A Composite Risk Score for Capsule Complications Based on Data from the Swedish National Cataract Register: Relation to Surgery Volumes.

PURPOSE: To investigate case mix in relation to capsule complication, possible associations between case mix and operation volume, and change in case mix over time. DESIGN: Register-based study. PARTICIPANTS: Swedish patients who underwent cataract surgery between 2007 and 2016. METHODS: Demographics and data on ocular comorbidity, intraoperative difficulties, and capsule complications were registered from 2007 to 2016 and analyzed retrospectively in relation to coded data on individual surgeons' operation volume. Single factor analysis and logistic regression were performed, and a composite risk score was created. MAIN OUTCOME MEASURES: Risk of capsule complication, given as adjusted and composite odds ratio in relation to cataract surgery volume. RESULTS: Preoperative and intraoperative variables significantly associated with capsule complications were best-corrected visual acuity (BCVA) ≤0.1 (decimal, adjusted odds ratio [aOR], 1.82; P < 0.001); pseudoexfoliation (PEX) (aOR, 1.53; P < 0.001); sight-threatening ocular comorbidity other than age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, or cornea guttata (aOR, 1.35; P = 0.006); use of Trypan blue (aOR, 1.76; P < 0.001); mechanical pupil dilation (aOR, 1.36; P = 0.024); and iris hooks at the rhexis margin (aOR, 6.99; P < 0.001). The composite risk score was 3.09 ± 6.40 (mean ± standard deviation) for patients with capsule complication and 1.28 ± 1.66 for uncomplicated procedures (P < 0.001). High-volume cataract surgeons (≥500 procedures yearly) had a significantly lower composite risk score (mean risk score ≤1.28; range, 1.01-2.02) compared with low- and medium-volume cataract surgeons (1.34 ± 0.56; range, 1.00-4.55 and 1.49 ± 0.58; range, 1.01-5.19), respectively. During the period 2007-2016, the proportion of patients aged >88 years, patients with BCVA ≤0.1, and patients with intraoperative difficulties decreased. CONCLUSIONS: Case mix, as calculated from a composite risk score based on preoperative and intraoperative parameters registered in the National Cataract Register (NCR), may contribute to the decrease in capsule complications from 2007 to 2016 and the lower complication rate observed in cases managed by high-volume cataract surgeons.

Clinical practice preferences for glaucoma surgery in Japan: a survey of Japan Glaucoma Society specialists.

PURPOSE: This study evaluated the surgical practice patterns of glaucoma management followed by glaucoma specialists in Japan. METHODS: A survey was administered to 50 glaucoma specialists who were councilors in the Japan Glaucoma Society about surgical preferences and postoperative glaucoma care. RESULTS: All 50 glaucoma specialists participated in the survey. Results show that, in 2019, compared to conventional trabeculotomy (4.6%), the frequency of minimally invasive glaucoma surgery (MIGS), combined with phacoemulsification, remarkably increased (79.0%) for non-operated eyes with mild open-angle glaucoma associated with cataract. Tube-shunt surgery was performed more often for open-angle glaucoma with previously twice failed trabeculectomy (65.8%) and neovascular glaucoma with previously once failed trabeculectomy (63.4%). In addition, during one year post-operatively, MIGS required less frequent follow-up visits compared to filtering surgery. CONCLUSION: Although glaucoma specialists in the Japan Glaucoma Society usually prefer trabeculectomy, in the past decade they have selected tube-shunt surgery more often to treat refractory glaucoma. MIGS is increasing remarkably as the choice primary glaucoma surgery.

Risk Factors for Intraocular Lens Dislocation After Phacoemulsification: A Nationwide Population-Based Cohort Study.

PURPOSE: Few studies have measured the incidence and risk factors of intraocular lens (IOL) dislocation in the total population. We investigate the risk factors for IOL dislocation in a nationwide Korean cohort. DESIGN: Retrospective cohort study. METHODS: National data on 2,162,191 subjects who underwent cataract surgery were collected from the Health Insurance Review and Assessment service database of health claims from 2009 to 2016. The Health Insurance Review and Assessment database was used to identify potential risk factors for IOL dislocation, including age, sex, and various pre- and postoperative ophthalmic conditions. The hazard ratios (HRs) and confidence intervals (CIs) of these risk factors were assessed with a multivariable-adjusted Cox regression model. RESULTS: IOL dislocation occurred in 15,170 patients (0.7%) in the cataract surgery cohort (2,162,191 patients). The incidence rate of IOL dislocation peaked at 40-50 years of age, although the mean age of IOL dislocation was 65.25 ± 10.81 years. The average male:female ratio was 1.8. The adjusted HR for IOL dislocation in patients with partial vitrectomy was 11.93 (95% CI 10.95-12.99; P < .0001). Posterior capsulotomy performed within 1 year after the cataract surgery significantly decreased IOL dislocation, with an adjusted HR of 0.48 (95% CI 0.44-0.51; P < .0001). CONCLUSIONS: IOL dislocation tended to occur in young males. Anterior vitrectomy was a significant risk factor for IOL dislocation, while posterior capsulotomy after surgery was associated with a decreased risk of IOL dislocation.

Anticoagulation and cataract surgery.

AIM: To assess the impact of anticoagulation on patients having cataract surgery. METHODS: Patients who underwent cataract surgery with phacoemulsification and intraocular lens insertion between 1 January 2015 and 31 December 2015 at Christchurch Hospital were identified and retrospectively audited. The outcome measures were the occurrence of intraoperative and postoperative haemorrhage, and thromboembolic events within two weeks after surgery. A control group was included to assess the outcome measures in a sample of patients who were not on anticoagulants or antiplatelets. RESULTS: Forty-four anticoagulated patients (46 eyes) and 41 controls (46 eyes) were identified. Seventy-four percent of those anticoagulated were on warfarin and 26% were on dabigatran. The incidence of haemorrhagic complications was 18%, 25% and 11% in the warfarin, dabigatran and control groups, respectively, although these differences were not statistically significant. Apart from one vitreous haemorrhage, which may have been present preoperatively, the haemorrhages that occurred were minor and not visually significant. No thromboembolic events were noted in any of the groups. CONCLUSION: There is no statistically significant increase in haemorrhagic complications in cataract surgery patients who were on warfarin or dabigatran. Therefore, continuing the anticoagulation in this setting may be appropriate.

Predictors of patient compliance with follow-up visits after cataract surgery.

PURPOSE: To identify patient characteristics associated with follow-up compliance and to draw implications for better cataract treatment services. SETTING: Aravind Eye Hospital, Madurai, India. DESIGN: Retrospective case study. METHODS: The data of all cataract surgeries performed in 2015 were analyzed. After each surgery, patients were asked to return for follow-up after 1 month. The follow-up rates were compared between patients with different demographic characteristics, surgical factors, and preoperative and discharge visual acuities. The behaviors of patients who complied with the follow-up advice were analyzed, including the number of days from surgery to follow-up and number of follow-up visits. Multivariate regression models were used to identify predictors associated with these behaviors. RESULTS: The overall follow-up rate for the 86 776 surgeries analyzed was 85.6%. Patients more likely to follow-up were women, younger than 70 years, and paying (versus subsidized or free) and had phacoemulsification rather than manual small-incision cataract surgery (all P < .001). Patients who had complications, reoperations, or poorer visual acuity at discharge were less likely to comply with the follow-up advice (P < .001). CONCLUSIONS: Targeted interventions to boost follow-up rates should be directed to patients with the characteristics found in this study. Furthermore, average measures of visual outcomes at 4 weeks are likely to be overstated relative to the truth.

Incidence of posterior capsular opacification requiring Nd:YAG capsulotomy after cataract surgery and implantation of enVista® MX60 IOL.

PURPOSE: To evaluate incidence of posterior capsule opacification requiring Nd:YAG capsulotomy over 3 years in a large series of eyes implanted with the enVista® MX60 Intraocular Lens (IOL). METHODS: A university-based, single-center, observational study of patients' medical records was conducted. Uneventful cataract surgery patients with in-the-bag implantations of the enVista® MX60 IOL with a minimum of 24 months follow-up were included in the study. Exclusion criteria were insufficient follow-up (<24 months), intraoperative complications and combined surgery. The primary outcome measure was rate of YAG laser capsulotomy, while secondary outcome measures were time to YAG laser capsulotomy and rate of glistenings. RESULTS: A total of 245 eyes of 143 patients received the MX60 IOL and were followed in the same center. Of these, 226 eyes were included in the study. Mean age was 80.7±8.3 years and M/F ratio was 42/101 (29.4/70.6%). The mean preoperative distance (logMAR) visual acuity was 0.67±0.5, while postoperatively it was 0.31±0.5 and 0.32±0.5 at the last visit. The Mean±SD follow-up time (min-max) was 35.2±7.2, (24-48.4) months. The incidence of Nd:YAG capsulotomy over 3 years was 5/226 (2.2%). Average time between surgery and Nd:YAG capsulotomy was 32.17 months. Univariate analysis of age, gender, presence of comorbidity and baseline visual acuity found no predictive factors for capsulotomy. No glistenings were reported at any postoperative visit. CONCLUSION: The three-year cumulative incidence of PCO requiring Nd:YAG laser capsulotomy was 2.2% for the enVista® MX-60 IOL, with no glistenings observed during follow-up. This low rate confirms the excellent safety profile of this IOL.

Corneal Astigmatism in cataract surgery candidates / Astigmatismo Corneano em candidatos à cirurgia de catarata

Abstract Purpose: To report the prevalence and analyse corneal astigmatism patterns in cataract surgery candidates. Methods: Researchers examined 2136 eyes from 1204 patients for cataract surgery from 1 January to 31 December 2016. All the candidates were evaluated with partial coherence interferometry (IOLMaster). The results were analysed statistically in relation to qualitative and quantitative variables. Results: The mean age of the patients was 71.9 years with a female predominance. Mean corneal astigmatism was 1.0 dioptre (D). Against the rule (ATR) astigmatism increased with age. Women presented with steeper corneas than men. In those patients who had both eyes measured, we found strong correlations between amount of right and left eye astigmatism, axis and keratometry. Overall, 39% of the eyes had corneal astigmatism > 1.00 D and 19% >1.50 D. Conclusions: A significant percentage of our population presents with corneal astigmatism > 1.00 D with a shift from WTR (with the rule) to ATR with increasing age. Our findings, in a population that has never been described before, will be helpful to surgeons to enhance surgical techniques, patients to improve visual outcomes, IOL (intraocular lens) manufacturers to make better designs and health agents to optimise resources.

Resumo Objetivo: Relatar a prevalência e analisar os padrões de astigmatismo corneano em candidatos à cirurgia de catarata. Métodos: Os pesquisadores examinaram 2136 olhos de 1204 pacientes a cirurgia de catarata de 1 de janeiro a 31 de dezembro de 2016. Todos os candidatos foram avaliados com interferometria de coerência parcial (IOLMaster). Os resultados foram analisados estatisticamente em relação às variáveis qualitativa e quantitativa. Resultados: A média de idade dos pacientes foi de 71,9 anos, com predomínio do sexo feminino. A média de astigmatismo corneano foi de 1,0 dioptria (D). Contra a regra (ATR), o astigmatismo aumentou com a idade. As mulheres apresentaram córneas mais íngremes que os homens. Nos pacientes que tiveram os dois olhos medidos, encontramos fortes correlações entre quantidade de astigmatismo nos olhos direito e esquerdo, eixo e ceratometria. No geral, 39% dos olhos tinham astigmatismo corneano >1,00 D, e 19% > 1,50 D. Conclusões: Uma percentagem significativa da nossa população apresenta astigmatismo corneano >1,00, D com uma mudança de WTR (a favor da regra) para ATR (contra a regra) com o aumento da idade. Nossas descobertas em uma população que nunca foi descrita antes serão úteis para os cirurgiões melhorarem suas técnicas cirúrgicas, os pacientes melhorarem seus resultados visuais, os fabricantes de LIOs (lentes intraoculares) criarem projetos melhores, e os agentes de saúde otimizarem os recursos.

Perfil epidemiológico do paciente submetido ao mutirão de catarata / Epidemiological profile of the patient undergoing cataract surgery

Resumo Objetivo: Avaliar a eficácia do mutirão de cirurgia de catarata realizado em um município, em 2017, visando o incremento na produção de cirurgias de catarata e a redução da prevalência de catarata na população. Métodos: Trata-se de um estudo observacional, descritivo, transversal e retrospectivo a partir da análise de dados do mutirão de catarata desenvolvida, no ano de 2017, por intermédio de informações de registros obtidas junto ao Sistema de Informação Ambulatorial (SIA/SUS) e o Sistema de Informação Hospitalar (SIH/SUS), concomitante com a Secretaria de Saúde de Itajubá. Foram realizadas análises estatísticas de acordo com características da amostra e considerado p-valor. Resultados: No estudo, observou-se que a significativa demanda regional por cirurgias de catarata, com destaque para a Fundação Hilton Rocha em Belo Horizonte, com 2030 no total. Na Santa Casa, foram atendidos 538 pacientes, em que todos estes realizaram o exame de ceratometria, 269 fizeram a biometria e o mapeamento de retina em ambos os olhos e por fim 195 pessoas fizeram a cirurgia de catarata do olho direito e 193 do olho esquerdo, totalizando 388 cirurgias. Sendo que 54% da demanda foi agendada. Em uma Clínica Especializada Assistência Médica, foram atendidos 446 pacientes, em que todos estes realizaram o exame de ceratometria, 352 fizeram a biometria do olho direito e 387 do olho esquerdo, 321 realizaram o mapeamento de retina do olho direito e 376 do olho esquerdo e por fim 200 pessoas fizeram a cirurgia de catarata do olho direito e 200 do olho esquerdo, totalizando 400 cirurgias. Conclusão: Os dados vão de encontro com a amostragem do presente estudo, já que foi possível perceber a grande demanda por cirurgias de catarata nas diferentes regiões e o grande impacto que o mutirão realizou na cidade, melhorando a qualidade de vida das pessoas. Dessa forma, o mutirão realizado foi de extrema importância, uma vez que com a cirurgia, evita-se que o quadro de catarata evolua para uma perda total da visão.

Abstract Objective: To evaluate the efficacy of cataract surgery performed in the city in 2017, aiming to increase the production of cataract surgeries and reduce the prevalence of cataract in the population. Methods: This is an observational, descriptive, cross-sectional and retrospective study based on the data analysis of the cataract mutirão developed in Itajubá, in the year 2017, through information from records obtained from the Outpatient Information System (SIA / SUS) and the Hospital Information System (SIH / SUS), concomitant with the Health Department. Statistical analyzes were performed according to sample characteristics and considered p-value. Results: In the study, there was a significant regional demand for cataract surgeries, especially the Hilton Rocha Foundation in Belo Horizonte, with 2030 in total. At Santa Casa, 538 patients were seen, all of whom underwent keratometry, 269 did the biometry and the retinal mapping in both eyes and finally 195 people underwent cataract surgery of the right eye and 193 of the left eye, totaling 388 surgeries. Being that 54% of the demand was scheduled. At the Specialized Medical Assistance Clinic, 446 patients were attended, all of whom performed the keratometry exam, 352 did the right eye biometrics and 387 left eye examinations, 321 performed the right eye retinal mapping and 376 of the left eye and finally 200 people underwent cataract surgery of the right eye and 200 of the left eye, totaling 400 surgeries. Conclusion: The data are in agreement with the sample of the present study, since it was possible to perceive the great demand for cataract surgeries in the different regions and the great impact that the collective mobilization for cataract surgery carried out in the city, improving the quality of life of the people. Thus, the effort made was extremely important, since with surgery, it is avoided that the cataract situation evolves into a total loss of vision.

Changes of intraocular pressure after cataract surgery in myopic and emmetropic patients.

To investigate the intraocular pressure (IOP) changes after cataract surgery, and its relationship with refractive conditions.IOP after phacoemulsification with intraocular lens (IOL) implantation was retrospectively reviewed. Patients were classified into 3 groups by refractive conditions: emmetropia, mild to moderate myopia, and high myopia. Basic information was collected including age, sex, place of IOL, and operating surgeon, with IOP and refractive conditions measured before surgery, and 1, 7, 30, and 90 days after surgery.The study comprised 353 eyes from 353 patients, of which 175 were emmetropia, 130 were mild to moderate myopia, and 48 were high myopia. A lower IOP than baseline was observed at 7, 30, and 90 days after surgery in emmetropic and mild to moderate myopia, while in high myopia, IOP was instable from 1 to 30 days, and reduced only in 90 days after surgery. Changes of IOP was more significant from 1 to 7 days in emmetropic and mild to moderate myopic patients, but from 30 to 90 days in high myopia. Patients over 75 showed a lower IOP at each follow-up than patients younger and female showed a higher baseline IOP than male. Different surgeons might influence the IOP fluctuation at first 90 days but not the final IOP.All patients with different refractive conditions showed a remarkably lower IOP at 90 days after cataract surgery. However, high myopia lowered the speed of IOP reduction, which might be explained by the anatomical changes of eye structure.

A Database Study of Visual Outcomes and Intraoperative Complications of Postvitrectomy Cataract Surgery.

PURPOSE: To analyze the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV). DESIGN: Retrospective, multicenter database study. PARTICIPANTS: Eyes that underwent phacoemulsification between June 2005 and March 2015 at 8 sites in the United Kingdom. METHODS: Study eyes were classified as vitrectomized (prior PPV group) or nonvitrectomized (reference group) depending on the vitreous state at the time of cataract surgery. Eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification were excluded. MAIN OUTCOME MEASURES: Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), rate of intraoperative complications, and time interval to cataract surgery. RESULTS: Eyes in the prior PPV group (n = 2221) had worse preoperative logMAR VA (0.96±0.60 vs. 0.62±0.52, P < 0.0001), were from younger patients, and had longer axial lengths than the nonvitrectomized group (n = 136 533). At all postoperative time points measured up to 24 weeks, mean vision was poorer in the prior PPV group (0.41±0.47 vs. 0.17±0.29 at 4-12 weeks, P < 0.0001) and a smaller proportion of eyes achieved postoperative VA ≤0.30 logMAR (Snellen, ≥20/40) (60.8% vs. 86.5% at 4-12 weeks, P < 0.0001). The rate of posterior capsular rupture was not different between the prior PPV (1.5%) and the nonvitrectomized (1.7%) groups, but the incidences of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragments (0.6% vs. 0.2%) were higher in the prior PPV group (P < 0.0001). The mean time interval between PPV and cataract surgery was 399 days. CONCLUSIONS: We found a significant improvement in VA with postvitrectomy cataract surgery. However, compared with eyes without prior PPV, there was a worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture.

Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomised controlled trial.

AIMS: To test a hypothesis that cataract operating room (OR) productivity can be improved with a femtosecond laser (FL) using a hub-and-spoke model and whether any increase in productivity can offset additional costs relating to the FL. METHODS: 400 eyes of 400 patients were enrolled in a randomised-controlled trial comparing FL-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS). 299 of 400 operations were performed on designated high-volume theatre lists (FLACS=134, CPS=165), where a hub-and-spoke FLACS model (1×FL, 2×ORs=2:1) was compared with independent CPS theatre lists. Details of operative timings and OR utilisation were recorded. Differences in productivity between hub-and-spoke FLACS and CPS sessions were compared using an economic model including testing hypothetical 3:1 and 4:1 models. RESULTS: The duration of the operation itself was 12.04±4.89 min for FLACS compared with CPS of 14.54±6.1 min (P<0.001). Total patient time in the OR was reduced from 23.39±6.89 min with CPS to 20.34±5.82 min with FLACS (P<0.001)(reduction of 3.05 min per case). There was no difference in OR turnaround time between the models. Average number of patients treated per theatre list was 9 for FLACS and 8 for CPS. OR utilisation was 92.08% for FLACS and 95.83% for CPS (P<0.001). Using a previously established economic model, the FLACS service cost £144.60 more than CPS per case. This difference would be £131 and £125 for 3:1 and 4:1 models, respectively. CONCLUSION: The FLACS hub-and-spoke model was significantly faster than CPS, with patients spending less time in the OR. This enabled an improvement in productivity, but insufficient to meaningfully offset the additional costs relating to FLACS.

[Cost of teaching cataract surgery in a public hospital]. / Évaluation du coût de l'enseignement de la chirurgie de la cataracte dans un établissement public de santé.

INTRODUCTION: The gold standard of cataract surgery, phacoemulsification is the most commonly performed surgical procedure in France. Surgical instruction often takes place in the operating room where residents and fellows perform real surgery, supervised by an experienced surgeon. The goals of this study were double: evaluate surgical times according to the person performing the surgery, in order to quantitate the cost incurred by teaching and compare complication rate between surgeons. METHODS: A retrospective single center study was performed at Simone-Veil Hospital, Eaubonne-Montmorency, France. Over a period of 13 consecutive weeks from January to March 2016, all patients who underwent phacoemulsification for cataract extraction were included. Patients were separated into three groups, according to the primary surgeon: group S for Senior was composed of two experienced surgeons who typically performed over 500 procedures per year; group A for assistant was composed of three residents who performed less than 500 procedures per year; 2 inexperienced interns constituted group I. Surgery duration was recorded by the OR nurse in minutes between the first incision and removal of the lid speculum. The cost of operating room time was estimated at seven euros per minute. The occurrence of complications was determined from the operative report. RESULTS: 408 cataract surgeries were performed during the study period, divided into 156 eyes in group S, 142 in group A and 110 surgeries in group I. The mean age at surgery was 74.1±9 years (39-95), comparable in the 3 groups. The operative time was significantly shorter in group S (11.7min) than in A (18.7min; P<0.001) and in I (18.8min; P<0.001). The complication rate was higher in group I than in group S (P=0.03). The average additional cost related to the lengthening of the teaching procedure was 49 euros for Group A and 49.7 euros for Group I. DISCUSSION: The hospital reimbursement for cataract surgery is higher in the public sector than in the private sector; it can absorb the cost of university training. CONCLUSION: Teaching cataract surgery entails an additional financial cost for the hospital. It is also responsible for a higher human cost due to a greater number of operative complications with interns.

Comparison of characteristics of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorrhexis: A meta-analysis of 5-year results.

OBJECTIVE: To perform a meta-analysis on the precision and safety of femtosecond laser-assisted anterior capsulotomy versus conventional manual continuous curvilinear capsulorrhexis. METHODS: This meta-analysis was conducted from February 2010 to November 2014. Literature search on PubMed, Google Scholar, ExcerptaMedica database and Cochrane Library was done to identify randomised controlled trials and case-control studies. SPSS 20 was used for data analysis. RESULTS: Of the 10 articles included, there were 3(30%) randomised controlled trials and 7(70%) non-randomised controlled trials. The meta-analysis was based on a total of 2,882eyes. Of them, 1,498(51.97%) underwent femtosecond laser-assisted capsulotomy and 1,384(48.02%) underwent manual continuous curvilinear capsulorrhexis. The diameter of the capsulotomy and the rates of anterior capsule tear showed no statistical difference between the femtosecond laser group and the manual capsulorrhexis group (p=0.29 and p=0.68). In terms of circularity of capsulotomy, femtosecond laser group had a more significant advantage than the manual capsulorrhexis group (p<0.001). CONCLUSIONS: Femtosecond laser performed capsulotomy with more precision and higher reliability than the manual continuous curvilinear capsulorrhexis.

Análisis cualitativo de ampollas de filtración reparadas mediante tomografía de coherencia óptica de segmento anterior / Qualitative analysis of repaired filtering blebs with anterior segment-optical coherence tomography

Objetivo: Realizar un análisis cualitativo de las ampollas de filtración que han sido reparadas quirúrgicamente por presentar Seidel tardío. Métodos: Estudio de 10 ampollas de filtración que requirieron reparación quirúrgica mediante la OCT-SA Triton (Topcon(R)). Se analizó, a los 6 meses de la cirugía, el patrón morfológico y las estructuras internas de las mismas, así como el estado del recubrimiento. La obtención de las imágenes fue mediante longitudes de onda de 1.050 nm. Resultados: Según la clasificación de Hirooka, encontramos 3 patrones diferentes en la morfología de la ampolla que pudimos relacionar con la funcionalidad de la misma. En un 70% de los casos el recubrimiento fue completo, presentando quistes subepiteliales difusos (tipo quístico). Dos casos mostraron una retracción conjuntival completa, sin cobertura por Tenon. Las paredes estaban adelgazadas, mostrando una desestructuración de la ampolla (patrón difuso). En un tercer grupo, la imagen obtenida mostraba una retracción conjuntival parcial con cobertura por Tenon. Presentaba algún quiste subepitelial difuso y con paredes siguiendo un patrón laminar. Conclusión: Mediante la OCT-SA es posible estudiar de forma detallada las características de la ampolla y las de su cobertura en el caso de reparación con avance conjuntival por Seidel tardío. Permite visualizar precozmente la retracción de la conjuntiva que en la lámpara de hendidura no sería visible y predecir mediante la morfología de la ampolla la funcionalidad de la misma (AU)

Objective: To provide a qualitative analysis of filtering blebs after being surgically repaired due to late blebs leaks. Methods: Blebs were studied 6 months after surgical reparation using AS-OCT Triton (Topcon(R)). An analysis was made of the morphological pattern and internal structures of blebs, including the covering, in 10 patients. The images were obtained using OCTs at a wavelength of 1050 nm. Results: According to the Hirooka classification, three different patterns were found in the structure of blebs, which made it possible to correlate them with their functionality. A full covering was observed in 70% of the cases, and they showed sub-epithelial cysts (cystoid pattern). Two cases showed a full conjunctival retraction without Tenon's covering. The walls were thin, with a de-structured bleb (diffuse pattern) being visualised. In the third group, the image showed a partial conjunctival retraction with Tenon's covering. There were some sub-epithelial diffuse cysts with walls following a laminar pattern. Conclusion: Using AS-OCT, it is possible to study the bleb's characteristics in detail, as well as the cover, in the case of blebs requiring repair due to late leaks, using conjunctival advancement. It allows for the early visualisation of conjunctival retractions that were not visible in a slit lamp, and to predict the functionality of the blebs by their morphology (AU)

Estudio prospectivo de las ampollas de filtración poscirugía de implante XEN45 / Prospective study of filtering blebs after XEN45 surgery

Objetivo: Analizar cualitativamente la evolución de las ampollas de filtración mediante tomografía de coherencia óptica de segmento anterior (OCT-SA) en pacientes con implante XEN45. Métodos: Estudio prospectivo de las ampollas de filtración de 30 ojos operados de catarata y glaucoma mediante facoemulsificación e implantación XEN45 (FACO-XEN). Se realizó OCT-SA analizando la morfología y la reflectividad de la ampolla al mes 3, 6 y 12 postoperatorio. La funcionalidad se estudió considerando una presión intraocular (PIO) ≤ 18mm Hg sin medicación hipotensora. Resultados: La PIO permitió clasificar las ampollas en no funcionales: planas (6,67%) y encapsuladas (3,33%) y funcionales (90%), las cuales dividimos según su morfología en quísticas (5/27), difusas (2/27) y laminar o en capas (20/27). Las quísticas presentaron una PIO media de 12,8, 12,6 y 14,0 mm Hg a los 3, 6 y 12 meses respectivamente. En las difusas la PIO media fue 13,0, 11,5 y 13,0 mm Hg a los 3, 6 y 12 meses respectivamente. En las de patrón en capas la PIO media fue 14,45, 14,55 y 14,8 mm Hg a los 3, 6 y 12 meses respectivamente. El porcentaje de ampollas con alta reflectividad fue de 48,15%, 62,96% y 77,78% a los 3, 6 y 12 meses, con una PIO media de 14,23, 14,59 y 15,14mmHg en cada período, respectivamente. Conclusión: El análisis de OCT-SA podría ser un buen predictor de la funcionalidad de la ampollas en la cirugía FACO-XEN. Aquellas quísticas o con menor reflectividad parecen tener mejor éxito postoperatorio. Pese a ello, se requieren estudios a mayor largo plazo (AU)

Objective: To qualitatively analyse the evolution of filtering blebs after XEN surgery, by using anterior segment optical coherence tomography (AS-OCT). Methods: A prospective study was performed on filtering blebs of 30 eyes with cataracts and glaucoma, surgically operated on using phacoemulsification and XEN45 implantation (PHACO-XEN). AS-OCT was used to analyse bleb morphology and reflectivity at 3, 6, and 12 months after surgery. Functionality was studied considering an intraocular pressure (IOP) ≤ 18 mm Hg without antihypertensive medication. Results: The IOP enabled the blebs to be classified into non-functional: flat (6.67%) and encapsulated (3.33%); and functional (90%), which were then divide by their morphology into cystic (5/27), diffuse (2/27), and layered (20/27). Cystic types had a mean IOP of 12.8, 12.6, and 14.0 mm Hg at 3, 6 and 12 months, respectively. In the diffuse type, the mean IOP was 13.0, 11.5 and 13.0 mm Hg at 3, 6 and 12 months, respectively. In the layers pattern the mean IOP was 14.45, 14.55 and 14.8 mm Hg at 3, 6 and 12 months respectively. The percentage of blebs with high reflectivity was 48.15%, 62.96%, and 77.78%, at 3, 6 and 12 months, with a mean IOP of 14.23, 14.59, and 15.14mmHg in each time period, respectively. Conclusion: AS-OCT could be a good predictor of bleb functionality in PHACO-XEN surgery. Those with a cystic pattern or low reflectivity seem to have better post-operative success. Nevertheless, more long-term studies are required (AU)

Eficacia del SENSIMED Triggerfish (R) para el seguimiento postoperatorio de la cirugía combinada FACO-ExPRESS / Efficacy of the SENSIMED Triggerfish(R) in the postoperative follow-up of PHACO-ExPRESS combined surgery

Objetivo: Estudiar la utilidad del sistema SENSIMED Triggerfish(R) en el control postoperatorio de la cirugía combinada de facoemulsificación e implante ExPRESS (FACO-ExPRESS) en pacientes con catarata y glaucoma primario de ángulo abierto (GPAA) con un seguimiento de 2 meses: Métodos Estudio prospectivo de 15 ojos intervenidos de cirugía combinada FACO-ExPRESS. Utilizando el sistema SENSIMED Triggerfish (R) (Sensimed AG, Lausanne, Suiza) se realizaron 2 registros de los patrones circadianos de la presión intraocular (PIO), uno previa y otro posterior a la cirugía. Se registró la agudeza visual mejor corregida, comorbilidades, PIO previa y de los días 7-30-60 poscirugía, medicamentos hipotensores y complicaciones. Resultados: La muestra final fue de 12 ojos. La agudeza visual mejor corregida (escala Log MAR) media preoperatoria fue 0,5 ± 0,2 y poscirugía 0,4 ± 0,1 (p = 0,02). La PIO media previa fue de 18,7 ± 3,8 mm Hg con 2,9 ± 0,7 fármacos. La PIO media en los días 7, 30 y 60 descendió a 13 ± 4,1mmHg (p = 0,002), 13,5 ± 2 mm Hg (p=0,001) y 13,9 ± 2,5 mm Hg (p=0,001) respectivamente. Las amplitudes de las curvas circadianas cambiaron significativamente entre antes y después de la cirugía (p = 0,007). Los valores medios de los periodos diurno y nocturno disminuyeron significativamente de 146,8 ± 80,9mVeq y 61,2 ± 92mVeq precirugía a 36,4 ± 36mVeq (p=0,000) y -23,2 ± 47,6mVeq (p = 0,014) poscirugía, respectivamente. Un paciente presentó complicaciones. Conclusiones: El sistema de monitorización SENSIMED Triggerfish(R) mostró cambios en los patrones circadianos, así como disminución de las amplitudes medias de las curvas tras la técnica combinada FACO-ExPRESS, lo que sugiere que este sistema puede convertirse en una herramienta útil para el seguimiento postoperatorio del GPAA (AU)

Objective: To determine the usefulness of the SENSIMED Triggerfish(R) system in the postoperative control of combined phacoemulsification and ExPRESS implant (PHACO-ExPRESS) surgery in patients with cataract and chronic open angle glaucoma (COAG) during a 2 months follow-up. Methods: A prospective study conducted on 15 eyes that were subjected to PHACO-ExPRESS combined surgery. Using the SENSIMED Triggerfish (R) system, two records of the circadian patterns of intraocular pressure (IOP) were performed, one before and one after surgery. A record was made of the best corrected visual acuity (BCVA), comorbidities, previous IOP, and 7-30-60 days after surgery, as well as any hypotensive drugs and complications. Results: The final sample was 12 eyes. The mean pre-operative BCVA (log MAR chart) before surgery was 0.5 ± 0.2, and after surgery 0.14 ± 0.1 (P = .02). The previous IOP was 18.7 ± 3.8mmHg with 2.9 ± 0.7 drugs. The mean IOP at 7, 30, and 60 days after surgery decreased to 13±4.1mmHg (P =.002), 13.5 ± 2mmHg (P =.001), and 13.9 ± 2.5mmHg (P =.001), respectively. The amplitudes of the circadian curves changed significantly after surgery (P =.007). The mean values between daytime and night-time periods decreased significantly from 146.8 ± 80.9 mVeq and 61.2±92.mVeq before surgery to 36.4 ± 36 mVeq (P =.000), and -23,2 ± 47.6mVeq (P =.014) after surgery, respectively. There were complications in one patient. Conclusions: The SENSIMED Triggerfish® monitoring system showed changes in the curves of the circadian patterns, as well as decreased mean amplitudes after the combined PHACO-ExPRESS technique, suggesting that it may become a useful tool for postoperative follow-up of COAG (AU)

Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012.

PURPOSE:: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. METHODS:: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. RESULTS:: This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). CONCLUSIONS:: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.

Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012 / Resultado da facoemulsificação em pacientes com uveíte em um centro terciário em São Paulo, Brasil: revisão de casos de 2007 a 2012

ABSTRACT Purpose: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. Methods: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. Results: This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). Conclusions: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.

RESUMO Objetivos: Avaliar os resultados da facoemulsificação com implante de lente intraocular em olhos com uveíte. Métodos: Foram incluídos pacientes consecutivos com catarata e uveíte, submetidos a facoemulsificação com implante de lente intraocular acrílica no período de 2007 a 2012, onde avaliou-se resultados visuais, etiologia e complicações. A inflamação estava quiescente por pelo menos três meses e foi usado prednisona oral (0,5 mg/kg/dia) em pacientes com uveíte não infecciosa. Resultados: Este estudo incluiu 45 olhos de 38 pacientes com idade media de 52±12.5 anos. As etiologias mais frequentes, entre as causas não-infecciosas (n=32; 73,3%), foram doença de Vogt-Koyanagi-Harada (n=9), idiopáticas (n=4), iridociclite heterocrômica de Fuchs (n=4) e oftalmia simpática (n=3). Entre as causas infecciosas (n=13; 28,9%), as mais frequentes foram toxoplamose (n=6) e tuberculose ocular presumida (n=4). Uma lente de acrílico foi implantada no saco capsular em todos os casos. Com um ano de seguimento, 38 olhos (84,4%) melhoraram 2 ou mais linhas; 28 olhos (62,2%) atingiram uma acuidade visual pós-operatória de 0,5 ou melhor. Opacidade de cápsula posterior foi observada em 10 olhos (22,2%). Inflamação pós-operatória persistente (>6 meses) foi observada em 7 olhos (15,5%) e a recorrência ocorreu em 4 olhos (8,8%). Houve necessidade de explante da lente em um olho. Hipertensão intraocular foi observada em 6 olhos (13,3%). Conclusões: Facoemulsificação com implante de lente intraocular melhorou a visão na maioria dos pacientes com catarata e uveíte. O controle adequado pré e pós-operatório da inflamação desempenha um papel reconhecidamente importante para obtenção de bons resultados visuais. O resultado visual final depende de alterações prévias do segmento posterior.