December 2019


Journal of Cataract & Refractive Surgery

In the journal: December 2019

Immediately sequential bilateral cataract surgery: The rationale, implementation and beliefs of ophthalmic surgeons across Europe

Emily C. Mills, BSc, Mehran Zarei-Ghanavati, MD, FICO, Christopher S.C. Liu, FRCOphth, FRCSEd, FRCP
A survey of members of the European Society of Cataract & Refractive Surgeons evaluated attitudes toward immediately sequential bilateral cataract surgery (ISBCS). Two-hundred and forty-seven responses to the survey (sent to 2,200 European consultant members) were analyzed, revealing that 67.2% of respondents performed ISBCS compared to 28.7% who did not and 4% who had but do so no longer. Those who did not perform ISBCS cited risk of endophthalmitis and medicolegal issues. The most common reason for stopping ISBCS (n=4) was no longer believing in the benefit of it. According to the authors, “reports of bilateral endophthalmitis are extremely rare when the correct recommendations are followed.” Overall, the authors wrote that the “findings from this survey could be used to inform service provision of ISBCS in the U.K., taking into consideration the voices of colleagues overseas.”

Extended depth-of-focus technology in intraocular lenses

Thomas Kohnen, MD, PhD, FEBO, Rajaraman Suryakumar, BS Optom, PhD, FAAO
Drs. Kohnen and Suryakumar reviewed the clinical performance of extended depth-of-focus (EDOF) IOLs using different technologies: small aperture, bioanalogic, diffractive optics, and non-diffractive optical manipulation. They note that comparing these different technologies is difficult “because of variations in methodology and reported outcome measures across studies.” The American Academy of Ophthalmology developed a framework to test the performance of EDOF technologies to obtain data that can be compared. The authors continued that EDOF lenses “generally provide good to excellent [visual acuity (VA)] at distance, improved intermediate VA compared with monofocal IOLs, and functional near VA.” Based on the current data reviewed by Drs. Kohnen and Suryakumar, EDOF IOLs provide “a welcome addition for surgeons worldwide to address evolving visual needs of patients” but “current technologies fall short in providing monofocal-like distance visual quality or have contrast sensitivity that is significantly poorer than monofocal IOLs.”

Localized calcification of hydrophilic acrylic intraocular lenses after posterior segment procedures

Vaishnavi Balendiran, MD, Kyle MacLean, MD, Nick Mamalis, MD, Manfred Tetz, MD,
Liliana Werner, MD, PhD

This case series describes analysis of opacified hydrophilic acrylic IOLs of different designs explanted after posterior segment procedures, such as pars plana vitrectomy or intravitreal anti-VEGF injections. Thirty IOLs of nine different designs from seven manufacturers were explanted due to visual impairment from opacification. Gross and light microscopy showed granular deposits in what the study authors described as “a dense, round pattern of distribution within the margins of the capsulorhexis or pupil on the anterior/subsurface of the IOLs.” Histochemical staining was positive for calcium and scanning electronic microscopy and with energy dispersive x-ray spectroscopy confirmed the granules were composed of calcium/phosphate. According to the study authors, this pattern of calcification is similar to that seen on hydrophilic acrylic IOLs after anterior segment procedures where intracameral air/gas was used. They concluded that it is “is likely due to breakdown of the blood-aqueous barrier from repeated intraocular procedures.”

In the journal: December 2019 In the journal: December 2019
Ophthalmology News - EyeWorld Magazine
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