für 2020.

BACKGROUND: Every year the Austrian Commission for Cataract Surgery and Intraocular Implants, conducts a national survey of all eye surgery departments in Austria. MATERIAL AND METHODS: The questionnaires were sent to departments of ophthalmology in Austria and were anonymously returned either printed or via an online form. Before analyzing the results it is important to consider that participation was voluntary and compared to the data of previous years. RESULTS: The responses of 18 departments of ophthalmology with a total of 149 are presented in this publication and combined with data from previous years.The participation rate was 72.4% with a total of 52,059 cataract surgeries reported. Compared to the previous year this amounts to a decrease of 24.8%; however, this is most likely caused by restrictions of elective surgery in association with the SARS-CoV­2 pandemic.

Computer-Based Tutorial to Enhance the Informed Consent Process for Cataract Surgery in Serbian- or Turkish-Speaking Patients.

INTRODUCTION: This study analyses if a translated version of the CatInfo tool increases the knowledge of Serbian- and Turkish-speaking patients about cataract surgery. METHODS: In total, 61 cataract patients, literate in Serbian or Turkish, were randomly allocated into two groups. Via an interactive computer-based tool ("CatInfo"), patients either saw a detailed audio-visual presentation about cataract surgery (study group) or a "placebo" video (control group). Afterwards, all participants had a face-to-face discussion with an ophthalmologist. Immediately after the interview and on the day of surgery, all patients had to fill out a questionnaire including knowledge and demographic questions. Patients in the study group were further asked about their satisfaction with the CatInfo tool and the usefulness of such a device before other interventions. RESULTS: Patients in the study group answered significantly more questions correctly compared to the control group, and this information gain remained stable over a 1-week period. There was a significant low negative correlation between educational level and the test results, whereas age and computer habits of the participants did not have an influence on correct answers. Satisfaction with the CatInfo tool was high in the Serbian and the Turkish group (96% and 84%, respectively), and 92% of Serbian patients as well as 62% of the Turkish patients rated that they could imagine to use such a device before any other surgery. DISCUSSION/CONCLUSION: The translated version of the CatInfo tool improved patients' knowledge, and this information gain remained stable until the day of the surgery.

Visual Outcomes and Patient Satisfaction After Bilateral Sequential Implantation of a Capsular Bag IOL and a Supplementary Sulcus-Fixated Trifocal IOL.

PURPOSE: To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. METHODS: All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. RESULTS: Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. CONCLUSIONS: Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

The forceps-needle: Combining needle and grasping functions in a single instrument.

A new forceps-needle to facilitate intrascleral haptic fixation surgery is described. In an initial series of 10 cases, the forceps-needle was used to grasp and externalize the haptic of a 3-piece intraocular lens (IOL) for transscleral fixation. The site of perforation was marked at 180 degrees 2.0 mm away from the limbus. Then, the IOL with polypropylene haptics was folded and implanted partially into the anterior chamber. A transconjunctival, scleral tunnel of about 2.0 mm length parallel to the limbus was prepared with the forceps-needle on 1 side, with the second hand holding the leading haptic through a side-port incision. The end of the first haptic was grasped and externalized after which the end of the haptic was flanged. Subsequently, a second scleral tunnel was prepared with the forceps-needle, and the second haptic was externalized and flanged. All procedures could be performed without any intraoperative complication.

Capsular bag-fixated and ciliary sulcus-fixated intraocular lens centration after supplementary intraocular lens implantation in the same eye.

PURPOSE: To assess capsular bag and sulcus intraocular lens (IOL) centration in eyes that had implantation of a sulcus-fixated supplementary IOL anterior to a preexisting capsular bag IOL. SETTING: Academic Teaching Hospital of St. John, Vienna, Austria. DESIGN: Retrospective case series. METHODS: A sulcus-fixated supplementary IOL (Sulcoflex) was implanted anterior to a preexisting capsular bag IOL. The geometric center of preexisting capsular bag IOLs and newly implanted sulcus-fixated IOLs was evaluated at least 12 months postoperatively and in relation to the geometric center of the pupil and limbus. RESULTS: The study comprised 48 eyes of 43 patients with a mean follow-up of 25 months (range 12 to 84 months). The mean decentration of the capsular bag-fixated IOL was 0.29 mm ± 0.02 (SEM) when compared with the limbus and 0.29 ± 0.03 mm when compared with the dilated pupil. The mean decentration of the sulcus-fixated IOL was 0.23 ± 0.02 mm in relation to the limbus and 0.22 ± 0.02 mm when in relation to the dilated pupil. Sulcus-fixated supplementary IOLs showed significantly better centration than bag-fixated IOLs when compared with the limbus and with the pupil (both P = .03, paired t test). CONCLUSIONS: Implantation of a sulcus-fixated supplementary IOL resulted in good centration of capsular bag-fixated IOLs and ciliary sulcus-fixated IOLs. However, ciliary sulcus-fixated IOLs achieved significantly better centration.

Intraindividual comparison of capsule behavior of 2 hydrophobic acrylic intraocular lenses during a 5-year follow-up.

PURPOSE: To evaluate and compare the 5-year postoperative anterior (ACO) and posterior capsule opacification (PCO), the occurrence of glistenings, and the level of anterior capsule retraction after implantation of 2 designs of 1-piece hydrophobic acrylic IOLs. SETTING: Hospital St. John, Vienna, Austria. DESIGN: Randomized controlled prospective case series. METHODS: Patients had an Acrysof SA60AT IOL (Group A) implanted in 1 eye and a Tecnis ZCB00 IOL (Group B) implanted in the fellow eye. At 1, 3, and 5 years, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software. The level of ACO and capsule retraction was graded subjectively. Glistenings were scored as present or not present. RESULTS: Fifty eyes of 25 patients were evaluated after 5 years. No significant differences in PCO scores were found between the 2 groups at all follow-up visits (1 year: 0.06 ± 0.12 [SD] versus 0.07 ± 0.13, P = .35; 3 years: 0.23 ± 0.36 versus 0.22 ± 0.32, P = .66; 5 years: 0.36 ± 0.41 versus 0.36 ± 0.54, P = .98). A significant increase in PCO score was found between 3 and 5 years (P < .01). Anterior capsule opacification was present in Group A and Group B in 18.0% and 2.7% of eyes (P = .03), in 92.0% and 24.0% of eyes, and in 100% and 52% of eyes (P < .01) at 1, 3, and 5 years, respectively. Glistenings (5 years 100%) were observed in Group A. CONCLUSION: Both IOLs had a comparable PCO rate 5 years after surgery, although more ACO and retraction as well as glistenings were observed in Group A.

Regression of epiretinal membrane after optic nerve atrophy.

PURPOSE: To describe a case of epiretinal membrane (ERM) regression after optic nerve atrophy. METHODS: Retrospective case report. RESULTS: A 56-year-old man with progressive visual impairment was found to have an ERM with associated retinal thickening and distortion (documented with spectral-domain optical coherence tomography [OCT]). In addition, we noted a slight unilateral paleness of the optic nerve. The patient denied any further diagnostic investigation and presented himself again 2 years after the initial presentation. A new OCT examination at this point revealed a remarkable regression of the ERM and atrophy of the retinal nerve fiber layer. CONCLUSIONS: Regression of ERM may occur after optic nerve atrophy. A potential causal linkage is suggested based on the atrophy of the retinal nerve fibers and regression of the glial cells.

Intraindividual comparative analysis of capsule opacification after implantation of 2 single-piece hydrophobic acrylic intraocular lenses models: Three-year follow-up.

PURPOSE: To compare the 3-year postoperative anterior (ACO) and posterior (PCO) capsule opacification and the level of anterior capsule retraction after implantation of 2 single-piece hydrophobic acrylic intraocular lens (IOL) models. SETTING: Hospital of St. John of God, Vienna, Austria. DESIGN: Comparative randomized controlled double-blind clinical trial. METHODS: Eyes with bilateral cataract were evaluated. Each patient had an Acrysof SA60AT (interrupted optic edge) IOL implanted in 1 eye (Group A) and a Tecnis ZCB00 (continuous optic edge) IOL implanted in the fellow eye (Group B). One and 3 years postoperatively, PCO was evaluated using Evaluation of Posterior Capsule Opacification software and the ACO level and capsule-retraction level were evaluated and graded subjectively. RESULTS: The study evaluated 100 eyes of 50 patients ranging from 61 to 80 years. Postoperatively, there were no statistically significant differences in PCO between Group A and Group B at 1 year (0.06 ± 0.12 [SD] and 0.07 ± 0.13, respectively; P = 4.35) or 3 years (0.23 ± 0.36 and 0.22 ± 0.32, respectively; P = .66). In Group A and Group B, ACO was present in 18.0% of eyes and 2.7% of eyes, respectively, at 1 year (P = .03) and in 92.0% and 24.0%, respectively, at 3 years (P < .01). Capsule phimosis (18.0% at 1 year; 30.0% at 3 years) and glistenings (66.0% at 1 year; 86.0% at 3 years) were observed in Group A only. CONCLUSION: Both IOLs had similarly low PCO rates 3 years postoperatively, although more ACO and capsule retraction were observed in eyes with the interrupted optic edge IOL.

Anterior and posterior capsular opacification with the Tecnis ZCB00 and AcrySof SA60AT IOLs: a randomised intraindividual comparison.

PURPOSE: To evaluate and compare the 1-year postoperative levels of posterior capsule opacification (PCO) as well as the level of anterior capsule retraction and opacification (ACO) after implantation of two single-piece hydrophobic acrylic intraocular lens (IOL) models. METHODS: Randomised, controlled, prospective and double-blind study including 148 eyes of 74 patients (age range, 61-80 years) with bilateral senile cataract. Each patient underwent surgery with implantation of an AcrySof SA60AT (Group A) in one eye and Tecnis ZCB00 (Group B) in the fellow eye by the same experienced surgeon. Lens allocation to the first or second operated eye followed a randomisation process. At 12 months postoperatively, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software, whereas the level of ACO and capsule retraction was evaluated and graded subjectively. RESULTS: All surgeries were uneventful. The mean PCO scores were 0.10 ± 0.17 and 0.21 ± 0.89 in Groups A and B, respectively, with no statistically significant differences between the groups (p=0.47). No significant correlation was found between the PCO scores in Groups A and B (r=0.16, p=0.17). Regarding ACO, it was present in 15 eyes (20.3%) and two eyes (2.7%) in Groups A and B, respectively (p=0.37). Capsular phimosis (13 eyes, 17.6%) was only observed in Group A. CONCLUSIONS: Both IOLs had a similar low rate of PCO 1 year after surgery. However, there seems to be a difference in the anterior capsule behaviour between both IOL models.

Biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with uveitis having cataract surgery: Long-term follow-up.

PURPOSE: To evaluate the long-term uveal and capsular biocompatibility of 5 intraocular lenses (IOLs) in eyes with uveitic cataract. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Comparative case series. METHODS: Patients with uveitis of various origin were consecutively recruited for cataract surgery (1998-2006) and received 1 of 3 hydrophilic acrylic IOLs (Hydroview, AcrySof MA60BM, or Injectacryl F3000), a silicone IOL (CeeOn 911), or a hydrophilic acrylic IOL with heparin surface modification (BioVue(3)). A 7-year follow-up was performed in the Hydroview, AcrySof, and CeeOn groups. Visual acuity, anterior chamber flare measurements, specular microscopy, biomicroscopy, and fundoscopy were performed postoperatively at 6 months and 1, 2, and 3 years. RESULTS: The study enrolled 136 eyes of 115 patients. There were no significant differences in anterior chamber flare results between the 5 groups. The Hydroview group had the highest grade and the CeeOn IOL and AcrySof groups had the lowest grade of posterior capsule opacification. The BioVue(3) and Injectacryl IOLs had good uveal biocompatibility. Patients in all groups had better visual acuity postoperatively. CONCLUSIONS: Overall, patients with uveitis benefited from cataract surgery. The long-term results indicate that all sharp-edged hydrophilic and hydrophobic IOLs performed well in eyes with uveitis. Higher uveal biocompatibility was achieved with the modern hydrophilic acrylic IOLs than with the hydrophobic acrylic IOL. Modern hydrophilic acrylic IOLs seem to be a good option in these cases. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of anterior-segment inflammation and retinal thickness change following cataract surgery.

PURPOSE: To investigate the physiological retinal response to uneventful cataract surgery using conventional time-domain (TD-OCT) and current spectral-domain optical coherence tomography (SD-OCT) in combination with an assessment of the anterior chamber inflammatory reaction by laser flare/cell meter (LCFM). METHODS: Thirty-four patients scheduled for cataract surgery were included in this prospective pilot study. Retinal parameters were examined according to a standardized examination procedure using TD-OCT (Stratus; Carl Zeiss Meditec, Dublin, California, USA) and SD-OCT (Cirrus; Carl Zeiss Meditec) devices. The inflammatory reaction of the anterior chamber was measured by LFCM (Kowa FC-1000, Kowa Co. Ltd, Tokyo, Japan). Examinations were carried out preoperatively and at day 2, week 1 and week 4 postoperatively. RESULTS: A slight decrease of central retinal thickness values was identified at day 2 postoperatively followed by an increase of these parameters at week 4. LFCM showed peak values in all patients at day 2 postoperatively with a constant decrease at the following visits. No visible pathological retinal changes were seen after surgery. CONCLUSION: A biphasic retinal response after surgery could be shown with SD-OCT and TD-OCT technology. By using the advantages of rasterscanning mode, SD-OCT technology is superior to TD-OCT imaging in the investigation of the physiological retinal response to cataract surgery.

Uveal and capsular biocompatibility after implantation of sharp-edged hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with pseudoexfoliation syndrome.

PURPOSE: To evaluate the uveal and capsular biocompatibility of 3 types of sharp-edged foldable intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome (PEX). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Eighty-five eyes with PEX had implantation of 1 of the following sharp-edged 3-piece IOLs: hydrophilic acrylic (Injectacryl F3000, OphthalMed), hydrophobic acrylic (AcrySof MA60MB, Alcon), or silicone (CeeOn 911, AMO). Postoperative evaluation (flare, cellular reaction, and capsular reaction) was performed at 1, 3, and 7 days as well as 1, 3, 6, and 12 to 18 months. RESULTS: One year after surgery, flare was comparable between the IOLs. In terms of uveal biocompatibility, whereas the Injectacryl had the highest deposition of debris on the IOL surface (P = .04), the CeeOn 911 had significantly more small round cells in the first 6 months (P<.03). The AcrySof had the highest number of foreign-body giant cells (P = .01). In terms of capsular biocompatibility, lens epithelial cell outgrowth was highest in the AcrySof group (P<.02). Anterior capsule opacification was comparable between the 3 groups. Posterior capsule opacification was mild in all groups but was significantly greater in the Injectacryl group (P<.05). There were no cases of clinically significant IOL decentration or capsule contraction. CONCLUSIONS: In general, inflammatory cells accumulated more easily on hydrophobic IOLs than on hydrophilic IOLs; the AcrySof IOL had the highest prevalence of foreign-body giant cells. All 3 IOLs had good biocompatibility, although the AcrySof group had increased inflammatory signs.