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A 64-year-old male farmer diagnosed as lens subluxation, cataract, secondary glaucoma, iris tear, old trauma and lower eyelid ectropion underwent cataract extraction, intraocular lens suspension fixation and coreoplasty. Mild intermittent ophthalmic pain occurred from half a month after surgery, and suppurative endophthalmitis was diagnosed 23 days after surgery. Vitrectomy was performed. The specimen culture result was Nocardia cyriacigeorgica. Gatifloxacin ophthalmic gel was effective for the infection.

This study aimed to investigate the short-term variability of ocular biometric measurements and to analyze the factors associated with high variability of biometric values in patients with cataract. This retrospective study included 60 eyes of 60 patients who underwent ocular biometry twice with the IOLMaster 700 (March to November 2023). Ocular surface parameters included tear film break-up time (TBUT), corneal and conjunctival staining scores (CSS/ConSS). Refractive surprise was defined as a mean absolute error exceeding 0.5 diopter (D). Participants included 22 men and 38 women with a mean age of 70.6 ± 8.4 years. The variability of mean keratometric (K) values and astigmatism showed notable variability compared to axial length (mean K: 0.18 ± 0.17D, astigmatism: 0.21 ± 0.26D, axial length: 0.01 ± 0.01 mm). A decreased TBUT and increased CSS were significantly associated with high variability (≥ 0.25D) of mean K (p = 0.040/0.008). The high K variability group (≥ 0.25D) revealed a significantly higher incidence of refractive surprise (> 0.5D) compared with the low K variability group (< 0.25D) (45.5%/17.9%, p = 0.037). Preoperative lower TBUT and higher CSS influenced the variability of K values in ocular biometry and may be related with postoperative refractive surprise due to erroneous K values., (© 2024. The Author(s).)

Purpose: To evaluate the causes of acute fluid misdirection (AFM) and the role of irido-zonulo-hyaloido-vitrectomy (IZHV) in the management of AFM., Methods: Among the 95,712 cataract surgeries performed between April 2017 and August 2022 at a tertiary center, six eyes of six patients developed intraoperative AFM and underwent IZHV through the anterior approach. AFM was diagnosed intraoperatively when there was sudden shallowing of the anterior chamber with markedly elevated intraocular pressures (IOPs) not attributable to external causes or choroidal effusion/hemorrhage. The condition resolved with deepening of AC following IZHV., Results: Five eyes had angle closure disease (one of them also had pseudoexfoliation), and one eye had open-angle glaucoma. The mean preop IOP was 25.8 ± 7.3 mmHg, with an IOP range of 18-36. The mean number of preop AGM was 3 ± 1.7. Four eyes developed AFM during combined cataract and trabeculectomy, and two eyes during cataract surgery. Four eyes had aqueous misdirection during or after cortical aspiration, and two eyes after creation of internal trabeculectomy ostium. IZHV was performed for all eyes through an anterior approach using a 23G vitrector, which resulted in instant resolution and deepening of the anterior chamber. The mean follow-up was 8.75 months (1-48 months), the mean postoperative IOP was 16.1 ± 2.6 mmHg, and the mean number of AGM at the last follow-up was 2.8 ± 2.2. The anterior chamber was deep, and IOP was under control in all eyes with four eyes needing AGM. One eye developed postoperative aqueous misdirection due to blockade of the IZHV opening., Conclusion: IZHV can be an effective solution for acute intraoperative AFM, which can be performed via an anterior approach by the anterior segment surgeon., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Introduction: Intraoperative floppy iris syndrome (IFIS) is defined as an excessive billowing of the iris during cataract surgery. Floppy eyelid syndrome is defined as an excessive hyperlaxity of the eyelids. Based in our daily experience, we suspected FES to be associated with IFIS. This association has been investigated. The goal of the study was to explore whether FES was predictive of IFIS., Material and Methods: We conducted a prospective observational single-center study at the University Hospital of Nice. IFIS and FES were investigated in patients undergoing cataract surgery from November 2019 to May 2021. In addition, tarsus and iris samples were harvested in 2 fresh cadavers, and Verhoeff staining was used to identify elastin fibers., Results: We included 452 eyes (n=312 patients, 50.9% male) with a mean age of 71.7years (±11.4). IFIS was diagnosed in 88 (19.5%) patients, including 20 (4.4%) grade 1, 34 (7.5%) grade 2, and 33 (7.3%) grade 3. FES was diagnosed in 35 (7.7%) patients. PEX was found in 23 (5.1%) patients. On multivariate analysis, FES (P<0.001), pseudo exfoliation (P=0.017), intracameral dilatation (P<0.004), senior surgeons (P=0.009) and α1-ARA (P<0.001) were associated with IFIS. Elastin fibers were identified in small amounts in the tarsus samples but not in the iris samples., Conclusion: FES is predictive of IFIS. Surgeons should be aware of this association to prevent intraoperative complications., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: To evaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Study (EVS), which showed that patients who present with light perception (LP) vision have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP)., Design: Retrospective cohort study., Subjects: Intelligent Research in Sight Registry patients undergoing cataract surgery between 2014 and 2022 (identified by Current Procedural Terminology codes), presenting with endophthalmitis (identified by International Classification of Diseases 10 codes) within 42 days postcataract surgery, and having a record of being treated with VIT or TAP on the same or 1 day after endophthalmitis diagnosis were identified., Methods: Potential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression., Main Outcome Measures: Treatment with VIT or TAP., Results: Of the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. Notably, 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP - odds ratio [OR] = 5.4; confidence interval [CI], 2.9-10.6; counting fingers, hand motions - OR = 1.9; CI, 1.1-3.6) versus (20/20-20/40) vision; Asian versus White race (OR = 2.6; CI, 1.3-5.2); Hispanic versus non-Hispanic ethnicity (OR = 1.9; CI, 1.1-3.2); living in the West (OR = 1.6; CI, 1.1-2.2) and Midwest (OR = 1.5; CI, 1.1-2.0) (vs. South), but not with age, sex, and insurance coverage (P > 0.05)., Conclusions: In the IRIS Registry, treatment patterns for postcataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with postcataract surgery endophthalmitis., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate predictors for myopic shift after pediatric cataract surgery after at least 3 years follow-up., Study Design: Cross-sectional and retrospective study., Methods: This study included patients treated for congenital or infantile cataract operated up to 5 years of age between 2010 and 2017. Patients were recruited for ophthalmologic evaluation. Surgical and medical data were acquired in medical charts., Statistical Analysis: Univariate and multivariate regressions were performed to look for potential risk factors for myopic shift., Results: This study evaluated 81 eyes of 50 patients, with 62 (77%) being bilateral cases, 48 (59%) with intraocular lens implantation, and 37 (74%) patients being strabismic. Age at surgery was 7.7 (3.7-30.5) months and at evaluation was 93.5 (55.1-113.0) months. Total myopic shift was -4.32 ± 3.25 D, significantly greater in patients operated on up to 6 months of life (-5.73 ± 3.14 D). The distant best-corrected visual acuity (BCVA) was 0.6 (0.3-1.0) log of minimum angle of resolution (logMAR). Regarding myopic shift, in univariate analysis, older age at surgery is a protective factor (+0.08 D for each month older, P = 0.001). The presence of strabismus (-2.52 D, P = 0.014), aphakia (-2.45 D, P = 0.006), distant BCVA (-0.15 D per 0.1 logMAR, P = 0.024), and surgical complications (-3.02 D, P = 0.001) are risk factors. In multivariate analysis, older age at surgery (+0.06 D, P = 0.012) and surgical complications (-2.52 D, P = 0.001) remain significant., Conclusion: In pediatric cataract surgery, myopic shift is greater when surgery is performed in a younger age and if associated with surgical complications., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To evaluate the incidence, remission, and relapse of post-surgical cystoid macular edema (PCME) following cataract surgery in inflammatory eye disease., Methods: A total of 1859 eyes that had no visually significant macular edema prior to cataract surgery while under tertiary uveitis management were included. Standardized retrospective chart review was used to gather clinical data. Univariable and multivariable logistic regression models with adjustment for inter-eye correlations were performed., Results: PCME causing VA 20/50 or worse was reported in 286 eyes (15%) within 6 months of surgery. Adults age 18-64 years as compared to children (adjusted odds ratio [aOR] = 2.42, for ages 18 to 44 years and aOR = 1.93 for ages 45 to 64 years, overall P = .02); concurrent use of systemic immunosuppression (conventional aOR 1.53 and biologics aOR = 2.68, overall P = .0095); preoperative VA 20/50 or worse (overall P < .0001); cataract surgery performed before 2000 (overall P = .03) and PMCE in fellow eye (aOR = 3.04, P = .0004) were associated with development of PCME within 6 months of cataract surgery. PCME resolution was seen in 81% of eyes at 12 months and 91% of eyes at 24 months. CME relapse was seen in 12% eyes at 12 months and 19% eyes at 24 months., Conclusions: PCME occurs frequently in uveitic eyes undergoing cataract surgery; however, most resolve within a year. CME recurrences likely are due to the underlying disease process and not relapses of PCME., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: To assess the safety of femtosecond laser-assisted cataract surgery (FLACS) based on surgical parameters and intraoperative complications analysis and to determine the length of the learning curve for FLACS., Methods: A prospective consecutive cohort study was conducted on Chinese patients who underwent either FLACS (3289 cases) or contemporaneous conventional phacoemulsification cataract surgery (2130 cases). The laser group was divided into four subgroups in chronological order. We recorded intraoperative complication incidences and compared with surgical parameters between groups. Subgroup analysis was conducted to explore the learning curve of FLACS., Results: The laser group had a 4.93% incidence of incomplete capsulotomies and a 1.22% incidence of anterior capsule tears. Subgroup analysis showed significant differences in 8 aspects between the first 250 cases (50 cases per surgeon) and the last 2539 cases, but only 2 aspects differed between the second 250 cases (50 cases per surgeon) and the last 2539 cases. There were no significant differences between the third 250 cases (50 cases per surgeon) and the last 2539 cases., Conclusions: The intraoperative complications of FLACS were reported, and the learning curve is associated with a significant reduction in the incidence of intraoperative complications. The length of the basic learning curve of FLACS is 100 cases, and the length of the advanced learning curve was 150 cases. This study demonstrated that FLACS is characterised by a relatively straightforward and secure operative technique., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To report the cumulative incidence of complications and to describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation after previous surgery for nontraumatic cataract., Design: Pediatric cataract registry., Participants: Eighty children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at younger than 13 years of age., Methods: Annual data collection from medical record review through 5 years after lensectomy., Main Outcome Measures: Cumulative incidence of newly emergent complications after secondary IOL implantation; refractive error and VA by 5 years after lensectomy., Results: Median follow-up after secondary IOL implantation was 2.7 years (interquartile range [IQR], 0.8-3.3 years; range, 0.6-5.0 years) for bilateral and 2.1 years (range, 0.5-6.4 years) for unilateral cases. A common complication after secondary IOL implantation was a glaucoma-related adverse event (GRAE; glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% confidence interval [CI], 3%-29%) in bilateral cases and 12% (95% CI, 0%-23%) in unilateral cases. The cumulative incidence of surgery for visual axis opacification was 2% (95% CI, 0%-7%) for bilateral cases and 4% (95% CI, 0%-10%) for unilateral cases. The median prediction error within 90 days of implantation was 0.88 diopter (D; IQR, -0.50 to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (IQR, -0.25 to +2.38 D) less among 19 unilateral cases. The median spherical equivalent refractive error at 5 years (at a median of 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (IQR, -2.38 to +2.94 D) for 48 bilateral cases and +0.06 D (IQR, -2.25 to +0.75 D) for 22 unilateral cases. Median monocular VA at 5 years was 20/63 (IQR, 20/50-20/100) for bilateral cases (n = 42) and 20/400 (IQR, 20/160-20/800) for unilateral cases (n = 33)., Conclusions: Eyes with secondary IOL implantation have a risk of developing new GRAEs. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), the average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify risk factors associated with the development of corneal edema (CE) and the need for corneal transplantation following cataract surgery., Design: Retrospective cohort study., Methods Setting: Nation-wide sample of Medicare beneficiaries from 2011-2015., Study Population: Medicare beneficiaries aged over 65 years who received cataract surgery between 2011-2014 with at least 1 year of continuous follow-up. Data was retrieved from the Denominator and Physician Supplier Part B file from the Center for Medicare and Medicaid Services., Main Outcome(s) and Measure(s): The main outcome was the association between demographic characteristics (e.g., age, sex, race/ethnicity) and systemic factors including diabetes status, hypertension, and tobacco use on the incidence of CE and the subsequent need for corneal transplantation following cataract surgery., Results: Among 187,746 beneficiaries, 67,734 had diabetes and 120,012 did not. Beneficiaries with diabetes were more likely to develop CE compared to those without (Odds ratio [OR] 1.19, 95% Confidence Interval [CI] [1.02-1.40]). Compared to those aged 65-74, beneficiaries aged 75-84 and over 85 were more likely to develop CE (OR 1.29 [1.09-1.52]) and OR 1.96 [1.55-2.46], respectively). Asian (OR 2.42 [1.66-3.40]), Hispanic (OR 2.60 [1.73-3.74]), and North American Native (OR 3.59 [1.78-6.39]) race was associated with increased likelihood of developing CE. North American Native beneficiaries had higher risk of requiring corneal transplantation compared to White beneficiaries (OR 9.30 [2.26-25.31]). Female sex decreased likelihood of requiring corneal transplantation post-operatively (OR 0.56 [0.36-0.87]). Amongst those with diabetes, the presence of proliferative diabetic retinopathy increased the likelihood of developing CE (OR 1.94 [1.05-3.39])., Conclusion: Older age, diabetes, and non-White race elevate the risk of CE following cataract surgery, with race incurring the highest risk. Further research is needed to understand the factors underlying the significantly increased risk of CE in racial and ethnic minorities within the United States., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: This study aimed to analyze the incidence and characteristics of intraocular lens (IOL) dislocation after cataract surgery in South Korea., Methods: We retrospectively analyzed the incidence of IOL dislocation after cataract surgery in patients diagnosed between 2002 and 2021. Data of all pseudophakic patients who underwent secondary IOL or IOL exchange surgeries due to IOL dislocation were extracted from the Korean National Health Insurance System database and the Korean Standard Classification of Diseases 7th Revision codes. The incidence per 1,000,000 person-years and corresponding 95% confidence intervals (CIs) were calculated., Results: Between 2002 and 2021, 39,965 of the 4,848,125 pseudophakic patients (0.82%) were diagnosed with IOL dislocation and surgically treated. The incidence of IOL dislocation requiring surgery in pseudophakic patients was 28,900 per 1,000,000 person-years (95% CI, 28,431-29,369), comprising 57,800 cases in male (95% CI, 56,730-58,870) and 10,800 in female patients (95% CI, 10,523-11,077), and the mean male to female ratio was 5.35. The incidence rate peaked in younger age group below 40 years, showing 107,000 per 1,000,000 person-years (95% CI, 102,900-111,100), and the average age of IOL dislocation requiring surgery was 68.1 ± 10.7 years. The average time lapse from cataract surgery to secondary IOL surgery due to IOL dislocation was 4.1 ± 4.7 years (median, 2.2 years), and the number of secondary IOL surgery due to dislocation of artificial lensrapidly occurred 10 years after cataract surgery among all age groups., Conclusions: The incidence of IOL dislocation requiring surgery was higher in younger and male patients. Our findings could be expected to aid establishing future healthcare policies for South Korean populations with an increased risk of IOL dislocation after cataract surgery.

Purpose: To protect the corneal endothelium, various ophthalmical viscoelastic devices (OVDs) are used during cataract surgery. In this study, we compared two sodium hyaluronate-based OVD, the bacteria-derived FIDIAL PLUS OVD (test) with the animal-derived IAL ® -F OVD (reference) during the surgical procedure. Methods: Fifty patients with bilateral cataract participated in the study: 50 eyes randomly received FIDIAL PLUS and 50 eyes received IAL ® -F (ratio 1:1). Noninferior efficacy of FIDIAL PLUS compared with reference OVD (first objective) was evaluated using a paired t -test comparing the mean percent loss of corneal endothelial cells (CECs) with FIDIAL PLUS against the mean percent loss with IAL ® -F. Corneal endothelial protection during cataract surgery with FIDIAL PLUS without significant (≥30 mmHg) postoperative intraocular pressure (IOP) increase (main secondary objective) was assessed using a repeated measures logistic model comparing the incidence of significant postoperative IOP elevation between the two groups. Safety, tolerability, and efficacy were also evaluated by assessing secondary endpoints before and after surgery. Results: FIDIAL PLUS showed a statistically noninferior efficacy compared with IAL ® -F; there was no significant increase in IOP in either group or different trends of the secondary endpoints were observed between the OVD groups. The safety profile was similar in both OVD groups and no adverse device effects were reported. Conclusions: This study demonstrates the equivalent efficacy, tolerability, and safety of the bacteria-derived FIDIAL PLUS compared with the animal-derived IAL ® -F, confirming the clinical value of this product.

Pachychoroid spectrum disease (PSD) involves various chorioretinal pathologies associated with increased choroidal blood flow. Theoretically, PSD could worsen after cataract surgery since the choroidal thickness tends to increase after surgery. Therefore, we evaluated the prevalence of asymptomatic PSD in patients who underwent cataract surgery and compared the clinical characteristics according to the presence of PSD. The subretinal fluid (SRF) development risk was evaluated using the Cox proportional hazard model. Of 924 eyes, 184 (19.9%) showed asymptomatic PSD. Patients with asymptomatic PSD were older, predominantly male, hyperopic, and showed thicker choroid (P < 0.001, 0.001, < 0.001, and < 0.001). Seven (3.8%) of 184 eyes with asymptomatic PSD developed SRF. The Cox proportional hazard model showed that the flat, irregular pigment epithelial detect (FI-PED; HR 37.337, 95% CI 3.880-359.9300, P = 0.002) was the sole indicator for the SRF development after adjustment of age, sex, and axial length. The SRF-developed PSD group experienced a profound and prolonged increase in the choroidal thickness (P = 0.001, 0.002, and 0.002 at 1, 3, and 12 months). Meticulous preoperative evaluation for FI-PED and postoperative monitoring for choroidal thickness would predict SRF development after cataract surgery in eyes with asymptomatic PSD., (© 2024. The Author(s).)

Background: In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation., Methods: This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years' post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated., Results: The mean age was 6.52 ± 4.61 years, with an age range of 1-15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of - 0.29 (P = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of - 1.05 (P = 0.009) and - 1.81 (P = 0.009), respectively., Conclusion: High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Postoperative endophthalmitis is a relatively uncommon, but potentially visually devastating, complication associated with cataract surgery. Specific microbial causes of endophthalmitis are characteristically associated with particular disease time courses. Although Cutibacterium acnes is typically associated with an indolent course of inflammation, we report a case of C. acnes endophthalmitis with onset on postoperative day (POD) 1 and a positive culture from POD 2., Methods: This is a case report., Results: A 56-year-old man underwent cataract extraction and posterior chamber intraocular lens placement in his left eye. On POD 1, he presented with severe discomfort, reduced visual acuity, and significant inflammation. On POD 2, his anterior chamber was tapped and injected with broad-spectrum antibiotics and steroids. The inflammation ultimately resolved, and his visual acuity improved to 20/20., Conclusion: C. acnes is a rare cause of hyperacute-onset postoperative endophthalmitis. Maintaining a high clinical suspicion and initiating prompt treatment can help to optimize long-term visual outcomes.

Purpose: To compare visual outcomes of endophthalmitis following intravitreal injections (IVIs) and cataract extraction by causative organism., Methods: Searches in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase identified articles reporting visual outcomes by causative organisms in post-IVI and cataract extraction endophthalmitis cases from January 2010 to February 2022. A random-effects meta-analysis compared visual improvement among endophthalmitis cases caused by causative organisms., Results: Eighty-five out of 3,317 retrieved studies were included. The highest degree of visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis was seen in cases caused by coagulase-negative staphylococci, followed by gram-negative organisms and other gram-positive organisms such as streptococci and enterococci. Culture-negative cases showed more visual acuity improvement than culture-positive cases in post-IVI endophthalmitis. These results remained consistent when accounting for endophthalmitis treatment, IVI type, condition requiring IVI treatment, follow-up period, and initial preprocedural visual acuity., Conclusion: Coagulase-negative staphylococci and gram-negative organisms show the most visual acuity improvement in both post-IVI and postcataract extraction endophthalmitis. Other gram-positive organisms such as streptococci and enterococci are associated with less visual improvement. This updated systematic review and meta-analysis revealed that the results of the Endophthalmitis Vitrectomy Study are consistent decades later despite advancements in surgical practices and the evolution of microorganisms over time.

Purpose: To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal., Methods: A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt., Results: Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position., Conclusion: The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery., Methods: We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome., Results: We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p  = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p  ≤ 0.00001), IOL centration ( D  = -0.07, 95% CI:-0.09-[-0.05], p  ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p  = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p  = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p  = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p  = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p  = 0.05)., Conclusions: Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values., Competing Interests: Declaration of conflicting interestsR. Gonzalez-Salinas reports personal fees from Inc., LayerBio, Inc., Alcon Laboratories, and Laboratorios Sanfer outside the submitted work.

Importance: Long-term trend analyses of overall endophthalmitis rates and treatment patterns are scarce. It is also unknown if the deviation from the recommendations of the Endophthalmitis Vitrectomy Study toward decreased utilization of vitrectomy is associated with different vision outcomes., Objective: To determine whether the rate of endophthalmitis after intraocular procedures or the primary treatment (prompt vitrectomy vs tap and inject) for endophthalmitis has changed over the past 20 years., Design, Setting, and Participants: This cohort study examined data for cohorts created by querying for different intraocular procedures, including intravitreal injections and surgeries for cataract removal, glaucoma, retinal conditions, and corneal transplants from 2000 to 2022. The data source was a US administrative medical claims database comprising commercial and Medicare Advantage insurance plans. Any intraocular procedure with at least 6 months of data available before and 6 weeks after the procedure was eligible. Exclusion criteria consisted of any previous diagnosis of endophthalmitis or another intraocular procedure during the follow-up period., Main Outcome Measure: The main outcomes were rate of postprocedure endophthalmitis and relative rate of prompt vitrectomy (vs tap and inject) as the primary method of treatment., Results: Among 2 124 964 patients, the mean (SD) age was 71.4 (10.2) years; 1 230 320 were female and 894 414 male. Over 22 years, 5 827 809 intraocular procedures were analyzed with 4305 cases of endophthalmitis found for an overall endophthalmitis rate of 0.07%. The yearly rate of endophthalmitis varied but generally declined from a high of 7 cases per 3502 procedures (0.20%) in 2000 to a low of 163 cases per 332 159 procedures (0.05%) in 2022. The percentage of cases treated with prompt vitrectomy also varied but generally declined over time with a high of 17 of 35 (48.6%) in 2003 and a low of 60 of 515 (11.6%) in 2021. Multivariable analysis of the endophthalmitis incidence rate ratio (IRR) showed a per-year decrease of 2.7% (IRR, 0.97; 95% CI, 0.97-0.98; P < .001) over the study period. A similar analysis also showed that the incidence rate of prompt surgical treatment decreased by 3.8% per year throughout the study period (IRR, 0.96; 95% CI, 0.95-0.97; P < .001)., Conclusions and Relevance: This study found that the incidence of endophthalmitis following intraocular procedures appears to have decreased substantially over the past 20 years while prompt vitrectomy is being used less frequently as primary treatment than in the past.

Purpose: To assess the incidence of secondary glaucoma in children following congenital cataract surgery., Design: Systematic review and meta-analysis., Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception through March 16, 2023. Studies reporting congenital cataract surgery and glaucoma were enrolled. The quality of the selected studies was assessed using the Newcastle Ottawa Scale, and data analysis was executed utilizing R software., Results: A total of 36 published studies with 3151 patients (4717 eyes) were included in the analysis. The incidence rate of glaucoma following congenital cataract surgery was 6.6% (95% CI: 3.9%, 9.9%). The incidence of secondary glaucoma in the primary intraocular lens (IOL) implantation group (3.3% [95% CI: 1.5%, 5.8%]) and the secondary IOL implantation group (3.5% [95% CI: 0%, 11.4%]) were lower compared to the aphakia group (13.5% [95% CI: 7.7%, 20.6%]). The incidence rate among children with congenital cataracts from Asia (6.9% [95% CI: 4.1%, 10.4%]) was higher than that in European children (0.9% [95% CI: 0%, 3.0%]; P < .01). A correlation was identified between the age at cataract surgery and the incidence of secondary glaucoma (P = .02)., Conclusions: This meta-analysis found that the incidence of secondary glaucoma following congenital cataract surgery is approximately 6.6%. Children with IOL implantation exhibit a lower incidence of secondary glaucoma, with a lower incidence noted in European children compared to their Asian counterparts. The age at cataract surgery is an important risk factor to consider., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To examine the long-term risk of glaucoma after cataract surgery in childhood., Methods: This study took place from January 2022 until December 2022 and included patients from a large family with hereditary childhood cataract who had cataract surgery before 18 years of age. Patients underwent an ophthalmologic examination to determine the presence of glaucoma or ocular hypertension (OHT). Patients who did not want to participate in the examination could contribute with a medical journal from their treating ophthalmologist. The risk of long-term glaucoma was determined using survival analysis, and risk factors were assessed using a Cox proportional hazards regression model., Results: We included 68 patients (133 eyes) with a median age at cataract surgery of 7 years (IQR: 5-10). The median follow-up time after cataract surgery to glaucoma/OHT or the latest ophthalmologic examination was 35 years (IQR: 15-48). Twelve patients (18 eyes) had glaucoma, and five patients (eight eyes) had OHT, resulting in 15 patients with glaucoma/OHT. The long-term risk of glaucoma/OHT diagnosed in adulthood was 47.7% (CI: 21.8-70.9) at the age of 70 years of patients who were free of glaucoma before their 18th year. We could not confirm or dismiss an association between glaucoma/OHT and sex, age at surgery, number of ocular interventions before 18 years of age or glaucoma after cataract surgery in a first-degree relative., Conclusion: Cataract surgery in childhood is associated with a high risk of late-onset glaucoma. Regular lifelong follow-up is important to ensure early diagnosis and prevent extensive vision loss., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: This retrospective study investigated the impact of corneal parameters on surgically induced astigmatism (SIA) in eyes with prior myopic correction undergoing cataract surgery., Setting: Department of Ophthalmology, San Marino Hospital, San Marino, Republic of San Marino., Design: This case-control study analyzed existing data retrospectively, without randomization or masking., Methods: Eighty eyes divided in group 1 (40 eyes previous underwent refractive surgery for myopia) and group 2 ( 40 myopic eyes) that underwent cataract surgery with intraocular lens (IOL) implantation were included. SIA was calculated using values from the IOL Master Zeiss 700 and mean pupil power (MPP) derived from the CSO Sirius Topographer (based on 3 mm pupil size) with vectorial analysis from doctor Hill software., Results: No significant difference in SIA was observed between eyes with prior myopic photorefractive keratectomy and the control group (p > 0.05). SIA calculations using the IOL Master and CSO Sirius Tomographer yielded similar results. There was no significant correlation between SIA and axial length, corneal curvature, peripheral corneal thickness, or anterior chamber depth (p > 0.05). However, an inverse correlation was found between SIA and horizontal corneal diameter (p < 0.05)., Conclusions: Corneal parameters, such as axial length, corneal curvature, peripheral corneal thickness, and anterior chamber depth, showed no significant influence on SIA. The inverse correlation between SIA and horizontal corneal diameter in study group suggests potential influence of white-to-white distance on SIA. These findings highlight the importance of considering corneal parameters for optimizing surgical outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Importance: Cataract is one of the leading causes of childhood blindness in Africa. The management of this condition requires timely surgical extraction of the cataractous lens with immediate optical correction and long-term follow-up to monitor visual improvement and manage complications that may arise. This review provides an opportunity to benchmark outcomes and to shed light on the reasons for those outcomes., Objectives: To review the published literature and report on the outcomes of paediatric cataract surgery with intraocular lens insertion in sub-Saharan Africa., Data Source: The EMBASE, PubMed, Scopus, and Web of Science were searched for relevant articles., Study Selection: We included all published primary studies from sub-Saharan Africa on cataract surgery outcomes in children aged 0-16 years with primary intraocular lens implantation conducted between 1990 and 2020. Eligible studies were those published in English or for which an English translation was available. In addition, reviewers screened the reference lists of all studies included in the full-text review for eligible studies. During the review, studies fitting the inclusion criteria above except for having been conducted in middle and high-income countries were tagged and placed in a comparison arm., Data Extraction and Synthesis: Study eligibility was determined by two independent reviewers, and data extraction was conducted by one reviewer with entries checked for accuracy by another reviewer. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data synthesis were followed. The Joanna Briggs Institute (JBI) critical appraisal checklist was used for quality appraisal of the studies. The statistical software R was used in the analysis, and data were pooled using a random-effects model. Forest plots were generated using the R package 'metafor'., Main Outcomes and Measures: The primary outcome was visual acuity (VA) after cataract surgery and the proportions of eyes that achieved good, borderline, or poor visual outcome according to the World Health Organisation (WHO) categorisation of post-operative visual acuity. The secondary outcome measures reported included lag time to surgery, rates of follow-up, and rate of complications., Results: Eight out of 4763 studies were eligible for inclusion in this review, and seven were included in the quantitative analysis. There was a male preponderance in the study population, and the mean age at the time of cataract surgery ranged from 3.4 to 8.4 years. Visual outcomes were available for short-term visual outcomes (1 to 6 months) as the studies had a significant loss to follow-up. The pooled proportion of eyes that achieved a good visual acuity (i.e. equal to or greater than 6/18) in the short-term period was 31% (CI, 20-42). The comparative studies from middle and high-income countries reported proportions ranging from 41 to 91%, with higher thresholds for good visual acuity of 6/12 and 6/15., Conclusion and Relevance: This review reports that there is a lower proportion of eyes with good outcomes after undergoing paediatric cataract surgery in sub-Saharan Africa than in middle- and high-income countries. Furthermore, this review states that there is a high proportion of patients lost to follow-up and suboptimal refractive correction and amblyopia treatment after paediatric cataract surgery., (© 2024. The Author(s).)

Importance: Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics., Objective: To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine., Design, Setting, and Participant: This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included., Exposure: Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears., Main Outcome and Measure: Postoperative endophthalmitis incidence., Results: Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000)., Conclusions and Relevance: No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

Background: Lactobacillus acidophilus is usually considered nonpathogenic and widely distributed in the human gastrointestinal and vaginal tract. In rare cases, lactobacilli may cause eye infections., Case Presentation: We report a 71-year-old man who experienced unexpected ocular pain and decreased visual acuity for one day after cataract surgery. He presented with obvious conjunctival and circumciliary congestion, corneal haze, anterior chamber cells, anterior chamber empyema, posterior corneal deposits, and pupil light reflection disappearance. This patient underwent the standard three-port 23-gauge pars plana vitrectomy and received the intravitreal perfusion of vancomycin at 1 mg/0.1 mL. The culture of the vitreous fluid produced Lactobacillus acidophilus., Conclusion: Acute Lactobacillus acidophilus endophthalmitis can occur after cataract surgery, which should be taken into consideration.

Purpose: We constructed a clinical clue-based algorithm to identify the microbiology-positive post-cataract surgery endophthalmitis., Methods: The Endophthalmitis Infectivity Measurement Algorithm (EIMA) was constructed using presenting Snellen vision (Letter score [LS]) and Inflammation Score (IS, from the cornea, anterior chamber, iris, and vitreous). Retrospective data (70% for training; 30% for testing) was fitted into CHAID (Chi-squared Automatic Interaction Detection). EIMA was validated with prospective data. EIMA-categorized disease severity was weighed against the symptom duration to detect infecting micro-organisms., Results: EIMA was constructed from 1444 retrospective data. The average LS was 6.03 ± 12.11, median IS was 14 (8-24), and culture positivity was 38%. The accuracy and area under the curve of CHAID were 66.36% and 0.642, respectively. EIMA was validated with 175 prospectively collected data. Microbiology positivity (culture + sequencing) was 58.9%. EIMA sensitivity, specificity, and accuracy against microbiology-positive endophthalmitis were 73.7 (95% confidence interval [CI], 64.19-81.96), 81.9 (95% CI, 71.1-90.02), 77.1 (95% CI, 70.20-83.14), respectively. The positive and negative likelihood ratios were 4.08 (95% CI, 2.46-6.67) and 0.32 (95% CI, 0.22-0.45), respectively. There was higher microbial growth in two days or less than in three- to six-day symptom duration (69.9% vs. 28.2%; P = 0.018) endophthalmitis. Gram-negative infection was higher in two days or less (55.6% vs. 20.2%; P = 0.014), and gram-positive infection was higher in three- to six-day endophthalmitis (62.1% vs. 27.7%; P = 0.027)., Conclusions: EIMA identified microbiology-positive endophthalmitis three-quarters of the time., Translational Relevance: EIMA suggested infectivity and the class of microbial infection could help targeted management of endophthalmitis after cataract surgery.

Purpose: To study the effect of prophylactic intracameral moxifloxacin (ICM) on microbiological profile and antimicrobial sensitivity of culture-proven postoperative endophthalmitis (POE)., Methods: This study evaluated culture-proven POE diagnosed within 6 weeks of cataract surgery over two periods, period-1 (January 2010-March 2015) and period-2 (April 2015-December 2019), before and after introduction of prophylactic ICM, respectively., Results: In period-1, 100 cases of culture-positive POE were reported (1 in 4879, 0.02%), while 20 cases (1 in 24635, 0.004%) were reported in period-2 (5-fold reduction, p < .001). The cumulative culture positivity rate decreased from 27.6% to 17.1% (1.6-fold) . Coagulase-negative Staphylococci (CoNS) were significantly reduced ( p  = .005)., Conclusions: ICM reduced the incidence of culture-proven POE, CoNS in particular. In future, POE caused by rarer pathogens may become more prevalent due to reduction in the rate of commoner and more virulent pathogens with use of intracameral antibiotics. The moxifloxacin sensitivity of CONS did not show change with the use of ICM. Studies with larger population of POE will be more helpful to understand the trend better.

Purpose: Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012-2020)., Methods: Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed., Results: Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above ( p -value 0.047), Malay ethnicity ( p -value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE., Conclusions: Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE.

Purpose: The aim of this study was to evaluate outcomes using total corneal astigmatism (TCA) to calculate arcuate keratotomy(ies) (AK) parameters performed with femtosecond laser-assisted cataract surgery to reduce low corneal astigmatism., Methods: Patients who had femtosecond laser-assisted cataract surgery and AK with 0.50 diopter (D) to 1.30 D of TCA were included. Exclusion criteria were intraoperative complications, preexisting corneal surgery, and comorbidities that might adversely affect outcomes. Corneal tomography (Galilei G4, Zeimer Ophthalmic Systems AG) was performed preoperatively and 1 month postoperatively. TCA was input into the Donnenfeld limbal relaxing incisions nomogram to calculate the AK parameters. Preoperative and postoperative tomographic and subjective refractive measurements were compared. The Alpins method for vector analysis evaluated results., Results: Eighty-two eyes of 82 patients were included. Mean preoperative TCA was significantly reduced from 0.80 ± 0.19 D to 0.51 D ± 0.26 D ( P < 0.001). Preoperative posterior corneal astigmatism, -0.28 ± 0.13 D, was unchanged, postoperative posterior corneal astigmatism, -0.28 ± 0.14 D ( P = 0.653). Target-induced astigmatism arithmetic mean (0.82 ± 0.21 D) was greater than that of the surgically induced astigmatism (0.70 ± 0.40 D), resulting in an arithmetic mean difference vector of 0.51 ± 0.27 D with a summated mean at 0.16 D at 20 degrees. The correction index was 0.87, indicating undercorrection. Angle of error arithmetic mean, -1.27 ± 23.27 degrees, indicated good alignment., Conclusions: Inputting TCA for calculation of femtosecond laser AK parameters can reduce low amounts of preoperative corneal astigmatism, thereby improving uncorrected vision., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To compare the efficacy of a 0.15% HA with that of 0.1% HA eye drops for DES after cataract surgery., Methods: This study was double blinded, randomized and prospective study, and conducted in 69 participants (70 eyes) from Pusan National University Yangsan Hospital and executed from February 1, 2022 to November 30, 2022. Participants were adult cataract patients with normal lid position, not suffering from any other ocular disease and not meet the exclusion cirteria of clinical trial. Participants were randomly divided into two groups: 35 participants (17 males and 18 females) in the 0.1% HA group and 34 participants (19 males and 15 females) in the 0.15% HA group, receiving treatment six times daily for 6 weeks following cataract surgery. Subjective and objective assessments were performed at preoperative and postoperative visits, including ocular surface disease index score, tear break up time, corneal staining score, Schirmer's I test score, lipid layer thickness), meiboscore, and biochemical analysis of the eye drops., Results: Throughout the study, the postoperative ocular surface disease index score was significantly lower in the group receiving 0.15% hyaluronic acid than in the group receiving 0.1% hyaluronic acid. Additionally, the postoperative ocular surface disease index score showed a significant positive correlation with the postoperative use of 0.15% hyaluronic acid and the preoperative Schirmer's I test score. In multivariate analysis, treatment with 0.15% hyaluronic acid and the preoperative ocular surface disease index score were significant independent parameters affecting the postoperative ocular surface disease index score., Conclusion: The use of 0.15% hyaluronic acid is recommended for its potential advantages in alleviating symptoms following cataract surgery, making it a viable alternative to traditional 0.1% hyaluronic acid treatment., Trial Registration: ISRCTN95830348., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Nationwide incidence and risk factors for incisional glaucoma surgery post-infantile cataract (IC) surgery in children remain poorly understood. We conducted a population-based cohort study using the Korean national health claims database to identify IC patients diagnosed before age 1 who had IC surgery among all Korean born between 2008 and 2018 (n = 9,593,003). We estimated the annual occurrence of undergoing incisional glaucoma surgery following IC surgery in the general population aged 0-10. The risk factors for incisional surgery including systemic comorbidities and ophthalmic anomalies were analyzed by multivariable logistic regression. Of 650 patients who had undergone IC surgery with a mean (standard deviation [SD]) follow-up period of 6.2 (3.2) years, 92 (14.2%) were diagnosed with glaucoma following infantile cataract surgery (GFICS). Among them, 21 patients (22.8%) underwent incisional glaucoma surgery after a mean (SD) follow-up duration of 5.4 (2.8) years from the diagnosis of GFICS. Median (InterQuartile Range) age at incisional surgery was 4 (2,6) years old. Twenty of 21 patients (95.2%) underwent incisional glaucoma surgery within 3 years of diagnosis of GFICS. No factors, except younger age at glaucoma diagnosis (P = 0.03), were associated with undergoing incisional surgery. These findings can better understand the epidemiologic features and clinical courses of GFICS., (© 2024. The Author(s).)

Introduction: This study focuses on the effect of chronic treatment on the eye, regarding the so-called Intraoperative Floppy Iris Syndrome (IFIS) or Floppy Iris Syndrome, which can occur during cataract surgery., Aim: The study aimed to establish the influence of tamsulosin, used in benign prostatic hyperplasia (BPH) treatment on the iris, during cataract surgery, considering the increased incidence of both conditions in older age., Methods: This study included one hundred male patients, operated on for cataracts at the Ofta Total Clinic and Dr. Stănilă Medical Centre, in Sibiu, out of 601 patients operated on for cataracts between February and October 2022. Of the 100 patients, 24 used medication for BPH. 5 patients used prostamol, a phytotherapeutic preparation, which is an extract from Serenoarepens, and the remaining 19 used tamsulosin, which is an alpha-blocker, most commonly used in the treatment of BPH, considered the first-line treatment option., Results: In 15 patients, we intraoperatively managed, a medium mydriasis through pharmacological dilation, including intracameral administration of phenocaine and mechanical dilation or stripping. In 4 patients it was necessary to apply iris dilators. Due to the small pupil in 2 patients, we caught the iris in the phacoemulsification probe, and a small, incomplete iris coloboma was formed. Sometimes, there was a turnover of Descemet in 4 patients. The pupil remained semi-dilated and slightly areflective in the patients to whom we applied iris hooks. The patients' visual acuity was satisfactory, between 0.9 and 0.6., Discussions: The topic gives rise to many discussions. It seems that stopping the administration of tamsulosin for a short time does not help the occurrence of IFIS, because the iris lesions seem irreversible. Patients at risk of developing cataracts should be evaluated and possibly referred to an ophthalmologist to determine surgery before starting treatment for BPH and to competently assess the administration of this medication., Conclusions: Collaboration between urologists and ophthalmologists is required for patients prone to the appearance of cataracts since both conditions are frequently encountered in elderly patients., Competing Interests: The authors state no conflict of interest., (© 2024 The Authors.)

Purpose: This article aims to highlight if the central macular retina suffers changes after cataract surgery, and to evaluate the eventually discovered changes regarding persistence., Material and Method: This retrospective study, which lasted over three years (2021-2023), included patients who underwent cataract surgery performed by one surgeon. Spectral-domain optical coherence tomography (SD-OCT) imaging assessed macular changes and measured the central macular thickness., Results: A total of 240 eyes with diagnosed senile cataract were included in this study. The mean age was 66 years ± 4 years. Preoperative central foveal thickness was 210 ± 27.3 µm, the postoperative thickness on day 1 was 234.3 ± 40.2 µm, at 6 months 230.5 ± 35.2 µm, and the 1-year follow-up 229.2 ± 30.3 µm., Discussion: Macular changes after cataract surgery are easily confirmed by SD-OCT. The evaluation and monitoring of macular changes can be done by using central macular thickness assessment., Conclusions: The study provides data from a Romanian pool of patients. The values correlated well with those from similar studies of SD-OCT examinations, but differences were still observed, as there were different devices for performing SD-OCTs., Competing Interests: The authors state no conflict of interest., (© 2024 The Authors.)

Introduction: Delayed cataract surgery has long been known to cause lens-induced glaucoma (LIG). This study examined the demographic and clinical profile, ocular characteristics and outcomes of LIG in a tertiary referral centre in Malaysia., Materials and Methods: Data from the National Eye Database (Malaysia) for cataract surgery performed at Hospital Taiping, Perak, between January 2019 and December 2020 were reviewed. The medical records of patients with LIG were retrieved to obtain demographic data, clinical profiles and visual outcomes., Results: Of 3233 patients who underwent cataract surgery at Hospital Taiping, Perak, between 2019 and 2020, 25 underwent emergency surgery for LIG. However, only 24 patients fulfilling the diagnostic criteria for LIG were included in the study: 14 (58.33%) patients with phacomorphic and 10 (41.6%) patients with phacolytic glaucoma. The mean age of the patients was 66±12 years. Women and men were equally affected. Most patients were Malay (75%), followed by Chinese (16.67%) and Indian (8.33%). The anterior chamber depth (ACD) was significantly shallow with a mean value of 2.72 mm. Nineteen (79.1%) patients presented with visual acuity of worse than counting fingers. The mean intraocular pressure (IOP) at presentation was 47.5±13.66mmHg, which improved to 15.08±8.09mmHg postoperatively. A best-corrected visual acuity of 6/15 and better was achieved in 20 patients (83.33%) despite glaucomatous optic neuropathy being present in 41.67% of the cases. The majority (58.3%) of surgeries were performed via extracapsular cataract extraction, while six (25%) of our patients underwent successful phacoemulsification. Seven (29.17%) patients had intraocular complications: five with zonular dialysis and two with posterior capsule rupture. Of these seven cases, four ended up with intracapsular cataract extraction, leaving two of them aphakic., Conclusion: Prompt cataract surgery is paramount in all LIG cases to reduce IOP and achieve better visual outcomes. Despite the promising prognosis associated with early surgical intervention, patients should be counselled about the potential for a guarded visual prognosis from complicated surgery and its long-term complications.

Purpose: To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery., Methods: We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO., Results: The median age at primary surgery was 7 (2-96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1-22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society ( P = 0.04)., Conclusion: Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti- inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: The purpose of this study was to describe the surgical management of bilateral giant full-thickness macular hole with sudden onset two months after cataract surgery in a patient with Alport syndrome., Methods: This was an observational, single-case report., Results: A 54-year-old woman with a history of Alport syndrome presented with severe bilateral visual loss two months after cataract surgery. The diagnosis of bilateral giant full-thickness macular hole was made. We found the absence of the internal limiting membrane and the inability to lift and peel a continuous posterior hyaloid sheet during surgical management with 25-gauge pars plana vitrectomy (left eye). Amniotic membrane grafting followed by gas tamponade were performed for hole closure. The hole remained closed but vision was poorly restored two months after., Conclusion: Cataract surgery in patients with Alport syndrome could promote early development of giant full-thickness macular hole. Collagen defects could underlie internal limiting membrane absence and the inability to properly peel the posterior hyaloid., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

A mature, hypermature, or white cataract needs posterior segment evaluation before surgery for prognostification. Ultrasonography is the preferred method for this. White cataract or intumescent cataract risks intraoperative capsulorhexis running out leading to devastating complications due to high intralenticular pressure. Altghough sligh-lamp examination before surgery can gives clue regarding fluid pockets under anterior capsule in these types of cataract, fluid in posterior compartment of lens can be detected by ultrasonography. The author here described a new sign, the double peak sign which can predict the high intra-lenticular pressure especially in posterior compartment of the lens. So if it detected before surgery, all precautions can be taken during surgery to prevent complications. The A-scan overlay on the B-scan in ultrasonography can detect the hypoechoic area corresponding to the lequified cortex in between solid lens nucleus and posterior capsule, so giving rise to the double peak sign which is described here as an innovation., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

We assessed risk factors for complications associated with resident-performed cataract surgery. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched 4databases in September, 2023. We included peer-reviewed, full-text, English-language articles assessing risk factors for complications in resident performed cataract surgery. We excluded studies describing cataract surgeries performed by fellows, combined surgeries, and studies with insufficient information. Our initial search yielded 6244 articles; 15 articles were included after title/abstract and full-text review. Patient-related risk factors included older age, hypertension, prior vitrectomy, zonular pathology, pseudoexfoliation, poor preoperative visual acuity, small pupils, and selected types of cataracts. Surgeon-related risk factors included resident postgraduate year and surgeon right-handedness. Other risk factors included absence of supervision, long phacoemulsification time, and phacoemulsification with high power and torsion. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation; most studies graded as moderate, primarily due to risk of bias. When assigning cases to residents, graduate medical educators should consider general and resident-specific risk factors to facilitate teaching and preserve patient safety., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Inc.)

Background: Congenital microcoria has been extensively reported and usually leads to visual dysfunction or blindness. However, micropupil development secondary to cataract surgery has never been reported. Here, we describe a rare case of micropupil development in infancy that occurred secondary to combined cataract extraction and intraocular lens implantation for treatment of congenital cataract. When the patient reached adulthood, the affected eye not only gained good vision but also showed better ocular development and refractive status than the fellow eye., Case Presentation: A 17-year-old boy presented to our outpatient clinic with decreased vision in his left eye related to congenital cataract surgery at 6 months of age. The affected eye had exhibited a pinhole pupil since the third month postoperatively. The condition had been managed with observation and regular monocular occlusion treatment. Upon presentation to our clinic, the best-corrected visual acuity (BCVA) in his fellow eye was 0.0 logMAR(20/20) with a refraction of - 5.75 diopters cylinder/-2.25 diopters sphere, and the BCVA in his affected eye was 0.5 logMAR(20/40) with a refraction of 0.00 diopters. Ophthalmic examination of the affected eye revealed a pinhole pupil (approximately 0.5 mm) with high light reflex sensitivity but no response to pupil-dilating drugs. The patient underwent pupilloplasty of the affected eye under corneal surface anesthesia. Postoperative examination revealed better ocular development in the affected eye than in the fellow eye (axial length: 24.21 vs. 27.02 mm, respectively) as well as better refractive status in the affected eye (BCVA of 0.0 logMAR(20/20) with a refraction of - 2.23 diopters cylinder/-3.00 diopters sphere vs. 0logMAR(20/20) with a refraction of -5.75 diopters cylinder/-2.25 diopters sphere)., Conclusions: We have reported a rare case of micropupil development secondary to congenital cataract surgery, which is an uncommon complication, especially in children. However, unlike congenital microcoria, the secondary pinhole pupil may have reduced imaging haze and halos, possibly favoring the development of the affected eye. This case provides further insight into the treatment of congenital cataract., (© 2024. The Author(s).)

To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOP BL ) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOP BL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOP BL was 0.85 and 0.94 (p < 0.0001, respectively), with IOP BL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOP BL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease., (© 2024. The Author(s).)

Poppers maculopathy is a complication of alkyl nitrate (poppers) inhalation. It presents with non-specific symptoms and variable signs, which can make it difficult to diagnose. We present a case of coexisting cataract and poppers maculopathy in a patient. He had vague visual symptoms that were attributed entirely to his cataract and he went on to have cataract surgery. Suboptimal postoperative visual acuity and normal clinical examination triggered further investigation with spectral-domain optical coherence tomography (SD-OCT), after which poppers maculopathy was diagnosed. We highlight the importance of performing OCT in the preoperative assessment of a cataract patient, especially where the cataract is mild and may not fully account for symptoms. The patient showed complete visual recovery on drug cessation despite ongoing maculopathy on OCT scans., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery., Methods: This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019., Results: We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5 months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2 years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively., Conclusion: Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: The aim of this study was to report on the long-term (>5 years) results of surgery for glaucoma after congenital cataract surgery., Design: Retrospective., Methods: A chart review was conducted of all children operated on for glaucoma after congenital cataract surgery in the Pediatric Ophthalmology Service of the Ophthalmology Department of Alexandria main University Hospital in Alexandria, Egypt, between 2005 and 2014 who completed 5 years of follow-up. Demographic, clinical, and operative data were retrieved from the medical records. Success was defined by stability and (or) reversal of optic nerve cupping in relation to presentation and, if this information was not available, by an intraocular pressure (IOP) less than the presenting IOP and less than 16 mm Hg with (true) or without (qualified) IOP-lowering therapy., Results: The records of 48 children were reviewed. Thirty-two eyes of 24 children had completed at least 5 years of follow-up and were included in the study. The mean age (±SD) of the study children was 11.6 ± 11.3 months (range, 3.2-52.0 months) at presentation, and the mean (±SD) follow-up was 105.5 ± 31.4 months (range, 60-156 months). Of 47 glaucoma surgical procedures in total, combined angle and filtering surgery with antimetabolite was the most common procedure performed (n = 30;63.8%). Annual success percentages from the fifth year onward to the thirteenth year were 69.6%, 68.8%, 77.8%, 50.0%, 71.4%, 60.0%, 50.0%, 83.3%, and 50.0%, respectively., Conclusions: Surgery for glaucoma after congenital cataract surgery remains safe and successful for 13 years after surgery., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

We report 2 pediatric cases of iris atrophy that developed roughly 1 month after intracameral injection of dexamethasone suspension 9% following unilateral goniotomy and cataract extraction., (Published by Elsevier Inc.)

Objective: To report the case of a 75-year-old patient who presented crystalline keratopathy secondary to the use of topical ciprofloxacin with histopathological verification, after cataract surgery without complications., Method: Case report with clinical and photographic follow-up, as well as slides with samples of epithelium and crystalline deposits., Results: Corneal deposits resolved after drug suspension, topical lubricant change, and subsequent surgical debridement. The histopathological examination reported epithelial cells and basophilic particles compatible with drug precipitates., Conclusions: Crystalline keratopathy is a condition in which crystals of various kinds are deposited in the corneal epithelium and/or in the anterior stroma. It may have an infectious, pharmacological cause or, in rarer cases, corneal dystrophies. Certain factors such as a previous epithelial defect, systemic pathology with diabetes mellitus, ocular surgery and previous dry eye can favor the deposition of ciprofloxacin leading to the formation of a keratopathy., (Copyright © 2024. Published by Elsevier España, S.L.U.)

A non-diabetic woman in her 80s presented 1 week following uncomplicated left eye cataract surgery complaining of decreased vision, gritty sensation and photophobia in the same eye. Postoperative treatment included G. Acular (Ketorolac Tromethamine 0.5%, NSAID: non-steroidal anti-inflammatory drug) and G. Tobradex (Tobramycin 0.3% and Dexamethasone 0.1%, antibiotic and steroid, respectively) each prescribed four times a day for 2 weeks. On examination, the patient had a corneal epithelial defect which progressed to a full-thickness perforation despite ceasing the NSAID drops. Cyanoacrylate glue application with a plastic drape patch failed to seal the perforation, and a full-thickness tectonic corneal transplant was performed. On investigation, the patient had positive anti-RO and anti-LA antibodies, suggesting a diagnosis of Sjögren's syndrome. We advocate for careful preoperative assessment prior to cataract surgery, patient education, close follow-up and cautious medication use postoperatively including avoiding NSAID drops in patients with risk factors for postoperative dry eye disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The authors describe a case of reverse pupillary block with pigment dispersion following sequential phakic intraocular lens (pIOL) implantation for high myopia, in a young female patient. The intraocular pressure (IOP) elevation began 3 weeks postoperatively, for which Nd-YAG laser peripheral iridotomies (PIs) were attempted elsewhere. Despite maximum medical therapy, the IOP was uncontrolled. She was referred to our institute for further management. Examination showed anteriorly displaced iris-pIOL diaphragm, iris pigment dispersion and raised IOP. The PIs were incomplete. Based on clinical evaluation and investigations, we concluded that the excess area of contact of the posterior iris over the pIOL caused a reverse pupillary block and pigment dispersion. The IOPs were controlled by repeating laser iridotomies and with medical therapy. Subsequently, the patient developed a low lens vault leading to bilateral cataract. Sequential explantation of the pIOL along with cataract extraction was performed and her vision was restored., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)