Refractive Laser-Assisted Cataract Surgery versus Conventional Manual Surgery: Comparing Efficacy and Safety in 3144 Eyes.

PURPOSE: To report on outcomes of the efficacy and safety in 1 of the largest series of eyes undergoing either conventional manual cataract surgery (MCS) or refractive femtosecond laser-assisted cataract surgery (ReLACS). DESIGN: Retrospective, consecutive, interventional comparative case series. METHODS: This study included 3144 consecutive eyes, of which 1580 were treated via MCS, and 1564 were treated via ReLACS at Uptown Surgical Centre in Vaughan, Ontario, Canada. Preoperative characteristics, best corrected visual acuity (BCVA), mean absolute spherical error (MAE), rates of intraoperative posterior capsular rupture, and postoperative complications were evaluated. RESULTS: Across all eyes, ReLACS was superior to MCS for reducing surgical time (MCS: 7.7 ± 0.1 min vs ReLACS: 6.8 ± 0.1 min, P < 0.001); was less commonly associated with postoperative cystoid macular edema (OR = 0.36, 95% CI: 0.14-0.91, P = 0.031) and more commonly reduced MAE (MCS: 0.60 ± 0.02 diopters (D) vs ReLACS: 0.54 ± 0.02 D, P = 0.02). There were no differences in rates of posterior capsular rupture (P = 0.918), overall postoperative complications (P = 0.088) or final BCVA (P = 0.881). When analyzing a subgroup of more difficult cases (n = 833), ReLACS was superior to MCS for: 1) being more likely to yield an improvement of more than 0.1 logarithm of the minimum angle of resolution BCVA (OR = 1.80, 95% CI: 1.15-2.74, P = 0.01); 2) reducing MAE (MCS: 0.73 ± 0.3 D vs ReLACS: 0.60 ± 0.27 D, P = 0.04); and 3) being more likely to yield an MAE within 0.5 D (OR = 1.61, 95% CI: 1.11-2.33, P = 0.012). CONCLUSIONS: Across all eyes, our results support that ReLACS and MCS yield similar outcomes. However, our results show trends toward a more pronounced benefit of ReLACS compared to MCS when treating more difficult eyes.

Effectiveness of telescopic magnification in the treatment of amblyopia: a pilot study.

OBJECTIVE: To compare the effectiveness of patching plus telescopic magnification vs patching alone in treating refractory amblyopia. METHODS: Children aged 4 to 17 years who failed previous amblyopia treatment were recruited into this prospective study. Subjects were randomly assigned to either 30 minutes per day of patching of the fellow eye only (n = 7) or 30 minutes per day of patching of the fellow eye plus concurrent use of a telescope in the amblyopic eye (n = 8). MAIN OUTCOME MEASURE: Best-corrected logMAR visual acuity score of the amblyopic eye after 17 weeks of treatment. RESULTS: Both treatment groups demonstrated significant improvement in visual acuity in the amblyopic eye after 17 weeks (P = .001). Improvements in the patching-only group were slightly greater over the course of treatment, but this difference was not statistically significant (P = .06). At 17 weeks, mean visual acuity improvement from baseline was 0.14 logMAR (SD, 0.13 logMAR) in the patching-only group and 0.06 logMAR (SD, 0.17 logMAR) in the patching plus telescope group (P = .11). The 17-week visual acuity was at least 0.2 logMAR and/or improved from baseline by at least 0.2 logMAR in 2 patients in the patching-only group and none in the patching plus telescope group (P = .08). CONCLUSION: Treatment of refractory amblyopia in children using telescopic magnification did not appear to confer any additional benefits over patching alone. APPLICATION TO CLINICAL PRACTICE: Occlusion and penalization remain the standard of care for patients with amblyopia and should remain the benchmark against which other treatments are compared in clinical trials for amblyopia therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00970554.

Second instrument tip breaks during phacoemulsification.

BACKGROUND: Second instrument tip breaks during phacoemulsification are complications that are anecdotally recalled, yet little information exists on why and how often they occur, whether they are consistently tracked, and how they are managed. They may be an underreported, but potentially serious, complication of phacoemulsification. METHODS: We surveyed 114 cataract surgeons in Ontario to determine reported rates of second instrument tip breaks, their management, and presumed etiology. We reviewed 4 Toronto cataract centres for incident reports, instrument sterilization processes, and purchase histories. Using scanning electron microscopy (SEM), we compared the characteristics of a broken Sweeney tip to new and used second instruments. RESULTS: Of the 35 surgeons responding to the survey, 34% had experienced a second instrument tip break during their careers. Approximately 73% (16 cases) of the 22 cases reported were managed successfully during the procedure by the primary surgeon, 14% (3 cases) required imaging by computerized tomography or x-ray, and another 14% (3 cases) required pars plana vitrectomy for tip retrieval. Purchase histories revealed that 1 Sweeney hook was exchanged monthly, equivalent to 100 to 150 surgeries. SEM of new and used second instruments revealed signs of metal fatigue on both new and used second instruments. INTERPRETATION: Although both physicians and hospitals lack a method for ensuring quality control of second instruments, approximately one third of cataract surgeons encounter second instrument tip breaks during the course of their careers. Although most cases are managed intraoperatively, consistent hospital tracking records and standardized instrument inspection by institutions and surgeons are needed to determine how these complications occur and to establish protocols for complication reporting and management.

Treatment of anisometropic amblyopia in older children using macular stimulation with telescopic magnification.

BACKGROUND: Brain plasticity exists beyond the critical period in children aged 9-17 years and in adults, and can result in vision restitution following more intense amblyopia treatments. Telescopic magnification provides a clearer image and better visual stimulation and hence promotes brain plasticity. The purpose of this study was to investigate the impact of vision therapy with telescopic magnification on brain plasticity when given after the traditional methods of amblyopia treatment currently in use in older children. METHODS: The study was a prospective, nonrandomized, interventional case series of children aged 7-18 years with a confirmed diagnosis of anisometropic amblyopia not amenable to any further medical or surgical treatments. Strabismic and deprivation amblyopia cases were excluded. The patients wore newly prescribed glasses and were instructed to use a telescopic device in conjunction with the glasses for 30 minutes every day while watching, undisturbed, a favourite television show. Compliance was verified by the parents and investigated at each visit. The outcome measure selected for this study was best corrected visual acuity (BCVA) achieved at the 6-month follow-up visit. RESULTS: Eighteen study subjects (11 males and 7 females) were recruited aged 7-16 (mean 11.7) years. Before telescopic training sessions the mean BCVA in the amblyopic eye for the entire group was 0.5 (SD 0.3) logMAR units (20/63 equivalent), and this improved following the sessions to 0.24 (SD 0.34) logMAR units (20/35 equivalent) (p < 0.0001). A BCVA of 20/25 or better was achieved in the amblyopic eye in 10 (55.6%) of our 18 study subjects and a BCVA of 20/40 or better in 15 (83.3%) of the 18. There were no side effects evident from the intervention, specifically, no diplopia. Compliance with training was complete as per protocol. INTERPRETATION: The addition of vision rehabilitation therapy in the form of training sessions with telescopic magnification as described in this paper enhanced vision restitution in older children with anisometropic amblyopia.