The simply modified intrascleral fixation using round flange (SMURF) technique for intrascleral intraocular lens fixation.

We describe a simply modified intrascleral fixation using round flange (SMURF) technique and report the clinical outcomes of the surgery. Forty-one eyes of 41 consecutive patients, with intraocular lens (IOL) dislocation, crystalline lens subluxation, and zonular weakness, who underwent surgery using the SMURF technique were included. The modified technique included the use of a conventional 27-gauge needle, a non-bent needle, oblique sclerotomy, direct threading of the leading haptic, and simple placement of the following haptic. IOLs were successfully placed and showed good centring. There were no cases of wound leakage or hypotony during the early postoperative period. Postoperative complications included vitreous haemorrhage in one eye (2.4%), intraocular pressure elevation in one eye (2.4%), and iris capture in six eyes (14.6%). There were no cases of postoperative retinal detachment, cystoid macular oedema, endophthalmitis, or IOL dislocation during the follow-up period. We proposed a few modifications in the intrascleral flanged technique for IOL fixation. The modified technique is a simple, easy, and minimally invasive procedure for successful IOL intrascleral fixation.

Posterior segment Intra-Ocular Implant (IOL) dislocation: Predisposing factors, surgical management, outcome analysis.

PURPOSE: To evaluate the predisposing factors, management and visual prognosis of intraocular Lens (IOL) dislocation into the posterior segment. METHODS: The cases of posterior IOL dislocation from January 2012 to May 2017 at 2 centers were reviewed. Only eyes with dislocations requiring IOL explantation or repositioning were included. Predisposing factors, interval between cataract surgery and IOL dislocation, circumstances of onset, management, and postoperative complications are reported. RESULTS: 72 eyes of 72 patients were included. The mean age was 67.6 years. 47 patients (68%) were men. The mean time interval from cataract surgery to IOL dislocation was significantly shorter in the out-of-the bag group than the in-the-bag IOL dislocation group (3.8 months vs 132 months, P=0.002). Predisposing factors for out-of-the-bag IOL dislocation were mainly capsular rupture and/or zonular dehiscence (83%) after complicated cataract surgery. The predisposing factors for in-the-bag IOL dislocation were high myopia (40%), pseudoexfoliation syndrome (40%), previous vitrectomy (38%), or Marfan syndrome (3%) with uneventful cataract surgery. The type of luxated implant was mainly a 3-piece foldable IOL (50%), followed by foldable one-piece IOL (28%) and a rigid one-piece IOL (17%). Most cases of posterior chamber IOL dislocation occurred spontaneously (80%) without a trigger event. Management consisted of a posterior approach in 24 cases (33%) or an anterior approach in 48 cases (67%), associated with IOL repositioning in 20 eyes (28%), and IOL replacement in 34 eyes (47%). Finally, 18 eyes (25%) were left aphakic. Postoperative complications occurred in 7 cases (9.7%). CONCLUSIONS: Predisposing factors and time from cataract surgery to IOL dislocation were different for out-of-the bag versus in-the-bag IOL dislocation. Management of IOL dislocation varied considerably, depending on surgeon preference and experience. Surgery for IOL dislocation significantly improved best corrected visual acuity and was associated with a low complication rate.

Effect of music tempo on operating room preparation time.

Most operating rooms around the world play music, both during the surgeries and in between cases. We investigated whether music tempo (fast or slow) can affect the operating room preparation time in between surgeries (turnover time) in an ambulatory outpatient surgical centre setting. We compiled two playlists, one with fast upbeat tempo and the other with slow relaxing tempo. Each of the playlists was played throughout the workday in the operating room for one week with the same surgeon and nursing staff. The turnover times for each case were analysed. Inclusion criteria were standard cataract extraction with intraocular lens implant surgery. Exclusion criteria were any external reasons causing delays in the turnover time (such as anaesthesia team break time, computer system down, etc.). The turnover time from 32 cases in the slow group and 26 cases in the fast group were compared with Student's t test. The turnover time was significantly faster in the fast group versus the slow group (17.0 ± 0.60 vs. 20.1 ± 0.96, p < 0.03). Our study demonstrated that fast music tempo in the operating room can significantly reduce turnover time. This improved efficiency could potentially lead to significant cost savings in the healthcare sector.

Incidence of Intraoperative and Early Postoperative Adverse Events in a Large Cohort of Consecutive Refractive Lens Exchange Procedures.

PURPOSE: To evaluate the incidence of adverse events (AEs) in patients who underwent refractive lens exchange. DESIGN: Retrospective case series. METHODS: Setting: Private refractive surgery clinics. Patients/Study Population: Patients who underwent refractive lens exchange between July 1, 2014, and June 30, 2016. Intervention/Observation Procedures: All AEs recorded in the electronic medical record were extracted and retrospectively reviewed. The total incidence of AEs and serious AEs was calculated. Loss of 2 or more lines of corrected distance visual acuity (CDVA) was calculated for the entire cohort of patients that attended a minimum of 3 months follow-up. MAIN OUTCOME MEASURES: AEs. RESULTS: The total number of patients included was 10,206 (18,689 eyes). A multifocal intraocular lens (IOL) was implanted in 84.3% of eyes; 15.7% of eyes received a monofocal IOL. A total of 1164 AEs were recorded (1112 eyes of 1039 patients, incidence 6.0% of eyes, 1:17 eyes). The most common AE was posterior capsular opacification (PCO; 748 eyes, incidence 4.0%). Of all AEs, 171 events (occurring in 165 eyes of 151 patients, incidence 0.9%, 1:113 eyes) were classified as serious, potentially sight threatening. Loss of 2 or more lines of CDVA was 0.56% when excluding eyes where the loss of CDVA was due to PCO; the majority of these were due to macular causes. CONCLUSION: The incidence of sight-threatening AEs and significant loss of CDVA in elective refractive lens exchange surgery was low. Other than PCO, postoperative macular issues were the most common cause of vision loss in this cohort.

Traumatic Cataracts in Children, Long-Term Follow-up in an Israeli Population: A Retrospective Study.

BACKGROUND: Ocular trauma in the pediatric population may lead to cataract formation. Managing traumatic cataracts in a visually immature child is a major challenge and can result in poor visual outcome. OBJECTIVES: To review our long-term surgical experience with childhood unilateral traumatic cataracts. METHODS: A retrospective observational study of children with unilateral traumatic cataracts with minimal follow-up of 5 years was conducted. Main outcomes included final visual acuity (VA) and occurrence of complications. RESULTS: Of the 18 children included in the study, 83% were male. Mean follow-up time was 12.5 years. Median age at injury was 7.5 years. Eleven patients (61%) presented with penetrating trauma injuries and 7 (39%) with blunt trauma. Sixteen patients (89%) had cataracts at presentation, while in two the cataracts developed during follow-up. Of the 18 total, cataract removal surgery was conducted in 16 (89%) with intraocular lens (IOL) implantation in 14 (87.5%), while 2 remained aphakic (12.5%). Two (11%) were treated conservatively. Long-term complications included IOL dislocation in 5 (36%), glaucoma in 8 (44%), and posterior capsular opacity in 10 (71%). No correlation was found between final visual acuity and the time interval between injury and IOL implantation nor between final VA and age at trauma. However, the final VA did correlate with time of follow-up. CONCLUSIONS: Severe complications occurred in over 30% of the patients during a long follow-up (mean 12.5 years). This finding shows the importance of discussions between the operating physician and the parents regarding the prognosis and necessity of scheduled follow-up.

Risk factors for the occurrence of visual-threatening posterior capsule opacification.

BACKGROUND: To evaluate the potential risk factor of visual-threatening posterior capsule opacification (PCO) via the analysis of National Health Insurance Research Database in Taiwan. PATIENTS AND METHODS: A total of 8571 patients (3767 male and 4804 female) were recruited in the study group and 17,142 patients (7534 male and 9608 female) in the control group. Patients undergoing cataract surgery, acrysof single-piece intraocular lens implantation and Nd:YAG capsulotomy were selected as the study group. After exclusion which aimed to standardize the ocular condition and exclude the possibility that patients undergoing cataract surgery and Nd:YAG capsulotomy in different eyes, each patient in the study group was age-gender matched to two patients undergoing cataract surgery but without Nd:YAG capsulotomy. The demographic data, systemic disease, and ocular co-morbidities were obtained and analyzed. Adjusted odds ratio (OR) of each demographic data and co-morbidities to the development of visual-threatening PCO, and adjusted OR of co-morbidities to visual-threatening PCO develop within 1 year postoperatively. RESULTS: The dry eye disease (DED), glaucoma, uveitis, age-related macular degeneration (AMD), hyperlipidemia, peptic ulcer disease and liver disease showed significant crude OR while the DED, glaucoma, AMD, hyperlipidemia and peptic ulcer disease revealed a significant adjusted OR. In the subgroup analysis, the DED, glaucoma, AMD, and hyperlipidemia still illustrated a higher adjusted OR to develop visual-threatening PCO within 1 year after the cataract surgery. CONCLUSION: The DED, glaucoma, AMD, hyperlipidemia and peptic ulcer disease may serve as the risk factor for the developing of visual-threatening PCO.

Visual outcomes and complications of congenital cataract surgery.

PURPOSE: To describe the visual results and postoperative complications of congenital cataract surgeries performed between 2005 and 2016. METHODS: A retrospective consecutive case series of congenital cataract surgeries was carried out at the Dijon University Hospital in France. Intraocular lens implantation was primary or secondary according to age. Pre- and post-operative assessment was performed through ophthalmologic consultations with orthoptic measurements. Visual function and adverse events were recorded. RESULTS: Fifty-six consecutive procedures were evaluated in 37 infants. Overall, 26.8% of patients had unilateral cataracts, and 73.2% had bilateral cataracts. Median age at surgery was 1.0 years [IQR (interquartile range): 0.3-5.2] and 2.7 years [IQR: 0.4-9.5] for unilateral and bilateral cataracts, respectively. Median best-corrected visual acuity (BCVA) at the last follow-up was 0.5logMAR [IQR: 0.2-0.8] and 0.1logMAR [IQR: 0.0-0.8] for the unilateral and bilateral group, respectively. Posterior capsule opacification (PCO) was the primary postoperative complication: 60.0% in unilateral cataract and 46.3% in bilateral cataracts (P=0.019). Median follow-up was 2.0 years [IQR: 1.0-5.0]. CONCLUSION: Congenital cataract surgery appears to be safe and effective when combined with early, conscientious amblyopia treatment. Bilateral congenital cataracts had better visual outcome than unilateral cataract.

Incidence and Determinants of Intraocular Lens Implantation in Type 2 Diabetes: The Fremantle Diabetes Study Phase II.

OBJECTIVE: To compare the incidence of intraocular lens (IOL) implantation for cataracts between people with and without type 2 diabetes and to determine associated risk factors in those with type 2 diabetes. RESEARCH DESIGN AND METHODS: Participants with type 2 diabetes (n = 1,499) from the community-based observational Fremantle Diabetes Study Phase II (FDS2) were age, sex, and zip code matched 1:4 with residents without diabetes. IOL implantation status was ascertained between entry (2008-2011) and the end of 2016 using validated data linkage. Age-specific incidence rates and incidence rate ratios (IRRs) for cataract surgery were calculated. Predictors of IOL implantation in FDS2 participants were assessed using proportional hazards and competing risk regression modeling. RESULTS: The crude IRR (95% CI) for cataract surgery in FDS2 participants (mean ± SD age 62.8 ± 10.8 years at entry) versus the matched group without diabetes was 1.50 (1.32-1.71), with the highest relative risk in those aged 45-54 years at the time of surgery (7.12 [2.05-27.66]). Competing risk analysis showed that age at entry, diabetes duration, serum HDL cholesterol, serum triglycerides, a severe hypoglycemic episode in the past year, and Asian and southern European ethnicity increased the risk of cataract surgery in participants with type 2 diabetes (P ≤ 0.025). CONCLUSIONS: People with type 2 diabetes, especially those in younger age-groups, are at a significantly increased risk of cataract surgery than matched people without diabetes. Multifaceted prevention strategies should be incorporated as part of routine care. As well as limiting ultraviolet light exposure, these might include lipid-modifying treatment and strategies to avoid severe hypoglycemia.

Distribution of preoperative and postoperative astigmatism in a large population of patients undergoing cataract surgery in the UK.

PURPOSE: To assess the prevalence and severity of preoperative and postoperative astigmatism in patients with cataract in the UK. SETTING: Data from 8 UK National Health Service ophthalmology clinics using MediSoft electronic medical records (EMRs). DESIGN: Retrospective cohort study. METHODS: Eyes from patients aged ≥65 years undergoing cataract surgery were analysed. For all eyes, preoperative (corneal) astigmatism was evaluated using the most recent keratometry measure within 2 years prior to surgery. For eyes receiving standard monofocal intraocular lens (IOLs), postoperative refractive astigmatism was evaluated using the most recent refraction measure within 2-12 months postsurgery. A power vector analysis compared changes in the astigmatic 2-dimensional vector (J0, J45) before and after surgery, for the subgroup of eyes with both preoperative and postoperative astigmatism measurements. Visual acuity was also assessed preoperatively and postoperatively. RESULTS: Eligible eyes included in the analysis were 110 468. Of these, 78% (n=85 650) had preoperative (corneal) astigmatism ≥0.5 dioptres (D), 42% (n=46 003) ≥1.0 D, 21% (n=22 899) ≥1.5 D and 11% (n=11 651) ≥2.0 D. After surgery, the refraction cylinder was available for 39 744 (36%) eyes receiving standard monofocal IOLs, of which 90% (n=35 907) had postoperative astigmatism ≥0.5 D and 58% (n=22 886) ≥1.0 D. Visual acuity tended to worsen postoperatively with increased astigmatism (ρ=-0.44, P<0.01). CONCLUSIONS: There is a significant burden of preoperative astigmatism in the UK cataract population. The available refraction data indicate that this burden is not reduced after surgery with implantation of standard monofocal IOLs. Measures should be taken to improve visual outcomes of patients with astigmatic cataract by simultaneously correcting astigmatism during cataract surgery.

Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista® MX60 IOL.

PURPOSE: To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista® MX60 Intraocular Lens (IOL). METHODS: A university-based, single-center, observational study of patients' medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista® MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (<24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings. RESULTS: A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7±8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67±0.5, while postoperatively it was 0.31±0.5 and 0.32±0.5 at the last visit. The Mean±SD follow-up time (min-max) was 35.2±7.2, (24-48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit. CONCLUSION: The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista® MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.

Clinical Characteristics and Outcomes of Malignant Glaucoma after Different Procedures Treated with Pars Plana Vitrectomy: A 10-Year Retrospective Study.

Background and objectives: Despite established common risk factors, malignant glaucoma (MG) remains a rare condition with challenging management. We aimed to analyze differences in risk factors for MG after different surgeries and outcomes after pars plana vitrectomy (PPV). Materials and Methods: This retrospective study included cases of MG treated with PPV between January 2005 and December 2015 in the Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Results: A total of 39 cases were analyzed: 23 (59%) after cataract surgery, 13 (33.3%) after trabeculectomy, and 3 (7.7%) after other interventions. Characteristics among the groups did not differ. Intraocular lens refractive power was significantly higher in the cataract group, in which intraocular pressure (IOP) before MG was significantly greater in the affected eye. Normotension was achieved in 92.3%, and a normal anterior chamber in 75%. Additional measures included eye drops (n = 24), trabeculectomy (n = 5), bleb revision (n = 2), synechiotomy (n = 4), and cyclophotocoagulation (n = 1). The proportion of drop-free patients significantly increased after PPV compared with that before MG development (38.5% versus 15.4%). Complications were observed in 11 cases: choroidal detachments with spontaneous resolution (n = 2); retinal detachment (n = 1); constant mydriasis (n = 1), neovascular glaucoma (n = 1); obstruction of filtrating zone by iris (n = 1) and by blood clot (n = 1); posterior synechia formation causing IOP rise (n = 4 (all resolved after synechiotomy)). The cataract group experienced significantly fewer complications than the trabeculectomy group (17.4% vs. 53.8%, respectively). Conclusions: There were no differences in the risk of MG among the different surgeries. However, higher IOP in the predisposed eye (versus contra-lateral eye) could indicate additional risk of MG after cataract surgery. PPV afforded reliable treatment for MG and the possibility for glaucoma patients to discontinue topical treatment.

Changes of intraocular pressure after cataract surgery in myopic and emmetropic patients.

To investigate the intraocular pressure (IOP) changes after cataract surgery, and its relationship with refractive conditions.IOP after phacoemulsification with intraocular lens (IOL) implantation was retrospectively reviewed. Patients were classified into 3 groups by refractive conditions: emmetropia, mild to moderate myopia, and high myopia. Basic information was collected including age, sex, place of IOL, and operating surgeon, with IOP and refractive conditions measured before surgery, and 1, 7, 30, and 90 days after surgery.The study comprised 353 eyes from 353 patients, of which 175 were emmetropia, 130 were mild to moderate myopia, and 48 were high myopia. A lower IOP than baseline was observed at 7, 30, and 90 days after surgery in emmetropic and mild to moderate myopia, while in high myopia, IOP was instable from 1 to 30 days, and reduced only in 90 days after surgery. Changes of IOP was more significant from 1 to 7 days in emmetropic and mild to moderate myopic patients, but from 30 to 90 days in high myopia. Patients over 75 showed a lower IOP at each follow-up than patients younger and female showed a higher baseline IOP than male. Different surgeons might influence the IOP fluctuation at first 90 days but not the final IOP.All patients with different refractive conditions showed a remarkably lower IOP at 90 days after cataract surgery. However, high myopia lowered the speed of IOP reduction, which might be explained by the anatomical changes of eye structure.

[Surgical treatment for persistent pupillary membranes].

OBJECTIVE: To explore surgical treatment for persistent pupillary membrane (PPM) and its effect.
 Methods: The medical records and postoperative follow-up data for 12 consecutive patients (16 eyes), who were submitted to PPM resection in Xiangya Hospital, Central South University from March 2011 to August 2016, were retrospectively reviewed.
 Results: Among 12 consecutive patients (16 eyes), 8 patients (12 eyes) with PPM and clear lens were submitted to simply PPM resection, and 4 patients (4 eyes) with PPM and cataract were submitted to PPM resection combined with cataract surgery. In the patients who received the combined operation, phacoaspiration with or without intraocular lens implantation was performed in 3 eyes or in 1 eye. In the early stage after surgery, 1 eye was complicated with a transient high intraocular pressure. In the patients who were submitted to PPM resection, the final follow-up visual acuity in 7 patients (11 eyes) were improved except 1 patient (1 eye). After the PPM resection combined with cataract surgery, the follow-up visual acuity was improved in 2 patients (2 eyes) but not in the other 2 patients (2 eyes).
 Conclusion: The surgical treatment is effect on congenital pupil residual membrane. Serious membrane pupil residual membrane should be surgically treated at early stage, and amblyopia treatment after the surgery is important.

Global Practice Patterns in the Management of Infantile Cataracts.

OBJECTIVES: Surveys are an important tool to assess the impact of research on physicians' approach to patient care. This survey was conducted to assess current practice patterns in the management of infantile cataracts in light of the findings of the Infant Aphakia Treatment Study. METHODS: Pediatric ophthalmologists were emailed a link to the survey using newsletters from American Association of Pediatric Ophthalmology and Strabismus, World Society of Pediatric Ophthalmology and Strabismus, and the Pediatric Listserv. The 17-question survey was anonymous and active during July to August 2016. RESULTS: One hundred twenty-five respondents (North America, 65%; Asia, 12%; Europe, 9%; and other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that unilateral cataract surgery should be performed between ages 4 to 6 weeks and aphakic contact lenses should be used to optically correct their eyes, particularly in children ≤6 months of age. For bilateral cataracts, there was a trend for surgeons to perform cataract surgery at an older age than unilateral cataract surgery. Surgeons who performed less than 5 versus greater than 20 pediatric cataract surgeries/year were more likely to use aphakic contact lenses in children undergoing cataract surgery more than 6 months of age (62% vs. 35%, P=0.04). Most respondents (73%) indicated that the Infant Aphakia Treatment Study had changed how they manage unilateral congenital cataracts. CONCLUSION: Most pediatric cataract surgeons perform congenital cataract surgery between ages 4 to 6 weeks and use aphakic contact lenses for initial optical correction in infants less than 6 months. Surgeons have equal preference for intraocular lenses and contact lenses in infants more than 6 months of age.

The Paediatric Cataract Register (PECARE): an overview of operated childhood cataract in Sweden and Denmark.

AIM: To report basic epidemiological data concerning surgically treated childhood cataract in Sweden and Denmark. METHODS: Data were derived from the Paediatric Cataract Register (PECARE), a binational, web-based surgical register representing Sweden and Denmark. All children operated before 8 years of age between 1 January 2007 and 31 December 2013 were included. Age-specific prevalence per 100 000 population was calculated. RESULTS: A total 574 operations in 213 boys (51.7%) and 199 girls (48.3%), altogether 412 children, were registered, the vast majority (n = 395/412; 95.9%) being individuals with congenital/infantile cataract. Of these 412, a total of 294 (147 boys and 147 girls) were Swedish and 118 (66 boys and 52 girls) were Danish. The age-specific prevalence of operated cataract in Sweden was 31/100 000 and in Denmark 28/100 000. In 454 of 574 eyes (79.1%), the cataract was dense. Altogether, 266 of 574 (46.3%) were operated during the first year of life, 193 during the first 12 weeks representing 33.6% of all operations. A primary intraocular lens (IOL) implantation was done in altogether 411 of 574 eyes (71,6%). In total, 210 unilateral cataract operations (210/574; 36.6%) were performed. Persistent fetal vasculature (PFV) was present in 64 of 193 (33.1%) of those with a congenital unilateral cataract. In 84 individuals (84/395; 21.3%) with congenital or infantile cataract, a coexisting disorder was found. CONCLUSION: The age-specific binational prevalence of operated congenital/infantile cataract in Sweden and Denmark is 30/100 000. About half of the operations are performed within the first year of life, one-third within the first 3 months. In our study population, a primary IOL was implanted in the majority of cases.

Hospital Choice for Cataract Treatments: The Winner Takes Most.

BACKGROUND: Transparency in quality of care is an increasingly important issue in healthcare. In many international healthcare systems, transparency in quality is crucial for health insurers when purchasing care on behalf of their consumers, for providers to improve the quality of care (if necessary), and for consumers to choose their provider in case treatment is needed. Conscious consumer choices incentivize healthcare providers to deliver better quality of care. This paper studies the impact of quality on patient volume and hospital choice, and more specifically whether high quality providers are able to attract more patients. METHODS: The dataset covers the period 2006-2011 and includes all patients who underwent a cataract treatment in the Netherlands. We first estimate the impact of quality on volume using a simple ordinary least squares (OLS), second we use a mixed logit to determine how patients make trade-offs between quality, distance and waiting time in provider choice. RESULTS: At the aggregate-level we find that, a one-point quality increase, on a scale of one to a hundred, raises patient volume for the average hospital by 2-4 percent. This effect is mainly driven by the hospital with the highest quality score: the effect halves after excluding this hospital from the dataset. Also at the individual-level, all else being equal, patients have a stronger preference for the hospital with the highest quality score, and appear indifferent between the remaining hospitals. CONCLUSION: Our results suggest that the top performing hospital is able to attract significantly more patients than the remaining hospitals. We find some evidence that a small share of consumers may respond to quality differences, thereby contributing to incentives for providers to invest in quality and for insurers to take quality into account in the purchasing strategy.

Scleral Fixation of Intraocular Lens with Ab Interno Technique.

INTRODUCTION: Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure. METHODS: Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016. RESULTS: The age range was from 15 to 79 years; mean age was 47.56 ± 20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months. CONCLUSIONS: SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.

Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012.

PURPOSE:: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. METHODS:: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. RESULTS:: This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). CONCLUSIONS:: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.