Journal of cataract and refractive surgery最新文献

Purpose: To compare long-term changes in endothelial cell loss (ECL) in different corneal regions after femtosecond laser-assisted cataract surgery (FLACS) or conventional phacoemulsification surgery (CPS).

Setting: Chang Gung Memorial Hospital, Linkou, Taiwan.

Design: Single-center retrospective study.

Methods: Adult patients who received a premium IOL via FLACS or CPS were included. Patients with an endothelial count less than 1,500 cells/mm2, NO5/NC5 nuclear sclerosis, and complications during surgery were excluded. All patients were followed at 1, 3, 6, 12, and 24 months postoperatively. ECL was measured at different positions of the cornea: Position 1, the corneal center; Position 2, nearest the main corneal incision; and Position 3, the peripheral region opposite the main wound.

Results: 48 eyes in the CPS group and 40 eyes in the FLACS group from 75 patients were included. In both groups, ECL was consistently greater at Position 2, and ECL at Positions 1 and 3 remained relatively stable across all time points. At postoperative 3 months at Position 3: the FLACS group had significantly lower ECL than the CPS group. However, at Position 2, ECL continued to increase until 6 months and then stabilized. No significant differences in other endothelial parameters, including the coefficient of variation, percentage of hexagonal cells, or corneal thickness, were observed between the two groups.

Conclusions: A significant difference in ECL between FLACS and CPS occurred only in the early postoperative period. ECL was highest near the main wound in both groups; it peaked at 6 months postoperatively and stabilized thereafter.

This letter highlights some of the physico-chemical characteristics of a microfiltered 0.4% solution of trypan blue, CAPSULblue (Excel-Lens, Los Gatos California USA). This dye is used to stain the anterior capsule to enhance its visibility and the stained capsule acts a target for a 590nm laser during selective laser capsulotomy. The characteristics of the 0.4% solution are compared to commercially available 0.06% trypan blue solutions. There is a striking variability seen in purity, pH, osmolality and monoazo-dye concentration in the 0.06% solutions when compared with the microfiltered 0.4% solution. Particulate matter is seen in one of the non-filtered examples which may induce toxic anterior segment syndrome (TASS). The speed of staining the anterior capsule is also compared demonstrating the much more rapid effect with the 0.4% solution. Finally, the rate of removal of the dye from the eye through the uveoscleral and trabecular outflow pathways after surgery is demonstrated.

Topic: To evaluate the efficacy of currently available digital and remote care applications for postoperative cataract management compared to traditional methods for postoperative clinical measurements.

Clinical relevance: With the increasing demand for ophthalmological services and an anticipated shortage of professionals, innovative approaches are needed to optimize care. Cataract surgery, characterized by its high safety profile and turnover rate, is well-suited for digital and remote care solutions, which could enhance the postoperative patient pathway, potentially leading to substantial time and cost savings.

Methods: A systematic search was performed in Ovid Embase, Ovid MEDLINE, KSR Evidence, CINAHL, and Cochrane CENTRAL Library for randomized controlled trials (RCTs) and observational studies on digital tools, telemedicine or remote care in postoperative cataract management. Reported outcomes included patient reported outcomes (PROMs), visual acuity, refraction, intraocular pressure, slitlamp and fundus examination, or complication prevalence. The risk of bias was evaluated using the Cochrane Risk-of-Bias Assessment Tool (version 2) and Joanna Briggs Institute Critical appraisal checklists. Data extraction included both qualitative and quantitative information. The protocol was registered at PROSPERO (CRD42024505933).

Results: The search identified 11,319 studies, of which 14 were included. These comprised 4 RCTs and 10 observational studies involving 2681 patients. Interventions were categorized into telephone consultation, messaging, automated phone calls, and mobile applications/software. Telephone consultations were effective for follow-up screening, and automated phone calls also showed promising results. Messaging was suggested to improve adherence in the early postoperative period. Visual acuity assessment tools showed potential as screening methods, but exhibited variability compared to conventional methods and had wide 95% limits of agreement. All types of interventions were well-accepted by patients.

Conclusion: Early evidence supports a positive impact of implementing digital and remote care tools in the postoperative cataract management pathway, particularly for screening purposes. However, further research is needed to define their roles and develop clinical practice guidelines.

Purpose: To assess the real-life impact of preoperative visual simulations with SimVis Gekko (SVG) on predicting postoperative visual performance in patients undergoing bilateral cataract surgery with trifocal or extended depth of focus (EDOF) intraocular lenses (IOL).

Setting: Centro Hospitalar Universitário de Coimbra, Portugal.

Design: Single-center prospective observational cohort study.

Methods: We included patients aged between 40 and 69 years with mild to moderate cataract and distance corrected visual acuity > 20/50, with indication to underwent cataract surgery with EDOF/trifocal IOL implantation. A trifocal, an EDOF and a monofocal IOL were simulated for each patient preoperatively. Distance, intermediate and near visual acuity (VA), subjective visual performance score (VSco) (from 0 to 10) and stereopsis were measured pre- and postoperatively.

Results: A total of 51 patients were tested and 44 (n=44) were included. The mean age of included patients was 56.0 (± 7.9) years, 26 patients received the trifocal IOL and 18 the EDOF IOL. The shape of the VA curve was comparable between preoperative simulation and the achieved postoperative VA for both IOLs; stereopsis was similar with and without simulation; VSco improved at the postoperative for both IOLs and was higher for trifocal group. Ninety-two-point-two percent of patients found the simulation very useful for choosing between IOLs.

Conclusion: SVG showed a good ability to simulate EDOF/trifocal IOLs in terms of the shape of the VA curve, stereopsis and VSco. This instrument appears to be very useful for the patient's decision-making process and may reduce dissatisfaction after surgery.

Purpose: To evaluate the repeatability of measurements obtained with a new spectral-domain optical coherence tomography-based biometer (Colombo IOL II, Moptim) and assess their agreement with those provided by the IOLMaster 700 (Zeiss).

Setting: I.R.C.C.S. Bietti Foundation, Rome, Italy.

Design: Prospective evaluation of diagnostic test.

Methods: Patients underwent 3 consecutive scans with the Colombo IOL II and 1 with the IOLMaster 700. Two groups were analyzed: Group A included a series of consecutive patients undergoing phacoemulsification and Group B a series of subjects with a clear lens. Axial length (AL), keratometry, keratometric astigmatism, anterior chamber depth (ACD), lens thickness (LT), corneal diameter (CD), central corneal thickness (CCT) and retinal thickness (RT) were analyzed. The within-subject standard deviation (Sw), intrasession test variability, coefficient of variation (CoV) and intraclass correlation coefficient (ICC) were calculated for repeatability analysis. 95% limits of agreement were calculated to assess agreement with the IOLMaster 700.

Results: Ninety-six unoperated eyes of 96 patients were enrolled (Group A: 45 Group B: 51). The CoV was low for most parameters, as it ranged between 0.04% (AL) to 4.47% (RT) in Group A and from 0.03% (AL) to 2.23% (LT) in Group B. Keratometric astigmatism measurements were less repeatable. Good agreement with the IOLMaster 700 was found for K, LT and AL, whereas the mean ACD was higher by 0.07±0.11 mm with the Colombo IOL II (p <0.0001).

Conclusion: Measurements by the Colombo IOL II showed high repeatability and good agreement with those provided by the IOLMaster 700.

Purpose: To examine the effect of a vortex beam on gas formation and interface quality after keratorefractive lenticule creation with a 347 nm UV femtosecond laser.

Setting: "masked for peer-review".

Design: Experimental study.

Methods: Refractive corneal lenticules were created in 40 ex vivo porcine eyes with a 347 nm UV femtosecond laser. In 20 eyes, the laser was operated with a (Laguerre-Gaussian) vortex beam (generated by a spiral phase plate), and in the remaining 20 with a normal (Gaussian) beam. In each group, 12 eyes were used for histological quantification of intraoperative gas formation. The remaining 8 eyes were subjected to scanning electron microscopy after lenticule extraction to evaluate the lenticule bed morphology. The vortex group was compared morphologically and morphometrically to the normal group.

Results: Application of a vortex beam significantly decreased the amount of gas produced intraoperatively. Semiquantitative 2D histomorphometrical analysis of the area occupied by gas bubbles yielded 20,156 ± 5,591 µm2/mm in the normal samples, as compared to 9,495 ± 3,966 µm2/mm in the vortex samples (p<0.001). Moreover, the lenticule beds created by a UV vortex beam were markedly smoother and more regular than those created by a normal UV laser beam.

Conclusions: Operating a UV femtosecond laser with a vortex beam may significantly decrease the risk of opaque bubble layer formation and increases surgical safety and precision.

Abstract: Astigmatism is the difference between the orthogonal principal planes of minimal and maximal powers of a toric surface, lens, or refraction. Corneal astigmatism is a common condition, and studies indicate that over 60% of individuals have more than 0.50 diopters (D) of astigmatism. Corneal astigmatism is measured in various ways, and measurements from different devices are usually not interchangeable due to variations in technology and the corneal regions that are imaged. The integrity of the ocular surface is critically important for accurately measuring corneal astigmatism. Optimizing the ocular surface before cataract surgery can significantly improve the accuracy of preoperative astigmatism measurements and refractive outcomes. It is advisable to obtain at least 2 or preferably 3 measurements when measuring corneal astigmatism. When a discrepancy in astigmatism meridian and magnitude occurs between the measurements, it is advisable to settle or at least minimize this discrepancy by repeating the measurements after optimizing the ocular surface. Posterior corneal astigmatism is an important component of total corneal astigmatism. Lens tilt can also induce visually significant refractive astigmatism and ideally should be accounted for in toric IOL planning.