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Purpose: To report findings that could suggest an elliptical shape of the capsular bag. Methods: Five eyes of three patients with axial length greater than 24 mm underwent phacoemulsification cataract surgery with plate-haptic multifocal toric intraocular lens (IOL) implantation oriented in the vertical meridian. Results: In all cases, correct orientation of the IOLs was verified 30 minutes after surgery. After 24 hours, all eyes demonstrated unwanted rotation of the IOLs ranging from 15 to 45 degrees. The IOLs remained stable in the new position in all cases until adhesion of the capsular bag took place. Conclusion: These observations could suggest that the perimeter of the capsular bag has an elliptical shape. Therefore, the IOL tends to become fixated in a meridian of the capsular bag that best fits the diagonal diameter of the IOL.

Background In this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE). Methods Commonly used search databases, specifically MEDLINE, Cochrane Central, EMBASE, and http://www.clinicaltrials.gov were carefully searched for English publications comparing FLACS versus CPE. The selected endpoints which were assessed included incomplete capsulotomy, anterior capsulotomy tag, anterior capsule tear, posterior capsule tear, injury to the descemet’s membrane, zonular dialysis, vitreous loss, macular or corneal edema, and elevated intra-ocular pressure. Statistical analysis was carried out by the latest version of the RevMan software (version 5.3) and represented by risk ratios (RR) with 95% confidence intervals (CI). Results A total number of 7156 participants were included. Three thousand five hundred and fifty four (3554) participants were assigned to the FLACS group. The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.42, 95% CI: 4.53–110.82; P  = 0.0001), (RR: 33.07, 95% CI: 6.53–167.56; P = 0.0001) and (RR: 4.74, 95% CI: 2.59–8.68; P  = 0.00001) respectively. The risks for macular/corneal edema (RR: 2.05, 95% CI: 1.18–3.55; P  = 0.01) and elevated intra-ocular pressure (RR: 3.24, 95% CI: 1.55–6.78; P  = 0.002) were also significantly higher with FLACS. However, the risks for impaired descemet’s membrane (RR: 0.95, 95% CI: 0.61–1.47; P  = 0.80), zonular dialysis (RR: 0.40, 95% CI: 0.06–2.72; P  = 0.35), vitreous loss (RR: 0.09, 95% CI: 0.01–1.63; P  = 0.10) and posterior capsular tear (RR: 1.45, 95% CI: 0.23–9.16; P  = 0.69) were not significantly different. Conclusions The current results showed that FLACS did not improve intra/post-operative complications in comparison to CPE. Further larger studies should confirm this hypothesis.

PurposeIt is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments.MethodsA comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager.ResultsA total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length.ConclusionsThe results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

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.

Dry eye is described as a multifactorial disorder of the tear film that occurs due to excessive tear evaporation or tears insufficiency, and so leads to ocular discomfort sensation and ocular tissue damage with time. To assess the incidence of dry eye disease after uncomplicated phacoemulsification surgery in patients with no pre-existed dry eye. This hospital-based cross-sectional study was conducted to assess the incidence of dry eye at 100 eyes of 100 patients who underwent uncomplicated phacoemulsification surgery, with age more than 45 years old. It is measured by dry eye tests Schirmer 1 and tear break up time. This study showed that 22% of the patients who underwent uncomplicated phacoemulsification surgery suffered from dry eye with significant results at 1st week post-operative that improved over time. There was a statistically significant drop in the results of the Schirmer test 1 and TBUT post phacoemulsification surgery, but with no clinical significance as they still at the normal range. The tear film assessment results at the 1st week post-operative were out of the normal range with TBUT and were borderline with ST1 in 22% of the patients. These results improved over time to return to the normal values within 12 weeks postoperatively.

Purpose: To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training. Materials and Methods: This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests. Results: Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (6 = 0.13, p < 0.0001) and POM1 ([beta] = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2). Conclusion: Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery. Keywords: cataract, cataract risk stratification, resident phacoemulsification surgery

Background: Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests. Purpose: To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests. Methods: The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality. Results: Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly (p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health (p = 0.235) and driving (p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses (p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status (p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses (p > 0.05 for all). Conclusion: Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.

Objective: To assess any association between the type of cataract and the central corneal thickness at pre-operative and postoperative three-day and one-month appointments after phacoemulsification surgery. Study Design: Prospective, comparative study. Place and Duration of Study: Eye Department Combined Military Hospital Multan, from Jun 2020 to Apr 2021. Methodology: A total of 89 patients requiring cataract surgery by phacoemulsification were recruited. Age and gender were recorded for each patient. Patient’s type of cataract based on maturity was recorded before the surgery. Phacoemulsification cataract surgery using ‘divide and conquer’ technique was carried out. Patients’ central corneal thickness was measured at the pre-operative, three-day post-operative and one-month post-operative appointment using traditional non-contact tonopachymeter. Results: There were 49 (55.1%) male and 40 (44.9%) female patients with a mean age of 62.15 ± 12.40 years. No significant association was found between the type of cataract and central corneal thickness at the three-time intervals (p=0.14). Central corneal thickness significantly increased from 0.48 ± 0.04 mm pre-operatively to 0.51 ± 0.04 mm at the three-day post-operative appointment (p<0.001). It then reduced to 0.49 ± 0.04 mm at the one-month appointment (p=0.01). Conclusion: The type of cataract is not associated with the variation in central corneal thickness due to cataract surgery. Central corneal thickness significantly increases from the pre-operative to right after the cataract surgery. However, it returns to preoperative levels after a one-month period.

Background To evaluate macular microvascular changes and associated factors in diabetic patients following uncomplicated phacoemulsification surgery. Methods In this prospective observational study, we enrolled diabetic patients and non-diabetic controls who underwent phacoemulsification surgery. Participants were examined at postoperative day 1 (POD1), 10 (POD10), 30 (POD30), and 90 (POD90), using macular 3x3mm OCT angiography scan (RTVue-XR Avanti; Optovue, Inc., Fremont, CA). Integrated automated algorithms were used to quantify parafoveal vessel density (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP). To minimize measurement bias, subjects with corneal edema or capsular opacity at any postoperative visit were excluded. Results The study included 21 eyes of 21 diabetic patients and 21 eyes of 21 non-diabetic controls. In diabetic patients, no significant change in SCP-VD could be detected ( P  = 0.57); DCP-VD reduced from 50.24 ± 2.33% at POD1 to 48.33 ± 3.07% at POD30 ( P  = 0.019), and restored to 50.74 ± 3.44% at POD90 ( P  = 1.00). The DCP-VD change at POD30 in diabetic patients (− 1.90 ± 2.61%) was significantly different from that in controls (1.31 ± 2.61%) ( P  < 0.001). The amount of DCP-VD reduction was correlated with foveal and parafoveal thickening ( r  = 0.431, P  = 0.051 and r  = 0.514, P  = 0.017, respectively), high cumulative dissipated energy ( P  = 0.032) and increased hemoglobin A1c concentration ( P  = 0.037). Conclusions Phacoemulsification in diabetic patients caused transient reduction in DCP-VD, which was associated with poor glycemic control, surgical trauma, and postoperative macular thickening. Our results added a new dimension to our understanding of the complex biologic effects of cataract surgery in diabetic subjects.

Background To report a case of herpetic uveitis caused by herpes simplex virus after cataract surgery in a patient without prior viral keratitis or uveitis. Case presentation A 70-year-old female was referred to our clinic with a 16-day history of acute blurry vision with painful redness in the right eye. She accepted cataract surgery for the right eye ten days before initial of ocular symptoms. There was significant inflammation in anterior chamber of the right eye. Retina exam showed moderate dense vitreous opacity but not necrotic or focal retinal lesion in the right eye. The aqueous humor collected from the right eye was positive for herpes simplex virus (HSV) DNA by PCR. The diagnosis of herpetic uveitis in the right eye was made due to clinical presentations and aqueous humor examination. Conclusion Herpetic virus reactivation might occasionally occur after intraocular surgery in patients without prior ocular viral diseases, inducing atypical postoperative intraocular inflammation.