Journal of cataract and refractive surgery最新文献

Purpose: To use a combination of partial least squares regression and a machine learning approach to predict intraocular lens (IOL) tilt using preoperative biometry data.

Setting: Kepler University Clinic Linz, Linz, Austria.

Design: Prospective single-center study.

Methods: Optical coherence tomography, autorefraction, and subjective refraction were performed at baseline and 8 weeks after cataract surgery. In analysis I, only 1 eye per patient was included and a tilt prediction model was generated. In analysis II, a pairwise comparison between right and left eyes was performed.

Results: In analysis I, 50 eyes of 50 patients were analyzed. Difference in amount, orientation, and vector from preoperative to postoperative lens tilt was -0.13 degrees, 2.14 degrees, and 1.20 degrees, respectively. A high predictive power (variable importance for projection [VIP]) for postoperative tilt prediction was found for preoperative tilt (VIP = 2.2), pupil decentration (VIP = 1.5), lens thickness (VIP = 1.1), axial eye length (VIP = 0.9), and preoperative lens decentration (VIP = 0.8). These variables were applied to a machine learning algorithm resulting in an out of bag score of 0.92 degrees. In analysis II, 76 eyes of 38 patients were included. The difference of preoperative to postoperative IOL tilt of right and left eyes of the same individual was statistically relevant.

Conclusions: Postoperative IOL tilt showed excellent predictability using preoperative biometry data and a combination of partial least squares regression and a machine learning algorithm. Preoperative lens tilt, pupil decentration, lens thickness, axial eye length, and preoperative lens decentration were found to be the most relevant parameters for this prediction model.

Purpose: We wanted to compare the refractive prediction errors (PEs) of formulas included in the ESCRS 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.

Design: Retrospective case-series.

Methods: We have included 748 eyes of 748 patients following implantation of one of 3 lenses, single-piece: the SN60WF (Alcon, USA), PCB00/ZCB00 (Tecnis, USA) and 3-piece: MA60MA (Alcon, USA). IOL constants recommended by the calculator were utilized for the study. We performed analysis for the whole dataset, short (<22mm) and long eyes (>25mm) as well as in subgroups based on the type of the implanted IOL. SD and RMSAE were selected as the primary endpoints.

Results: Cooke K6 had the lowest SD of PEs in the whole dataset (p<0.05) when compared with Barrett, EVO, and Hoffer-QST. In the subgroup of long eyes, the Kane formula had the lowest RMSAE (p<0.05) when compared with Barrett and EVO. We did not find any significant differences in primary endpoints for implantation of the 3 types of IOL. However, the median absolute error following implantation of the MA60MA was significantly higher than for all other formulas except for Pearl-DGS.

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

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 EMR cataract workflow followed by digital workflow (integrated data management system with data reviewer, surgical planner, and data transfer to OR) 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 the number of support staff needed was 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 investigate the effects of cylinder axis-flip following 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 randomised study of TIOLs.

Methods: Axis-flip was defined as a change in post-operative refractive cylinder axis of 900 +/- 22.50 from the pre-operative biometric axis. Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), residual refractive cylinder (RC), and CATPROM-5 and EQ5D3L quality of life (QOL) scores were analysed.

Results: At 6 months, axis flip occurred in 29 (34.5%) of 84 eyes, of which 28 had with-the-rule astigmatism (WTR) pre-operatively. Mean (+/-standard deviation) UDVA (logMAR) was 0.13 (0.16) in flipped cases (FC) and 0.10 (0.14) in un-flipped cases (UF) (p=0.88). BDVA was 0.01 (0.11) in FC and was 0.00 (0.09) in UF (p=0.68). Mean RC was 0.74 dioptres (D) (0.41) in FC and 0.93D (0.47) in UF (p=0.08). Mean CATPROM-5 score was -6.22.98 (2.56) in FC and -5.52 (3.03) in UF (p=0.29). Mean EQ5D3L calibrated score was 0.89 (0.19) in FC and 0.85 (0.19) in UF (p=0.35). 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 following TIOL implantation did not adversely influence visual acuity or PROMs scores. Most FC had WTR pre-operatively. Adjusting for PCA might have reduced axis flip in some of these eyes.

Purpose: To investigate if phacoemulsification 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, 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 either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis.

Result: The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules.

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

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 to topical medication regimens.

Setting: United States 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 two-sided, one-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 to $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (p < 0.001). 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 to various topical regimens.

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 US-both preloaded and non-preloaded.

Methods: Samples were collected from multiple IOL companies in 2023. The primary endpoint 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 (IFU) 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 the IOL packaging weight and waste were noted across different models and manufacturers. Electronic IFU 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.

Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.

Purpose: To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL).

Setting: Eye and ENT Hospital of Fudan University, Shanghai, China.

Design: Retrospective propensity score-matched cohort study.

Methods: This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM).

Results: This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group.

Conclusions: The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.

Purpose: To investigate the intraoperative performance and lens fragmentation efficacy of a non-cavitating handheld lensectomy system in mild, moderate, and severe cataract.

Setting: Ambulatory surgical centers.

Design: Retrospective consecutive case series.

Methods: 665 consecutive eyes underwent cataract surgery by 12 surgeons using a new handheld non-cavitating lensectomy system for nuclear fragmentations and extraction. Intraoperative measurements included surgical time, miLOOP pretreatment, and irrigation fluid use.

Results: Of the 665 eyes, 38 (6%), 468 (70%), 126 (19%), and 33 (5%) were of grade 1, 2, 3, and 4 nuclear densities, respectively, as graded by the surgeon intraoperatively. Successful nuclear fragmentation, lens extraction, and cortical removal were achieved in all eyes. Total nucleus fragmentation and extraction times were 70.1 seconds, 100.3 seconds, 132.6 seconds, and 287.9 seconds for grades 1, 2, 3, and 4, respectively ( P < .001). In addition, irrigation and aspiration cortical removal times were 64.1 seconds, 51.1 seconds, 48.5 seconds, and 59.0 seconds, respectively ( P = .14). There was a low rate of capsular tear (3 cases in 665 surgeries, 0.45%) and no other emergent adverse events.

Conclusions: The miCOR handheld non-cavitating lensectomy system demonstrated nuclear fragmentation and extraction in the absence of intraocular cavitation across all grades of nuclear densities.