March 2019

ASCRS•ASOA UPDATE

In the Journal of Cataract & Refractive Surgery March 2019


Long-term effectiveness and safety of trabecular micro-bypass stent
implantation with cataract surgery in patients with glaucoma or ocular hypertension: 5-year outcomes

Tobias Neuhann, MD, Dana Hornbeak, MD, Raphael Neuhann, MD, Jane Ellen
Giamporcaro, MS

How does implantation of a trabecular micro-bypass stent in conjunction with cataract surgery affect eyes with ocular hypertension or open angle glaucoma? In a recent prospective consecutive case series, investigators reported on 26 eyes of patients with open angle glaucoma who had completed 5 years of follow up in this ongoing investigation. Investigators determined that there was a 38% decrease in mean IOP to 14.7 mm Hg among those who had not previously undergone trabeculectomy and/or glaucoma laser procedures. Medication usage, which was at 2 preoperatively, dropped by 75% to a mean of 0.5. Just 4% of patients required 3 to 4 medications versus 28% preoperatively. Investigators found that while 5% required no medications preoperatively, this rose to 69% postoperatively. They determined that postoperatively mean medication number was 0.5 or lower at all visits and mean IOP was 16 mm Hg or lower. Investigators concluded that with implantation at the time of cataract surgery of a trabecular micro-bypass stent in eyes with ocular hypertension or open angle glaucoma, safe and lasting medication and IOP reductions were attained through the 5-year mark.

Parameters affecting anterior capsulotomy tear strength and distension

Sheraz Daya, MD, Soon-Phaik Chee, FRCOphth, Seng-Ei Ti, FRCS(Ed), Richard
Packard, MD, David Mordaunt PhD

In two separate randomized cadaver eye preclinical studies, investigators examined the effects on tear threshold of the diameter of the anterior capsulotomy and continuity of the capsulotomy. Included were 40 cadaver eyes from 20 donors in which continuous curvilinear capsulorhexis was performed. Eyes were divided into two groups. In Study A investigators compared continuous to discontinuous capsulotomies. In Study B they compared a 5.0 mm continuous capsulotomy diameter or less to one that was 5.2 mm or more. Investigators found that in Study A for both anterior tear threshold load and distension the continuous capsulotomies were superior. In Study B, investigators determined that in 80% of the cases, a capsulotomy with a 5.2 mm diameter or greater was less likely to tear than if this was 5 mm or less. Investigators concluded that when it came to anterior tears, continuous circular capsulotomies were more resistant than their discontinuous counterparts. For this kind of anterior tear, capsulotomies with larger diameters were more resistant than the smaller ones.

Refractive outcomes of phacoemulsification after pars plana vitrectomy using traditional and new IOL calculation formulas

Thomas Lamson, BS, Jane Song, MD, Azin Abazari, MD, Sarah Weissbart, MD
With this retrospective review, investigators considered how eyes that had previously undergone vitrectomy fared in terms of refraction after undergoing cataract surgery. They examined how well this population did with formulas for calculating IOL powers. For the study, investigators considered all patients who underwent phacoemulsification at Stony Brook University Hospital from 2013 to 2017 who had previously undergone pars plana vitrectomy in the same eye. Investigators found that with the Holladay 1 formula the mean prediction error was 0.30, with the WKA-H1 was –0.09, with the Holladay 2 was 0.23, with the SRK/T was 0.25, with the WKA-SRK/T was 0.04, with the Barrett was 0.30, with the Hill-RBF was 0.33, and with the Ladas was 0.45. They reported that the Holladay 2 with 60.42% of predictions within 0.5 D of postoperative outcome had the most eyes in this range. Investigators determined that with the exception of the WKA-H and WKA-SRK/T, there were statistically significant differences between refractive outcomes that were predicted and those that occurred. All of the formulas also had low repeatability. Investigators reached the conclusion that for patients who have had vitrectomized eyes and who underwent cataract surgery, refractive outcomes tended toward being more hyperopic and were more variable than outcomes attained in other populations. This is something that such patients should be advised about, the investigators concluded.

In the Journal of Cataract & Refractive Surgery March 2019 In the Journal of Cataract & Refractive Surgery March 2019
Ophthalmology News - EyeWorld Magazine
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2019-03-05T07:32:11Z
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