Background: In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. We aim to compare cataract surgery complication rates and clinical outcomes using different pupil expansion methods.
Methods: This retrospective cohort study grouped patients according to four techniques of mechanical pupil expansion techniques: sphincterotomy (N = 339), iris stretching (N = 242), iris hooks (N = 391) and expansion rings (N = 294). Incidences and odds ratios for major complications and outcomes were compared between the groups.
Results: This single-center study included 1266 adult patients who underwent routine cataract surgery with mechanical pupil dilatation. The mean (± SD) age was 75.5 (± 13.0) years and 727 (57%) patients were male. The risk of pseudophakic cystoid macular edema (PCME) did not differ between the groups. Iris hooks were associated with the highest incidence of posterior capsular rupture (PCR) (3.3%) as compared to sphincterotomy, stretching and expansion rings (0.9%, 0.4% and 1.4%, respectively, P = 0.016). However, this effect was not supported by multivariable analysis. Zonular dialysis tended to be higher among eyes operated with iris hooks and pupil expansion rings, compared with iris stretching and sphincterotomy (2.0% and 1.7%, respectively, P = 0.058) and was found to be independently associated with a specific mechanical pupil expansion method on multivariable analysis (P = 0.050). No differences were observed for other complications, intraocular pressure or best-corrected visual acuity (VA) gain. Surgeon seniority was a significant protective factor from postoperative uveitis on multivariable analysis (P = 0.032).
Conclusions: Our large cohort study found no difference between the groups regarding major complications or clinical outcomes, suggesting that all four methods may be equally safe.
Key messages: WHAT IS KNOWN : • In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. • Different pupil dilation methods have been used, ranged from topical and intracameral mydriatics and visco-mydriasis to mechanical dilation maneuvers. • Four principal techniques of mechanical pupil expansion, including sphincterotomies, manual iris stretching, iris retracting hooks and pupil expansion rings, are available.
What is new: • This single-center study included 1266 adult patients found no difference between the groups regarding major complications or clinical outcomes such as pseudophakic cystoid macular edema (PCME), posterior capsular rupture, zonular dialysis, intraocular pressure, uveitis or best-corrected visual acuity gain. • Surgeon seniority was a significant protective factor from postoperative uveitis.
Purpose: To evaluate the efficacy and safety of TriMix, a new multiple-action tear substitute in patients with dry eye disease (DED).
Methods: This was a randomized, multicenter, single-masked, hyaluronic acid (HA)-controlled clinical trial conducted between July, 2023 and May, 2024. A total of 115 patients were randomly allocated to receive either TriMix tear substitute or 0.15% HA tear substitute 3 times daily. Clinical outcomes include ocular surface disease index (OSDI) questionnaire, non-invasive tear film break-up time (NIBUT) and Schirmer I test (ST) without anesthesia at 3 and 6 months of follow-up.
Results: Of the 115 patients randomized, 80 completed the study (TriMix, n = 56; HA, n = 24). At months 3 and 6, improvements from baseline were statistically greater with TriMix tear substitute compared to HA 0.15% tear substitute for OSDI: -3.7 points (95% CI, -6.9 to -0.6; p = 0.011) and - 7.5 points (95% CI, -10.3 to -4.6; p < 0.001), respectively. Similar results were reported for NIBUT: 0.9 s (95% CI, 0.3 to 1.6; P = 0.040) and 1.6 s (95% CI, 0.7 to 2.6; P < 0.001), respectively. Regarding safety, no serious ocular adverse events occurred. Three patients complained of burning after instillation of TriMix tear substitute.
Conclusion: This RCTs demonstrate that TriMix tear substitute provides statistically significant and clinically evidence of the reduction of DED symptoms with a satisfactory safety profile through 6 months of follow-up. Findings suggest the use of this tear substitute, but results should be confirmed independently over longer time periods.
Purpose: To evaluate real world efficacy and safety of the Preserflo MicroShunt (PM) in a heterogenous patient cohort at a single tertiary eye care centre.
Patients and methods: A retrospective data analysis of PM implantations between 2019 and 2022 was performed. Primary outcome measures were complete-, qualified-, and overall- success as well as failure defined according to the WGA criteria. Secondary outcomes were intraocular pressure (IOP) and IOP lowering medications.
Result: 38 patients were included in the study. After 24 months, complete success was achieved in 31.58% and qualified success in 28.95% whereas 39.47% were classified as failure. IOP was reduced by 55.2% from mean 25.57 ± 10.03 mmHg at baseline to 11.45 ± 3.37 mmHg two years postoperative in eyes classified as success. The number of IOP lowering medications was reduced from 2.73 ± 1.33 before surgery to 1.14 ± 1.31 at the end of the follow-up period.
Conclusion: Two years postoperatively an overall success rate of 60.53% was achieved and a significant IOP reduction was preserved over the complete two years follow-up time.
Key messages: What is known Multiple studies have proven that the Preserflo MicroShunt is a safe and efficient surgical procedure to lower intraocular pressure. The success rates reported for primary open angle glaucoma are comparable to trabeculectomy. What is new Real world data including different glaucoma subtypes at one tertiary care centre are reported with a two-year follow up. An overall surgical success rate of 60.53% was achieved. An intraocular pressure reduction of 50.2% was sustained over the two years follow up period.
Purpose: To compare the results in terms of visual acuity and complication rates between eyes undergoing Descemet's membrane endothelial keratoplasty (DMEK) with the help or not of intraoperative optical coherence tomography (iOCT).
Methods: Non-randomized retrospective comparative study including 288 eyes of 227 patients (age, 30 to 90 years) undergoing DMEK surgery with the use of iOCT (OPMI Lumera 700 surgical microscope, Carl Zeiss Meditec, Jena, Germany) (135 eyes, iOCT group) and without it (153 eyes, non-iOCT group. Corrected distance visual acuity (CDVA) and complication rates were evaluated during a 24-month follow-up.
Results: Significantly worse CDVA (p=0.010) and more equally distributed the Fuchs endothelial corneal dystrophy/bullous keratopathy (p=0.001) were found in iOCT group preoperatively. A difference close to the statistical significance was found in CDVA at 1 month after surgery, with a trend to a better visual outcome in the iOCT group (p=0.066). Likewise, a significantly larger CDVA improvement was found in iOCT groups at 1 (p=0.002), 3 (p=0.012) and 6 months after surgery (p=0.032), with no difference between groups afterwards. No significant differences between groups were found in the re-bubbling rate (p=0.597): iOCT 17/135 (12.6%) vs. non-iOCT 15/153 (9.8%). A trend to a lower rate of primary failure of the transplant in the iOCT group was found, but it did not reach statistical significance (5/135, 3.7% vs. 13/153, 8.5%, p=0.097).
Conclusions: iOCT-assisted DMEK allows a faster visual recovery during the initial 6 months after surgery than DMEK procedures performed without the use of such technology.
Purpose: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.
Methods: This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.
Results: The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).
Conclusion: The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.
Purpose: To assess the diagnostic performance of the InflammaDry test in diagnosing dry eye disease (DED) using different diagnostic criteria and across varying severities.
Methods: A retrospective study was conducted on 1,515 patients. Subjects were categorized into three groups: Group (1) DED based on Dry Eye Workshop-II (DEWS-II): Ocular Surface Disease Index (OSDI) ≥ 13 and at least one abnormal clinical sign (non-invasive tear break-up time [NIBUT] < 10 s, osmolarity > 308 mOsm/L, or corneal/conjunctival staining). Group (2) DED based on criteria used in prior clinical trials: OSDI > 13, Schirmer < 10 mm in 5 min, NIBUT < 10 s, and keratoconjunctival staining. Group (3) Healthy controls: OSDI ≤ 7, NIBUT ≥ 10 s, Schirmer ≥ 10 mm, and no keratoconjunctival staining. DED severity was classified using the ODISSEY European Consensus Group's definitions into severe and non-severe. Sensitivity, specificity, and predictive values were calculated for both criteria.
Results: 1,363 patients were included in Group 1, 401 in Group 2, and 152 in Group 3. Sensitivity was 81.30% in the population diagnosed using previous clinical trial criteria but decreased to 69.99% when applying the DEWS-II criteria. Specificity was 38.16% in both groups, with 409/467 false negatives respectively.
Conclusion: InflammaDry shows good sensitivity in detecting DED in highly symptomatic cases with multiple clinical signs, but its performance decreases when broader criteria like DEWS-II are used. While valuable for detecting inflammation, routine use for DED diagnosis may lead to false negatives, especially in milder cases.
Purpose: To investigate whether in diabetic cataract (DC), FoxO1 regulates high glucose (HG)-induced activation of NLRC4/IL-6 inflammatory mediators in human lens epithelial cells (SRA01/04) via the JAK1/STAT1 pathway, leading to cataract formation.
Methods: Expression levels of FoxO1, inflammatory factor IL-6 and inflammatory vesicle NLRC4 were examined in SRA01/04 under high glucose (HG) stress at 25-150 mM. Rat lenses were also cultured using HG medium with or without the addition of the FoxO1 inhibitor AS1842856 and the JAK1 agonist RO8191. 5.5 mM glucose concentration group (NG) was used as a control. Real-time PCR, Western blots, and immunofluorescent staining evaluated the mRNA and protein levels of FoxO1, NLRC4, and IL-6. Apoptosis, cell viability, and EDU Staining were also assessed.
Results: HG stimulation induced elevated FoxO1 expression and caused NLRC4/IL-6 activation in a concentration-dependent manner. Whereas knockdown of FoxO1 inhibited the high expression of NLRC4/IL-6 inflammatory mediators in response to HG stimulation. The growth of SRA01/04 was inhibited under HG condition, and the cell proliferation ability was restored and even promoted by knocking out FoxO1. HG incubation of rat lens resulted in lens clouding and cataract formation, which was prevented by AS1842856 treatment and reversed by RO8191.
Conclusion: FoxO1 positively regulates HG-induced SRA01/04 inflammatory activation through the JAK1/STAT1 pathway and promotes DC. This provides a feasible strategy for the treatment of diabetic cataract.
Purpose: To evaluate the efficacy and safety of phacoemulsification combined with glaucoma surgeries based on new criteria of axial length (AL) in nanophthalmos patients with secondary angle closure glaucoma (NSACG).
Methods: This retrospective study analyzed medical records of NSACG patients, categorized into two groups based on AL. Group 1 (AL: 17-20 mm) underwent phacoemulsification with intraocular lens implantation, viscogonioplasty, and anterior pars plana vitrectomy (PVP), combined with trabeculectomy (Trab) or endoscopic photocoagulation (ECP). Group 2 (AL < 17 mm) underwent PVP combined with trabeculectomy and sclerectomy (PVPTS).
Results: A total of 22 patients (31 eyes) with NSACG were enrolled with a mean follow-up of 50.2 ± 26.2 months. Patients with axial length < 17 mm (Group 2) exhibited significantly worse visual acuity (P < 0.05) and required more IOP-lowering medications (P = 0.007) than those with axial length ≥ 17 mm (Group 1). Postoperatively, both groups demonstrated statistically significant reductions in IOP and the number of IOP-lowering medications (All P < 0.05). IOP reduction ≥ 20% was achieved in 92.3% (Group 1) and 94.4% (Group 2), with IOP < 21 mmHg in 69.2% and 77.8%, respectively. No postoperative malignant glaucoma occurred in either group.
Conclusions: PVP combined with Trab or ECP and PVPTS are effective and safe surgical interventions for patients with NSACG. Surgeries applied using the new criteria of AL have the potential to achieve better IOP control outcomes with lower complication rates.
Key messages: What was known before Nanophthalmos with secondary angle closure glaucoma (NSACG) is challenging to manage surgically due to unique anatomical features and high risk of complications. Short axial length (AL) is a risk factor for postoperative complications in nanophthalmos. What that study adds Phacoemulsification with viscogonioplasty and anterior pars plana vitrectomy (PVP) combined with trabeculectomy or endoscopic cyclophotocoagulation is effective and safe for NSACG patients with AL ≥ 17 mm and < 20 mm. PVP combined with trabeculectomy and sclerectomy (PVPTS) is effective and safe for NSACG patients with AL < 17 mm. The new AL criteria can be considered an effective surgical intervention strategy in treating patients with NSACG.
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