Suhua Zhang

Anterior chamber interleukin 1β, interleukin 6 and prostaglandin E2 in patients undergoing femtosecond laser-assisted cataract surgery

Purpose To evaluate the interleukin (IL) 1β, IL-6 and prostaglandin E2 (PGE2) concentrations in aqueous humour in patients undergoing femtosecond laser-assisted cataract surgery. Methods In 27 eyes of 27 patients undergoing femtosecond laser-assisted cataract surgery (femto group), aqueous humour of 100 μL was collected after laser treatment. In 15 eyes of 15 subjects undergoing routine cataract surgery (control group), aqueous humour of 100 μL was also collected. The IL-1β, IL-6 and Prostaglandin E2 (Human Interleukin 1β, Interleukin 6 and Prostaglandin E2 ELISA Kits, Bio-Swamp Life Science) were used to determine the concentrations of IL-1β, IL-6 and PGE2 in the aqueous humour. All patients were treated with non-steroidal anti-inflammatory drugs prior to surgery. Results For IL-1β, IL-6 and PGE2, respectively, the mean concentration values in aqueous humour were 25.6, 24.6 and 64.2 pg/mL in the femto group, and 17.1, 15.2 and 45.7 pg/mL in the control group (table 2). Concentrations of IL-1β, IL-6 and PGE2 were significantly higher in the femto group than those in the control group (all p<0.01). There were no significant correlations between concentrations of IL-1β, IL-6 or PGE2 and age, cataract densities, suction time or laser time (all p>0.05). Conclusions Inflammatory cytokines IL-1β, IL-6 and PGE2 significantly increased after femtosecond laser-assisted cataract surgery, which maybe the cause of intraoperative miosis seen in these patients.

Femtosecond laser penetrating corneal relaxing incisions combined with cataract surgery.

Purpose To evaluate the effectiveness of femtosecond laser penetrating corneal relaxing incisions (CRIs) in reducing corneal astigmatism during cataract surgery. Setting Shanxi Eye Hospital, Taiyuan, Shanxi Province, China. Design Prospective case series. Methods Using the Lensx laser, CRIs were placed at a diameter of 8.0 mm with a depth of 90%. Corneal astigmatism was measured before surgery and 1 and 3 months after surgery. Vector analyses were performed. To obtain the net corneal changes, the with‐the‐wound (WTR) and against‐the‐wound (ATR) changes were calculated along the meridian of the CRI. Multiple regression analysis with generalized estimating equations was used to evaluate the factors contributing to the effectiveness of CRIs. Results The study comprised 51 eyes. One and 3 months postoperatively, respectively, the mean keratometric astigmatism was reduced significantly by 0.65 diopter (D) and 0.67 D (both P < .05); compared with preoperative corneal astigmatism, the percentage of eyes within ±0.50 D of refractive astigmatism significantly increased by 42.6% and 46.7% (both P < .05) and the mean refractive astigmatism was significantly decreased at 1 month (0.27 @ 93 versus 0.17 × 17) (P < .05) but not at 3 months (0.09 @ 138 versus 0.07 × 172) (P > .05). The mean WTW and ATW changes were −1.05 D and −1.00 D, respectively, and 14.9% and 6.7% of eyes, respectively, were overcorrected. Age, CRI length, and CRI location were factors contributing to net corneal changes. A nomogram is proposed. Conclusion Femtosecond laser CRIs were effective in reducing corneal astigmatism during cataract surgery, and their long‐term effectiveness should be evaluated. Financial Disclosure Dr. Koch is a consultant to Abbott Medical Optics, Inc., Alcon Laboratories, Inc., and Revision Optics, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

Corneal biomechanical properties changes after coaxial 2.2-mm microincision and standard 3.0-mm phacoemulsification.

AIM To compare the changes in corneal biomechanics measured by ocular response analyzer (ORA) after 2.2-mm microincision cataract surgery and 3.0-mm standard coaxial phacoemulsification. METHODS The prospective nonrandomized study comprised eyes with cataract that had 2.2-mm coaxial microincision or 3.0-mm standard incision phacoemulsification. The corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg) were measured by ORA preoperatively and at 1d, 1-, 2-, 3- and 4-week postoperatively. Results were analyzed and compared between groups. RESULTS In both groups, CH decreased in the immediate postoperative period (P<0.05), returned to the preoperative level at one week (P=0.249) in the 2.2-mm group, and at two weeks in the 3.0-mm group (P=0.264); there was no significant change in CRF values. In 2.2-mm group, mean IOPcc and IOPg increased at 1d postoperatively (both P<0.05), and returned to preoperative level at one week (P=0.491 and P=0.923, respectively). In 3.0-mm group, mean IOPcc and IOPg increased at 1d and 1wk postoperatively (P=0.005 and P=0.029, respectively), and returned to preoperative level at 2wk (P=0.347 and P=0.887, respectively). CONCLUSION Significant differences between preoperative and postoperative corneal biomechanical values were found for CH, IOPcc and IOPg. But the recovery time courses were different between the two groups. The 2.2-mm coaxial microincision cataract surgery group seemed recovery faster compared to the 3.0-mm standard coaxial phacoemulsification group.

Comparison of axial length, anterior chamber depth and intraocular lens power between IOLMaster and ultrasound in normal, long and short eyes

Purpose To compare the axial length (AL), anterior chamber depth (ACD) and intraocular lens power (IOLP) of IOLMaster and Ultrasound in normal, long and short eyes. Methods Seventy-four normal eyes (≥ 22 mm and ≤ 25 mm), 74 long eyes (> 25 mm) and 78 short eyes (< 22 mm) underwent AL and ACD measurements with both devices in the order of IOLMaster followed by Ultrasound. The IOLP were calculated using a free online LADAS IOL formula calculator. Results The difference in AL and IOLP between IOLMaster and Ultrasound was statistically significant when all three groups were combined. The difference in ACD between IOLMaster and Ultrasound was statistically significant in the normal group (P<0.001) and short eye group (P<0.001) but not the long eye group (P = 0.465). For the IOLP difference between IOLMaster and Ultrasound in the normal group, the percentage of IOLP differences <|0.5|D, ≥|0.5|D<|0.75|D, ≥|0.75|D<|1.0|D, and ≥|1.0|D were 90.5%, 8.1%, 1.4% and 0%, respectively. For the long eye group, they were 90.5%, 5.4%, 4.1% and 0%, respectively. For the short eye group, they were 61.5%, 23.1%, 10.3%, and 5.1%, respectively. Conclusions IOLMaster and Ultrasound have statistically significant differences in AL measurements and IOLP (using LADAS formula) for normal, long eye and short eye. The two instruments agree regarding ACD measurements for the long eye group, but differ for the normal and short eye groups. Moreover, the high percentage of IOLP differences greater than |0.5|D in the short eye group is noteworthy.

Evaluation of Femtosecond Laser Versus Manual Clear Corneal Incisions in Cataract Surgery Using Spectral-Domain Optical Coherence Tomography

PURPOSE To investigate the wound healing changes of clear corneal incisions performed with a femtosecond laser or a steel bevel knife in cataract surgery using spectral-domain optical coherence tomography. METHODS Prospectively, consecutive patients undergoing either femtosecond laser-assisted cataract surgery (femtosecond laser group) using the LenSx laser (Alcon Laboratories, Inc., Fort Worth, TX) or traditional cataract surgery using steel blades (control group) were enrolled. The incidence of posterior wound gape, Descemets membrane detachment, posterior wound retraction, and the inner and outer corneal incision thicknesses were assessed. RESULTS Compared to the control group, the femtosecond laser group had significantly lower incidences of posterior wound gape at 1 day (P = .012) and Descemets membrane detachment at 1 week (P = .030), 1 month (P = .048), and 3 months (P = .048), and a significantly higher incidence of posterior wound retraction at 1 month (P < .001) and 3 months (P < .001) postoperatively. The inner and outer corneal incision thicknesses decreased over time in both groups. CONCLUSIONS The clear corneal incisions created by femtosecond laser demonstrated a lower incidence of posterior wound gape and Descemets membrane detachment. However, the higher posterior wound retraction incidence, which indicated that there was wound remodeling, was apparent. [J Refract Surg. 2018;34(1):17-22.].

Iris autofluorescence in Fuchs’ heterochromic uveitis

Aims To explore the characteristic autofluorescence patterns of iris depigmentation in eyes diagnosed with Fuchs’ heterochromic uveitis (FHU). Methods Near-infrared autofluorescence images and colour images of iris were taken in 21 eyes of 21 patients with FHU, 30 eyes of 15 normal subjects, 30 eyes of 15 normal age-related iris atrophy and 33 eyes of 20 patients with uveitis other than FHU. The confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2, HRA2) was used for melanin-related autofluorescence imaging. The indocyanine green angiography mode of HRA2 was applied for near-infrared laser imaging, and the wavelength of the excitation laser was 795 nm. Iris colour images were also taken with the slit lamp. Results In normal iris, moderately intense autofluorescence was noted for the pigment ruff at the pupillary border, the crests in the pupillary zone and the collarette; and there was mild autofluorescence in the ciliary zone. In eyes with age-related iris atrophy and uveitis, much less autofluorescence was seen than the healthy normal irides. In eyes with FHU, there was moderate but discontinuous autofluorescence in the pigment ruff, a petaloid pattern of autofluorescence in the pupillary zone, moderate autofluorescence in the collarette and reticular pattern of autofluorescence in the ciliary zone. Conclusions Characteristic autofluorescence patterns appeared in eyes diagnosed with FHU. Near-infrared autofluorescence is a promising objective technique to document the iris changes in FHU.

Effect of pupil dilation on biometric measurements and intraocular lens power calculations in schoolchildren

Purpose To investigate the effect of pupil dilation on ocular biometric parameters and intraocular lens (IOL) power calculation in schoolchildren using the Lenstar LS 900. Methods One hundred forty eyes of 140 healthy schoolchildren were included in the analysis. Axial length (AL), central corneal thickness (CCT), aqueous depth (AD), anterior chamber depth (ACD), lens thickness (LT), flat keratometry (K), steep K, astigmatism, white-to-white (WTW), and iris/pupil barycenter distance were measured, before and after pupil dilation. Anterior segment length (ASL) was defined as the sum of ACD and LT, and lens position (LP) was defined as ACD plus half of the LT. The relative lens position (RLP) was defined as LP divided by AL. IOL power was calculated using the eight formulas (Hill-RBF, Barrett, Haigis, Hoffer Q, Holladay, Olsen, SRK II, and SRK/T) integrated in the Lenstar LS 900. Parameters before and after pupil dilation were compared. Results AL, AD, ACD, LT, ASL, LP, RLP, flat K, iris barycenter distance, pupil barycenter distance, and PD differed significantly after pupil dilation (P < 0.001 in all cases), as compared to before dilation. The Olsen formula demonstrated significant differences in the magnitude of astigmatism (P = 0.010) and IOL power (P = 0.003) after pupil dilation. Using the different formulas, 23.6–40.7% of participants had IOL power changes of more than 0.50 diopters, while 0.7–1.4% had IOL changes of more than 1.0 diopter after pupil dilation. Conclusions Dilated and undilated pupil size affected the Lenstar LS 900 measurement of some ocular biometric parameters, and pupil dilation led to IOL power changes exceeding 0.50 diopters with a high percentage (from 23.6% to 40.7%) in schoolchildren, which should be noticed in clinical practice.

Acute clouding of trifocal lens during implantation: a case report

BackgroundIntraoperative IOLs clouding of several kinds of hydrophilic acrylic intraocular lenses (IOLs) have been reported due to temperature changes. This phenomenon reported previously occurred in cold countries and during the winter months. However, no clinical case was reported about trifocal IOL opacification during operation. We report a case in which acute opacification of the optical region occurred simultaneously when AT LISA tri 839mp(Carl Zeiss) was implanted into the eye.Case presentationA 79-year-old woman with a cortex and nucleus cataract was scheduled to undergo right eye phacoemulsification assisted by femtosecond technique. The trifocal lens (AT LISA tri 839mp), which is made of hydrophilic acrylic (25%) with hydrophobic surface properties, was chosen for implantation. As the IOL was implanted into the eye, it became cloudy immediately. Then it was replaced by another AT LISA tri 839mp, which was transferred from lens company outside, the same phenomenon was observed. These two lenses underwent the same temperature fluctuation from cold outside to operating room. Finally, a ZCB00 (Allergan) was implanted.ConclusionsThe acute intraoperative clouding of trifocal lens(AT LISA tri 839mp) results from fluctuation of temperature should be noticed.