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Published: 1 October 2021
Clinical Ophthalmology, pp 4259-4267; https://doi.org/10.2147/opth.s334425

Abstract:
Purpose: To study the current practices in Jordan regarding cataract surgical procedures and anesthesia trends for cataract surgery. Methods: A cross-sectional survey of members of the Jordanian Ophthalmology Society was conducted in October 2020. The questionnaire included questions about participants’ demographics, the preferred surgical techniques for cataracts, the preferred anesthesia technique for cataract surgery, the factors which affect the choice of anesthesia technique, the use of sedation, who gives the anesthesia, if there is an anesthesia-trained person who observes the patient during cataract surgery, and the changing trends towards anesthesia between the surgeons. Results: More than half of the respondents (59.1%) had been in practice for more than 5 years. The preferred method for routine cataract was phacoemulsification for most participants (98.4%). For mature cataract, phacoemulsification was the preferred method for 61.4% of participants. More than half (55.1%) used topical with intracameral anesthesia for phacoemulsification. Two thirds of the participants (66.3%) performed retrobulbar anesthesia for extracapsular cataract surgery. In the majority of cases (86.6%), the respondent themself is the one who administers the anesthesia. No sedation was used before surgery in 62.6% of cases. Two thirds of the respondents (70.1%) reported that they had an anesthesia-trained person monitoring the patient during surgery. Patient cooperation was the most important factor (70.9%) affecting the surgeon’s choice of anesthesia technique followed by surgeon skill and experience (57.5%). Conclusion: Presently, phacoemulsification is the preferred surgical technique for cataract in Jordan. Topical with intracameral anesthesia is the most common anesthesia for phacoemulsification while retrobulbar anesthesia is the most common for extracapsular cataract extraction.
Chang Rae Rho, Jin-Hyoung Kim, In Kwon Chung, Eun Chol Kim, Young Keun Han, Sang Youp Han, Youngsub Eom, Tae-Young Chung, Do-Hyung Lee
Korean Journal of Ophthalmology, Volume 35, pp 272-279; https://doi.org/10.3341/kjo.2020.0001

Abstract:
Purpose: To describe current cataract surgery practice patterns and trends among Korean ophthalmologists.Methods: A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys.Results: The largest percentage of respondents (39%) had 11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks.Conclusions: This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.
, Friedrich Lersch, Alfred W. Y. Chua, ,
Published: 3 February 2021
Eye, Volume 35, pp 1295-1304; https://doi.org/10.1038/s41433-021-01412-5

Abstract:
Sub-Tenon’s block (STB) is a good technique of local anaesthesia for many types of eye surgery. It has a relatively good risk profile, in that sight- and life-threatening complications appear to be extremely rare. STB has gained popularity in the last three decades, with refinements including different types of blunt metal cannula, plastic cannulae and ‘incisionless’ approaches. Usage of STB varies significantly across the globe. This narrative review documents the historical evolution of STB techniques, anatomical and physiological considerations, its utility and suitability, complications, explores the current practice and possible future applications.
, Bobak Bahrami, Lourens van Zyl, Adrian Esterman, Michael Goggin
Clinical & Experimental Ophthalmology, Volume 49, pp 25-37; https://doi.org/10.1111/ceo.13890

The publisher has not yet granted permission to display this abstract.
Muge Coban-Karatas, ,
Published: 1 October 2020
Eye, Volume 35, pp 1961-1966; https://doi.org/10.1038/s41433-020-01207-0

Abstract:
Background/objectives Standard sub-Tenon’s block (STB) involves incision (dissection) of conjunctiva and Tenon’s capsule with the help of blunt scissors and forceps, insertion of a blunt sub-Tenon’s cannula under the Tenon’s capsule and injection of local anaesthetic agent. STB is frequently associated with minor complications such as chemosis and postoperative subconjunctival haemorrhage but rare sight and life-threatening complications. To reduce these minor complications, several variations of incisionless STB have been described however, there are no comparative data. One such incisionless STB involves the use of lacrimal dilator which is easily available in the operating theatre. We compared incisionless lacrimal dilator-facilitated with the standard STB for effectiveness, chemosis, and postoperative subconjunctival haemorrhage. Subjects/methods After obtaining ethical approval, patients scheduled to undergo elective phacoemulsification cataract surgery were enroled to receive incisionless lacrimal dilator-facilitated STB (Group LD) or a standard STB using Wescott scissors and blunt forceps (Group WS). All patients received 3 mL 2% lidocaine without any adjuvant. No sedation was administered. Demographics of the patients, duration of the procedure, analgesia, akinesia, duration of the procedure intraoperative chemosis, and postoperative subconjunctival haemorrhage were compared. Results Both groups were comparable for demographic data, duration of the procedure, analgesia, and akinesia (p > 0.05). The severity of chemosis and postoperative subconjunctival haemorrhage were significantly lower in Group LD (n = 32) in comparison to Group WS (n = 31) (p < 0.001). Conclusions Incisionless lacrimal dilator-facilitated STB decreases intraoperative chemosis and postoperative conjunctival haemorrhage in comparison to standard STB. Analgesia and akinesia are comparable in both techniques.
Steve A. Arshinoff, Milad Modabber
Published: 21 May 2020
The publisher has not yet granted permission to display this abstract.
, Jie Zhang, Dipika V. Patel
Journal of the Royal Society of New Zealand, Volume 50, pp 245-262; https://doi.org/10.1080/03036758.2020.1714673

Abstract:
Cataract is the most common, reversible cause of visual impairment and blindness in the world. Cataract surgery in primitive form has been around for millennia but the last 50 years have witnessed a monumental revolution in cataract surgery making it the most common, and one of the most successful, operations world-wide. Major advances have included the development of phacoemulsification techniques, refinement of small incision approaches, foldable and injectable specialised intraocular lenses (IOLs), day-case local anaesthetic approaches and a better understanding of risks and benefits. Clinicians and scientists in New Zealand / Aotearoa have contributed significantly to the global knowledge of cataract surgery, including aspects of indications for surgery, assessment and use of specialised IOLs including aspheric, toric and secondary IOLs, effect of surgical techniques on corneal structure and performance, training of cataract surgeons, intraoperative and post-operative complications, strategies to minimise complications, and visual outcomes following phacoemulsification surgery. These studies also reveal disparities in health care, with the indigenous Māori population demonstrating more advanced cataract at an earlier age, associated with greater risk of intra-operative complications, yet accessing cataract services disproportionally less. This review highlights key research contributions from a New Zealand perspective, in the light of contemporary knowledge and practice.
Tarek Abdelrazek Hafez,
Published: 1 October 2019
Clinical Ophthalmology, pp 2111-2117; https://doi.org/10.2147/opth.s215229

Abstract:
Purpose: To assess spectacle independence and patient satisfaction with pseudophakic mini-monovision in patients undergoing routine bilateral cataract surgery with implantation of an aspherical aberration-free intraocular lens (Akreos AO, Bausch and Lomb, USA). Methods: This study was a retrospective analysis that included 60 eyes of 30 consecutive patients between 2016 and 2018. The included patients had undergone sequential bilateral routine phacoemulsification after choosing the mini-monovision option. Test for ocular dominance was done using a sighting test. Emmetropia was aimed at in the dominant eye, while in the non-dominant eye the aim was myopia between −1 D and −1.5 D. The main outcome parameters were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and data reported from a questionnaire given to the patients at 3 months postoperative visit. Results: The study included 60 eyes of 30 consecutive patients. The mean binocular UDVA was 0.09 ± 0.07 logMAR. Twenty-eight patients (93%) had binocular UDVA of 0.2 logMAR or better. The mean binocular uncorrected intermediate distance visual acuity (at 65 cm) was 0.16 ± 0.12 logMAR. Twenty-six patients (87%) had binocular uncorrected intermediate distance visual acuity of 0.2 logMAR or better. The mean binocular UNVA (at 35 cm) was 0.30 ± 0.21 logMAR. Fourteen patients (47%) had binocular UNVA of 0.2 logMAR or better. The patients score in the questionnaire was significantly higher in far and intermediate vision than near vision (p = 0.022). The patients score was significantly higher in day vision than night vision (p = 0.031). The mean overall patient satisfaction was good (9.1 ± 1.54). Twenty-eight patients (93%) reported high spectacle independence for far vision (score 8, 9, or 10). Conclusion: Pseudophakic mini-monovision shows good results for spectacle independence and high patient satisfaction. It is a safe and inexpensive option after bilateral cataract surgery for correcting distance and intermediate vision. However, it might show lower results with near and night vision which is generally acceptable. Using aberration-free monofocal IOL allows for the residual normal positive corneal aberration that may augment the effect of monovision.
, Hyung Keun Lee, Mee Kum Kim, Hong Kyun Kim, Sun Woong Kim, Eun Chul Kim,
Korean Journal of Ophthalmology, Volume 33, pp 451-457; https://doi.org/10.3341/kjo.2019.0064

Abstract:
To describe current cataract surgery practice patterns and changing trends among Korean ophthalmologists. A survey of members of the Korean Society of Cataract and Refractive Surgery was performed in July 2018. One hundred and two (12.7%) of 801 questionnaires were returned for analysis. The data were analyzed using descriptive statistics and compared with previous surveys. Most of the respondents (75%) had been in practice for 6 or more years and performed an average of 31 cataract surgeries per month. The preferred method for cataract surgery was phacoemulsification (95%); 5% used a femtosecond laser. The use of topical anesthesia markedly increased from 69% (2012) to 80% (2018). The use of optical biometry exceeded that of ultrasound A-scan biometry. A multifocal intraocular lens was used by 76% of the respondents compared with 44% of the respondents in 2012. Topical nonsteroidal anti-inflammatory drugs were used by 70% of the respondents postoperatively. Most (59%) of these anti-inflammatory drugs were prescribed for 4 weeks. This survey provided a comprehensive update of the present cataract surgery practices in the Republic of Korea. The results emphasized the increasing use of premium intraocular lenses, optical biometry, and topical anesthesia.
Yong Seng Tam, Chandra M Kumar, Kah Guan Au Eong, Chee Chew Yip, Jason Cheng
Annals of the Academy of Medicine, Singapore, Volume 47, pp 390-393; https://doi.org/10.47102/annals-acadmedsg.v47n9p390

, Akihito Igarashi, , , Masaki Sato, , Survey Working Group of the Japanese Society of Cataract and Refractive Surgery
Published: 1 September 2017
Journal of Refractive Surgery, Volume 33, pp 598-602; https://doi.org/10.3928/1081597x-20170621-01

Abstract:
PURPOSE: To retrospectively evaluate the current practice, trends, and outcomes of refractive surgery in Japan. METHODS: This multicenter survey comprised 78,248 eyes of 39,727 consecutive patients who underwent refractive surgery at 45 major institutions in Japan. The corresponding ophthalmologists responded to a selfadministered questionnaire. The authors especially evaluated the safety, efficacy, predictability, stability, and adverse events of LASIK and phakic intraocular lens (IOL) implantation 3 months postoperatively. RESULTS: The most common refractive surgery was LASIK (90.9%), followed by corneal inlay (5.0%), posterior chamber phakic IOL implantation (1.3%), laser-assisted subepithelial keratomileusis (1.0%), refractive lens exchange (0.9%), photorefractive keratectomy (0.3%), and refractive lenticule extraction (0.2%). For subgroup analysis, 69,987 eyes (99.5%) and 67,512 eyes (95.9%) achieved corrected and uncorrected distance visual acuity of 20/20 or better, respectively, after LASIK, and 935 eyes (98.8%) and 890 eyes (94.1%), respectively, after phakic IOL implantation. There were 69,176 eyes (98.3%) and 908 eyes (96.0%) within ±1.00 diopter (D) of the attempted correction after LASIK and phakic IOL implantation, respectively. There were 1,926 eyes (2.7%) and 1 eye (0.1%) with changes in refraction of 1.00 D or less from 1 week to 3 months after LASIK and phakic IOL implantation, respectively. No vision-threatening complications occurred in any case. CONCLUSIONS: According to this survey, LASIK remains the most prevalent surgical technique in Japan. Both LASIK and phakic IOL implantation offered good safety and efficacy outcomes, yielding predictable and stable results. [J Refract Surg. 2017;33(9):598–602.]
, Akihito Igarashi, , , Masaki Sato,
American Journal of Ophthalmology, Volume 175, pp 159-168; https://doi.org/10.1016/j.ajo.2016.12.009

Abstract:
To assess the clinical outcomes of currently used refractive surgery procedures performed in 2015. Prospective, multicenter cohort study. This prospective study included 15 011 eyes of 7622 consecutive patients who underwent laser in situ keratomileusis (LASIK), surface ablation, refractive lenticule extraction (ReLEx), or phakic intraocular lens (IOL) implantation at 42 major institutions. We determined the safety, efficacy, predictability, stability, and adverse events of these surgeries preoperatively and at 1 week and 1 and 3 months postoperatively. Mean logMAR corrected distance visual acuity 3 months after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, or iris-supported phakic IOL implantation was -0.18 ± 0.07, -0.16 ± 0.08, -0.17 ± 0.09, -0.21 ± 0.08, and -0.10 ± 0.12, respectively; the corresponding values for logMAR uncorrected distance visual acuity were -0.15 ± 0.11, -0.12 ± 0.12, -0.12 ± 0.13, -0.15 ± 0.12, and 0.01 ± 0.21, respectively. The percentages within ±1.0 diopter (D) of the attempted correction were 96%, 93%, 97%, 99%, and 84% after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, and iris-supported phakic IOL implantation, respectively. Refractive change from 1 week to 3 months was -0.08 ± 0.07, 0.21 ± 0.63, -0.04 ± 0.41, 0.01 ± 0.31, and 0.01 ± 0.46 D, respectively. No vision-threatening complications occurred during the observation period. Although more prolonged follow-up is still necessary, currently used refractive surgery procedures have good safety and efficacy outcomes, yielding predictable and stable results. Contemporary LASIK, surface ablation, ReLEx, and phakic IOL implantation appear to be feasible options for the treatment of refractive errors.
, Annalisa Dragoni, Giampaolo Orsolini, , Alfredo Beccasio, , Amedeo Moretti,
Published: 13 January 2017
Current Eye Research, Volume 42, pp 847-851; https://doi.org/10.1080/02713683.2016.1256414

Abstract:
Purpose: To assess aqueous humor antimicrobial activity in vitro after topical 0.5% chloramphenicol application. Materials and methods: This investigation included 63 eyes from 65 cataract surgery patients. The study group of 48 eyes received preoperatively four topical applications of 0.5% chloramphenicol. The control group of 15 eyes was given no topical applications. Aqueous humor samples were collected for in vitro antimicrobial analysis using Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Pasteurella multocida organisms by means of disk diffusion test. Results: No inhibition halo was observed around all aqueous humor samples from all chloramphenicol-treated patients, irrespective of the sample quantity added to the paper disks, with no significant difference from aqueous humor from untreated control patients. Conclusions: Aqueous humor displayed no bactericidal effect against any of the microorganisms evaluated after topical 0.5% chloramphenicol application.
Catriona Hamer, Hetal Buckhurst, Christine Purslow, Gary L Shum, Nabil E Habib,
Clinical and Experimental Optometry, Volume 99, pp 583-589; https://doi.org/10.1111/cxo.12329

Abstract:
When considering MSE alone IOLMaster, Pentacam, OPD scan and Medmont may be considered interchangeable; however, assessment of astigmatism shows greater variability between instruments, sessions and observers.
, Per Flesner, Jens Andresen, Ditte Erngaard, Britta Tendal, Jesper Hjortdal
Published: 16 March 2015
Acta Ophthalmologica, Volume 93, pp 303-317; https://doi.org/10.1111/aos.12684

The publisher has not yet granted permission to display this abstract.
, Soichiro Ogawa, , Koichi Yoshimura
Published: 1 February 2015
American Journal of Ophthalmology, Volume 159, pp 232-240; https://doi.org/10.1016/j.ajo.2014.10.023

Abstract:
To compare binocular visual function of pseudophakic patients having modified monovision (0.75 diopter [D] anisometropia) with that of patients having conventional monovision (1.75 D anisometropia).Prospective observational study.Eighty-two patients that underwent bilateral implantation of a monofocal intraocular lens were recruited at 3 months postoperatively. Modified monovision was simulated by adding a +0.75 D spherical lens to the nondominant eye, while conventional monovision was simulated by adding a +1.75 D spherical lens. Binocular corrected visual acuity (VA) at various distances, binocular contrast VA (contrast VA) and that with glare (glare VA), and stereoacuity were evaluated.With modified monovision, mean binocular corrected intermediate VA at 1.0 m was 20/19 and near VA at 0.3 m was 20/51, and stereoacuity was 125 ± 100 seconds of arc. Mean binocular intermediate VA at 1.0 m was significantly better with modified monovision than with conventional monovision (P = .0001), while near VA and intermediate VA at 0.5 m were significantly worse (P < .0001). Mean binocular photopic and mesopic contrast VA and glare VA tended to be better with modified monovision than with conventional monovision, but the difference was not significant. Mean stereoacuity was significantly better with modified monovision than with conventional monovision (P = .0020).Modified pseudophakic monovision provided excellent binocular VA from far to intermediate distances, although near VA was worse than that with conventional monovision. Contrast VA with and without glare tended to be better and stereoacuity was significantly better with modified monovision, suggesting that this method is useful for correcting presbyopia without marked impairment of binocular function.
P. Huang, L. Gopal,
Published: 1 February 2014
British Journal of Anaesthesia, Volume 112, pp 381-382; https://doi.org/10.1093/bja/aet556

Abstract:
Editor—Sub-Tenon's block is an established simple, safe, and effective local anaesthetic technique for routine cataract surgery.1 The technique involves insertion of a blunt cannula and injection of local anaesthetic agent under the Tenon's capsule after dissection with the help of scissors and forceps. The technique is inherently associated with intraoperative subconjunctival haemorrhage due to dissection and is reported to range from 25% to 100%.2,3 Although subconjunctival haemorrhage is not known to hinder or influence the outcome of surgery,2 most eyes intraoperatively appear red after sub-Tenon's block4 compared with mostly white looking eyes after topical anaesthesia as there is no injection involved. This technique is popular in Australia,5 New Zealand,6 and the UK7 but not so popular in many parts of the world probably due to unknown fear of postoperative red looking eyes.
, Adeola O Onakoya, Bola G Balogun, Olugbemisola Oworu
Middle East African Journal of Ophthalmology, Volume 20, pp 341-4; https://doi.org/10.4103/0974-9233.120022

Abstract:
Purpose: To assess the current techniques of ophthalmic anesthesia in Nigeria. Materials and Methods: A cross sectional survey among Nigerian ophthalmology delegates attending the 36 th Annual Scientific Congress of the Ophthalmology Society of Nigeria. Self administered and anonymous questionnaires were used and data were collected to include details of the institution, preferred local anesthesia techniques, the grade of doctor who administers the local anesthesia, complications, preferred facial block techniques (if given separately), and type of premedication (if used). Results: Out of the 120 questionnaires distributed, 81 forms were completed (response rate 67.5%). Out of the 74 who indicated their grade, 49 (66.2%) were consultants, 22 (29.7%) were trainees, and 3 (7.1%) were ophthalmic medical officers. For cataract surgery, peribulbar anesthesia was performed by 49.1% of the respondents, followed by retrobulbar anesthesia (39.7%). Others techniques used were topical anesthesia (5.2%), subtenon anesthesia (4.3%), subconjunctival anesthesia (2.6%), and intracameral anesthesia (0.9%). For glaucoma surgery, 47.2% of the respondents use peribulbar anesthesia, 32.1% use retrobulbar anesthesia, 9.4% used general anesthesia, and 6.6% used subconjunctival anesthesia. Among the trainees, 57.8% routinely perform retrobulbar anesthesia while 55.6% routinely perform peribulbar anesthesia. At least one complication from retrobulbar anesthesia within 12 months prior to the audit was reported by 25.9% of the respondents. Similarly, 16.1% of the respondents had experienced complications from peribulbar anesthesia within the same time period. Retrobulbar hemorrhage is the most common complication experienced with both peribulbar and retrobulbar anesthesia. Conclusion: Presently, the most common technique of local anesthesia for an ophthalmic procedure in Nigeria is peribulbar anesthesia, followed by retrobulbar anesthesia. Twelve months prior to the study, 25.9% of the respondents had experienced at least one complication from retrobulbar anesthesia and 16.1% from peribulbar anesthesia. Retrobulbar hemorrhage was the most common complication reported.
Kumiko Tanaka, Koji Kakisu, Tomoko Okabe, Shinichiro Kobayakawa, Tetsuo Tochikubo
Published: 11 May 2012
Current Eye Research, Volume 37, pp 471-478; https://doi.org/10.3109/02713683.2011.648254

Abstract:
Purpose: The aim of this study is to evaluate the calcification and membrane formation in different intraocular lenses (IOLs) models by implanting the IOLs in the subcutaneous plane of a Rabbit model. Design: Experimental study. Methods: IOLs were implanted subcutaneously in 13 Japanese albino rabbits for 1 month (n = 6), 3 months (n = 4) and 6 months (n = 3). Five kinds of IOLs were used, including three hydrophobic acrylic IOLs, the MA60AC (Alcon), ZA9003 (AMO) and X-60 (Santen), and two hydrophilic acrylic IOLs, the HP60M and MI60 (Bausch & Lomb). Scanning electron microscopy was used to observe the IOL optics. Energy dispersive x-ray spectroscopy and infrared spectroscopy were used to analyse any surface depositions on the optics, and the modulation transfer function was applied to evaluate the optical performance. Results: Membrane formation was noted to have occurred on the surfaces of the two hydrophobic acrylic IOLs (MA60AC and ZA9003) during the investigation period. The membrane components originated from a serum protein that most likely would be serum albumin. Calcification was noted to have occurred on the surfaces of the two hydrophilic IOLs. However, no calcification was observed on the hydrophobic IOLs, nor was there any membrane formation on the hydrophilic IOLs. The values for the MI60 were not measurable at all at 3 or 6 months. The values of the three hydrophobic IOLs were significantly better than the value for the HP60M at three and six months (p< 0.01). Conclusion: Calcification to the hydrophilic IOLs severely affected optical performance, whereas, membrane formation on the hydrophobic IOLs did not affect optical performance. The X-60 had the optics that best maintained long-term transparency.
Sebastiano Serrao, , Pietro Ducoli,
Journal of Cataract and Refractive Surgery, Volume 37, pp 1655-1666; https://doi.org/10.1016/j.jcrs.2011.03.046

Abstract:
To analyze the higher-order corneal wavefront aberration during an 8-year follow-up after photorefractive keratectomy (PRK). IRCCS Fondazione G.B. Bietti, Rome, Italy. Case series. Patients having PRK using the Technolas 217C excimer laser platform were divided into 3 groups according to the preoperative refraction as follows: low myopia, high myopia, and astigmatism. The preoperative and 1-, 4-, 6-, and 8-year postoperative root mean square (RMS) values of coma, spherical aberration, and total higher-order aberrations (HOAs) were calculated with 3.5 mm and 6.0 mm simulated pupils. The mean preoperative and postoperative higher-order corneal wavefront aberration maps, point-spread functions, and radial modulation transfer functions (MTFs) were represented to describe the impact of PRK on the optical quality of the anterior cornea. The study enrolled 33 patients (66 eyes). Corneal spherical aberration was statistically significantly higher after PRK for simple myopia with 3.5 mm and 6.0 mm pupils (P<.05). The postoperative increase in coma was statistically significant in the high-myopia group with both pupil sizes (P<.05). Total RMS HOAs increased postoperatively with a 6.0 mm pupil in all groups (P<.05). The mean radial MTF was almost stable in all groups between preoperatively and postoperatively. Higher-order corneal wavefront aberrations stabilized 1 year after PRK to treat myopia or myopic astigmatism. The effect of induced corneal HOAs tended to increase after correction of high myopia with large pupils, although without degrading the image optical quality of the cornea over the long term.
N. Tanabe, K. Go, Y. Sakurada, M. Imasawa, F. Mabuchi, T. Chiba, K. Abe, K. Kashiwagi
Methods of Information in Medicine, Volume 50, pp 427-434; https://doi.org/10.3414/me10-01-0064

Abstract:
SummaryObjectives: To develop a remote-operating slit lamp microscope system (the remote slit lamp) as the core for highly specialized ophthalmology diagnoses, and to compare the utility of this system with the conventional slit lamp microscope system (the conventional slit lamp) in making a diagnosis.Methods: The remote slit lamp system was developed. Three factors were evaluated in comparison to the conventional slit lamp. The ability to acquire skills was investigated using a task loading system among specialists and residents in ophthalmology. Participants repeated a task up to ten times and the time required for each task was analyzed. The consistency of the two systems in making a diagnosis was investigated using eyes of patients with ocular diseases as well as healthy volunteers.Results: The remote slit lamp is composed of a patient’s unit and ophthalmologist’s unit connected by high-speed internet. The two units share images acquired by the slit lamp in addition to the images and voices of patients and ophthalmologists. Both ophthalmology specialists and residents could minimize the completion times after several trials. The remote slit lamp took more time than the conventional slit lamp. Both systems showed a high consistency in evaluations among eyes with healthy eyes or those with ocular diseases.Conclusions: The remote slit lamp has a similar diagnostic ability, but required more examination time in comparison to the conventional slit lamp. The currently developed remote slit lamp has the potential to be employed for telemedicine purposes in the field of ophthalmology.
, Arash Mazouri, Mercede Majdi-N, Mahmoud Jabbarvand, Hadi Z-Mehrjardi, Hassan Hashemi
Middle East African Journal of Ophthalmology, Volume 18, pp 173-7; https://doi.org/10.4103/0974-9233.80709

Abstract:
Purpose : To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran.Materials and Methods : Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients (405 eyes) in 2006 and 125 patients (153 eyes) in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P <0.05 was considered statistically significant.Results : The phacoemulsification rate increased from 25% to greater than 90% between 2003 and 2006, rates of corneal incisions and use of foldable intraocular lenses tripled, administration of general anesthesia dropped from 80% to 12%, the outpatient admission rate rose from 5.2% to 71%, 4% vs. 66% of the operations were performed by a senior phacoemulsification surgeon and the number of advanced surgeons changed from 6% to 38% (all P-values < 0.001). In 2006, more patients at the two extremes of age, more patients with poor systemic conditions and myopes underwent surgery (all P-values < 0.05); the cataract surgery volume increased by 49% and post-operative visual acuity improved (P = 0.03) while patient satisfaction was unchanged.Conclusion : We objectively documented the transition in cataract surgery technique to phacoemulsification at the Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill.
, Jianhe Xiao, Caihui Jiang
Published: 1 January 2011
Indian Journal of Ophthalmology, Volume 59, pp 481-5; https://doi.org/10.4103/0301-4738.86318

Abstract:
There are few studies on pseudophakic monovision even though it is widely applied. We reviewed the published literature on pseudophakic monovision. Surgeons select patients who not only have a strong desire to be free of glasses after surgery, but also fully understand monovision design and its drawbacks. However, other criteria adopted for pseudophakic monovision are very different. Both traditional monovision and cross monovision are used in pseudophakic monovision, and the target binocular anisometropia ranges from -1.0 D to -2.75 D. Postoperative results were acceptable in every study and most patients were satisfied, with vision being improved and presbyopia corrected. Complications were decreased stereopsis, contrast sensitivity, and visual fields, similar to other types of monovision. The term "pseudophakic monovision" should include more than just monocular intraocular lens implantation in two eyes, and further studies are required.
Clinical and Experimental Optometry, Volume 93, pp 409-418; https://doi.org/10.1111/j.1444-0938.2010.00515.x

Abstract:
High levels of corneal astigmatism are prevalent in a significant proportion of the population. During cataract surgery pre-existing astigmatism can be corrected using single or paired incisions on the steep axis of the cornea, using relaxing incisions or with the use of a toric intraocular lens. This review provides an overview of the conventional methods of astigmatic correction during cataract surgery and in particular, discusses the various types of toric lenses presently available and the techniques used in determining the correct axis for the placement of such lenses. Furthermore, the potential causes of rotation in toric lenses are identified, along with techniques for assessing and quantifying the amount of rotation and subsequent management options for addressing post-operative rotation.
Journal of Cataract and Refractive Surgery, Volume 36, pp 1523-1528; https://doi.org/10.1016/j.jcrs.2010.03.047

Abstract:
To assess the stability of the Akreos AO intraocular lens (IOL) platform with a simulated toric design using objective image analysis. Six hospital eye clinics across Europe. After implantation in 1 eye of patients, IOLs with orientation marks were imaged at 1 to 2 days, 7 to 14 days, 30 to 60 days, and 120 to 180 days. The axis of rotation and IOL centration were objectively assessed using validated image analysis. The study enrolled 107 patients with a mean age of 69.9 years +/- 7.7 (SD). The image quality was sufficient for IOL rotation analysis in 91% of eyes. The mean rotation between the first day postoperatively and 120 to 180 days was 1.93 +/- 2.33 degrees, with 96% of IOLs rotating fewer than 5 degrees and 99% rotating fewer than 10 degrees. There was no significant rotation between visits and no clear bias in the direction of rotation. In 71% of eyes, the dilation and image quality was sufficient for image analysis of centration. The mean change in centration between 1 day and 120 to 180 days was 0.21 +/- 0.11 mm, with all IOLs decentering less than 0.5 mm. There was no significant decentration between visits and no clear bias in the direction of the decentration. Objective analysis of digital retroillumination images taken at different postoperative periods shows the aspheric IOL platform was stable in the eye and is therefore suitable for the application of a toric surface to correct corneal astigmatism.
, V. Nangalia, C. E. Hugkulstone
Published: 25 March 2010
British Journal of Anaesthesia, Volume 104, pp 577-581; https://doi.org/10.1093/bja/aeq056

Abstract:
Recent advances in cataract surgery techniques have enabled these to be performed under less invasive local anaesthetic techniques. As a result, ophthalmic surgeons are increasingly prepared to give the local anaesthesia to the patient themselves without the need for the presence of an anaesthetist. A national postal survey was conducted in 2008, asking all consultant ophthalmic surgeons for their choice of local anaesthetic technique, whether an anaesthetist or a surgeon performs the block, the current level of anaesthetic cover for the ophthalmic operating sessions, and the need for anaesthetists for phacoemulsification under local anaesthesia in future. No reminders were sent to the non-respondents. The response rate was 62%. The choice of local anaesthetic technique was sub-Tenon's 47%, topical 33%, peribulbar 16%, retrobulbar 2%, and others 2%. Twenty-eight per cent of sub-Tenon's blocks were given by the surgeons and 47% by the anaesthetists. Of peribulbar blocks, 9% were given by the surgeons and 85% by the anaesthetist. Seventy-five per cent of ophthalmic operating sessions had allocated anaesthetic cover. Ophthalmic surgeons felt that in their judgement, only 10% of the phacoemulsifications under local anaesthesia would necessitate the presence of an anaesthetist. The consultant eye surgeons, based on their judgement, are prepared to undertake a bigger proportion of cataract surgeries under local anaesthesia without the presence of an anaesthetist. This development is bound to have a significant impact on manpower planning for ophthalmic anaesthetists.
Emmanuel Nouvellon, Philippe Cuvillon, , Eric J. Viel
Published: 1 January 2010
Drugs & Aging, Volume 27, pp 21-38; https://doi.org/10.2165/11318590-000000000-00000

Abstract:
Cataract surgery is the most frequent surgical procedure requiring anaesthesia in developed countries. It is performed mainly in elderly patients, who present with many coexisting diseases that induce subsequent hazards from general anaesthesia. Cataract anaesthesia is performed following various techniques of regional anaesthesia, which are detailed in this review. Needle block carries a low but real risk of complications, mainly because of needle misplacement. Correct teaching and training are mandatory to prevent complications. The main patient risk factor for inadvertent globe perforation is the presence of a myopic staphyloma. Retrobulbar block has been progressively phased out and replaced by peribulbar block, sub-Tenon’s block (STB) or topical anaesthesia (TA). The requirement for very deep block with total akinesia has greatly decreased with the use of phacoemulsification for cataract surgery, allowing for use of TA or low-volume STB. However, non-akinesia techniques may give rise to impaired surgical conditions, which have the potential to result in surgical complications. A surgical approach to accessing sub-Tenon’s space avoids needle block, but does not totally prevent complications. When deep anaesthesia is required, low-volume STB, performed using either the needle technique or a surgical approach, appears to be the technique of choice in terms of efficacy. Increasing the anaesthetic volume provides reproducible akinesia. Various local anaesthetics may be used, depending on their availability and respective properties. The most useful adjuvant to local anaesthetic is hyaluronidase.
Pammal T Ashwin, Sunil Shah,
Clinical and Experimental Optometry, Volume 92, pp 333-342; https://doi.org/10.1111/j.1444-0938.2009.00393.x

Abstract:
Cataract surgery is a technique described since recorded history, yet it has greatly evolved only in the latter half of the past century. The development of the intraocular lens and phacoemulsification as a technique for cataract removal could be considered as the two most significant strides that have been made in this surgical field. This review takes a comprehensive look at all aspects of cataract surgery, starting from patient selection through the process of consent, anaesthesia, biometry, lens power calculation, refractive targeting, phacoemulsification, choice of intraocular lens and management of complications, such as posterior capsular opacification, as well as future developments. As the most common ophthalmic surgery and with the expanding range of intraocular lens options, optometrists have an important and growing role in managing patients with cataract.
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