Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Humanitarian missions and visual outcomes in cataract surgery: A literature review.

The limited accessibility to ophthalmological services in remote regions of developing countries poses a significant challenge in visual healthcare. Cataracts and refractive errors are prominent causes of visual impairment, and surgery, despite being an efficient option, faces barriers in developing countries due to financial and geographical constraints. Humanitarian missions play a vital role in addressing this issue. The improvement in the accuracy of calculating IOL power through techniques such as keratometry and biometry is a fundamental step towards optimizing surgical outcomes and the quality of life for patients in these underserved regions. In this context, the consideration of keratometry and immersion ultrasound biometry as preoperative assessment standards in cataract surgeries in developing countries is presented as a pertinent and advisable strategy.

Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España / Budget impact analysis of the XEN®63 for the treatment of primary open angle glaucoma in Spain

Antecedentes y objetivo Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones poscirugía, se emplearon datos de la literatura y se validaron con un panel de cuatro expertos. Los costes unitarios (€de2021) se obtuvieron de la base de datos ESALUD Resultados la inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y del procedimiento (−423.120; −0,7%), de las visitas de seguimiento (−777.407€; −4,5%), de los procedimientos adicionales (−1.048.145€, −20,6%) y de las complicaciones poscirugía (−321.065€, −14,2%). Conclusiones La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS (AU)

Background and objective To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1year. The comparators considered (trabeculectomy, deep non-perforating sclerectomy, Ahmed valve, iStent inject®, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€2021) were obtained from the ESALUD database. Result The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). Conclusion The incorporation of XEN®63 in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS (AU)

Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain.

BACKGROUND AND OBJECTIVE: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. MATERIALS AND METHODS: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. RESULTS: The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (-€423,120; -0.7%), follow-up visits (-€777,407; -4.5%), additional procedures (-€1,048,145; -20.6%) and post-surgery complications (-€321,065; -14.2%). CONCLUSIONS: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS.

Factores asociados al desprendimiento de retina pseudofáquico: seguimiento a largo plazo en una población colombiana / Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

Objetivo Identificar factores asociados a la aparición de desprendimiento de retina pseudofáquico en pacientes con antecedente de cirugía de catarata. Métodos Estudio retrospectivo de casos y controles de 802 ojos de 783 pacientes con antecedente de cirugía de catarata. Los casos fueron pacientes con desprendimiento de retina pseudofáquico (n=258 ojos), mientras que los controles fueron pacientes con cirugía de cataratas que no desarrollaron desprendimiento de retina durante un período de seguimiento de 10 años (n=544 ojos). Resultados La edad de la cirugía de cataratas entre los casos fue menor que en el grupo control (57±13 vs. 67±14 años, respectivamente; p<0,0001). La edad al desprendimiento de retina fue de 59±13 años (rango 6-88) y el tiempo entre la cirugía de catarata y el desprendimiento de retina tuvo una mediana de 2 años (rango intercuartílico 1-4), con un rango de un mes a 14 años. Los factores asociados para el desprendimiento de retina pseudofáquico fueron la edad más joven (<50 años: razón de probabilidad ajustada [ORa]=18,03; intervalo de confianza del 95% [IC 95%]=5,92-54,87; 50-59 años: ORa=10,09, IC 95%=3,37-30,23 y 60-69 años: ORa=5,48, IC 95%=1,88-15,93), sexo masculino (ORa=3,71, IC 95%=2,54-5,44), vitrectomía anterior (ORa=3,26, IC 95%=1,16-9,16), antecedentes de desprendimiento de retina en el ojo contralateral (ORa=6,95, IC 95%=3,15-15,31) y complicaciones intraoperatorias durante la extracción de cataratas (ORa=7,45, IC 95%=3,54-15,69). Conclusiones Este es el primer artículo de factores asociados al desprendimiento de retina pseudofáquico en población colombiana. Se encontró que las complicaciones quirúrgicas, el sexo y la edad estaban asociados con el desprendimiento de retina. Los pacientes deben ser conscientes de estos riesgos potenciales para tomar decisiones informadas sobre su salud ocular (AU)

Objective To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. Methods Retrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n=258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n=544 eyes). Results Age at cataract surgery among cases was lower than in the control group (57±13 vs. 67±14 years old, respectively; P<.0001). Age at retinal detachment was 59±13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR]=18.03, 95% confidence interval [95% CI]=5.92–54.87; 50–59 years: aOR=10.09, 95% CI=3.37–30.23; and 60–69 years: aOR=5.48, 95% CI=1.88–15.93), male sex (aOR=3.71, 95% CI=2.54–5.44), anterior vitrectomy (aOR=3.26, 95% CI=1.16–9.16), history of retinal detachment in the fellow eye (aOR=6.95, 95% CI=3.15–15.31), and intraoperative complications during cataract extraction (aOR=7.45, 95% CI=3.54–15.69). Conclusions This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health (AU)

Repetibilidad y comparabilidad de un nuevo tomógrafo con tecnología SS-OCT en biometría óptica / Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry

Objetivo Evaluar la reproducibilidad en la medición de los parámetros biométricos utilizando un nuevo biómetro por tomografía de coherencia óptica con fuente de barrido y compararlo con un biómetro por reflectometría óptica de baja coherencia. Diseño Estudio observacional, descriptivo, de corte transversal. Método Se incluyeron 45 ojos derechos de 45 pacientes, a los que se realizó tres mediciones consecutivas con el biómetro Anterion y una con el biómetro Lenstar LS900. Se recogieron las siguientes variables: longitud axial (AXL), profundidad de cámara anterior (ACD), K plana (K1), K curva (K2), grosor corneal central (CCT), grosor del cristalino (LT) y distancia blanco-blanco (WTW). Para evaluar la repetibilidad se calculó el coeficiente de Pearson «R» y la desviación estándar intrasujeto (Sw). Para evaluar la comparabilidad entre los biómetros se utilizó el coeficiente de correlación de concordancia (CCC) y el coeficiente de correlación intraclase (CCI). Además, se realizaron gráficos de Bland-Altman para cada variable. Resultados El coeficiente de Pearson fue excelente y estadísticamente significativo en la evaluación de la repetibilidad para todas las variables. Los valores más altos fueron 0,987 (AXL), 0,983 (CCT) y 0,942 (ACD). No hubo diferencias estadísticamente significativas entre las repetidas mediciones con Anterion para todas las variables. Los valores de CCC y CCI fueron excelentes en la evaluación de las variables AXL, CCT y ACD, y fueron altos para las variables K1, K2, LT y WTW. Conclusiones La realización de una biometría óptica ocular con el biómetro SS-OCT Anterion es un procedimiento reproducible y comparable con el biómetro Lenstar LS900 (AU)

Purpose To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. Design An observational, descriptive, cross-sectional study. Methods 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson «R» were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland–Altman plot was performed for each variable. Results The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. Conclusions Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900 (AU)

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Repeatability and comparability of a new swept-source optical coherence tomographer in optical biometry.

PURPOSE: To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence reflectometry biometer. DESIGN: An observational, descriptive, cross-sectional study. METHODS: 45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson "R" were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland-Altman plot was performed for each variable. RESULTS: The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW. CONCLUSIONS: Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900.

Quistes secundarios de iris / Secondary Iris Cysts

Los quistes epiteliales del iris o de cámara anterior son una rara y grave complicación tras la cirugía o traumatismos penetrantes del segmento anterior del ojo. Son secundarios a la invasión epitelial de la cámara anterior. Se ha descrito una incidencia de 0,09-0,12 por ciento, aunque estudios histopatológicos en ojos enucleados, tras cirugía de cataratas señalan una incidencia del 16 por ciento. Frecuentemente evolucionan hacia un aumento progresivo de tamaño y la producción de complicaciones visuales como glaucoma (de ángulo abierto por liberación de contenido mucoso del quiste, o cerrado), uveítis, descompensación corneal y membranas retrocorneales. Se presenta el caso de un paciente masculino de 61 años de edad, que acude a consulta tras una cirugía de dos meses de evolución, en la que se le realizó una cirugía combinada de catarata y glaucoma Al examen en lámpara de hendidura le son detectados varios quistes retroiridianos(AU)

Iris epithelial or anterior chamber cysts are a rare and serious complication following surgery or penetrating trauma to the anterior segment of the eye. They are secondary to epithelial invasion of the anterior chamber. An incidence of 0.09-0.12 percent has been described, although histopathological studies in enucleated eyes after cataract surgery indicate an incidence of 16 percent. They frequently evolve towards a progressive increase in size and the production of visual complications such as glaucoma (open angle due to the release of mucous content of the cyst, or closed), uveitis, corneal decompensation and retrocorneal membranes. We present the case of a 61-year-old male patient, who came to the clinic after a two-month surgery, in which he underwent a combined cataract and glaucoma surgery(AU)

Límites de la precisión en el resultado refractivo tras la cirugía de cataratas / Limits of the precision in refractive results after cataract surgery

Antecedentes y objetivo Para mejorar los resultados refractivos en cirugía de cataratas con implante de lente intraocular es importante conocer las fuentes de error, así como el límite de mejora de dicho proceso. Por tanto, el objetivo del presente trabajo es aproximar el límite teórico en la precisión en el resultado refractivo tras cirugía de cataratas con los medios disponibles en la actualidad y valorar el impacto de distintas fuentes de error en dicho proceso. Materiales y métodos Realizamos una búsqueda de la bibliografía para determinar la variabilidad aportada por cada componente del proceso. Tomando como base la fórmula de Barrett Universal-II realizamos un análisis de propagación de errores. El límite teórico fue definido como la situación en la que el resultado refractivo únicamente está afectado por la variabilidad en los parámetros introducidos en la fórmula, la tolerancia de la lente intraocular y la refracción subjetiva. Resultados Los principales contribuidores al error fueron: 1. La variabilidad intraoperatoria y postoperatoria, variables no consideradas por las fórmulas (49,33%). 2. La refracción subjetiva postoperatoria (38,29%). 3. La queratometría media (5,98%), y 4. la variabilidad en el etiquetado de la potencia de la lente intraocular (5,09%). El límite teórico obtenido para el cálculo de lente intraocular con los medios disponibles actualmente fue del 91,9% de los ojos entre + -0,50D. Conclusiones El límite teórico de la precisión es de 91,92% de los ojos entre + - 0,5D. Para aproximarnos al límite de precisión descrito en el estudio requiere de la utilización de biometría óptica y fórmulas de última generación, una técnica quirúrgica reproducible y la compensación de los errores sistemáticos mediante el ajuste de constantes (AU)

Background and objective In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. Materials and methods We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction Results The main contributors to the error were: 1. Intraoperative and postoperative variability variables not considered by the formulas (49.33%). 2. Postoperative subjective refraction (38.29%). 3. Mean keratometry (5.98%), and 4. the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between + -0.50D. Conclusions We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between + -0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants (AU)

Cirugía de catarata bilateral secuencia e inmediata / Immediate bilateral sequential cataract surgery

Propósito Existe una constante controversia entre la realización de la cirugía de la catarata de un ojo o de ambos ojos en la misma sesión quirúrgica. El objetivo de este estudio es revisar la evidencia científica sobre eficacia y seguridad, valorar la reducción de costes de la cirugía de catarata bilateral simultánea en el mismo día en comparación con la cirugía de la catarata secuencial en 2tiempos, así como comparar la tasa de complicaciones asociadas. Métodos Se ha hecho una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre cirugía de catarata bilateral secuencial desde el año 2000 hasta el 31 de diciembre de 2020. Resultados La literatura revisada muestra evidencias sólidas que demuestran la eficacia y seguridad de la cirugía de la catarata bilateral simultánea cuando se han seguido protocolos muy estrictos de esterilidad entre la cirugía de cada ojo. Bajo estas condiciones, en los estudios no se ha encontrado una mayor tasa de complicaciones postoperatorias que en la cirugía de catarata secuencial en 2tiempos. Conclusiones Existe evidencia sustancial de que la cirugía de catarata bilateral simultánea es una adecuada opción quirúrgica para la resolución de la catarata, que provoca una rápida rehabilitación visual y sin mayor número de complicaciones que la cirugía secuencial en 2tiempos cuando se extreman los protocolos de esterilidad entre los procedimientos de ambos ojos. Además, proporciona una reducción en el gasto sanitario. Existe un miedo psicológico a la realización de la cirugía bilateral por el potencial riesgo de complicaciones que afectaría a los 2ojos operados. Dentro del presente artículo discutimos la eficacia, seguridad, tasa de complicaciones y costes asociados en la cirugía de catarata bilateral simultánea en el mismo acto quirúrgico (AU)

Purpose There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. Methods A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. Results Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. Conclusions Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act (AU)

Limits of the precision in refractive results after cataract surgery.

BACKGROUND AND OBJECTIVE: In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. MATERIALS AND METHODS: We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction. RESULTS: The main contributors to the error were (1) intraoperative and postoperative variability variables not considered by the formulas (49.33%), (2) postoperative subjective refraction (38.29%), (3) mean keratometry (5.98%) and (4) the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between ±0.50D. CONCLUSIONS: We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between ±0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants.

Immediate bilateral sequential cataract surgery.

PURPOSE: There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. METHODS: A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. RESULTS: Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. CONCLUSIONS: Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act.

Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery.

OBJECTIVE: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS: An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS: There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS: Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Evidencia en la prevención de la recurrencia de queratitis por herpes simple y herpes zóster tras cirugía ocular / Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery

Propósito: La queratitis herpética, ya sea por herpes simple (HSK) o por herpes zóster oftálmico (HZO) puede presentar recaídas tras la cirugía ocular. Se postula como necesaria una profilaxis para evitarla. El objetivo de este estudio es revisar la evidencia científica sobre los métodos preventivos empleados en el período perioperatorio en pacientes previamente afectados de HSK/HZO.MétodosSe ha realizado una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre profilaxis y riesgo de recurrencia de HSK/HZO en pacientes sometidos a cirugía ocular hasta el 31 de diciembre de 2019.ResultadosHay pruebas sólidas de que la profilaxis oral debe recomendarse tras una queratoplastia penetrante en pacientes que hayan sufrido previamente HSK/HZO. Para otros tipos de cirugías, la evidencia es menos convincente; sin embargo, debe considerarse un período latente de inactividad entre la enfermedad y la profilaxis oral.ConclusionesLa queratoplastia penetrante y lamelar, crosslinking corneal, cirugía de catarata y cirugía fotorrefractiva y fototerapéutica provocan una alteración del plexo nervioso sub-basal de la cornea. Debido al traumatismo quirúrgico, así como a la modulación de la respuesta inmunológica ocular causada por los esteroides aplicados en el postoperatorio, es posible inducir la reactivación de HSK/HZO, siendo en algunos casos común. Dentro del presente artículo discutimos la evidencia disponible para la profilaxis de HSK/HZO en cirugía ocular. Son necesarios estudios adicionales para definir el riesgo real de recurrencia de HSK/HZO después de cirugías oculares, particularmente en cirugía de catarata y para confirmar la eficacia de la profilaxis perioperatoria con antivíricos anti HSK/HZO (AU)

Objective: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.° Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.MethodsAn exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.ResultsThere is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.ConclusionsPenetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals (AU)

Citation network analysis of the various types of multifocal intraocular lenses.

BACKGROUND AND OBJECTIVE: The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. MATERIAL AND METHODS: The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens¼, «Bifocal intraocular lens¼, «Trifocal intraocular lens¼, «Diffractive intraocular lens¼, «Refractive intraocular lens¼, «Accommodative intraocular lens¼ and «Extended depth of focus intraocular lens¼, for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. RESULTS: A total of 1293 publications were found, with 11,730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens¼ by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. CONCLUSIONS: The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.

Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery.

PURPOSE: The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS: This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS: The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ±â€¯0.37 D in the transepithelial group and 0.53 ±â€¯0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ±â€¯0.71 in the transepithelial group and 0.68 ±â€¯0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group. CONCLUSIONS: Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas / Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Objetivo El objetivo del estudio fue comparar los resultados de las incisiones arcuatas (IA) intraestromales y transepiteliales para tratar el astigmatismo corneal en el momento de la cirugía de catarata asistida con láser de femtosegundo (FLACS). Método Este estudio retrospectivo incluyó 20 pacientes con astigmatismo corneal entre 0,70 y 2,00 dioptrías (D) que se sometieron a FLACS con IA intraestromales en un ojo e IA transepiteliales en el ojo adelfo. Los principales datos evaluados a los 2-3meses de seguimiento fueron la diferencia entre el cilindro corneal queratométrico preoperatorio y postoperatorio (Kcyl), el índice de corrección (IC) y el porcentaje de sobrecorrección. Resultados La diferencia media entre Kcyl preoperatorio y postoperatorio reveló un valor medio de 0,36±0,37D en el grupo transepitelial y 0,53±0,42D en el grupo intraestromal (p<0,001). El IC medio fue de 0,83±0,71 en el grupo transepitelial y de 0,68±0,29 en el grupo intraestromal (p=0,17). Cinco ojos (25%) tuvieron una sobrecorrección del astigmatismo en el grupo transepitelial y un ojo (5%) en el grupo intraestromal. Conclusiones Tanto las IA intraestromales como las IA transepiteliales mostraron potencial para la corrección de astigmatismo leve a moderado y parecen ser un procedimiento seguro. A pesar de que las IA transepiteliales presentaron un IC más alto, los resultados de las IA intraestromales fueron más predecibles (AU)

Purpose The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). Methods This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. Results The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group. Conclusions Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable (AU)

Citation network analysis of the various types of multifocal intraocular lenses. / Análisis de redes de citación sobre los diversos tipos de lentes intraoculares multifocales.

BACKGROUND AND OBJECTIVE: The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. MATERIAL AND METHODS: The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens¼, «Bifocal intraocular lens¼, «Trifocal intraocular lens¼, «Diffractive intraocular lens¼, «Refractive intraocular lens¼, «Accommodative intraocular lens¼ and «Extended depth of focus intraocular lens¼, for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. RESULTS: A total of 1293 publications were found, with 11730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens¼ by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. CONCLUSIONS: The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.