One-Year Comparative Evaluation of iStent or iStent inject Implantation Combined with Cataract Surgery in a Single Center.

INTRODUCTION: This retrospective consecutive case series assessed 12-month effectiveness and safety of iStent® or iStent inject® trabecular micro-bypass implants with cataract surgery in patients with open-angle glaucoma (OAG) in a real-world clinical setting. METHODS: Effectiveness outcomes consisted of intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving IOP < 18, < 15, or < 12 mmHg; and proportional analysis of medication usage. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA). RESULTS: This evaluation included 58 eyes with OAG (35 iStent, 23 iStent inject), with 96.6% of eyes having mild or moderate glaucoma. Diagnoses included primary open-angle glaucoma (the majority; 72.4%), pseudoexfoliative glaucoma, and pigmentary glaucoma. Baseline mean IOP and medications were statistically comparable between groups: 16.1 ± 3.6 mmHg on a mean of 1.8 ± 0.8 medications in the iStent group, and 16.2 ± 3.1 mmHg on a mean of 1.7 ± 0.8 medications in the iStent inject group. Twelve months after stent-cataract surgery, mean IOP was significantly lower in the iStent inject group than in the iStent group (13.1 mmHg vs. 15.4 mmHg, respectively; p < 0.001), and the percent reduction in IOP from baseline was significantly greater in iStent inject eyes than in iStent eyes (19.1% vs. 4.3% reduction, respectively; p < 0.001). At 12 months postoperative, significantly greater proportions of iStent inject eyes than iStent eyes achieved IOP < 18 mmHg (100% vs. 80.0% of eyes, respectively; p = 0.035), IOP < 15 mmHg (73.9% vs. 34.3% of eyes, respectively; p = 0.003), and IOP < 12 mmHg (26.1% vs. 0% of eyes, respectively; p = 0.002). Meanwhile, both groups achieved significant medication reductions at 12 months vs. baseline (94.1% reduction in iStent inject eyes, p < 0.0001; and 72.2% reduction in iStent eyes, p < 0.0001), with the percent reduction being significantly greater in iStent inject eyes than in iStent eyes (p = 0.023). At 12 months, mean number of medications was significantly lower in iStent inject eyes than iStent eyes (0.1 vs. 0.5 medications, respectively; p = 0.021), and significantly more iStent inject eyes (95.7%) than iStent eyes (71.4%) were off medications entirely (p = 0.021). A similarly high safety profile was observed in both groups. CONCLUSION: iStent or iStent inject implantation with cataract surgery resulted in substantial and safe reductions in IOP and medications through 12 months postoperative. Consistent with prior observations, greater efficacy was observed with iStent inject than with iStent. FUNDING: The Rapid Service Fees were funded by Glaukos Corporation.

Factores de riesgo de la endoftalmitis posquirúrgica en la cirugía de catarata / Risk factors for postsurgical endophthalmitis in the cataract surgery

Objetivo: identificar factores de riesgo asociados a la endoftalmitis poscirugía de catarata. Métodos: se realizó un estudio retrospectivo-observacional analítico de caso-control de enero de 2011 a diciembre de 2013. Se incluyeron pacientes operados de cirugía de catarata. La muestra quedó conformada por 33 casos que sufrieron endoftalmitis posquirúrgica y los controles por 65 pacientes. La información se obtuvo de las hojas de trazabilidad quirúrgica y de la planilla de casos infectados del Instituto Cubano de Oftalmología Ramón Pando Ferrer.Resultados: el sexo masculino representó un riesgo mayor que el femenino (p= 0,014; OR= 2,91). La cirugía practicada en la estación de verano incrementó el riesgo de endoftalmitis (p= 0,000; OR= 9,91), así como un volumen quirúrgico mayor de 10 casos por posición (p= 0,000; OR = 27,8). La ruptura de cápsula posterior representó un riesgo mayor (p= 0,016; OR= 7,00). La técnica de Blumenthal resultó un riesgo mayor que la faco (p= 0,008; OR= 3,60). Otras variables como la edad, la diabetes mellitus y el tiempo quirúrgico, destacadas en otras series, no tuvieron significación estadística en este estudio. Conclusiones: el sexo masculino, el clima elevado y la técnica de Blumental representan un mayor riesgo en la aparición de la endoftalmitis posquirúrgica(AU)

Objective: to identify the risk factors associated to endophthalmitis after cataract surgery. Methods: case-control analytical observational and retrospective study conducted from January 2011 through December 2013, which included those patients operated on for cataract. The final sample was made up of 33 cases who suffered postsurgery endophthalmitis and 65 patients were included as controls. The information was collected from surgical traceability sheets and from the infected case forms at Ramon Pando Ferrer Cuban Institute of Ophthalmology.Results: males were at greater risk for the disease than females (p= 0,014; OR= 2,91). The surgery performed at summer time increased the risk of suffering endophthalmitis (p= 0,000; OR= 9,91) as well as a surgical volume over 10 cases per surgical position (p= 0,000; OR= 27,8). The posterior capsule rupture was the major risk (p= 0,016; OR=7,00). Blumenthal technique resulted in greater risk for endophthalmitis than the phaco technique (p= 0,008; OR= 3,60). Other variables such as age, diabetes mellitus and surgical time, which were remarkable in other case series, had no statistical significance in this study.Conclusions: males, the high climate and the Blumenthal technique represent a greater risk in the apparition of the postsurgery endophthalmitis(AU)

Factores de riesgo de la endoftalmitis posquirúrgica en la cirugía de catarata / Risk factors for postsurgical endophthalmitis in the cataract surgery

OBJETIVO: identificar factores de riesgo asociados a la endoftalmitis poscirugía de catarata. MÉTODOs: se realizó un estudio retrospectivo-observacional analítico de caso-control de enero de 2011 a diciembre de 2013. Se incluyeron pacientes operados de cirugía de catarata. La muestra quedó conformada por 33 casos que sufrieron endoftalmitis posquirúrgica y los controles por 65 pacientes. La información se obtuvo de las hojas de trazabilidad quirúrgica y de la planilla de casos infectados del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". RESULTADOS: el sexo masculino representó un riesgo mayor que el femenino (p= 0,014; OR= 2,91). La cirugía practicada en la estación de verano incrementó el riesgo de endoftalmitis (p= 0,000; OR= 9,91), así como un volumen quirúrgico mayor de 10 casos por posición (p= 0,000; OR = 27,8). La ruptura de cápsula posterior representó un riesgo mayor (p= 0,016; OR= 7,00). La técnica de Blumenthal resultó un riesgo mayor que la faco (p= 0,008; OR= 3,60). Otras variables como la edad, la diabetes mellitus y el tiempo quirúrgico, destacadas en otras series, no tuvieron significación estadística en este estudio. CONCLUSIONES: el sexo masculino, el clima elevado y la técnica de Blumental representan un mayor riesgo en la aparición de la endoftalmitis posquirúrgica.

OBJECTIVE: to identify the risk factors associated to endophthalmitis after cataract surgery. METHODS: case-control analytical observational and retrospective study conducted from January 2011 through December 2013, which included those patients operated on for cataract. The final sample was made up of 33 cases who suffered postsurgery endophthalmitis and 65 patients were included as controls. The information was collected from surgical traceability sheets and from the infected case forms at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. RESULTS: males were at greater risk for the disease than females (p= 0,014; OR= 2,91). The surgery performed at summer time increased the risk of suffering endophthalmitis (p= 0,000; OR= 9,91) as well as a surgical volume over 10 cases per surgical position (p= 0,000; OR= 27,8). The posterior capsule rupture was the major risk (p= 0,016; OR=7,00). Blumenthal technique resulted in greater risk for endophthalmitis than the phaco technique (p= 0,008; OR= 3,60). Other variables such as age, diabetes mellitus and surgical time, which were remarkable in other case series, had no statistical significance in this study. CONCLUSIONS: males, the high climate and the Blumenthal technique represent a greater risk in the apparition of the postsurgery endophthalmitis.

Prevalence of myopic shifts among patients seeking cataract surgery.

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.(AU)

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.(AU)

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.

Prevalence of myopic shifts among patients seeking cataract surgery. / Prevalence of myopic shifts among patients seeking cataract surgery.

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6

, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1

of subjects (95

CI: 30.8

-43.4

). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

[Assessment of clinical practice guidelines about cataract management]. / Evaluación de guías de práctica clínica sobre catarata.

PURPOSE: To evaluate the quality of clinical practice guidelines (CPG) about the management of cataract in adults. MATERIAL AND METHOD: A bibliographic search was carried out selecting the CPG based on the evidence or on the expert consensus, published since the year 2000. The guidelines selected were assessed with the AGREE Instrument. RESULTS: Six guidelines were assessed. Three were classified as "recommend with provisos or alterations" and the others "would not be recommended". In accordance with the AGREE Instrument criteria, no guidelines can be recommended for their use in the clinical practice if they were not modified previously.

Second eye cataract surgery: perceptions of a population assisted at a university hospital.

OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during an interview. RESULTS: Before surgery, 60.7% complained about visual impairment (moderate or marked); after surgery, 92.8% had no difficulty. Routine activities, mobility, and leisure activities were significantly altered after surgery (P =.001). CONCLUSION: According to the patients' perceptions, there was a significant reduction in visual difficulties after second eye cataract surgery.

Second eye cataract surgery: perceptions of a population assisted at a university hospital

OBJETIVO: Identificar dificuldades na vida diária percebidas por pacientes com catarata senil, antes e após a cirurgia de catarata no segundo olho. MÉTODOS: Estudo longitudinal prospectivo de 84 pacientes consecutivos atendidos por "Projeto Catarata", com acuidade visual maior ou igual a 20/30 no olho pseudofácico e menor ou igual a 20/40 with the best possible optical correction no olho com catarata. Aplicou-se questionário por entrevista. RESULTADOS: Antes da cirurgia 60,7% declararam dificuldade visual (média ou muita); após, 92,8% nenhuma dificuldade. Atividades rotineiras, de mobilidade e lazer alteraram-se significativamente após a cirurgia (p= 0,001). CONCLUSÃO: Na percepção dos pacientes, após a cirurgia de catarata do segundo olho houve redução importante das dificuldades visuais.

[Predictive value of preoperative fasting glucose test of diabetic patients regarding surgical outcome in cataract surgery]. / Valor preditivo da glicemia de jejum pré-operatória de pacientes diabéticos quanto ao resultado cirúrgico da cirurgia de catarata.

OBJECTIVE: To determinate the predictive value of preoperative glucose test of diabetic patients, with age above 40 years, for visual acuity outcome and clinical perioperative complications, in cataract surgery with local anesthesia, in an academical medical center. METHODS: Type 2 diabetic patients, above 40 years of age, indicated for cataract surgery between February 10, 2000 and January 10, 2001, at the State University of Campinas, São Paulo, Brazil. All patients had a preoperative medical assessment by a physician one week before surgery, and were submitted to serum fasting glucose test and 12-lead electrocardiogram. There was no delay in the surgeries of patients with abnormal serum glucose test results, so, the result of the test alone was not a reason to cancel the surgery. According to the glucose test, the patients were assigned to one of two groups: Normal Glucose Test Group (60-115 mg/dL) or Abnormal Glucose Test Group (>115 mg/dL). Postoperative best-corrected visual acuity and clinical perioperative complications were recorded on a standardized form. RESULTS: The sample consisted of 193 patients. 67 (34.7%) had a serum glucose test within normal limits (normal glucose test group) and 126 (65.3%) outside normal limits (abnormal glucose test group). The mean result of the "normal glucose test group" was 98.5+/-17.3 mg/dL and 166.5+/-48.9 mg/dL for the "abnormal glucose test group" (p<0.001). We observed perioperative complications in 21 (10.7%) patients, all arterial hypertension cases; 7 (10.5%) of these in patients with normal glucose test result and 14 (11.1%) in patients with abnormal result (p<0.888). The postoperative best-corrected visual acuity was similar in both groups. CONCLUSION: There was no influence of the preoperative serum glucose level on perioperative clinical complications or visual acuity outcome.

Valor preditivo da glicemia de jejum pré-operatória de pacientes diabéticos quanto ao resultado cirúrgico da cirurgia de catarata / Predictive value of preoperative fasting glucose test of diabetic patients regarding surgical outcome in cataract surgery

OBJETIVO: Determinar o valor preditivo do resultado da glicemia de jejum pré-operatória de pacientes diabéticos tipo 2, com idade superior a 40 anos, sobre a acuidade visual pós-operatória e a ocorrência de complicações clínicas peroperatórias, em facectomias sob anestesia local, num centro médico acadêmico. MÉTODOS: Foram analisados pacientes diabéticos tipo 2, maiores que 40 anos de idade, com facectomias indicadas entre 10 de fevereiro de 2000 e 10 de janeiro de 2001 em hospital universitário, cujo Serviço de Oftalmologia assiste a região em torno da cidade de Campinas, São Paulo, Brasil. Os pacientes foram avaliados por um clínico uma semana antes da cirurgia, além de realizarem os exames glicemia de jejum e eletrocardiograma. Os pacientes com resultados de glicemia de jejum anormal não tiveram as cirurgias postergadas, ou seja, o resultado do exame laboratorial, isoladamente, não foi considerado motivo para suspender a cirurgia. De acordo com o resultado da glicemia de jejum, o paciente era designado para um dos grupos: grupo de glicemia normal (60-115 mg/dL) e grupo de glicemia anormal (>115 mg/dL). Acuidade visual pós-operatória corrigida e complicações clínicas peroperatórias eram registradas em formulário padronizado. RESULTADOS: A amostra incluiu um total de 193 pacientes diabéticos tipo 2, desses 67 (34,7 por cento) tiveram o resultado da glicemia de jejum dentro dos limites normais (grupo glicemia normal) e 126 (65,3 por cento) fora destes limites (grupo glicemia anormal). A média do resultado da glicemia de jejum nos pacientes com glicemia normal foi de 98,5±17,3 mg/dL e a do grupo com glicemia anormal foi de 166,5± 48,9 mg/dL (p< 0,001). Ocorreram complicações intra-operatórias em 21 (10,7 por cento) pacientes, todos casos de hipertensão arterial. Desses, 7 (10,5 por cento) em pacientes com glicemia normal e 14 (11,1 por cento) pacientes com glicemia anormal (p<0,888). Não houve diferença estatisticamente significante, entre os grupos, em relação à acuidade visual pós-operatória corrigida. CONCLUSÕES: Não se observou influência da glicemia de jejum pré-operatória nas complicações clínicas intra-operatórias ou na acuidade visual final.

Cataract surgery: expectations of patients assisted during a community project in São Paulo, state of São Paulo, Brazil.

OBJECTIVE: To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY: Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye) aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São Paulo, Brazil, in 1999. RESULTS: The sample was composed of 331 subjects of low socioeconomic level ranging in age from 50 to 97 years (average = 71.8 years). Expectation of total recovery from the cataract condition by means of surgery was declared by 80.0% of the respondents, with no significant differences between male and female subjects (P < 0.1723). Hope to resume manual activities was expressed by 59.8%. CONCLUSION: A predominance of expectations of resuming normal activity and achieving a better quality of life after cataract surgery were identified.