Journal of cataract and refractive surgery最新文献

The rising age of pilots and the extension of retirement age underscore the importance of investigating Presbyopia correction intraocular lenses during cataract surgery for Aviation Pilots. This study aims to assess recommendations from aviation regulatory agencies, providing guidance on the use of multifocal intraocular lenses in both commercial and military pilots. A review analysed the perspectives of aviation regulatory agencies regarding the implantation of multifocal intraocular lenses in pilots. Findings reveal a lack of consensus among agencies regarding the use of multifocal intraocular lenses. Some adopt a permissive stance, permitting their use, while others maintain restrictive approaches. Variations in the post-cataract surgery unfit assessment period were observed, ranging from six to twelve weeks. The implantation of multifocal intraocular lenses in aviation pilots remains contentious. Further research is crucial to address unresolved aspects associated with using multifocal intraocular lenses in this context.

Abstract: Harold Ridley permanently implanted the first intraocular lens (IOL) in 1950. The widely accepted narrative is that Ridley and his invention received a hostile reception from Stewart Duke-Elder and other ophthalmic thought leaders. Ridley suffered greatly but was eventually vindicated as later IOL designs were widely accepted. This narrative casts Ridley as a prophetic innovator who suffered and eventually triumphed against the forces of animosity, jealousy and close-mindedness arrayed against him. We argue that this narrative is biased because it was told by Ridley himself and amplified by his biographer and close friend, David Apple. There were good reasons to be skeptical of Ridley's invention. Ridley had not done pre-clinical studies, so his first patients suffered avoidable complications. He worked in secret at a time when openness was the norm. Ridley's IOL had a high percentage of poor outcomes. The cautious approach that Duke-Elder and others had towards IOLs is understandable. The accurate history is a story of a clash of worldviews between an inventor who was focused on innovating quickly to solve a major clinical problem and established leaders who were concerned about the harm to patients from a flawed invention. The skepticism of established thought leaders remains a valuable check on aggressive innovation today.

One of the most impactful recent developments in the glaucoma community has been the concept of interventional glaucoma. In brief, this paradigm shift involves proactive rather than reactive intervention to address glaucoma earlier in the disease process, including in both standalone and combination-cataract settings. By intervening earlier with minimally invasive surgical, laser, or drug-delivery treatments instead of prolonged topical medications, interventional glaucoma aims to take the burden of medication compliance off the patient. It also allows for standalone surgical interventions rather than letting cataract surgery dictate the glaucoma treatment plan. This interventional mindset has been made possible by the increasing diversity and availability of effective minimally invasive treatment options. With these options as a springboard, it is time to reevaluate and advance the traditional glaucoma treatment paradigm.

Purpose: To evaluate the rotational stability and visual performance of the enVista toric intraocular lens (IOL) (MX60ET) in cataract patients with preexisting astigmatism.

Setting: 6 U.S. sites.

Design: Prospective, multicenter.

Methods: Cataract patients 18 years and older with preexisting astigmatism (0.77 to 4.53 diopters [D]) underwent phacoemulsification and implantation of enVista toric IOL (MX60ET). Outcome measures were the proportion of patients with absolute IOL axis rotation of ≤5 degrees, uncorrected and corrected distance visual acuities (UDVA and CDVA) at 4 m, uncorrected intermediate visual acuity (UIVA) at 66 cm, manifest refraction, and adverse events. The patients were followed up on days 1 to 2, 7 to 14, 30 to 60, and 120 to 180.

Results: Mean astigmatism of 101 eyes (101 patients) reduced from 1.47 ± 0.64 D preoperatively to 0.38 ± 0.38 D at days 120 to 180 ( P < .001), with 88.1% (N = 89/101) of eyes achieving astigmatism within 0.75 D. Mean postoperative UDVA and UIVA were 0.10 ± 0.16 and 0.25 ± 0.15 logMAR, respectively. While 79.2% (N = 80/101) of patients had postoperative UDVA of 20/32 or better, 63.9% (N = 62/97) had UIVA of 20/40 or better. The mean toric IOL rotation from the operative visit to days 30 to 60 was 1.97 ± 2.06 degrees, with 97.4% (N = 74/76) of eyes showing toric IOL rotation of 5 degrees or less.

Conclusions: The enhanced enVista toric IOL (MX60ET) demonstrated excellent rotational stability and astigmatic outcomes indicating good efficacy of the IOL for the correction of astigmatism during cataract surgery.

Purpose: To evaluate and compare dynamic vault range (DVR) and asymmetry of the vault during a 3-month follow-up after the implantation of 2 posterior chamber phakic intraocular lenses (pIOLs).

Setting: Aver Clinic, Madrid, Spain.

Design: Prospective comparative study.

Methods: 119 eyes (65 patients) that underwent refractive surgical correction with implantation of 1 of 2 distinct pIOLs were enrolled: Eyecryl Phakic from Biotech Vision Care (Eyecryl group, 72 eyes) and Evo Visian Implantable Contact Lens from Staar Surgical (ICL group, 47 eyes). Besides evaluation of visual acuity, refraction, and ocular integrity, the pIOL vault centrally and at 2 mm nasally and temporally as well as the DVR from photopic (50 lux) to mesopic (10 lux) illumination conditions were measured.

Results: No significant differences were found between the pIOL groups in visual and refractive outcomes ( P ≥ .454). No significant differences between the groups were found in central (523.72 ± 168.4 vs 494.16 ± 156.7 μm, P = .248) and temporal (499.43 ± 155.8 vs 431.28 ± 150.5 μm, P = .067) vaults. However, nasal vault was significantly lower in the ICL group (465.6 ± 149.1 vs 375.4 ± 144.0 μm, P = .045). A trend of a larger DVR was observed in the ICL group, although differences between groups did not reach statistical significance (54.00 ± 36.39 vs 86.5 ± 57.9 μm, P = .070). The pIOL diameter only correlated significantly with vault measurements in the ICL group ( r ≥ 0.650, P < .001).

Conclusions: The Eyecryl pIOL showed more symmetric vaults and a trend of fewer light-induced changes in the central vault compared with the ICL pIOL. The clinical relevance of this finding should be investigated further.

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 report functional and refractive outcomes of manual arcuate keratotomy (AK) with compression sutures for high regular postkeratoplasty astigmatism.

Setting: Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.

Design: Retrospective analysis.

Methods: This study included 90 eyes with high regular postkeratoplasty astigmatism (>4 diopters [D]) who received AK with compression sutures between 2010 and 2022. Functional and refractive outcomes were assessed by evaluating topographic indices and by performing vector astigmatism and Fourier analysis.

Results: At last follow-up (mean 13.7 ± 16.6 months), corrected distance visual acuity improved from 0.59 ± 0.28 to 0.34 ± 0.25 logMAR. Cylinder magnitude decreased from 9.91 ± 2.88 to 5.42 ± 3.35 D. Surface asymmetry index, irregular astigmatism index, and corneal eccentricity index were equal to preoperative values, whereas surface regularity index approached normal values at last follow-up. Fourier analysis indicated a decrease in the regular astigmatic component, whereas nonregular components (asymmetry and higher-order irregularity) remained stable. In vector astigmatism analysis, target-induced astigmatism magnitude was 9.92 ± 2.86 D and surgically induced astigmatism magnitude was 10.16 ± 4.86 D (correction index of 0.91 ± 0.48) with a difference vector of 5.42 ± 3.35 D at last follow-up. Correction of astigmatism magnitude was adequate in 40% of the eyes, undercorrected in 30%, and overcorrected in 30%. Angle of error was <|22.5 degrees| in 88% resulting in a low risk of off-axis treatment.

Conclusions: AK with compression sutures is a simple, relatively effective, and safe surgical procedure for astigmatism reduction after keratoplasty. In case of regular astigmatism, the procedure does not increase corneal irregularities. The remaining refractive error might be further corrected by spectacles, contact lenses, or toric intraocular lens implantation (in-the-bag/add-on), thus reducing the need for repeat keratoplasty.

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 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.