SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Eye surgery

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PURPOSE: To compare the visual outcomes of additional multifocal intraocular lenses (IOLs) for sulcus fixation with those of standard multifocal IOLs in the capsular bag. SETTING: Department of Ophthalmology, Rudolf-Virchow-Klinikum Glauchau, Glauchau, Germany. DESIGN: Prospective controlled clinical trial. METHODS: Eyes had phacoemulsification and implantation of a monofocal IOL in the capsular bag and an additional aberration-free diffractive IOL in the ciliary sulcus (multifocal add-on IOL group). Measurements of uncorrected and distance-corrected distance, intermediate, and near visual acuities; contrast sensitivity; and defocus curve were performed 3 months postoperatively. Results were compared with those in eyes with an aberration-correcting diffractive posterior chamber IOL (multifocal PC IOL group). RESULTS: The multifocal add-on IOL group comprised 34 eyes of 20 patients and the multifocal PC IOL group, 31 eyes of 17 patients. Cataract surgery, IOL implantation, and the postoperative course were uneventful in all cases. There were no statistically significant differences in uncorrected and distance-corrected distance, intermediate, or near visual acuities between the 2 groups. The median uncorrected distance visual acuity was 0.00 logMAR in both groups, and the median uncorrected near visual acuity was 0.10 logMAR in both groups. Contrast sensitivity testing yielded significantly better results in the multifocal add-on IOL group, especially at spatial frequencies over 1.5 cycles per degree. Defocus curves were similar in the 2 groups. CONCLUSION: Visual performance with a multifocal diffractive add-on IOL was equivalent to that achieved with a commonly used multifocal diffractive PC IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Concepts: Statistical significance, Visual acuity, Ophthalmology, Lens, Contact lens, Intraocular lens, Eye surgery, Cataract

28

This literature review looks at the current status of multifocal intraocular lenses (IOLs) in cataract surgery. The results of implantation of multifocal IOLs of diffractive, refractive, and hybrid diffractive-refractive design are described with regard to uncorrected near and distance visual acuity and spectacle independence. The occurrence of photic phenomena and contrast sensitivity loss with multifocal IOLs are also addressed. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Concepts: Visual acuity, Ophthalmology, The Current, Contact lens, Intraocular lens, Eye surgery, Cataract, Corrective lenses

28

PURPOSE: To study macular hole (MH) surgery in terms of baseline demographics, intraoperative complications, post-vitrectomy cataract, reoperation, and visual outcome. DESIGN: National Ophthalmology Database study. PARTICIPANTS: A total of 1078 eyes from 1045 patients undergoing primary MH surgery. METHODS: Participating centers prospectively collected clinical data using a single electronic medical record (EMR) system, with automatic extraction of anonymized data to a national database, over 8 years. The following data were extracted for eyes undergoing MH surgery: demographics, procedure elements, intraoperative complications, visual acuity (VA), and further surgery. MAIN OUTCOME MEASURES: Description of the primary procedures performed, intraoperative complication rate, change in VA, proportion of eyes undergoing subsequent surgery for persisting MH, cataract, or retinal detachment. RESULTS: The median age was 70.3 years, with a 2.2:1 female preponderance. All operations included a pars plana vitrectomy (PPV)-41.1% with hexafluoroethane (C(2)F(6)), 25.6% with perfluoropropane (C(3)F(8)), 24.5% with sulfahexafluoride (SF(6)), 2.2% with air, and 0.4% with silicone oil. A PPV was combined with internal limiting membrane (ILM) peel in 94.1% and cataract surgery in 40.5%. One or more intraoperative complications occurred in 12.4%. The median presenting logarithm of the minimum angle of resolution (logMAR) VA improved from 0.80 to 0.50 after a median follow-up of 0.6 years; 57.8% of eyes improved ≥0.30 logMAR units (∼2 Snellen lines). The choice of gas tamponade did not significantly influence the visual outcome, but eyes undergoing ILM peel were significantly more likely to gain ≥0.30 logMAR units, as were eyes with poor presenting VA. Subsequently, 4.2% of eyes underwent repeat surgery for MH and 2.4% for retinal detachment, and, excluding pseudophakic eyes, 64.6% underwent cataract surgery within 1 year. CONCLUSIONS: This study provides pooled, anonymized data on the demographics, complications, and visual outcome of MH surgery. This may enable vitreoretinal surgeons to benchmark their case-mix and outcomes, and facilitate risk-benefit and cost-benefit analyses. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Concepts: Surgery, Retina, Visual acuity, Ophthalmology, Vitrectomy, Cost-benefit analysis, Eye surgery, Cataract

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BACKGROUND: Cataracts are a common and significant cause of visual impairment globally. We aimed to evaluate uncorrected distance visual acuity (UDVA) as an outcome in treating astigmatic cataract patients to assist clinicians or ophthalmologists in their decision making process regarding available interventions. RESULTS: The systematic review identified 11 studies which reported UCVA. All 11 studies reported UDVA. Four brands of toric intraocular lenses (IOLs) were reported in these studies. All studies identified in the literature search reported improvements in UDVA following surgical implant of a toric IOL. The largest improvements in VA were reported using the Human Optics MicroSil toric IOL (0.74 LogMAR, UDVA) and the smallest improvements were also reported using the Human Optics MicroSil toric IOL (0.23 LogMAR, UDVA) in a different study. CONCLUSIONS: The results of this systematic review showed the aggregate of studies reporting a beneficial increase in UDVA with the use of toric IOLs in cataract patients with astigmatism.

Concepts: Decision making, Visual acuity, Ophthalmology, Presbyopia, Intraocular lens, Eye surgery, Cataract

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BACKGROUND: Over the last decade inpatient treatment has been reduced in favor of outpatient care or markedly shortened inpatient stays in most organ-specific surgical specialties such as ophthalmology in Germany. METHODS: Data from the federal statistics agency on the international classification of disease (ICD), diagnosis-related groups (DRG) and performed operations and procedures from 2000 to 2010 as well as data from the Institute for Reimbursements of Hospitals (InEK) on average costs per DRG in every German DRG (G-DRG) version from 2004 to 2010 were analyzed for ophthalmology. RESULTS: From 2000 to 2010, the number of cases with a main ophthalmological diagnosis decreased (-19 %), which was mostly due to a reduction in the number of cataract inpatients (-56 %). All subspecialties such as glaucoma (+82 %) and retina (+68 %) with the exception of primary strabismus diagnoses (-15 %) gained in number of cases. Inpatient cataract surgery was the most common surgery in 2004 but numbers decreased to 2010 (-9 %). The most often performed inpatient procedure was vitreoretinal surgery in 2007 and 2010 (increase 2004-2010  + 46 %). Average hospital stay decreased between 2005 and 2010 from 3.9 to 3.4 days and the average cost per case increased by 3.6 % overall and by 13.4 % for surgical cases. CONCLUSION: Ophthalmic healthcare provided as inpatient services decreased with a trend towards more complex cases being treated as inpatients from 2000 to 2010.

Concepts: Medicine, Hospital, Surgery, 1920, Ophthalmology, Phacoemulsification, Eye surgery, 1921

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To evaluate the safety and efficacy of the iol-AMD technology (London Eye Hospital Pharma, London, UK), which includes two injectable, hydrophobic acrylic intraocular lenses (IOLs) in a pilot study of patients diagnosed as having cataract and dry age-related macular degeneration.

Concepts: Pharmacology, Retina, Macular degeneration, Lens, Intraocular lens, Eye surgery, Cataract, London

23

To compare visual outcomes after cataract surgery with bilateral implantation of 2 intraocular lenses (IOLs): extended range of vision and trifocal.

Concepts: Comparison, Visual perception, Ophthalmology, Comparisons, Lens, Intraocular lens, Eye surgery, Cataract

3

Vitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy.

Concepts: Cohort study, Clinical trial, Statin, Surgery, The Association, Ophthalmology, Intraocular lens, Eye surgery

3

In recent years new models of intraocular lenses are appearing on the market to reduce requirements for additional optical correction. The purpose of this study is to assess visual outcomes following bilateral cataract surgery and the implant of a FineVision® trifocal intraocular lens (IOL).

Concepts: Ophthalmology, Lens, Presbyopia, Intraocular lens, Eye surgery, Cataract, Aphakia

2

Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™).

Concepts: Time, Term, Lens, Intraocular lens, Eye surgery, Finance, Cataract, Aphakia