Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation

PurposeTo describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation.MethodsTwenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed.ResultsThe age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed.ConclusionNd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure

Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification Surgery: Clinical Outcomes with EDOF IOLs

In this study, we evaluate and compare the outcomes of conventional phacoemulsification cataract surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) with the implantation of an extended depth of field (EDOF) intraocular lens (IOL). A prospective, consecutive cohort study was conducted. Patients were given the option to choose FLACS or CPS and were implanted with an EDOF IOL. Refractive data, visual acuity data, ocular aberration measured with a wavefront aberrometer, and optical quality measured with an optical quality analysis system II were collected at one month postoperatively. A total of 92 eyes of 64 patients were enrolled in this study; 35 eyes of 26 patients were treated with FLACS, whereas 57 eyes of 38 patients were treated with CPS. Uncorrected visual acuity at far, intermediate, and near distance and best-spectacle-corrected visual acuity were not statistically significantly different between the groups (all p > 0.05), nor were the mean cylinder and mean spherical equivalent refraction (both p > 0.05). The FLACS group had a lower ocular trefoil than the CPS group (p = 0.033), and there was no significant difference between the two groups considering other aberration parameters, whether ocular or internal (all p > 0.05). Optical-quality-related parameters showed also no significant difference between the two groups (all p > 0.05). In conclusion, there was no significant difference between FLACS and CPS with implantation of EDOF IOLs in postoperative ocular parameters, refractive outcomes, ocular aberration, optical quality, and aberration parameters, except a lower ocular trefoil in the FLACS group. In terms of these indicators, FLACS does not provide an additional clinical benefit for patients over CPS

Spatial Driven Effects of Multi-Dimensional Urbanization on Carbon Emissions: A Case Study in Chengdu-Chongqing Urban Agglomeration

Previous studies lacked attention to the spatial heterogeneity of the impact of urbanization on carbon emissions. To fill this knowledge gap, this study analyzed the spatio-temporal variations of carbon emissions (TCE), the per capita carbon intensity (PCI), and the economic carbon intensity (ECI) in the Chengdu-Chongqing urban agglomeration (CUA) based on the Open-Data Inventory for Anthropogenic Carbon dioxide (ODIAC) from 2000–2018. Bivariate spatial autocorrelation, and spatial Durbin models were combined to quantify the spatial correlation and driving mechanisms between carbon emission intensity and multi-dimensional urbanization (population, economic, and land urbanization). The following are the main results: (1) The TCE in CUA increased by 3.918 million tons at an average annual growth of 6.86%; CUA ranked last among China’s national strategic urban agglomerations in terms of TCE, PCI, and ECI. (2) High carbon emission values were concentrated in the Chengdu and Chongqing metropolitan areas, presenting a spatial feature of “Core-Periphery” gradient decay. (3) Nearly 30% of the agglomeration had carbon emission growth at low rates, with the growth cores concentrated in the main urban areas of Chengdu and Chongqing. (4) The “Low-Low” positive correlation was the main correlation type between multi-dimensional urbanization and carbon emissions and was distributed mainly in mountainous areas (e.g., Leshan and Ya’an). (5) Among the urbanization dimensions, the impacts on carbon emissions in local and adjacent areas exhibited varying levels of spatial heterogeneity. Economic urbanization was found to have the strongest positive direct and spillover effects; land urbanization inhibited the growth of carbon emissions in local and adjacent areas; population urbanization promoted carbon emission reduction in adjacent areas. Our findings provide support for CUA to carry out cross-city joint governance strategies of carbon emissions, also proving that regional carbon emission reduction should be an integration of various efforts including low-carbon living of residents, green transformation of economy and optimal land management

Spatial Driven Effects of Multi-Dimensional Urbanization on Carbon Emissions: A Case Study in Chengdu-Chongqing Urban Agglomeration

Previous studies lacked attention to the spatial heterogeneity of the impact of urbanization on carbon emissions. To fill this knowledge gap, this study analyzed the spatio-temporal variations of carbon emissions (TCE), the per capita carbon intensity (PCI), and the economic carbon intensity (ECI) in the Chengdu-Chongqing urban agglomeration (CUA) based on the Open-Data Inventory for Anthropogenic Carbon dioxide (ODIAC) from 2000–2018. Bivariate spatial autocorrelation, and spatial Durbin models were combined to quantify the spatial correlation and driving mechanisms between carbon emission intensity and multi-dimensional urbanization (population, economic, and land urbanization). The following are the main results: (1) The TCE in CUA increased by 3.918 million tons at an average annual growth of 6.86%; CUA ranked last among China’s national strategic urban agglomerations in terms of TCE, PCI, and ECI. (2) High carbon emission values were concentrated in the Chengdu and Chongqing metropolitan areas, presenting a spatial feature of “Core-Periphery” gradient decay. (3) Nearly 30% of the agglomeration had carbon emission growth at low rates, with the growth cores concentrated in the main urban areas of Chengdu and Chongqing. (4) The “Low-Low” positive correlation was the main correlation type between multi-dimensional urbanization and carbon emissions and was distributed mainly in mountainous areas (e.g., Leshan and Ya’an). (5) Among the urbanization dimensions, the impacts on carbon emissions in local and adjacent areas exhibited varying levels of spatial heterogeneity. Economic urbanization was found to have the strongest positive direct and spillover effects; land urbanization inhibited the growth of carbon emissions in local and adjacent areas; population urbanization promoted carbon emission reduction in adjacent areas. Our findings provide support for CUA to carry out cross-city joint governance strategies of carbon emissions, also proving that regional carbon emission reduction should be an integration of various efforts including low-carbon living of residents, green transformation of economy and optimal land management

Comparison of the Accuracy of IOL Power Calculation Formulas for Pediatric Eyes in Children of Different Ages

Purpose. This study aims to compare the accuracy of five intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, and Holladay 2) for pediatric eyes in children of different ages. Methods. In this prospective study, patients who received cataract surgery and IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of 5 formulas at 1 month postoperatively and performed subgroup analysis with the patients divided into three groups according to their ages at the time of surgery as follows: group 1 (age ≤ 2 years, 35 eyes), group 2 (2 years  5 years, 29 eyes). Results. 75 patients (102 eyes) were enrolled in this study. The Haigis formula got the smallest PE among all formulas in all three groups. With regard to APE, there were no statistical differences among the formulas except group 2, with the SRK/T formula a little smaller, the Holladay 2 formula a little larger in group 1, and the Haigis formula a little smaller in group 3. In group 2, the Haigis formula had the lowest APE (0.87 ± 0.61 D), while the Holladay 2 formula had the largest (1.71 ± 1.20 D, p<0.001), followed by the Holladay 1 formula (1.51 ± 1.07 D, p=0.002). On comparing the percentage of APE within 0.5 D and 1.0 D obtained with 5 formulas in each group, there were no statistical differences. The SRK/T formula and the Holladay 1 formula showed the highest percentage (40.00% and 60.00%) in group 1. While the Haigis formula got the highest percentage in less than 0.5 D (34.21%) and less than 1 D (60.53%) in group 2. In group 3, the Holladay 2 formula and the Haigis formula got the highest percentage less than 0.5 D (58.62%) and less than 1 D (79.31%). The multiple linear regression indicated that the age at the time of surgery was a significant factor affecting the accuracy of APE; after removing the age, AL was the only factor that affected the accuracy of APE. Conclusion. The SRK/T and the Holladay 1 formulas were relatively accurate in patients younger than 2 years old, while the Haigis formula performed better in patients older than 2

Efficacy of Toric Intraocular Lens Implantation in Patients Older Than 80 Years with Cataracts and Corneal Astigmatism

Abstract Introduction This study analyzed the visual outcome following cataract surgery with toric intraocular lenses (IOLs) in patients older than 80 years with corneal astigmatism. Methods A total of 159 patients (159 eyes) older than 80 years with corneal astigmatism (≥ 0.75 D) were included. Fifty-three eyes received Acrysof IQ® toric IOLs (SN6AT2–5), while the others received non-toric IOLs: 51 eyes received Acrysof IQ® IOLs (SN60WF) and 55 eyes received A1-UV IOLs. The uncorrected distance visual acuity, corrected distance visual acuity, and refraction (spherical equivalent, refractive cylinder) were assessed at 3 months postoperatively. The prediction error of refractive outcome and percentages of eyes within ± 0.50 D and ± 1.00 D in the toric IOL group obtained using five toric IOL formulas (Barrett predicted posterior corneal astigmatism (PCA), Barrett measured PCA, Kane, EVO 2.0 and Næser–Savini) were compared. Results At 3 months postoperatively, the average uncorrected distance visual acuity was better in the toric IOL group than the non-toric IOL group (p < 0.001). The mean residual refractive cylinder was lower in the toric IOL group than the non-toric IOL group (p < 0.001). The Næser–Savini formula achieved the lowest mean absolute error (0.39 D) and had the highest percentages of eyes within an absolute error of 0.50 D and 1.00 D (72% and 98%) compared to the other formulas. Conclusion The results demonstrate the efficacy of toric IOL implantation in patients older than 80 years with corneal astigmatism and provide strong evidence for cataract surgeons to encourage such patients to choose toric IOLs

Sustained accuracy improvement in intraocular lens power calculation with the application of quality control circle

Abstract Accurate intraocular lens (IOL) power calculation is always a challenge in ophthalmology, and unoptimized process may lead to inaccurate refractive outcomes. Quality control circle (QCC) has shown its success in many fields as a process management tool. However, its efficacy in ophthalmology remains unclear. Here we utilized the QCC method to optimize the process and evaluate its efficacy in improving the accuracy of IOL power calculation. After the QCC application, the percentage of eyes with achieved refractive outcomes within 0.5 diopter significantly increased from 63.2% to 80.8% calculated by Haigis formula and 59.2% to 75.8% by SRK/T formula in patients with normal axial length (AL) (22 mm ≤ AL < 26 mm). Although there were no statistically significant differences in patients with long AL by the two formulas (p = 0.886 and 0.726), we achieved an accuracy of 75% with the application of the PhacoOptics software, which was significantly higher than that using the other two formulas (p < 0.001). Our findings indicated that QCC optimized and standardized the process of IOL power calculation, thus improved the accuracy of IOL power calculation in patients who underwent cataract surgery

An Optical Section-Assisted In Vivo Rabbit Model for Capsular Bend and Posterior Capsule Opacification Investigation.

To establish an optical section-assisted in vivo rabbit model for capsular bend and posterior capsule opacification (PCO) investigation.A total of 10 rabbits underwent phacoemulsification surgery and intraocular lens (IOL) implantation. On the basis of the relationship between the anterior capsule and IOL, the rabbits were divided into complete overlap and incomplete overlap groups, in which six and four rabbits were included, respectively. The capsular bend optical sections were assessed using ultra-long scan depth optical coherence tomography (UL-OCT), and posterior capsule opacification was evaluated with slit lamp on postoperative day 3, 7, 14, and 28. In addition, histopathological section was used to verify the accuracy of capsular bend type captured by OCT in three rabbits.Based on the special animal model, six capsular bend types were observed, namely, anterior (A), middle (M), posterior (P), detachment (D), funnel (Fun) and furcate adhesion (Fur). On day 3, capsular bend began to form. On 14 days, the capsular bends were comprised of A, M and D types, which were almost maintained until day 28. Histopathological section findings were consistent with optical sectioning results. In the incomplete and complete groups, the earliest PCO within the optical zone were on day 7 and 28, respectively. The incomplete group exhibited higher incidence and faster PCO on day 7 (p = 0.038) and 14 (p = 0.002).This animal model not only mimics capsular bend evolution and PCO processes but also produces OCT optical section images equivalent to and more repeatable than histopathology, thereby providing a promising method for the further investigations of PCO

Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Purpose. To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes. Methods. This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded. Results. The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P>0.05). Conclusions. PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov