Surgical and visual outcomes of posterior dislocated lens fragments after cataract surgery during 5-years at a tertiary eye hospital of North India

2019 ◽  
Vol 11 (2) ◽  
pp. 172-180
Author(s):  
Lagan Paul ◽  
Manisha Agarwal ◽  
Shalini Singh ◽  
Rahul Mayor ◽  
Chanda Gupta ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Cataract Surgery ◽  
Visual Outcome ◽  
Vitreous Cavity ◽  
Age Related Macular Degeneration ◽  
Visual Outcomes ◽  
Poor Visual Outcome ◽  
Age Related

Objective: To determine the surgical and visual outcomes of posteriorly dislocated lens fragments in the vitreous cavity in patients undergoing cataract surgery. Methods: A total of 149 eyes of 149 patients from 2013 to 2018 were included in the study. The primary cataract surgery was performed either at the base hospital and its peripheral centres or referred from elsewhere. Pars plana vasectomy and nucleus removal was performed along with implantation of intraocular lens, wherever possible. Success was defined as best corrected visual acuity (BCVA) ≥ 6/12 at 3 months follow up. Poor visual outcome was defined as per WHO guidelines as BCVA ≤ 3/60. Results: Posterior capsular rupture and dislocation into vitreous cavity most frequently occurred during phaco-fragmentation in cases of phacoemulsification and during nucleus delivery in cases of small incision cataract surgery. Early vitrectomy was performed within 3 days in 36.2% of cases and within 14 days in 63.8% of cases. Successful visual outcome was achieved in 85.2% of patients at 3 months follow up after vitrectomy. Iatrogenic retinal break occurred in five patients during vitrectomyand five patients had retinal detachment. Poor visual outcome was observed in 12eyes, out of which glaucomatous optic neuropathy seen in 5 cases, cystoid or diabeticmacular edema in 4 cases and age related macular degeneration in 3 cases. Conclusion: Posterior dislocation of lens can be successfully managed in majority of cases with vitreoretinal surgical intervention. The timing of vitrectomy whether performed early or late did not affect the visual outcome. The most important predictorof final visual acuity after PPV for retained lens fragments is a less complicated clinical course without any associated complications such as retinal detachment, cystoidmacula edema and glaucoma. Expertise of the primary cataract surgeon could not be assessed in this study, though surgeon grade with more experience is an important factor in the assessment of complications during the cataract surgery.

scholarly journals Limited Treatment Response during Follow-up after Switching to Aflibercept in Neovascular Age-related Macular Degeneration

2021 ◽  
Vol 62 (9) ◽  
pp. 1218-1226
Author(s):  
Gon Soo Choe ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Macular Degeneration ◽  
Treatment Response ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
The Mean

Purpose: To investigate the limited response to aflibercept after switching to aflibercept in neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 70 eyes with neovascular AMD that were initially treated with ranibizumab and then switched to aflibercept. The incidence and timing of the limited response to aflibercept were identified and visual outcome was compared between eyes with and without limited response. In addition, factors predictive of limited response were analyzed. Results: A limited response to aflibercept was noted in approximately 1/5 of the patients who underwent switching to aflibercept in neovascular AMD. Switching to aflibercept was performed at a mean of 16.2 ± 12.7 months after diagnosis. During the mean 34.7 months of follow-up after switching, limited response was noted in 15 eyes (21.4%) at a mean of 22.0 ± 13.9 months after switching. The degree of reduction in visual acuity was mean logMAR 0.34 ± 0.41 in eyes with limited response and mean 0.06 ± 0.20 in eyes without (p = 0.002). In addition, the duration between the diagnosis and the switching was shorter (p = 0.012), and the number of ranibizumab injections before switching was lower (p = 0.016) in eyes with limited response than in eyes without. Conclusions: Patients who showed limited response to aflibercept after switching to aflibercept showed a worse visual outcome. The probability of having a limited response is higher when the switching is performed earlier.

scholarly journals Do Africans really need to go overseas for Phaco training? Performance audit of a locally trained phaco surgeon in rural Kenya

2019 ◽  
Author(s):  
Jean Claude Niyonzima ◽  
Stephen Gichuhi ◽  
Sarah Sitati ◽  
Ernest Ollando
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
P Value ◽  
Visual Outcomes ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Case Series Study ◽  
Best Corrected Visual Acuity

Abstract Purpose: To audit phacoemulsification cataract surgeries performed independently after a short - term training completed in a rural hospital in Kenya, and to benchmark the outcomes against WHO recommendations. Methods: This retrospective case-series study recruited patients who had had phacoemulsification cataract surgery at Sabatia Eye Hospital from January to December 2018. All the surgeries were performed by a single surgeon following a brief training in the same center. Data were collected retrospectively using a detailed questionnaire. Results: Of the one hundred and twenty eyes operated on during this period, one-hundred and sixteen eyes of 86 patients met the inclusion criteria. The mean age was 62 years and the majority of the eyes (83.6%) had vision less than 6/18 preoperatively. Co-morbidities included diabetic retinopathy (3.4%), age-related macular degeneration (2.6%), trauma (1.7%) and glaucoma (0.9%). Surgical complications were not severe enough to affect the final best-corrected visual acuity, unlike the comorbidities that were negatively correlated with visual outcomes (p-value< 0.001). Good outcomes were 81% against a WHO target of 80% for uncorrected visual acuity category, and 96.6% in the best-corrected visual acuity category against a target of 90%. The Royal College of Ophthalmology database of cataract surgery outcomes and the European Registry of Quality Outcomes for cataract and refractive surgery had comparable results. Conclusions: This local training model was based on apprenticeship and skills transfer. It can achieve high-quality visual outcomes meeting WHO recommendations.

scholarly journals Visual outcome after cataract surgery in a tertiary eye hospital of Chittagong district, Bangladesh

2019 ◽  
Vol 5 (3) ◽  
pp. 212-218
Author(s):  
Jannat Ul Ferdosh ◽  
Mezbah Uddin ◽  
Rajib Husain
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Visual Outcome ◽  
Tertiary Hospital ◽  
Small Incision Cataract Surgery ◽  
Eligibility Criteria ◽  
Common Procedure ◽  
Poor Visual Outcome ◽  
Good Visual Acuity ◽  
Age Related

To evaluate the visual outcome in patients who have had their cataract surgery in a tertiary hospital of Chittagong district in Bangladesh. This is a clinic-based study of consecutive cataract-operated patients who had age-related cataract with vision less than <6/60 before surgery. A total of 228 patients who visited the hospital and met the eligibility criteria were included in the study. The mean age of the patients was 62.46± 10.14 years and 134 (58.8%) were female. A total of 456 surgeries were performed on 228 patients. The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation, operated in 422(92.5%) eyes. Among cataract-operated eyes, 290 (64%) had presenting vision >6/18 and <6/60 were found in 11 (2.4%) eyes. In most of the cases, visual acuity has improved after best correction as the percentages with the best correction were 402(88%) and 7(1.55%) respectively. Analysis of multiple logistic regression shows that patient’s older age (OR 9.101; 95% CI 3.331, 24.869), gender female (OR 2.374 CI 1.403, 4.017), literacy (OR 1.660; CI 1.009, 2.733) and SICS surgery technique (OR 3.540; CI1.298, 9.659) were significantly associated with poor visual outcome. Overall, this study demonstrates that cataract surgery can restore good visual acuity. However, the visual outcome needs to be improved to meet the WHO standard, and more attention should be directed towards monitoring of outcomes and correction of refractive error after cataract surgery. Asian J. Med. Biol. Res. June 2019, 5(3): 212-218

The patient-reported outcome of age-related cataract using Catquest-8SF questionnaire

2020 ◽  
Vol 1 (3) ◽  
pp. 145-153
Author(s):  
Sheng-Xia Wang ◽  
◽  
Yun-Hong Du ◽  
Wen-Jing Liu ◽  
Ping Liu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Patient Reported Outcome ◽  
Chinese Version ◽  
Surgery Group ◽  
Age Related ◽  
Patient Reported ◽  
Degree Of Satisfaction ◽  
Improvement Score

AIM: To assess the patient-reported outcome of phacoemulsification with posterior chamber single focus foldable intraocular lens (SIOL) using the Chinese version of Catquest-8SF questionnaire (Catquest-8SF-CN), evaluate the applicability of Catquest-8SF scale in northern Chinese and its sensitivity to cataract surgery. METHODS: Prospective clinical case follow-up study. The patients were recruited from the Central Hospital of Tai’an and completed the Catquest-8SF questionnaire by face-to-face interviews before and 3mo after surgery at the hospital. RESULTS: A total of 120 cataract patients with median age 67.6y and 52.5% female completed the Catquest-8SF. The Cronbach’s α coefficient of the total scale, daily-activity sub-table and comprehensive-evaluation sub-table were 0.861, 0.853 and 0.748 respectively. There was a high level of consistency between two investigators. The cumulative contribution rate was 66.64% by using the principal component analysis and the maximum variance orthogonal rotation method. The preoperative score of the Catquest-8SF-CN had a significant negative correlation with preoperative binocular mean weighted visual acuity and age (P<0.05), while a significant positive correlation with education level (F=6.094, P<0.001). The patients without systemic comorbidities got higher score than those who with (P<0.05). Three months after surgery, 102 (85%) patients came for follow-up and completed the questionnaire. Significant improvement of visual acuity was observed in both binocular and monocular surgery groups (t=10.404, P<0.001). There was higher improvement in binocular weighted visual acuity of binocular surgery group than in monocular surgery group (t=-20.77, P<0.001). The postoperative score was significantly higher in both groups than before (P<0.001). There was a significant improvement in the total score after cataract surgery. The 94 patients (92.2%) were very satisfied or satisfied with the operation; 92 patients (90.2%) thought the surgery achieved their expectations, and they all felt satisfactory. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery. CONCLUSION: The Chinese version of Catquest-8SF questionnaire is suitable for the age-related cataract population in northern China. It is highly responsive to cataract surgery and brief, so it may have the potential to become part of a routine clinical assessment for cataract surgery in China. The patient’s overall satisfaction is high, which illustrates that the medical service we provide matches the patient’s needs. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery.

scholarly journals Visual Outcomes of Macula-Involving Rhegmatogenous Retinal Detachment in Patients with and Without Age-Related Macular Degeneration

2022 ◽  
Author(s):  
P. Barrett Paulk ◽  
Dala Eloubeidi ◽  
John O. Mason III ◽  
Christine A. Curcio ◽  
Jason N. Crosson ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Degeneration ◽  
Rhegmatogenous Retinal Detachment ◽  
Age Related Macular Degeneration ◽  
Light Perception ◽  
Postoperative Visual Acuity ◽  
Age Related ◽  
Functional Vision ◽  
Better Than

Abstract Background Patients presenting with macula-off rhegmatogenous retinal detachment (RRD) with concomitant age-related macular degeneration (AMD) and their treating physicians would benefit from knowledge regarding the visual prognosis after repair. The prognosis for such patients is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD. Methods This was a retrospective chart review of 1,149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls) and 29 AMD eyes. The main outcome measure was postoperative visual acuity in control eyes versus AMD eyes, and this was compared using Fisher’s exact test. Results There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023). More specifically 5.56% of non-AMD eyes and 3.45% of AMD eyes were 20/40 or better, 77.16% of non-AMD and 55.17% of AMD eyes were worse than 20/40 and better than 20/200, 10.49% of non-AMD eyes and 37.93% of AMD eyes were 20/200 or worse, and there were 11 eyes in the non-AMD group with CF, HM, LP, or NLP vision while there was only 1 eye in the AMD group with CF vision. Conclusions Though postoperative visual acuity was worse in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is not likely a clinically significant finding. Rather, it is a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. Our study suggests that approximately 58% of patients with AMD can expect to maintain functional vision better than 20/200. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD. These findings may be helpful in guiding realistic expectations of AMD patients with RRD.

scholarly journals A COMPARISION OF POSTERIOR CAPSULAR OPACITY FORMATION UPTO 1 YEAR IN PATIENTS WITH SMALL INCISION CATARACT SURGERY WITH FOLDABLE INTRAOCULAR LENS AND PHACOEMULSIFICATION WITH THE SAME INTRAOCULAR LENS

2020 ◽  
pp. 173-176
Author(s):  
Kinjal Rathod ◽  
Kinjal Trivedi ◽  
Snehal Nayi ◽  
Somesh Aggarwal
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Intraocular Lens ◽  
Nd:Yag Laser ◽  
Visual Outcome ◽  
Posterior Capsular Opacification ◽  
P Value ◽  
Small Incision Cataract Surgery ◽  
Common Procedure ◽  
Age Related

Introduction: Cataract is most common cause of curable blindness worldwide and cataract surgery is most common procedure performed in ophthalmology. Posterior capsular opacification (PCO) is most common complication after cataract surgery which is usually treated with Neodymium-doped: Yttrium Garnet (Nd:YAG) laser posterior capsulotomy or occasionally with a surgical capsulotomy. The incidence and severity of PCO correlates to the type of surgical technique, IOL optic edge designs and IOL materials. Material and Methods: 70 eyes of 64 patients operated for age related cataract were studied in this prospective interventional study. Phacoemulsification was done in 35 eyes and SICS in 35 eyes with hydrophobic single piece biconvex foldable intraocular lens. Patients were followed up at 1, 3, 6, 9 and 12 months for the development of PCO. Clinically significant PCO (loss of 2 or more lines of Snellen’s visual acuity chart) was treated with Nd:YAG laser capsulotomy. Results: The overall incidence of PCO was 22.85%. Amongst the patients who developed PCO, SICS and phacoemulsification was performed in 62.5% and 37.5% patients respectively. Result was statistically significant with p value <0.05 using z test. On first postoperative day, patients operated with phacoemulsification had better visual acuity than SICS. Conclusion: Phacoemulsification can provide early and better visual outcome than SICS and has lower incidence of PCO formation which may be due to difference in irrigation and aspiration and less disruption of blood aqueous barrier than SICS. PCO can be reduced by atraumatic surgery and thorough cortical clean up and capsular polishing.

scholarly journals Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2021 ◽  
Vol 11 (10) ◽  
pp. 1024
Author(s):  
Timothy Y. Y. Lai ◽  
Ricky Y. K. Lai
Keyword(s):  
Visual Acuity ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Thickness Variability ◽  
The Mean ◽  
Endothelial Growth Factor

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

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