ASCRS News
June 2022

The effect of phacoemulsification fluid flow on the corneal endothelium: An experimental study in rabbit eyes 

Emilie Ungricht, BS, Catherine Culp, MD, Phillip Qu, MD, Jacob Harris, BA, Ben Brintz, PhD, Nick Mamalis, MD, Randall Olson, MD, Liliana Werner, MD, PhD 

Damage to the corneal endothelium due to fluid flow during phacoemulsification was evaluated in an experimental study in rabbit eyes. Twelve New Zealand white rabbits underwent bilateral cataract surgery, with six eyes serving as controls with no irrigation (only the incision was performed). In 18 eyes, the Intrepid Balanced phaco tip of the Centurion Ozil handpiece (Alcon) was used for continuous irrigation at 50 mL/minute with either 250 mL or 500 mL of balanced salt solution. The rabbits were euthanized, and the corneas of the eyes removed for analysis. The X400 photographs showed no statistical differences between the controls or either of the balanced salt solution groups in terms of intact, damaged, or endothelial cells lost. The overview photographs did show statistically significant differences in terms of intact and damaged cells. The authors said this was likely due to “peripheral areas of damage related to touches between the phaco tip and endothelium during irrigation.” With these findings, they concluded that volume of balanced salt solution flow is not a major contributing source of endothelial cell damage. 

Late-onset toxic anterior segment syndrome after possible aluminum-contaminated and silicon-contaminated intraocular lens implantation

Dries Wijnants, MD, Heleen Delbeke, MD, Joachim Van Calster, MD, Nancy Beerlandt, MD, Ivo Nijs, MD, Liliana Werner, MD, PhD, Nick Mamalis, MD, PhD, Isabelle Saelens, MD, PhD

A retrospective, single-center, observational study described an outbreak of late-onset toxic anterior segment syndrome (TASS) after implantation of a hydrophilic acrylic IOL, specifically the monofocal, toric, or EDOF Synthesis IOL (Cutting Edge) between August 2019 and August 2020. Two hundred and three eyes were included in the study, 28 of which had TASS. The mean onset of time after surgery was 28.9 days. Patients presented with anterior chamber cells, deposits on the IOL, and/or fibrinous inflammation. Four eyes required surgical intervention, while 24 resolved with topical therapy. Laboratory analyses of the IOLs showed aluminum and silicon particles on the monofocal IOL and silicon particles on the EDOF IOL. No particles were on the toric IOL. The authors said this “atypical, late-onset TASS” was “possibly correlated to aluminum and silicon contamination of IOL surfaces.”

Non-diffractive wavefront shaping extended depth of focus (EDOF) intraocular lens: visual performance and patient-reported outcome

Thomas Kohnen, MD, PhD, Kerstin Petermann, MSc, Myriam Böhm, MD, Eva Hemkeppler, Wasim Ahmad, Lisa Hinzelmann, Katarzyna Pawlowicz, MD, Tyll Jandewerth, MD, Christoph Lwowski MD

Visual performance and patient-reported outcomes of the AcrySof IQ Vivity (Alcon), a non-diffractive, wavefront shaping EDOF IOL, was evaluated in a prospective, single-arm, single-center study. The study included 32 eyes that received bilateral Vivity as part of cataract surgery with a target refraction of emmetropia in both eyes. Mean spherical equivalent was –0.16±0.37 D at 3 months postop, and binocular UDVA at distance (4 m), intermediate (80 cm), and near (66 cm and 40 cm) was 0.01±0.05 logMAR, 0.05±0.05 logMAR, 0.07±0.06 logMAR, and 0.25±0.11 logMAR, respectively. Sixty-three percent of patients said they didn’t experience any optical phenomenon. Photopic contrast sensitivity was 1.25±0.41 logCS, mesopic 0.96±0.24 logCS, and mesopic and glare 0.93±0.24. Eighty-eight percent of patients reported they would choose the same lens again.

Characterizing astigmatism in the United States

Girish Valluru, MS, Janek Klawe, MA, Bian Liu, PhD, Pradeep Ramulu, MD, Sumayya Ahmad, MD 

Using data from the 1971–1975 and 1999–2008 National Health and Nutrition Examination Survey, investigators determined that there has been an increased prevalence in astigmatism and in against-the-rule astigmatism in recent years compared to the 30 years prior. Factors the authors associated with against-the-rule astigmatism were being male, white, and non-myopic. Astigmatism in men in the 1970s was 14%; it was 24% in 2000s. It was 16% in women in the 1970s and 24% in the 2000s. The authors reported that adjusted analysis in the 2000s cohort showed that myopes had an 8.34 times greater chance of having astigmatism than non-myopes.

United States military implantable collamer lens surgical outcomes: an 11-year retrospective review

Kyle Packer, MD, Anton Vlasov, DO, David Greenburg MD, Andrew Coggin, MD, James Weightman, MD, Thomas Beltran, MA, Cristóbal Berry-Cabán, PhD, Robert Carroll, MD

This study of long-term outcomes of implantable collamer lenses (ICLs) in active duty U.S. military personnel evaluated 3,105 eyes where patients received ICLs either due to abnormal topography (68%) or high myopia (32%). Nearly 80% of eyes maintained a UDVA of 20/25 or better postop, and desired refractive correction was met in 97% of cases at 1 year and 90% of cases at 8 years. There was minimal change in manifest refraction. Endothelial cell count loss was 22% at 5 years postop, and the overall rate of adverse events was 1.2%. The removal/replacement rate was 4.5%. The authors concluded that ICLs are safe and effective. They observed a decrease in vault size over time, suggesting increased risk of cataract formation after 7 years. The authors suggested further study to assess long-term clinical significance of endothelial cell count decline. 

Physician burnout in ophthalmology: a national survey

Jessica Sedhom, MS, Jennifer Patnaik, PhD, Emily McCourt, MD, Sophie Liao, MD, Prem Subramanian, MD, PhD, Richard Davidson, MD, Alan Palestine, MD, Malik Kahook, MD, Leonard Seibold, MD 

Ophthalmologists, according to this cross-sectional study, have a high degree of self-reported burnout. A survey was sent to email list servs of several national ophthalmology societies, with participants (n=592) completing a modified Mini Z Burnout survey, which assesses stress, burnout, and work satisfaction. In all, 37.8% of ophthalmologists reported symptoms of burnout, with vitreoretinal specialists being the lowest and uveitis specialists being the highest. Most categorized their burnout as mild (65.2%), 29.5% said it was moderate, and 5.4% severe. Female ophthalmologists were almost twice as likely to report burnout, and those working at academic or hospital facilities had higher rates of burnout compared to those in large private groups. Burnout was associated with feeling like one had low work control, insufficient time for documentation, and a misalignment with departmental leaders.