Wenwen He

Factors influencing 1-year rotational stability of AcrySof Toric intraocular lenses

Purpose To investigate the 1-year rotational stability of AcrySof Toric intraocular lenses (IOLs) and factors influencing their stability. Methods This retrospective study enrolled 75 patients who underwent phacoemulsification, and were implanted with an AcrySof Toric IOL for 1 year. Their preoperative clinical data were reviewed. The 1-year clinical outcomes included uncorrected visual acuity, best-corrected visual acuity and residual astigmatism. Rotation of the IOL and the grade of anterior capsular opacification (ACO; graded from 0=none to 3=severe) were evaluated after mydriasis. Results Of the 75 eyes analysed, 29.33% had high myopia. Residual astigmatism at 1 year (−0.76±0.47 dioptre(D)) was significantly reduced compared with the preoperative corneal astigmatism (2.08±0.71 D). The mean absolute rotation of the IOL was 8.83±5.26°. Toric IOL rotation was significantly and positively correlated with the degree of residual astigmatism in the T3 (Pearsons r=0.552, p<0.001) and T4 groups (Pearsons r=0.622, p=0.003). Regarding factors associated with IOL rotation, toric IOL rotation was positively correlated with axial length (AXL; Pearsons r=0.335, p=0.003) and negatively correlated with ACO grade (Spearmans r=−0.541, p<0.001). On multiple linear regression analysis, only AXL (B=0.889, p=0.031) and ACO grade (B=−3.216, p<0.001) were predictors of toric IOL rotation (R2=0.397). Conclusions Long AXL is a risk factor for toric IOL rotation, while higher ACO grade may decrease toric IOL rotation, indicating that reducing the polishing of anterior capsule may improve the rotational stability of a toric IOL. Trial registration number NCT02182921.

Perceived Pain during Cataract Surgery with Topical Anesthesia: A Comparison between First-Eye and Second-Eye Surgery

Purpose. To compare pain scores between first-eye and second-eye cataract surgery and to determine the affecting factors. Methods. 106 first-eye and 53 second-eye cataract surgery patients (mean age: 67 ± 13 and 69 ± 10 years, resp.) were enrolled. The patients completed simplified State-Trait Anxiety Inventory and visual analog scale (VAS) for anxiety questionnaires before surgery, and VAS for pain and Wong-Baker Faces Pain Rating Scale questionnaires after surgery. Blood pressure (BP) and heart rate (HR) were recorded perioperatively. Results. A greater proportion of patients who underwent second-eye surgery reported intraoperative pain compared with first-eye surgery patients (85% versus 35%, P < 0.001). The pain scores were higher in second-eye surgery, while the VAS anxiety score was lower in second-eye surgery. Moreover, 31 patients reported greater pain during second-eye surgery than their first one, with higher pain scores than other 22 patients (P = 0.032 and 0.003, resp.). The VAS pain score of these 31 patients was positively correlated with the differences between the intraoperative and postoperative diastolic BP, mean arterial pressure, and HR. Conclusions. Cataract patients were likely to have more pain during second-eye surgery, which may be related to lower preoperative anxiety. Monitoring perioperative BP and HR may help to identify patients with intraoperative pain.

Molecular Inflammation in the Contralateral Eye After Cataract Surgery in the First Eye.

PURPOSE The purpose of this study was to assess the inflammatory status of the aqueous humor in the fellow eye after uneventful cataract surgery in the first eye. METHODS At the screening stage, aqueous humor samples from 15 first-eye and 15 second-eye cataract patients were collected just before cataract surgery and assayed using human cytokine antibody array. Screened cytokines were then verified using a suspension array system with aqueous humor samples obtained from 35 first-eye and 36 second-eye cataract patients. RESULTS The cytokine antibody array revealed that interleukin-1 receptor antagonist (Il-1ra) and macrophage inflammatory protein (MIP)-1a and MIP-1b were expressed at high levels in first-eye patients and were lower in second-eye patients, whereas opposite trends were found for monocyte chemoattractant protein 1 (MCP-1) and for regulated on activation, normal T expressed and secreted (RANTES) (all, P < 0.05, Students t-test). However, only MCP-1 and IL-1ra were significantly different between the two groups after Bonferroni correction (both P < 0.00125). In the replication stage, the suspension cytokine array revealed that only MCP-1 expression was significantly greater in the aqueous humor of second-eye patients than in that of first-eye patients (P = 0.0067, Students t-test). CONCLUSIONS This study revealed that expression of MCP-1, a pain-related inflammatory chemokine, was significantly increased in aqueous humor in the contralateral eye after first-eye cataract surgery. This suggests there may be a sympathetic ophthalmic type uveitis in the contralateral eye after first-eye cataract surgery and that may help to explain why second-eye phacoemulsification is often more painful. (ClinicalTrials.gov number, NCT01824927.)

Schlemm's Canal Expansion After Uncomplicated Phacoemulsification Surgery: An Optical Coherence Tomography Study

Purpose To evaluate the effects of phacoemulsification cataract surgery on Schlemms canal (SC) using swept-source optical coherence tomography (OCT). Methods Patients with a senile cataract were included. The SC area and diameter were checked by OCT at the baseline and 1 day, 1 week, 1 month, and 6 months after the cataract surgery. Multivariate linear regression analysis was performed for predictors of change in the mean SC area and diameter. Results Twenty-five eyes (25 patients) were included in the final analysis. After the cataract surgery, there was a significant increase in the SC area and diameter, and a decrease in the intraocular pressure (IOP) (repeated-measures analysis of variance; all P < 0.05), which extended to the end of the follow-up period. After multivariate analysis, the changes in the SC area and diameter 6 months after surgery were correlated with the change in the IOP (SC area, β = -0.575, P < 0.0001; SC diameter, β = -0.576, P < 0.0001) and the change in the anterior vault (AV) (SC area, β = 0.359, P = 0.007; SC diameter, β = 0.413, P = 0.003). Conclusions Expansion of the SC was observed after cataract surgery. The degree of expansion was related to the extent of the decrease in the IOP. Further studies are needed to determine whether these changes will last over a long period of time.

Adhesion of the posterior capsule to different intraocular lenses following cataract surgery.

To investigate the prevalence and morphologic and clinical features of posterior capsule–optic inadhesion following cataract surgery.

Evaluation of Anterior Chamber Volume in Cataract Patients with Swept-Source Optical Coherence Tomography.

Purpose. To evaluate the anterior chamber volume in cataract patients with Swept-Source Optical Coherence Tomography (SS-OCT) and its influencing factors. Methods. Anterior chamber volume of 92 cataract patients was evaluated with SS-OCT in this cross-sectional study. Univariate analyses and multiple linear regression were used to investigate gender, age, operated eye, posterior vitreous detachment, lens opacity grading, and axial length (AXL) related variables capable of influencing the ACV. Results. The average ACV was 139.80 ± 38.21 mm3 (range 59.41 to 254.09 mm3). The average ACV was significantly larger in male patients than in female patients (P = 0.001). ACV was negatively correlated with age and LOCS III cortical (C) grading of the lens (Pearsons correlation analysis, r = −0.443, P < 0.001, and Spearmans correlation analysis, ρ = −0.450, P < 0.001). ACV was also increased with AXL (Pearsons correlation analysis, r = 0.552, P < 0.001). Multiple linear regression showed that, with all of the covariates entered into the model, gender (P = 0.002), age (P = 0.015), LOCS III C grade (P = 0.043), and AXL (P = 0.001) were still associated with ACV (F = 10.252  P < 0.001  R 2 = 0.498). Conclusion. With SS-OCT, we found that, in healthy cataract patients, ACV varied significantly among different subjects. Influencing factors that contribute to reduced ACV were female gender, increased age, LOCS III C grade, and shorter AXL.

Near-term analysis of corneal epithelial thickness after cataract surgery and its correlation with epithelial cell changes and visual acuity

Purpose To quantify corneal central epithelial thickness and cell changes 2 weeks after cataract surgery and correlate it with corrected distance visual acuity (CDVA). Setting Eye and ENT Hospital of Fudan University, Shanghai, China. Design Prospective observational study. Methods Patients having cataract surgery were assessed preoperatively and 1, 2, 3, 5, 7, and 14 days postoperatively. Anterior segment spectral‐domain optical coherence tomography and corneal confocal laser scanning microscopy were used to measure central epithelial thickness, central corneal thickness (CCT), corneal basal epithelial cell density, and Langerhans cell density. Results The CCT and central epithelial thickness were significantly increased on 1 day postoperatively. From 1 day to 14 days, the CCT gradually decreased but was greater than the baseline value, whereas the central epithelial thickness declined to near baseline values at 3 days, became thinner at 5 and 7 days, and then returned to baseline at 14 days. The corneal basal epithelial cell density increased significantly postoperatively. Significant Langerhans cell infiltration was seen at 3 days and 5 days. Significant correlations were found between CDVA and the central epithelial thickness and CCT. The maximum increase in central epithelial thickness and CCT correlated with the lowest achieved values of CDVA postoperatively. Patients with significant edema at 1 day had worse CDVA at 14 days. Conclusions Near‐term epithelial remodeling occurred, initially appearing as a thickening that might be attributed to edema. This was followed by thinning, possibly caused by inflammation, and finally reaching baseline levels. Edema of the corneal epithelium was related to visual recovery after cataract surgery. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Efficacy of cataract surgery in patients with uveitis: A STROBE-compliant article

Abstract To evaluate the visual outcomes of cataract surgery in patients with uveitis, and to determine risk factors for the recurrence of uveitis and postoperative complications. Eighty patients with uveitis who underwent phacoemulsification with intraocular lens (IOL) implantation were included in this retrospective study. We analyzed the following data: patient characteristics, medications used, visual acuity, and complications of cataract surgery. The mean ± standard deviation time from cataract surgery to the last visit was 20.8 ± 10.4 months. Best-corrected visual acuity improved significantly after surgery (P < .001). The visual outcome was worse in patients with Behçet disease than in patients with other etiologies of uveitis. Gender (P = .018) and IOL type (P = .020) were significantly associated with recurrent uveitis after surgery. The incidence of recurrent inflammation was not significantly different between patients who did or did not receive systemic therapy (P = .43). Perioperative systemic therapies (P = .011) and recurrent uveitis within 3 months of surgery (P = .043) were associated with posterior capsular opacification. Perioperative systemic therapies (P = .026) and recurrent uveitis after surgery (P = .006) were also significantly associated with cystoid macular edema. Patients with uveitis could benefit from cataract surgery. Patients with Behçet disease had worse postoperative prognosis than patients with other etiologies of uveitis. A heparin-surface-modified IOL may reduce the incidence of recurrent inflammation.

Objective functional visual outcomes of cataract surgery in patients with good preoperative visual acuity

PurposeTo explore the objective functional visual outcomes of cataract surgery in patients with good preoperative visual acuity.MethodsWe enrolled 130 cataract patients whose best-corrected visual acuity (BCVA) was 20/40 or better preoperatively. Objective visual functions were evaluated with a KR-1W analyzer before and at 1 month after cataract surgery.ResultsThe nuclear (N), cortical (C), and N+C groups had very high preoperative ocular and internal total high-order aberrations (HOAs), coma, and abnormal spherical aberrations. At 1 month after cataract surgery, in addition to the remarkable increase of both uncorrected visual acuity and BCVA, both ocular and internal HOAs in the three groups decreased significantly after cataract surgery (all P<0.05). Point spread function and modulation transfer functions were also improved significantly in these patients (all P<0.05).ConclusionsThe objective functional vision of patients with 20/40 or better preoperative BCVA improved significantly after cataract surgery. This finding shows that the arbitrary threshold of BCVA worse than 20/40 in China cannot always be used to determine who will benefit from cataract surgery.

Traumatic Cataract in Children in Eastern China: Shanghai Pediatric Cataract Study

Traumatic cataract is a main cause of visual impairment in pediatric populations and is preventable. Awareness of the causes and consequences of pediatric eye trauma play roles in health education and prevention of blindness. We conducted a retrospective chart review based on 5-year clinical data of pediatric traumatic cataract cases treated at the Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China. Clinical features including demographic data, injury mechanism, and causative agents were analyzed. A total of 321 eyes of 321 children (male, 74.1%) were included. Penetrating injury accounted for 76.6% of all injuries; 65% of children with such injuries underwent their first surgery on the day of injury. The average age at injury was 6.3 ± 3.7 years, while the peak age was from two to eight years. The main causes of ocular injury were sharp metal objects, toys, and wooden sticks. The causative agent changed with increasing age; however, scissors were the leading cause within almost all age groups. Cataract surgery significantly improved visual acuity in children with traumatic cataract. These findings add information regarding the characterization of pediatric traumatic cataract in China and can help guide safety education and preventative measures.