Optical coherence tomography as a diagnostic intervention before cataract surgery-a review.

The purpose of this study was to perform a systematic review of existing literature on OCT screening before cataract surgery. Available literature was evaluated and projections on how it could be applied to enhance postoperative outcomes of cataract surgery were summarised. The PubMed, Embase and Cochrane databases were searched for articles pertaining to preoperative OCT screening. Selected articles were qualitatively and quantitatively analysed. Across 9 studies, the addition of OCT macular screening resulted in preoperative detection of macular pathology in 13.7% of eyes that were determined to be normal on fundoscopic examination alone. The types of macular pathology most frequently detected through preoperative OCT screening were interface abnormalities followed by macular degeneration. Comparative analysis of SS-OCT biometer and SD-OCT found that SS-OCT had a sensitivity of 0.48-0.81 in the detection of macular pathology in eyes with pathology diagnosed by SD-OCT. OCT screening prior to cataract surgery results in the detection of occult macular pathology that may influence postoperative visual outcomes in approximately 1 in 10 eyes (13.7%). As a result, OCT screening should be considered in the routine preoperative workup for cataract surgery.

Rapid Rehabilitation With Skin-Muscle Sparing Orbital Exenteration: A Single-Center Series.

AIMS: To examine the features and clinical management of patients who underwent skin-muscle sparing orbital exenteration in a tertiary referral center. PATIENTS AND METHOD: Retrospective case-note review for patients undergoing skin-muscle sparing orbital exenteration at Moorfields Eye Hospital between 1997 and 2012. Patient demographics, clinical features, histopathology, clearance, surgery, adjuvant therapy, and outcomes were analyzed. RESULTS: Seventy-four patients (33 male; 45%) had skin-muscle sparing orbital exenteration at a median age of 63.8 years (median 65.5, range 13-96 years) for malignancies primarily arising in the eyelids (34 cases; 46%), orbit (25 cases; 34%) or conjunctiva (15 cases; 20%). The commonest pathologies were sebaceous carcinoma (20 cases; 27%), melanoma (19 cases; 26%), squamous cell carcinoma (12 cases; 16%), and basal cell carcinoma (9 cases; 12%). The patients had very rapid rehabilitation with primary closure of skin-muscle flaps over the cavity, either directly (63/74 patients; 85%), or with addition of local flaps. Local radiotherapy had been given before exenteration to 18 (24%) patients, was administered after exenteration in 19 (26%) patients, and both before and after surgery in 5 (7%); those having postoperative radiotherapy were referred at 2-3 weeks after exenteration, and the initial prosthetics fitting was started at 3-6 weeks after surgery. Thirty-eight (51%) patients died during a follow-up of 1-164 months (mean 55, median 47 months); 20/38 (53%) died from metastases-although 9/20 had known metastatic disease prior to palliative exenteration. Three patients were alive with apparently inactive metastases at 30, 39, and 140 months after surgery. CONCLUSION: Direct closure of skin-and-muscle flaps is achievable in almost all undergoing orbital exenteration. In contrast to skin-grafting, free myocutaneous flaps or secondary intention healing, this allows early referral if adjunctive orbital radiotherapy is needed, and the initial fitting of prosthetics can be within weeks of surgery. The technique also avoids the much greater donor-site morbidity of other reconstructive techniques, such as local or free myocutaneous flaps.

Can simulators be applied to improve cataract surgery training: a systematic review.

OBJECTIVE: The purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed. METHODS AND ANALYSIS: The PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed. RESULTS: A total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Quality assessment of included studies was satisfactory. CONCLUSION: Current studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training.

Cataract surgery in eyes with congenital ocular coloboma.

PURPOSE: To assess the safety, efficacy, and complication rate of phacoemulsification and intraocular lens (IOL) implantation in patients with congenital uveal coloboma and to evaluate the role of pupilloplasty. METHODS: A retrospective review of 41 eyes (31 patients) with congenital coloboma that underwent phacoemulsification and IOL implantation between September 2012 and September 2018. Preoperative, intraoperative, and postoperative data were collected for analysis. RESULTS: The mean patient age at surgery was 53.9 years (range 15-82). The primary indication for surgery was cataract removal for visual improvement, and lens subluxation was additionally present in two eyes (5%) preoperatively. The mean preoperative corrected distance visual acuity (CDVA) was 0.90 LogMAR. Phacoemulsification surgery was performed in all cases and nine eyes (22%) had pupilloplasty for pupil reconstitution at the time of the procedure. Surgeon grade varied from trainee surgeon under supervision to consultant. Eight patients (19.5%) had posterior capsular rupture (PCR) with or without vitreous loss requiring anterior vitrectomy. Of these, 2 cases (5%) had dropped nuclear fragments requiring subsequent pars plana vitrectomy and lens fragment removal. The mean postoperative CDVA was 0.62 LogMAR (p = 0.0003). CONCLUSION: Patients with iridolenticular choroidal coloboma appear to be more at risk of complications, as were cases performed by non-consultant surgeons. Contrary, patients with phakodonesis, preoperative anterior chamber vitreous, dense cataracts, and cases were iris hooks used had no significant difference at PCR rate. The risk of postoperative glare and pupilloplasty needs to be considered in cases with good visual potential to avoid a possible second procedure.

Surgical efficiency in femtosecond laser cataract surgery compared with phacoemulsification cataract surgery: a case-control study.

OBJECTIVES: To investigate differences in surgical time, the distance the surgical instrument travelled and number of movements required to complete manual phacoemulsification cataract surgery versus femtosecond laser cataract surgery. DESIGN: Non-randomised comparative case series. SETTING: Single surgery site, Moorfields Eye Hospital, UK. PARTICIPANTS: 40 cataract surgeries of 40 patients. INTERVENTIONS: Laser-assisted and manual phacoemulsification cataract surgery. Laser-assisted surgery cases were performed using the AMO Catalys platform. PRIMARY AND SECONDARY OUTCOME MEASURES: Computer vision tracking software PhacoTracking were applied to the recordings to establish the distance the instrument travelled, total number of movements (the number of times an instrument stops and starts moving) and time taken for surgery steps including phacoemulsification, irrigation-aspiration (IA) and overall surgery time. The time taken for laser docking and delivery was not included in the analyses. RESULTS: Data on 19 laser-assisted and 19 manual phacoemulsification surgeries were analysed (two cases were excluded due to insufficient video-recording quality). There were no differences in the number of instrument moves, the distance the instrument travelled or time taken to complete the phacoemulsification stage. However for IA, the number of instrument moves (manual: mean 20 (SD 15) vs laser: mean 38 (SD 22), P=0.008) and time taken (manual: mean 75 s (SD 24) vs laser: mean 108 s (SD 36), P=0.003) were significantly greater for laser cases. For laser versus manual cases overall, there was no difference in number of moves or the distance the instrument travelled, but laser cases took longer (mean 88 s, P=0.049). CONCLUSIONS: Laser cataract surgery cases took longer to complete without accounting for the time taken to complete the laser procedure itself. This appears to be in part due to IA requiring more instrument manoeuvres and taking longer to complete. Data from a large randomised series would better elucidate this relationship.

Incidence of eyelid basal cell carcinoma in England: 2000-2010.

INTRODUCTION: Basal cell carcinomas (BCCs) are the most frequently diagnosed type of skin cancer, with eyelid (including canthus) BCCs accounting for a notable proportion of these. Using population-based data from the English Cancer Registries, we report here the incidence of eyelid BCCs in England, for the period 2000-2010. METHODS: ICD-10 and histology codes for eyelid BCCs (including canthus) from the English National Cancer Data Repository were used to identify incident events. Crude incidence rates by age and sex, together with directly standardised incidence rates for eyelid BCCs in England in 3-year cohorts, are presented, in keeping with the reporting practice of the English Cancer Registries. RESULTS: Over the 11-year study period, there were a total of 33 610 recorded eyelid BCCs; 18 146 in females and 15 464 in males. There were regional variations in registrations. Incidence of eyelid BCCs increased with age. No major change in the age-standardised incidence of BCC was observed during the period 2000-2010. Overall, the age-standardised incidence of BCCs during 2008-2010 was similar for males and females (4.51 per 100 000 (95% CI 4.37 to 4.65) and 4.53 per 100 000 (95% CI 4.40 to 4.67), respectively). However, females under 50 years of age had higher incidence rates, and males over 75 years of age had higher rates. CONCLUSIONS: The findings provide the current frequency and distribution of eyelid BCCs in England, highlighting opportunities for health education and improving reporting and registration of events, and for informing service planning.

Patient-reported outcome measuring tools in cataract surgery: Clinical comparison at a tertiary hospital.

PURPOSE: To assess the performance of patient-reported outcome measure questionnaires and determine their appropriateness for routine use in cataract patients. SETTING: Moorfields Eye Hospital, London, United Kingdom. DESIGN: Prospective cohort study. METHODS: Patients having cataract surgery between February and March 2013 were recruited. The following 4 questionnaires-Catquest-9SF, EuroQol 5-dimensions questionnaire (EQ-5D) and visual analog scale (EQ-VAS), National Eye Institute Socioemotional Scale (NEI-SES), and short-form Visual Function Index (VF-8R)-were completed preoperatively and 3 weeks and 3 months postoperatively. The questionnaires' performances were then compared. The paired Student t test and Pearson correlations were used for statistical analysis. RESULTS: One hundred twenty-two patients were recruited; 67.2% and 61.8% completed 3-week and 3-month follow-up, respectively. The changes in the mean scores for the Catquest-9SF, EQ-5D, EQ-VAS, NEI-SES, and VF-8R at 3 weeks were 120.86% (P < .0001), 1.61% (P = .61), 3.37% (P = .09), 16.12% (P = .12), and 61.76 % (P < .0001), respectively. At 3 months, the changes were 162.42% (P < .0001), 4.54% (P = .16), 4.84% (P = .09), 54.63% (P < .0001), and 87.55% (P < .0001), respectively. Correlations between patient-reported outcome measure questionnaires and visual acuity measures were variable and weak at best. CONCLUSIONS: It is feasible to assess patient-reported outcomes in cataract surgery as part of routine clinical practice. In addition, visual acuity might not fully reflect patients' visual function. Clinicians should consider using patient-reported outcome measure questionnaires to facilitate surgical decision-making and outcome monitoring. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.