Changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography.

AIM: To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA). METHODS: Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery. RESULTS: In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001). CONCLUSION: Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.

Combination of Toric and multifocal intraocular lens implantation in bilateral cataract patients with unilateral astigmatism.

AIM: To assess the binocular visual function in bilateral cataract patients with unilateral astigmatism after combined implantations of Toric with multifocal intraocular lens (IOL), and to compare with that of Toric and monofocal IOL implantation. METHODS: All the 30 patients with unilateral astigmatism suffered bilateral cataract were randomly divided into two groups: Toric plus multifocal IOL group and Toric plus monofocal IOL group. Uncorrected and corrected visual acuity at distance (5.0 m), intermediate distance (0.6 m), and near (0.33 m), contrast sensitivity, and stereopsis were assessed 6mo after surgery. Patients were also surveyed for visual disturbances and spectacle dependence. RESULTS: Binocular uncorrected visual acuity (LogMAR) of Toric/multifocal IOL eyes at distance, intermediate, near were 0.05±0.05, 0.24±0.10, and 0.14±0.06 respectively. The values of Toric plus monofocal IOL eyes were 0.06±0.07, 0.26±0.08, and 0.37±0.10 respectively. These values did not indicate significant differences between two groups with exception of near visual acuity. In the photopic condition (with or without glare), the contrast sensitivity of multifocal IOL eyes was significant lower than the monofocal IOL eyes in 18 cpd. In the mesopic condition, the contrast sensitivity of multifocal group was significant lower than monofocal group in 12 cpd, and in mesopic glare condition, this significant difference was found both in 6 cpd and 12 cpd. The stereopsis of Toric/multifocal IOL eyes decreased slightly (100±80 seconds of arc, t=2.222, P=0.136). Mean near vision for patient satisfaction was statistically significantly higher in Toric/multifocal IOL group patients versus than that in Toric/monofocal IOL group (80% vs 25.5%, P=0.000). Visual disturbance was not noticed in either group. CONCLUSION: Although the combination of Toric and multifocal IOL implantation results in compromising stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.

Out-of-the-bag intraocular lens dislocation: outcomes of posterior chamber intraocular lens exchange, risk factors, and prevention.

BACKGROUND: Dislocation of posterior chamber intraocular lens is one of the most common complications of intraocular lens implantation. Lens exchange is an effective solution to this unsatisfactory status. This study was conducted to analyze the possible predisposing factors for out-of-the-bag posterior chamber intraocular lens dislocation and to study the outcomes of lens exchange surgery. METHODS: Thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation who underwent posterior chamber intraocular lens exchange in Zhongshan Ophthalmic Center of Sun Yat-sen University (Guangdong, China) from January 2003 to October 2009 were included. A 6-month follow-up was completed. The causes for out-of-the-bag intraocular lens dislocation and visual outcomes of posterior chamber intraocular lens exchange were analyzed. The out-of-the-bag intraocular lens dislocation was diagnosed on the basis of the findings from slit-lamp microscope and B-ultrasound. The dislocated intraocular lens was explanted. Reimplantation of a new posterior chamber intraocular lens was performed in each case using standardized surgical procedures. RESULTS: In this study, a total of thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation underwent posterior chamber intraocular lens exchange surgery. Causes for out-of-the-bag intraocular lens dislocation included posterior capsule rupture during the initial cataract extraction procedure (23 eyes, 63.8%), trauma (5 eyes, 13.9%),neodymium-doped yttrium aluminium garnet (Nd:YAG) laser-induced dislocation (2 eyes, 5.6%), the status after vitrectomy (2 eyes, 5.6%) and unidentifiable etiology (4 eyes, 11.1%). Symptoms of these patients mainly included decrease in visual acuity (17 cases, 47.2%), blurred vision (16 cases, 44.4%), glare (1 case, 2.8%), diplopia (1 case, 2.8%), and halo (1 case, 2.8%). Intraocular lens dislocation into the posterior vitreous cavity (29 eyes, 80.5%), anterior chamber (1 eye, 2.8%) and anterior vitreous cavity (6 eyes, 16.7%) was found in this series. The foldable intraocular lenses (acrylic or silicone) were explanted from 27 eyes (75%) and rigid intraocular lenses (poly methyl methacrylate, PMMA) from 9 eyes (25%). The most common explanted intraocular lens material was single-piece acrylic (13 pieces, 36.1%), followed by 3-piece acrylic (9 pieces, 25%), single-piece PMMA (9 pieces, 25%), and 3-piece silicone (5 pieces, 13.9%). Uncorrected visual acuity postoperatively improved in 29 eyes (81%), unchanged in 4 eyes (11%), and worsened in 3 eyes (8%) in comparison to that before exchange operation (P = 0.006). Best corrected visual acuity tended to improve, but the improvement was not significant (P = 0.206). Complications related to lens exchange surgery were mainly intraocular lens redislocation (1 eye), retinal detachment (1 eye), vitreous hemorrhage (1 eye), and cystoid macular edema (1 eye). CONCLUSIONS: Out-of-the-bag intraocular lens dislocation was mainly caused by posterior capsule rupture during the initial cataract extraction procedure and the foldable lens was the most common dislocated intraocular lens. In most cases, posterior chamber intraocular lens exchange surgery could provide satisfied final visual outcomes.