June 2019


Journal of Cataract & Refractive Surgery

In the journal: June 2019

Factors affecting cataract surgery operating time among trainees and consultants 

Paul Nderitu, MBChB, Paul Ursell, MD
In this retrospective study, investigators examined how cataract surgery operating times were affected by certain factors. Included here were primary manual phacoemulsification cases performed from January 2012 through December 2016. During this period, there were recorded operating times for 9,552 cases. Investigators found that especially for trainees, operating times were significantly shorter when topical anesthesia was used compared with topical, sub-Tenon’s, or general anesthesia. The increasing complexity of the case did not affect consultant operating times, with the exception of extreme cases. Increased operating times were seen in cases with small pupils or involving the use of capsular tension rings or pupil expanders, as well as occurrences of posterior capsular rupture and zonular rupture or dialysis. Use of Malyugin rings tended to be less time consuming at just 6 minutes versus 16 for use of iris hooks. Practitioners with more than 5 years of experience had a decrease in operating time of about 3 minutes. Investigators concluded that myriad factors played a role in operating time.

In vitro comparison of delivery performance of four preloaded intraocular lens injector systems for corneal and sclerocorneal incisions

Tetsuro Oshika, MD, Patricia Wolfe, PhD
Investigators compared the use of different preloaded IOL injector systems in porcine eyes that were placed in 11 study groups. With the UltraSert injector (Alcon), system U, one group received a corneal incision of 2.2 mm and the other one of 2.4 mm. With the UltraSert long tip group, system ULT, a corneal 2.6 mm incision was made, as well as sclerocorneal 2.4 mm and 2.6 mm incisions. In cases using the iTec (Johnson & Johnson Vision), system iT, corneal incisions of 2.2 and 2.4 mm were used, as well as sclerocorneal incisions of 2.2 and 2.4 mm. Lastly, with the Vivinex iSert (Hoya Surgical Optics), system iS, a corneal 2 mm incision was used, as well as a sclerocorneal incision of 1.8 mm. Investigators determined that with system iS, cartridge tip splitting was seen. When it came to incisional and sclerocorneal incisional enlargement, system U caused the least amount of enlargement with the 2.4 mm incision as did system ULT for the 2.6 mm sclerocorneal incision. Meanwhile, for both types of incisions, system iS resulted in the greatest amount of incisional enlargement. However, the final incision size with this system was also the smallest of any of the other systems, with the exception of the U 2.2 mm corneal incision. The conclusion reached was that there’s a greater amount of wound enlargement with a cartridge insertion technique when this goes through a smaller incision. Also, as a result of wound enlargement, using a preloaded delivery system with a tighter pre-implantation incision does not always make for a significantly smaller final incision.

Prevention of macular edema in patients with diabetes after cataract surgery – a systematic review and meta-analysis

Sophie Bryde Laursen, Jesper Høiberg Erichsen, MD, Lars Morten Holm, MD, Line Kessel, MD
Can a regimen of topical steroids either alone or in conjunction with depot steroids, NSAIDs and anti-VEGFs help diabetic patients avoid pseudophakic cystoid macular edema? Investigators conducted a literature search honing in on randomized controlled trials published after 1990. They determined that in diabetic patients, a combination regimen of topical steroids with NSAIDs prevented 75.8% of pseudophakic cystoid macular edema events. The use of a steroid depot in conjunction with topical steroids in this diabetic population was superior to use of topical steroids in conjunction with NSAIDs or alone. However, with this depot approach there was an increase in incidence of elevated IOP. Meanwhile, when it came to prevalence of pseudophakic cystoid macular edema in this diabetic population, the use of topical steroids and anti-VEGF, with or without NSAIDs, had no impact on postoperative occurrence of this condition.

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