An evaluation of the efficacy of a supplemental computer-based tutorial to enhance the informed consent process for cataract surgery: an exploratory randomized clinical study.

BACKGROUND: To assess whether informing patients with a computer-based tutorial in addition to standard informed consent influences the patient's attitude towards surgery and increases patient's knowledge. METHODS: In this prospective, exploratory, randomized clinical study, patients scheduled for their first eye cataract surgery were randomly allocated to two groups, receiving standard face-to-face informed consent (control group) or additionally using an interactive computer-based tool (CatInfo) containing an audiovisual presentation about cataract and its treatment (study group). Cataract-related knowledge and decisional confidence (decisional conflict scale (DCS)) were assessed as well as one-month postoperatively decisional regret (decision regret scale (DRS)) and willingness to exchange face-to-face discussion time for the use of such a tool. RESULTS: The study comprised 134 patients, 64 patients in the study group and 70 in the control group. Patients in the study group answered more questions correctly, 16.3 ± 2.0 (median 16.5, 11.0-19.0) versus 15.5 ± 1.9 (median 16.0, 8.0-19.0; p = 0.01). Patients showed a high decisional confidence with a study group mean DCS score of 92.4 ± 9.8 (median 96.9, 65.6-100) and control group score of 91.6 ± 10.9 (median 95.3, 43.3-100; p = 0.52). Mean DRS score in the study group was 2.5 ± 8.0 (median 0, 0-40) and 4.3 ± 12.5 (median 0, 0-75) in the control group (p = 0.14). Of study group patients 23 (67.6%) were willing to trade time, on average 158 ± 180 s (median 120 s, 45-900). Satisfaction with the tool was high with a mean of 9.1 ± 1.3 out of 10 (median 9.7, 5.0-10). CONCLUSIONS: Cataract-related knowledge was generally good, with slightly higher scores in the study group. In both groups, decisional confidence was high and regret after surgery was low. A tendency towards slightly higher decisional confidence and lower regret was found in the study group, although these differences were not statistically significant. Additional use of an interactive computer-based tool may prove useful in the informed consent process in a high-volume cataract outpatient setting. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04975126. Retrospectively registered - July 23, 2021.

Effect of Air Tamponade on Postoperative Visual Acuity and Intraretinal Cystoid Changes after Peeling of Idiopathic Epiretinal Membranes in Pseudophakic Patients.

PURPOSE: Epiretinal membrane is a macular disorder leading to metamorphopsia and decreased visual acuity. The aim of the present study was to assess the possible effects of air tamponade, balanced salt solution (BSS), and combined phacoemulsification on functional and anatomical outcomes. PROCEDURES: This prospective exploratory analysis included 72 eyes with idiopathic epiretinal membranes, scheduled to undergo 23-G pars plana vitrectomy with membrane peeling. Air tamponade or BSS was used in all cases. Optical coherence tomography (OCT) imaging was performed intraoperatively, and follow-up including visual acuity testing and OCT measurements was conducted until 3 months postoperatively. RESULTS: Mean best-corrected visual acuity improved between +2.1 and +3.1 letters, and mean central subfield thickness of the macula decreased between -29.6 and -76 µm in the examined groups, without significant differences between the air tamponade and BSS groups. There was no significant difference in the presence of intraretinal cystoid changes between the groups. CONCLUSIONS: The use of air tamponade did not show any significant differences in the anatomical and functional postoperative results compared to BSS. Furthermore, phacovitrectomy did not result in significantly more intraretinal cystoid changes 3 months after surgery.

Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: Advantages and Limitations.

PURPOSE: Epiretinal membranes (ERMs) are a disorder leading to progressive vision loss and metamorphopsia. The gold standard in therapy is vitrectomy with membrane peeling. The aim of this study was to assess whether the use of intraoperative optical coherence tomography (iOCT), which allows tomographic visualization of the membrane during peeling, enables peeling without staining. METHODS: This prospective study included 30 eyes of 30 patients with idiopathic ERMs scheduled for surgery. Pars plana vitrectomy with iOCT was performed in all cases, whereas staining of ERMs was only performed if needed. Internal limiting membrane (ILM) peeling was performed in case of wrinkled retinal surface after peeling of ERMs. RESULTS: In 63% (n = 19) eyes the ERM could be peeled successfully without use of staining. Nevertheless, in 89% (n = 17) of patients having had ERM peeling without dye, staining of the ILM was performed afterwards for peeling the ILM. Best corrected visual acuity improved in 80% (n = 24) and remained unchanged in 7% (n = 2) 3 months after surgery. There were no significant differences in postoperative results between patients with and without staining for ERM peeling. CONCLUSIONS: Use of iOCT helps to complete ERM peeling in a majority of cases without use of a chromovitrectomy dye, but as iOCT fails to visualize the ILM, chromovitrectomy still facilitates macular surgery in a majority of cases.

Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

PURPOSE: Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. METHODS: A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. RESULTS: Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3 months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3 months after surgery (p = 0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p = 0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p = 0.23; odds ratio: 2.6), age over 70 years (p = 0.29; odds ratio: 0.5) and air-tamponade (p = 0.59; odds ratio: 1.5) were not found to be significant. CONCLUSION: There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery.

Internal limiting membrane flap transposition for surgical repair of macular holes in primary surgery and in persistent macular holes.

PURPOSE: Classical or temporal internal limiting membrane (ILM) flap transposition with air or gas tamponade are current trends with the potential to improve surgical results, especially in cases with large macular holes. METHODS: A prospective case series included patients with idiopathic macular holes or persistent macular holes after 23-G pars plana vitrectomy (PPV) and ILM peeling with gas tamponade. In all patients, 23-G PPV and ILM peeling with ILM flap transposition with gas tamponade and postoperative face-down position was performed. RESULTS: In 7 of 9 eyes, temporal ILM flap transposition combined with pedicle ILM flap could be successfully performed and macular holes were closed in all eyes after surgery. The remaining 2 eyes were converted to pedicle ILM flap transposition with macular hole closure after surgery. Three eyes were scheduled as pedicle ILM flap transposition due to previous ILM peeling. In 2 of these eyes, the macular hole could be closed with pedicle ILM flap transposition. In 3 eyes, free ILM flap transposition was performed and in 2 of these eyes macular hole could be closed after surgery, whereas in 1 eye a second surgery, performed as pedicle ILM flap transposition, was performed and led to successful macular hole closure. CONCLUSIONS: Use of ILM flaps in surgical repair of macular hole surgery is a new option of treatment with excellent results independent of the diameter of macular holes. For patients with persistent macular holes, pedicle ILM flap transposition or free ILM flap transposition are surgical options.