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Cataract Surgery and Postoperative Care

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (8 October 2021) | Viewed by 32016

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Dr. Raimo Tuuminen

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1. Helsinki Retina Research Group, University of Helsinki, 00014 Helsinki, Finland
2. Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
Interests: cataract surgery; corneal diseases; presbyopic-correcting surgery; registry-based studies; refractive lens exchange
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Dear Colleagues,

Cataract surgery is one of the most frequently performed surgical procedures in many countries. The surgical procedure itself is considered safe and efficient with good visual outcomes, and the development of modern surgical techniques and technologies has considerably reduced the frequency of complications. Furthermore, these advancements yielding precise postoperative refractive results have raised patients’ expectations for excellent uncorrected distance visual acuity. Multifocal intraocular lenses (MIOLs) are used more commonly, to a considerable extent for refractive purposes in non-cataractous eyes.

Complications are still a substantial burden because of the sheer number of cataract surgeries performed worldwide each year. Pseudophakic cystoid macular edema (PCME; Irvine–Gass syndrome) is one of the most common causes of visual impairment after cataract surgery. PCME may occur even in the absence of complications and risk factors. Intraoperative complications including capsule rupture, vitreous loss, and iris trauma are associated with a higher risk for PCME. Other risk factors include uveitis, poor glycemic control of diabetes, and various posterior segment diseases. Currently, there is no common definition for PCME, and therefore the incidences vary greatly among previously published studies.

Pre- and postsurgical medical interventions are employed in order to minimize postoperative inflammation and the risk of developing PCME. Other points of interest when comparing different anti-inflammatory drugs have been the speed of visual recovery, drug tolerability, and patient satisfaction to new treatment protocols such as “dropless” cataract surgery. Other interesting aspects involve quality-of-life after RLE/MIOLs.

Achieving the best outcomes and preventing later complications requires diligent postoperative care, which also necessitates adequate patient compliance.

Dr. Raimo Tuuminen
Guest Editor

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Keywords

Anti-inflammatory therapy
Aqueous flare
Cataract surgery
Complication management
Intraocular lens
Phacoemulsification
Posterior capsule opacification
Pseudophakic cystoid macular edema
Quality of life
Refractive lens exchange

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Published Papers (9 papers)

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Editorial

Jump to: Research

3 pages, 201 KiB

Open AccessEditorial

Advancements in Postoperative Care after Cataract Surgery

by Piotr Kanclerz and Raimo Tuuminen

J. Clin. Med. 2022, 11(11), 3162; https://doi.org/10.3390/jcm11113162 - 2 Jun 2022

Cited by 1 | Viewed by 1921

Abstract

Cataract surgery is one of the most frequently performed surgical procedures in many countries [...] Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

Research

Jump to: Editorial

7 pages, 221 KiB

Open AccessArticle

Cataract Surgery in Very Old Patients: A Case-Control Study

by Hanan Nussinovitch, Erez Tsumi, Raimo Tuuminen, Boris Malyugin, Yotam Lior, Hadar Naidorf Rosenblatt, Matthew Boyko, Asaf Achiron and Boris Knyazer

J. Clin. Med. 2021, 10(20), 4658; https://doi.org/10.3390/jcm10204658 - 11 Oct 2021

Cited by 4 | Viewed by 2459

Abstract

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

13 pages, 3640 KiB

Open AccessArticle

Incidence and Characteristics of Intraocular Lens Dislocation after Phacoemulsification: An Eight-Year, Nationwide, Population-Based Study

by Ga-In Lee, Dong Hui Lim, Sang Ah Chi, Seon Woo Kim, Jisang Han, Dong Wook Shin and Tae-Young Chung

J. Clin. Med. 2021, 10(17), 3830; https://doi.org/10.3390/jcm10173830 - 26 Aug 2021

Cited by 9 | Viewed by 2260

Abstract

Background: We investigate the incidence and characteristics of IOL dislocation among the pseudophakic population after phacoemulsification. Methods: National data were collected from the health claims recorded with the Health Insurance Review and Assessment Service of South Korea from 2009 to 2016. Pseudophakic patients aged 40 years or older were included. The incidence estimates of phacoemulsification and IOL dislocation were analyzed, and the cumulative probabilities of IOL dislocation among the pseudophakic population and general population were calculated as a proportion. Results: Of 51,307,821 total subjects, 25,271,917 of whom were aged 40 years or older, 3,906,071 cataract cases in 2,650,104 pseudophakic patients were identified, and 72,309 patients experienced IOL dislocation. The cumulative probability was 2.73% per person and 1.85% per surgery among patients 40 years of age or older. The eight-year incidence rate for IOL dislocation in the pseudophakic population aged 40 years or older was 7671 per 1,000,000 person-years (95% CI: 7616–7727), including 10,341 cases in men and 5814 in women. Incidence peaked in the seventh decade of life for cataract surgery but in the fifth decade of life for IOL dislocation. The cumulative probability of IOL dislocation after phacoemulsification was approximately 2%, and the incidence rate was about 7000 per 1,000,000 pseudophakic patients. Conclusions: There was a significantly higher incidence of IOL dislocation among young males, even though the higher incidence of cataract surgery was observed among older females. These estimates of the nationwide, population-based incidence of IOL dislocation can help increase understanding of the population vulnerable to IOL dislocation. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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10 pages, 242 KiB

Open AccessArticle

Accelerated Corneal Endothelial Cell Loss after Phacoemulsification in Patients with Mildly Low Endothelial Cell Density

by Hung-Chi Chen, Chen-Wei Huang, Lung-Kun Yeh, Fang-Chi Hsiao, Yi-Jen Hsueh, Yaa-Jyuhn James Meir, Kuan-Jen Chen, Chao-Min Cheng and Wei-Chi Wu

J. Clin. Med. 2021, 10(11), 2270; https://doi.org/10.3390/jcm10112270 - 24 May 2021

Cited by 11 | Viewed by 3296

Abstract

By evaluating preoperative endothelial cell density (ECD), ECD loss after phacoemulsification can be predicted. In this retrospective cross-sectional study, we compared outcomes of phacoemulsification with different levels of preoperative ECD. Three-hundred-and-fifty-three patients aged between 18 and 90 years received phacoemulsification at Chang Gung Memorial Hospital. Age (p = 0.003), preoperative logMAR (p = 0.048), cataract grade (p = 0.005), preoperative ECD (p < 0.001), operation time (p = 0.043), phacoemulsification time (p = 0.001), and phacoemulsification energy (p < 0.001) were significantly associated with postoperative ECD change (%). Patients were divided into three groups according to preoperative ECD levels. Level of ECD, coefficient of variation (CV), cell hexagonality (HEX), central corneal thickness (CCT), visual acuity, underlying diseases, and complications were analyzed. With regard to groups, 29, 71, and 252 patients were respectively allocated into the markedly low (group A; ECD below 1000 cells/mm²), mildly low (group B; ECD between 1000 to 2000 cells/mm²), and normal (group C; ECD above 2000 cells/mm²) ECD level groups. The highest CV (40.8 ± 13.9%; p < 0.001) and lowest HEX (58.4 ± 14.6%; p < 0.001) were found in group A. Significant ECD loss was found in group B (28.9 ± 9.2%) as compared to group A (19.9 ± 5.4%) and C (15.0 ± 12.0%) (p < 0.001). No significant differences were found with regard to changes in CV (p = 0.941), HEX (p = 0.937), CCT (p = 0.346), and logMAR (p = 0.557) among the three groups. In conclusion, preoperative ECD level could be a novel predictive value for postoperative cell loss, which was the most prominent in mildly low ECD level group. Less phacoemulsification energy, earlier surgical intervention, or novel topical medications could be suggested for patients with an ECD range from 1000 to 2000 cells/mm². Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

11 pages, 3691 KiB

Open AccessArticle

Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

by Joaquín Fernández, Manuel Rodríguez-Vallejo, Javier Martínez, Noemi Burguera and David P. Piñero

J. Clin. Med. 2021, 10(9), 2009; https://doi.org/10.3390/jcm10092009 - 7 May 2021

Cited by 14 | Viewed by 5275

Abstract

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m⁻¹ and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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9 pages, 2241 KiB

Open AccessArticle

A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies

by Jorge Mandelblum, Naomi Fischer, Asaf Achiron, Mordechai Goldberg, Raimo Tuuminen, Eran Zunz and Oriel Spierer

J. Clin. Med. 2020, 9(11), 3503; https://doi.org/10.3390/jcm9113503 - 29 Oct 2020

Cited by 18 | Viewed by 6434

Abstract

Background: The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. Methods: Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild “green nucleus” with plus sign for yellow reflection of the posterior cortex), 3 (medium “yellow nucleus” with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being “red/brown nucleus” and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. Results: Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman′s rho = 0.8, p < 0.001). Conclusion: This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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7 pages, 388 KiB

Open AccessArticle

Intraocular Lens Power, Myopia, and the Risk of Nd:YAG Capsulotomy after 15,375 Cataract Surgeries

by Juha-Matti Lindholm, Ilkka Laine and Raimo Tuuminen

J. Clin. Med. 2020, 9(10), 3071; https://doi.org/10.3390/jcm9103071 - 24 Sep 2020

Cited by 11 | Viewed by 2828

Abstract

The present study estimated the 5-year cumulative probability of Nd:YAG laser posterior capsulotomy according to the diopter power of implanted hydrophobic acrylic intraocular lenses (IOLs). Data were retrospectively collected of 15,375 eyes having cataract surgery and in-the-bag implantation of hydrophobic acrylic monofocal IOLs at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland between the years 2007 and 2016. The cumulative probability of Nd:YAG capsulotomy was calculated by Kaplan–Meier estimates, and potential risk factors were analyzed using the Cox proportional hazards model. The 5-year cumulative probability of Nd:YAG capsulotomy after cataract surgery was 27.4% (95% confidence interval (CI) 22.9–32.6%) for low-diopter (5–16.5 D) IOLs, 14.6% (13.8–15.5%) for mid-diopter (17–24.5 D) IOLs, and 13.6% (11.7–15.6%) for high-diopter (25–30 D) IOLs. A multivariate Cox regression analysis showed that low-diopter IOLs (HR 1.76; 95% CI 1.38–2.25; p < 0.001) were associated with an increased risk of Nd:YAG capsulotomy compared to mid-diopter IOLs over the follow-up period after accounting for other predictors. Real-world evidence shows that low-diopter IOLs are associated with significantly higher risk of Nd:YAG capsulotomy within five years following implantation. Estimation should help in evaluating the risks of cataract surgery in myopic eyes. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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11 pages, 1089 KiB

Open AccessArticle

Prevalence of Ocular Demodicosis and Ocular Surface Conditions in Patients Selected for Cataract Surgery

by Katarzyna Nowomiejska, Piotr Lukasik, Agnieszka Brzozowska, Mario Damiano Toro, Aleksandra Sedzikowska, Katarzyna Bartosik and Robert Rejdak

J. Clin. Med. 2020, 9(10), 3069; https://doi.org/10.3390/jcm9103069 - 23 Sep 2020

Cited by 12 | Viewed by 3009

Abstract

The aim of the study was to analyze the prevalence of ocular demodicosis and ocular surface conditions in patients selected for cataract surgery. Eyelashes from 73 patients selected for cataract surgery were evaluated at ×40 and ×100 magnification using light microscopy. The anterior segment was assessed with the slit lamp. Additionally, Schirmer I and break up time (BUT) tests were carried out before surgery and 1 and 3 months postoperatively. A specially designed questionnaire containing e.g., information about chronic skin and eye diseases, previous ophthalmic surgeries, and patient’s hygiene habits was used to assess the demographic variables. A majority of patients were at the age of 70–79 years, and there were more females (83%) in the study group. Demodex folliculorum was found in 48% of the patients. There was a correlation between the number of parasites and the presence of blepharitis, discharge at eyelid margins, and conjunctival hyperemia. Schirmer I and BUT test results were lower in patients with Demodex infestation before and after cataract surgery. The higher number of mites was correlated with lower Schirmer I test results postoperatively. The presence of Demodex mites influences the conjunctiva and lid margins leading to inflammation. The higher number of Demodex mites disturbs the tear film over time after cataract surgery. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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10 pages, 456 KiB

Open AccessArticle

Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac

by Alexander Aaronson, Asaf Achiron and Raimo Tuuminen

J. Clin. Med. 2020, 9(9), 3034; https://doi.org/10.3390/jcm9093034 - 21 Sep 2020

Cited by 9 | Viewed by 3549

Abstract

Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment. Full article

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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