Journal of cataract and refractive surgery最新文献

Purpose: To compare time and resource saving with integration of digital cataract workflow to the existing workflow in high-volume cataract surgery clinics.

Setting: L V Prasad Eye Institute, Hyderabad, India (site 1), and Narayana Nethralaya, Bengaluru, India (site 2).

Design: Prospective, time and motion.

Methods: The total time to complete each step (preoperative measurements, surgical planning, and surgical procedures) of the cataract workflow, number of data fields entered, and support staff required for both workflows were recorded. All study measurements were determined first for existing electronic medical record (EMR) cataract workflow followed by digital workflow (integrated data management system with data reviewer, surgical planner, and data transfer to operating room) at both sites.

Results: A total of 85 (site 1, 44; site 2, 41) cataract workflows were analyzed. The integration of digital workflow into the site's existing EMR workflow reduced the mean time for preoperative measurements by 25.3% ( P = .006), surgical planning by 55.1% ( P = .008), and surgical procedures by 22.6% ( P = .002). The mean ± SD overall time for the surgery was significantly shorter in the digital group (887.3 ± 103.3 vs 1271.3 ± 300.7 seconds; P < .0001). For both sites, the number of data fields recorded and number of support staff needed were significantly lesser for the digital workflow ( P < .0001, for both).

Conclusions: Integration of digital workflow significantly reduced the overall cataract surgery time, variability of overall time, number of data fields recorded, and resource utilization. Complete digitalization has important implications for improving the efficiency and standardization of cataract surgery workflow.

Purpose: To compare the refractive prediction errors (PEs) of formulas included in the ESCRS intraocular lens (IOL) power calculator to aid in informed decisions on IOL power selection based on the output of this tool.

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

Design: Retrospective case-series.

Methods: 748 eyes of 748 patients after implantation of 1 of 3 lenses were included, single-piece: the SN60WF, PCB00/ZCB00 and 3-piece: MA60MA. IOL constants recommended by the calculator were used for the study. We performed analysis for the whole dataset, short (<22 mm) and long eyes (>25 mm) as well as in subgroups based on the type of the implanted IOL. SD and root mean square absolute error (RMSAE) were selected as the primary endpoints.

Results: Cooke K6 had the lowest SD of PEs in the whole dataset ( P < .05) when compared with Barrett, EVO, and Hoffer QST. In the subgroup of long eyes, the Kane formula had the lowest RMSAE ( P < .05) when compared with Barrett and EVO. No significant differences in primary endpoints for implantation of the 3 types of IOLs were found. However, the median absolute error after implantation of the MA60MA was significantly higher for Hoffer QST than for all other formulas except for Pearl-DGS.

Conclusions: Significant differences in the performance of formulas included in the calculator were found. In the whole dataset, Cooke K6 had the lowest SD of PEs among the analyzed formulas.

Purpose: To differentiate a normal cornea from a forme fruste keratoconus (FFKC) with the swept-source optical coherence tomography (SS-OCT) topography CASIA 2 using machine learning artificial intelligence algorithms.

Setting: Monocentric, performed in CHU Bordeaux, Bordeaux, France.

Design: Retrospective case-control.

Methods: 3 groups were included: KC group (108 eyes), FFKC (88 eyes), and normal corneas (162 eyes). The data were analyzed and processed using the Dataiku data science platform. Machine learning models (random forest [RF], logistic regression [LR]) were used to develop a multiclass classifier for automated early KC detection. The models were trained using a training database and tested using a test database. Then, algorithms were compared with the Ectasia Screening Index (ESI), which is an OCT-topography inherent screening score for ectasia.

Results: The LR and RF detected FFKC with an area under the curve of 0.99 and 0.98, respectively. The sensitivities of LR (100%) and RF (84%) were better than the ESI (28%) for the diagnosis of FFKC. However, ESI has a maximum specificity (100%) compared with the LR (100%) and 90% for RF.

Conclusions: This study identified discriminating topographic parameters to be considered in refractive surgery screening on SS-OCT CASIA 2. An algorithm capable of classifying normal eyes vs FFKC cases was developed, with improved performance compared with the ESI score.

A 23-year-old woman was referred for low visual acuity in the left eye after a corneal ulcer associated with contact lens use 2 years previously. The patient had a history of contact lens use, reported use of antibiotic eye drops with improvement of infection, and subsequent scarring. There were no comorbidities. The manifest refraction was -3.25 -2.25 × 180 (20/20) in the right eye and was -2.00 esf -2.00 × 165 (20/80) in the left eye. The patient demands a solution in a reasonable time because of the need for functional vision and possible restoration of her binocular functions. The slitlamp examination revealed a corneal scar partially affecting the visual axis (Figure 1JOURNAL/jcrs/04.03/02158034-202412000-00016/figure1/v/2024-12-12T192825Z/r/image-tiff). Corneal topography revealed an irregular pattern and spectral-domain optical coherence tomography (OCT) examinations revealed scarring in the anterior stroma (Figures 2 and 3JOURNAL/jcrs/04.03/02158034-202412000-00016/figure2/v/2024-12-12T192825Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202412000-00016/figure3/v/2024-12-12T192825Z/r/image-tiff). Given the patient's refraction, corneal scar, and visual demands, would you perform photorefractive keratectomy (PRK) treatment to correct ametropia and partially remove the anterior stroma? Would you perform excimer laser treatment for therapeutic purposes guided by topography? Would you opt for a 2-stage treatment, regularizing the cornea with neutral phototherapeutic keratectomy (PTK) or PRK treatment guided by topography and then correcting the ametropia? Considering the OTC maps, would you perform a femtosecond laser-assisted anterior lamellar keratoplasty (FALK), deep anterior lamellar keratoplasty (DALK), or even penetrating keratoplasty? Would you consider any other surgical step to prevent delayed cornea healing-persistent epithelial defect?

Purpose: To investigate the effects of cylinder axis-flip after toric intraocular lens (TIOL) implantation on vision and patient-reported outcome measures (PROMs).

Setting: Teaching hospital in the United Kingdom.

Design: Post hoc analysis of data from patients who participated in a prospective randomized study of TIOLs.

Methods: Axis-flip was defined as a change in postoperative refractive cylinder (RC) axis of 90 ± 22.5 degrees from the preoperative biometric axis. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual RC, and CATPROM-5 and EQ-5D-3L quality-of-life scores were analyzed.

Results: At 6 months, axis-flip occurred in 29 (34.5%) of 84 eyes of which 28 had with-the-rule (WTR) astigmatism preoperatively. Mean (±SD) UDVA (logMAR) was 0.13 (0.16) in flipped cases (FCs) and 0.10 (0.14) in unflipped cases (UFs) ( P = .88). CDVA was 0.01 (0.11) in FC and was 0.00 (0.09) in UF ( P = .68). Mean RC was 0.74 diopters (D) (0.41) in FC and 0.93 D (0.47) in UF ( P = .08). Mean CATPROM-5 score was -6.22 (2.56) in FC and -5.52 (3.03) in UF ( P = .29). Mean EQ-5D-3L calibrated score was 0.89 (0.19) in FC and 0.85 (0.19) in UF ( P = .35). Retrospectively applying coefficients of adjustment to account for posterior corneal astigmatism (PCA) suggested that 6 eyes (21%) of FC with WTR might have avoided axis-flip.

Conclusions: Axis flipping after TIOL implantation did not adversely influence visual acuity or PROMs scores. Most FC had WTR preoperatively. Adjusting for PCA might have reduced axis-flip in some of these eyes.

Purpose: To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared with topical medication regimens.

Setting: U.S. national medical expenditures database.

Design: Retrospective cost analysis.

Methods: Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using 2-sided, 1-sample t tests.

Results: There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared with $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) ( P < .001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450 000 000 and $225 000 000, respectively.

Conclusions: An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison with various topical regimens.

Purpose: To investigate whether phacoemulsification (PE) experience impacts and transfers to the skill acquisition of novices in manual small-incision cataract surgery (MSICS) within a simulation environment.

Setting: Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.

Design: Prospective controlled experimental study.

Methods: The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to have either (1) proficiency on the EyeSi surgical simulator (PE group [PG]) or (2) no prior extensive exposure to the EyeSi simulator or any PE surgery experience as a primary surgeon (control group [CG]). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including 9 modules and 30 steps (points). A pass/fail score was determined at 20 points (of 30 points). Performance scores were analyzed using independent samples t tests, pass rates using the Fisher exact test, and individual modules using Fisher-Freeman-Halton analysis.

Results: The PG performed significantly better in overall performance score (mean ± SD, PG; 21.8 points ± 2.3 vs CG; 18.9 points ± 2.2, P = .002, t -value = -3.39) and pass rates (PG; 72% vs CG; 22%, P = .018). The subanalysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules.

Conclusions: The results suggest a positive interprocedural transfer of skills between PE and MSICS. Pretraining and experience in PE demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that PE experience provides an advantage before MSICS training in surgical residency programs.