Clinical Practice of Cataract Special Care Standards in Nonophthalmic Wards

Cataract is a lens metabolism disease, which is caused by various factors, and leads to metamorphic lens proteins turbidity. Cataract commonly occurs in elderly patients, and majority of these patients have clinical manifestations of blurred vision and other symptoms. In this study, we explored the clinical practice and observations of cataract care criteria in nonophthalmic wards. To realize this, a total of one hundred and twenty (120) cataract patients, admitted to the East Department of Ophthalmology, Shanghai Sixth People’s Hospital, particularly from April 2019-2020, were divided into the control and observation groups, where 60 cases were added to each group. The control group received routine nursing, and observation group was treated with cataract care criteria based on the control group. The complication rate, health cognition, and patient’s satisfaction were compared with existing approaches. The incidence of corneal edema, anterior chamber hemorrhage, endophthalmitis, and incision infection, specifically in the observation group, was lower than that in the control group ( P < 0.05 ). Likewise, the number of hospitalization days and expenses, specifically in the observation group, were lower than those in the control group ( P < 0.05 ). Health knowledge and satisfaction scores of the observation group were higher than the control group ( P < 0.05 ). Active service, service attitude, psychological support, caring patients, and health education dissatisfaction rate of the observation group were lower than the control group ( P < 0.05 ). Finally, the standard of cataract care in nonophthalmic wards reduces the incidence of complications, improve health awareness of patients, and help to improve satisfaction of patients with nurses. Furthermore, it is worthy of promotion and application particularly in traditional hospitals.

Persimmon Leaves (Diospyros kaki) Extract Enhances the Viability of Human Corneal Endothelial Cells by Improving Na+-K+-ATPase Activity

The Na+/K+-ATPase, present in the basolateral membrane of human corneal endothelial cells (HCECs), is known to play an important role for corneal transparency. Na+/K+-ATPase dysfunction is one of the major causes of corneal decompensation. The ethanol extract of Diospyros kaki (EEDK) has been reported to increase corneal cell viability. Thus, we treated HCECs with EEDK and studied its effects on HCECs survival and Na+/K+-ATPase against cytotoxic drugs like staurosporine (ST) and ouabain (OU). Firstly, survival assays, (MTT assay and live dead-imaging) showed that decreased HCECs viability by ST and OU was significantly recovered by EEDK co-treatment. Secondly, Na+/K+-ATPase activity assays revealed that EEDK enhanced Na+/K+-ATPase enzymatic activity (* p < 0.01) with/without ST and OU. Finally, Na+/K+-ATPase expression analysis (Western Blot and confocal microscopy) demonstrated that EEDK treatment with/without ST and OU facilitates Na+/K+-ATPase expression in HCECs. Taken together, our findings led us to the conclusion that EEDK might aid HCECs survival in vitro by increasing the activity and expression of Na+/K+-ATPase enzyme. Since Na+/K+-ATPase activity is important to maintain cellular function of HCECs, we suggest that EEDK can be a potential effective agent against corneal edema and related corneal disorders.

Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

Antipsychotics are widely used in psychiatric practice for treating schizophrenia, bipolar disorder, and other diseases, including those treated off-label. They manifest many adverse effects, including ophthalmic ones. Some of these effects, such as persistent mydriasis, cycloplegia, extraocular muscle dystonia, and visual hypersensitivity attacks are reversible, since they disappear after dose reduction or drug withdrawal. Yet other side effects, such as cataracts, corneal edema, acute angle closure glaucoma and retinopathy are threatening for sight and may lead to permanent visual acuity decline and even blindness. The review provides data on the incidence of ocular side effects (both typical and atypical) of multiple antipsychotics, their clinical manifestations, pathogenesis and treatment. Eye examination is recommended for patients taking antipsychotics in the early periods of treatment and then twice a year. The psychiatrists need to know about the adverse effects of individual drugs whilst the ophthalmologists should be aware of their semiotics, pathogenesis and treatment, since timely diagnosis and treatment of pathological changes, together with antipsychotic therapy modification, prevent the development of severe and irreversible visual impairment in the majority of cases.

Enlargement of Phimotic Capsulorhexis Using Plasma Energy: A Case Series

Purpose: to evaluate the effectiveness and safety of the plasma ablation technique of Fugo blade system to enlarge phimotic capsulotomies in the management of anterior capsule contraction syndrome.Patients and methods. Results of the enlargement of phimotic capsulotomies using the plasma ablation technique in 17 patients with anterior capsule contraction syndrome (10 men and 7 women, 18 eyes; average age — 73.8 ± 9.6 years) were retrospectively analyzed. Surgically, after pupil dilation, the anterior chamber was irrigated with a viscoelastic device (1.4 % solution of hyaluronic acid), and the tip of the Fugo blade was inserted through a 2.0–2.2 mm wide corneal incision. After slightly touching the anterior capsule, the apparatus was activated, and its tip was moved in a concentric manner, excising the required size of the fibrosed anterior capsule in a resistance-free fashion. Finally, the viscoelastic material was aspirated, and the incisions were hydrated.Results. Phimotic capsulotomies were enlarged in all cases. Except for three cases where the bimanual technique was required to ablate the anterior capsule, all other cases were managed single-handedly. The use of cohesive viscoelastic device (1.4 % solution of hyaluronic acid) made it possible to perform this procedure with minimum trauma and under visual control. No serious complications were encountered during surgery or in the early postoperative period. Patients were discharged 1–2 days after surgery. Corneal edema, which was observed in six eyes, resolved within 3–4 days. Visual acuity improved in all cases, except for 2 patients with complete glaucomatous optic atrophy. IOP remained under control in all cases. No negative effect on the hypotensive results of previous glaucoma surgeries was observed.Conclusion. The plasma-generating Fugo blade system is an effective and safe tool to enlarge phimotic capsulorhexis in a resistance-free fashion. It is easy to use, mastering of new surgical skills is not required, surgical trauma is minimal, the surgical time is reduced, and the patient’s rehabilitation period is significantly shortened.

Bi-weekly Subconjunctival Injection of Bevacizumab for Corneal Neovascularization after Burn Injury

Purpose: We report two cases of corneal neovascularization (NV) after burn injury successfully treated by subconjunctival bevacizumab injections at 2-week intervals.Case summary: Three bi-weekly subconjunctival injections of bevacizumab were administered to two patients with corneal NV after burn injury. In our first patient, corneal NV was markedly reduced by bevacizumab injection. The patient exhibited with a clear cornea and improved visual acuity (20/30) after treatment. Eleven weeks after the last injection, the cornea remained clear, with clinical regression of smaller vessels; the improvement in visual acuity was maintained. In the second case, the diameter of the vessels, hemorrhagic lesions, and corneal edema decreased/regressed, with improvement of the visual acuity to 20/25; these improvements persisted for 12 weeks after the last subconjunctival injection.Conclusions: Our results suggest that bi-weekly subconjunctival injection of bevacizumab is well-tolerated and effective for inhibiting chronic corneal NV after burn injury.

REGIONAL VARIATION IN FLUID RESERVOIR THICKNESS, OXYGEN TRANSMISSIBILITY AND CORNEAL OEDEMA DURING SCLERAL LENS WEAR

Purpose: To determine if regional variation in post lens fluid reservoir thickness (PLFT) during scleral lens wear leads to regional variation in oxygen transmissibility and corneal edema during 4 hours of non-fenestrated scleral lens wear.Methods: About 20 healthy subjects (mean age, 28.8 ± 4.2 years) were fitted with nonfenestrated rotationally symmetric scleral lenses. Anterior segment optical coherence tomography was used to measure cornea thickness before and after lens wear, PLFT 10 minutes and 4 hours after lens application, and scleral lens thickness (with the scleral lens in situ) 4 hours after scleral lens application. These measurements were limited to the central 6 mm and divided into three zones (central, mid-peripheral, and peripheral zones). In the mid-peripheral and peripheral zones, eight principal meridians were measured, generating 17 measurement points in total. Scleral lens thickness and PLFT measurements were corrected for optical distortions by a series of equations. Oxygen transmissibility was calculated by dividing the scleral lens oxygen permeability by the optically-corrected scleral lens thickness, taking into account the oxygen permeability of saline and fluid reservoir thickness.Results: A significant regional variation in PLFT (F = 12.860, P = 0. 012) was observed after 10 minutes of the lens application, PLFT was thickest and thinnest in the inferotemporal and the superonasal region of the peripheral zones( 322.6 ± 161.8 µm and 153.8 ± 96.4 µm, respectively); however, this variation was not statistically significant at 4 hours of scleral lens wear (F = 4.692; P = 0.073). Despite significant regional variation in oxygen transmissibility (F = 48.472; P = 0.001) and relatively low oxygen transmissibility through the scleral lens, induced corneal edema did not vary significantly in different regions (F = 3.346; P = 0.126). In the central corneal region, the induced corneal edema correlated moderately with PLFT (r = 0.468; P = 0.037) and oxygen transmissibility (r = -0.528; P = 0.017). This relationship was insignificant in the peripheral cornea.Conclusion: The inferotemporal peripheral region had the thickest PLFT and least oxygen transmissibility, and the superonasal region had the vice versa. Despite significant variation in PLFT and oxygen transmissibility initially, in healthy corneas, this variation does not seem to induce statistically significant regional variation in corneal edema. Increased central PLFT and decreased oxygen transmissibility moderately correlate with central corneal edema.

Comparative Outcomes of Standard Perioperative Eye Drops, Intravitreal Triamcinolone Acetonide-Moxifloxacin, and Intracameral Dexamethasone-Moxifloxacin-Ketorolac in Cataract Surgery

Background: Since the advent of cataract surgery, topical eye drops have been the mainstay of postoperative prophylaxis and treatment. Due to factors such as high expenses and poor patient compliance, there has been a growing interest and acceptance of “dropless” alternatives. The purpose of this study is to compare the effectiveness of intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac to a standard eye drop regimen in controlling postoperative inflammation, corneal edema, and intraocular pressure (IOP) among cataract patients.Methods: A retrospective longitudinal comparative study among 619 consecutive eyes receiving either a standard eye drop regimen, intraoperative triamcinolone acetonide-moxifloxacin or dexamethasone-moxifloxacin-ketorolac was performed between October 2016 and December 2020. Primary endpoints at postoperative day one (POD1), week one (POW1), and month one (POM1) included corneal edema, anterior chamber inflammation (ACI), and IOP.Results: Throughout the postoperative time points, there were no significant differences in corneal edema between intravitreal triamcinolone acetonide-moxifloxacin versus the standard eye drop therapy (OR [95%CI]: 1.09 [0.82, 1.45], P = .54) and intracameral dexamethasone-moxifloxacin-ketorolac versus the standard eye drop treatment (OR [95% CI]: 1.22 [0.89, 1.67], P = .22). The postoperative ACI severity was lower in the dexamethasone-moxifloxacin-ketorolac group compared to the triamcinolone acetonide-moxifloxacin group by 35% on postoperative day 1 (P = .01). The differences at subsequent postoperative time points were not statistically significant (P = .27 and P = 1.00 for POW1 and POM1 respectively). IOP at POM1 follow up visit was statistically significantly higher for the triamcinolone acetonide-moxifloxacin group [mean (±SD): 15.64 (4.26)] compared to the dexamethasone-moxifloxacin-ketorolac [mean (±SD): 14.16 (4.02)] (P < .01). There was no statistical difference in rates of CME (P = .16) and there were no cases of endophthalmitis.Conclusions: Intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac demonstrate similar levels of efficacy to a standard eye drop regimen after cataract surgery. This study reinforces them as viable alternatives to traditional postoperative drops.