Journal of Cataract and Refractive Surgery

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ISSN / EISSN : 0886-3350 / 1873-4502
Total articles ≅ 15,901
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, Robert Ang, Dean Corbett, Peter Hoffmann, Manfred Tetz, Alberto Villarrubia, Carlos Palomino, Alfredo Castillo-Gomez, Linda Tsai, Eugenia K. Thomas, et al.
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000971

Abstract:
Purpose: To compare clinical performance of TECNIS Synergy multifocal (model ZFR00V) intraocular lens (IOL) vs Acrysof PanOptix Trifocal (model TFNT00) IOL in patients undergoing bilateral cataract surgery. Setting: Multicenter clinical setting. Design: Prospective, randomized, comparative study. Methods: Patients aged ≥22 years were randomly assigned (2:1) to bilateral implantation with ZFR00V or TFNT00. Endpoints included mean binocular distance-corrected near visual acuity (DCNVA) at 40 cm, photopic and mesopic DCNVA at 33 cm, photopic low-contrast best corrected distance visual acuity (BCDVA) and mesopic BCDVA, nondirected patient responses to an ocular/visual symptoms questionnaire, and safety. Results: Of the 150 implanted patients, 95 of 97 patients with ZFR00V implants and 52 of 53 patients with TFNT00 implants completed the 3-month follow-up. Most patients in the ZFR00V and TFNT00 groups achieved 20/25 or better binocular BCDVA (100% vs 96.2%) and DCNVA measured at 40 cm (88.4% vs 75.0%) and 33 cm (78.9% vs 51.9%). The mean between-group difference in binocular DCNVA at 40 cm favored ZFR00V (0.5 lines Snellen; 95% CI, 0.012–0.089; P ≤ .05). Similarly, mean binocular photopic and mesopic DCNVA at 33 cm (0.8 lines Snellen each; both P ≤ .05 vs TFNT00) and photopic high- and low-contrast BCDVA (0.5 lines Snellen each; both P ≤ .05 vs TFNT00) favored ZFR00V. Patient-reported ocular/visual symptoms and safety were generally similar between the two IOLs. Conclusions: The ZFR00V IOL showed an extensive range of vision, particularly through near distances, and better mesopic performance versus TFNT00 IOL in patients undergoing cataract surgery.
Wen Jing Luo, Shu Qiong Hu, Yong Wang, Han Song Zheng, Suo Wang Zhou, Julio Ortega-Usobiaga
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000970

Abstract:
Purpose: To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser cataract surgery(FLCS), and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted. Setting: Aier Eye Hospital of Wuhan University, China Design: Retrospective observational case series Methods: The patients who underwent FLCS from March 2020 to March 2021 were reviewed. ADC in FLCS were measured and compared with PDC. The effects of age, gender and biometrics on DDC were analyzed. Results: 412 eyes of 336 patients were included. The mean age was 53.0±0.91(range 3 to 91 years). When PDC was set to 4.50mm, the results showed that ADC was 5.21±0.21mm with a significant difference between them (P0.05). No correlation (P>0.05) was found between both: DDC and the axial length (AL), DDC and the anterior chamber depth (ACD) as well as DDC and the average keratometry (Km); but a negative correlation was found between DDC and the lens thickness (LT) (r =-0.21; P<0.05) and DDC with age (r =-0.70; P<0.05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted : ADC=PDC+1.23-0.30ln (x) (x=age ≥3) (R2 =0.65; F =752.39; P=0.00). Conclusions: The consistency of ACD and PCD were influenced by age and LT. For patients ≤40s, the younger the patient, the wider was DDC, for patients>40s, the DDC was small. The thicker the LT, the smaller the DDC.
Quan-Yong Yi, Jia-Ning Ying, Shan-Jun Wu, Guo-Hai Wu, Zhi-Tao Su, Sang-Sang Wang, Yan Gong
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000969

Abstract:
A technique using the single-string, closed-loop fixation method to reposit dislocated triple-looped haptic IOL-capsular bag complexes is described. The long needle or curved needle with 10-0 / 8-0 polypropylene suture and 27 / 30g needle were used as the guide needle to pass through the fenestrated haptics for two times. The scleral interlaminar course was used as the fixed point. last, A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached needle.Four eyes from 4 consecutive patients were studied retrospectively; During all follow-up visits, the IOLs were well centered and stable, No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed.
, Keiko Mine, Ken Hayashi
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000967

Abstract:
Purpose: To determine morphological changes in the lens capsule with aging. Design: Cross-sectional study. Setting: Hayashi Eye Hospital, Fukuoka, Japan. Methods: Twenty-five eyes from the older patient group (aged ≥ 80 years) and 25 eyes from the younger patient group (aged ≤ 65 years) who were diagnosed with cataract and indicated for surgery were included in the study. After continuous curvilinear capsulorhexis (CCC), the anterior lens capsule was collected, immediately fixed, and processed for electron microscopy analysis. Backscattered electron images of the cross-section of the anterior lens capsule were observed under a scanning electron microscope. The ultrastructure of the anterior lens capsule was observed and compared between groups. Factors associated with the occurrence of the lamellar structure were also identified. The presence or absence of a lamellar structure was an objective variable, and preoperative clinical characteristics were the explanatory variables. Results: Fifty eyes of 50 patients were included. In the younger patient group, 20 (80%) eyes had a homogeneous lens capsule, whereas 5 eyes had a lamellar structure. By contrast, in the older patient group, 5 eyes had homogeneous structures, while the remaining 20 (80%) eyes had lamellar structures. One eye showed capsular delamination. The only significant factor for the occurrence of lamellar structures was age group (p<0.01, nominal logistic regression analysis). Conclusions: Lamellar structures appear in the anterior capsule during aging. The appearance of lamellar structures indicates fragility of the lens capsule, which may, in turn, lead to capsular delamination or lens dislocation in some cases.
Amy Q. Lu, Monica Rizk, Tara O’Rourke, Kristin Goodling, Erik Lehman, Ingrid U. Scott,
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000963

Abstract:
Purpose: To compare the safety and efficacy of topical prednisolone and intra-canalicular dexamethasone ophthalmic insert for the prevention of post-operative inflammation after cataract surgery. Setting: Penn State College of Medicine, Hershey, PA. Design: Retrospective consecutive case series. Methods: Patients scheduled for elective phacoemulsification cataract surgery with a plan to receive inflammation prophylaxis with topical prednisolone (prednisolone acetate 1mg/1mL) between January 2018 and November 2019 or intracanalicular dexamethasone (Dextenza, 0.4mg, Ocular Therapeutix) between December 2019 and March 2021 were screened. Patients were seen 1 day, 1 week, and 4-16 weeks postoperatively. Medical records were also reviewed for any urgent messages between visits. Primary endpoints were proportion of eyes with 1) breakthrough inflammation requiring escalation of anti-inflammatory therapy and 2) intraocular pressure (IOP) increase ≥ 10mmHg at 4-16 weeks follow-up. Secondary endpoints included incidence of intra-operative complications, cystoid macular edema, and infectious sequelae. Results: Three-hundred and fifty-eight patient charts (358 eyes) were screened. Of these, 262 eyes of 262 patients met criteria for inclusion in the study; 131 eyes received topical drops and 131 eyes received the intracanalicular insert. Amongst eyes that completed follow-up, 9 eyes (6.9%) in the drops group and 12 eyes (9.2%) in the insert group experienced breakthrough inflammation necessitating treatment (P = .50). Two eyes in the drops group and 1 eye in the insert group had elevated IOP. Conclusions: Postoperative inflammation prophylaxis with the intracanalicular insert may be associated with similar rates of breakthrough inflammation and IOP elevation as topical drops.
Kathleen Kwedar, Joseph Arnold, Nathan Hesemann
Journal of Cataract and Refractive Surgery; https://doi.org/10.1097/j.jcrs.0000000000000966

Abstract:
Purpose: To answer patient questions about the expected timeline for recovery, the objective post-operative visual acuities were reviewed for patients undergoing immediately sequential bilateral cataract surgery (ISBCS). Setting: Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri. Design: Retrospective chart review. Methods: All patients who underwent ISBCS in 2019 were evaluated. A total of 116 patients (232 eyes) were studied. Uncorrected distance visual acuity (UDVA) for post-op day 0 or post-op day 1 (POD0/1), post-op week 1 (POW1), and post-op month 1 (POM1) were required for study inclusion. Patients with ocular comorbidities were not excluded, though all patients passed an initial screen in order to qualify for ISBCS. Outcome measures included POD0/1, POW1, and POM1 UDVA. Results: Postoperative UDVA was stable or improved compared to pre-operative corrected VA (CDVA) for 48% (66/138) of eyes on POD0, 79% (74/94) of eyes on POD1, and 90% (209/232) of eyes on POW1. 83% of patients at POD1 and 90% of patients at POW1 had stable or improved VA in at least one eye. 92% (214/232) of eyes had a POW1 UDVA of 20/40 or better. Of the 18 eyes with a postoperative POW1 UDVA of 20/50 or worse, 5 (28%) were known pre-operatively to have limited visual potential. 99% (115/116) of patients had at least one eye 20/40 or better. Conclusions: Most patients who underwent ISBCS demonstrated meaningful improvement in UDVA compared to pre-operative CDVA as early as POD1. These results serve to guide discussion of post-operative expectations with patients interested in ISBCS.
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