Journal of cataract and refractive surgery最新文献

Topic: This systematic review and meta-analysis aimed to determine whether adding preoperative topical antibiotics to povidone-iodine (PVI) offers any additional benefit over PVI alone in reducing conjunctival bacterial flora, thereby potentially lowering the risk of postoperative endophthalmitis. The participants included 1423 eyes undergoing elective intraocular surgeries (e.g., cataract, keratoplasty, trabeculectomy) or receiving intravitreal injections. The interventions studied were PVI combined with third-generation quinolones (levofloxacin, moxifloxacin, or gatifloxacin) compared with PVI alone. The outcome measure was post-intervention rate of positive conjunctival bacterial cultures prior to ophthalmic procedure.

Clinical relevance: Postoperative endophthalmitis is a rare but serious complication of intraocular surgery, potentially leading to significant vision loss. While PVI is widely recognised as an essential prophylactic measure, the role of preoperative topical antibiotics remains debated. Defining the necessity of antibiotic use in routine cataract surgery is important, especially given the concerns about antibiotic resistance and the rising cost of healthcare. The current standard of care varies globally, with PVI commonly used alone in many regions, such as the UK.

Methods: Studies were included based on the comparison of preoperative PVI with or without antibiotics in patients undergoing intraocular surgery. Searches were conducted in PubMed, Cochrane, and Embase databases, covering literature up to October 2024. Risk of bias was assessed using the Cochrane risk of bias tool.

Results: Seven studies were included, comprising 1423 eyes. A meta-analysis revealed no significant difference in the reduction of conjunctival bacterial flora between PVI + antibiotics and PVI alone (OR: 0.77, 95% CI 0.42-1.42, p=0.41). Subgroup analysis showed that levofloxacin combined with PVI significantly reduced positive culture rates (OR: 0.48, 95% CI 0.29-0.81, p=0.006), while moxifloxacin and gatifloxacin did not show similar benefits. Moderate heterogeneity was observed across studies (I2=58%, p=0.04).

Conclusion: This review found no conclusive benefit of using preoperative topical antibiotics alongside PVI in routine ophthalmic procedures. However, in patients at high-risk of endophthalmitis, levofloxacin may offer additional protection.

Purpose: To evaluate a novel software program (SpikeFinder) that improves quality of measurements obtained by optical low coherence reflectometry (OLCR) biometry (Lenstar).

Setting: Tertiary care academic center.

Design: Retrospective case series.

Method: ology: After applying inclusion criteria, 12,988 eyes scanned with OLCR biometry and swept-source OCT (SS-OCT) biometry (IOLMaster700) were analyzed. Measurements, including axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), were compared. SpikeFinder was applied to eyes with the most prominent ACD and LT measurement differences. Statistical testing was performed using Wilcoxon (two variables) and Kruskal-Wallis ANOVA tests (multiple variables) with Tukey post-hoc adjustments. Heteroscedastic testing (WHWK Statistics Package) was used to assess differences after software application.

Results: 99.1% of AL measurements were within 0.01 mm between the two biometers. SS-OCT LT was significantly longer than the OLCR LT: 33% differed by ≥ 0.50 mm (p<0.001). Correspondingly, SS-OCT ACD was significantly shorter than OLCR ACD: 14% differed by ≥ 0.50 mm (p<0.001). SS-OCT biometer - OLCR biometer values for ACD and LT before applying SpikeFinder were -0.64 ± 0.31 mm and 1.15 ± 0.38 mm, respectively (p<0.001). After applying SpikeFinder to a subgroup of 337 eyes, these differences were -0.02 ± 0.03 mm and 0.01 ± 0.11 mm, respectively. SpikeFinder ACD and LT values were similar to SS-OCT biometer-measured ACD (p=0.872) and LT (p=0.987) values.

Conclusion: The SpikeFinder program can help improve the accuracy of ACD and LT measurements obtained by the OLCR biometer, which may enhance the performance of formulas that utilize these measurements.

Purpose: To evaluate visual, refractive, corneal topographic, and aberrometric results of asymmetric intracorneal ring segments (AS ICRS) with variable width to manage asymmetric keratoconus.

Setting: Quinze-Vingts National Ophthalmology Hospital, Paris, France.

Design: Prospective observational study.

Methods: According to their tomographic pattern, patients receiving one AS ICRS (INTRASEG asymmetric; Gamma Vision) were included. AS INTRASEG features an arc length of 150 degrees and asymmetric width (800 to 1200 µm). Anterior segment optical coherence tomography (AS-OCT) combined with Placido disc MS-39 (CSO, Firenze, Italy) were performed before, 1, and 6 months after surgery to assess keratometric, aberrometric outcomes, and epithelial remodeling. Refractive outcomes were also evaluated. Analysis of the correction profile according to the width of the base of the ICRS was performed.

Results: 43 keratoconic eyes were analyzed. Significant improvement of corrected distance visual acuity was observed (LogMAR): from 0.34 ± 0.23 to 0.08 ± 0.10 (p<0.001). The flattening effect was higher at the widest end than the narrowest end (-10.59D ± 2.59 versus -4.54D ± 1.30, p<0.001), contributing to reduce the Symmetry Index Front from 9.06 ± 4.02 to 2.21 ± 3.81. Total higher orders aberrations reduced from 2.13 ± 0.94 µm to 1.77 ± 0.59 µm (p<0.001) with a halving of the coma aberration from 1.84 ± 0.87 µm to 0.89 ± 0.50 µm (p<0.001).

Conclusion: Implantation of AS INTRASEG in asymmetric keratoconus improves refractive, topographic, and aberrometric parameters. The progressive width of the base is efficient for reducing vertical asymmetry and higher-order aberrations of asymmetric keratoconus phenotype.

Purpose: To detect free radicals during phacoemulsification in different use cases and with emulsification of lens tissue.

Setting: Institute for Interfacial Engineering and Biotechnology, Fraunhofer Institute, Stuttgart, Germany.

Design: Experimental study.

Methods: Three experimental setups were used: 1. Setup without running fluidics to produce air bubbles inside the system. 2. Circulation fluidic setup to compare measurements with and without cataractous lens material. 3. A surgery-comparable system that closely mimics a realistic setup.Porcine lenses were incubated for 1.25h in formalin to simulate middle hard cataracts and emulsified in a test chamber. Free radicals were captured by the spin-trapping agent 5,5'-dimethyl-1-pyrroline N-oxide and measured using electron-paramagnetic resonance spectroscopy.

Results: Hydroxyl-radicals were the predominant free radicals detected. The maximum amount of radicals was produced when air bubbles were allowed to build up inside the system. Less radicals were produced during lens-emulsified compared to application without lens. This effect was enhanced when the phacotip was in close contact with the lens during the whole procedure. In the surgery-comparable setup, the least amount of free radicals was detected.

Conclusion: For the first time we were able to analyze free radicals during phacoemulsification of lens-tissue. We show that emulsification of lens tissue reduces the production of free radicals, an effect that is enhanced during close contact of the tissue with the phacotip. Also, we show that air-bubbles should be avoided during cataract surgery, as they may enhance free radical production. Furthermore, running fluidics remove most of the radicals making oxidative stress less likely.

Purpose: To measure the equatorial lens diameter in vivo and correlate it with other biometric variables in children undergoing cataract surgery.

Setting: Tertiary care institution.

Design: Prospective case series.

Methods: Children < 5 years with cataracts were included. Those with corneal opacities, previous ocular surgery, traumatic cataracts, and or any coexisting corneal or retinal ocular pathology were excluded.In addition to routine investigations, all patients underwent Ultrasound biomicroscopy (UBM) of both eyes. Correlation between the measured value of axial length, corneal diameter, age, and bag diameters and their effect on Intraocular Lens (IOL) implantation (Aphakia/Pseudophakia) were observed.

Results: We included 112 eyes of 68 children with a mean age of 11.42 + 11.34 months ( 1 month - 4 years). Mean capsular bag diameter(CBD) in the eyes where IOL was placed successfully in the bag was 8.27 ± 0.6 mm (7.1 - 9.39 mm). The eyes in which IOL placement was difficult in the bag and who were either left aphakic or bicapsular capture IOL was performed had a mean diameter of 7.09 ±0.99 mm (5.23 - 9.09 mm) (p<0.05). A significant and positive correlation was found between CBD and age, axial length, and corneal diameter (p=0.00; 0.00; 0.001 and r=0.4,0.4 and 0.8, respectively). Bag diameter had the highest association(odds ratio 4) with successful IOL placement.

Conclusions: Bag diameters should be measured preoperatively in children with cataracts along with other biometric variables as it is the most important measurement that helps in making a decision regarding implantation and positioning of IOL.

Purpose: To report rates of change and identify factors associated with late change in refractive outcome after toric intraocular lens (IOL) implantation.

Setting: Single-site study at the Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.

Design: Retrospective cohort study.

Methods: Study inclusion required uncomplicated posterior chamber Alcon SN6ATT toric IOL implantation from 2010 -2017 and refractions 1 month and 5 years after surgery. Exclusion criteria were sulcus IOL placement, subsequent intraocular or refractive surgery in the operative eye, and 5-year Snellen visual acuity of 20/60 or worse. Outcomes of interest were change in spherical equivalent and change in magnitude of the astigmatism vector between the postoperative month 1 and postoperative year 5 refractions. Refractive stability was defined as ≤0.5D change in spherical equivalent and ≤1D change in magnitude of the astigmatism vector. Predictive factors analyzed included age, sex, race, pseudoexfoliation (PXF) syndrome, axial length (AL), pre-operative keratometry measurements (∆K), IOL power, neodymium:yttrium-aluminum-garnet capsulotomy, and intravitreal injections.

Results: Of the 320 eyes meeting study criteria, spherical equivalent was stable in 241 (75%) eyes, astigmatism was stable in 266 (83%) eyes, and 205 (64%) eyes met criteria for refractive stability with both measures. Multivariable regression analysis identified shorter AL (p=0.018) and larger ∆K (p=0.002) as significant predictors of change in refractive astigmatism and PXF syndrome (p=0.006) as a predictor of hyperopic shift >0.5D.

Conclusions: A minority of eyes exhibit late refractive change after toric IOL implantation. AL, ∆K, and PXF syndrome are independent predictors of late refractive change.

Purpose: Evaluate visual outcomes following implantation of a non-diffractive extended deapth of focus (EDOF) intraocular lens (IOL) in patients with early dry age-related macular degeneration (AMD).

Setting: Iladevi Cataract & IOL Research Centre, Ahmedabad, India.

Design: Prospective, interventional series.

Methods: Patients undergoing cataract surgery with the EDOF Acrysof Vivity IOL and having early dry AMD were included. Primary outcome measures were monocular unaided and corrected distance visual acuity (UDVA, CDVA) 3 months postoperatively. Secondary outcome measures were: monocular unaided and distance corrected intermediate (UIVA, DCIVA) (66cm) and near (UNVA, DCNVA) (40cm) visual acuity as well as mesopic contrast sensitivity (CS).

Results: 40 eyes (40 patients) with a mean age of 68.5 + 8.38 (standard deviation, SD) years were included. UDVA and CDVA at 3 months follow up were 0.12 + 0.07 and 0.10 + 0.10 (SD) LogMAR. UIVA, DCIVA were 0.25 + 0.09, 0.12 + 0.09 LogMAR. UNVA, DCNVA were 0.23 + 0.10, 0.19 + 0.15 LogMAR. Mesopic CS values without glare were 1.50 + 0.10, 1.69 + 0.26, 1.40 + 0.30 and 0.84 + 0.5 units at 3, 6, 12 and 18 cycles per degree (CPD). Mesopic CS with glare was 1.53 + 0.16, 1.63 + 0.21, 1.21 + 0.45 and 0.75 + 0.42 units.

Conclusion: The Acrysof Vivity IOL gives very good distance visual acuity with improved intermediate and near visual acuity without significant compromise in contrast sensitivity in eyes with early dry AMD.

Purpose: To determine the intraocular lens (IOL) rotational stability depending on patient position in the first postoperative hour after femtosecond laser assisted cataract or refractive surgery with implantation of a non-toric IOL in the capsular bag.

Setting: Department of Ophthalmology, Goethe-University, Frankfurt, Germany.

Design: Prospective, randomized clinical trial.

Methods: In this study, 38 eyes of 36 patients received femtosecond laser assisted phacoemulsification and implantation of a non-toric IOL in the capsular bag. Patients were randomized into two groups: patients laid down for one hour after surgery due to the clinical standard (LD group), patients walked around in the first postoperative hour (W group). No miotic eye drops were applied at the end of operation. A retroilluminated slit lamp picture was taken at the end of the operation (baseline), one hour and one day postoperative. Changes in IOL position were measured by an axis between two episcleral landmarks and the haptics of the IOL. Measurements were performed by an image processing application specified for medical and scientific purpose. If not normally distributed, the paired t-test was used. Otherwise, the Mann-Whitney-U-Test was used if data was not normally distributed.

Results: IOL rotation in the first hour was 1.80° ± 1.80° in the LD group and 1.21° ± 2.11° in the W group (p=0.123). One day after operation, IOL position differed from the baseline measurement with 1.52° ± 1.89° in the LD group and 1.51° ± 1.69° in the W group (p=0.773).

Conclusion: Early postoperative patient position does not seem to influence IOL rotational stability.

Purpose: To evaluate CT Lucia 602 intraocular lenses implanted in cases lacking capsular support and explanted because of decentration/dislocation with subsequent pathological analysis. The main objectives were to (1) document the status of haptics and (2) verify the presence of the rotisserie effect.

Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design: Case series with clinicopathological correlation.

Methods: 13 explanted CT Lucia 602 lenses were included: 12 implanted by the Yamane technique and 1 that was iris-fixated. 4 lenses were explanted between October 2020 and February 2022. 9 lenses, explanted between November 2022 and February 2024, also exhibited severe optic tilt, leading to explantation. A chart review was performed to obtain clinical information from each case. Explanted lenses underwent gross and microscopic examination for haptic status and rotation, in the dry state (room temperature) and after hydration (body temperature).

Results: Time between implantation and explantation was longer for lenses explanted before November 2022 (without severe tilt). Among the 26 haptics evaluated, 15 were deformed, 6 were broken, 2 were detached, and 3 were unremarkable. 4 haptics of Yamane lenses explanted between November 2022 and February 2024 showed free rotation within the optic insertion, after hydration at body temperature.

Conclusions: Anecdotal reports of the rotisserie effect of CT Lucia 602 lenses implanted by the Yamane technique appeared mostly during the second half of 2022 and suggested that affected lenses were from specific batches, which seems to be consistent with the findings of this study.

Purpose: The main objective was to develop a prediction model based on machine learning to calculate the postoperative vault as well as the ideal implantable collamer lens (ICL) size, considering for the first time the implantation orientation in a Caucasian population.

Setting: Arruzafa Ophthalmological Hospital (Cordoba, Spain) and Barraquer Ophthalmology Center (Barcelona, Spain).

Design: Multicenter, randomized, retrospective study.

Methods: Anterior segment biometric data from 235 eyes of patients who underwent ICL lens implantation surgery were collected using the anterior segment optical coherence tomography (AS-OCT) CASIA II, to train and validate five types of multiple regression models based on advanced machine learning techniques. To perform an external validation a dataset of 45 observations was used.

Results: The Pearson correlation coefficient between observed and predicted values was similar in the five models in the external validation, with least absolute shrinkage and selection operator (LASSO) regression being the highest (r = 0.62, p < 0.001), followed by random forest regression model (r = 0.60, p < 0.001) and backward stepwise regression (r = 0.58, ρ < 0.001). In addition, the predictions generated by the different models showed closer agreement with the actual vault compared with the Nakamura formulas. Using the new methods, about 70% of the observations had a prediction error below 150 µm.

Conclusions: Advanced forms of regressions models based on machine learning allow satisfactory calculation of the ideal lens size, offering greater precision to surgeons customizing surgery according to implant orientation.