OBJECTIVE

Toric intraocular lens implantation has been used to correct corneal astigmatism during cataract surgery. The study aimed to compare the visual outcomes between manual vs markerless toric intraocular lens implantation in astigmatic correction.

The medical records of patients at American Eye Center who underwent phacoemulsification by multiple surgeons with insertion of monofocal or multifocal toric lenses via manual marking and markerless method from 2010-2019 were reviewed.

A total of 70 patients were included in the study. Results showed no significant difference in the following characteristics between manual and markerless method at one month and two months post-cataract surgery: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near vision acuity (UNVA), corrected near vision acuity (CNVA), refraction spherical equivalent. The UDVA, CDVA, UNVA, CNVA and astigmatism had significantly lower median/mean-rank at one and two months postoperatively compared to preoperative values.

In conclusion, our findings indicated that both manual-based and markerless systems effectively facilitated accurate placement of the toric IOL on the desired axis. Notably, there was no significant difference observed between the two methods. Both systems are straightforward to execute. In low-resource settings like the Philippines, the manual marking method can be employed when markerless guidance equipment is unavailable.

Objective: Toric intraocular lens implantation has been used to correct corneal astigmatism during cataract surgery. The study aimed to compare the visual outcomes between manual vs markerless toric intraocular lens implantation in astigmatic correction. Methods: The medical records of patients at American Eye Center who underwent phacoemulsification by multiple surgeons with insertion of monofocal or multifocal toric lenses via manual marking and markerless method from 2010-2019 were reviewed. Results: A total of 70 patients were included in the study. Results showed no significant difference in the following characteristics between manual and markerless method at one month and two months post-cataract surgery: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near vision acuity (UNVA), corrected near vision acuity (CNVA), refraction spherical equivalent. The UDVA, CDVA, UNVA, CNVA and astigmatism had significantly lower median/mean-rank at one and two months postoperatively compared to preoperative values. Conclusion In conclusion, our findings indicated that both manual-based and markerless systems effectively facilitated accurate placement of the toric IOL on the desired axis. Notably, there was no significant difference observed between the two methods. Both systems are straightforward to execute. In low-resource settings like the Philippines, the manual marking method can be employed when markerless guidance equipment is unavailable.
Phacoemulsification ; Astigmatism ; Philippines

Objective: To report a case of a suture-related corneal abscess caused by Enterococcus casseliflavus on a phacoemulsification corneal incision. Method: This is a case report. Results: An elderly female underwent complicated phacoemulsification surgery on the left eye requiring sutures to seal the corneal incisions. Suture removal was incomplete at the side port, and a suture abscess developed after 9 weeks. Cultures revealed heavy growth of Enterococcus casseliflavus which was initially treated with an empiric broad-spectrum antibiotic (levofloxacin 1.5%) administered via intrastromal and subconjunctival injections, followed by culture-guided topical and oral medications. The corneal infection resolved but significant corneal thinning led to perforation, requiring a modified Gunderson flap procedure to repair the defect. Conclusion Intrastromal and subconjuctival injection of levofloxacin 1.5% may be a viable empiric treatment option for Enterococcus casseliflavus suture-related corneal abscess.
Phacoemulsification

Objective: To present a case of neovascular glaucoma secondary to ocular ischemic syndrome following an uncomplicated phacoemulsification Methods: This is a case description of a 74-year-old male who developed blurred vision and increased intraocular pressure (IOP) two months after an uncomplicated phacoemulsification cataract surgery with posterior chamber lens implantation of the left eye. There was iris neovascularization with absence of retinal dot/blot hemorrhages or neovascularization. The fluorescein angiogram (FA) showed delayed choroidal fluorescence and arteriovenous time. IOP-lowering medications and intravitreal injection of aflibercept were given. Carotid doppler test showed 70% stenosis of the ipsilateral artery but a subsequent magnetic resonance angiography (MRA) did not show evidence of significant stenosis. Results: At his last consultation, visual acuity improved to counting fingers. IOP was maintained at 12 mmHg with one anti-glaucoma medication. Conclusion Ocular ischemia can confound the outcome of an uncomplicated cataract surgery. Doppler scans are usually chosen as the first-line exam for those suspected of carotid stenosis but, at times, may have contradictory results with MRA.
Glaucoma, Neovascular ; Phacoemulsification

PURPOSE: In this study, we evaluated changes in the anterior chamber structure and lens position before and after phacoemulsification in eyes grouped by axial length (AL).METHODS: This study included 65 eyes (16 short eyes [AL < 22.5 mm], 33 normal eyes [22.5 mm < AL < 25.0 mm], and 16 long eyes [AL > 25.5 mm]) that underwent cataract surgery. Pre- and postoperative anterior chamber depth (ACD) was measured using Pentacam® and IOL Master®,. In addition, we evaluated the anterior chamber angle (ACA), anterior chamber volume (ACV), epithelium-iris distance, and iris-lens (intraocular lens [IOL]) distance.RESULTS: The change in ACD was significantly smaller in long eyes (Pentacam®,, p = 0.000; IOL Master®,, p = 0.001). The change in ACA was significantly larger in short eyes (p = 0.000), and the change in ACV was significantly smaller in long eyes (p = 0.000). The change in the epithelium–iris distance was significantly smaller in long eyes (p = 0.000), and the change in the iris-lens (IOL) distance was significantly smaller in short eyes (p = 0.000).CONCLUSIONS: In short eyes, changes in ACD, ACA, and ACV were found to be larger than those of other groups as the iris moved backward. In long eyes, greater backward movement of the IOL was observed. Therefore, the appropriate IOL power should be chosen, considering the postoperative position of the IOL during cataract surgery of short and long eyes.
Anterior Chamber ; Cataract ; Iris ; Lenses, Intraocular ; Phacoemulsification

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.
Anterior Chamber ; Cornea ; Corneal Edema ; Corneal Transplantation ; Descemet Membrane ; Endothelial Cells ; Female ; Humans ; Lenses, Intraocular ; Methods ; Middle Aged ; Phacoemulsification ; Tissue Donors ; Transplants ; Visual Acuity

Background: Phacoemulsification is the most important cataract surgical procedure performed by ophthalmology residents. There is an increasing and consistent trend in international studies on decreased complication rates and more efficient surgical techniques with more surgeries performed. The data collected from this study can be used to quantitatively assess the cataract surgery training of Ophthalmology residents in the country and can help to improve the quality of cataract surgeries taught and performed in the training programs. Objectives: To analyze outcomes of phacoemulsification cataract surgeries and to determine the intraoperative complication rates of third-year residents of the University of the Philippines - Philippine General Hospital (UP-PGH). Methods: Retrospective chart review of phacoemulsification cases done by eight third-year ophthalmology residents at the UP-PGH from January 1 to December 31, 2017. Outcomes measured included postoperative best corrected visual acuity (BCVA), intraoperative complications (posterior capsular rent and vitreous loss), and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). Results: Four hundred ninety-two (492) cases were analyzed. Postoperative mean BCVA was 20/25. There were no significant differences in visual acuity outcomes over the course of training. Intraoperative complications occurred in 33 cases, with fewer cases with posterior capsule rent and vitreous loss later in training after the first 50 cases. There was a downward trend of adjusted phacoemulsification time throughout training, with a significant difference between the first 50 and 100 cases. Conclusion Good visual outcomes are achievable throughout the resident’s phacoemulsification learning curve. Surgical competency in phacoemulsification, as measured by complication rates and phacoemulsification efficiency, still improves significantly with an increasing number of cases and experience beyond the first 100 cases.
Phacoemulsification

OBJECTIVE: To evaluate the application of femtosecond laser technology in the management of subluxated lens. METHODS: We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients' eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed. RESULTS: We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03%) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation ( < 0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90%) showed slight tilt of the IOLs, and 3 eyes (10.34%) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87%), incomplete capsulotomy (17.24%) and contracted pupils (13.79%). CONCLUSIONS The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients' visual function.
Humans ; Laser Therapy ; Lens Implantation, Intraocular ; Lens Subluxation ; surgery ; Lenses, Intraocular ; Phacoemulsification ; Retrospective Studies

PURPOSE: To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS: Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS: In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25–1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13–3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71–11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03–2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18–1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31–1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01–1.62; p=0.039) were found to be related to APE development. CONCLUSION: The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.
Cataract Extraction ; Cataract ; Endophthalmitis ; Foreign Bodies ; Glaucoma ; Hominidae ; Humans ; Hypertension ; Incidence ; Insurance ; Kidney Failure, Chronic ; Korea ; Male ; Phacoemulsification ; Risk Factors ; Sutures ; Vitrectomy

PURPOSE: To report a case of recurrent endophthalmitis due to methicillin resistant Staphylococcus hemolyticus after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. CASE SUMMARY: A 76-year-old female visited our outpatient clinic with decreased vision 40 days after uncomplicated cataract surgery in her right eye. At the visit, anterior chamber inflammation and cloudy fluid between the posterior capsule and IOL were observed. Uveitis due to residual cortex of lens or capsular block syndrome was suspected, so YAG laser capsulotomy and subconjunctival injection of dexamethasone were performed. Two days later, hypopyon and vitreous opacity were seen. The patient underwent an emergency vitrectomy and intravitreal antibiotic injection with suspicion of bacterial endophthalmitis. The culture was negative. Twenty days after the vitrectomy, anterior chamber inflammation and vitreous opacity developed. The recurrence of endophthalmitis was suspected due to infection by bacteria in the surrounding tissue of the IOL, so the patient underwent an IOL and lens capsule removal with intravitreal antibiotic injection. At this time, the culture revealed methicillin resistant staphylococcus hemolyticus. Systemic and topical vancomycin was then administered, resulting in decreased inflammation. Twenty days after the IOL removal, decreased vision, anterior chamber inflammation, and vitreous opacity developed. Endophthalmitis was decreased by intravitreal antibiotic injection and topical antibiotic treatment. CONCLUSIONS: Methicillin resistant staphylococcus hemolyticus should be considered in the differential diagnosis of chronic recurrent endophthalmitis after cataract surgery.
Aged ; Ambulatory Care Facilities ; Anterior Chamber ; Bacteria ; Cataract ; Dexamethasone ; Diagnosis, Differential ; Emergencies ; Endophthalmitis ; Female ; Humans ; Inflammation ; Lasers, Solid-State ; Lenses, Intraocular ; Methicillin Resistance ; Methicillin ; Phacoemulsification ; Recurrence ; Staphylococcus ; Uveitis ; Vancomycin ; Vitrectomy