Abstract: Advances in intraocular lens (IOL) design have rendered cataract surgery a refractive procedure. Newer IOL types include bifocal, trifocal and extended depth of focus (EDOF) IOLs. Their basic difference nestles in the number of focal points that each lens provides, which in turn leads to different visual outcomes. Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs. In this review, we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance, intermediate and near vision, contrast sensitivity, and reading performance. Finally, we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.
Background: To study the application of management tools such as Plan-Do-Check-Action (PDCA) cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.
Methods: The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017, set up a project activity improvement team, unified the surgical labeling processing plan, and made the fundus surgery procedure, and established the preoperative health education for surgical patients, and standardized the training content of post-rotating doctors and interns.
Results: The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.
Conclusions: Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care, improve the efficiency and accuracy of the surgical procedure delivery and operation, and optimize the satisfaction of the three parties of doctor-nurse-patient.
Abstract: Intraocular foreign body residue following ophthalmic surgery is rare but may cause severe postoperative occult inflammation. In some cases, small foreign bodies located in the anterior chamber angle may be missed by follow-up ultrasound biomicroscopy (UBM). We report the case of an elderly female whose right eye was injured by a nail and received corneal repair surgery in our hospital. Eleven days post-surgery, we found a mobile, short, translucent, rod-shaped foreign body in the upper corner of the right eye and another in the iris root at 7 o’clock. Two months post-surgery, the patient consulted a doctor due to right eye redness, pain, and vision loss, which was ultimately shown to be associated with foreign body residue resulting in a delayed postoperative inflammatory response. The patient was cured by surgeries and active anti-inflammatory and anti-infection treatments, but the final diagnosis of the patient was infectious endophthalmitis misdiagnosed as uveitis, which worths our consideration. We also review relevant literature on the differentiation of postoperative infectious endophthalmitis from noninfectious uveitis. It’s a reminder that patients with delayed endophthalmitis after open ocular trauma should not exclude the possibility of intraocular foreign bodies. As well clinicians can distinguish infectious endophthalmitis from uveitis by needle aspiration biopsy or vitrectomy for microbial culture in order to determine the need for antibiotic treatment.
Abstract: Glaucoma is a group of eye diseases that seriously threaten human visual health. Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels. The trabecular meshwork (TM) is a multi-layer spongy tissue that filters aqueous humor. Its structure changes and the filtering capacity decreases, leading to an increase in intraocular pressure. Surgical methods for TM are constantly updated. Compared with traditional glaucoma surgical techniques, such as external trabeculectomy, the development of a new surgical technique—minimally invasive glaucoma surgery (MIGS)—enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye. MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway, uveoscleral outflow pathway, and subconjunctival outflow pathway. A new surgical instrument, the Kahook Dual Blade, appears to optimize the TM outflow pathway in the surgical technique. The Kahook Dual Blade is a new type of angle incision instrument. Because of its unique double-edged design, in the process of goniotomy, it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly. Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants. The operation time is relatively short, the surgical technique is easy to master, and the TM resection scope can be determined based on the patient’s condition. It can be used to treat some clinically meaningful glaucoma. This article is organized as follows. We present the following article following the Narrative Review reporting checklist.
Abstract: Navigation technology in ophthalmology, colloquially called “eye-tracking”, has been applied to various areas of eye care. This approach encompasses motion-based navigation technology in both ophthalmic imaging and treatment. For instance, modern imaging instruments use a real-time eye-tracking system, which helps to reduce motion artefacts and increase signal-to-noise ratio in imaging acquisition such as optical coherence tomography (OCT), microperimetry, and fluorescence and color imaging. Navigation in ophthalmic surgery has been firstly applied in laser vision corrective surgery and spread to involve navigated retinal photocoagulation, and positioning guidance of intraocular lenses (IOL) during cataract surgery. It has emerged as one of the most reliable representatives of technology as it continues to transform surgical interventions into safer, more standardized, and more predictable procedures with better outcomes. Eye-tracking is essential in refractive surgery with excimer laser ablation. Using this technology for cataract surgery in patients with high preoperative astigmatism has produced better therapeutic outcomes. Navigated retinal laser has proven to be safer and more accurate compared to the use of conventional slit lamp lasers. Eye-tracking has also been used in imaging diagnostics, where it is essential for proper alignment of captured zones of interest and accurate follow-up imaging. This technology is not routinely discussed in the ophthalmic literature even though it has been truly impactful in our clinical practice and represents a small revolution in ophthalmology.
Background and Objective: Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades. Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema, subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma. Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques, including subthreshold selective laser trabeculoplasty (SSLT), micropulse laser trabeculoplasty (MLT), pattern-scanning laser trabeculoplasty (PSLT), titanium laser trabeculoplasty (TLT), and micropulse transscleral cyclophotocoagulation (MP-TSCPC).
Methods: This was a narrative review compiled from literature of PubMed and Google Scholar. The review was performed from March 2021 to October 2021 and included publications in English. We also included information from web pages to cover details of relevant laser systems. We discuss the history of subthreshold laser, recent advancements in subthreshold techniques, and commercially available systems that provide subthreshold capabilities for glaucoma. We highlight basic science and clinical studies that deepen the understanding of treatment mechanisms and treatment effectiveness in the clinical setting respectively. We review commonly used parameters for each technique and provide comparisons to conventional treatments.
Key Content and Findings: We found five distinct types of subthreshold laser used in the management of glaucoma. Numerous subthreshold laser systems are commercially available and can provide this treatment. Therefore, understanding the differences between subthreshold techniques and laser systems will be critical in utilizing subthreshold laser in the clinical setting.
Conclusions: Traditional laser trabeculoplasty (LT) and cyclophotocoagulation (CPC) have shown effectiveness in the treatment of various types of glaucoma but are associated with visible damage to the underlying tissue and adverse effects. Subthreshold laser systems aim to provide the therapeutic effect found in traditional lasers, while minimizing unwanted treatment related effects. Further clinical studies are needed to evaluate the role of subthreshold lasers in the management of glaucoma.
Background: Surgically induced astigmatism (SIA) and corneal high-order aberrations (HOAs) are the two main causes of poor visual quality after cataract surgery. Changes in the parameters of corneal HOAs after cataract surgery and their effects on and relationships with changes in corneal curvature have not yet been reported. This study aimed to explore changes in anterior, posterior and total corneal curvature, astigmatism and HOAs after microincision cataract surgery.
Methods: Sixty-one age-related cataract patients (61 eyes) were included in this prospective study. The total, anterior and posterior corneal astigmatism and corneal HOAs were analyzed by anterior segment optical coherence tomography (AS-OCT) and iTrace before, one day, one week and three months after 2.2 mm temporal microincision coaxial phacoemulsification to evaluate the changes in anterior, posterior and total corneal curvature, astigmatism and corneal HOAs.
Results: The mean J0 and J45 values of anterior, posterior and total corneal curvature obtained by AS-OCT showed no statistically significant difference between preoperatively and any postoperative follow-up. SIA occurred on the anterior, posterior and total corneal surfaces and showed no statistically significant difference at any postoperative follow-up. No significant changes in 3rd-order oblique trefoil, vertical coma or 4th-order spherical aberrations were observed after surgery except for a significant increase in horizontal coma at postoperative day 1 (POD1).
Conclusions: There were no significant changes in corneal curvature after 2.2 mm temporal microincision coaxial phacoemulsification, and the corneal HOAs were not changed significantly except for the increase in horizontal coma at POD1, which may be one of the main reasons of poor visual quality at POD1 in some cataract patients who have good uncorrected or corrected distance vision.
Background: To investigate the outcome of cataract surgery in patients with legal blindness defined as best-corrected visual acuity (BCVA) of 20/1,000 or lower and to determine factors influencing the visual outcome in these patients.
Methods: Medical records of 68 eyes of 62 patients diagnosed with legal blindness and underwent cataract surgery were reviewed. The study population was divided into 3 groups based on types of cataracts (Group A: posterior subcapsular cataract, Group B: mature or brunescent cataract, and Group C: cataract combined with other ocular diseases). Data including demographics, predisposing factors, BCVA before and 6 months after surgery and post-operative complications were collected and analyzed.
Results: Mean preoperative logMAR BCVA was 1.88±0.24, 2.24±0.26 and 1.96±0.31 in Groups A, B and C, respectively (P=0.003). The postoperative BCVA was 0.49±0.35, 0.51±0.47 and 0.90±0.53 in Groups A, B and C, respectively (p=0.003). Significant improvement in BCVA was shown in all 3 groups (P<0.001 in Groups A and B and, P=0.001 in Group C). There was significant difference in the amount of visual improvement among the 3 groups, P<0.001). Although there was no significant difference in the amount of visual improvement between group A and C (P=0.379), significantly higher visual improvement was achieved in group B compared with group A (P=0.012) and C (P=0.001).
Conclusions: Cataract surgery should be encouraged for patients with legal blindness, even in the presence of other ocular disease. Significant visual recovery was observed in all the groups, particularly in those with mature or brunescent cataract.
