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Purpose Materials and Methods Results Conclusion To investigate antibiotic usage practices in ophthalmic surgeries in Germany.An online questionnaire was sent to veterinary surgeons (general veterinarians and veterinarians with additional qualification in ophthalmology) inquiring about their antibiotic preferences, administration methods, and factors affecting antibiotic usage in ophthalmic surgical procedures.A total of 417 questionnaires were analyzed. Postoperative antibiotics (systemic/topical in percent when used) were used all or most of the time by 69% of veterinarians following enucleation (99/6), by 62% after eyelid surgery (54/69), by 68% after third eyelid (TEL) surgery (19/92) and by 80% after keratectomy (6/99). The most commonly used systemic antibiotic was amoxicillin with clavulanic acid and the most commonly used topical antibiotic was chloramphenicol.WHO “watch‐group” antibiotics were infrequently administered systemically but frequently utilized topically; including in 13% of eyelid surgery, 15% of TEL surgery, and 35% of keratectomies. Factors influencing antibiotic use included fear of complications (67%), personal experience (63%), diagnostic uncertainty (21%), and owner expectations (9%). Participants following institutional guidelines used fewer antibiotics in enucleations (p = .002) and were less likely to choose fluoroquinolones post‐eyelid surgery (p = .044).The potential for reducing antibiotic use following ophthalmic soft tissue surgery is significant. Addressing barriers such as concerns about postoperative complications and the reliance on individual clinical experience, the implementation of standardized guidelines could facilitate a shift toward more judicious antibiotic practices. [ABSTRACT FROM AUTHOR]

In this study, the electrochemical properties of nepafenac, used after eye surgery operations, were investigated on a disposable pencil graphite electrode. Cyclic and square wave voltammetry techniques were used to investigate the electrochemical properties of nepafenac. Two peaks at potentials of approximately +0.33 V and +1.03 V in the anodic direction and two peaks at potentials of approximately +0.29 V and +0.08 V in the cathodic direction were observed on the surface of the disposable pencil electrode in acetate (pH 4.8) medium with the cyclic voltammetry technique. The analytical performance of the developed voltammetric technique had good linearity in the concentration range of 0.30 µM to 3.5 µM at pH 4.8. The LOD value of this voltammetric method in acetate (pH 4.8) medium was calculated as 0.035 µM (8.90 ng mL−1). For reproducibility, the relative standard deviation (RSD) values for Ia and IIa anodic peak current/potential were found to be 1.45%/0.43% and 1.28%/0.25%, respectively. The voltammetric method was successfully applied to urine and pharmaceutical preparations and the results were compared with the spectrophotometric method. [ABSTRACT FROM AUTHOR]

Retinal surgery requires enclosed spatial constraints to improve the safety and success of the surgery. Herein, a shared control method is proposed for master–slave robot systems, utilizing tubular guidance constraints based on a novel potential field function to optimize the commands of the surgeon. Within the tube, attractive constraints intensify with increasing task error and approach infinity at the boundary of the tube. This ensures that the surgery is confined within a closed tubular space. Haptic feedback provides force cues to inform the surgeon about the feasibility of the input commands. Theoretical derivations demonstrate that the entire closed‐loop system is passive. Two simulation experiments are conducted on the ophthalmic surgery robot platform to evaluate the functionality of the proposed method. The experimental results indicate that translational errors are kept less than certain predefined values. Furthermore, the proposed method outperforms the comparison method in terms of task accuracy and efficiency. [ABSTRACT FROM AUTHOR]

Background: The 30‐day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30‐day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission. Methods: All patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity. Results: For the 8522 ophthalmic surgeries performed in the four‐year study period, 282 30‐day unplanned readmissions were identified. The overall 30‐day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non‐elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30‐day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30‐day readmissions were not associated with an ophthalmological problem. Conclusions: This study is the first to report 30‐day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals. [ABSTRACT FROM AUTHOR]

Background: To compare retention times of various ophthalmic viscosurgical devices (OVDs) and soft‐shell combinations. Methods: Experimental study. Eighteen rabbit eyes were divided into six groups of three eyes, based on OVDs tested. A: Endocoat, B: HealonPro, C: Viscoat, D: Provisc, E: Endocoat and HealonPro and F: Viscoat and Provisc. OVDs were stained with 10% fluorescein dye before being injected into the anterior chamber. Phacoemulsification, using fixed parameters, was performed. If OVD persisted after 60 s, a standardised irrigation and aspiration technique replaced phacoemulsification. The time until central and complete clearance of the OVD were video‐recorded and measured. Results: Mean central retention times (CRT) were found to be: HealonPro—5.33 ± 2.56 s, Provisc—3.33 ± 1.11 s, Endocoat—75.0 ± 3.26 s, Viscoat—62.33 ± 5.19 s, combining HealonPro with Endocoat—22.67 ± 4.75 s and Provisc with Viscoat—11.0 ± 0.82 s. The mean total retention time (TRT) was: Endocoat—80.0 ± 8.17 s, Viscoat—81.67 ± 2.09 s, HealonPro with Endocoat—81.33 ± 3.35 s, and Provisc with Viscoat—71.0 ± 2.94 s. For HealonPro and Provisc, CRT and TRT remained identical across all trials. Conclusions: Retention times varied, with cohesive OVDs exhibiting shorter durations than dispersive OVDs. Among dispersive OVDs, TRTs were comparable; however, Endocoat displayed an extended CRT. In soft shell trials, the combination of HealonPro and Endocoat exhibited prolonged CRT and TRT, suggesting enhanced corneal protection. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the inflammatory reaction in eyes with late in‐the‐bag intraocular lens (IOL) dislocation. Methods: This prospective clinical study with fellow‐eye comparison consists of 76 of the patients (76 eyes) with late in‐the‐bag IOL dislocation enrolled in the LION trial. The main outcome measure was anterior chamber flare before surgery measured with a laser flare meter in photon counts per millisecond (pc/ms). The dislocation was graded as 1 (small: optic still covering the visual axis), 2 (optic equator close to the visual axis) or 3 (optic decentred beyond the visual axis, but the IOL–capsule complex partly visible in the pupillary area). The secondary aim was to compare intraocular pressure (IOP) before surgery. Results: Flare levels before surgery were significantly higher in the dislocation eyes than in the fellow eyes with a median flare of 21.5 (range 5.4–135.7) pc/ms versus 14.1 (2.0–42.9) pc/ms, respectively (p ˂ 0.001). A regression analysis of log‐transformed flare values showed that the dislocation eyes had a non‐significant tendency towards higher flare in dislocation grade 1 with a median flare of 24.6 (5.4–135.7) pc/ms compared to grade 2; 19.6 (6.5–41.5) pc/ms (p = 0.06), and no significant difference compared to grade 3; 19.4 (10.2–53.5) pc/ms (p = 0.47). The IOP was significantly higher in the dislocation eyes than in the fellow eyes (p ˂ 0.001). Conclusions: Eyes with late in‐the‐bag IOL dislocation had increased flare levels compared to their fellow eyes. This suggests that inflammation is part of the clinical picture of late in‐the‐bag IOL dislocation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the changes in the lower eyelid position, following ptosis surgery of the upper eyelid of the same eye in blepharoptosis patients. Methods: This prospective interventional before and after study included patients aged more than 5 years with blepharoptosis. Margin reflex distance one (MRD‐1), MRD two (MRD‐2), and levator function were measured before and the 6 months after the surgery. Results: Sixty patients with blepharoptosis (33 congenital and 27 acquired) were recruited. The mean age was 21.61 ± 10.82 and 59.8 ± 13.73 years in congenital and acquired groups, respectively. The mean MRD‐1 improved from 1.95 ± 0.99 before treatment to 4.47 ± 0.47 after treatment (p < 0.001). The mean MRD‐2 improved from 5.57 ± 0.63 before treatment to 4.95 ± 0.51 after treatment (p < 0.001). There was no statistically significant difference in MRD‐1 and MRD‐2 changes between the two groups (p > 0.05) There was no statistically significant correlation between MRD‐2 changes and LF (r = −0.03. p = 0.83). Conclusion: Present study showed a significant improvement in the condition of the lower eyelid improved after upper eyelid ptosis surgery. [ABSTRACT FROM AUTHOR]

The utilization of 27‐G TSV, or 27‐Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27‐G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27‐G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow‐up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27‐G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic. [ABSTRACT FROM AUTHOR]

This article discusses the incidence of liquefied after-cataract, a manifestation of posterior capsular opacification (PCO) that can affect vision. The study found that liquefied after-cataract was common in eyes undergoing laser posterior capsulotomy, occurring in more than one-third of eyes. The interval from cataract surgery to laser capsulotomy was longer in eyes with liquefied after-cataract, indicating minimal symptoms. The study did not find any significant relationship between age, sex, ethnicity, or axial length and liquefied after-cataract, which contrasts with reported risk factors for capsular block syndrome. [Extracted from the article]

A meta‐analysis was conducted to evaluate the impact of transconjunctival sutureless vitrectomy (TSV) over 20 G vitrectomy on wound healing, as well as the requirements for closing the wound in order to treat vitreoretinal diseases. Among the 500 cases who had been treated with vitrectomy to September 2023, 250 were treated by transconjunctiva without vitrectomy and 250 were treated with 20 G vitrectomy. The odds ratio (OR) and mean difference (MD) of 95% confidence interval (CI) were computed to evaluate the influence of wound opening and closing on vitrectomy diseases. The evaluation of vitreoretinal diseases was performed with either a random‐or fixed‐effect model, which involved TSV compared to 20 G vitrectomy. Compared to 20 G vitrectomy, the opening time of the wound in TSV was less (MD, −2.03; 95% CI, −2.87, −1.19; p < 0.0001); Compared to 20 G vitrectomy, the closing time of the wound was less (MD, −4.84; 95% CI, −6.38, −3.03; p < 0.0001); Nevertheless, there were no statistically significant differences in the incidence of vitreous haemorrhage after TSV surgery compared with 20 G vitrectomy (OR, 0.74; 95% CI, 0.25, 2.18; p = 0.59). TSV vitrectomy can shorten the duration of the operation and speed up the healing of the wound. It is suggested that additional studies be carried out with a larger sample size in order to verify this conclusion. [ABSTRACT FROM AUTHOR]

Background: Pain recognition in hospitalized horses is challenging, and the utility of pain scoring systems in horses with ocular disease has not been well‐described. Hypothesis/Objectives: Evaluate the horse grimace scale (HGS) and behavior pain score (BPS) in hospitalized horses with ocular disease. We hypothesized that HGS and BPS would be associated with different clinical progressions. Animals: Privately owned horses hospitalized for ocular disease between September 2018 and September 2020. Methods: Retrospective observational study. The HGS and BPS were recorded daily throughout hospitalization. Clinical progressions were categorized as: (a) discharge from hospital after medical treatment, (b) ophthalmic surgery (eg, keratectomy, conjunctival flap, amniotic membrane transplantation, corneal transplant), or (c) enucleation. Temporal trends in HGS and BPS were assessed using linear regression. Correlations among slope, intercept, and progression were determined using the Kruskal‐Wallis test. Results: Of 65 horses that met inclusion criteria, 29 (45%) were discharged after exclusively medical management, 28 (43%) underwent ophthalmic surgery, and 8 (12%) underwent enucleation. Two horses (3%) had 2 ophthalmic surgeries performed. The BPS scores at admission were higher in horses that were managed medically than in those that underwent enucleation (P =.01). Horses requiring enucleation had higher increases in HGS (P =.02) and BPS (P =.01) during hospitalization than horses that were medically managed and a higher increase in BPS (P =.04) than horses that required ophthalmic surgery. Conclusions and Clinical Importance: Pain scoring may represent a useful tool for monitoring progression and response to treatment in hospitalized horses with ocular disease. [ABSTRACT FROM AUTHOR]

Idiopathic macular hole (IMH) is a vitreoretinal disease that causes severe visual impairment, and the pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) is the traditional treatment for IMH. Since the dissociated optical nerve fiber layer (DONFL) is observed in the eyes after the surgery, a modified surgery is put forward to minimize the injury. However, the extent to which the modified surgery reduced damage is not clear. A novel automated image processing system was developed in this study to quantify the damage after the surgery, revealing how the modified surgery reduced the DONFL. Optical coherence tomography (OCT) images and visual acuity were collected from 65 eyes that underwent a vitrectomy with traditional and modified ILM peeling procedure at Zhejiang Provincial People's Hospital preoperatively. We found that DONFL occurred in all 65 eyes of both the traditional and modified ILM peeling groups. The concentric macular dark spots (CMDS) were automatically measured by the image processing system. The mean total area of CMDS was smaller in the modified ILM peeling group (0.224 ± 0.110 mm2) than that of the traditional ILM peeling group (0.385 ± 0.237 mm2), and there is a significant difference between the two groups (p <.05). The morphological difference in the temporal quadrant of CMDS between the two surgery technology groups was significant (p <.001). This study will provide a clinical research basis for the improvement of macular hole surgery. [ABSTRACT FROM AUTHOR]

A request for an ultrasound of the eye can be a relatively infrequent occurrence for a sonographer, but ultrasound can play a pivotal role in the detection of vision threatening conditions. In those instances where sonographers are required to perform the occasional ocular ultrasound, a sound knowledge of normal anatomy, scanning techniques, technical parameters and pitfalls is pertinent to ensure pathology is not overlooked. Ultrasound of the eye is commonly performed following trauma or visual disturbance. As such it is a useful diagnostic tool when fundoscopic examination of the eye is limited. The fact that it lacks the use of ionizing radiation, is non‐invasive and readily accessible are just some of its many advantages. However, the greatest advantage is its ability to provide a dynamic assessment of the eye. Ocular structures have a higher sensitivity to ultrasound exposure, which necessitates the correct use of technical parameters so as to not induce any vision affecting biological effects. The purpose of this article is to introduce sonographers to normal ocular anatomy, optimal scanning techniques for enhanced pathology detection, and most importantly the safe use of physical parameters to minimize damage to sensitive ocular structures. [ABSTRACT FROM AUTHOR]

Objective: To compare the variability in the duration of action of a single dose of rocuronium or cisatracurium, and duration of subsequent top‐up doses in anesthetized dogs. Animals: Thirty dogs requiring ophthalmic surgery with neuromuscular block. Procedures: Neuromuscular function was monitored with train‐of‐four (TOF) and acceleromyography. Dogs received an initial dose of rocuronium 0.6 mg/kg, or cisatracurium 0.15 mg/kg IV, which produced complete neuromuscular block. Upon return of the first response (T1) of TOF, a third of the initial dose was repeated. The duration of the initial dose and its variability were compared between agents. Duration of subsequent top‐up doses was assessed with mixed effect models. Spontaneous (from last return of T1) or neostigmine‐enhanced (from administration to complete recovery) recovery times were measured for each agent. Results: Duration of action of the initial dose was [median (range)] 25 (10–60) min with rocuronium and 35 (15–45) min with cisatracurium (p =.231). The variability of rocuronium was 3.25 times larger than cisatracurium (p =.034). Duration of top‐up doses did not vary for either agent. Spontaneous recovery was shorter for rocuronium [15 (10–20) min] than cisatracurium [25 (15–45) min] (p =.02). Neostigmine‐enhanced recovery times were 5 (5–25) for rocuronium and 10 (5–10) for cisatracurium (p =.491). Conclusions: Duration of action for a single dose is significantly more variable with rocuronium than cisatracurium. Time to spontaneous recovery was longer for cisatracurium, and cases of unexpectedly long recovery times were observed with both agents. Objective monitoring is recommended. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess accommodative function in non‐presbyopic individuals diagnosed with type 1 diabetes (T1D) without any signs of retinopathy, to determine the existence of possible accommodative disorders related to this disease, and to determine the influence of T1D duration and glycosylated haemoglobin values on accommodative function. Methods: This comparative, cross‐sectional study included 60 participants between 11 and 39 years old, 30 with T1D and 30 controls, with no previous eye surgery, ocular disease or medication that could affect the results of the visual examination. Amplitude of accommodation (AA), negative and positive relative accommodation (NRA and PRA), accommodative response (AR) and accommodative facility (AF) were assessed using the tests that showed the highest repeatability. Participants were classified based on normative values into 'insufficiency, excess or normal results', and a diagnosis of accommodative disorders (accommodative insufficiency, accommodative infacility and accommodative excess) was made. Results: Participants with T1D had statistically significant lower AA and AF and higher NRA values than the controls. Furthermore, AA was significantly and inversely correlated with age and the duration of diabetes; however, AF and NRA were only correlated with disease duration. In the classification by accommodative variables, a higher percentage of 'insufficiency values' was observed in the T1D group (50%) than in the control group (6%; p < 0.001). In terms of accommodative disorders, accommodative infacility was the most prevalent (15%), followed by accommodative insufficiency (10%). Conclusions: Our findings indicate that T1D affects most accommodative parameters, with accommodative insufficiency being associated with this disease. [ABSTRACT FROM AUTHOR]

Background: To report one‐year outcomes from a single‐centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery. Methods: Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. Results: Forty‐five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%–100%) and 73.3% (60%–86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%–93.3%) and 74.4% (51.1%–80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%–75.6%) and 46.7% (31.2%–62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%–40.0%) and 22.2% (11.1%–33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7–48 mmHg) to 12.0 mmHg (3–24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP‐lowering agents from 0.5 (0–3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2–12 m). Mean IOP before the removal was 21.9 mmHg (12–38 mmHg) and decreased to 11.3 mmHg (6–16 mmHg). Conclusions: PGI surgery is an effective procedure for reducing IOP and pressure‐lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course. [ABSTRACT FROM AUTHOR]

Severe coloboma of ocular malignant neoplasms post‐resection poses a reconstructive challenge to surgeons. To compare the practicability, manipulability and outcomes of temporal (myocutaneous) flaps (TFs), forehead (supratrochlear artery/supraorbital artery) flaps (FFs) and buccal (facial artery) flaps (BFs) for periorbital defects reconstruction, a retrospective case series was conducted and evaluated between March 2014 and March 2021. Patient demographics and clinical parameters including age, gender, pathological diagnosis, operative methods, flap selection, operation time, aesthetic satisfaction and follow‐up period were collected. The differences in complications were compared and assessed of the three flaps, including flap survival, venous congestion and donor site healing. Totally, 68 patients who underwent periorbital reconstructive operations because of common ocular malignant tumours were reviewed in this study. As for aesthetic satisfaction, a score more than "moderately dissatisfied" was obtained in 21 patients with TFs (95.5%), and of which the scores in FFs group were 12 cases (60%) and 16 cases with BFs reconstruction (61.5%) (P <.05). Severe microvascular complications underwent re‐exploration operation occurred in one patient with FFs (1.5%) (P >.05). Notable flap necrosis was observed in two patients with BFs repair (2.9%) and in one case with FFs repair (1.5%), with no statistical difference between the three flap selections (P >.05). Moderate venous congestion occurred in one patient with TFs (1.5%), which was fully meliorated non‐surgically. The three familiar facial island flaps are considered as minor trauma and time‐saving process for reconstructing the extensive periorbital defects with comparable ranks of complications. [ABSTRACT FROM AUTHOR]

Background: To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)‐lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open‐angle glaucoma (POAG). Methods: This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either 'success' or 'failure' based on three scores: IOP at follow‐up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re‐surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re‐surgery (Score C). Results: The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C. Conclusions: In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP‐lowering in the initial eye, which should be considered by the surgeon for second eye surgeries. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the surgical and pharmacological management and outcomes of patients with cataract and concurrent uveitis. Methods: Data from the Swedish National Cataract Register, 2018–2019, were collected and analysed. Uveitic eyes were identified and eyes without uveitis were used as controls. Generalized estimating equations were used to adjust for intra‐individual correlation. Results: The study included 719 eyes with and 256 360 without uveitis. The mean age was 66.0 ± 13.5 (standard deviation [SD]) years in the uveitis group and 74.3 ± 8.7 years in the control group (p < 0.001). Surgery was associated with more intraoperative difficulties in eyes with uveitis (27.0%) than in control eyes (7.1%; p < 0.001). Posterior capsule rupture/zonular complications were registered in nine eyes with uveitis (1.3%) and in 1464 eyes without uveitis (0.6%; p = 0.02). Hydrophilic acrylic intraocular lenses (uveitis 3.6%, controls 1.2%) and subconjunctival steroids (uveitis 17.4%, controls 6.1%) were more frequently used in eyes with uveitis (p < 0.001). post‐operative best‐corrected visual acuity (BCVA) was 0.16 ± 0.38 logarithm of the minimum angle of resolution (logMAR, mean ± SD) in eyes with uveitis (n = 52) and 0.08 ± 0.20 in control eyes (n = 14 489; p = 0.008). Conclusion: In this large registry‐based Swedish cohort study, the findings demonstrate that cataract surgery in patients with uveitis poses more challenges and requires special surgical precautions. Eyes with concurrent uveitis had worse BCVA prior to and following surgery. Despite the intraoperative challenges, the visual improvement was greater in the uveitic group. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to investigate the incidence for endophthalmitis and blebitis after deep sclerectomy (DS) and trabeculectomy with routine use of Mitomycin C (MMC) 0.4 mg/ml. Methods: Electronic medical records of patients who underwent surgery 1/2008–4/2020 were reviewed. Cumulative incidence for bleb‐associated infection (BAI), including both endophthalmitis and blebitis, was calculated with cumulative incidence function (CIF) and Kaplan–Meier analysis. Risk factors for BAI were evaluated with univariate competing risk regression analysis and Log‐rank analysis. Competing event in CIF was death. Results: In this retrospective single‐centre cohort study, a total of 2653 patients and 3411 eyes underwent surgery: 3478 glaucoma surgeries, 2419 DS and 1059 trabeculectomies. Two cases of endophthalmitis and three of isolated blebitis developed. Median follow‐up from the most recent surgery on the eye until the end of the study was 5.5 years, and until last visit at the ophthalmology department was 1.9 years. For the whole follow‐up period in CIF‐analysis, cumulative incidence for BAI was 0.16% (95% CI 0.06–0.36) at five years. Incidence was higher with eyes not treated with an antifibrotic during surgery (sub‐hazard ratio 11.66, 95% CI 1.94–70.21, p = 0.007). Cumulative incidence between surgery and last visit with Kaplan–Meier analysis was 0.21% (95% CI 0.08–0.52) at five years, similarly, not using an antifibrotic increased incidence (Log‐rank p < 0.001). Conclusion: Cumulative incidence for BAI was low despite routine use of high‐dose MMC. [ABSTRACT FROM AUTHOR]

We performed a meta‐analysis to evaluate the effect of 27‐gauge microincision vitrectomy surgery compared with 25‐gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease. A systematic literature search up to June 2022 was performed and 1264 subjects with the vitreoretinal disease at the baseline of the studies; 562 of them were using the 27‐gauge microincision vitrectomy surgery, and 722 were using 25‐gauge microincision vitrectomy surgery. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of 27‐gauge microincision vitrectomy surgery compared with 25‐gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease using the dichotomous, and contentious methods with a random or fixed‐effect model. The 27‐gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication (OR, 6.66; 95% CI, 0.46‐0.95, P =.02), and wound suture number (OR, 0.38; 95% CI, 0.20‐0.71, P =.002), and best corrected visual acuity (MD, −0.03; 95% CI, −0.05 to −0.001, P =.02) compared with 25‐gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. However, 27‐gauge microincision vitrectomy surgery subjects had no significant difference in the wound closure time (MD, −8.45; 95% CI, −23.44 to 6.55, P =.27), operation time (MD, 0.85; 95% CI, −1.17 to 2.86, P =.41), intraocular pressure at postoperative day 1 (MD, 0.42; 95% CI, −1.45‐2.28, P =.66), primary anatomical success rate (OR, 0.83; 95% CI, 0.42‐1.63, P =.58), and central macular thickness (MD, 1.81; 95% CI, −21.76 to 25.37, P =.88) compared to 25‐gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The 27‐gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication, wound suture number, and best corrected visual acuity, and no significant difference in the wound closure time, operation time, intraocular pressure at postoperative day 1, primary anatomical success rate, and central macular thickness compared to 25‐gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The analysis of outcomes should be with caution because of the low sample size of 12 out of 15 studies in the meta‐analysis and a low number of studies in certain comparisons. [ABSTRACT FROM AUTHOR]

Micro‐/nanorobots have tremendous potential in biomedical applications, as they efficiently and accurately perform local diagnosis and targeted therapy. A magnetic field provides a wireless mean to drive and control micro/nanorobots. This method requires no fuel and is convenient for debugging, reconfiguration, and programmability; it is recyclable and allows nondestructive penetration of biological tissue. The successful integration of well‐designed robots, remote actuation systems, and imaging techniques has become a crucial step toward biomedical applications, particularly in vivo implementations. Herein, the fabrication methods of micro/nanorobots are examined, the driving mechanism of magnetic micro/nanorobots is explained, and the development of micro/nanorobots as transport tools to load and deliver drugs, biological reagents, and live cells is traced. Applications of these micro/nanorobots are expanding as surgical tools for sample collection, ophthalmic surgery, and biofilm degradation and as tools for in vivo and in vitro imaging relying on light, sound, and magnetism. Finally, the challenges faced by micro/nanorobots in in vivo applications and their future prospects are discussed. [ABSTRACT FROM AUTHOR]

Purpose: To compare phacoemulsification versus phacovitrectomy regarding postoperative intraocular lens (IOL) shift and refraction. Methods: This prospective bilateral comparison study included 40 eyes of 20 patients. Inclusion criteria were combined phacovitrectomy without gas/air tamponade in one eye and cataract surgery in the contralateral eye with implantation of the same IOL. Postoperative anterior chamber depth (ACD) was compared between both groups 1–5 hr, 1 day and 8 weeks after surgery. Postoperative refraction was compared after 8 weeks using the Holladay I, HofferQ, SRK/T, Haigis and Barrett formulae. Results: There were no intergroup differences in ACD (8 weeks: 0.02 mm absolute difference, SD 0.22, range −0.36 to 0.65, p = 0.401), mean absolute refractive error (8 weeks: Holladay I p = 0.452; HofferQ p = 0.475; SRK/T p = 0.498; Haigis p = 0.869; and Barrett p = 0.352) or percentages within the 0.5 D and 1.0 D range at any time‐point. All formulae were optimized for the phacovitrectomy and the cataract groups. There was no correlation of macular thickness change and refractive error (cataract group r2 = −0.13, p = 0.58; phacovitrectomy group r2 = −0.10, p = 0.68). Conclusion: Combined phacovitrectomy without air/ gas tamponade caused neither ACD displacement nor refractive shifts compared to phacoemulsification alone. Surgically induced macular thickness change had no significant influence on postoperative refraction in this study. All five IOL formulae showed comparable postoperative refractive outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate potential risk factors, particularly antimetabolite choice, with regard to the development of adverse bleb morphology in eyes that had undergone trabeculectomy surgery. Methods: A single‐centre, observational cohort study of 631 consecutive eyes, which had undergone trabeculectomy over an 11‐year period. For each case, bleb morphology was recorded at 2 years, and its association with the per‐operative antimetabolite as well as potential confounding risk factors was analysed using univariate (unadjusted) and multivariate (adjusted) logistical regression analyses to identify those that could contribute to the development of adverse blebs. A standard protocol for 5‐fluorouracil and mitomycin‐C utilization was employed in the majority of cases. Results: When 5‐fluorouracil was used (n = 257), 24% of patients formed cystic or partially cystic blebs, whereas with mitomycin‐C (n = 299), only 12% formed such adverse blebs, the difference being statistically significant (OR = 3.54, p = 0.002 unadjusted; OR = 7.49, p = 0.00 adjusted). Of the other potential confounding factors, care within the private sector (OR = 0.30 p = 0.02) and a history of previous ocular surgery involving a conjunctival incision were identified as potential risk factors for the formation of adverse cystic blebs (OR = 0.28, p = 0.02). Conclusions: Modern use of mitomycin‐C appeared to be better than 5‐fluorouracil as an adjunctive antimetabolite used at the time of trabeculectomy, with respect to the development of preferable final bleb morphology. The only potential preoperative risk factors found to be significant with respect to adverse cystic bleb development were care in the private health sector and previous ocular surgery involving a conjunctival incision. [ABSTRACT FROM AUTHOR]

Objective: To compare fall incidence, and visual acuity and refractive status, before surgery and after first and second eye cataract surgery. Design, setting: Prospective observational study in eight tertiary referral ophthalmology clinics in public hospitals in Sydney, Melbourne, and Perth. Participants: People aged 65 years or more referred for bilateral age‐related cataract surgery during 2013–16, followed for maximum of 24 months after study entry or until six months after second eye surgery, whichever was shorter. Main outcome measures: Primary outcome: age‐ and sex‐adjusted incidence of falls. Secondary outcomes: visual acuity and refractive error. Results: The mean age of the 409 included participants was 75.4 years (SD, 5.4 years); 220 were women (54%). Age‐ and sex‐adjusted fall incidence prior to surgery was 1.17 (95% CI, 0.95–1.43) per year, 0.81 (95% CI, 0.63–1.04) per year after first eye surgery, and 0.41 (95% CI, 0.29–0.57) per year after second eye surgery. For the 118 participants who underwent second eye surgery and participated in all follow‐up visits, age‐ and sex‐adjusted incidence before (0.80 [95% CI, 0.55–1.15] falls per year) and after first eye surgery (0.81 [95% CI, 0.57–1.15] falls per year) was similar, but was lower after second eye surgery (0.32 [95% CI 0.21–0.50] falls per year). Mean habitual binocular visual acuity (logMAR) was 0.32 (SD, 0.21) before surgery, 0.15 (SD, 0.17) after first eye surgery, and 0.07 (SD, 0.15) after second eye surgery. Conclusions: First eye surgery substantially improves vision in older people with cataract, but second eye surgery is required to minimise fall incidence. Timely cataract surgery for both eyes not only optimises vision in older people with cataract, but also reduces their risk of injury from falls. [ABSTRACT FROM AUTHOR]

Objective: Orbital compartment syndrome (OCS) is a time critical condition, with ischaemic complications occurring after 90–120 min. In the prehospital setting, the diagnosis and management of OCS is challenging due to complex environmental considerations, competing clinical priorities, and limited equipment. This study aims to provide learning points on performing lateral canthotomy and cantholysis (LCC) in the prehospital setting. Methods: We performed a retrospective audit of LCC in our service from January 2016 to December 2020 by retrieving demographic and clinical details from LifeFlight Retrieval Medicine electronic database using 'OCS' and 'LCC' as keywords. Results: Three cases out of 7413 trauma missions were identified over the 5‐year period. LCC was performed at the primary scene in two cases, while one patient underwent LCC at a rural hospital near the scene of injury. Clinical findings, aeromedical considerations, and radiological findings at the receiving facility, along with visual outcomes at time of discharge are discussed. Conclusion: Prehospital LCC is rare. The Australian aeromedical context often involves lengthy transfers of trauma patients. Clinical diagnosis and management of OCS are highly challenging in the prehospital setting. It is important that prehospital physicians have access to appropriate equipment to perform LCC. They should be provided with suitable training and supported by a standard operating procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the risk of intraoperative complications during cataract surgery in eyes with a prior vitrectomy. Methods: A retrospective review of data from our cataract surgery registry of all patients undergoing cataract surgery between 2014 and 2018 at the University of Colorado Hospital. Univariate and multivariate analyses were conducted, accounting for intra‐patient correlation in subjects who underwent two cataract surgeries. The three main outcomes of interest, zonulopathy, posterior capsule (PC) tears and dropped lens fragments, were analysed for their association with prior pars plana vitrectomy (PPV) and clinical characteristics of patients such as history of prior intravitreal injection and surgeon level of experience. Results: 10 540 eyes of 6447 patients were included in the analysis. 371 (3.5%) eyes had a prior PPV. Eyes with a prior PPV experienced more zonulopathy during cataract surgery (adjusted OR 2.2, 95% confidence interval: 1.3–3.7, p = 0.002). Combined phacoemulsification/PPV were significantly more likely to experience all 3 complications, and this effect was even greater for eyes with a prior PPV. Conclusions: All complications were rare; however, there was a significant association with prior PPV and intraoperative zonulopathy. Cataract surgeons must be aware of a patient's prior vitrectomy and plan accordingly for the increased risk of intraoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: To analyse if patients with diabetic retinopathy (DR) subjected to cataract surgery differ in outcome compared to patients without DR with regard to best‐corrected visual acuity (BCVA), deviation from target refraction, intraoperative difficulties and risk of complications. Methods: A register‐based study from the Swedish National Cataract Register (NCR) during the years 2015–2017 including 358 040 cataract procedures. Patients with other ocular pathology than cataract and DR were omitted from outcome analyses. Results: Diabetic retinopathy was reported in 13 724 of all eyes (3.8%). Preoperative BCVA was significantly worse in DR patients than in patients without DR, 0.54 ± 0.33 compared to 0.40 ± 0.27 (logMAR, mean ± SD, p < 0.001). The same was evident for postoperative BCVA, 0.15 ± 0.25 for DR patients versus 0.06 ± 0.13 (p < 0.001). The improvement in BCVA was slightly better in DR than in non‐DR, −0.40 ± 0.32 (logMAR; mean ± SD) versus −0.35 ± 0.27, p < 0.001. The absolute mean biometry prediction error was 0.42 ± 0.50 diopters (D) in DR and 0.43 ± 0.71 D in non‐DR patients, p = 0.768. One or more intraoperative difficulties, including mechanical pupil dilation, capsular stain, hooks at capsulorhexis margin or capsular tension ring, had an adjusted odds ratio (OR) of 1.75 (95% confidence interval [CI] 1.61–1.90, p < 0.001) in DR versus non‐DR cases and the rate of posterior capsular tears (PCR) had an adjusted OR of 1.76 (95% CI 1.40–2.20, p < 0.001). Conclusion: Eyes with DR have inferior pre‐ and postoperative BCVA compared to non‐DR eyes. There is little difference in improvement of BCVA and no difference in absolute mean biometry prediction error. Importantly, intraoperative difficulties and PCRs are almost twice as common in DR patients, strongly indicating that these patients should be managed by experienced surgeons. [ABSTRACT FROM AUTHOR]

Atropine eye drops are frequently used in the treatment of keratitis and during ophthalmic surgery. We described a rare complication of central anticholinergic syndrome secondary to atropine eye drops. [ABSTRACT FROM AUTHOR]

Background: Wet age‐related macular degeneration (AMD) and age‐related cataract are often coexisting causes of visual impairment. Yet, the timing of cataract surgery in wet AMD patients is controversial. Methods: One hundred and eleven eyes of 111 patients with wet AMD underwent cataract surgery at Helsinki University Hospital in Finland during 2014–2018. Best‐corrected visual acuity and central subfield macular thickness (CSMT) were analysed at the time of wet AMD diagnosis, at the last recording prior to cataract surgery and at the first recording and at 1 year after surgery. The cumulative number of antivascular endothelial growth factor (anti‐VEGF) injections at surgery, systemic and topical medication and postoperative anti‐VEGF burden were recorded. Results: Mean age was 78.9 ± 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 ± 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 ± 0.46 logMAR units preoperatively to 0.39 ± 0.40 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, p < 0.001 for both) and anti‐VEGF treatment intervals lengthened despite the surgery (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, p = 0.246, and to 7.05 ± 2.57 weeks at the last documented visit, p = 0.035). A CSMT increase of over 30% from the preoperative values was seen in only one case (1 out of 111 eyes, 0.9%). Macular status at surgery, wet AMD subtype, comorbidity of type II diabetes, systemic drugs and topical anti‐inflammatory medication were not associated with macular changes nor with treatment intervals after surgery. The cumulative number of anti‐VEGF injections correlated neither with CSMT change postoperatively (r = −0.051, p = 0.619) nor with CSMT change at 1 year (r = 0.091, p = 0.426). Conclusion: Satisfactory visual outcomes and controlled disease activity were seen in patients with wet AMD undergoing cataract surgery. We found no evidence to support delaying surgery in patients who require it. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association of systemic statin therapy and reoperation rate after glaucoma filtration surgery (GFS). Methods: This is a population‐based, historic cohort study of 2705 eyes undergoing GFS in Finland between July 2009 and December 2016. GFSs were identified from national administrative healthcare registers. Baseline sociodemographic and health characteristics were documented. Reoperation rates of GFS subgroups were analysed, with statin users compared to non‐users. The outcomes were modelled using a Poisson regression model adjusted for age, sex, education, statin use, chronic comorbidities, and cataract surgery with incident rate ratios (IRR) as the main outcome measure. Results: The cohort contained 2263 subjects with open‐angle glaucoma (OAG), 823 men and 1440 women. Surgery was performed on 2705 eyes. First documented procedures: deep sclerectomy (DS) (n = 1601), trabeculectomy (TRE) (799) and glaucoma drainage device (GDD) implantation (305) respectively. In total, 438 secondary operations were performed during the 7.5‐year (median 2.25 years) follow‐up period. The reoperation rates were 19% after DS, 12% after TRE, and 13% after GDD. Of the surgical procedures, 32% were performed on eyes of patients receiving statin therapy. Statin users showed no difference in reoperation rates (IRR 1.06, CI 0.82–1.37). In subgroups, no difference was observed in the reoperation rates adjusted with statin use after filtration surgery (DS, TRE) (IRR 1.06, CI 0.8–1.40) or GDD implantation (0.57, CI 0.20–1.63). Conclusion: Systemic statin therapy among surgically treated OAG patients had no impact on secondary surgery rates following DS, TRE or GDD implantation. [ABSTRACT FROM AUTHOR]

Thyroid eye disease is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight‐threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the clinical activity score (CAS) to assist in treatment selection. Non‐surgical management can extend from observation alone to minor therapy such as oral selenium, then glucocorticoid therapy, cyclosporin, mycophenolate, rituximab, immunoglobulin, teprotumumab, and orbital radiotherapy. High‐dose intravenous methylprednisolone therapy is used in active vision‐threatening disease with early use of tarsorrhaphy and orbital decompression. Inactive but moderate to severe disease may be treated by orbital decompression, strabismus and eyelid surgery. Systematic assessment and management by both an endocrinologist and ophthalmologist to achieve and maintain euthyroidism and select and sequence treatments according to activity and severity of thyroid eye disease gives the best results for quality of life and vision. [ABSTRACT FROM AUTHOR]

Iris‐claw lenses have gained increasing popularity over the last years and are by many surgeons regarded as viable options in eyes with insufficient capsular or zonular support. The iris‐claw lens has two haptics with fine fissures for folding (enclavating) the mid‐peripheral part of the iris stroma and can either be placed in front of or posterior to the iris. In particular, the retropupillary implantation has been increasingly chosen probably due to having an anatomical position similar to that of the crystalline lens. The present review is based on a literature review and also on the authors' clinical experience with this lens, and it focuses on surgical techniques and outcomes especially related to the characteristics of this lens, having haptics with claws that fixate the lens to the posterior iris. Implanting retropupillary iris‐claw lenses has a relatively short learning curve, and there are only few complications reported during surgery. Retropupillary iris‐claw lenses have demonstrated generally favourable efficiency and safety. However, the outcomes are probably more influenced by the reason for surgery and eye comorbidity than the lens itself. Albeit seldom reported, the postoperative complications have mostly been related to atrophy of the iris at the site of the haptics, or IOL decentration or disenclavation of one of the haptics. To date, however, there are few randomized clinical trials comparing this lens to other lens alternatives in eyes exhibiting insufficient capsular or zonular support for placing the lens in the ciliary sulcus. In the future, prospective studies with large samples should be performed to gain insights into the long‐term safety of retropupillary placed iris‐claw lenses, and for comparisons with the various other techniques of lens fixation. [ABSTRACT FROM AUTHOR]

Since both patients had a history of hyaluronidase injection, we consider hyaluronidase allergy. Based on the specific history of hyaluronidase injection and positive result of intradermal test with hyaluronidase, the final diagnosis was hyaluronidase allergy. Skin prick tests of hyaluronidase were negative; however, intradermal tests using hyaluronidase were performed and showed immediate reactions, erythema and weal in both patients (Fig. [Extracted from the article]

Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase‐change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN–8 N). The catheter is equipped with a magnet and a micro‐gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system. [ABSTRACT FROM AUTHOR]

Objective: To document the effectiveness and outcome of corneal grafting using acellular porcine corneal stroma (APCS) for veterinary use (BioCorneaVet™) to restore corneal integrity in dogs. Methods: A review of medical records of patients that underwent keratoplasty with APCS graft to repair deep corneal defects, descemetoceles, and perforations between 2019 and 2021 was carried out. Only animals with intact dazzle reflex, consensual PLR before the surgery and a minimum follow‐up of four weeks were considered for the study, with forty dogs (1 eye each) meeting the inclusion criteria. Results: Brachycephalic breeds were the most frequently represented, and 20 right eyes and 20 left eyes were affected with 25 perforations, 8 descemetoceles, and 9 deep stromal defects (1 eye had both perforation and descemetocele). Most of the patients had concurrent ocular diseases or had undergone previous surgery on the other eye. Two different thickness of xenograft was used (300 or 450 µm), and the diameter ranged from 3 to 10 mm. Postoperative complications included mild to severe corneal vascularization, partial dehiscence, melting, and glaucoma. Follow‐up time ranged from 28 to 797 days (mean: 233 days). Ocular integrity was maintained in 37/40 cases (92.5%), and vision was preserved in 36 cases (90%). Conclusion: The use of APCS (BioCorneaVet™) is an effective surgical treatment for deep stromal defects, descemetocele, and perforations in dogs, providing a good tectonic support and preserving anatomical integrity and vision. The cosmetic appearance was considered good in all the cases and continued to improve with time. [ABSTRACT FROM AUTHOR]

Objective: To study the surgical, anesthetic and recovery qualities of horses receiving either a neuromuscular blocking agent (atracurium) or intravenous lidocaine (treatment groups A and L, respectively). Animals studied: A total of thirty horses presented for ocular surgery were used in this study. Procedure: Horses were randomly assigned to receive either atracurium (group A) or a lidocaine constant rate infusion (group L). Surgical quality was graded on a scale from 1 (excellent)‐5 (poor). While anesthetized, the heart rate, oxygen saturation and mean arterial blood pressure, and end‐expiratory carbon dioxide and desflurane concentration were monitored and recorded every 5 minutes. Recovery was scored on a scale from 10 (best)‐115 (worst). Results: Horses in treatment group A needed significantly less desflurane then horses in treatment group L (p = 0.04). Horses in treatment group A had a significantly better surgery score of 1 (1–2) (median and range) then horses in treatment group L (2.5; 1–5) (p = 0.02). The quality of recovery was significantly better in horses in treatment group A compared with treatment group L, and horses needed significantly less time to reach the standing position. Conclusions: Atracurium and lidocaine CRI are safe methods of anesthesia for equine patients undergoing ocular surgery. Horses receiving atracurium needed less desflurane and had better surgery and recovery scores than horses receiving a lidocaine constant rate infusion. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical features and long‐term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral‐fixated (SFIOL) versus retropupillary iris‐claw IOL (RPICIOL). Methods: Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best‐corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation. Results: This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p = 0.76) or endothelial cell density (ECD) (p = 0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p = 0.005) sustained to over 36 months (p = 0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p = 0.027), and shorter operation times (52.7 vs. 60.9 min, p = 0.015). There was no difference in ECD after 12 months (P = 0.282). Over a mean follow‐up duration of 33 months (152 cases >3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p = 0.006), suture exposure (7 vs. 0, p = 0.045), and redislocation (17.7% vs. 10.1%, p < 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P = 0.007), older age (p = 0.001), intraoperative complications (p = 0.002), past history of vitrectomy/glaucoma surgery or uveitis (p = 0.046), and surgically induced astigmatism >1D (p = 0.029). Conclusions: RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long‐term follow‐up, comparing favourably against conventional SFIOL. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the refractive precision of three‐piece versus one‐piece intraocular lenses (IOLs) in eyes with pseudoexfoliation (PXF) and changes in anterior chamber depth (ACD) following cataract surgery. Methods: This prospective, nonrandomized, interventional, comparative case series included PXF eyes, which were implanted with one‐piece acrylic IOL or three‐piece acrylic IOLs (Group A; n = 31, Group B; n = 30). Non‐PXF control eyes were implanted with one‐piece acrylic IOL (Group C; n = 30). Postoperative refractive error (RE) and absolute RE, as well as pre‐ to postoperative ACD changes, were statistically analysed. A p value < 0.05 was considered statistically significant. Results: Changes in ACD (mean ± standard deviation) in Groups A, B and C were 0.9 ± 0.4, 1.0 ± 0.3 and 0.7 ± 0.4 mm, respectively. Significant differences were found between Groups A and C (p = 0.043) and between Groups B and C (p = 0.008). In Groups A, B and C, the median and interquartile (Q1 to Q3) values were 0.3 (−0.8 to 1.0), −0.5 (−0.8 to −0.3) and 0.1 (−0.4 to 0.3) for RE and 1.0 (0.4 to 1.3), 0.5 (0.3 to 0.8) and 0.3 (0.3 to 0.5) for absolute RE, respectively. The RE differences between Group A and B (p = 0.009) and Group B and C (p < 0.001) were statistically significant. For absolute RE, the differences were significant for all comparisons (p < 0.05). Conclusion: Refractive precision in PXF eyes may be better with three‐piece than with one‐piece IOL implantation, but worse than with one‐piece IOL implantation in non‐PXF eyes. Significant changes in ACD in PXF eyes may be related to RE. [ABSTRACT FROM AUTHOR]

A juvenile goliath tigerfish (Hydrocynus goliath) was presented with a traumatic full‐thickness corneal laceration and associated iris prolapse. Debridement and corneal flap repair using N‐butyl cyanoacrylate tissue glue was performed under general anaesthesia. This article describes the initial ocular surgery and documents the recovery and healing process over the following 3‐week period. The fish was discharged from treatment at this point, and there were no complications over the ensuing 1‐year period. [ABSTRACT FROM AUTHOR]

Background: A great number of sedatives and anaesthetics have been used to perform surgeries or routine ophthalmologic examinations in animals and sometimes the combination of these medicines has more suitable effects than each one alone. Objectives: This paper aims to explore the main effects of Medetomidine + Acepromazine, Dexmedetomidine + Acepromazine on intraocular pressure, tear secretion and pupil diameter. Methods: To accomplish the aforementioned aim, 32 adult dogs (aged one‐to‐three‐years‐old) were clinically examined. Dogs were divided into four groups consisting of group DA, Dexmedetomidine (5 µg/kg) + Acepromazine (0.05 mg/kg); Group D, Dexmedetomidine (5 µg/kg); Group M, Medetomidine (10 µg/kg); Group MA, Medetomidine (10 µg/kg) + Acepromazine (0.05 mg/kg). The ocular factors including tear production, pupil diameter and intraocular pressure of both right and left eyes were first measured and then recorded in each dog at time T0 (−15 min). Afterwards, the drugs were administered intramuscularly, based on which the ocular factors were re‐measured at T1 (+5 min), T2 (+15 min) and T3 (+20 min). All four groups showed a reduction in intraocular pressure, which was significant in DA, D and M groups. Results: Furthermore, there was a fluctuation in the amount of tear secretion in DA and D groups (increase and then decrease), as well as a significant reduction in M and MA groups. Decreasing in pupil diameter also occurred in all four groups, but the reduction was significant only in DA and MA groups. Conclusion: According to the results obtained, as the changes caused by the systemic administration of the above drug compounds did not exceed the physiological range, it can be concluded that these combinations could be utilized as suitable sedatives or pre‐anaesthetic compounds in the eye surgeries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to determine whether caffeine concentrations in human lens epithelial cells (LECs) achieved from acute peroral caffeine intake inhibit ultraviolet radiation‐induced apoptosis in vitro. Methods: Patients were planned for cataract surgery of both eyes with a caffeine abstinence of 2 weeks in total, starting 1 week before surgery of the first eye. The second eye was scheduled 1 week after the first eye. At the day of the second eye surgery, patients were given coffee containing 180 mg caffeine shortly before surgery. Lens capsules including LEC, harvested after capsulorhexis, were transferred to a cell culture dish and immediately exposed to close to threshold ultraviolet radiation (UVR). At 24 hr after UVR exposure, apoptotic LECs were analysed by TdT‐mediated dUTP‐biotin nick end labeling (TUNEL) staining. Results: TUNEL‐positive cells were detected in UVR‐exposed lens capsules both after caffeine intake and in controls. The mean difference in TUNEL‐positive cells between caffeine intake and contralateral controls (no caffeine) resulted in a 95% CI 15.3 ± 10.4% (degrees of freedom: 16). Conclusion: Peroral caffeine consumption significantly decreased UVR‐induced apoptosis in LEC supporting epidemiological findings that caffeine delays the onset of cataract. [ABSTRACT FROM AUTHOR]

Purpose: To assess correlation between results from both eyes of the same patient after implantation of intrastromal corneal ring segments (ICRS) and define whether they can be used together in clinical studies. Methods: A review of medical records of 74 patients with keratoconus implanted with bilateral Ferrara ICRS at Centro de Oftalmología Barraquer from January 2005 until December 2014. Data were collected on uncorrected visual acuity, best‐corrected visual acuity and subjective refractive values (sphere, cylinder and axis). Results: A total of 39 patients were male (53%), and 35 were female (47%). Mean age at the time of implantation was 32.5 ± 10 years. No major complications occurred. A significant correlation between the results from right and left eyes was found (p < 0.0043), indicating that both eyes significantly resembled each other. No significant interaction in the magnitude of change between eye and surgery was observed under classic and mixed models. Conclusion: Based on our data, whenever application is not possible under mixed‐model analyses, we recommend the use of a first eye operated only, either right or left, in order to avoid bias and errors derived from autocorrelation and guarantee the independence of the registered observations. [ABSTRACT FROM AUTHOR]

Background: To determine whether the outcome of the first eye may serve as a predictor for intraocular pressure (IOP)‐lowering effectiveness in the second eye following bilateral ab interno trabeculectomy. Methods: This retrospective single‐centre study included 168 eyes from 84 participants, who underwent combined Trabectome surgery with phacoemulsification cataract surgery in a hospital setting. The clinical endpoint was defined as either 'success' or 'failure' based on four separate scores at the longest follow‐up time point: IOP at follow‐up <21 mm Hg (Score A) or IOP < 18 mm Hg (Score B), without re‐surgery and IOP reduction >20%; IOP ≤15 mm Hg without re‐surgery and IOP reduction ≥40% (Score C); and the sole absence of re‐surgery according to the discretion of the surgeon (Score D). Results: No significant difference was observed between the outcomes of first and second eyes. The frequency of success in the second eye after effective surgery in the first eye significantly exceeded that after prior failure. Within our analysis, the probability calculations determined a 75% chance of success following prior success for Score A. If surgery in the first eye failed, the chance of success in the subsequent eye was 37%. The corresponding probabilities were 79% and 32% for Score B, 56% and 9% for Score C, and 99% and 50% for Score D. Conclusion: The results of our study offer a useful tool to assess the success of subsequent eye surgeries based on the outcome in the initial eye, owing to the high predictive potential. [ABSTRACT FROM AUTHOR]

Purpose: Cataract surgery on eyes with shallow anterior chambers may be demanding. Glycerol intake prior to surgery has been a well‐known method in an effort to increase anterior chamber depth. It is used since it is thought that glycerol as an osmotic agent causes the vitreous body to shrink, pulling back the iris and thereby deepening the anterior chamber – making the surgery easier. Our controlled clinical trial tests this hypothesis and investigates the effect of glycerol on anterior chamber depth (ACD), intraocular pressure (IOP), corneal thickness (CCT), pupil diameter change after viscodilation (PD), operating time and perioperative complications. Methods: We performed a controlled clinical trial. All patients underwent cataract surgery on both eyes with at least 7 days apart. Preoperatively the patient was given glycerol orally when the right eye was operated – when the left eye was operated, nothing was given. In this way, each patient was serving as its own control. Measurements of ACD, IOP and CCT were performed before and after glycerol intake, pupillary diameter was measured before and after viscoelastics during the operation, and operating time and surgical complications were noted. Results: The study included 22 patients with bilateral cataract and anterior chambers depth <2.5 mm. Glycerol caused the anterior chamber to increase by 0.022 mm (p < 0.05), and IOP was lowered by 5.1 mmHg compared to the control group (p < 0.05). However, exposure to glycerol showed no effect on CCT, pupillary dilation of viscoelastics, operating time or surgical complications. Conclusion: Glycerol increases anterior chamber depth and lowers intraocular pressure significantly. These changes had no significant impact on operating time nor on the complication rate, suggesting that these changes are too subtle to have a clinical impact on the cataract procedure. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical experience of using a three‐dimensional (3D) system for ophthalmic surgical procedures. Methods: We retrospectively analysed video recordings of patients who underwent 3D ophthalmic surgery, using the NGENUITY® 3D visualization system, or traditional microsurgery at our hospital, from August 2017 to February 2018. Patients underwent phacoemulsification or phacoemulsification combined with vitrectomy. Diagnoses, operation type, duration of continuous curvilinear capsulorhexis (CCC), number of forceps nips during CCC and capsulorhexis complications were recorded. Five surgeons and four assistants answered a 3D surgery questionnaire. Results: Twenty‐six of 46 patients who underwent 3D surgery, and 31 of 51 patients who underwent traditional microsurgery (control group) were enrolled. The mean CCC duration in the study and control groups was 31.2 ± 10.8 and 28.7 ± 13.2 seconds (p = 0.071), and the mean number of forceps nips was 5 ± 2 and 5 ± 2 (p = 0.634), respectively. The anterior capsular rupture rate of phacoemulsification under 3D and traditional conditions was 3.85% (1/26 cases) and 3.23% (1/31 cases), respectively. The complication rate was similar between the two groups (p > 0.999). Four of five surgeons and two of four assistants believed the clarity of 3D surgery was similar or better than that of traditional microsurgery. The occurrence of dizziness (p > 0.999), shoulder and neck pain (p = 0.262), backache (p = 0.471) and visual fatigue (p = 0.347) did not differ significantly between the two methods. Conclusion: The 3D surgical system facilitated similar operation speed and stability as the traditional microscope and provided reliable support for ophthalmic surgery. [ABSTRACT FROM AUTHOR]

Background: Glaucoma filtration surgery (GFS) is limited by subconjunctival, episcleral and scleral fibrosis sealing the trabeculectomy and scarring the filtering bleb. Mitomycin‐C (MMC) is commonly applied intraoperatively to the subconjunctival and/or intrascleral space to reduce scarring and promotes GFS success but is associated with postoperative scleral melting and bleb leaks. IP‐10 peptide (IP‐10p), an ELR‐negative CXC chemokine mimetic and inhibitor of fibroblast function, may be an alternative or adjunct to current postoperative GFS treatments. This study sought to determine if IP‐10p produces histological changes in tissue remodelling, vascularity and fibrosis that enhance bleb survival after GFS. Methods: Rabbits underwent tube‐assisted filtration surgery on the right eye with either: (a) IP‐10p injected into bleb at time of surgery and postoperative days 2, 4 and 7, (b) intraoperative MMC or (c) intraoperative MMC plus IP‐10p injected into bleb at time of surgery and postoperative days 2, 4 and 7. Left contralateral eyes were treated with balanced salt solution (BSS). Results: IP‐10p‐treated blebs demonstrated reduced collagen deposition, cellularity and overall reduction of scar formation compared to BSS‐control. Bleb vascularity was reduced compared to BSS‐control and MMC treatment groups. Additionally, IP‐10p/MMC treated eyes demonstrated an increased number of conjunctival goblet cells in bleb histology compared to the dramatic loss seen with MMC treatment alone. Conclusions: This study demonstrates that IP‐10p significantly reduces histological scarring compared to BSS or MMC alone, does not damage the conjunctiva to the extent of current standards, and may be an alternative or adjunct to MMC for those undergoing GFS. [ABSTRACT FROM AUTHOR]

Endophthalmitis is a sight threatening complication of ocular surgery with 62%-75% of cases associated with cataract surgery.1 Fifty percentage of patients recover 6/12 or better vision whilst 10% only retain 6/240 or worse.2 Effective prophylaxis of postoperative endophthalmitis is therefore an important practice for all ophthalmologists and should require good treatment evidence. There was no evidence of an association between endophthalmitis and chloramphenicol use following cataract surgery and little difference made to final outcomes for patients. [Extracted from the article]