A novel two-surgeon technique of simultaneous bilateral cataract surgery with complete delinking

Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon technique of SBCS on a 50-year-old mentally subnormal patient. Under general anesthesia, two surgeons performed phacoemulsification simultaneously, using two separate microscopes, irrigation lines, phaco machines, instruments, and assistants. Intraocular lens (IOL) implantation was performed in both eyes (OU). The patient had a visual recovery from 5/60, N36 in OU preoperatively to 6/12, N10 in OU on post-operative day 3 and 1 month, with no complications. This technique can potentially reduce the risk of endophthalmitis, repeated and prolonged anesthesia, and the number of hospital visits. To the best of our knowledge, this two-surgeon technique of SBCS has never been reported in the literature.

Immediately sequential bilateral cataract surgery in Down syndrome

The exponential increase in world population and average human lifespan is expected to result in geriatric population globally. The problem of preventable blindness due to cataract will increase manifold. Simultaneous Bilateral cataract surgery (SBCS) is a viable option in such subset of patients. Despite faster visual recovery, economic benefits to patients and health care providers, decreased risk of complications associated with General anaesthesia, there is significant resistance in accepting SBCS as a routine procedure. Bilateral endophthalmitis is the main deterrent in performing ISBCS. This case highlights successful ISBCS in 36 years old female patient with Down抯 syndrome.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Comparison between Active and Gravity-based Phacoemulsification Fluidics Systems in Immediate Sequential Bilateral Cataract Surgery

PURPOSE: To compare the clinical outcomes during phacoemulsification when using active fluidics (Centurion®) and gravity-based fluidics (Infiniti®) in immediate sequential bilateral cataract surgery. METHODS: From January 2015 to September 2015, 68 eyes of 34 patients with bilateral cataract were assigned to receive immediate sequential bilateral cataract surgery by Centurion® in one eye and Infiniti® in the other eye. We measured and compared intraoperative factors, including cumulative dissipated energy (CDE), ultrasound time, mean amount of balanced salt solution (BSS) used, and pain using a scale. Best corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were also evaluated preoperatively and 1 month postoperatively. RESULTS: Intraoperative measurements showed significantly less CDE (5.05 ± 2.18 vs. 7.05 ± 3.82), ultrasound time (24.65 ± 9.68 vs. 34.95 ± 17.95 seconds), and mean amount of BSS used (37.06 ± 10.25 vs. 44.88 ± 16.38 mL) in the Centurion® group than in the Infiniti® group (p = 0.011, p = 0.005, p = 0.021, respectively). The intraoperative pain scale was 0.26 ± 0.51 in the Centurion® group and 0.50 ± 0.71 in the Infiniti® group, and was not significantly different (p = 0.121). BCVA, increase of CCT and decrease of ECD were not significantly different between the two groups at 1 month postoperatively. CONCLUSIONS: The efficacy of phacoemulsification in the Centurion® group was superior to that in the Infiniti® group. The level of intraoperative pain and clinical outcomes 1 month after surgery were not significantly different between the two groups.

Efficacy and Safety of Immediate Sequential Bilateral Cataract Surgery

PURPOSE: To evaluate the efficacy and safety of immediate sequential bilateral cataract surgery with respect to patient outcomes and complication rates. METHODS: From January 2010 to December 2014, we conducted a retrospective study of patients who had immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with an interval of one to two months between the first and the fellow eye operations. The changes in visual acuity, manifest spherical equivalent, and refractive error of 140 eyes of 70 patients of both groups were compared postoperatively at one month. The incidence of endophthalmitis was investigated during the same period. RESULTS: At one month postoperatively, log MAR best corrected visual acuity were measured to be 0.06 +/- 0.72 in the ISBCS group and 0.09 +/- 0.66 in the DSBCS group, and that of the fellow eyes were 0.07 +/- 0.64 and 0.07 +/- 0.18, respectively (p = 0.331, p = 0.781, respectively). The postoperative spherical equivalents were -0.18 +/- 0.23 D in the ISBCS group and -0.19 +/- 0.25 D in the DSCBS group, and that of the fellow eyes were -0.15 +/- 0.18 D and -0.16 +/- 0.21 D, respectively. There were no significant statistical differences between the two groups (p = 0.835, p = 0.676, respectively). The postoperative refractive error was -0.20 +/- 0.21 D in the ISCBS group and -0.18 +/- 0.13 D in the DSBCS group, and that of the fellow eyes were -0.14 +/- 0.22 D and -0.19 +/- 0.22 D, respectively (p = 0.482, p = 0.237, respectively). A total of 21,140 eyes had cataract surgery performed, and only 10 eyes (0.05%) developed endophthalmitis. Endophthalmitis did not occur in the ISBCS group. CONCLUSIONS: In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISBCS can safely provide comparable visual outcome and better satisfaction of the patient with good efficacy.