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Cataract Surgery and Postoperative Care – Part II

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (23 May 2023) | Viewed by 17716

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Dr. Raimo Tuuminen

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Guest Editor

1. Helsinki Retina Research Group, University of Helsinki, 00014 Helsinki, Finland
2. Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
Interests: cataract surgery; corneal diseases; presbyopic-correcting surgery; registry-based studies; refractive lens exchange
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Dr. Piotr Kanclerz

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Co-Guest Editor

Hygeia Clinic, Gdańsk, Poland and Helsinki Retina Research Group, University of Helsinki, 00014 Helsinki, Finland
Interests: refractive surgery; optical coherence tomography; cataract surgery; phacoemulsification; posterior capsule opacification; anti-inflammatory medication; pseudophakic cystoid macular edema; quality-of-life
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In January 2020, the first volume of the Special Issue “Cataract Surgery and Postoperative Care” was launched (https://www.mdpi.com/journal/jcm/special_issues/Cataract_Postoperative). We received many excellent papers on cataract surgery. Now, we would like to launch the second volume on this topic.

Cataract surgery is one of the most frequently performed surgical procedures in many countries. The surgical procedure itself is considered safe and efficient with good visual outcomes, and the development of modern surgical techniques and technologies has considerably reduced the frequency of complications. Furthermore, these advancements, yielding a precise postoperative refractive result, have raised the patient’s expectations for excellent uncorrected distance visual acuity. Multifocal intraocular lenses (MIOLs) are used more commonly and to a considerable extent for refractive purposes in non-cataractous eyes.

Complications are still a substantial burden because of the sheer number of cataract surgeries performed worldwide each year. Pseudophakic cystoid macular edema (PCME; Irvine–Gass syndrome) is one of the most common causes of visual impairment after cataract surgery. PCME may occur even in the absence of complications and risk factors. Intraoperative complications including capsule rupture, vitreous loss, and iris trauma are associated with a higher risk for PCME. Other risk factors include uveitis, poor glycemic control of diabetes, and various posterior segment diseases. Currently, there is no common definition for PCME; therefore, the incidences vary greatly among previously published studies.

Pre- and postsurgical medical interventions are employed in order to minimize postoperative inflammation and the risk of developing PCME. Other points of interest when comparing different anti-inflammatory drugs have been the speed of visual recovery, drug tolerability, and patient satisfaction to new treatment protocols such as “dropless” cataract surgery. Other interesting aspects involve the quality of life after RLE/MIOLs.

Achieving the best outcomes and preventing later complications requires diligent postoperative care, which also necessitates adequate patient compliance.

Dr. Raimo Tuuminen
Dr. Piotr Kanclerz
Guest Editors

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Keywords

anti-inflammatory therapy
aqueous flare
cataract surgery
complication management
intraocular lens
phacoemulsification
posterior capsule opacification
pseudophakic cystoid macular edema
quality-of-life
refractive lens exchange

Published Papers (10 papers)

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Editorial

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4 pages, 215 KiB

Open AccessEditorial

Should Multifocal Intraocular Lenses Become a Standard in Phacoemulsification Cataract Surgery?

by Achia Nemet, Piotr Kanclerz and Raimo Tuuminen

J. Clin. Med. 2023, 12(5), 1983; https://doi.org/10.3390/jcm12051983 - 2 Mar 2023

Viewed by 1425

Abstract

Cataracts impair daily activities such as reading, outdoor sports, and driving, which may not match best-corrected visual acuity at optimal room light conditions, but can be just as important to patients [...] Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

Research

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10 pages, 4789 KiB

Open AccessArticle

Research on Establishing Corneal Edema after Phacoemulsification Prediction Model Based on Variable Selection with Copula Entropy

by Yu Luo, Guangcan Xu, Hongyu Li, Tianju Ma, Zi Ye and Zhaohui Li

J. Clin. Med. 2023, 12(4), 1290; https://doi.org/10.3390/jcm12041290 - 6 Feb 2023

Viewed by 1070

Abstract

Background: Corneal edema (CE) affects the outcome of phacoemulsification. Effective ways to predict the CE after phacoemulsification are needed. Methods: On the basis of data from patients conforming to the protocol of the AGSPC trial, 17 variables were selected to predict CE after phacoemulsification by constructing a CE nomogram through multivariate logistic regression, which was improved via variable selection with copula entropy. The prediction models were evaluated using predictive accuracy, the area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA). Results: Data from 178 patients were used to construct prediction models. After copula entropy variable selection, which shifted the variables used for prediction in the CE nomogram from diabetes, best corrected visual acuity (BCVA), lens thickness and cumulative dissipated energy (CDE) to CDE and BCVA in the Copula nomogram, there was no significant change in predictive accuracy (0.9039 vs. 0.9098). There was also no significant difference in AUCs between the CE nomogram and the Copula nomogram (0.9637, 95% CI 0.9329–0.9946 vs. 0.9512, 95% CI 0.9075–0.9949; p = 0.2221). DCA suggested that the Copula nomogram has clinical application. Conclusions: This study obtained a nomogram with good performance to predict CE after phacoemulsification, and showed the improvement of copula entropy for nomogram models. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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9 pages, 802 KiB

Open AccessArticle

Comparison of Visual and Aberrometric Outcomes in Suture-Free Scleral Fixation: Three-Piece Lenses versus Carlevale Lenses

by Fabrizio Franco, Federica Serino, Giulio Vicini, Cristina Nicolosi and Fabrizio Giansanti

J. Clin. Med. 2023, 12(1), 188; https://doi.org/10.3390/jcm12010188 - 26 Dec 2022

Cited by 2 | Viewed by 1528

Abstract

Purpose: To compare the refractive results between sutureless scleral fixation intraocular lens (IOLs) (Carlevale, Soleko) and suture-free scleral fixation three-piece IOLs (Sensar AR40, Johnson & Johnson) for secondary implantation in patients with IOL dislocation or aphakia. Methods: This is a monocentric retrospective study on 28 patients (28 eyes) with sutureless scleral fixation Carlevale IOL and 25 patients (25 eyes) with suture-free scleral fixation three-piece IOL. Best-corrected visual acuity (BCVA) evaluation, refractive measures and IOL tilt evaluation with anterior segment optical coherence tomography were conducted at one, three, six and twelve months after surgery. Point Spread Function (PSF) was measured using a total ocular aberrometer. Results: BCVA in both groups improved since the postoperative visit at 1 month and reached a stable value at 3 months At month 12, mean BCVA was 0.23 logMAR in group one and 0.32 logMAR in group two. Mean IOL tilt angle at 12 months was 2.76° ± 1.87 in group one and 2.51° ± 1.80 in group two. PSF at 12 months was 0.18 ± 0.09 in group one and 0.15 ± 0.05 in group two. There were no statistically significant differences (p > 0.05) for all comparisons. The post-operative complications were similar within the two groups. Conclusions: Our results show that secondary IOL implantation has similar visual and surgical outcomes when a sutureless Carlevale lens scleral fixation and a suture-free scleral fixation three-piece IOL are used. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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16 pages, 2565 KiB

Open AccessArticle

Comparative Visual Outcome Analysis of a Diffractive Multifocal Intraocular Lens and a New Diffractive Multifocal Lens with Extended Depth of Focus

by Majid Moshirfar, Seth R. Stapley, Wyatt M. Corbin, Nour Bundogji, Matthew Conley, Ines M. Darquea, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(24), 7374; https://doi.org/10.3390/jcm11247374 - 12 Dec 2022

Cited by 11 | Viewed by 2348

Abstract

This study compares the visual and refractive performance of the TECNIS Synergy (DFR00V-DFW150-225-300-375) multifocal intraocular lens (IOL) and the AcrySof IQ PanOptix (TFAT00-30-40-50-60) multifocal IOL. Patients who underwent phacoemulsification and cataract extraction and received either a multifocal Synergy or PanOptix IOL were included. Monocular uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance (CDVA) visual acuities were assessed at three and six months postoperatively. Secondary outcome measures of photic phenomena were also assessed. A total of 140 patients (224 eyes) were included in this study, with 69 patients (105 eyes) in the Synergy group and 71 patients (119 eyes) in the PanOptix group. There were no statistically significant differences in UIVA or CDVA measurements across all time points. When assessing UDVA, at three months postoperatively, there were more eyes in the PanOptix group with vision better than 20/40 (p = 0.04). At three and six months postoperatively, the average UNVA was superior in the Synergy group (p = 0.01, 0.002). While the Synergy group reported more night vision disturbances at one and three months (p = 0.01, 0.03), the PanOptix group had more night vision disturbances at six months (p = 0.02). Although not statistically significant, the AcrySof IQ PanOptix multifocal IOL demonstrated better UDVA and UIVA sooner postoperatively than the TECNIS Synergy multifocal IOL. The Synergy IOL provided statistically better UNVA compared to the PanOptix IOL at three and six months postoperatively. Synergy patients reported more early photic phenomena than PanOptix patients, which later diminished. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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11 pages, 1842 KiB

Open AccessArticle

Clinical Outcomes after Bilateral Implantation of Trifocal Diffractive Intraocular Lenses and Extended Depth of Focus Intraocular Lenses

by Kyoung Yoon Shin, Dong Hui Lim and Tae-Young Chung

J. Clin. Med. 2022, 11(19), 5729; https://doi.org/10.3390/jcm11195729 - 27 Sep 2022

Cited by 3 | Viewed by 1978

Abstract

The purpose of this retrospective study is to investigate clinical outcomes of bilateral implantation of diffractive trifocal intraocular lenses (IOLs) and extended depth of focus IOLs in Koreans. The clinical outcomes of cataract surgery with bilateral implantation of PanOptix, FineVision, Symfony, and MiniWell were evaluated. Uncorrected distant, intermediate (80 cm, 60 cm), near (40 cm) visual acuity, defocus curve, manifest refraction, contrast sensitivity, and higher-order aberrations, quality of vision, spectacle independence, and subjective satisfaction at postoperative 3 months were assessed. A total of 136 eyes in 68 patients were included in the analyses. PanOptix and FineVision performed better visual acuity compared to Symfony and MiniWell at 40 cm distance. Defocus curve showed broad range of vision in PanOptix and FineVision with visual acuity of more than 0.1 logarithm of the minimum angle of resolution at −2.5 diopter (D) of defocus power, while Symfony and MiniWell presented excellent intermediate vision without a dip at defocus power of −0.5 D to −1.0 D. Glare, halo, and starburst were significantly less in MiniWell compared to others. In conclusion, all four IOLs presented satisfactory clinical outcomes. PanOptix and FineVision provided good near and intermediate vision, while Symfony and MiniWell provided good intermediate vision. MiniWell induced little dysphotopsia. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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10 pages, 269 KiB

Open AccessArticle

Change Patterns in Corneal Intrinsic Aberrations and Nerve Density after Cataract Surgery in Patients with Dry Eye Disease

by Dalan Jing, Xiaodan Jiang, Xiaotong Ren, Jie Su, Shanshan Wei, Ran Hao, Yilin Chou and Xuemin Li

J. Clin. Med. 2022, 11(19), 5697; https://doi.org/10.3390/jcm11195697 - 27 Sep 2022

Cited by 1 | Viewed by 1529

Abstract

This study aimed to evaluate the change patterns in corneal intrinsic aberrations and nerve density after cataract surgery in dry eye disease. The preoperative, 1- and 3-month postoperative dry eye-related parameters were obtained by the Oculus keratograph and the ocular surface disease index questionnaire. The corneal intrinsic aberrations were measured using the Pentacam HR system. In vivo confocal microscopy was performed to observe the vortical and peripheral corneal nerves. An artificial intelligence technique run by the deep learning model generated the corneal nerve parameters. Corneal aberrations on the anterior and total corneal surfaces were significantly increased at 1 month compared with the baseline (p < 0.05) but gradually returned to the baseline by 3 months (p > 0.05). However, the change in posterior corneal aberration lasted up to 3 months (p < 0.05). There was a significant decrease in the corneal vortical nerve maximum length and average density after the operation (p < 0.05), and this damage lasted approximately 3 months. The corneal vortical nerve maximum length and average density were negatively correlated with the anterior corneal surface aberrations before and 1 month after the operation (correlation coefficients, CC = −0.26, −0.25, −0.28; all p < 0.05). Corneal vortex provided a unique site to observe long-term corneal nerve injury related to eye dryness. The continuous damage to the corneal vortical nerve may be due to the continuous dry eye state. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

11 pages, 998 KiB

Open AccessArticle

Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses

by Miguel Á. Gil, Consuelo Varón, Genis Cardona and José A. Buil

J. Clin. Med. 2022, 11(14), 4150; https://doi.org/10.3390/jcm11144150 - 17 Jul 2022

Cited by 7 | Viewed by 1592

Abstract

The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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Review

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13 pages, 294 KiB

Open AccessReview

Application of the Active-Fluidics System in Phacoemulsification: A Review

by Yu Luo, Guangcan Xu, Hongyu Li, Tianju Ma, Zi Ye and Zhaohui Li

J. Clin. Med. 2023, 12(2), 611; https://doi.org/10.3390/jcm12020611 - 12 Jan 2023

Cited by 2 | Viewed by 1801

Abstract

The fluidics system is an indispensable and primary component of phacoemulsification. Both the gravity-fluidics system and active-fluidics system are commonly used in practice. The irrigation pressure of the gravity-fluidics system is determined by the bottle height, which is relatively constant, while the active-fluidics system is paired with a cassette that contains pressure sensors to monitor intraocular pressure changes. The active-fluidics system allows surgeons to preset a target intraocular pressure value, and it replenishes the fluids proactively; thus, the intraocular pressure is consistently maintained near the target value. Under such circumstances, stable intraocular pressure and anterior chamber volume values could be acquired. Research on surgical safety, efficiency and results have reported several strengths of the active-fluidics system. It is also advantageous in some complicated cataract surgeries. However, the system is not widely used at present, mainly due to its low penetration rate and high equipment cost. Some of its updates such as the new Active Sentry handpiece showed potential superiority in laboratory studies recently, but there is still further research to be conducted. This article gives an overview of the mechanism and performance of the active-fluidics system, and it is expected to provide clues for future research. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

13 pages, 2636 KiB

Open AccessReview

Unexpected Poor Vision within 24 h of Uneventful Phacoemulsification Surgery—A Review

by Harry Rosen and Stephen A. Vernon

J. Clin. Med. 2023, 12(1), 48; https://doi.org/10.3390/jcm12010048 - 21 Dec 2022

Cited by 2 | Viewed by 1526

Abstract

Review on day one post uneventful phacoemulsification surgery is no longer standard practice due to the infrequency of complications when using modern cataract removal techniques. Clinicians are therefore likely to be unfamiliar with the potential causes of reduced vision when presented with a patient in the immediate postoperative period. The purpose of this review is to discuss the various differential causes of early visual loss, for the benefit of clinicians presented with similar patients in emergency care, with the use of an illustrative clinical case of paracentral acute middle maculopathy (PAMM), which recently presented to the authors. A thorough literature search on Google Scholar was conducted, and only causes of visual loss that would manifest within 24 h postoperatively were included. Complications are inherently rare in this period; however, various optical, anterior segment, lens-related and posterior segment causes have been identified and discussed. Front-line clinicians should be aware of these differentials with different mechanisms. PAMM remains to be the only cause of unexpected visual loss within this time frame that may have no abnormal findings on clinical examination. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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12 pages, 472 KiB

Open AccessReview

Refractive Outcomes of Non-Toric and Toric Intraocular Lenses in Mild, Moderate and Advanced Keratoconus: A Systematic Review and Meta-Analysis

by Tal Yahalomi, Asaf Achiron, Idan Hecht, Roee Arnon, Eliya Levinger, Joseph Pikkel and Raimo Tuuminen

J. Clin. Med. 2022, 11(9), 2456; https://doi.org/10.3390/jcm11092456 - 27 Apr 2022

Cited by 8 | Viewed by 1980

Abstract

Background: To perform a systematic review and meta-analysis of the refractive outcomes of non-toric and toric intraocular lenses (IOLs) in keratoconus (KC) using different IOL power calculation formulas. Methods: A systematic search was conducted to identify studies that report on refractive outcomes of different IOL power calculation formulas in KC patients undergoing cataract surgery. Inclusion criteria were primary posterior chamber non-toric and toric monofocal intraocular lens implantation, data on the degree of KC, explicit mention of the formula used for each stage of KC, and the number of eyes in each category. We calculated and compared the absolute and mean prediction errors, percentage of eyes within 0.5 D and 1 D from target, and the weighted absolute prediction errors of IOL formulas, all were given for KC degrees I–III. Results: The bibliographic search yielded 582 studies published between 1996 and 2020, 14 of which (in total 456 eyes) met the criteria: three studies on non-toric IOL (98 eyes), eight studies on toric IOLs (98 eyes) and three studies of unknown separation between non-toric and toric IOLs (260 eyes). The lowest absolute prediction error (APE) for mild, moderate, and advanced KC was seen with Kane’s IOL power formula with keratoconus adjustment. The APE for the top five IOL power formulas ranged 0.49–0.73 diopters (D) for mild (83–94%) of eyes within 1 D from the target), 1.08–1.21 D for moderate (51–57% within 1 D), and 1.44–2.86 D for advanced KC (12–48% within 1 D). Conclusions: Cataract surgery in eyes with mild-to-moderate KC generally achieves satisfactory postoperative refractive results. In patients with advanced KC, a minority of the eyes achieved spherical equivalent refraction within 1 D from the target. The Kane’s formula with keratoconus adjustment showed the best results in all KC stages. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care – Part II)

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