Journal of cataract and refractive surgery最新文献

Purpose: To assess visual and subjective outcomes in eyes with low to moderate irregular astigmatism following extended-depth-of-focus (EDOF) IOL implantation.

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

Design: Single-center, prospective, clinical trial.

Methods: This study assessed patients with low to moderate irregular astigmatism who received bilateral cataract surgery using the non-toric/toric AcrySof IQ Vivity IOL (Alcon Labs, Fort Worth, USA). At the 4-months examination, monocular and binocular CDVA and DCIVA, monocular 5% low contrast CDVA and DCIVA, monocular DCNVA and CNVA, monocular defocus curve from +0.5D to -2.5D, wavefront aberrometry and subjective outcome (VF-7) were evaluated.

Results: In total, 28 patients presenting low to moderate irregular astigmatism with mean 1.27±0.83D cylinder and 0.04±0.01μm/mm2 RMS/A were analyzed. At the follow-up visit, mean logMAR results were the following: monocular CDVA was -0.01±0.08, binocular CDVA was -0.08±0.07, monocular DCIVA was 0.18±0.11, binocular DCIVA was 0.08±0.08, monocular 5% low contrast CDVA was 0.40±0.12 and DCIVA was 0.38±0.11, monocular DCNVA was 0.38±0.09 and CNVA was 0.09±0.09. Monocular defocus curves demonstrated 0.16±0.09 logMAR at -1.5D of defocus and ≤0.2 logMAR visual acuity up to -1.66D of defocus. Difficulties during daily life activities (VF-7 questionnaire) were low.

Conclusions: In eyes with low to moderate irregular astigmatism, the AcrySof IQ Vivity IOL provided very good monocular and binocular visual performance at far and intermediate distance following bilateral cataract surgery. These findings suggest that low to moderate irregular astigmatism does not substantially worsen visual outcome after bilateral EDOF IOL implantation.

Purpose: To evaluate the effectiveness and usability of a safety-first, clinician-validated conversational AI chatbot for cataract surgery education compared with standard brochures.

Setting: University Hospital (UZ Brussel), Brussels, Belgium.

Design: Prospective, single-center, randomized controlled trial.

Methods: Adults scheduled for cataract operation were randomized to receive either standard information brochures alone (control group) or brochures plus access to a hospital-specific chatbot ("Mina"). Primary outcomes were knowledge gain, change in pre- to post-information anxiety, and satisfaction. Those outcomes were measured with questionnaires. Secondary outcomes included chatbot usability (measured with the System Usability Scale, SUS) and engagement with the chatbot.

Results: Sixty-four patients were randomized (chatbot group 33, control group 31). Postoperative questionnaires were completed by 35 patients (14/33 chatbot, 21/31 control). No significant differences were detected in knowledge gain, anxiety change, or satisfaction (p>0.05). Knowledge increased in both groups after receiving information (p<0.001). In the chatbot group, 17/33 (52%) did not engage with the chatbot. Participants engaging with the chatbot tended to be younger (mean age: 64.1 ± 10.9 years) than those who did not (mean age: 74.1± 10.5 years). Among users, 63% of submitted questions matched validated answers. The SUS mean score indicated high usability (83.1±12.1).

Conclusions: A custom-built chatbot with only clinician-validated responses showed high usability but did not improve knowledge, reduce anxiety, or increase satisfaction compared with brochures. Chatbot engagement barriers, particularly among older adults, and limits of validated-only content indicate the need for a hybrid approach of those models, to balance safety and flexibility in digital patient education.

Abstract: This retrospective study compared characteristics and surgical outcomes of immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) in the United States Department of Veterans Affairs. Patients undergoing ISBCS (same day) or DSBCS (1-14 days apart) between January 1, 2004, and January 1, 2024, with topical anesthesia were included. Among 47,892 patients undergoing bilateral surgery, 1,151 (2.4%) received ISBCS. There were no significant differences in mean age (p = 0.065) or sex distribution (p = 0.853). ISBCS patients had a greater travel burden (p<0.001) and fewer ocular comorbidities (p < 0.001); the Charlson Comorbidity Index did not differ (p = 0.086) between the two groups. ISBCS was more likely to occur at higher-volume centers (p = 0.008) and less likely when residents were primary surgeons (p < 0.001). There was no significant difference in postoperative complication rates between the two groups (p = 0.565).

Following recent publications on microfiltered trypan blue 0.4% ophthalmic solution, some theoretical concerns have been raised about the potential toxicity of this higher than standard concentration. Research into this matter has revealed that concentration is not the concern, instead the fundamental issue is the level of impurities present and their clinical implications-specifically monoazo compounds. This article reviews the evidence and highlights the concentration of dye, dose of dye used, concentration of impurities in a number of available trypan blue products. High-performance liquid chromatography demonstrates that CAPSULBlue, VisionBlue and MembraneBlue have much higher purity levels having been made from trypan blue for use in humans. Monoazo levels are also much lower and practically non-existent in CAPSULBlue. No incidence of toxic anterior segment syndrome has been reported in these high purity products.

Purpose: To create an accessible, online tool that determines the likelihood of an endophthalmitis outbreak.

Setting: Surgical centers that perform cataract surgeries.

Design: Mathematical modelling study.

Methods: The global risk of acute post-operative endophthalmitis (POE), defined as occurring within 6 weeks following standalone cataract surgery, was determined from a systematic review. An online tool was then created using the Poisson model to determine the likelihood of a POE outbreak. The model used the number of cataract surgeries performed, time, and number of POE cases observed. Significance was defined as p<0.05, p<0.01, or p<0.001.

Results: From the 25 included studies, the mean standard risk of POE following standalone cataract surgery was 0.0692% (range: 0.0189-0.102%). The model demonstrated that for a center that performs 1,000 cataract surgeries in a month, the probability of at least 1 POE cases occurring in a month is not statistically significant (p=0.461, p>0.05), and therefore outbreak is unlikely. In contrast, the probability of at least 3 POE cases occurring in a month at this center is statistically significant (p<0.05), and thus, has moderate evidence for outbreak with 95% confidence.

Conclusions: The Poisson model represents an evidence-based way to determine whether the number of POE cases are within expectations for the number of cataract operations performed over a period. This online tool provides ophthalmologists and public health agencies helpful data to guide POE outbreak declaration decisions.

Purpose: To compare the impact of intraocular lens (IOL) decentration and tilt on the visual performance of five presbyopia-correcting IOLs in patients after cataract surgery.

Setting: Zhongshan Ophthalmic Center, Guangzhou, China.

Design: Prospective, observational study.

Methods: Cataract patients undergoing uncomplicated phacoemulsification with extended depth-of-focus (EDOF) IOLs (Vivity, ZXR00) and FULL-Range of Field (RoF) IOLs (ZMB00, TFNT00, ZFR00V) were enrolled. Each IOL group was stratified by the third quartile (Q3) of IOL tilt and decentration measured by CASIA2. Intraocular higher-order aberrations (HOAs), contrast sensitivity (CS), modulation transfer function (MTF), Strehl ratio and patient-reported outcomes 3 months postoperatively were compared between subgroups.

Results: A total of 260 patients (260 eyes) were included. Based on the Q3 values, eyes were categorized into tilt subgroups T1 (<5.63°) and T2 (≥5.63°), and decentration subgroups D1 (<0.24 mm) and D2 (≥0.24 mm). No significant differences in visual quality were observed between Vivity and ZXR00 subgroups. In contrast, T2 subgroups of TFNT00, ZMB00 and ZFR00V exhibited higher HOAs and coma, and lower CS, than their T1 subgroups (all P<0.05). The D2 subgroup of ZFR00V showed increased HOAs and coma, and reduced CS under photopic and mesopic conditions with glare (all P<0.05). The D2 subgroup of ZMB00 demonstrated higher HOAs and coma, as well as lower MTF (all P<0.05). The D2 subgroup of TFNT00 reported significantly lower patient satisfaction (3.25±0.46 vs 3.83±0.38, P=0.008).

Conclusion: EDOF IOLs (ZXR00, Vivity) demonstrated greater tolerance to tilt and decentration compared to FULL-RoF IOLs (ZMB00, TFNT00, ZFR00V).