Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Retrospective analysis of the role of anterior segment optical coherence tomography and outcomes of cataract surgery in posterior polar cataract

Purpose: To evaluate the visual and surgical outcomes of cataract surgery in patients with posterior polar cataract (PPC) and to evaluate the benefits of preoperative anterior segment optical coherence tomography (AS?OCT). Methods: This was a retrospective, single?center study. Case records of patients diagnosed with PPC who underwent cataract surgery either by phacoemulsification or manual small?incision cataract surgery (MSICS) from January to December 2019 were analyzed. Data collected include demographic details, preoperative best corrected visual acuity (BCVA), AS?OCT, type of cataract surgery, intraoperative and postoperative complications, and visual outcome at 1?month follow?up. Results: One hundred patients were included in the study. Preoperative posterior capsular defect was noted on AS?OCT in 14 patients (14%). Seventy?eight underwent phacoemulsification and 22 underwent MSICS. Intraoperatively, posterior capsular rupture (PCR) was seen in 13 patients (13%) and cortex drop was noted in one among them (1%). Out of 13 PCRs, 12 were found to have posterior capsular dehiscence preoperatively in AS?OCT. The sensitivity of AS?OCT for detecting posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value and negative predictive value were 85.7% and 98.8%, respectively. There was no significant difference in the incidence of PCR between phacoemulsification and MSICS (P = 0.475). The mean BCVA at 1 month was found to be better with phacoemulsification than MSICS (P = 0.004). Conclusion: Preoperative AS?OCT has excellent specificity and negative predictive value in identifying posterior capsular dehiscence. It thus helps to plan the surgery and counsel patients appropriately. Both phacoemulsification and MSICS provide good visual outcome with similar complication rates.

Study-of-phacoemulsification-vs-phacotrabeculectomy-in-management-of-primary-angle-closure-glaucoma

Introduction: The study was conducted to evaluate IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. Vision impairment is a major public health problem and the burden is increasing with increase in aged population. This study wasAims And Objectives: undertaken for study the IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. A pre-designed prospective study was conducted at the OPD of upgraded Department of Ophthalmology at LLRM Medical College, Meerut. A total of 60 patients were divided in to two equal groups randomly and studied. Majority of the patients in both the groups wereObservation And Result: aged between 61 – 70 years. Females outnumbered males in this study which was statistically significant between the two groups. The mean pre- operative intra ocular pressure was 23.3 mm Hg in combined surgery group and 23.9 mm Hg in cataract surgery alone group. Mean Intra ocular pressure decreased regularly in each follow up more in combined group than the cataract surgery alone group. The mean intra ocular pressure after 1 years follow up in combined surgery group was 10.8 mm Hg and 13.4 mm Hg in the cataract surgery alone groups which was statistically significant. Mean BCVA before the operation was 3.2 in combined surgery group and 3.8 in cataract surgery before surgery. Mean BCVA declined after 1 year of follow up in combined surgery group was 1.9 and 2.7 in cataract surgery alone group which was statistically significant. The surgery success was complete in 80.0% of the combined surgery group and 60% of the cataract alone group. Criteria For Failure Of Surgeries Ÿ The IOP >23 MMHG at the end of 1 year or Ÿ The IOP not reduced by 20 % from base line at the end of 1 year Conclusion: This study was mainly undertaken to study the efficacy of combined trabeculectomy with cataract extraction and cataract only on primary angle closure glaucoma. This study had found that, the reduction of intra ocular pressure in both the groups but more prominent in combined surgery group than cataract alone surgery group.

Hydrophilic Intraocular Lens Opacification � A Case Report

Purpose : To report a case of late opacification of the hydrophilic acrylic Intraocular Lens (IOL) after uneventful Cataract Surgery. Methods : A 60-year-old male presented with chief complaint of gradual diminution of vision in right eye over the past one year. He was Normotensive, Non-diabetic and had a normal Lipid Profile. History revealed that he underwent uneventful phacoemulsification with posterior chamber hydrophilic intraocular in the bag implantation for pre-senile cataract in his Right Eye ten years ago. He had the best corrected visual acuity of 6/6 in his Right Eye for nine years Post Cataract Surgery. Slit-lamp examination confirmed Intraocular Lens Opacification. Results : Intraocular Lens exchange was performed in his Right Eye. The hydrophilic IOL was replaced with poly methyl methacrylate intraocular lens. The explanted IOL showed uniform grayish-white opacification. Post operative period was uneventful. Intraocular pressure by applanation tonometry was 16.4 mm Hg in both the eyes. Patient抯 best corrected visual acuity was 6/6 with -1 D Cyl. at 90 degree, Postoperatively. Over a follow up period of one year, the patient did not develop complications like posterior capsular IOL opacification. Conclusion: Intraocular Lens opacification is an extremely rare late postoperative complication of Phacoemulsification which can be managed effectively by IOL exchange procedure in cases of opacified IOL optics causing visual morbidity

Important signs to check posterior capsule integrity

For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.

Risk factors for posterior capsule rupture in mature cataract surgery: A study of 1302 cases

Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17–14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59–8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64–12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60–4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20–3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher?risk cases can reduce complications

Effect of anterior capsule polishing on the visual quality after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the effect of anterior capsule polishing on visual quality after phacoemulsification.METHODS: Prospective randomized control study. A total of 65 patients(73 eyes)with age-related cataract who underwent phacoemulsification combined with intraocular lens(IOL)implantation in the Emergency General Hospital between November 2021 and June 2022 were included. These patients were randomly assigned to two groups, with one group(anterior polishing group)underwent anterior and posterior capsule polishing(30 cases, 35 eyes), while the other(control group)receive routine posterior capsule polishing(35 cases, 38 eyes). Best corrected visual acuity was observed at 1wk, 1, 3 and 6mo after operation. Area of anterior capsule orifice was measured at 3 and 6mo after operation. Meanwhile, posterior capsular opacification(P score), IOL tilt and decentration were recorded by Pentacam Scheimpflug system. In addition, wavefront aberration, Strehl ratio(SR)of point spread function(PSF)and modulation transfer function(MTF)were evaluated by OPD-Scan Ⅲ.RESULTS: At 1wk, 1, 3 and 6mo after operation, best corrected visual acuity in anterior polishing group is significantly better than that of control group(P&#x003C;0.05). There were no significant differences in area of anterior capsule opening, P score, IOL decentration, SR of PSF and MTF between two groups at 3 and 6mo after operation(P&#x003E;0.05). At 3mo follow-up, no significant differences in IOL tilt and wavefront aberration were measured between two groups either(P&#x003E;0.05). However, IOL tilt [(1.65±0.60)° vs.(2.34±0.43)°, P&#x003C;0.001] and wavefront aberration(0.03±0.01μm vs. 0.06±0.03μm, P&#x003C;0.001)in anterior polishing group were significant lower compared to control group at 6mo after operation.CONCLUSION: 360° polishing of anterior and posterior capsule during phacoemulsification can improve best corrected visual quality, with reduced IOL tilt, lower wavefront aberration and better visual quality.

Effects of can walking anterior and posterior capsule polishing combined with tension ring implantation on lens capsular stability after phacoemulsification for ultra-high myopia cataract / 中华显微外科杂志

Objective:To observe the effects of polishing the anterior and posterior capsule with irrigation/aspiration (I/A) injection needle and capsular tension ring (CTR) implantation on intraocular lens (IOL) capsular stability after phacoemulsification for ultra-high myopia with 2.0 mm coaxial micro incision.Methods:This is a prospective randomized controlled study. There were 40 patients(80 eyes) aged 46-72 years old with ultra-high myopia cataract. The grade of lens opacity was grade II-IV, and the diopter was -10 D - -24 D. During 2.0 mm coaxial micro incision phacoemulsification, adopt coin tossing method randomly, 1 eye was operated using the anterior and posterior capsule polishing 360° with I/A injection needle combined with CTR implantation as the experimental group(40 eyes), the other eye was neither polished nor CTR implantated as the control group(40 eyes). The operation interval of both eyes was less than 1 week. The size of anterior capsular orifice, effective intraocular lens position(ELP), IOL eccentricity and posterior capsular opacification(PCO) were recorded at 1 week, 1, 3 and 6 months after operation in outpatient clinic. Two independent sample t-test and Fisher exact probability test were used to compare the differences between the 2 groups. P<0.05 was defined significant difference. Results:During the follow-up period, there were no significant change in the anterior capsule area, IOL eccentricity and ELP in the experimental group. However in the control group, the anterior capsular area decreased gradually with time, and gradually IOL eccentricity increased and ELP decreased. There was no significant difference between the 2 groups in each observation index at 1 week after operation, but it was ELP that first showed the difference tendency( P<0.01). The ELP of the control group was significantly lower than that of the experimental group at 1, 3 and 6 months after operation( P<0.05). There was no significant difference in anterior capsule area and IOL eccentricity between the 2 groups at 1 and 3 months after operation( P>0.05), but there was a significant difference at 6 months( P<0.05). In terms of PCO, the incidence of PCO was 0%, 2.5% and 7.5% in the experimental group and 5.0%, 17.5% and 32.5% in the control group respectively at 1, 3 and 6 months after operation. The incidence of PCO in the experimental group was significantly lower than that in the control group( P<0.05). Conclusion:Ultra-high myopia with cataract are prone to have capsular contraction after operation, which is characterized by IOL instability and anterior capsular orifice narrowing gradually. Combined 360° anterior and posterior capsular polishing with tension ring implantation in operation can effectively maintain the stability of ELP, reduce the degree of contraction of anterior capsular orifice, reduce the eccentricity of IOL and the incidence of PCO. Polishing the anterior and posterior capsule with I/A injection needle combined with CTR implantation, is safe and effective for patients with ultra-high myopia cataract.

Inhibitory effect of siRNA-Pax6 on biological behavior and epithelial-mesenchymal transition of human lens epithelial cells / 中华实验眼科杂志

Objective:To explore the effect of knockdown of the homeobox gene paired-box 6 ( Pax6) on the biological behavior and epithelial-mesenchymal transition (EMT) of human lens epithelial cells (LECs). Methods:The SRA01/04 human LECs were divided into small interfering RNA-Pax6 (siRNA-Pax6) group transfected with siRNA-Pax6 and siRNA negative control (siRNA-NC) group transfected with disordered siRNA.Cell survival rate was detected by cell counting kit-8 method at 24, 48 and 72 hours after transfection.Cell cycle distribution and apoptosis were analyzed by flow cytometry at 48 hours after transfection.Migratory capability of cells was examined by cell scratch test at 24 hours after transfection.The mRNA relative expression levels of Pax6, α-crystallin A (CRYAA), α-crystallin B (CRYAB), Sox2, α-smooth muscle actin (α-SMA) and E-cadherin were detected by quantitative real-time PCR at 48 hours after transfection.The relative expression of Pax6 protein was detected by Western blot at 48 hours after transfection.Results:There was a significant difference in cell survival rates at different time points between the two groups ( Fgroup=4.776, P<0.05; Ftime=13.535, P<0.05). The cell survival rate of siRNA-Pax6 group was obviously lower than that of siRNA-NC group at 48 and 72 hours after transfection, and the differences were statistically significant (both at P<0.05). Compared with siRNA-NC group, the proportion of cells in G 0/G 1 phase was significantly increased and the proportion of cells in S phase was significantly reduced in siRNA-Pax6 group ( t=9.971, -5.063; both at P<0.05). The cell migration rate of siRNA-Pax6 group was (19.73±6.07)%, which was lower than (70.56±2.97)% of siRNA-NC group, showing a statistically significant difference ( t=-7.245, P<0.05). The relative expressions of Sox2 mRNA and α-SMA mRNA were lower, and the relative expression of E-cadherin mRNA was higher in siRNA-Pax6 group than siRNA-NC group, with statistically significant differences between them ( t=-23.254, -5.294, 6.062; all at P<0.01). The relative expression of CRYAA mRNA and CRYAB mRNA was significantly higher in siRNA-Pax6 group than siRNA-NC group, and the differences were statistically significant ( t=5.521, 8.270; both at P<0.01). The relative expressions of Pax6 mRNA and protein in siRNA-Pax6 group were 0.27±0.01 and 0.24±0.05, respectively, which were both lower than 1.00±0.05 and 1.14±0.10 in siRNA-NC group, showing statistically significant differences ( t=-14.456, -4.458; both at P<0.001). Conclusions:Silence of Pax6 can suppress the proliferation and EMT of human LECs and enhance the expression of crystallin.

Advances in interdisciplinary medical and engineering research of intraocular lens surface modifications to prevent posterior capsule opacification / 中南大学学报(医学版)

Posterior capsule opacification (PCO), a common complication after cataract surgery, impacts a patient's long-term visual quality to various degrees. Although a neodymium:yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy is a very effective treatment, it may lead to a serial of complications. Accordingly, the search for simple, safe, and effective methods to prevent PCO has received widespread attention. Various researchers are committed to the interdisciplinary collaboration between medicine and engineering fields, such as functionalizing the surface of the intraocular lens (IOL) via supercritical fluid impregnation, coating the surface of the IOL, high-concentration drug immersion, and application of a drug delivery system, to effectively reduce the incidence and severity of PCO.

Short Term Visual and Refractive Outcome following Surgical Intervention forPosterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital

BACKGROUND: PCO occurs commonly postoperatively followingcataract extraction in children, obscuring vision as did the initialcataract. It may require a second surgical procedure when it is dense.It is expected that this results in restoration of vision and it is importantto ascertain that this is the case as well as to examine any significantchanges in refraction thereafter.M ETHODS: A retrospective observational study extractingdemographic and clinical information from case notes of patients whohad membranectomy and/or capsule polishing between October 2017and September 2018.RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1male: female ratio. Mean age at cataract surgery was 6.33 3.59yearswhilst that for PCO surgery was 9.68 3.89years. Postoperativevisual acuity (by WHO definition) was good (between 6/6 and 6/18)in 33.3%, compared to 8.8% preoperatively. Whereas presenting visualacuity was poor (<6/60) in 61.4% preoperatively, this reduced to30% postoperatively. Visual outcome was influenced by age at cataractsurgery, age at PCO surgery, interval between cataract and PCO surgeryand type of cataract. Children >8 years of age at time of PCO surgeryhad a greater proportion of good post-operative best corrected visualacuity (BCVA) (52.6%), whilst 75% of children younger than 8yearsat time of surgery turned out with poor BCVA after surgery.Developmental cataracts proportionately had the best outcome ofvisual acuity. There was a range of refractive shift of +0.25D to ­5.25D with a mean myopic shift of ­1.51D following membranectomy. CONCLUSION: There was a good proportion of children withsignificant improvement in visual acuity on the short term,and a mildmyopic shift following membranectomy.

Comparative study between iris-claw and scleral-fixated intraocular lens in patients with aphakic eye / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy of iris-claw intraocular lens(ICIOL)and scleral-fixator intraocular lens(SFIOL)in terms of visual outcomes, surgical time, and postoperative complications in the aphakic patients.<p>METHODS: This study was a prospective study with 60 aphakic eyes of 60 patients who attended our outpatient department from October 2018 to February 2020. These patients were divided into two groups and each with 30 patients. Patients in Group I were underwent ICIOL whereas patients in Group II underwent SFIOL implantation. Patients with pre-existing ocular pathologies, previous history of retinal surgery of the eye were excluded. The preoperative and postoperative evaluation was done for the follow up period of 9mo.<p>RESULTS: Twenty-six(87%)patients in the ICIOL group and 24(80%)patients in SFIOL group had best corrected visual acuity(BCVA,LogMAR)with 0.50-0.00 after 9mo follow up. The mean of BCVA(LogMAR)was comparable in both the groups. The surgical time in ICIOL was significantly less than the SFIOL group(<i>P</i><0.01). Complications related to sutures were significantly more in the SFIOL group. Complications found in the ICIOL group were very mild and harmless. <p>CONCLUSION: The visual outcome was comparable in both groups. ICIOL with fewer complications and requiring less surgical time was found to be a better alternative to SFIOL in the correction of aphakia.

Application of 23G vitrectomy system in pediatric congenital cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of 23G vitrectomy system used in children with congenital cataracts.<p>METHODS: From November 2017 to December 2018, 11 children(19 eyes)aged 3-8 years old with congenital cataract were recruited in the Department of Ophthalmology, the First Affiliated Hospital of Hainan Medical University. 23G vitrectomy instruments were used to enter the anterior chamber through the incision at the corneal limbus, and complete ring resection of anterior capsule, cataract aspiration, intraocular lens implantation, and ring resection of posterior capsule combined with anterior vitrectomy. The visual acuity, intraocular pressure and ocular conditions of the children were observed during 3-24mo of follow-up.<p>RESULTS: All the surgeries were uneventful. During the surgeries, the anterior chambers were stable, the ring resections of lens capsules were accurate, and the IOLs were implanted at the 1^st phase. The postoperative visual acuity was significantly improved compared with that before surgery. Only 1 patient had intraocular pressure higher than 25mmHg after surgery, which was controlled within the normal range after medication was given. During the follow-up period, all the children had clear corneas, no anterior chamber hemorrhage, no pupil deformation, the intraocular lens was in the center and the right position, the optic axis was transparent, and no obvious complications occurred.<p>CONCLUSION: The 23G vitrectomy system is safe and effective for the surgery of congenital cataract, it can achieve little trauma, accurate lens capsule resection, little postoperative reaction and few complications.

Observation of intraocular lens and posterior capsular attachment after high myopia cataract operation by new generation of AS-OCT / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To quantify and evaluate the capsular adhesion to intraocular lens(IOL)in subjects with high myopia by the latest anterior segment optical coherence tomography(AS-OCT).<p>METHODS: Retrospective case observation study was designed. Sixty eyes of 60 patients who received extra-capsular extraction combined with IOL implantation in Shenzhen Eye Hospital from October 2019 to December 2019 were divided into two groups by axial length(AL), of which 30 eyes were highly myopic(AL>26mm)and 30 eyes were emmetropic(22mm<AL<24.5mm). All eyes were examinated by AS-OCT at 1, 7, and 30d after operation. The area between IOL and posterior capsule(AREAP)and residual side length of posterior capsule not adhesion were evaluated. Kaplan-Meier survival analyses of attachment rates were studied. The ratios of posterior capsule attached IOL of the two groups at different postoperative times were compared by Log-Rank.<p>RESULTS: In the emmetropic group, the AREAP was(0.81±0.37),(0.33±0.19)and(0.14±0.06)mm² at 1, 7, and 30d after operation, respectively. The residual side lengths of posterior capsule not adhesion were(7.93±3.03),(3.95±2.44)and(1.26±0.08)mm. The ratios of posterior capsule attached to IOL were 33%, 67% and 83%. In the highly myopic group, the AREAP were(3.29±0.43),(1.54±0.66)and(0.62±0.28)mm² at 1, 7, and 30d postoperatively, respectively. The residual side lengths of posterior capsule not adhesion were(13.56±4.02),(8.13±3.90)and(3.78±2.51)mm. The ratios of posterior capsule attached to IOL were 0, 7% and 23%. There were statistically significant differences between the two groups in AREAP, residual side lengths of posterior capsule not adhesion and the ratios of posterior capsule attached to IOL(<i>P<</i>0.05).<p>CONCLUSION: There is more space between posterior capsule and IOL after cataract surgery in highly myopic patients. The new generation of AS-OCT can clearly display the image of the posterior capsule of the lens, which is expected to be an effective examination device for the study of lens-related diseases.

Capsulotomía posterior en el Hospital General Docente Dr. Agostinho Neto, Guantánamo 2015-2019 / Capsulotomia posterior no Hospital General Docente Dr. Agostinho Neto / Capsulotomy outcomes at the Hospital General Docente Dr. Agostinho Neto

Introducción: La opacificación de la cápsula posterior continúa siendo la complicación posoperatoria tardía más frecuente tras la cirugía de catarata. Objetivo: Determinar los resultados visuales en la realización de la capsulotomía posterior con el equipo NIDEK YAG C-1800 a 75 pacientes que desarrollaron opacidad de la cápsula posterior (150 ojos); los cuales asistieron al Centro Oftalmológico del Hospital General Docente "Dr. Agostinho Neto", provincia Guantánamo, en el período comprendido entre abril de 2015 a abril de 2019. Método: Se efectuó un estudio longitudinal, prospectivo y descriptivo en pacientes diagnosticados con opacidad de la cápsula posterior, a los cuales se les realizó capsulotomía posterior en dicho centro antes mencionado. Las variables estudiadas fueron: edad, sexo, agudeza visual corregida con cristales (AV.cc) a los tres meses posteriores a la cirugía y complicaciones encontradas. Resultados: El 57,3 % presentó una edad mayor a los 75 años, el sexo femenino quedó representado en un 62 %. La metaplasia fibrosa con un 57,3 % fue la opacidad de cápsula posterior más frecuente después de la aplicación del láser y el 74,7 % de los pacientes evolucionó con una buena agudeza visual, mayor o igual a 0,6. La complicación más frecuente fue la elevación transitoria de la tensión ocular con un 32,7 %. Conclusiones: La capsulotomía posterior con NIDEK YAG C-1800 demuestra ser un procedimiento quirúrgico efectivo en los pacientes diagnosticados con opacidad de la cápsula posterior, la mayoría de los pacientes alcanzó una agudeza visual mayor a 0,5. Existieron pocas complicaciones relacionadas con el proceder.

Introduction: The opacification of the posterior capsule remains the most frequent late postoperative complication following cataract surgery. Objective: To determine the visual outcomes obtained in the performance of posterior capsulotomy with the NIDEK YAG C-1800 equipment in 75 patients with opacification of the posterior capsule (150 eyes) who were attended in the Ophthalmology Center setted at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo, from April 2015 to April 2019. Method: A longitudinal, prospective and descriptive study was carried out in patients diagnosed with posterior capsule opacity, who underwent posterior capsulotomy in the aforementioned center. Variables studied were as follow: age, sex, visual acuity corrected with glasses (VA.cc) (3 months after surgery), and complications encountered. Results: The 57.3% of the total were over 75 years of age, and 62% were female. Fibrous metaplasia was the most frequent posterior capsule opacity found after laser application (57.3%) and the 74.7% of patients evolved with good visual acuity (≥0,6). The most frequent complication was transient elevation of ocular pressure (32.7%). Conclusions: Posterior capsulotomy with NIDEK YAG C-1800 proved to be effective, as surgical procedure, in patients diagnosed with posterior capsule opacity, most patients achieved visual acuity over 0.5. There were minimum complications related to the procedure.

Introdução: A opacificação da cápsula posterior continua sendo a complicação pós-operatória tardia mais frequente após a cirurgia de catarata. Objetivo: Determinar os resultados visuais na realização da capsulotomia posterior com o equipamento NIDEK YAG C-1800 em 75 pacientes que desenvolveram opacidade da cápsula posterior (150 olhos); que frequentaram o Centro Oftalmológico do Hospital General Docente "Dr. Agostinho Neto", província de Guantánamo, no período de abril de 2015 a abril de 2019. Método: Foi realizado um estudo longitudinal, prospectivo e descritivo em pacientes com diagnóstico de opacidade da cápsula posterior, submetidos à capsulotomia posterior no referido centro. As variáveis estudadas foram: idade, sexo, acuidade visual corrigida por cristal (AV.cc) três meses após a cirurgia e complicações encontradas. Resultados: 57,3% tinham mais de 75 anos, o sexo feminino estava representado em 62%. Metaplasia fibrosa com 57,3% foi a opacidade da cápsula posterior mais frequente após a aplicação do laser e 74,7% dos pacientes evoluíram com boa acuidade visual, maior ou igual a 0,6. A complicação mais frequente foi a elevação temporária da tensão ocular com 32,7%. Conclusões: A capsulotomia posterior com NIDEK YAG C-1800 se mostra um procedimento cirúrgico eficaz em pacientes com diagnóstico de opacidade da cápsula posterior, a maioria dos pacientes alcançou acuidade visual maior que 0,5. Houve poucas complicações relacionadas ao procedimento.

To Study the Outcome of Cataract Surgery in a Rural Indian Population Which Primarily Depends on Camps and NGOs for a Free Cataract Surgery

The present study was conducted as a rapid assessment of avoidable blindness survey by cluster sampling, aimed primarily to assess the outcome of cataract surgery in a rural Indian population. MethodsAn Observational Point Prevalence study including 407 pseudophakic eyes of 382 subjects, screened through Survey across District in Rural Wardha and admitted in the eye ward of a Rural Tertiary Care Teaching Centre, who gave informed consent were included in this study. History of cataract surgery (time, place, cost and provision of glasses), diabetes mellitus, past history of laser capsulotomy was recorded. Visual acuity and thorough ocular examination including grading of PCO were done. Ocular findings were recorded on pre-tested proforma. ResultsPrevalence of PCO among the pseudophakic eyes was 31.4%. Mean age of study population was 68.1 +8.3 years (range 14-86 years). Rates of PCO are noted to be minimum (21.4%) in the age group 55 - 59 years and maximum (36.1%) in the age group 75 - 79 years. Mean duration since surgery in eyes with PCO among the total 407 pseudophakic eyes included in the study was 27.9 +23.7 months (range 1 - 120 months), 14.9% eyes developed visually significant PCO in <12 months since surgery. Prevalence of PCO ranged from 14.9% in <12 months since surgery to 32.0% at <60 months since surgery (c2=23.99, p<0.05). In the study group which included 5 (23.9%) eyes with a Foldable IOL, developed PCO as compared to 133 (34.5%) in the eyes implanted with PMMA IOL. Prevalence of PCO was higher in PMMA IOL. In the study group, 45 (59.2%) eyes with a Decentered IOL had PCO as compared to 93 (28.1%) eyes within the Bag placed IOL group. There was a higher prevalence of visually significant PCO in eyes with decentered IOL, as compared to eyes within the Bag IOL placement. (c2=26.71, DF=1, p=0.00000). Out of 407 pseudophakic eyes included in the study, history of diabetes was noted in 14 persons, of whom 14 (3.4%) pseudophakic eyes were included in this study and 9 (64.3%) of these developed PCO. The prevalence of PCO was significantly higher among diabetic patients (c2=4.65, p<0.05). The presence of uveitis in pseudophakic eyes was significantly related to higher PCO rates as compared to pseudophakic eyes without uveitis. (c2=24.68, DF=1, p=0.000001). ConclusionsVisually Significant PCO is seen in 1/3rd of eyes following cataract surgery. Duration since cataract surgery is a major factor influencing its genesis. IOL material, cataract surgery type, and IOL position are also important factors. Role of diabetes and uveitis needs to be studied further.

Comparing the number of attempts required for complete nuclear chop using calibrated and conventional phacotip

Background: Phacoemulsification is a state of art technique with a steep learning curve the configuration of the phacotip affects the efficacy and execution of the nuclear chopping techniques. Inadequate penetration of phacotip may result in partial thickness nuclear cleavage with residual posterior plane and over enthusiastic penetration may result in posterior capsule rupture. This may be avoided if some estimate can be made preoperatively of the depth of penetration required to achieve full thickness crack.Methods: A total of 60 eyes of 60 patients with age related cataract with grade 4.0 to 6.9 (LOCS III) fulfilling the inclusion and exclusion criteria were included in the study after written informed consent. They were divided into two groups A and B with 30 patients each randomly using envelope method and were operated using conventional and calibrated phacotips respectively and the number of attempts required to achieve complete nuclear chop was noted.Results: In group A, vertical chop was safely and effectively done is 23 patients in just one attempt while it took 2 attempts in 6 patients and 3 attempts in 1 patient. In group B, it took just one attempt in 26 patients while 2 attempts were required in 4 patients. The two groups were comparable (p value 0.453) and was found to be statistically significant.Conclusions: With the use of a calibrated phacotip, the surgeon already knows to what depth he has to penetrate the tip into the center of nucleus depending upon the grade of cataract which results in safe and effective chop in minimum attempts where as in the conventional phacotip, it is more of a blind process. Hence the calibrated phacotip has taken the guess work out of question.

Let-7a-5p represses proliferation, migration, invasion and epithelial-mesenchymal transition by targeting Smad2 in TGF-β2-induced human lens epithelial cells

Transforming growth factor b2 (TGF-b2)/Smad signaling is widely accepted as a key inducer of proliferationand epithelial-mesenchymal transition (EMT) of human lens epithelial cells (LECs), contributing to thedevelopment of posterior capsule opacification (PCO). Increasing evidence shows that microRNAs (miRNAs)play important roles in PCO pathogenesis. Herein, we aimed to explore the role and molecular mechanism oflet-7a-5p on TGF-b2-induced proliferation and EMT in LECs. qRT-PCR was performed to detect theexpression of let-7a-5p and Smad2 mRNA. Western blot was used to determine the Smad2 level and theinduction of EMT. The targeted correlation between let-7a-5p and Smad2 was confirmed using dual-luciferasereporter and RNA immunoprecipitation assays. CCK-8 assay was employed to determine cell proliferation, andtranswell assays were performed to assess cell migration and invasion. We found that TGF-b2 induced EMT ofLECs, and TGF-b2 upregulated Smad2 expression and reduced let-7a-5p expression in LECs. Smad2 was adirect target of let-7a-5p. Moreover, let-7a-5p upregulation repressed proliferation, migration, invasion andEMT in TGF-b2-induced LECs. But, Smad2 expression restoration abrogated the inhibitory effect of let-7a-5pupregulation. In conclusion, our data indicated that let-7a-5p upregulation repressed TGF-b2-induced proliferation, migration, invasion and EMT at least partly by targeting Smad2 in LECs, highlighting that let-7a-5pmight act as a promising therapeutic target to intervene to the progression of PCO.

Evaluation of quality of life and visual acuity after posterior capsulotomy with neodymium: YAG laser in adults / Avaliação da qualidade de vida e da acuidade visual após capsulotomia com Neodymium: YAG laser em adultos

Abstract Purpose: To determine the impact of neodymium:YAG (Nd:YAG) laser posterior capsulotomy on quality of life and visual acuity in adults. Methods: A prospective study that included patients over 65 years old with clinical indications for Nd: YAG laser capsulotomy. On the day of the procedure, corrected distance visual acuity tests, slit-lamp examination and posterior capsule opacification (PCO) photo documentation were performed, followed by application of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The PCO rate was evaluated with Evaluation of Posterior Capsule opacification (EPCO 2000) software. Four weeks after the posterior capsulotomy, corrected distance visual acuity was measured, and the NEI-VFQ-25 was applied again. Complications were also reported. Results : Sixty eyes from 45 patients were enrolled in the study. The mean age was 71.51 ± 6.38 years (65 to 93). Comparing the results before and after the Nd:YAG laser capsulotomy, there was a statistically significant improvement in quality of life according to the NEI-VFQ-25 (p<0.001) and in visual acuity (p=0.0). The mean score in NEI-VFQ-25 Questionnaire before capsulotomy was 62.07 ± 20.90 (16.81-95.90) and after was 83.95±19.49 (20.68 - 100.0). The mean CDVA before the procedure was 0.75 ± 0.35 LogMAR (0.1-1.3) and after was 0.21 ± 0.20 LogMAR (0.0-1.3). The mean PCO rate measured by the EPCO software was 0.688 ± 0.449. There was a positive correlation between the EPCO score and the total score of quality of life after Nd: YAG laser capsulotomy (r=0.845, p=0.00). Damage to intraocular lens was the only complication observed in six eyes (10%). Conclusion: Nd: YAG laser capsulotomy, in addition to improving visual acuity, is able to improve quality of life.

Resumo Objetivo: Determinar o impacto da capsulotomia posterior com laser de neodímio: YAG (Nd: YAG) na qualidade de vida e na acuidade visual em adultos. Métodos: Estudo prospectivo que incluiu pacientes acima de 65 anos com indicação clínica para capsulotomia com laser de Nd: YAG. No dia do procedimento, foram realizados testes de acuidade visual corrigida, exame com lâmpada de fenda e fotodocumentação da opacificação da cápsula posterior (OCP), seguido da aplicação do National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). A taxa de OCP foi avaliada utilizando o software de avaliação de opacificação de cápsula posterior (EPCO 2000). Quatro semanas após a capsulotomia posterior, a acuidade visual corrigida foi medida, e o NEI-VFQ-25 foi aplicado novamente. Complicações também foram relatadas. Resultados: Sessenta olhos de 45 pacientes foram incluídos no estudo. A idade média foi de 71,51±6,38 anos (65 to 93). Comparando os resultados antes e após a capsulotomia com laser Nd: YAG, houve melhora estatisticamente significante na qualidade de vida de acordo com o NEI-VFQ-25 (p <0,001) e na acuidade visual (p = 0,0). A média do escore total do questionário NEI-VFQ-25 pré capsulotomia foi de 62.07 ± 20.90 (16.81-95.90) e pós foi de 83.95 ±19.49 (20.68 - 100.0). A AVCC antes do procedimento foi 0.75 ± 0.35 LogMAR (0.1-1.3) e após foi 0.21 ± 0.20 LogMAR (0.0-1.3). A taxa média de OCP medida pelo software EPCO foi de 0,688 ± 0,449. Houve correlação positiva entre o escore EPCO e o escore total de qualidade de vida após a capsulotomia com laser de Nd: YAG (r = 0,845, p = 0,00). O dano à lente intraocular foi a única complicação observada em seis olhos (10%). Conclusão: A capsulotomia com laser Nd: YAG, além de melhorar a acuidade visual, é capaz de melhorar a qualidade de vida.

Effect of capsular LECs removal on capsular stability in patients with high myopia and cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of LECs removal on the stability of lens capsule bag in patients with high myopia.<p>METHODS: From March 2018 to April 2019, 98 cases(120 eyes)of cataract patients with high myopia were treated in Cataract Department of Hebei Province Eye Hospital. They were divided into two groups according to whether the LECs were removed during the operation. In group A, the anterior and posterior capsule were polished in 50 cases(60 eyes), while in group B, 48 cases(60 eyes)were not polished. During the follow-up period we used anterior segment OCT to detect the change of effective intraocular lens position(ELP), the eccentricity of intraocular lens(IOL)and the reduction of anterior capsule opening in the two groups, and used slit lamp to observe the occurrence and degree of PCO.<p>RESULTS: We compared the changes of ELP(0.16±0.06mm <i>vs</i> 0.55±0.07mm)and the changes of contraction of anterior capsule(0.18 ± 0.16mm <i>vs</i> 0.92 ± 0.13mm)on the first day and three months after operation. Three months after operation, we compared the IOL eccentricity of the two groups(0.02±0.005mm <i>vs</i> 0.69±0.23mm). There were differences between the two groups(<i>P</i><0.05). At 3mo after operation, the PCO of group A was observed by slit lamp: grade I 4 eyes, grade II 2 eyes, grade III 1 eye. The PCO of group B: grade I 16 eyes, grade II 8 eyes, grade III 4 eyes and grade IV 3 eyes. There was significant difference between the two groups(<i>Z</i>=-4.765, <i>P</i><0.01).<p>CONCLUSION: The removal of LECs could reduce the contraction of anterior capsule, decrease the change of ELP and enhance the stability of bag IOL complex, which played a good role in reducing PCO.