Can a Set of Questions after Routine Cataract Surgery Predict Unexpected Findings and Avoid an Unnecessary Follow-Up Visit?

Background and Objectives: to evaluate whether a set of questions after a routine cataract surgery can predict unexpected findings and avoid an unnecessary follow-up visit. Materials and Methods: single-center, prospective, cohort study included 177 routine cataract surgery cases of two experienced surgeons between November 2019 and December 2020. Inclusion criteria included unremarkable postoperative day one follow-up examination. A set of seven questions regarding complaints with positive or negative answers was presented at the second follow-up visit (PV2)—one week (mean 8.34 ± 1.73 days) after the surgery. The outcome measures were the incidence of unexpected management changes (UMCs) at the PV2 visit (change or addition from a prescribed postoperative drop plan, extra procedures, an urgent referral to an ophthalmologist) and UMCs associations with the answers to a question set. Results: 81.4% of patients had no complaints about postoperative ocular status and answered with negative answers, 18.6% reported one or more complaint (positive answer): dissatisfaction with postoperative visual acuity (6.2%, 11 cases), eye pain (4.0%, 7 cases), increase in floaters after the surgery (4.0%, 7 cases), red eye (4.0%, 7 cases) and others. The prevalence of UMCs at PV2 was 1.7% (3 cases), of which 0.6% (1 case) was the prolonged antibiotic prescription due to conjunctivitis, 0.6% (1 case) was the addition of IOP lowering medication and 0.6% (1 case) was additional medication due to uveitis management. None of the complaints (positive answers) at PV2 were associated with the incidence of UMCs (p > 0.05). Conclusions: there were no associations of UMCs determined with positive answers to the questions. The prediction of UMCs incidence based on the positive answers was not obtained. Thus, we cannot exclude the necessity of a postoperative week one follow-up visit.

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Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1167 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Shua Azam ◽

Abdul Hameed Talpur ◽

Mahak Shaheen ◽

Sadia Bukhari

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Open Angle Glaucoma ◽

Case Series ◽

Angle Closure ◽

Inclusion Criteria ◽

Primary Angle Closure Glaucoma ◽

Closed Angle ◽

Operative Assessment

Purpose: To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma. Study Design: Interventional case series. Place and Duration of Study: Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019. Methods: Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age > 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated. Results: A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg. Conclusion: Phacoemulsification produces a useful decrease in IOP in glaucoma patients. Key Word: Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

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Late within the Capsular Bag Intraocular Lens Dislocation (Ten – Year Experience)

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i2.1110 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Munir Amjad Baig ◽

Rabeeya Munir

Keyword(s):

Cataract Surgery ◽

Intraocular Lens ◽

Inclusion Criteria ◽

Lens Dislocation ◽

Mature Cataract ◽

Intraocular Lens Dislocation ◽

Plate Design ◽

Capsular Bag ◽

Iol Dislocation

Purpose: To find out the frequency and causes of within the bag intraocular lens dislocation. Study Design: Descriptive, retrospective study. Place and Duration of Study: Federal Government Services Hospital Islamabad, from 2008 to 2018. Methods: Records of all the patients who underwent uneventful phacoemulsification were studied. Patients with Pseudoexfoliation and glaucoma were excluded. Out-of-the bag IOL dislocations and early dislocations that occurred within first three months after the cataract surgery were also not included. Percentage of patients with dislocated lens within the capsular bag after three months or more was calculated and the cause of dislocation was found. Results were presented in percentages. Results: Three thousand patients underwent uneventful phacoemulsification. Two thousand nine hundred thirty two (2932) patients fulfilled the inclusion criteria while 68 patients did not return for follow up. Age ranged between 25 and 75 years. There were 1600 males and 1332 were females. One thousand seven hundred and sixty were right eyes and one thousand one hundred and seventy two were left eyes. Sixty one (2.08%) developed late IOL dislocations, 35 (57.3%) males and 26 (42.7%) females. Patients of age group 50 – 75 years had more IOL dislocations. Causes of dislocation included; advanced mature cataract 21.3%, 19.7% with postoperative trauma, uveitis 14.7%, Myopia 9.8%, Silicon plate design in 9.8%, eccentric capsulorhexis 8.1%, small capsulorhexis 6.5%, retinitis pigmentosa 3.2% and in 6.5% no cause was found. Conclusion: Advanced mature cataract and postoperative trauma were the commonest causes of IOL dislocation. Key Words: Cataract surgery, Phacoemulsification, Trauma, Capsulorhexis. Intra ocular lens dislocation.

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Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

Medical Principles and Practice ◽

10.1159/000514662 ◽

2021 ◽

Author(s):

Nikolaos Dervenis ◽

Anna Praidou ◽

Panagiotis Dervenis ◽

Dimitrios Chiras ◽

Brian Little

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Exclusion Criteria ◽

Related Factors ◽

Postoperative Visual Acuity ◽

Good Visual Acuity ◽

Snellen Visual Acuity ◽

Vitreous Loss ◽

Surgery Outcomes

Abstract Objective: To analyze cataract surgery outcomes and related factors in eyes presenting with good visual acuity. Subject and Methods: Retrospective longitudinal of patients undergoing phacoemulsification between the years 2014-2018 in Moorfields Eye Hospital and satellite units. Pre- and postoperative visual acuity (unaided, with glasses, with pinhole) were analyzed. Inclusion criteria were age≥40 years and pinhole visual acuity ≥6/9 preoperatively. Exclusion criteria were no postoperative visual acuity data. VA change variable was also defined according to postoperative visual acuity being above or below the Snellen 6/9 threshold. Results: 2720 eyes were included in the analysis. The unaided LogMAR visual acuity improved from 0.54 to 0.20 (p<0.001), the LogMAR visual acuity with glasses improved from 0.35 to 0.05(p<0.001) and the LogMAR pinhole visual acuity improved from 0.17 to 0.13(p<0.001). 8.1% of patients had Snellen visual acuity <6/9 postoperatively. Mean follow up period was 23,6±9.9 days. In multivariate logistic regression, factors associated with visual acuity <6/9 postoperatively were: age [OR=0.96, 95% CI (0.95, 0.98), p<0.001], vitreous loss [OR=0.21, 95% CI (0.08, 0.56), p=0.002] and iris trauma [OR=0.28, 95% CI (0.10, 0.82) p=0.02]. No significant adverse events occurred. Conclusions: Visual acuity improved significantly overall in this group of patients, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.

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Postoperative follow-up for selected diffuse low-grade gliomas with WHO grade III/IV foci

Neurology ◽

10.1212/wnl.0000000000008877 ◽

2020 ◽

Vol 94 (8) ◽

pp. e830-e841 ◽

Cited By ~ 1

Author(s):

Amélie Darlix ◽

Valérie Rigau ◽

Julien Fraisse ◽

Catherine Gozé ◽

Michel Fabbro ◽

...

Keyword(s):

Medical Treatment ◽

Malignant Tumor ◽

Tumor Grade ◽

Subtotal Resection ◽

Time Interval ◽

Low Grade ◽

Single Center ◽

Inclusion Criteria ◽

Grade Iii

ObjectiveDiffuse low-grade gliomas (DLGG) are defined by continuous growth and an almost unavoidable malignant transformation. Foci of malignant glioma can be found within DLGG samples obtained from surgical resections. As the medical management of patients is classically based on the higher tumor grade, an immediate adjuvant treatment is usually proposed. To determine whether postponing the medical treatment in selected patients is feasible, we conducted a single-center retrospective study.MethodsThis was a single-center retrospective analysis of a consecutive series of DLGG managed with this conservative strategy. Inclusion criteria were at least 1 focus of malignant tumor (grade III–IV, WHO 2016), no previous chemotherapy or radiotherapy, no less than a subtotal resection of the fluid-attenuated inversion recovery tumor volume, no intention of treating with immediate adjuvant therapy, and minimum 2 years of follow-up. The time interval to the following oncologic medical treatment was analyzed, as well as the functional and survival results.ResultsForty-four patients met the inclusion criteria (median age 36, median time interval from diagnosis 7 months). Most tumors (88%) were IDH-mutant and 1p19q intact (59%); 9 presented with grade IV foci. With a median follow-up of 6.7 years, 75% of patients received a subsequent medical treatment, after a median time of 3.4 years since surgery. At the time of analysis, 9 patients (20.0%) had died (5- and 7-year survival rates: 95% and 67.0%). Most surviving patients were still active professionally, without seizures.ConclusionsPostponing the medical treatment in DLGG with foci of malignant tumor following total or subtotal resection should be considered in selected patients.

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Lateral one-third gland resection in Cushing patients with failed adenoma identification leads to low remission rates: long-term observations from a small, single-center cohort

Acta Neurochirurgica ◽

10.1007/s00701-021-04830-2 ◽

2021 ◽

Author(s):

Lukas Andereggen ◽

Luigi Mariani ◽

Jürgen Beck ◽

Robert H. Andres ◽

Jan Gralla ◽

...

Keyword(s):

Pituitary Gland ◽

Pituitary Hormone ◽

Single Center ◽

Inclusion Criteria ◽

Inferior Petrosal Sinus Sampling ◽

Single Center Study ◽

Remission Rates ◽

Subsequent Risk

Abstract Background Currently, there are no guidelines for neurosurgeons treating patients with Cushing’s disease (CD) when intraoperative adenoma identification is negative. Under these circumstances, a total hypophysectomy or hemi-hypophysectomy on the side indicated by inferior petrosal sinus sampling (IPSS) is the approach being used, although there is a subsequent risk of hypopituitarism. Data on whether one-third lateral pituitary gland resection results in cure of hypercortisolism and low rates of hypopituitarism remain inconclusive. Methods Retrospective single-center study of CD patients with failed intraoperative adenoma identification and subsequent resection of the lateral one-third of the pituitary gland as predicted by IPSS. We assessed (i) histopathological findings, (ii) early and long-term remission rates, and (iii) rates of additional pituitary hormone insufficiency. Results Ten women and three men met the inclusion criteria. At 3 months, remission was noted in six (46%) patients: three (23%) had histologically confirmed adenomas, two (15%) had ACTH hyperplasia, and one patient (8%) was positive for Crooke’s hyaline degeneration. New pituitary hormone deficits were noted in two patients (15%). After a median (±SD) follow-up of 14±4 years, recurrence was noted in two (15%) patients. Long-term control of hypercortisolism was attained by 10 patients (77%), with additional therapies required in nine (69%) of them. Conclusions In CD patients with failed intraoperative adenoma visualization, lateral one-third gland resection resulted in low morbidity and long-term remission in 31% of patients without the need for additional therapies. Bearing in mind the sample size of this audit, the indication for lateral one-third-gland resection has to be critically appraised and discussed with the patients before surgery.

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Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one

PLoS ONE ◽

10.1371/journal.pone.0221243 ◽

2019 ◽

Vol 14 (9) ◽

pp. e0221243

Author(s):

Giannis A. Moustafa ◽

Durga S. Borkar ◽

Sheila Borboli-Gerogiannis ◽

Scott H. Greenstein ◽

Alice C. Lorch ◽

...

Keyword(s):

Cataract Surgery ◽

Standard Set ◽

Management Changes

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Tissue Augmenting Palatoplasty for the Treatment of Velopharyngeal Insufficiency

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211053761 ◽

2021 ◽

pp. 105566562110537

Author(s):

Erin E. Anstadt ◽

Madeleine K. Bruce ◽

Matthew Ford ◽

Noel Jabbour ◽

Miles J. Pfaff ◽

...

Keyword(s):

Difficult Problem ◽

Velopharyngeal Insufficiency ◽

Pediatric Hospital ◽

Single Center ◽

Inclusion Criteria ◽

Tissue Augmentation ◽

History Of ◽

The Mean ◽

Velopharyngeal Function

Purpose Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty remains a difficult problem to treat. This study evaluates speech outcomes following revision palatoplasty with tissue augmentation using buccal myomucosal flaps (BMF) as an alternative to pharyngoplasty for patients with VPI. Methods A retrospective single-center review of revision palatoplasty with tissue augmentation at a tertiary pediatric hospital Cleft-Craniofacial Center between January 2017 and March 2021 was conducted. Patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI, and comprehensive pre- and postoperative speech evaluations who underwent revision palatoplasty with BMF were included. Results Twenty patients met inclusion criteria (35% female, 20% syndromic). Mean age at the time of revision palatoplasty with BMF was 9.7 years. Preoperatively, all patients had stigmatizing speech and received the recommendation for speech surgery; the mean Pittsburgh Weighted Speech Score (PWSS) was 14.3 ± 4.9. The mean postoperative PWSS at the most recent assessment was 4.2 ± 2.3, representing a statistically significant improvement from preoperative scores ( P < .001). Mean follow-up time was 8.9 months. Following revision palatoplasty with BMF, only one patient has received the recommendation for further speech surgery. No complications were noted. Conclusion In patients with VPI following primary palatoplasty, revision palatoplasty with tissue augmentation offers an alternative to pharyngoplasty. This approach preserves dynamic velopharyngeal function, improves speech outcomes, and should be considered an option when treating patients with post-primary palatoplasty VPI.

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