Results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was <25 mm Hg, then phacoemulsification was performed; 2) if IOP remained >25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

Clinical case of fungal uveitis in a patient who underwent COVID-19

Purpose. To analyze a clinical case of fungal uveitis in a patient who has undergone COVID-19. Material and methods. A patient born in 1962 was admitted to the Kaluga branch of the MNTK with complains of blurred vision. From the anamnesis: in the first half of 2020, he was treated at the Kaluga branch of the MNTK with a diagnosis of complicated cataract, highly complicated myopia, PCRD, CCRD, pigmentary glaucoma; in the autumn of 2020, he suffered a coronavirus infection complicated by severe bilateral interstitial pneumonia, he was in the intensive care unit for 2 weeks. Results. During examination of the patient, the clinical picture and data of objective methods indicated the development of bilateral uveitis in the patient. A course of anti-inflammatory therapy was prescribed, and positive dynamics were achieved. But there was a sharp deterioration on the 10th day. Concilium was held: a fungal etiology of uveitis was suspected. The anterior chamber was washed, material from the anterior chamber was taken for bacterial culture. At the 3rd day the results of bacterial culture showed the growth of Candida albicans fungi. A multistage complex medical and surgical treatment was carried out. The outcome is encouraged however, the observation time is insufficient to draw final conclusions. Conclusion. The incidence of COVID-19 remains high, so ophthalmologists should remain vigilant, collect a careful anamnesis and expect an increase of the number of patients with intraocular fungal infection. Key words: uveitis; fungal infection; COVID-19.

Correlation between one month post operative refractive status with pre operative calculated IOL power

To study the correlation between preoperative calculated IOL power and post operative refractive error in temporal phacoemulsification. This study was a retrospective analysis in which data of 100 cases of senile cataract who underwent temporal phacoemulsification with foldable IOL was selected. Patients underwent post op examination at 4 weeks and only those patients whose vision was improving to 6/6 with or without correction was selected and their post operative refractive error in form of spherical equivalent was evaluated at 4 weeks of surgery and analysed with the preoperative calculated IOL power. All complicated cataract, cases with ocular pathology, patient with intraoperative or post operative complication and patient with history of any ocular surgery were excluded from the study. Formula used were SRK/T, HOFFER Q and HAIGIS.The mean IOL power used was20.39± 4.91, mean axial length was 23.43±1.53. The mean refractive error in form of spherical equivalent was-0.32±0.74. A total of 84 percent patients refractive error was upto 1D.A total of 37 percent patient had refractive error upto 0.25D, 57 percent upto 0.50 and 72 percent upto 0.75D.Myopic shift was present in 53 percent patients and hyperopic shift in 24 percent patient. There was no statistically significant correlation between iol power and refractive error at 4 week of temporal phacoemulsification as p value came as p=0.34While pre op accurate calculation of IOL power is very important for better visual acuity post op but just looking at any IOL power we cannot guess about refractive error that it may result.

Spontaneous attachment of complex Descemet’s membrane detachment following multiple failed interventions

We describe a case with complex Descemet membrane detachment (DMD) which persisted despite initial two failed surgical attempts to appose the ocular tissues. However, over time, tissue alignment was obtained spontaneously. A 60-year-old woman, operated trabeculectomy, had a total DMD intraoperatively during a complicated cataract surgery. Initial attempt to DM repositioning with intracameral air injection failed. Anterior Segment Optical Coherence Tomography (ASOCT) showed detachment of both DM and pre-Descemet’s layer (PDL). After consultation with a corneal surgeon, patient was again attempted for Intra-operative Optical Coherence Tomography (iOCT)-guided settlement of DMD with intracameral air which again failed. So, the patient was registered for lamellar corneal transplant, but at 3 months follow-up, DM had spontaneously attached, confirmed on ASOCT. This case shows for the first time that even complex DMDs involving PDL, can spontaneously appose despite failed surgical interventions.

Removal of a migrated dexamethasone implant (Ozurdex) from the anterior chamber using an intravenous cannula

Ozurdex is a dexamethasone intravitreal implant used for the treatment of macular oedema. A rare but serious complication is the migration of the implant into the anterior chamber (AC) in eyes with absent or incomplete posterior capsules that may lead to corneal decompensation. We report the case of a 75-year-old woman who presented with a 1-day history of decreased vision in her left eye. She had a history of complicated cataract surgery and had received multiple Ozurdex implants for postoperative cystoid macular oedema in the same eye. She had significant left corneal decompensation and a mobile Ozurdex implant in the AC. We report a simple but novel surgical technique for removing an Ozurdex implant from the AC using an intravenous cannula (Venflon). This technique can also be applied to removing a fluocinolone acetonide (Iluvien) implant in similar situations.

Long-term results of combined surgical treatment of patients with primary open-angle glaucoma in combination with complicated cataract

Purpose. To improve the effectiveness of surgical treatment of patients with primary open-angle glaucoma in combination with complicated cataract in the long-term period. Material and methods. A retrospective analysis of the cards of 64 patients (64 eyes) with 1-3 stage primary open-angle glaucoma (POAG) in combination with complicated cataract, who applied to the Orenburg branch of The S. Fyodorov Eye Microsurgery Federal State Institution and underwent combined surgical treatment in the form of microinvasive non-penetrating deep sclerectomy with simultaneous implementation of cataract phacoemulsification. We analyzed the results of combined surgical treatment of this group of patients 1, 6 and 12 months after surgery. Results. The obtained results indicate the stabilization of intraocular pressure in 60.9% of cases. However, in 26.5% of cases in patients with POAG of stage 3, it was necessary to prescribe a combination of antiglaucoma drugs. The total field of view in these patients remained unchanged, however, according to OCT-angio and computed perimetry, they had a negative trend. Conclusion. Combined surgical treatment of microinvasive non-penetrating deep sclerectomy with simultaneous implementation of cataract phacoemulsification followed by implantation of a posterior chamber IOL is an effective method of treating patients with glaucoma and cataract, while both the hypotensive and optical effect persists one year after the operation. Key words: open-angle glaucoma, cataract, dry eye syndrome, unstabilized glaucoma.

A Clinical case of surgical treatment of complicated cataracts in a patient with combined congenital eye pathology

Purpose. To evaluate the clinical and functional visual results in a patient with complicated cataract on the background of combined congenital eye pathology after performing cataract phacoemulsification with toric intraocular lens implantation. Material and methods. Under the supervision of patient Ch., who successfully underwent surgery on the right eye-cataract phacoemulsification with implantation of an intraocular lens for complicated cataracts against the background of combined congenital eye pathology. Results. The patient Ch. was subjectively satisfied with the visual functions obtained in the right eye. Conclusion. Thus, this clinical case demonstrates a very successful implementation of cataract phacoemulsification with implantation of a toric intraocular lens in a patient with complicated cataracts against the background of a combined congenital eye pathology. Key words: complicated cataract, coloboma of the iris, coloboma of the choroid, phacoemulsification of the cataract, astigmatic correction.

Intraoperative intravitreal triamcinolone acetonide injection for prevention of postoperative inflammation and complications after phacoemulsification in patients with uveitic cataract

Background We aimed to evaluate the efficacy and safety of phacoemulsification with intravitreal 3 mg triamcinolone acetonide injection in preventing postoperative inflammation and complications in patients with non-infectious anterior uveitis and panuveitis complicated cataract. Method In this retrospective cohort study, 140 uveitic cataract patients who received phacoemulsification and intraocular lens implantation in Shanxi Eye hospital from January 2018 to January 2020 were reviewed. The IVTA group (51 eyes of 41 patients) received intravitreal injection of 3 mg triamcinolone acetonide (TA) at the end of surgery, and the control group (51 eyes of 41 patients) without injection matched by propensity score matching were enrolled. Outcome measures were best corrected visual acuity (BCVA), anterior chamber inflammation, intraocular pressure, corneal endothelial cell density, central macular thickness and complications within 3 months follow-up. Results The degree of postoperative anterior chamber inflammation in the IVTA group was lighter than that in the control group (P < 0.05). The postoperative logMAR BCVA of anterior uveitis was better and improved more quickly in the IVTA group(P < 0.05). Postoperative time of using corticosteroids was shorter in the IVTA group as compared to the control group (P < 0.05). The central macular thickness at postoperative month 1 was statistically significantly lower in the IVTA group (P < 0.05). There were no statistically significant differences between the two groups in postoperative corneal endothelial cell density and intraocular pressure (P > 0.05). Two of 51 eyes (3.9%) in the IVTA group and 8 of 51 eyes (15.7%) in the control group had recurrence of uveitis; 6 of 45 eyes (13.3%) in the control group developed cystoid macular edema but none in the IVTA group; 11 of 51 eyes (21.6%) in the IVTA group and 22 of 51 eyes (43.1%) in the control group developed posterior synechiae postoperatively. Conclusions Intraoperative Intravitreal injection of 3 mg TA is an effective and safe adjunctive therapy for preventing postoperative inflammation and complications to promote early recovery for anterior uveitis or panuveitis complicated cataract patients following phacoemulsification. Trial registration This retrospective cohort study was in accordance with the tenets of the Helsinki Declaration and was approved by the Shanxi Eye Hospital Ethics Committee. Written informed consent was obtained from all participants for their clinical records to be used in this study.