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Visual Outcomes of Combined Cataract Surgery and Minimally Invasive Glaucoma Surgery
1422 REVIEW/UPDATE Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery Steven R. Sarkisian Jr, MD, Nathan Radcliffe, MD, Paul Harasymowycz, MD, Steven Vold, MD, Thomas Patrianakos, MD, Amy Zhang, MD, Leon Herndon, MD, Jacob Brubaker, MD, Marlene Moster, MD, Brian Francis, MD, for the ASCRS Glaucoma Clinical Committee Minimally invasive glaucoma surgery (MIGS) has become a reliable on visual outcomes based on the literature and the experience of standard of care for the treatment of glaucoma when combined the ASCRS Glaucoma Clinical Committee. with cataract surgery. This review describes the MIGS procedures J Cataract Refract Surg 2020; 46:1422–1432 Copyright © 2020 Published currently combined with and without cataract surgery with a focus by Wolters Kluwer on behalf of ASCRS and ESCRS inimally invasive (sometimes referred to as mi- and thereby lower IOP. The endoscope consists of a fiber- croinvasive) glaucoma surgery (MIGS) is a pro- optic camera, light source, and laser aiming beam with an Mcedure that lowers intraocular pressure (IOP) 832 nm diode laser. The endoscope probe is introduced into without significantly altering the tissue, allows for rapid the globe via a limbal corneal or pars plana incision. The visual recovery, is moderately effective, and can be com- anterior approach requires inflation of the ciliary sulcus with bined with cataract surgery in a safe and efficient manner.1,2 an ophthalmic viscosurgical device, whereas the posterior This is in contrast to more conventional glaucoma surgery approach uses a pars plana or anterior chamber irrigation (eg, trabeculectomy or large glaucoma drainage device port. Although the anterior approach can be used in a phakic implantation), which requires conjunctival and scleral eye, it is typically performed with cataract extraction as a incisions as well as suturing. -
Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients
Ocular Surface Disease: Supplement April 2018 Accurately Diagnose & Effectively Treat Your Surgical Patients Supported by an unrestricted educational grant from Ocular Surface Disease: Accurately Diagnose & Effectively Treat Your Surgical Patients Prevalence of Ocular Surface Disease and Its Impact on Surgical Outcomes Accurate diagnosis of dry eye disease is critical before cataract or refractive surgery By Elisabeth M. Messmer, MD ry eye is a common disease, but it may remain EPIDEMIOLOGY OF DRY EYE SYNDROME undetected. If it is not treated before cataract or 1-4 refractive surgery, patients may have suboptimal visual AFTER CATARACT SURGERY outcomes from their procedures. D l Very limited data available, mostly small descriptive/ IMPACT ON CATARACT SURGERY non-randomised studies There are a number of triggering factors for dry eye (Figure 1). l 10-20% of patients: DED induced or worsened after Cataract surgery worsens or causes dry eye in approximately uncomplicated cataract surgery 10% to 20% of patients (Figure 2).1-4 l In all studies: Signs and symptoms of dry eye In a study of 136 patients with a mean age of 71 years who increase after surgery were having cataract surgery, 22% had a prior diagnosis of dry eye that was not treated.5 Thirty-one percent complained l In most studies: gradual improvement of signs and of stinging, burning or other symptoms of dry eye when asked symptoms of dry eye within 3 months about their symptoms, and 41% reported a foreign body l In some studies: signs and symptoms persist > 3 months sensation. When the patients were examined, 77% had corneal staining and 50% had central staining. -
CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g. -
Clinical Findings and Management of Posterior Vitreous Detachment
American Academy of Optometry: Case Report 5 Clinical Findings and Management of Posterior Vitreous Detachment Candidate’s Name, O.D. Candidate’s Address Candidate’s Phone number Candidate’s email Abstract: A posterior vitreous detachment is a degenerative process associated with aging that affects the vitreous when the posterior vitreous cortex separates from the internal limiting membrane of the retina. The composition of the vitreous gel can degenerate two collective ways, including synchysis or liquefaction, and syneresis or shrinking. Commonly, this process of separation occurs with the posterior hyaloid resulting in a Weiss ring overlying the optic nerve. Complications of a posterior vitreous detachment may include retinal breaks or detachments, retinal or vitreous hemorrhages, or vitreomacular traction. This case presentation summarizes the etiology of this ocular condition as well as treatment and management approaches. Key Words: Posterior Vitreous Detachment, Weiss Ring, Vitreous Degeneration, Scleral Depression, Nd:YAG Laser 1 Introduction The vitreous humor encompasses the posterior segment of the eye and fills approximately three quarters of the ocular space.1 The vitreous is a transparent, hydrophilic, “gel-like” substance that is described as a dilute solution of collagen, and hyaluronic acid.2,3,4 It is composed of 98% to 99.7% water.4 As the eye matures, changes may occur regarding the structure and composition of the vitreous. The vitreous functions to provide support to the retina against the choroid, to store nutrients and metabolites for the retina and lens, to protect the retinal tissue by acting as a “shock absorber,” to transmit and refract light, and to help regulate eye growth during fetal development.3,4 Case Report Initial Visit (03/23/2018) A 59-year-old Asian female presented as a new patient for examination with a complaint of a new onset of floaters and flashes of light in her right eye. -
Contacts Vs. Iols for Congenital Cataract
in Review News commentary and perspectives Contacts vs. IOLs for Congenital Cataract he verdict is in on the issue of optical correction in children who undergo unilateral cataract surgery before age 7 months: Aphakia, corrected with a contact lens, is a better option than an T CONTACT LENS PATIENT. Dr. Lambert examines a 6-year-old intraocular lens (IOL) for 55 others who received an aphakic girl in the IATS trial. This child was prescribed a most of these babies. IOL implant (median VA in contact lens in one eye at 1 month of age and could insert “Primary IOL implan- both groups, 0.90 logMAR her own contact lens by the age 4 years. tation should be reserved [20/159]). for those infants where, in More complications. pillary membranes occurred one normal eye. But the the opinion of the surgeon, However, a significantly 10 times more often in the thing about children is that the cost and handling of greater number of the pseu- pseudophakic eyes. they’re going to live for a a contact lens would be so dophakic eyes required one Scott R. Lambert, MD, very long time, and it is burdensome as to result in or more additional intra- a professor of ophthalmol- important for them to have significant periods of uncor- operative procedures over ogy at Emory University in the best possible visual acu- rected aphakia,” stated the the course of the study (41 Atlanta and the lead inves- ity in their problem eye,” investigators in the Infant patients compared with tigator in the trial, credited he said, particularly in case Aphakia Treatment Study.1 12 in the aphakic group; advocacy by the pediatric anything should happen to Comparable VA. -
Refractive Errors a Closer Look
2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep. -
Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation
10.5005/jp-journals-10025-1024 JaimeCASE Levy REPORT et al Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation Jaime Levy, Anry Pitchkhadze, Tova Lifshitz ABSTRACT implantation in the right eye. On presentation, uncorrected We present the case of a 73-year-old patient who underwent visual acuity (UCVA) was 6/60 OU. Refraction was –0.75 successful phacoemulsification and toric intraocular lens (IOL) –5.0 × 65° OD and –3.25 –4.0 × 98° OS. Nuclear sclerosis implantation to correct high stable astigmatism due to and posterior subcapsular cataract +2 was observed in the keratoconus and cataract. Preoperative refraction was –3.25 – left eye. The posterior segments were unremarkable. 4.0 × 98°. A toric IOL (Acrysof SN60T6) with a spherical power of 16.5 D and a cylinder power of 3.75 D at the IOL plane and Corneal topography performed with Orbscan (Bausch 2.57 D at the corneal plane was implanted and aligned at an and Lomb, Rochester, NY) showed central thinning of 457 axis of 0°. Uncorrected visual acuity improved from 6/60 to microns and positive islands of elevation typical for 6/10. Postoperative best corrected visual acuity was 6/6, 6 months after the operation. In conclusion, phacoemulsification keratoconus in the right eye (Fig. 1). In the left eye a less with toric IOL implantation can be performed in eyes with pronounced inferior cone was observed (Fig. 2), without keratoconus and cataract. any area of significant thinning near the limbus typical for Keywords: Intraocular lens, Toric IOL, Keratoconus, Cataract pellucid marginal degeneration.2 Keratometry (K)-values surgery. -
Incidence of Posterior Vitreous Detachment After Cataract Surgery
ARTICLE Incidence of posterior vitreous detachment after cataract surgery Alireza Mirshahi, MD, FEBO, Fabian Hoehn, MD, FEBO, Katrin Lorenz, MD, Lars-Olof Hattenbach, MD PURPOSE: To report the incidence of posterior vitreous detachment (PVD) after uneventful state- of-the-art small-incision phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). SETTING: Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany. METHODS: This prospective study evaluated the vitreous status of eyes by biomicroscopic exam- ination, indirect binocular ophthalmoscopy, and B-scan ultrasonography before planned cataract surgery. Patients with the posterior vitreous attached were included for follow-up and examined 1 week, 1 month, and 1 year after uneventful phacoemulsification with PC IOL implantation. The preoperative prevalence and postoperative incidence of PVD were determined by ultrasonography. RESULTS: The study included 188 eyes of 188 patients (131 women, 57 men) with a mean age of 77.2 years. The mean spherical equivalent was À0.78 diopter (D) (range À8.75 to C6.25 D) and the mean axial length (AL), 23.22 mm (range 20.50 to 26.04 mm). Preoperatively, 130 eyes (69.1%) had PVD and 58 eyes (30.9%) had no PVD. Postoperatively, 12 eyes (20.7%) developed PVD at 1 week, 18 eyes (31%) at 1 month, and 4 eyes (6.9%) at 1 year. The vitreous body remained at- tached to the retina in 24 eyes (41.4%) 1 year after surgery. No preoperatively measured parameter (eg, age, refraction, AL, effective phacoemulsification time) was predictive of the occurrence of PVD after cataract surgery. CONCLUSION: The occurrence of PVD after modern cataract surgery was frequent in cases in which the posterior hyaloid was attached to the retinal surface preoperatively. -
Florida Board of Medicine and Florida Board Of
FLORIDA BOARD OF MEDICINE AND FLORIDA BOARD OF OSTEOPATHIC MEDICINE APPROVED INFORMED CONSENT FORM FOR CATARACT OPERATION WITH OR WITHOUT IMPLANTATION OF INTRAOCULAR LENS DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES _____ NO_____ TO THE PATIENT: You have the right, as a patient, to be informed about your cataract condition and the recommended surgical procedure to be used, so that you may make the decision whether or not to undergo the cataract surgery, after knowing the risks, possible complications, and alternatives involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so that you may give or withhold your consent to cataract surgery and should reflect the information provided by your eye surgeon. If you have any questions or do not understand the information, please discuss the procedure with your eye surgeon prior to signing. WHAT IS A CATARACT, AND HOW IS IT TREATED? The lens in the eye can become cloudy and hard, a condition known as a cataract. Cataracts can develop from normal aging, from an eye injury, various medical conditions or if you have taken certain medications such as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed to try to improve your vision. Surgery is the only way to remove a cataract. You can decide to postpone surgery or not to have the cataract removed. -
Perspectives on Presbyopia
PERSPECTIVES ON PRESBYOPIA EXTRA CONTENT FOUR PATIENTS AVAILABLE FIVE EXPERTS BY MARY WADE, CONTRIBUTING WRITER ew presbyopia treatments, such as the corneal inlays Kamra and Raindrop, are slowly wending their way through the U.S. Food and Drug Administration approval process. Entirely new approaches to intraocular lenses (IOLs) are in development internationally. Meanwhile,N patients arrive in your office daily, seeking better vision without reading glasses. What are the best treatments to offer them right now? EyeNet asked five leading refractive surgeons to review four hypothetical patients with pres- byopia or pre-presbyopia. The differing recommendations made by these clinicians illustrate the range of valid approaches. The surgeons emphasize that, in all cases, it’s critical to conduct a thorough assessment, talk with patients about their vision priorities, discuss the pros and cons of various approaches, and mention the option of “watchful waiting”—that is, forgoing treatment for the time being. When patients are considering corrective surgery, one of the surgeon’s most important tasks is to help them form realistic expectations regarding visual outcomes and possible complications. (See “Counseling Caveats.”) For those patients who choose to pursue vision correction surgery, the perspectives presented by these refractive experts can help to guide treatment choices with today’s technologies. BONNIE A. HENDERSON, MD KEVIN M. MILLER, MD J. BRADLEY RANDLEMAN, MD STEVEN I. ROSENFELD, MD, FACS SONIA H. YOO, MD ALFRED T. KAMAJIAN T. ALFRED eyenet 37 eventually need cataract surgery, prior refractive surgery may make accurate refraction difficult and constrain lens choices. It makes sense to leave the corneas pristine in older patients. -
Cataract Surgery a Cataract Is Any Opacity Within the Lens of the Eye
The Ohio State University Veterinary Medical Center Cataract Surgery A cataract is any opacity within the lens of the eye. The lens sits within the eye and helps to focus images onto the retina. Cataracts can be caused by genetics, diabetes, aging, and other diseases of the eye, such as retinal disease or inflammation. If cataracts are severe enough, visual deficits can be noted at home or in unfamiliar environments (e.g. bumping into things, missing treats or stairs). Diagrammatic cross section of the eye What do I need to do for my pet prior to cataract surgery? In order to ensure the best chance of vision after cataract surgery, the health of both eyes and the animal are evaluated. Vitreous This includes: Health of the Eye Lens Retina • Complete ophthalmic exam by an ophthalmologist, including Cornea tests to evaluate tear production and intraocular pressure • Electroretinogram (ERG) – this is an electrical test used to evaluate the health of the retina behind the lens, usually performed without general anesthesia • Ultrasound of the eye to evaluate the structural integrity of the lens, retina and fluid behind the lens (the vitreous) Health of the Animal • Physical exam, including listening to the heart and lungs • Basic blood and urine tests to evaluate the overall health of the animal Diabetic animals should receive additional diagnostics • Fructosamine and/or glucose curve should be performed by your referring veterinarian to evaluate for adequate diabetic Mature cataract in a dog with diabetes mellitus. control (occasional spot-checks at home are not adequate prior to surgery) • Urine culture collected sterilely directly from the bladder, to ensure there is no active urinary tract infection present These evaluations should be performed within one month of the planned surgery to ensure we have the most up-to-date picture of your pet’s health. -
Review of the Impact of Presbyopia on Quality of Life in the Developing and Developed World
Acta Ophthalmologica 2014 Review Article Review of the impact of presbyopia on quality of life in the developing and developed world Ariana D. Goertz,1 William C. Stewart,2 William R. Burns,3 Jeanette A. Stewart2 and Lindsay A. Nelson2 1University of Nevada, Las Vegas, Nevada, USA 2PRN Pharmaceutical Research Network, LLC, Cheyenne, Wyoming, USA 3Encore Vision, Inc., Fort Worth, Texas, USA ABSTRACT. (Barbero 2013). Everyone eventually Purpose: To examine the public health impact of presbyopia regarding its effect develops presbyopia but symptoms on quality of life (QoL) and society in both the developed and developing worlds. may vary. The major risk factor for Methods: A database was created from articles found on PubMed, the Cochrane presbyopia is age although the condi- Library and Science Direct using the following search terms: presbyopia, QoL, tion may be affected by other factors accommodation, impact, cost, prevention, treatment and public health. Articles including disease, trauma and medica- were accepted into the database if they addressed presbyopia and public health. tions (American Optometric Associa- Results: This study showed in the developed world presbyopic subjects treated tion 2010). with reading glasses suffered a reduction in QoL parameters compared with Presbyopia is classically believed to those who were younger and emmetropic. A small minority of subjects were result from hardening of the lens although other causes have been assessed to be a candidate for additional non-spectacle treatment measures. In described as well such as changes in undeveloped areas, the manifestations of presbyopia were similar to the tissue elasticity and the ciliary body developed world in symptoms, age and reduced QoL.