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Concept: Phacoemulsification

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It is generally accepted that Jacques Daviel introduced in the 18th century the extracapsular technique of extraction of the lens while the couching method of cataract operation had already been practiced since ancient times. Present study analyses the first known cataract surgery description in three translations into English from the original Sanskrit Sushruta textbook and all the available literature on the subject. We found evidences that some sort of extraocular expulsion of lens material through a limbal puncture (paracentesis) was described by the Indian surgeon. Nevertheless, this incision cannot be considered as a classic extracapsular procedure because it was not large enough to allow the extraction of the entire lens.

Concepts: Surgery, China, Ophthalmology, 18th century, Phacoemulsification, Sushruta Samhita, Louis Althusser, Cataract surgery

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To analyze the possible factors correlated with the development of retinal detachment (RD) after cataract extraction and intraocular lens (IOL) implantation in a single medical center.

Concepts: Ophthalmology, Intraocular lens, Phacoemulsification

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To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS).

Concepts: Cornea, Ophthalmology, Lens, Contact lens, Intraocular lens, Phacoemulsification, Cataract, Aphakia

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PURPOSE: To compare the outcomes of 2 intraocular lenses (IOLs) for the treatment of age-related cataracts. DESIGN: Prospective, randomized trial. PARTICIPANTS: Patients with age-related cataracts were recruited and randomized to receive phacoemulsification and implantation of either the AcrySof SA60AT lens (Alcon, Inc, Fort Worth, TX) or the low-cost Tecsoft Flex lens (Fred Hollows Foundation, Tilganga, Nepal). A total of 300 patients were available for description and analysis (148 in the AcrySof group and 152 in the Tecsoft group). METHODS: Patients underwent phacoemulsification and implantation of the AcrySof SA60AT lens or the Tecsoft Flex lens. They were followed up and examined at baseline, 1 week, 1 month, 6 months, and 12 months after cataract surgery. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), incidence of posterior capsule opacification (PCO), Visual Function Index questionnaire results, and safety of the implanted IOLs. RESULTS: No significant difference (P>0.05) was found in UDVA and BDVA after surgery between the 2 groups. The equivalence test of the 95% confidence intervals showed that both lenses had an equal improvement of UDVA and BDVA as well as similar rates of PCO after cataract surgery. There was no significant difference between the 2 groups with regard to visual functioning or the incidence of adverse surgical events during (P>0.05) or after (P>0.05) the surgery. CONCLUSIONS: The Tecsoft Flex IOL is a low-cost suitable alternative that is similar to the AcrySof IOL in terms of safety and visual outcomes. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Concepts: Visual acuity, Ophthalmology, Lens, Intraocular lens, Phacoemulsification, Cataract, Binary relation, Fred Hollows

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Abstract Background: Gait speed and sleep quality are the health indices related to longevity and mortality. In the present study, we measured sleep quality, quality of life, gait speed, and visual acuity before and after cataract surgery to evaluate the efficacy of the procedure on systemic health. Methods: The study was conducted on 155 patients (93 women; average age 74.8 years) undergoing cataract surgery with the implantation of a yellow soft acrylic lens. Patients were evaluated using the Pittsburgh sleep quality index (PSQI) and the National Eye Institute Visual Function Questionnaire (VFQ-25; vision-related quality of life) before and then 2 and 7 months after surgery. Four-meter gait speed was also determined. Results: Of the 155 patients, 68 (43.9%) were classified as poor sleepers (PSQI >5.5) prior to surgery. Significant improvements were noted in sleep 2 months after surgery (P < 0.05, paired t-test), but thereafter the improvements were not significant. Prior to surgery, 117 patients (77.0%) were classified as slow walkers (speed<1.0 m/s). Gait speed increased significantly in these patients 2 months after surgery (P < 0.001, paired t-test). Multiple regression analysis revealed significant correlations between the preoperative VFQ-25 score and both PSQI (P < 0.05) and gait speed (P < 0.001). Postoperative increases in the VFQ-25 score were positively correlated with decreases in the PSQI (P < 0.05). Improvements in visual acuity were correlated with improvements in the VFQ-25 score, but not with either PSQI or gait speed. Conclusion: Cataract surgery effectively improves sleep quality and slow gait speed.

Concepts: Regression analysis, Linear regression, Statistics, Improve, Visual acuity, Ophthalmology, Phacoemulsification, F-test

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PURPOSE:To report an intraocular lens opacification case during cataract surgery. METHODS:An 80-year-old woman with a history of hypertension and type 2 diabetes mellitus presented with advanced nuclear cataract in her left eye and underwent coaxial phacoemulsification through a 1.8-mm micro-incision and insertion of with an in-the-bag intraocular lens (IOL). There was subsequently rapid, homogenous, and complete opacification of the lens, which remained opaque for 2 hours postoperatively. At 24 hours postoperatively, the IOL was transparent with no signs of opacification and the only findings were moderate corneal edema and mild remains of sub-incisional cortex. At the last postoperative visit 1 month after surgery, the IOL remained clear and the visual acuity was 20/20. The same conditions were reproduced in vitro and the same complete and homogenous opacification of the lens was observed. RESULTS:After an extensive review of the literature about other IOL opacification cases reported, no previously published case related to this condensation was found. CONCLUSION:The description of the temporary IOL opacification phenomenon due to condensation could be useful to cataract surgeons, who might avoid cold storage of IOLs. The known self-resolution of this kind of IOL opacification makes advisable to delay IOL surgical explantation in these cases.[J Refract Surg. 20XX;XX(X):XX-XX.].

Concepts: Diabetes mellitus, Surgery, Visual acuity, Ophthalmology, Lens, Intraocular lens, Phacoemulsification, Cataract

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OBJECTIVE: To compare effective phacoemulsification time after femtosecond laser pretreatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss. DESIGN: Prospective, consecutive, single-surgeon case-control study. CONTROLS: Controls underwent phacoemulsification cataract extraction plus insertion of an intraocular lens (IOL). Cases underwent pretreatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion. METHODS: Two hundred one eyes underwent cataract surgery between April 2012 and July 2012. Data collected included patient demographics, preoperative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intraoperative complications, and postoperative outcomes. MAIN OUTCOME MEASURES: Effective phacoemulsification time, intraoperative complications, corneal endothelial cell loss, as well as postoperative best-corrected visual acuity, intraocular pressure, and refractive outcomes. RESULTS: Patient demographics were similar between groups. There was no difference between baseline cataract grades (2.59±0.71 vs. 2.52±0.72, not significant). One hundred percent of cases pretreated with the femtosecond laser had complete capsulotomy. Mean EPT was reduced by 83.6% in the femtosecond pretreatment group (P<0.0001) when compared with controls, with 30% having 0 EPT (P<0.0001). Effective phacoemulsification time was reduced 28.6% within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8% reduction was achieved with a 20-gauge phacoemulsification tip. Overall, there was a 96.2% reduction in EPT between controls and the optimized femtosecond pretreatment group. This was associated with a 36.1% reduction in endothelial cell loss in the femtosecond group. Visual and refractive outcomes were similar to those of conventional cataract surgery. CONCLUSIONS: Femtosecond laser pretreatment results in a significant reduction in effective phacoemulsification time, including the possibility of 0 EPT. Further reductions may be achieved using optimization of lens fragmentation patterns and surgical technique. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Concepts: Surgery, Visual acuity, Cornea, Ophthalmology, Lens, Intraocular lens, Phacoemulsification, Cataract

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PURPOSES:: To describe a case of hemorrhagic Descemet membrane detachment following canaloplasty and to discuss its management using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser Descemet membranotomy. METHODS:: Interventional case report. RESULTS:: A 71-year-old woman with chronic open-angle glaucoma developed a hemorrhagic Descemet detachment after combined phacoemulsification, intraocular lens insertion, and canaloplasty. The hematoma did not improve with initial expectant management. Two and a half weeks after surgery, the Nd:YAG laser was applied to create a break in the Descemet membrane in the region of the hematoma. The intracorneal blood quickly dissipated into the anterior chamber. Visual acuity improved to 20/20. The endothelial cell count was 2342 cells per square millimeter 4 years after the surgery. Pachymetry did not show any long-term alterations as a result of the Nd:YAG treatment. CONCLUSIONS:: Hemorrhagic Descemet detachment is an uncommon complication after canaloplasty. Nd:YAG Descemet membranotomy is a successful means of clearing the hematoma and thus can prevent further complications, such as corneal blood staining.

Concepts: Surgery, Cornea, Ophthalmology, Lens, Contact lens, Intraocular lens, Phacoemulsification, 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 audit the results of 15 years' experience of suction posterior capsulorhexis (SPC) during phacoemulsification and compare the outcomes with a recently published multicentre audit of cataract surgery, the Cataract National Dataset (CND).

Concepts: Ophthalmology, Phacoemulsification, Cataract surgery