Journal of cataract and refractive surgery最新文献

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 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.

Purpose: To compare intraindividually the incidence and intensity of posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) differing slightly in their particular material, optic surface, and sharp posterior edge design over a period of 3 years.

Setting: Department of Ophthalmology, Medical University Vienna, Vienna, Austria.

Design: Randomized, prospective, patient-masked and examiner-masked clinical trial with intraindividual comparison.

Methods: 100 patients randomly received a Vivinex XY1 IOL in 1 eye and a Clareon CNA0T0 IOL in the fellow eye. The amount of PCO (score 0 to 10) was assessed subjectively and objectively with digital retroillumination pictures using automated image analysis software (Automated Quantification of After-Cataract). Corrected distance visual acuity and the presence of glistenings, subjective visual symptoms, and Nd:YAG laser capsulotomy rate were noted.

Results: 67 of 100 patients were available for the 3-year follow-up examination. The objective PCO score of the Vivinex XY1 IOLs was 1.0 ± 1.0 compared with the PCO score of 1.5 ± 1.2 for the Clareon CNA0T0 IOLs ( P < .001). 7.5% of patients had a Nd:YAG capsulotomy in the Vivinex XY1 eye, and 9.0% had a capsulotomy in the Clareon CNA0T0 eye ( P = 1.0).

Conclusions: Both hydrophobic acrylic IOLs showed low PCO and YAG rates with a small but significant favor of the Vivinex XY1 IOL compared with the Clareon CNA0T0 IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge is the major key for PCO prevention.

Clinical trial number: NCT04369482.

Purpose: To analyze waste from intraocular lens (IOL) packaging across a variety of brands.

Setting: Private clinical practice.

Design: Prospective weight and composition analysis of all elements of unopened packages of IOLs sold in the United States-both preloaded and non-preloaded.

Methods: Samples were collected from multiple IOL companies in 2023. The primary end point for comparison was the total weight of each IOL package, because this generally correlates with the carbon footprint. The percentage of total weight contributed by paper, plastic, Tyvek, foil, sterile saline solution (fluid), metal, or glossy paper material was also calculated.

Results: The non-preloaded IOL package weights ranged from 29 g (Zeiss Lucia) to 80 g (RxSIGHT LAL). Most of the weight was attributable to paper, including the box and instructions for use (IFUs) pamphlet. The latter was generally the largest component within the box. The weights of preloaded IOL packages were generally higher than those of their non-preloaded counterparts and ranged from 67 g (Hoya iSert) to 116 g (Rayner RayOne Spheric).

Conclusions: Meaningful differences in IOL packaging weight and waste were noted across different models and manufacturers. Electronic IFUs linked to QR codes could replace the need for an IFU pamphlet within every box, significantly reducing the box's size, weight, and carbon footprint. Pairing preloaded IOL cartridges with autoclavable injectors could reduce associated waste. Because of the enormous global volume of IOL implantation, these waste-reducing strategies should be prioritized by IOL manufacturers.