Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

● AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. ● METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. ● RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. ● CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation

Astigmatism management in cataract surgery with Precizon(®) toric intraocular lens: a prospective study

PURPOSE: The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon(®) toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. SETTING: Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. DESIGN: This was a prospective clinical study. PATIENTS AND METHODS: A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon(®) toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster(®)). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month's evaluations. RESULTS: The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from -3.35±3.10 D to -0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. CONCLUSION: Precizon(®) toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.info:eu-repo/semantics/publishedVersio

Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery.

Purpose:To describe a case of suprachoroidal hemorrhage that occurred during femtosecond laser assisted cataract surgery (FLACS). Observations:A 67-year-old woman with high myopia underwent FLACS. Following two unsuccessful attempts at docking due to interface air bubbles, the third attempt was successful. Laser treatment and cataract surgery proceeded uneventfully until intraocular lens (IOL) implantation. While positioning the IOL within the capsular bag, the anterior chamber began to shallow, intraocular pressure became high by palpation, and the optic of the IOL prolapsed partially out of the bag. A segmental suprachoroidal hemorrhage was identified in the superior peripheral retina by intraoperative indirect ophthalmoscopy. Following an hour of waiting in the recovery room, the anterior chamber deepened and the intraocular pressure was low enough to position the IOL centrally within the bag. Her subsequent postoperative course was uneventful. Conclusions and Importance:To our knowledge, this is the first report of suprachoroidal hemorrhage during FLACS. We speculate that repeated sudden drops in intraocular pressure associated with multiple undockings triggered the suprachoroidal hemorrhage in this case

Nova aplicação do azul de tripano para superfície ocular: redefinindo corantes vitais

Different applications of trypan blue (TB) for intraocular surgery have been reported, with very high levels of safety and efficacy. We describe the use of TB as an alternative vital dye for staining the ocular surface to assess the integrity of superficial cell layers of the cornea and the surface environment. This facilitates the diagnosis of various ocular surface disorders, including screening for dry eye disease (DED) among refractive and cataract patients. TB staining properties are different from fluorescein and both are stable in a solution, so that a double staining technique is introduced.Diferentes aplicações do azul de tripano (AT) foram descritas para cirurgia intraocular, com elevados patamares de eficácia e segurança. Neste relato, é descrito a aplicação do AT como corante vital para superfíce ocular, de modo a estudar a integridade das células da superfície corneana e conjuntival na superfície ocular. Tal abordagem permite um diagnóstico mais sensível de desordens da superfície ocular, destacando-se disfunção lacrimal ou síndrome do olho seco. O AT tem propriedades distintas da fluoresceína, com a qual se mantém estável em solução permitindo a técnica de coloração dupla que é introduzida.Instituto de Olhos Renato AmbrósioCorneal Tomography and Biomechanics Study GroupDoheny Eye InstitutePrice Vision GroupUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Unintentional staining of lens posterior capsule with trypan blue during extracapsular cataract extraction: case report

Report of a complication related to the use of 0.1% trypan blue during capsular staining of the anterior crystalline lens capsule in an extracapsular cataract extraction with intraocular lens implantation. The capsular dye was injected using an air-bubble technique, inadvertently, it was done using high pressure dispersing the dye through the zonules leading to a complete losts of red reflex, the following steps of the procedure becoming more difficult after the cataract extraction and causing a temporary disturbance of visual acuity in the postoperative period. In order to avoid this complication, the authors also describe the use of Modified air-bubble technique where dispersive viscoelastic is placed into the iridolenticular space 360&deg; to create a protection barrier.Relato de complicação relacionada ao uso do azul de tripano 0,1% ocorrida ao corar a cápsula anterior do cristalino em facectomia extracapsular com implante de lente intra-ocular. O corante foi injetado sob alta pressão utilizando a técnica de bolha de ar ocasionando a migração deste através da zônula e conseqüente perda do reflexo vermelho no peroperatório dificultando os passos subseqüentes à extração da catarata e comprometendo temporariamente a acuidade visual no pós-operatório. Tendo como objetivo evitar esta complicação, os autores descrevem ainda, o uso da Técnica de bolha de ar modificada no qual o viscoelástico dispersivo é injetado no espaço iridolenticular 360&deg; para compor uma barreira de proteção.Universidade Federal de São Paulo (UNIFESP)Faculdade de Medicina do ABC Departamento de OftalmologiaUniversidade Federal de São Paulo, EPM, São Paulo, BrazilSciEL

Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

PURPOSE: To evaluate posterior capsule opacification (PCO) in humans after cataract surgery with intraocular lens (IOL) implantation, by using optical coherence tomography (OCT-1). METHODS: Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 microm. Results were compared with visual acuity (VA) and PCO type. RESULTS: Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88-20.41) and 11.9 (8.58-14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 microm; range, 46.33-115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 microm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (r(o) = 0.66; P = 0.01). CONCLUSIONS: OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation

Szabadgyök-felszabadulás vizsgálata femtoszekundum lézerrel asszisztált capsulotomiát követően | Evaluation of free radical quantity in the anterior chamber following femtosecond laser-assisted capsulotomy

Absztrakt Bevezetés: A femtoszekundum lézer alkalmazása forradalmi, innovatív kezelési eljárás a szürkehályog-sebészetben. Célkitűzés: Tanulmányunk célja a femtoszekundum lézeres capsulotomia során az elülső csarnokban képződő szabad gyök mennyiségének meghatározása sertésszemben. Módszer: Hetven friss sertésszemet vontunk be a vizsgálatba, amelyeket post mortem 2 órán belül 4 ºC hőmérsékleten szállítottunk, a kezelést pedig 7 órán belül végeztük el. Harmincöt szemet vizsgáltunk a kontroll- és a femtoszekundum lézeres capsulotomia csoportban is. Luminoldependens kemilumineszcens módszer segítségével vizsgáltuk a csarnokvíz szabadgyök-fogó kapacitását, mint a szabadgyök-termelődés indikátorát. Az emittált fotonok mennyiségét relatív fényegység százalékban fejeztük ki. Eredmények: A relatív fényegység százalék alacsonyabb volt a kontrollcsoportban (medián 1%, interkvartilis tartomány 0,4–3%), mint a femtoszekundum lézeres capsulotomia csoportban (medián 4,4%, interkvartilis tartomány 1,5–21%) (p = 0,01). Következtetések: A femtoszekundum lézeres capsulotomia gyengíti a csarnokvíz antioxidáns védelmét, amely a femtoszekundum lézeres capsulotomia során felszabaduló szabad gyökök hatására utal. Orv. Hetil., 2016, 157(47), 1880–1883. | Abstract Introduction: Femtosecond laser is a revolutionary, innovative treatment method used in cataract surgery. Aim: To evaluate free radical quantity in the anterior chamber of the eye, during femtosecond laser assisted capsulotomy, in a porcine eye model. Method: Seventy fresh porcine eyes were collected within 2 hours post mortem, were transported at 4 ºC and treated within 7 hours. Thirty-five eyes were used as control and 35 as femtosecond laser assisted capsulotomy group. A simple luminol-dependent chemiluminescence method was used to measure the total scavenger capacity in the aqueous humour, as an indicator of free radical production. The emitted photons were expressed in relative light unit %. Results: The relative light unit % was lower in the control group (median 1%, interquartile range [0.4–3%]) than in the femtosecond laser assisted capsulotomy group (median 4.4%, interquartile range [1.5%–21%]) (p = 0.01). Conclusions: Femtosecond laser assisted capsulotomy decreases the antioxidant defense of the anterior chamber, which refers to a significant free radical production during femtosecond laser assisted capsulotomy. Orv. Hetil., 2016, 157(47), 1880–1883

Congenital ectopia lentis : diagnosis and treatment

Congenital ectopia lentis (EL) is an ocular condition, which typically causes a high grade of refractive errors, mainly myopia and astigmatism. These might be difficult to compensate for, especially in children, who might develop ametropic amblyopia. Surgery on ectopic lenses has previously been controversial, due to the risk of sightthreatening complications. In paper I we studied retrospectively visual outcomes and complications in children, who were operated for congenital EL, and who had en scleral-fixated capsular tension ring (CTR) and an intra-ocular lens (IOL) implanted at the primary surgery. Thirty-seven eyes of 22 children were included. Visual acuity (VA) improved in all eyes, and only few had persistent amblyopia at the end of the follow-up. A great majority of the eyes had postoperative visual axis opacification (VAO), which was expected, since the posterior capsule was left intact at the primary surgery. Two eyes required secondary suturing for IOL decentration. No eye had any serious complications such as retinal detachment, glaucoma or endophthalmitis. Congenital ectopia lentis is often an indicator of a systemic connective tissue disorder, and Marfan syndrome (MFS) is diagnosed in 70% of the cases. This genetic disorder affects basically all organ systems in the body, EL and dilatation of the ascending aorta being the cardinal signs. MFS is associated with markedly decreased life expectancy due to the cardiovascular complications. Therefore, an early and accurate diagnosis is of importance. In paper II we measured the accommodative power, lens thickness, anterior chamber depth (ACD), and pupil size in these eyes, using an optical coherence tomography (OCT). Thirty-one eyes of 31 cases of MFS were included, and these were compared to non-affected controls. We found that the lens was significantly thicker in MFS at all stages. The pupil size was significantly smaller in MFS at baseline, decreased less in accommodation and dilated more during dilatation. No significant difference was seen in the accommodative power or ACD. No difference was seen in any parameter between the MFS eyes with, and without EL. We conclude, that even though the lens and the pupil seem to be affected in MFS, these eyes seem to have the same ability to accommodate as normal subjects. The observed changes seem to be associated to MFS independently of EL. In paper III we studied the corneal curvature, thickness and endothelial cell density (ECD) in 39 MFS eyes and compared those to non-affected controls. We found significantly lower keratometric (K) values and corneal thickness in MFS, but no difference in the ECD. No significant difference was found in these parameters between MFS eyes with and without EL. We also reported on generally increased corneal astigmatism in MFS, especially in eyes with EL. In paper IV we described the ocular characteristics in 102 eyes of 56 cases of MFS. We found increased axial length, but mostly only moderate myopia, which seemed to be compensated by the flat cornea. The majority of the eyes had EL, or were pseudophakic due to EL. Other associated diagnosis included amblyopia, glaucoma, retinal detachment and strabismus. In conclusion, we found that surgery for EL in children, including CTR and IOL gives good visual development and no serious complications. Also, most of the ocular changes in MFS seem to be connected to MFS itself, rather than EL

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract.

BACKGROUND: Age-related cataract is the opacification of the lens, which occurs as a result of denaturation of lens proteins. Age-related cataract remains the leading cause of blindness globally, except in the most developed countries. A key question is what is the best way of removing the lens, especially in lower income settings. OBJECTIVES: To compare two different techniques of lens removal in cataract surgery: manual small incision surgery (MSICS) and extracapsular cataract extraction (ECCE). SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to September 2014), EMBASE (January 1980 to September 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2014), Web of Science Conference Proceedings Citation Index- Science (CPCI-S), (January 1990 to September 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 September 2014. SELECTION CRITERIA: We included randomised controlled trials (RCTs) only. Participants in the trials were people with age-related cataract. We included trials where MSICS with a posterior chamber intraocular lens (IOL) implant was compared to ECCE with a posterior chamber IOL implant. DATA COLLECTION AND ANALYSIS: Data were collected independently by two authors. We aimed to collect data on presenting visual acuity 6/12 or better and best-corrected visual acuity of less than 6/60 at three months and one year after surgery. Other outcomes included intraoperative complications, long-term complications (one year or more after surgery), quality of life, and cost-effectiveness. There were not enough data available from the included trials to perform a meta-analysis. MAIN RESULTS: Three trials randomly allocating people with age-related cataract to MSICS or ECCE were included in this review (n = 953 participants). Two trials were conducted in India and one in Nepal. Trial methods, such as random allocation and allocation concealment, were not clearly described; in only one trial was an effort made to mask outcome assessors. The three studies reported follow-up six to eight weeks after surgery. In two studies, more participants in the MSICS groups achieved unaided visual acuity of 6/12 or 6/18 or better compared to the ECCE group, but overall not more than 50% of people achieved good functional vision in the two studies. 10/806 (1.2%) of people enrolled in two trials had a poor outcome after surgery (best-corrected vision less than 6/60) with no evidence of difference in risk between the two techniques (risk ratio (RR) 1.58, 95% confidence interval (CI) 0.45 to 5.55). Surgically induced astigmatism was more common with the ECCE procedure than MSICS in the two trials that reported this outcome. In one study there were more intra- and postoperative complications in the MSICS group. One study reported that the costs of the two procedures were similar. AUTHORS' CONCLUSIONS: There are no other studies from other countries other than India and Nepal and there are insufficient data on cost-effectiveness of each procedure. Better evidence is needed before any change may be implemented. Future studies need to have longer-term follow-up and be conducted to minimize biases revealed in this review with a larger sample size to allow examination of adverse events