October 2020


Journal of Cataract & Refractive Surgery
In the journal: October 2020

Visual outcomes of combined cataract and minimally invasive glaucoma surgery

Steven 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, for the ASCRS Glaucoma Clinical Committee
The ASCRS Glaucoma Clinical Committee conducted a literature review and shared its perspectives on MIGS combined with cataract surgery. The literature review included analysis of endocyclophotocoagulation; trabecular microbypass options; suprachoroidal and supraciliary implant options; ab interno trabeculotomy, goniotomy, viscodilation, and canaloplasty; and subconjunctival MIGS. Overall, the authors concluded that the current MIGS approved by the FDA do not adversely affect visual outcomes when combined with phacoemulsification. When devices are not canal based and involve more significant space in the anterior chamber, the effect on visual outcomes needs to be weighed, the committee wrote. The committee stated in the paper that it is “our majority opinion that devices such as CyPass … be made available to surgeons with updated ‘directions for use.’” The committee also discussed IOL selection in the setting of glaucoma/MIGS, writing that “simply because a patient has the diagnosis of glaucoma does not preclude them from achieving the best possible postoperative visual outcomes, which may include the use of premium IOLs (toric, presbyopia-correcting, or a combination of both).” The committee concluded that longer-term studies will show the continued success of MIGS for IOP and that they think visual outcomes will be affected not by the MIGS itself but by the effect of glaucoma and other age-related optic nerve progression.

The effect of manual, preloaded and automated preloaded injectors on corneal incision architecture after intraocular lens implantation

Michela Cennamo, MD, Eleonora Favuzza, MD, Maria Cristina Salvatici, PhD, Gabriele Giuranno, MD, Matilde Buzzi, MD, Rita Mencucci, MD
The effects of manual, preloaded, and automated preloaded IOL injectors on corneal morphology were analyzed with environmental scanning electron microscopy on donated human corneas (n=30) and with anterior segment OCT (AS-OCT) after patients underwent phacoemulsification (n=48). Manually loaded injectors (Monarch III, Alcon) were used in 26 cases, manual preloaded injectors (UltraSert, Alcon) in 26 cases, and automated preloaded injectors (AutonoMe, Alcon) in 26 cases. According to the research, the donated corneas had a wider incision width when a higher diopter IOL was inserted with a manually loaded inserter and also identified more Descemet’s tearing compared to those inserted with AutonoMe. In vivo cases evaluated with AS-OCT revealed a lower incidence of Descemet’s membrane detachment, posterior gape, and wound retraction on postop day 1 in the AutonoMe group as well. This led the investigators to conclude that an automated preloaded injector causes less wound trauma and preserves endothelial cells, especially in the setting of higher-power IOLs.

Aerosol and droplet creation during oscillatory motion of the microkeratome amidst COVID-19 and other infectious diseases

Pooja Khamar, MD, Rohit Shetty, MD, Nikhil Balakrishnan, MD, Prasenjit Kabi, PhD, Durbar Roy, MTech, Saptarshi Basu, PhD, Abhijit Sinha Roy, PhD
This laboratory investigational study looked at atomization of liquid over the cornea during LASIK flap creation with a microkeratome to simulate what could be the spread of COVID-19 and other viruses or bacteria that could be present on the ocular surface. Aerosolization was viewed with high-speed shadowgraphy. Two conditions were investigated: one with constant airflow (simulating uniform airflow in a room like that of a refractive surgery theater) and one with a decaying jet of air that assumed air velocity at the site where measurements were taken was smaller than that near an air duct (similar to that of an operating theater with air handling). The minimum droplet size observed when the microkeratome (One-Use Plus SBK, Moria) was passed over the corneal surface of enucleated goat eyes that had been wetted with balanced salt solution was ~90 μm. The furthest a droplet traveled was ~1.8 m and ~1.3 m, in a constant air flow condition and decaying jet condition, respectively. Overall, the investigators found that while the use of a microkeratome to create a LASIK flap spread droplets, it did not result in formation of aerosols. They concluded that the risk of virus transmission to others in this setting would be low.

Journal of Cataract & Refractive Surgery In the journal: October 2020 Journal of Cataract & Refractive Surgery In the journal: October 2020
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