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Medicina
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Challenging Conditions in Cataract Surgery: Post-refractive, Absence of Capsular Support,...
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Challenging Conditions in Cataract Surgery: Post-refractive, Absence of Capsular Support, Cornea Transplant (Keratoplasty), Glaucoma

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (1 January 2021) | Viewed by 4897

Special Issue Editor

Prof. Dr. Salvatore Cillino

E-Mail Website
Guest Editor
Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, Palermo, Italy
Interests: refractive cataract surgery; glaucoma surgery; corneal transplant surgery

Special Issue Information

Dear Colleagues,

Today, cataract surgery is the most frequent age-related surgical procedure and the main refractive procedure performed in older adults. Smaller incisions, improvements in phacoemulsification machines, microscopes, lens implants, such as toric and multifocal intraocular lenses (IOLs), allow for visual outcomes far beyond previous expectations. Notwithstanding, in many conditions the cataract surgery procedure poses challenging problems.

For instance, there is an expected increase of patients with a history of laser vision correction who need cataract surgery:  in these cases, surgery may be a major challenge since it yields unexpected refractive errors. No consensus exists about the best method, among the various calculation methods and correction algorithms, to determine the correct IOL power following refractive surgery.

Another challenging condition consists in IOL implantation in the absence of capsular support. Modern techniques of sutureless IOL scleral fixation (SSF) in aphakic eyes with no capsular bag include the Agarwal procedure (2007), the Yamane procedure (2017), and the sclera-fixated Carlevale IOL (2020). No procedure is today regarded as first-choice.

As regards cataract surgery in subjects where a cornea transplant is required or was already performed, challenging problems include the decision to perform a separate or combined triple surgical procedure (being aware that unacceptable postoperative refractive errors can occur), dealing with graft endothelial damage and preoperative astigmatism in previously transplanted eyes, and the quality of life (QoL) following the various available keratoplasty techniques, such as penetrating and lamellar keratoplasty.

Finally, the role of cataract surgery in the management of glaucoma and the co-management of cataract and glaucoma, both with traditional glaucoma surgery and with minimally invasive glaucoma surgery procedures, appear arguments worthy of serious analysis.

Therefore, given the importance of the four abovesaid items in the field of surgery for ophthalmological diseases, the journal Medicina is launching this Special Issue.

We encourage you and your co-workers to submit articles reporting on these topics. Reviews or original articles dealing with personal outcomes of cataract surgery in post-refractive surgery patients, as well as articles providing an up-to-date comparison of sutureless scleral fixation techniques are welcome. In addition, we warmly invite you to submit articles reporting on evidence and expectations from patients with coexistent cataract and corneal diseases or glaucoma, with special focus on individualized approaches.

Prof. Dr. Salvatore Cillino
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Cataract Surgery
  • Challenging cases
  • Post-refractive
  • Keratoplasty
  • Absence of capsular support
  • Glaucoma
  • Triple procedures

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Published Papers (2 papers)

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Research

13 pages, 1818 KiB  
Article
Bilateral Ultrathin Descemet’s Stripping Automated Endothelial Keratoplasty vs. Bilateral Penetrating Keratoplasty in Fuchs’ Dystrophy: Corneal Higher-Order Aberrations, Contrast Sensitivity and Quality of Life
by Massimo Castellucci, Costanza Novara, Alessandra Casuccio, Giovannni Cillino, Carla Giordano, Valentina Failla, Vincenza Bonfiglio, Maria Vadalà and Salvatore Cillino
Medicina 2021, 57(2), 133; https://doi.org/10.3390/medicina57020133 - 3 Feb 2021
Cited by 6 | Viewed by 1922
Abstract
Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs’ endothelial dystrophy (FED). Materials and Methods: Retrospective comparative [...] Read more.
Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs’ endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, p < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes. Full article
(This article belongs to the Special Issue Challenging Conditions in Cataract Surgery: Post-refractive, Absence of Capsular Support, Cornea Transplant (Keratoplasty), Glaucoma)
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12 pages, 1349 KiB  
Article
Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support
by Juris Vanags, Renārs Erts and Guna Laganovska
Medicina 2021, 57(1), 35; https://doi.org/10.3390/medicina57010035 - 3 Jan 2021
Cited by 4 | Viewed by 2456
Abstract
Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective [...] Read more.
Background and Objectives: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. Materials and Methods: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. Results: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. Conclusion: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support. Full article
(This article belongs to the Special Issue Challenging Conditions in Cataract Surgery: Post-refractive, Absence of Capsular Support, Cornea Transplant (Keratoplasty), Glaucoma)
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