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Worldwide, healthcare systems are struggling to tackle a nursing shortage. As per the data released by the American Hospital Association, the healthcare workforce could face a loss of around 5 lakh nurses by the end of the year. Consequently, it could result in those deficiencies, which will be 1.1 million instead of 0.6 million. The current nursing scenario in India as per the Indian Nursing Council (INC), which is a board under the ministry and is responsible for legally confirming and maintaining universal standardized training for nursing, is that the 1.96 nurses out of every 1000 Indians that are there are much behind the World Health Organization's (WHO) recommended figure of 3 nurses per 1000. To mitigate the nurse shortage, a collaborative robotic system was designed that can assist with surgical procedures with a collaborative robot acting as a scrub nurse for cataract surgery (CRASCS) represented in Fig. 1. Accordingly, the model has been built to empower a customized 3d printed 5-Degree of freedom robotic arm by tracking the phase of surgery in real-time and automatically supplying the clinician with the ideal equipment that is needed for the particular phase of surgery. The system is supported with one more model which can identify where the surgical equipment is located within the arm range. The system is also supported with voice commands which help in picking up the right surgical equipment in the middle of any phase of the surgery. In this way, the system could be able to potentially handle the shortage of surgical nurses around the world and benefit humanity., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract., Methods: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule., Results: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes., Conclusions: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery., (© 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.)

The present study investigated the role of early visual experience in the development of postural control (balance) and locomotion (gait). In a cross-sectional design, balance and gait were assessed in 59 participants (ages 7-43 years) with a history of (a) transient congenital blindness, (b) transient late-onset blindness, (c) permanent congenitally blindness, or (d) permanent late-onset blindness, as well as in normally sighted controls. Cataract-reversal participants who experienced a transient phase of blindness and gained sight through cataract removal surgery showed worse balance performance compared with sighted controls even when tested with eyes closed. Individuals with reversed congenital cataracts performed worse than individuals with reversed developmental (late emerging) cataracts. Balance performance in congenitally cataract-reversal participants when tested with eyes closed was not significantly different from that in permanently blind participants. In contrast, their gait parameters did not differ significantly from those of sighted controls. The present findings highlight both the need for visual calibration of proprioceptive and vestibular systems and the crossmodal adaptability of locomotor functions.

Purpose: The purpose of this study was to develop deep learning models for surgical video analysis, capable of identifying minimally invasive glaucoma surgery (MIGS) and locating the trabecular meshwork (TM)., Methods: For classification of surgical steps, we had 313 video files (265 for cataract surgery and 48 for MIGS procedures), and for TM segmentation, we had 1743 frames (1110 for TM and 633 for no TM). We used transfer learning to update a classification model pretrained to recognize standard cataract surgical steps, enabling it to also identify MIGS procedures. For TM localization, we developed three different models: U-Net, Y-Net, and Cascaded. Segmentation accuracy for TM was measured by calculating the average pixel error between the predicted and ground truth TM locations., Results: Using transfer learning, we developed a model which achieved 87% accuracy for MIGS frame classification, with area under the receiver operating characteristic curve (AUROC) of 0.99. This model maintained a 79% accuracy for identifying 14 standard cataract surgery steps. The overall micro-averaged AUROC was 0.98. The U-Net model excelled in TM segmentation with an Intersection over union (IoU) score of 0.9988 and an average pixel error of 1.47., Conclusions: Building on prior work developing computer vision models for cataract surgical video, we developed models that recognize MIGS procedures and precisely localize the TM with superior performance. Our work demonstrates the potential of transfer learning for extending our computer vision models to new surgeries without the need for extensive additional data collection., Translational Relevance: Computer vision models in surgical videos can underpin the development of systems offering automated feedback for trainees, improving surgical training and patient care.

Background: Manual small incision cataract surgery (SICS) is a cost-effective and safe procedure offering comparable outcomes to phacoemulsification. It holds significance for outreach and economically disadvantaged patients in developing countries, while also being important for complex cataracts in developed nations. The SICS technique revolves around a three planar self-sealing sclero corneal tunnel (SCT), a critical element for rapid and suture-less healing. The tunnel's components include the incision, side pocket, internal entry, and depth each affecting astigmatism and successful nucleus delivery.[1-3] Various incision types are explored, with the frown incision yielding minimal astigmatism but posing challenges.[2,4] Inappropriate SCT leads on to high induced astigmatism, post op hypotony, and chances of infection., Purpose: This video introduces "Tunnel stamp" which is a novel device designed to guide the incision length, internal entry line, and side pocket accuracy thus making a perfect SCT particularly for novice surgeons, who often encounter intraoperative and postoperative complications due to inappropriate SCT. The device is produced through 3D printing with thermoplastic polyurethane (TPU), an easily available and economically feasible material. The prototype's practicality is demonstrated through successful wet lab trials on goat eyes and subsequently on human eyes. The device is aligned using a limbus-matching step and a sterilized marker pen., Synopsis: This device has unique advantage to take care of the three aspects of SCT, that is, incision, side pocket, and internal entry. One can have custom-made guarded knife to perform scleral groove in optimum depth, which is another important dimension of SCT. Future developments involve creating the tunnel stamp in transparent flexible silicon to enhance alignment accuracy. Given the diversity of cataract types, multiple sizes of the device are envisioned to accommodate nucleus size variability and different stages of cataract development. To aid novice surgeons, two variations of incision guides (straight and frown) are proposed for immature and harder cataracts reducing induced astigmatism., Highlights: Overall, this innovative tunnel stamp aims to enhance SICS outcomes, enabling more precise and consistent SCT creation while addressing challenges posed by various cataract types and surgeon experience levels., Video Link: https://youtu.be/yzV-UC4jwPg., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To describe the advantages of Ngenuity 3D digital filters for enhancing visualization during cataract and corneal transplant surgery., Methods: All surgeries were performed by the same experienced surgeon (L.M.) using the Ngenuity 3D heads-up visualization system connected to a microscope. Images were simultaneously captured with and without the filter in each of the following phases: endothelial evaluation, capsulorhexis, capsule rupture, vitreous leak, cortex removal, visco removal, corneal suture, descemetorhexis, DMEK graft preparation and insertion., Results: In cataract surgery, green and monochrome filters facilitate capsulorhexis in difficult situations by highlighting the anterior capsule and can improve visualization of a posterior capsular tear. The enhanced contrast of the monochrome filter is also useful for cortex and viscoelastic removal. In corneal surgery, the green filter highlights the rim of the DMEK graft during tissue preparation, the yellow filter enhances the contrast of the stained DMEK graft in the anterior chamber, the monochrome filter simplifies descemetorhexis by improving visualization of the Descemet/endothelial layer and allows a better view in red saturated images while performing sutures., Conclusions: Ngenuity digital filters have the potential to enhance tissue visualization during cataract and corneal surgeries, especially in poor visibility conditions.

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.

Purpose: To evaluate the effectiveness and stability of refractive astigmatism reduction after penetrating femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery., Methods: Non-randomized retrospective data analysis of all patients that underwent femtosecond laser-assisted cataract surgery with femtosecond laser-assisted arcuate keratotomy over a 4-year period with a non-toric monofocal intraocular lens (2017-2021) at a tertiary care academic center. Postoperative visual acuity, manifest refraction, and predicted residual refractive error were also recorded at 1 month, 3-6 months, 12-18 months, and 2 years postoperatively. Preoperative keratometric astigmatism was compared to postoperative refractive astigmatism using vector calculations and the ASCRS double-angle plot tool., Results: This study comprised 266 eyes (179 patients) that met inclusion criteria. The mean preoperative keratometric astigmatism magnitude was 0.99 ± 0.53 D. At 1 month, 3-6 months, 12-18 months, and 2 years postoperatively, the mean refractive cylinder was 0.49 ± 0.45 D, 0.49 ± 0.45 D, 0.55 ± 0.54 D, and 0.52 ± 0.46 D, respectively. Horizontal against-the-rule astigmatism showed a higher tendency toward undercorrection than vertical with-the-rule astigmatism, which had a slightly higher tendency toward overcorrection. With-the-rule astigmatism had smaller difference vectors between target-induced astigmatism and surgically induced astigmatism., Conclusions: Femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery was an effective option for correcting low-to-moderate corneal astigmatism for up to 2 years.

Purpose: The goal of this study is to describe characteristics of cataract surgery patients who previously underwent laser in situ keratomileusis/photorefractive keratectomy (LASIK/PRK) in comparison to non-LASIK/PRK cataract surgery patients including psychiatric comorbidities, as well as describe refractive prediction error after cataract surgery while accounting for axial length (AL) using the Barrett True-K and Barrett Universal II formulas., Methods: This was a retrospective study of patients from the University of Colorado Cataract Outcomes Registry. The primary outcomes were refraction prediction error (RPE), mean absolute RPE, and median absolute RPE. Outcomes were stratified by five axial length groups. Univariate and multivariate models for RPE were stratified by the AL group., Results: Two hundred eighty-one eyes with prior LASIK/PRK and 3101 eyes without are included in the study. Patients with prior LASIK/PRK were significantly younger: 67.0 vs 69.9 years, p < 0.0001. The LASIK/PRK group had significantly better mean pre-operative BCVA in comparison to the non-LASIK group, logMAR 0.204 vs logMAR 0.288, p = 0.003. The LASIK/PRK group had significantly lower rates of cardiovascular disease (18.5% vs 29.3%, p < 0.001), hypertension (49.1% vs 59.3%, p < 0.012), and type 2 diabetes (10.7% vs 26.0%, p < 0.001), and no significant difference in psychiatric disease. The absolute RPE was higher for the LASIK group for all ALs, but only significantly higher for eyes with AL less than 25 mm., Conclusion: Patient eyes with prior LASIK/PRK surgery undergoing cataract surgery were significantly younger, had significantly less comorbidities, and a significantly better pre-operative BCVA. Using the Barrett formulas, absolute prediction error for eyes with longer ALs was not significantly worse for LASIK/PRK eyes than those without and the difference was smaller for eyes with longer AL., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes., Methods: A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT)., Results: Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively., Conclusion: FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Rationale: Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts., Patient Concerns: A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment., Diagnoses: The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract., Interventions: Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy., Outcomes: The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively., Lessons: This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Modern intraocular lens (IOL) designs for cataract treatment can be broadly classified into three focal range categories; monofocal, extended depth-of-focus (EDOF) and multifocal IOLs.Monofocal IOLs allow spectacle independence for one focus, typically distance. In contrast, EDOF IOLs provide a greater range of vision, extending spectacle independence to intermediate distance, while multifocal IOLs enable spectacle independence at all distances with the drawback of positive dysphotopsias and reduced contrast perception.EDOF lenses are an attractive compromise with fewer dysphotopic side effects than multifocals. The purpose of this study is to assess whether implanting an EDOF IOL in the second eye of a patient who received a monofocal IOL in the first eye can improve spectacle independence while maintaining the same optical quality as bilateral monofocal IOL implantation., Methods and Analysis: This study compares combined monofocal and EDOF IOL implantation versus bilateral monofocal IOL implantation in terms of clinical and patient-reported outcomes in a monocentric, randomised, patient-masked and assessor-masked, parallel group trial in 88 bilateral cataract patients. The primary outcome measure is binocular photopic distance corrected intermediate visual acuity. The secondary outcome measures include (un)corrected distance and near visual acuity, reading speed at intermediate distance, quality of visual function assessments, patient-reported spectacle independence, contrast sensitivity, aberrometry, stereopsis and straylight measurement at the 3-month follow-up., Ethics and Dissemination: The protocol was approved by the ethical committee of the University Hospital of Brussels (BUN 23219&#95;EDOF)., Trial Registration Number: NCT06002399., Competing Interests: Competing interests: The authors have no financial interest in any of the interventions or products associated with this trial., (© 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 compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery., Methods: This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment., Results: Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group ( P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group ( P = .04). This association remained significant using survival analysis ( P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group ( P = .042)., Conclusions: In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [ J Refract Surg . 2024;40(8):e520-e526.] .

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Purpose: To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation., Methods: This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm., Results: Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery., Conclusion: Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

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.)

Cataract surgery outcomes in centenarian patients have not previously been explored. This study aimed to examine characteristics and report clinical results of people aged ≥100 years undergoing cataract surgery. This was a retrospective observational study, including patients aged ≥100 years who underwent cataract surgery between 2003 and 2021 at Miyata Eye Hospital in Japan. Medical charts were reviewed for information on cataract severity, surgery type, anesthesia, as well as ocular and medical comorbidities. Using Mann-Whitney test, visual acuity, intraocular pressure, and corneal endothelial cell density were compared before and after surgery. Eight eyes of 5 patients were included in the study (mean age, 101.5 ± 1.2 years). Seven of these eyes (87.5%) belonged to women. All surgeries were performed under topical anesthesia using phacoemulsification and insertion of the intraocular lens fixed in the bag. All patients had multiple preoperative medical comorbidities; however, there were no intraoperative, postoperative ocular, or general complications. The postoperative best-corrected visual acuity was significantly improved compared to that before surgery (1.18 ± 0.74 and 0.29 ± 0.52, respectively, P = .004). Neither intraocular pressure nor corneal endothelial cell density demonstrated a significant difference postoperatively. Cataract surgery can be safely performed under topical anesthesia in centenarians without complications using proper perioperative medical control and preparation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To compare unused phacoemulsification tips and those used different times with different techniques of cataract surgery (divide and conquer and chop), in vivo phacoemulsifications were performed with tips of different numbers of operation. These were compared with the same number of sterilized-only and unused tips with the help of an atomic force microscope. Comparison of roughness values (Sa, Sq), geometric and measurable flange length and surface was also performed (profile length %, area %). The differences between the parameters that can be measured during surgery (average ultrasound percentage, US ave %, Average Phaco Time, APT) were also analyzed. We found significant correlations between age and lens hardness (p = 0.0045), area % and APT (p = 0.03), between area % and US ave% (p = 0.03) and also between the two surgical techniques in terms of area% (p = 0.04) and US ave % (p < 0.01). Roughness increased with the number of uses. An increase in profile length% can be observed up to the twentieth operation. This can result from scratches and microscopic damages and also from abrasion and possible material additions on the surface of the needles. The divide and conquer technique causes less microscopic damage to the surface, and smaller average US energy is required during surgery., (© 2024. The Author(s).)

Background: Cataract, defined as an opacity of the lens in one or both eyes, is the leading cause of blindness worldwide. Cataract may initially be treated with new spectacles, but often surgery is required, which involves removing the cataract and placing a new artificial lens, usually made from hydrophobic acrylic. Recent advancements in intraocular lens (IOL) technology have led to the emergence of a diverse array of implantable lenses that aim to minimise spectacle dependence at all distances (near, intermediate, and distance). To assess the relative merits of these lenses, measurements of visual acuity are needed. Visual acuity is a measurement of the sharpness of vision at a distance of 6 metres (or 20 feet). Normal vision is 6/6 (or 20/20). The Jaegar eye card is used to measure near visual acuity. J1 is the smallest text and J2 is considered equivalent to 6/6 (or 20/20) for near vision., Objectives: To compare visual outcomes after implantation of trifocal intraocular lenses (IOLs) to those of extended depth of focus (EDOF) IOLs. To produce a brief economic commentary summarising recent economic evaluations that compare trifocal IOLs with EDOF IOLs., Search Methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE, Embase, and three trial registries on 15 June 2022. For our economic evaluation, we also searched MEDLINE and Embase using economic search filters to 15 June 2022, and the NHS Economic Evaluation Database (EED) from 1968 up to and including 31 December 2014. We did not use any date or language restrictions in the electronic searches., Selection Criteria: We included studies comparing trifocal and EDOF IOLs in adults undergoing cataract surgery. We did not include studies involving people receiving IOLs for correction of refractive error alone (or refractive lens exchange in the absence of cataract)., Data Collection and Analysis: We used standard Cochrane methods. Two review authors working independently selected studies for inclusion and extracted data from the reports. We assessed the risk of bias in the studies, and we assessed the certainty of the evidence using the GRADE approach., Main Results: We included five studies that compared trifocal and EDOF lenses in people undergoing cataract surgery. Three trifocal lenses (AcrySof IQ PanOptix, ATLISA Tri 839MP, FineVision Micro F) and one EDOF lens (TECNIS Symfony ZXR00) were evaluated. The studies took place in Europe and North America. Follow-up ranged from three to six months. Of the 239 enroled participants, 233 (466 eyes) completed follow-up and were included in the analyses. The mean age of participants was 68.2 years, and 64% of participants were female. In general, the risk of bias in the studies was unclear as methods for random sequence generation and allocation concealment were poorly reported, and we judged one study to be at high risk of performance and detection bias. We assessed the certainty of the evidence for all outcomes as low, downgrading for the risk of bias and for imprecision. In two studies involving a total of 254 people, there was little or no difference between trifocal and EDOF lenses for uncorrected and corrected distance visual acuity worse than 6/6. Sixty per cent of participants in both groups had uncorrected distance visual acuity worse than 6/6 (risk ratio (RR) 1.06, 95% confidence intervals (CI) 0.88 to 1.27). Thirty-one per cent of the trifocal group and 38% of the EDOF group had corrected distance visual acuity worse than 6/6 (RR 1.04, 95% CI 0.78 to 1.39). In one study of 60 people, there were fewer cases of uncorrected near visual acuity worse than J2 in the trifocal group (3%) compared with the EDOF group (30%) (RR 0.08, 95% CI 0.01 to 0.65). In two studies, participants were asked about spectacle independence using subjective questionnaires. There was no evidence of either lens type being superior. One further study of 60 participants reported, "overall, 90% of patients achieved spectacle independence", but did not categorise this by lens type. All studies included postoperative patient-reported visual function, which was measured using different questionnaires. Irrespective of the questionnaire used, both types of lenses scored well, and there was little evidence of any important differences between them. Two studies included patient-reported ocular aberrations (glare and halos). The outcomes were reported in different ways and could not be pooled; individually, these studies were too small to detect meaningful differences in glare and halos between groups. One study reported no surgical complications. Three studies did not mention surgical complications. One study reported YAG capsulotomy for posterior capsular opacification (PCO) in one participant (one eye) in each group. One study reported no PCO. Two studies did not report PCO. One study reported that three participants (one trifocal and two EDOF) underwent laser-assisted subepithelial keratectomy (LASEK) to correct residual myopic refractive error or astigmatism. One study reported a subset of participants who were considering laser enhancement at the end of the study period (nine trifocal and two EDOF). Two studies did not report laser enhancement rates. No economic evaluation studies were identified for inclusion in this review., Authors' Conclusions: Distance visual acuity after cataract surgery may be similar whether the lenses implanted are trifocal IOLs or EDOF (TECNIS Symfony) IOLs. People receiving trifocal IOLs may achieve better near vision and may be less dependent on spectacles for near vision. Both lenses were reported to have adverse subjective visual phenomena, such as glare and halos, with no meaningful difference detected between lenses., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: To investigate the influence of femtosecond laser-assisted cataract surgery (FLACS) on macula by examining changes in retinal layers after FLACS and to compare these changes with those after conventional cataract surgery (CCS)., Methods: This study included 113 unrelated Korean patients with age-related cataract who underwent CCS or FLACS in Severance Hospital between September 2019 and July 2021. Optical coherence tomography was performed before and 1 month after surgery. The total retinal layer (TRL) was separated into the inner retinal layer (IRL) and outer retinal layer (ORL); moreover, the IRL was subdivided into the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer (INL), outer plexiform layer, and outer nuclear layer. We performed between-group comparisons of the postoperative thickness in each retinal layer and the postoperative differences in retinal thickness. The average retinal thickness of the four inner macular ring quadrants was used for comparative analysis., Results: Compared with the CCS group, the FLACS group exhibited a thicker ORL (P = 0.004) and a thinner INL (P = 0.007) after surgery. All retinal layer thickness values showed significant postoperative changes regardless of the type of surgery (P < 0.05). The postoperative increase in TRL and IRL thickness was significantly smaller in the FLACS group than in the CCS group (P = 0.027, P = 0.012)., Conclusions: The 1-month postoperative retinal changes were less pronounced in the FLACS group than in the CCS group., (© 2024. The Author(s).)

Background: Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model., Methods: We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China., Results: In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA  < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020., Conclusions: Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Despite cataract surgery being a safe procedure with a low incidence of perioperative complications rates, poor knowledge, concerns about the effectiveness of treatment and cost-benefit analysis of the procedure significantly hinder cataract surgery uptake rates in Africa. This study describes the effect of a decision aid on knowledge and decision conflict on cataract patients in Africa., Methods and Analysis: 120 patients with cataracts reporting to a tertiary hospital in Ghana were randomly assigned to receive a decision aid containing information on the possible outcomes of cataract surgery or a control booklet containing general knowledge about cataracts without information about cataract surgery. The primary outcome measured was the effect of the decision aid on their knowledge of cataract surgery. A score greater than 6/12 (50%) was deemed adequate knowledge. The secondary outcome was the decision conflict experienced by the participants assessed using the Decision Conflict Scale., Results: Compared to the control group, the participants in the intervention group scored higher marks across all sections of the questionnaire (2.92 vs 2.7, p = 0.042 in section "Background"; 2.62 vs 1.77, p < 0.001 in section "Materials"; 1.87 vs 1.55, p = 0.03 in section "Results"). The average total score was higher in the intervention group than in the control (36.7% difference; p < 0.001). Participants in the intervention group also demonstrated lower decision conflict scores than those in the control group (13.00 vs 37.17; p < 0.001)., Conclusion: The decision aid increased knowledge of cataract surgery and reduced decision conflict among patients in a developing country., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose of Review: Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery., Recent Findings: Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches., Summary: As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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.)

Purpose: To evaluate the efficacy and safety of combined cataract surgery with insertion of an ab interno trabecular microbypass device (iStent Inject, Glaukos Corporation) compared to cataract surgery alone in patients with mild-to-moderate glaucoma., Design: Prospective, randomized, assessor-masked controlled trial at a single centre., Participants: Eyes with visually-significant cataract and mild-to-moderate glaucoma with preoperative intraocular pressure (IOP) of 12 to 30 mmHg on 0 to 3 ocular hypotensive medications., Methods: Participants eyes were randomized (2017-2020) 1:1 to combined cataract surgery with iStent Inject (treatment group, n = 56) or cataract surgery alone (control group, n = 48), and followed up for 2 years., Main Outcome Measures: The co-primary effectiveness endpoints were the number of ocular hypotensive medications and IOP at 24-months post-surgery. The secondary effectiveness endpoints were ocular comfort as measured by the Ocular Surface Disease Index (OSDI) and vision-related quality of life as measured by the Glaucoma Activity Limitation Questionnaire (GAL-9) at 24-months. Safety measures included postoperative visual acuity, any unplanned return to the operating theatre, adverse events, and complications., Results: Participants (67.3% male) were aged 53 to 85 years, and treatment groups were similar in terms of mean medicated IOP (treatment group 17.7 mmHg ± 4.0; control group 17.1 mmHg ± 3.1), and number of ocular hypotensive medications (treatment group 1.69 ± 1.05; control group 1.80 ± 1.22) at baseline. At 24 months, the number of ocular hypotensive medications were 0.7 ± 0.9 in the treatment groups compared to 1.5 ± 1.9 in the control group, with an adjusted difference of 0.6 fewer medications per eye in the treatment group (95% CI 0.2-1.1, P = 0.008). In the treatment group, 57% of eyes were on no glaucoma medications compared to 36% in the control group. There was no significant difference in IOP between the 2 groups beyond the 4-weeks. There were no differences in patient-reported outcomes between the 2 groups. The visual outcomes and safety profiles were similar between the 2 groups., Conclusions: Combined cataract surgery with iStent Inject achieved a clinically- and statistically-significantly greater reduction in ocular hypotensive medication usage at 24-months compared to cataract surgery alone, with no significant difference in IOP., 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 study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery., Methods: Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied., Results: We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection., Conclusion: Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Competing Interests: Financial disclosures/conflicts of interest: None reported.

Background/aim: To assess the refractive outcomes of secondary intraocular lenses (IOL) in patients with traumatic aphakic eyes with corneal penetrating injury and compare different corneal curvature measurement methods., Methods: Patients with unilateral penetrating eye injuries underwent corneal wound repair and cataract extraction, followed by secondary IOL implantation. Corneal curvature measurements were taken on the contralateral healthy eye (Group A), from the affected eye before removing corneal sutures (Group B), or after suture removal (Group C). The refractive outcomes were compared among the three groups., Results: The study included 261 eyes. The Mean Absolute Error (MAE) in Group C (0.99 ± 0.85 D) was significantly smaller than that in Group A (1.87 ± 1.71 D) and Group B (1.37 ± 1.20 D) (both P < 0.001). Moreover, the percentage of eyes with IOL prediction errors within ± 0.50 D in Group C (40%) was higher than that in group A (21.7%) (OR = 2.364, 95%CI: 1.272-4.392, P = 0.006) and group B (28.0%) (OR = 1.714, 95%CI: 0.948-3.099, P = 0.073), and the percentage of eyes with IOL prediction errors within ± 1.0 D in Group C (90.9%) was higher than that in group A (67.9%) (OR = 4.758, 95%CI: 2.131-10.626, P < 0.001) and group B (75.0%) (OR = 3.370, 95%CI: 1.483-7.660, P = 0.003) as well., Conclusions: In traumatic aphakic eyes with corneal sutures, IOL power calculation based on the corneal curvature of the injured eye after removing the corneal sutures yields the best refractive outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Cataract surgery in patients after penetrating keratoplasty (PKP) is often challenging because of changes in corneal structure induced by PKP and primary corneal disease. Femtosecond laser-assisted cataract surgery offers several advantages over conventional phacoemulsification, and has been widely used in complicated cataract surgery., Case Report: We report the use of femtosecond laser-assisted cataract surgery in 3 challenging cases after penetrating keratoplasty. Case 1 involved a patient with hard nuclear grade IV° cataract. After surgery, his corrected distance visual acuity (CDVA) improved from 20/400 to 20/25, and the endothelial cell loss (ECL) % was 12.05 % at 3 months postoperatively. The rotation of the toric IOL in Case 1 was 2°. Case 2 involved a patient with severe nuclear cataract and an endothelial cell density of 837 cells/mm2. After surgery, the CDVA improved from 20/100 to 20/40. The ECL% was 4.06% at 1 week postoperatively. Case 3 was a 91-year-old woman with a short axis length of 21.35 mm and an endothelial cell density number of 1238 cells/mm2. After surgery, the CDVA improved from light perception to 20/133, and the ECL% was 26.09% at 1 week postoperatively; ECL% was 2.67% at 1 month post-operation. The corneal grafts were transparent., Conclusion: Femtosecond laser-assisted cataract surgery seems to be an effective, predictable, and safe approach for challenging patients after PKP, and improves visual recovery and optimal refractive outcomes., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Multifocal intraocular lenses (MIOLs) have demonstrated efficacy and safety in adult cataract surgery, yet they encounter many challenges in pediatric applications. This article elaborates on the difficulties in biometric measurements in children, the unpredictability of postoperative refraction outcomes, the lack of long-term spectacle independence in children with MIOLs, the absence of significant advantages in correcting childhood amblyopia, and the potential increase in the rate of secondary surgeries. Due to the insufficient clinical evidence supporting the use of MIOLs in children at present, it is proposed that MIOLs be cautiously applied to children with congenital cataracts in clinical practice. Further research in this area is encouraged.

Objective: To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts, considering varying nuclear hardness. Methods: This non-randomized controlled trial involved 161 patients (161 eyes) with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022. The cohort comprised 73 males and 88 females, with an average age of (65.9±5.23) years. Based on patient preference, 101 individuals underwent conventional phacoemulsification (group A), while 60 chose femtosecond laser-assisted phacoemulsification (group B). Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1 (grade Ⅰ and Ⅱ), A2/B2 (grade Ⅲ), and A3/B3 (grade Ⅳ) subgroups. The study compared effective phacoemulsification time (EPT), cumulative energy release of phacoemulsification (CDE), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagon cell ratio (HEX) before and after surgery at 1 day, 1 week, 1 month, and 3 months. Results: The intraoperative EPT of patients in groups A and B were (6.52±4.93) and (5.63±4.31)s, respectively, and the CDE were 11.57%±5.21% and 10.68%±6.02%, respectively. The differences between them were not statistically significant (all P >0.05).There were no significant differences in EPT and CDE between groups A1 and B1 (all P >0.05), and there were statistically significant differences between groups A2 and B2, A3 and B3 (all P <0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery (all P >0.05), and there were statistically significant differences in CCT between A2 and B2, A3 and B3 groups at 1 day and 1 week after surgery (all P< 0.05), and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery ( P> 0.05).ECD was reduced in both groups.There was no statistically significant difference in ECD at different time of operation between A1 and B1 groups (all P >0.05), while there was statistically significant difference in ECD at 1 day, 1 week, 1 month and 3 months after operation in A2 and B2, A3 and B3 groups (all P <0.05). Group B was significantly better than group A. There was no significant difference in coefficient of variation and HEX between the two groups at different time after surgery ( P >0.05). Conclusion: Femtosecond laser-assisted phacoemulsification demonstrates benefits in preserving corneal endothelial cells, reducing early postoperative corneal edema, and minimizing corneal injury in type 2 diabetes patients with cataracts of high nuclear hardness.

Purpose: To evaluate the clinical effects between dexamethasone and triamcinolone acetonide (TA) after phacoemulsification and intraocular lens implantation among cataract patients., Methods: Pubmed, Embase, and the Cochrane Library were searched for studies published up to August 2020. The primary outcome was intraocular pressure. The secondary outcomes were the logarithm of the minimum angle of resolution (logMAR), anterior chamber cell, and anterior chamber flare. The pooled effect sizes were expressed as weighted mean differences (WMDs) or standardized mean differences (SMDs) of 95% confidence intervals (95% CIs). Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale criteria were used for the quality assessment of included studies., Results: Seven relevant studies met the inclusion criteria. For the primary outcome, there was no significant difference between TA injection and dexamethasone in comparing intraocular pressure (IOP) (SMD = 0.22, 95% confidence interval [CI] [-0.29, 0.73], P = .408; I² = 86.9%) in the first day after treatment and last day of assessment. For the secondary outcomes, the logMAR (WMD = 0.01, 95% CI [-0.06, 0.08]) and the anterior chamber flare (SMD = 0.08, 95% CI [-0.01, 0.18], P = .087; I² = 0%) showed no differences. However, the amount of anterior chamber cells (SMD = -0.21, 95% CI [-0.42, -0.01], P = .044; I² = 0%) in the TA injection on the first day postoperative was higher than for dexamethasone. After treatment, there was no difference between the 2 groups., Conclusions: This study supports that there were no differences in IOP, logMAR, and anterior chamber flare between TA injection and dexamethasone among cataract patients. TA injection treatment on the first day showed higher amounts of anterior chamber cells than with dexamethasone., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background:  This project is part of a broader effort to develop a new electronic registry for ophthalmology in the KwaZulu-Natal (KZN) province in South Africa. The registry should include a clinical decision support system that reduces the potential for human error and should be applicable for our diversity of hospitals, whether electronic health record (EHR) or paper-based., Methods:  Post-operative prescriptions of consecutive cataract surgery discharges were included for 2019 and 2020. Comparisons were facilitated by the four chosen state hospitals in KZN each having a different system for prescribing medications: Electronic, tick sheet, ink stamp and handwritten health records. Error types were compared to hospital systems to identify easily-correctable errors. Potential error remedies were sought by a four-step process., Results:  There were 1307 individual errors in 1661 prescriptions, categorised into 20 error types. Increasing levels of technology did not decrease error rates but did decrease the variety of error types. High technology scripts had the most errors but when easily correctable errors were removed, EHRs had the lowest error rates and handwritten the highest., Conclusion:  Increasing technology, by itself, does not seem to reduce prescription error. Technology does, however, seem to decrease the variability of potential error types, which make many of the errors simpler to correct.Contribution: Regular audits are an effective tool to greatly reduce prescription errors, and the higher the technology level, the more effective these audit interventions become. This advantage can be transferred to paper-based notes by utilising a hybrid electronic registry to print the formal medical record.

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.)

Background: Anterior vitrectomy is a skill all cataract surgeons should develop and master. Every surgeon will have complications at some point in his/her career. Complication management should be part of the surgical training for all cataract surgeons. Posterior capsular rent does not translate to poor visual outcomes. If managed properly, excellent visual outcomes can be achieved and complications minimized. We aim to simplify the anterior vitrectomy procedure by this video., Purpose: This video will serve as a step-by-step practical guide to the intraoperative management of posterior capsular rent by simplifying the anterior vitrectomy procedure., Synopsis: This video will demonstrate how to tackle the dreaded complication of a posterior capsular rent with vitreous disturbance, and achieve optimal postoperative outcomes., Highlights: We demonstrate how a PCR appears, and once identified, how to proceed. In addition, nuances regarding foot positions and different vitrectomy modes are included. Biaxial vitrectomy is explained. Lens placement post-PCR is demonstrated. Furthermore, a brief about postoperative management is included., Video Link: https://youtu.be/dTo7sMpe8h8., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Competing Interests: Declaration of competing interest Nil.

Background: Informed consent constitutes an important aspect of eye care. However, patients often experience difficulties understanding and retaining information presented to them during consultations. This study investigates the efficacy of pictorial aids in supplementing preoperative counselling of patients undergoing cataract surgery., Methods: Patients attending routine pre-cataract surgery counselling were randomized to receive either a standard verbal consultation (control) or a verbal consultation with a digitalized pictorial aid illustrating key surgical steps (intervention). Patients were assessed after the consultation on their knowledge, satisfaction, anxiety and preparedness using an anonymous questionnaire., Results: Seventy-six patients were recruited and randomized into the control and intervention groups. The intervention group attained better Knowledge Scores (control: 5 [2-6] vs. intervention: 6 [6]), and more patients "strongly agreed" that they were more prepared (control: 78.9% vs. intervention: 97.4%, P=0.028). A higher proportion of patients in the control group either "disagreed" or "neither disagree nor agreed (neutral)" that they were less worried (control: 15.8% vs. intervention: 0.0%, Fisher's Exact Test P=0.025). Although the consultation duration was shorter in the intervention group (21±4mins vs. 27±6mins, P<0.001), the use of digital pictorial aids during consultation resulted in more effective counselling with increased patient knowledge, easier decision-making process and reduced patient anxiety., Conclusion: Pictorial aids add to the repository of tools available to eye-care practitioners and are low-cost, easy to implement, and can effectively augment existing preoperative counselling processes to ensure accurate and effective preoperative counselling of patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objectives: To assess pain perception in patients undergoing manual cataract surgery versus femtosecond laser-assisted cataract surgery (FLACS) and pain perception of patients receiving anaesthesia at 2 different time points during the FLACS procedure. We also aimed to assess the factors affecting pain perception in these different study groups., Design: Prospective cohort comparison of patient-selected surgical approach., Participants: Patients undergoing delayed sequential bilateral cataract surgery at an ambulatory surgical centre in Ontario., Methods: Patients were assigned to 3 groups: a manual cataract surgery cohort (n = 30) and 2 FLACS cohorts, those who received neurolept anaesthesia just prior to draping for phacoemulsification (FLACS standard cohort; n = 38) and those who received neurolept anaesthesia prior to the femtosecond laser part of the procedure (FLACS early cohort; n = 35). Outcome metrics included pain scores on the visual analogue scale on postoperative day 0 and at postoperative week 1. Secondary outcome measures included anxiety scores, surgeon or anaesthesiologist patient cooperation scores, ocular metrics, and perioperative systemic vitals., Results: There were no significant differences in pain perception on postoperative day 0 and at postoperative week 1 among the manual cataract surgery and FLACS standard cohorts (p = 0.94 and p = 0.72, respectively) or FLACS early and FLACS standard cohorts (p = 0.76 and p = 0.67, respectively). Patients had higher pain scores during second-eye procedures than first-eye procedures., Conclusions: Cataract surgery technique or timing of anaesthesia for FLACS procedures does not affect pain perception postoperatively. Second-eye procedures are associated with higher pain scores than first-eye procedures., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

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.)

Abstract: IntroductionWe aimed to identify injury-related risk factors for secondary cataract incidence after eye and brain injury and polytrauma. We also examined the effect of direct and indirect eye injury management on cataract diagnosis and treatment. Prevention or mitigation strategies require knowledge of the causes and types of combat injuries, which will enable more appropriate targeting of resources toward prevention and more efficient management of such injuries., Materials and Methods: Data were gathered from the Military Health System using the Military Health System Management and Analysis Reporting Tool (M2) between 2017 and 2021 from inpatient and outpatient Service Members (SMs) (active duty and National Guard). The date of the first cataract diagnosis was tracked to estimate the annual incidence rate, and it was longitudinally linked to any prior diagnosis of ocular trauma (OT), traumatic brain injury (TBI), or polytrauma to calculate the relative risk. International Classification of Disease codes, 10th Revision, were used to identify those diagnosed with cataracts, TBI, and polytrauma. Defense and Veterans Eye Injury and Vision Registry data were used to examine SMs who sustained ocular injuries from 2003-2020 and who may have had cataract surgery following a cataract diagnosis., Results: The relative risk of traumatic cataract formation from OT, TBI, and polytrauma are 5.71 (95% CI, 5.05-6.42), 2.32 (95% CI, 2.03-2.63), and 8.95 (95% CI, 6.23-12.38), respectively. Traumatic cataracts in SMs more commonly result from open-globe injuries (70%) than closed-globe injuries (30%). By specific sub-injury type, traumatic cataracts occur most frequently from intraocular foreign bodies (22%). More than 400 patients in the cohort suffered from TBI and traumatic cataracts, more than 300 from OT and cataracts, and more than 20 from polytrauma and cataracts. The battlefield is the riskiest environment for trauma exposure, with 62% of OT occurring in combat. There was a statistically significant difference between the mean visual acuity value before cataract surgery (M = 1.17, SD = 0.72) and the mean visual acuity value after cataract surgery (M = 0.44, SD = 0.66, P < .001)., Conclusion: Traumatic cataracts often occur in SMs who sustain ocular injuries. New to the literature is that relationships exist between traumatic cataract formation and nonglobe trauma, specifically TBI and polytrauma. Ocular injury calls for an ophthalmic examination. A low threshold should exist for routine ocular exam consultation in the setting of TBI and polytrauma. Separately, polytrauma patients should undergo a review of systems questions, particularly questions about the ocular and visual pathways. A positive response to screening warrants further investigation of possible ocular pathology, including traumatic cataract formation. Cataract surgery is an effective treatment in improving the vision of SMs who suffer from traumatic cataracts. Constant effort must be made to limit occurrences of occupation-related traumatic cataracts., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: To evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts., Methods: This was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively., Results: The logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT., Conclusions: FLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA., (© 2024. The Author(s).)

Purpose: To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery., Methods: The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1 week and 1 month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared., Results: A statistically significant difference was determined between the two groups at postoperative 1 month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1 month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1 month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1 week (p < 0.01) and preoperative values were reached at 1 month postoperatively., Conclusion: In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Cataract surgery offers significant improvement to quality of life for patients with cataracts. However, there are growing waiting lists and challenges in providing this type of surgery in a timely manner. Feedback from stakeholders had previously indicated infection prevention and control (IPC) as a potential barrier to high-throughput surgery. Antimicrobial Resistance and Healthcare Associated Infection Scotland was asked to support the implementation of high-throughput cataract surgery aimed at addressing these challenges., Aim: To develop an IPC pathway to facilitate high-throughput surgery. This would be based on best practice, and would address any barriers identified by stakeholders., Methods: A short life working group with input from key stakeholders, including clinical teams, was established. A rapid literature review was also undertaken., Results: An agreed patient pathway was developed, with the aim of helping to facilitate high-throughput surgery. Pre-, intra- and postoperative phases were considered. Where literature was unavailable, expert/consensus opinion was utilized. Facilities for high-throughput surgery were also considered, including the Jack and Jill theatre arrangement which lends itself well to this concept., Conclusion: Through collaboration with stakeholders, an IPC pathway was developed to facilitate high-throughput cataract surgery and address any potential IPC barriers to implementation. The process and the output described could be utilized to develop similar pathways for other surgeries that lend themselves well to high throughput, improving quality of life for patients and reducing waiting times. This study highlights the importance of establishing surveillance for postoperative endophthalmitis following implementation., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)