Type 1 and type 2 diabetes predisposed to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases.

OBJECTIVE: To assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery. DESIGN: A retrospective cohort study. METHODS: All patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies. RESULTS: Included were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. CONCLUSION: In our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.

Use of corneal cross-linking beyond keratoconus: a systemic literature review.

PURPOSE: The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. METHODS: A systemic literature review. RESULTS: We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. CONCLUSION: Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

Modified "Top-up sandwich" technique for the management of corneal perforations: A case report and a literature review.

Purpose: We describe a modified technique for managing a peripheral, non-infected, corneal perforation using a "Sandwich" technique that combines posterior lamellar keratoplasty, an amniotic membrane patch and a Gundersen conjunctival flap. Observations: A 75-year-old female patient presented with Sjogren's syndrome-related corneal perforation. A mini-Descemet stripping automated endothelial keratoplasty (DSAEK) graft (5 mm) was introduced into the anterior chamber and was mobilized to plug the perforation. Then, two amniotic membrane patches were stacked over the perforation and glued. Finally, the whole area was covered with a Gundersen conjunctival flap, mobilized from the inferior conjunctiva and secured in place using interrupted 10-0 nylon sutures. A step-by-step guide is also described. At three months, the final visual acuity was 6/9. A literature review revealed ten cases in which a posterior lamellar graft was effectively employed to treat corneal perforations. Conclusions and Importance: We described a modified approach for treating peripheral corneal perforation surgically. This "sandwich" approach is simple to replicate and can give quick healing with few visual repercussions. Our detailed guide may be utilized to obtain similar results and may be added to the array of treatment options for peripheral corneal perforation.