Journal of cataract and refractive surgery最新文献

Purpose: To compare corneal endothelial loss in manual small incision cataract surgery (MSICS) following three different techniques of nucleus delivery (Viscoexpression, Irrigating Vectis, Phacosandwich).

Setting: Mahatma Gandhi Medical College and Research Institute, Puducherry, India.

Design: Prospective, single blinded, randomized controlled trial.

Methods: Willing patients > 40years of age with immature cataract and posted for MSICS were recruited for the study. Those with systemic or ocular comorbidities which may influence corneal endothelium, dilated pupil size of <5mm, intraoperative complications and postoperative corneal haze were excluded. They were randomly divided to one of the three groups (Group 1- Viscoexpression, Group 2- Irrigating Vectis, Group 3- Phacosandwich) for nucleus delivery. Visual acuity and corneal endothelial parameters were recorded preoperatively and postoperatively at 6-8weeks.

Results: A total of 90 patients with mean age of 59.13 ± 9.42 years (range 40-82years) were studied with 30 patients in each group. Following MSICS there was a 12.12% (p=0.001) endothelial cell loss. It was 10.81% in viscoexpression group, 11.3% in irrigating vectis group and 14.28% in phacosandwich group. Post hoc analysis with Dunn Bon ferroni test showed endothelial cell loss following viscoexpression and irrigating vectis methods of nucleus delivery were comparable (p=0.096) and significantly lesser (p<0.001) than in Phacosandwich group.

Conclusion: There was significant endothelial cell loss following MSICS. Nucleus delivery by viscoexpression and irrigating vectis had similar endothelial cell loss while it was greater with phacosandwich technique.

Purpose: To determine characteristics and differences in intraocular lens (IOL) exchange between eyes with an open (OPC) and closed posterior capsule (CPC).

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

Design: Retrospective case series and review of literature.

Methods: Charts of all cases of IOL exchange between January 2010 and May 2024 were retrospectively reviewed. Main outcome measures were indications for surgery, IOL implantation technique, and the necessity of anterior vitrectomy. MEDLINE database and Google scholar were used to identify relevant past publications.

Results: We included 37 eyes of 30 patients with a mean age of 62.1 ± 10.2 years, with 16 eyes (43.2%) with OPC undergoing IOL exchange. Mean interval between IOL implantation and IOL exchange was 61.50 ± 62.00 months in the OPC group and 15.81 ± 15.03 months in the CPC group. The most common indication was optical phenomena in 18 cases (48%). In the OPC group, intraoperative anterior vitrectomy was necessary twice as often (OPC nine cases (56%) vs. CPC five cases (24%)). Bag-to-bag IOL exchange was performed in all eyes with CPC, and in 10/16 (62%) with OPC (p=0.009). Postoperative complications were seen in a total of 7/16 eyes (43.7%) with OPC and 3/21 (14.3%) with CPC (p=0.012).

Conclusion: The success rate of repositioning an IOL within a bag with OPC is less than that achieved with CPC. A vitrectomy is typically required when attempting a bag-to-bag IOL exchange with an OPC. Capsulotomy should only be performed if the necessity of an IOL exchange is unlikely.

Purpose: To assess 5-years trends in the rate of immediate sequential bilateral cataract surgery (ISBCS) and surgeon characteristics associated with performing ISBCS.

Setting: 100% Medicare Fee-for-service beneficiaries from 2018-2022.

Design: Cross-sectional study.

Methods: ISBCS cases were identified among patients aged ≥ 65 years undergoing bilaterally performed cataract surgery (BPCS). Cochrane Armitage trend test was used to assess patient and surgeon characteristics over time. Multivariable logistic regression was used to evaluate surgeon characteristics associated with performing ISBCS.

Results: Among 1,190,169 BPCS, 3,954 (0.33%) were ISBCS. Quarterly ISBCS rate increased from 2.12 to 5.5 per 1,000 BPCS (p<0.001). Among 10,290 surgeons, 1,119 (10.87%) performed ISBCS on some patients. Proportion of surgeons performing ISBCS per 1,000 cataract surgeons increased from 15.63 during the first quarter of 2018 to 26.55 during the last quarter of 2022 (p<0.001). Among the ISBCS surgeons, the proportion of ISBCS cases per 1,000 BPCS doubled from 17.20 in 2018 to 35.50 in 2022 (p<0.001). On multivariable analysis, surgeons in the highest surgical volume quartile (OR: 1.21; 95% CI: 1.01-1.45; Ref: lowest quartile), recent graduates (0-10 years OR: 2.43, 95% CI: 1.87-3.15; Ref: ≥ 31 years) and surgeons in West (OR: 2.408, 95% CI: 2.052-2.826; Ref: South) had higher odds of performing ISBCS.

Conclusions: There was an increased rate of ISBCS possibly suggesting greater interest among patients and surgeons. Although the overall ISBCS rate remained low, the number of surgeons performing ISBCS increased. Higher volume surgeons, recent graduates, and those practicing in the West were more likely to perform ISBCS.

Purpose: To evaluate the ZEISS AI IOL Calculator (ZEISS AI) and compare its accuracy in refractive prediction to the Barrett Universal II (BUII) and Kane formulas.

Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, TX.

Design: Retrospective case series.

Methods: The ZEISS AI IOL Calculator (ZEISS AI) is an artificial intelligence (AI) based IOL-optimized formula. The refractive prediction errors (PEs) were calculated in the entire dataset and subgroups of short eyes (axial length (AL) ≤ 22.5 mm) and long eyes (AL ≥ 25.0 mm). The standard deviation (SD), root-mean-square absolute error (RMSAE), mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D of PEs were calculated. Values with ZEISS AI were compared to those from Barrett Universal II (BUII) and Kane. Advanced statistical methods were applied using R.

Results: A dataset of 10,838 eyes was included. Compared to ZEISS AI, BUII produced significantly greater SDs, RMSAEs, and MAEs in the whole group and short eyes, and the Kane had greater SD, RMSAE, and MAE in short eyes (all adjusted P<0.05); the BUII had significantly lower percentages of eyes within ±0.50 D of PEs in the whole group (80.0% vs 81.2%) and in short eyes (71.3% vs. 76.1%), and the Kane had lower percentage of eyes within ±0.50 D of PEs in short eyes (71.9% vs. 76.1%) (all adjusted P<0.05).

Conclusion: The ZEISS AI IOL Calculator had superior performance compared to the BUII and Kane formulas, especially in short eyes.

Purpose: To investigate the light transmission (LT) of UV-A and green light through infected corneas saturated with riboflavin or rose bengal in an ex vivo porcine model for infectious keratitis.

Setting: University of Zurich and EMPA.

Design: Laboratory study.

Methods: Ex vivo porcine eyes (n=162) were divided into three groups: control eyes, eyes infected with Staphylococcus aureus, and eyes infected with Pseudomonas aeruginosa. Corneas remained either uninfected, or were infected with S. aureus, and P. aeruginosa, respectively, and were either left untreated, or were instilled with 0.1% riboflavin or 0.1% rose bengal. Corneal buttons were prepared, and corneal LT was measured at 365 nm and 522 nm using a spectrophotometer. LTs were calculated and compared. Transmission electron microscopy (TEM) was used to visualize structural damage and bacteria within infected corneas.

Results: Riboflavin-saturated corneas infected by S. aureus or P. aeruginosa (LT = 0.77% [0.41-1.87] and 0.81% [0.23, 1.46]) exhibited 3.18-fold and 3.02-fold lower LTs than uninfected corneas (LT = 2.45% [2.15, 5.89]) (both p-values < 0.001). No LT difference was found between rose bengal-saturated corneas infected by S. aureus or P. aeruginosa and uninfected corneas (all LTs = 0.01% [0.01-0.01]; both p-values = 0.08). TEM showed bacteria on corneal stroma borders and occasionally inside the stroma.

Conclusion: Our results indicate that the amount of light arriving at the corneal endothelium is substantially reduced in infected corneas. The total fluence of clinical PACK-CXL protocols can be safely increased substantially while maintaining a low risk of corneal endothelial damage.

Purpose: To compare three biometers equipped with swept-source optical coherence tomography (OCT), including ARGOS (OCTB1), IOLMaster 700 (OCTB2), and Anterion (AS-OCTB). The primary aim was to assess the axial length (AL) acquisition success rates, and secondary aims included comparing parameters obtained from the three devices and evaluating postoperative refractive prediction errors.

Setting: Chukyo Eye Clinic, Nagoya, Japan.

Design: Retrospective observational study.

Methods: The study included patients undergoing preoperative assessments for cataract surgery using the three biometers. The AL acquisition success rates and parameters obtained from the three devices were compared and the postoperative refractive prediction errors (defined as the difference between subjective refractive error and predicted refractive error) were assessed at one month after surgery.

Results: The study included 361 eyes from 361 patients. The AL acquisition success rates for all patients were 100.0% (n=361) (OCTB1), 98.6% (n=356) (OCTB2), and 96.7% (AS-OCTB) (P < .0001), and those for nuclear sclerosis of grade 4 or higher were 100.0%, 87.8%, and 87.8%, respectively (P = .007). The AL of mature cataract was measurable only with OCTB1 using the enhanced retina visualization mode. Although there were significant differences in parameters obtained on the three devices, there were no significant differences in postoperative refractive prediction errors.

Conclusions: OCTB1 demonstrated the highest AL acquisition success rate and was able to measure AL even in eyes with dense or mature cataract. AS-OCTB using a wavelength of 1300 nm showed lower AL acquisition success rates compared to the other two devices probably due to reduced light transmission through the vitreous body.

Purpose: To evaluate the safety and effectiveness of thermo-mechanical action (Tixel C, Novoxel) compared with thermal pulsation (LipiFlow, Johnson & Johnson) in meibomian gland dysfunction (MGD).

Setting: Private clinics and University clinic, USA.

Design: Prospective, randomized (1:1), evaluator-masked, multicenter study.

Methods: Subjects with Ocular Surface Disease Index (OSDI) between 23 and 79, fluorescein tear break-up time (TBUT) <10 s and Meibomian Gland Score (MGS) ≤12 in each eye received bilateral thermo-mechanical action (TMA) or thermal pulsation (TP). The treatment consisted of three sessions, two weeks apart, for TMA and one session for TP. TBUT, OSDI, MGS, and corneal and conjunctival staining (CCS) were assessed at baseline and at Weeks 4 and 12 post-last treatment session. The primary effectiveness endpoint was change in TBUT at Week 4.

Results: Among the 106 treated subjects (N=53 per group), TBUT improved significantly (p<0.001) by 3.0±3.2 and 3.1±4.3 seconds after TMA and 2.7±2.7 and 3.3±3.6 seconds after TP, at Week 4 and Week 12, respectively. The change in TBUT for TMA was non-inferior to TP (linear mixed-effects model, p<0.001). OSDI, MGS and CCS significantly improved from baseline (p<0.001), with no significant between-group differences (p>0.05). OSDI improved by 26.4±21.1 and 28.6±22.4 after TMA and 18.8±21.0 and 21.9±18.5 after TP, at Week 4 and Week 12, respectively. No device-related adverse event occurred in either group.

Conclusion: TMA safely and effectively improved clinical signs and symptoms of evaporative dry eye disease associated with MGD over a 12-week period, comparable to TP.

Purpose: To assess an new objective deep learning model cataract grading method based on Swept-Source Optical Coherence Tomography (SS-OCT) scans provided by the Anterion® (Heidelberg, Germany).

Setting: Single centre study at the Rothschild Foundation, Paris, France.

Design: Prospective cross-sectional study.

Methods: All patients consulting for cataract evaluation and consenting to study participation were included. History of previous ocular surgery, cornea or retina disorders, and ocular dryness were exclusion criteria. Our CATALYZE pipeline was applied to Anterion® image providing layer-wise cataract metrics and an overall Clinical Significance Index of cataract (CSI). Ocular scatter index (OSI) was also measured with a double-pass aberrometer (OQAS®), and compared to our CSI.

Results: Five hundred forty eight eyes were included, 331 in the development set (48 with cataract and 283 controls) and 217 in the validation set (85 with cataract and 132 controls) of 315 patients aged 19-85 years (mean ± SD: 50 ± 21 years). The CSI correlated with the OSI (r2 = 0.87, P <0.01). CSI area under the ROC curve (AUROC) was comparable to OSI AUROC (0.985 vs 0.981 respectively, P>0.05) with 95% sensitivity and 95% specificity.

Conclusions: Our deep learning pipeline CATALYZE based on Anterion® SS-OCT is a reliable and comprehensive objective cataract grading method.

Purpose: To investigate the effectiveness and safety of customized femtosecond laser-assisted corneal allogenic intrastromal ring segments (CAIRS) implantation in keratoconus patients with a history of intrastromal corneal ring segment (ICRS) explantation.

Setting: Sorocaba Eye Hospital (Hospital Oftalmológico de Sorocaba - HOS), Sorocaba, Brazil.

Design: Prospective case series.

Methods: We included eight keratoconus patients with stable disease and with history of ICRS explantation at least six months before the inclusion in the study. Patients were excluded if presenting any other ocular pathology. Customized CAIRS was produced and implanted using femtosecond laser LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland). Patients were followed-up for six months.

Results: The mean reduction of the maximum, mean, and steep central keratometry was 3.03 ± 1.35 diopters (D) (p =0.01), 2.88 ± 2.51 D (p=0.02), and 2.41 ± 2.72 D (p=0.04), respectively. The mean spherical equivalent and refractive astigmatism reduced 6.28 ± 2.71 D (p =0.01), and 1.62 ± 2.83 D (p=0.16). All eyes, but one gained two or more lines of best spectacle corrected visual acuity (BSCVA).Additionally, five patients achieved a BSCVA of 20/40 or better. No intra or post-operative complications were observed.

Conclusions: Customized femtosecond laser assisted CAIRS may be an effective and safe option for visual rehabilitation in keratoconus patients with previous ICRS explantation.

Purpose: To evaluate visual and refractive outcomes in eyes with a history of radial keratotomy (RK) implanted with the second-generation light-adjustable lens (LAL).

Setting: Private practice, multiple locations.

Design: Retrospective, consecutive case series.

Methods: Eyes with a history of RK that underwent cataract surgery with implantation of the LAL and were targeted for emmetropia prior to lock-in were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and the percentage (%) of eyes within ±1.00 diopter (D), ±0.50 D, and ±0.25 D and of their refractive target.

Results: 94 eyes from 77 patients were included. 28% (n = 26) were a history of 4-cut RK, 12% (n = 11) were 6-cut RK, 55% (n = 52) were 8-cut RK, and 5% (n = 5) were 16-cut RK. Overall, 82% (n = 77) of all eyes achieved 20/25 UDVA or better, 74% (n = 70) of all eyes achieved UDVA of 20/20 or better, and 94% (n = 88) were correctable to 20/20 or better postoperatively. For refractive outcomes, 98% (n = 92) of eyes were within ±1.00 D of target, 88% (n = 83) were within ±0.50 D, and 69% (n = 65) were within ±0.25 D of preoperative refractive target.

Conclusions: Patients with a history of RK achieved favorable visual and refractive outcomes with the LAL. Postoperative light adjustments should be delayed to allow for refractive stabilization. The LAL is a promising option for post-RK patients who are motivated to obtain favorable uncorrected acuity after cataract surgery.