Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Desc...Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].展开更多
As cataract surgery progresses from “restoration of sight” to “refractive correction”, precise prediction of intraocular lens (IOL) power is critical for enhancing postoperative visual quality in patients. IOL pow...As cataract surgery progresses from “restoration of sight” to “refractive correction”, precise prediction of intraocular lens (IOL) power is critical for enhancing postoperative visual quality in patients. IOL power calculation methods have evolved and innovated throughout time, from early theoretical and regression formulas to nonlinear formulas for estimating effective lens position (ELP), multivariable formulas, and innovative formulas that use optical principles and AI-based online formulas. This paper thoroughly discusses the development and iteration of traditional IOL calculation formulas, the emergence of new IOL calculation formulas, and the selection of IOL calculation formulas for different patients in the era of refractive cataract surgery, serving as a reference for “personalized” IOL implantation in clinical practice.展开更多
Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and fro...Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.展开更多
This review is to elucidate the retinal toxicity following intraocular injections of cefuroxime,including possible risk factors,clinical manifestations,visual prognosis and treatment.Refereed publications were retriev...This review is to elucidate the retinal toxicity following intraocular injections of cefuroxime,including possible risk factors,clinical manifestations,visual prognosis and treatment.Refereed publications were retrieved from PubMed,the Cochrane Library,and EMBASE databases,using the search terms cefuroxime,retina,macular edema,serous retinal detachment,toxic,cataract surgery.The screening was not limited by publication date,country or study type.We screened out 51 articles out of which 32 met the inclusion criteria for this systematic review.Data regarding sample size calculation reporting and trial characteristics were extracted for each trial.Retinal toxicity can be caused by both high and standard doses of cefuroxime injections in different ethnic groups,with risk factors including overdose,blood-retinal barrier disruption,anterior and posterior chamber connection.The typical clinical manifestations of retinal toxicity are cystoid macular edema and extensive serous retinal detachment,mainly involving the outer nuclear and outer plexiform layers,with a good prognosis for visual acuity in most cases,but in a small number of cases,the prognosis is not satisfactory.In conclusion,though the current use of intracameral injection antibiotics in cataract surgery is gradually increasing,the potential risks should not be ignored.Unexplained poor vision on the first day after cataract surgery can be supplemented with macular optical coherence tomography to rule out cefuroxime-related retinal toxicity.展开更多
AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between ...AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.展开更多
AIM:To investigate the optimal timing and therapeutic effects of cataract surgery in patients with moderate to severe thyroid-associated ophthalmopathy(TAO).METHODS:Data from TAO patients who underwent cataract surger...AIM:To investigate the optimal timing and therapeutic effects of cataract surgery in patients with moderate to severe thyroid-associated ophthalmopathy(TAO).METHODS:Data from TAO patients who underwent cataract surgery between 2014 and 2024 were analyzed.patients were categorized into two groups based on the hospital where their cataract surgery was performed:an external hospital surgery group and an in-house hospital surgery group.Patients in external hospital presenting with complications within six months postoperatively were assessed for clinical features,imaging,thyroid function,and outcomes.Patients who underwent surgery at West China Hospital were evaluated for clinical status,imaging,laboratory findings,and manifestations.RESULTS:In the external hospital group(n=31),common symptoms included eyelid swelling(64.52%)and diplopia(51.61%),with restricted eye movement in all patients.Most patients were in the active stage(87.10%)and exhibited various complications,such as dysthyroid optic neuropathy(DON)in 4 patients,misdiagnosis of glaucoma in 1 patient,and enucleation due to fungal infection in 1 patient.In the West China Hospital group(n=30),2 patients were in the active stage,and 28 were in the inactive stage.Postoperative visual acuity improved in 36 eyes,except for in 2 eyes with DON.Active TAO patients with mature cataracts had effective inflammation control and no complications at the 6-month follow-up.CONCLUSION:In patients with moderate to severe active TAO complicated by cataracts,delaying cataract surgery until 6mo of TAO control should be considered if cataracts are stable.Simultaneous anti-inflammatory treatment and cataract surgery should be performed for mature/hypermature cataracts,and TAO management should be continued after surgery.展开更多
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
AIM:To explore the effect of Alpha angle and Kappa angle before multifocal intraocular lenses(MIOLs)implantation on postoperative visual quality of patients.METHODS:Before and 3mo after cataract surgery,Alpha angle an...AIM:To explore the effect of Alpha angle and Kappa angle before multifocal intraocular lenses(MIOLs)implantation on postoperative visual quality of patients.METHODS:Before and 3mo after cataract surgery,Alpha angle and Kappa angle were collected using IOL Master 700,iTrace,and Pentacam for clinical observation.Postoperative visual quality indicators,including high-order aberrations(HOA),modulation transfer function(MTF)and point spread function(PSF),were collected using iTrace.multiple linear regression analysis was used to analyze the correlation of the Kappa angle and the Alpha angle with age,axial length(AL),anterior chamber depth(ACD),keratometry(K),lens thickness(LT)and corneal white to white distance(WTW).Pearson correlation coefficient was used to analyze the correlation between Alpha angle and Kappa angle;Bland Altman analysis was used to evaluate the consistency of pairwise detection results of three instruments.RESULTS:The Alpha angle was modeled as Alpha=2.230+0.003×age-0.036×AL-0.025×K-0.058×WTW and the Kappa angle was modeled as Kappa=0.685+0.003×age-0.013×K-0.061×WTW.The correlation between the total Alpha angle and Kappa angle of the three instruments was weakly positive(r=0.291,P=0.000).Comparing the measurement of Alpha angle and Kappa angle using three instruments,only IOL Master 700 and iTrace showed good consistency in measuring Kappa angle(P=0.4254).After 3mo of surgery,the Alpha angle and Kappa angle significantly decreased(P=0.011,0.018;P=0.008,0.036).△Kappa=1.136-0.021×AL-0.013×K.Kappa angle could positively predict HOA(β=0.18,P=0.000),MTF(β=0.171,P=0.000),PSF(β=0.088,P=0.000),Alpha angle cannot(P>0.05).CONCLUSION:The patients with older age,flatter K and shorter WTW should be alert to the possibility of larger Alpha angle and Kappa angle.Alpha angle should also consider the factor of AL.When selecting patients with MIOLs implantation,there is no need to consider the Alpha angle.Careful consideration should be given to the Kappa angle,and the preoperative standard of<0.5 mm can refer to△Kappa=1.136-0.021×AL-0.013×K and be appropriately relaxed.展开更多
AIM:To assess the refractive and functional outcomes of a novel trifocal intraocular lens(IOL)with smooth micro phase technology.METHODS:This prospective,single-arm,single-center,observational study included patients ...AIM:To assess the refractive and functional outcomes of a novel trifocal intraocular lens(IOL)with smooth micro phase technology.METHODS:This prospective,single-arm,single-center,observational study included patients who underwent cataract surgery with the implantation of the AT ELANA 841P(Carl Zeiss Meditec,Berlin,Germany)IOL.Visual acuity(VA)at distance,intermediate,and near were evaluated 1-and 3-month postop as well as refractive outcomes.Monocular and binocular defocus curve,binocular contrast sensitivity(M&S^(■)Technologies)and patient satisfaction with the Catquest-9SF questionnaire were measured at 3-month postop.RESULTS:In total,46 eyes(23 patients)were bilaterally implanted with the IOL.Mean patient age was 59.86±5.55y.At 1-month postop,monocular corrected VA for distance,intermediate,and near were-0.15±0.09,0.11±0.10,and 0.15±0.12 logMAR,respectively.These outcomes remained stable at the 3-month follow-up(P>0.05).Spherical equivalent(SE)at 1-and 3-month postop remained stable(P>0.05).Following surgery,91%of the eyes at 1mo and 95%of the eyes at 3mo were within±0.5 D of SE.Monocular defocus curve showed that the lens can be categorized as a steep transition IOL.The contrast sensitivity function revealed high values at low spatial frequencies and decreased values at high spatial frequencies.The results of the Catquest-9SF questionnaire showed that all patients were fairly or very satisfied with their vision after surgery.CONCLUSION:The AT ELANA 841P IOL offers excellent visual outcomes across distance,intermediate,and near ranges,along with satisfactory contrast sensitivity.Additionally,the lens is associated with high patient satisfaction and minimal visual difficulties during daily activities.展开更多
Objective: To analyze the clinical manifestations of intraocular lens (IOL) opacity after cataract surgery through case reports, and to explore its pathogenesis and diagnosis and treatment ideas, so as to provide a ba...Objective: To analyze the clinical manifestations of intraocular lens (IOL) opacity after cataract surgery through case reports, and to explore its pathogenesis and diagnosis and treatment ideas, so as to provide a basis for the early diagnosis and correct treatment of IOL opacity. Methods: The clinical data of one patient diagnosed with IOL opacity and underwent intraocular lens replacement in the Department of Ophthalmology, Affiliated Hospital of Youjiang Medical College for Nationalities in December 2023 were reported. The characteristics of IOL opacity were observed, and the research progress and pathogenesis of IOL opacity were understood by consulting the literature. Results: This patient is the first case of IOL opacity in our hospital. The specific reason is unclear. It is considered to be related to the IOL material. Conclusion: Hydrophilic acrylic IOL is widely used in clinic because of its good histocompatibility. However, due to its hydrophilicity, there are more cases of IOL opacity than other types of IOL. At present, there is no unified conclusion on the etiology and mechanism of IOL opacity. IOL opacity can seriously affect vision and is easily misdiagnosed as a posterior cataract. We should fully disperse the large pupil and carefully observe under the slit lamp. The most effective treatment for this disease is IOL replacement.展开更多
Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of i...Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of intraocular ointment after cataract surgery.PubMed,Scopus,Embase,CNKI,WANFANG data,China Science and Technology Journal Database and Chinese Medical Journal Full-text Database were systematically searched from their commencement to 30 th October 2023,and 19 literatures were screened out and 31 cases of intraocular ointment after surgery were collected.Among the 31 patients,the age of presentation ranged from 55 to 87 years with a median of 73,males accounted for 45.2%and females accounted for 32.3%.The length of the incision was generally 3.2 mm.Most of the patients detected ointment within 3 days post-operation and presented without complications(45.2%).The most common ocular manifestations were corneal edema,glaucoma and uveitis.Early postoperative follow-up is very important.Presence of anterior chamber ointment is a rare complication after cataract surgery,but it can lead to severe vision loss if not detected and treated on time.When patients complain of foreign body sensation in the in the eye after cataract surgery,ophthalmologists need to take a kin interest and examine the eye for early detection of ointment for appropriate intervention and prevent further complications.展开更多
AIM:To find out intraoperative and postoperative outcomes of congenital cataract surgery in eyes with microcornea.METHODS:This retrospective consecutive case series study compared outcomes after congenital cataract su...AIM:To find out intraoperative and postoperative outcomes of congenital cataract surgery in eyes with microcornea.METHODS:This retrospective consecutive case series study compared outcomes after congenital cataract surgery in eyes with/without microcornea.Infants(<1 year old)who underwent lensectomy surgery left aphakic were included.Microphthalmos was defined as an eye that has a horizontal corneal diameter less than or equal to 9.0 mm.RESULTS:There were 40 infants(54 eyes)in the microcornea group and 58(87 eyes)in the control group.The two groups were age-and sex-matched.The microcornea group showed significantly smaller corneal diameter(P<0.001),steeper corneal keratometry(P=0.001),thinner lens thickness(P<0.001),and shorter axial length(AL,P<0.001).And microcornea increased the incidence of poor pupil dilation(P<0.01).The two groups showed no significant differences in postoperative intraocular pressure(IOP),best-corrected visual acuity,central corneal thickness(CCT),AL,and the incidence of strabismus and nystagmus at the last follow-up.CONCLUSION:Although microcornea have different features from normal ones,the one-year follow-up after surgery has shown that early surgical intervention for congenital cataracts in eyes with microcornea can result in favourable outcomes with an acceptable rate of postoperative complications.Regular follow-up and timely management of postoperative complications are crucial for successful outcomes.展开更多
AIM:To analyze the environmental impact of patient travel for cataract surgery at a German ophthalmology center.METHODS:All cataract surgeries performed between October 23 and October 27,2023,were analyzed,and all pat...AIM:To analyze the environmental impact of patient travel for cataract surgery at a German ophthalmology center.METHODS:All cataract surgeries performed between October 23 and October 27,2023,were analyzed,and all patient records were reviewed for follow-up visits.All travel distances were calculated,and the associated emissions were quantified.Additionally,patients’utilization of geographically closer branch practices for follow-up care was evaluated,along with the corresponding effects on travel-related emissions.RESULTS:A total of 69 patients underwent unilateral cataract surgery.The average one-way travel distance was 40.1 km(24.9 mi;SD=23.6 km).Corresponding emissions were 1284.8 kg of greenhouse gas(GHG),2.477 kg of nitrogen oxides,and 0.101 kg of particulates.All patients attended at least two follow-up visits.Conducting followup visits at branch practices reduced travel distance by 49.1%.The associated GHG emissions from all travel were 1984.3 kg.Emissions from follow-up visits were 54.4%higher than those from the surgery itself.Total GHG emissions amounted to 3269.1 kg,with an average of 47.4 kg of GHG per patient for all travel associated with cataract surgery.CONCLUSION:A dense network of branch practices contributes to reducing the carbon footprint of cataract surgery-related patient travel;however,the development of digital health approaches for follow-up care is necessary to further optimize the environmental sustainability of cataract surgery.展开更多
BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devas...BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devastating consequences on their health,social life,and academic performance and places a socio-economic burden on the child’s family and society as a whole.Globally,pediatric cataract is a significant contributor to ocular morbidity and blindness.Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services.AIM To evaluate the visual acuity outcomes of children after cataract surgery.METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital(KATH),Ghana.Patient clinical data including demographics,cataract presentation,pre-operative and post-operative visual acuity,surgical procedure,postoperative complications,interventions and refraction were collected and analyzed using the Statistical Package and Service Solution.Pearson'sχ2 test and regression statistics were used to summarize data at a significance of P<0.05.RESULTS 163 children(257 eyes)underwent cataract surgery at KATH.The overall mean age was 3.81±3.56 years.Congenital cataract was commonly observed(56.4 All children underwent keratometry and phacoemulsification procedures.A few children(9.8%)experienced postoperative complications while 90.8%did not require further intervention after the surgery.After the surgery 27.0%of the children had refraction and the majority were corrected for myopia and near addition(12.9%).An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant(P value<0.05).There was a significant improvement in the visual outcomes following cataract surgery.CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes.Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.展开更多
AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary ...AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.展开更多
BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical sign...BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.展开更多
Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal...Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.展开更多
AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patien...AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.展开更多
Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedu...Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.展开更多
AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electro...AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).展开更多
基金Supported by the Natural Science Foundation of Fujian Province(No.2024J011318No.2024J011321)Fuzhou Science and Technology Program(No.2023-S-005).
文摘Dear Editor,Descemet’s membrane detachment(DMD)is considered as a potential sight-threatening complication following various intraocular surgeries,particularly cataract surgery[1].The labile adhesion between the Descemet’s membrane(DM)and the posterior corneal stromal layer can be easily separated with minimal mechanical force.Several risk factors have been associated with the development of DMD including old age,improper intraoperative operation,corneal ectatic disorders,and endothelial disorders and so on[1-4].
文摘As cataract surgery progresses from “restoration of sight” to “refractive correction”, precise prediction of intraocular lens (IOL) power is critical for enhancing postoperative visual quality in patients. IOL power calculation methods have evolved and innovated throughout time, from early theoretical and regression formulas to nonlinear formulas for estimating effective lens position (ELP), multivariable formulas, and innovative formulas that use optical principles and AI-based online formulas. This paper thoroughly discusses the development and iteration of traditional IOL calculation formulas, the emergence of new IOL calculation formulas, and the selection of IOL calculation formulas for different patients in the era of refractive cataract surgery, serving as a reference for “personalized” IOL implantation in clinical practice.
文摘Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.
基金Supported by Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases,Shanghai,China(No.19DZ2250100)Shanghai First People’s Hospital Featured Research Projects(No.CCTR-2022C08).
文摘This review is to elucidate the retinal toxicity following intraocular injections of cefuroxime,including possible risk factors,clinical manifestations,visual prognosis and treatment.Refereed publications were retrieved from PubMed,the Cochrane Library,and EMBASE databases,using the search terms cefuroxime,retina,macular edema,serous retinal detachment,toxic,cataract surgery.The screening was not limited by publication date,country or study type.We screened out 51 articles out of which 32 met the inclusion criteria for this systematic review.Data regarding sample size calculation reporting and trial characteristics were extracted for each trial.Retinal toxicity can be caused by both high and standard doses of cefuroxime injections in different ethnic groups,with risk factors including overdose,blood-retinal barrier disruption,anterior and posterior chamber connection.The typical clinical manifestations of retinal toxicity are cystoid macular edema and extensive serous retinal detachment,mainly involving the outer nuclear and outer plexiform layers,with a good prognosis for visual acuity in most cases,but in a small number of cases,the prognosis is not satisfactory.In conclusion,though the current use of intracameral injection antibiotics in cataract surgery is gradually increasing,the potential risks should not be ignored.Unexplained poor vision on the first day after cataract surgery can be supplemented with macular optical coherence tomography to rule out cefuroxime-related retinal toxicity.
文摘AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.
基金Supported by Sichuan Science and Technology Program(No.2022JDKP0010).
文摘AIM:To investigate the optimal timing and therapeutic effects of cataract surgery in patients with moderate to severe thyroid-associated ophthalmopathy(TAO).METHODS:Data from TAO patients who underwent cataract surgery between 2014 and 2024 were analyzed.patients were categorized into two groups based on the hospital where their cataract surgery was performed:an external hospital surgery group and an in-house hospital surgery group.Patients in external hospital presenting with complications within six months postoperatively were assessed for clinical features,imaging,thyroid function,and outcomes.Patients who underwent surgery at West China Hospital were evaluated for clinical status,imaging,laboratory findings,and manifestations.RESULTS:In the external hospital group(n=31),common symptoms included eyelid swelling(64.52%)and diplopia(51.61%),with restricted eye movement in all patients.Most patients were in the active stage(87.10%)and exhibited various complications,such as dysthyroid optic neuropathy(DON)in 4 patients,misdiagnosis of glaucoma in 1 patient,and enucleation due to fungal infection in 1 patient.In the West China Hospital group(n=30),2 patients were in the active stage,and 28 were in the inactive stage.Postoperative visual acuity improved in 36 eyes,except for in 2 eyes with DON.Active TAO patients with mature cataracts had effective inflammation control and no complications at the 6-month follow-up.CONCLUSION:In patients with moderate to severe active TAO complicated by cataracts,delaying cataract surgery until 6mo of TAO control should be considered if cataracts are stable.Simultaneous anti-inflammatory treatment and cataract surgery should be performed for mature/hypermature cataracts,and TAO management should be continued after surgery.
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
基金Supported by National Natural Science Foundation of China(No.81902751).
文摘AIM:To explore the effect of Alpha angle and Kappa angle before multifocal intraocular lenses(MIOLs)implantation on postoperative visual quality of patients.METHODS:Before and 3mo after cataract surgery,Alpha angle and Kappa angle were collected using IOL Master 700,iTrace,and Pentacam for clinical observation.Postoperative visual quality indicators,including high-order aberrations(HOA),modulation transfer function(MTF)and point spread function(PSF),were collected using iTrace.multiple linear regression analysis was used to analyze the correlation of the Kappa angle and the Alpha angle with age,axial length(AL),anterior chamber depth(ACD),keratometry(K),lens thickness(LT)and corneal white to white distance(WTW).Pearson correlation coefficient was used to analyze the correlation between Alpha angle and Kappa angle;Bland Altman analysis was used to evaluate the consistency of pairwise detection results of three instruments.RESULTS:The Alpha angle was modeled as Alpha=2.230+0.003×age-0.036×AL-0.025×K-0.058×WTW and the Kappa angle was modeled as Kappa=0.685+0.003×age-0.013×K-0.061×WTW.The correlation between the total Alpha angle and Kappa angle of the three instruments was weakly positive(r=0.291,P=0.000).Comparing the measurement of Alpha angle and Kappa angle using three instruments,only IOL Master 700 and iTrace showed good consistency in measuring Kappa angle(P=0.4254).After 3mo of surgery,the Alpha angle and Kappa angle significantly decreased(P=0.011,0.018;P=0.008,0.036).△Kappa=1.136-0.021×AL-0.013×K.Kappa angle could positively predict HOA(β=0.18,P=0.000),MTF(β=0.171,P=0.000),PSF(β=0.088,P=0.000),Alpha angle cannot(P>0.05).CONCLUSION:The patients with older age,flatter K and shorter WTW should be alert to the possibility of larger Alpha angle and Kappa angle.Alpha angle should also consider the factor of AL.When selecting patients with MIOLs implantation,there is no need to consider the Alpha angle.Careful consideration should be given to the Kappa angle,and the preoperative standard of<0.5 mm can refer to△Kappa=1.136-0.021×AL-0.013×K and be appropriately relaxed.
文摘AIM:To assess the refractive and functional outcomes of a novel trifocal intraocular lens(IOL)with smooth micro phase technology.METHODS:This prospective,single-arm,single-center,observational study included patients who underwent cataract surgery with the implantation of the AT ELANA 841P(Carl Zeiss Meditec,Berlin,Germany)IOL.Visual acuity(VA)at distance,intermediate,and near were evaluated 1-and 3-month postop as well as refractive outcomes.Monocular and binocular defocus curve,binocular contrast sensitivity(M&S^(■)Technologies)and patient satisfaction with the Catquest-9SF questionnaire were measured at 3-month postop.RESULTS:In total,46 eyes(23 patients)were bilaterally implanted with the IOL.Mean patient age was 59.86±5.55y.At 1-month postop,monocular corrected VA for distance,intermediate,and near were-0.15±0.09,0.11±0.10,and 0.15±0.12 logMAR,respectively.These outcomes remained stable at the 3-month follow-up(P>0.05).Spherical equivalent(SE)at 1-and 3-month postop remained stable(P>0.05).Following surgery,91%of the eyes at 1mo and 95%of the eyes at 3mo were within±0.5 D of SE.Monocular defocus curve showed that the lens can be categorized as a steep transition IOL.The contrast sensitivity function revealed high values at low spatial frequencies and decreased values at high spatial frequencies.The results of the Catquest-9SF questionnaire showed that all patients were fairly or very satisfied with their vision after surgery.CONCLUSION:The AT ELANA 841P IOL offers excellent visual outcomes across distance,intermediate,and near ranges,along with satisfactory contrast sensitivity.Additionally,the lens is associated with high patient satisfaction and minimal visual difficulties during daily activities.
文摘Objective: To analyze the clinical manifestations of intraocular lens (IOL) opacity after cataract surgery through case reports, and to explore its pathogenesis and diagnosis and treatment ideas, so as to provide a basis for the early diagnosis and correct treatment of IOL opacity. Methods: The clinical data of one patient diagnosed with IOL opacity and underwent intraocular lens replacement in the Department of Ophthalmology, Affiliated Hospital of Youjiang Medical College for Nationalities in December 2023 were reported. The characteristics of IOL opacity were observed, and the research progress and pathogenesis of IOL opacity were understood by consulting the literature. Results: This patient is the first case of IOL opacity in our hospital. The specific reason is unclear. It is considered to be related to the IOL material. Conclusion: Hydrophilic acrylic IOL is widely used in clinic because of its good histocompatibility. However, due to its hydrophilicity, there are more cases of IOL opacity than other types of IOL. At present, there is no unified conclusion on the etiology and mechanism of IOL opacity. IOL opacity can seriously affect vision and is easily misdiagnosed as a posterior cataract. We should fully disperse the large pupil and carefully observe under the slit lamp. The most effective treatment for this disease is IOL replacement.
文摘Intraocular ointment is conventionally placed on the eye to prevent infection after cataract surgery.The purpose of this study is to report a case and conduct a systematic review of a rare occurrence of the entry of intraocular ointment after cataract surgery.PubMed,Scopus,Embase,CNKI,WANFANG data,China Science and Technology Journal Database and Chinese Medical Journal Full-text Database were systematically searched from their commencement to 30 th October 2023,and 19 literatures were screened out and 31 cases of intraocular ointment after surgery were collected.Among the 31 patients,the age of presentation ranged from 55 to 87 years with a median of 73,males accounted for 45.2%and females accounted for 32.3%.The length of the incision was generally 3.2 mm.Most of the patients detected ointment within 3 days post-operation and presented without complications(45.2%).The most common ocular manifestations were corneal edema,glaucoma and uveitis.Early postoperative follow-up is very important.Presence of anterior chamber ointment is a rare complication after cataract surgery,but it can lead to severe vision loss if not detected and treated on time.When patients complain of foreign body sensation in the in the eye after cataract surgery,ophthalmologists need to take a kin interest and examine the eye for early detection of ointment for appropriate intervention and prevent further complications.
基金Supported by the“Pioneer”and“Leading Goose”R&D Program of Zhejiang(No.2022C03070)Zhejiang Medical and Health Science and Technology Plan(No.2023KY913)+2 种基金the Zhejiang Provincial Program of China for the Cultivation of Health Leading TalentsWenzhou Basic Scientific Research Projects(No.Y20220145)The Science and Technology Program Project jointly built by the Science and Technology Department of the National Administration of Traditional Chinese Medicine and the Zhejiang Provincial Administration of Traditional Chinese Medicine(No.GZY-ZJKJ-24089).
文摘AIM:To find out intraoperative and postoperative outcomes of congenital cataract surgery in eyes with microcornea.METHODS:This retrospective consecutive case series study compared outcomes after congenital cataract surgery in eyes with/without microcornea.Infants(<1 year old)who underwent lensectomy surgery left aphakic were included.Microphthalmos was defined as an eye that has a horizontal corneal diameter less than or equal to 9.0 mm.RESULTS:There were 40 infants(54 eyes)in the microcornea group and 58(87 eyes)in the control group.The two groups were age-and sex-matched.The microcornea group showed significantly smaller corneal diameter(P<0.001),steeper corneal keratometry(P=0.001),thinner lens thickness(P<0.001),and shorter axial length(AL,P<0.001).And microcornea increased the incidence of poor pupil dilation(P<0.01).The two groups showed no significant differences in postoperative intraocular pressure(IOP),best-corrected visual acuity,central corneal thickness(CCT),AL,and the incidence of strabismus and nystagmus at the last follow-up.CONCLUSION:Although microcornea have different features from normal ones,the one-year follow-up after surgery has shown that early surgical intervention for congenital cataracts in eyes with microcornea can result in favourable outcomes with an acceptable rate of postoperative complications.Regular follow-up and timely management of postoperative complications are crucial for successful outcomes.
文摘AIM:To analyze the environmental impact of patient travel for cataract surgery at a German ophthalmology center.METHODS:All cataract surgeries performed between October 23 and October 27,2023,were analyzed,and all patient records were reviewed for follow-up visits.All travel distances were calculated,and the associated emissions were quantified.Additionally,patients’utilization of geographically closer branch practices for follow-up care was evaluated,along with the corresponding effects on travel-related emissions.RESULTS:A total of 69 patients underwent unilateral cataract surgery.The average one-way travel distance was 40.1 km(24.9 mi;SD=23.6 km).Corresponding emissions were 1284.8 kg of greenhouse gas(GHG),2.477 kg of nitrogen oxides,and 0.101 kg of particulates.All patients attended at least two follow-up visits.Conducting followup visits at branch practices reduced travel distance by 49.1%.The associated GHG emissions from all travel were 1984.3 kg.Emissions from follow-up visits were 54.4%higher than those from the surgery itself.Total GHG emissions amounted to 3269.1 kg,with an average of 47.4 kg of GHG per patient for all travel associated with cataract surgery.CONCLUSION:A dense network of branch practices contributes to reducing the carbon footprint of cataract surgery-related patient travel;however,the development of digital health approaches for follow-up care is necessary to further optimize the environmental sustainability of cataract surgery.
文摘BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devastating consequences on their health,social life,and academic performance and places a socio-economic burden on the child’s family and society as a whole.Globally,pediatric cataract is a significant contributor to ocular morbidity and blindness.Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services.AIM To evaluate the visual acuity outcomes of children after cataract surgery.METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital(KATH),Ghana.Patient clinical data including demographics,cataract presentation,pre-operative and post-operative visual acuity,surgical procedure,postoperative complications,interventions and refraction were collected and analyzed using the Statistical Package and Service Solution.Pearson'sχ2 test and regression statistics were used to summarize data at a significance of P<0.05.RESULTS 163 children(257 eyes)underwent cataract surgery at KATH.The overall mean age was 3.81±3.56 years.Congenital cataract was commonly observed(56.4 All children underwent keratometry and phacoemulsification procedures.A few children(9.8%)experienced postoperative complications while 90.8%did not require further intervention after the surgery.After the surgery 27.0%of the children had refraction and the majority were corrected for myopia and near addition(12.9%).An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant(P value<0.05).There was a significant improvement in the visual outcomes following cataract surgery.CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes.Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.
基金Supported by the Shenzhen Science and Technology Program(No.JCYJ20220818103207015)the SanMing Project of Medicine in Shenzhen(No.SZSM202311012).
文摘AIM:To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy(PPV)in patients with primary rhegmatogenous retinal detachment(RRD).METHODS:Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected.Twenty-four potential influencing factors,including patient characteristics and surgical factors,were selected for analysis.Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis.A risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,area under the ROC curve(AUC),calibration plots,and decision curve analysis(DCA)curves.RESULTS:The 386 cases(389 eyes)of patients who underwent PPV and had complete surgical records were ultimately included.Within a 2-year longitudinal observation,41.39%of patients developed cataract secondary to PPV.Logistic regression results identified a history of hypertension[odds ratio(OR)=1.78,95%CI:1.002–3.163,P=0.049],silicone oil tamponade(OR=3.667,95%CI:2.373–5.667,P=0.000),and lens thickness(OR=1.978,95%CI:1.129–3.464,P=0.017)as independent risk factors for cataract secondary to PPV.The constructed nomogram achieved AUC=0.6974.Calibration plots indicated good agreement between predicted and observed outcomes,while DCA curves demonstrated the model’s clinical utility.CONCLUSION:By incorporating a history of hypertension,vitreous substitute type,and lens thickness,this study constructs a prediction model with moderate discriminative ability.This model offers a valuable tool for clinicians to identify high-risk patients early,potentially allowing for more timely interventions and improved patient outcomes.
基金Supported by Tianjin Health Research Project,No.TJWJ2023MS062。
文摘BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.
基金Supported by Independent Research Foundation of the 305 Hospital of PLA(No.24ZZJJLW-010).
文摘Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.
基金Supported by a Research to Prevent Blindness challenge grant to the Department of Ophthalmology,University of Colorado,and by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535.
文摘AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.
基金Supported by the National Natural Science Foundation of China (No.82171038No.81974129)Jiangsu Provincial Medical Key Discipline (No.JSDW202245).
文摘Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.
文摘AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).
