Frequency doubling technology perimetry after clear and yellow intraocular lens implantation

PURPOSE: To evaluate the effect of intraocular lens (IOL) color on frequency doubling technology (FDT). DESIGN: Randomized clinical trial. METHODS: For 26 eyes of 26 patients, FDT perimetry (24-2-threshold test) was measured three months after cataract surgery. An acrylic IOL was randomly selected from clear (VA60BB, HOYA) and yellow-tinted lenses (YA60BB, HOYA), which only differed by color. As a control, a further 14 cataractous eyes with visual acuity > or =20/30 were examined. We analyzed mean deviation (MD) and pattern standard deviation (PSD) among the three groups. RESULTS: After cataract surgery, MD significantly improved (Fisher protected least significant difference (PLSD): P < .05), but PSD did not change (analysis of variance (ANOVA): P = .94) compared with control values. There was no significant difference between the two IOLs for either MD (Mann-Whitney test; P = .15) or PSD (Mann-Whitney test; P = .84). CONCLUSIONS: When interpreting the results of FDT, the effect of cataract should be considered but that of IOL color does not need consideration.     

Visual field changes after cataract extraction: the AGIS experience

PURPOSE: To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas. DESIGN: Experimental study with no control group. METHODS: One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index ("scotoma depth index") to investigate changes of scotoma depth after surgery. RESULTS: Mean values for MD, PSD, and CPSD were -13.2, 6.4, and 5.9 dB before and -11.9, 6.8, and 6.2 dB after cataract surgery (P < or = .001 for all comparisons). Mean (+/- SD) number of abnormal points on pattern deviation plot was 26.7 +/- 9.4 and 27.5 +/- 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (-19.3 vs -19.2 dB, P = .90). CONCLUSIONS: Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.     

Impact of cataract on the results of frequency-doubling technology perimetry

PURPOSE: To determine the effect of cataract on the results of frequency-doubling technology (FDT) perimetry. DESIGN: Consecutive cohort study. PARTICIPANTS: Forty-four patients with normal ophthalmic examinations, with the exception of cataract, scheduled to undergo phacoemulsification and posterior chamber lens implantation were prospectively identified and completed the study. METHODS: All subjects underwent FDT perimetry using the full-threshold C-20 strategy. Both eyes were tested within 1 month before cataract surgery and up to 3 months after surgery. The unoperated fellow eyes served as controls. MAIN OUTCOME MEASURES: Changes in visual acuity (VA), mean deviation (MD), and pattern standard deviation (PSD) were evaluated. For each subject, the change in MD and PSD in the eye that underwent cataract surgery was adjusted for change in the control eye that is thought to occur due to a learning effect. RESULTS: Among the eyes that underwent cataract surgery, the median preoperative VA was 20/60 (range, 20/30-20/800) and the mean preoperative MD was -4.00+/-3.72 decibels (dB). Postoperatively, the median VA improved to 20/30 (range, 20/20-20/70) and the mean postoperative MD was -0.26+/-3.09 dB (P<0.001). Among the control eyes, MDs were -1.74+/-3.71 dB preoperatively and -0.94+/-3.85 dB postoperatively (P = 0.019). The adjusted improvement in MD among eyes that underwent cataract surgery was 2.94+/-3.44 dB (P<0.001). There was no significant change in PSD. Preoperative VA correlated significantly with preoperative MD (r = 0.39, P = 0.01). The improvement in VA correlated significantly with the adjusted improvement in MD (r = 0.38, P = 0.01). CONCLUSIONS: Cataract has an adverse effect on the MD but not the PSD in FDT perimetry. Among eyes with visually significant cataract, the MD correlates significantly with VA. After cataract surgery, the change in VA correlates significantly with the adjusted change in MD.     

Effect of cataract extraction on SITA perimetry in patients with glaucoma

PURPOSE: To evaluate the effect of cataract extraction on Swedish Interactive Thresholding Algorithm (SITA) perimetry in patients with coexisting cataract and glaucoma. PATIENTS AND METHODS: This is a retrospective noncomparative interventional study. Thirty-seven consecutive patients with open-angle glaucoma who had cataract extraction alone or combined with trabeculectomy were included. All patients had SITA-standard 24-2 visual fields before and after the surgery. The main outcome measures were changes in mean deviation (MD) and pattern standard deviation (PSD). Additionally, changes in best-corrected visual acuity, intraocular pressure, and number of glaucoma medications were also studied. RESULTS: Visual field tests were performed 3.9+/-4.4 months before surgery and 4.1+/-2.8 months after surgery. Mean visual acuity improved after the surgery, from 0.41+/-0.21 to 0.88+/-0.32 (P<0.001). After cataract extraction, SITA-standard mean MD improved from -12.3+/-5.8 to -11.1+/-6.3 (P=0.023), whereas the change in mean PSD was statistically nonsignificant (from 7.2+/-3.0 to 7.3+/-3.6; P=0.84). CONCLUSIONS: In glaucoma patients examined with SITA-standard, MD improved but PSD change was statistically nonsignificant, after the cataract surgery. SITA-standard PSD can be used to monitor glaucoma progression in patients with coexisting glaucoma and cataract.     

The effect of yellow tinted intraocular lenses on the result of frequency doubling perimetry after cataract surgery

Purpose

To investigate the effect of yellow tinted intraocular lenses (IOLs), implanted in the bag after phacoemulsification, on the result of frequency doubling technique (FDT) perimetry.

Methods

For 68 eyes of 52 patients, an IOL was implanted in the bag after phacoemulsification. The patients were categorized into three groups according to the type of implanted IOLs used. IOLs were selected randomly among two types of yellow IOLs (Acrysof SN60WF IOL, Hoya YA60BBR IOL) and a clear IOL was used as a control. A FDT Humphrey matrix was performed 2 months after the surgery. The mean deviation (MD) and pattern standard deviation (PSD) among these three groups was analyzed using Mann-Whitney U-test.

Results

Two months after the procedure, there was no significant difference between each of the three groups: the clear IOL and Hoya YA60BBR IOL (MD, p = 0.21; PSD, p = 0.27), the clear IOL and Alcon SN60WF IOL (MD, p = 0.11; PSD, p = 0.22), and the Hoya YA60BBR IOL and Alcon SN60WF IOL (MD, p = 0.33; PSD, p = 0.56).

Conclusions

When interpreting the result of the FDT after cataract surgery, the color and type of IOLs used should not be considered.     

Effect of cataract extraction on frequency doubling technology perimetry in patients with glaucoma

AIM: To evaluate the effect of cataract surgery on frequency doubling technology (FDT) perimetry in patients with co-existing cataract and glaucoma. METHODS: In this consecutive prospective cohort study 27 patients with open angle glaucoma scheduled for cataract extraction alone or combined with trabeculectomy were enrolled. All patients underwent FDT threshold C-20 visual fields within 3 months before and 3 months after surgery. Changes in mean deviation (MD) and pattern standard deviation (PSD) were evaluated. Additionally, changes in best corrected logMAR visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications were also studied. RESULTS: 22 patients completed the study. VA improved after surgery, from 0.47 (SD 0.19) to 0.12 (0.17) (p<0.001). The visual indexes changed after cataract extraction: MD improved (from -10.9 (SD 4.6) dB to -7.0 (4.6) dB; p<0.001) while PSD worsened (from 7.1 (SD 3.5) dB to 8.5 (3.8) dB; p = 0.001). CONCLUSION: In patients with co-existing cataract and glaucoma, examined with FDT, MD improved and PSD worsened after cataract surgery. Global indexes of FDT should be interpreted with caution in patients with glaucoma and cataracts.     

非球面与球面人工晶状体植入术后视野的比较

目的分析和对比不同人工晶状体（IOL）植入术后的视野特点。方法前瞻性病例对照研究。选取因年龄相关性白内障已行白内障超声乳化摘除联合IOL植入术患者36例。根据IOL的不同分为2组,A组19例（21眼）,植入的是Acry Sof IQ（SN60WF）型非球面IOL;B组17例（21眼）,植入的是Sensar AR40e型球面IOL;另选取12例（21眼）年龄相匹配的正常未手术者作为C组。术后1个月检查3组视力、视野[包括视野平均缺损（MD）、模式标准差（PSD）和不同区域的MD值]。数据采用独立样本t检验和单因素方差分析进行比较。结果A、B组术后裸眼视力均≥4．7。视野检测结果示：中心视野的MD值A组为（-4．37±2．29）dB,B组为（-4．57±2．74）dB,C组为（-1．86±0．56）dB;PSD值A组为（2．5l±1．35）dB,B组为（2．63±0．94）dB,C组为（1．92±0．63）dB。A、B组间MD、PSD值及不同对应区域的MD值比较,差异均无统计学意义,但A、B组MD值及不同对应区域的MD值分别与C组比较,差异均有统计学意义（P〈0．01）。结论IOL植入术后视力均较术前有显著提高,而视网膜光敏感度普遍性下降,非球面IOL AcrySof IQ（SN60WF）植入眼的光敏感度并不比球面IOL Sensar AR40e好。     

Prospective randomized comparative study of frequency doubling perimetry vs standard automated perimetry in patients with glaucoma

AIM: To compare frequency doubling perimetry (FDP) versus standard automated perimetry in glaucoma. To evaluate the reproducibility of both methods. PATIENTS AND METHODS: All the patients were tested (full threshold test) twice with both FDP (N-30) and Humphrey Field Analyzer II model 750 (HFA) (30-2 procedures) in random sequence, within one day. The parameters mean deviation (MD), pattern standard deviation (PSD) and measured thresholds per quadrant and center areas were evaluated for FDP/HFA comparison in 45 glaucoma patients. The same parameters were used for testing the reproducibility of FDP (n = 46) and HFA (N = 39). Additionally, the center and each quadrant area were checked for any deviation in the total deviation probability plots. For statistical analysis Kappa coefficients and Bland/Altman plots were used. RESULTS: An average MD (FDP vs HFA) of -7.3 +/- 5.8 dB vs -8.9 +/- 7.6 dB and PSD of 6.9 +/- 2.4 dB vs 6.5 +/- 3.6 dB were found. Kappa coefficients denote marginal accordance (kappa: 0.11-0.38) for area deviations. In a total of 225 areas HFA detected 191 deviations and FDP 165. HFA measured more negative deviation compared with FDP in the case of MD < -15 dB. The reproducibility was 0.98 (MD) and 0.92 (PSD) for FDP and 0.98 (MD) and 0.95 (PSD) for HFA (95% confidence interval). CONCLUSIONS: There was great conformity between FDP and HFA in glaucoma patients. HFA detected more deviations in the total deviation probability plots than FDP. There was a high reproducibility of both methods. FDP is an appropriate tool for detecting visual field loss in glaucoma patients.     

Frequency-doubling perimetry: comparison with standard automated perimetry to detect glaucoma

PURPOSE: To compare second generation frequency-doubling perimetry (FDP) with standard automated perimetry (SAP) to detect glaucomatous visual field abnormalities. DESIGN: Prospective, cross-sectional, controlled observational study. METHODS: Fifty eyes of 50 patients with glaucoma with confirmed SAP visual field abnormalities and 42 eyes from 42 normal control subjects were studied. Swedish Interactive Thresholding Algorithm (SITA) standard 24-2 SAP and FDP visual fields were performed. The correlation of global indices and the number of defects on total deviation (TD) and pattern deviation (PD) plots were compared. The spatial concordance of FDP and SAP defect locations was determined. RESULTS: In patients with glaucoma, significant correlations of mean deviation (MD) and pattern standard deviation (PSD) were found between SAP and FDP (P < .001 for MD and P < .001 for PSD), but not in the normal group. FDP had significantly greater defect scores than SAP on total deviation and PD plots in the glaucoma group (P = .028 and P = .01, respectively). In comparison with SAP, sensitivity and specificity of FDP were 92% and 98% with glaucoma hemifield test criteria and 98% and 93% with PSD <5% criteria, respectively. Similarly high diagnostic precision was found with MD and PSD (at 95% specificity; MD and PSD sensitivity was 82% and 90%, respectively). The location of defects within 12 hemifield clusters found with FDP agreed moderately well with those detected with SAP (kappa = .48). CONCLUSIONS: FDP and SAP perform similarly in their ability to detect visual field defects in early to moderate glaucoma. Larger and deeper defects detected with FDP suggests the possibility of earlier detection at high specificity.     

Effect of myopia on frequency-doubling perimetry

PURPOSE: To examine the effect of myopia, occasionally associated with glaucomatous eyes, on the results obtained by frequency-doubling perimetry (FDP). METHODS: Sixty emmetropic or myopic normal volunteers (mean age, 26.2 +/- 0.35 years, mean +/- SEM; range, 19-34) with good visual acuity and without glaucoma were divided into three groups. The groups were emmetropia to low-myopia (mean refractive error, -1.16 +/- 0.23 D), intermediate-myopia (-4.95 +/- 0.17 D), and high-myopia (-8.12 +/- 0.36 D; n = 20 each). All subjects were tested on the FDP full-threshold C-20 program and the Humphrey Field Analyzer (HFA; Humphrey, Dublin, CA) full-threshold program on one randomly selected eye. FDP and the HFA test were conducted with the subjects wearing their full distance correction and with their distance correction with appropriate additional correction for near, respectively. The calculated mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), and test durations for FDP and the HFA test for the three groups were compared using one-way analysis of variance. The relationship between the refractive error and MS, MD, or PSD was also analyzed by simple regression analysis. RESULTS: The MS and MD for the fields determined by the HFA decreased significantly as the refractive errors increased, but there were no significant differences in the MS, MD, and PSD for FDP between the three groups. There were no significant differences in the test durations between the three groups for both FDP and HFA testing. The refractive error was correlated with both MS and MD only for the fields determined by the HFA. CONCLUSIONS: The results showed that lens-corrected myopia does not alter the visual fields obtained by FDP, and FDP can therefore be used regardless of the presence of myopia.     

应用AccuMap多焦视觉诱发电位客观视野检测法观察晶状体混浊对青光眼视野检测结果的影响

目的探讨AccuMap多焦视觉诱发电位客观视野检测法观察晶状体混浊对青光眼视野检测结果的影响及与Humphrey自动视野检测结果之间的相关性。方法观察和比较原发性青光眼伴有中等程度晶状体混浊患者白内障术前后AccuMap与Humphrey视野计检测结果。术前由同一位有经验的眼科医师观察并记录(采用LOCSⅢ标准)患者晶状体的混浊程度。结果符合入选标准并完成观察者共22例。(1)AccuMap视野检测平均振幅术前为(308.0±96.6)nV,术后为(382.6±146.7)nV,术前与术后平均振幅差异有统计学意义(P=0.01)。平均视野损害严重程度指数(accumapseverityindex,ASI)术前为90.0±54.8,术后为48.6±42.4,术后比术前ASI显著下降(P<0.001)。潜伏期术前后无明显变化,术前平均为(1207.5±67.7)ms,术后为(1191.2±61.9)ms(P=0.289)。(2)晶状体混浊程度与AccuMap振幅的变化AccuMap振幅的变化与晶状体混浊程度无明显相关性(Spearman秩相关分析,P=0.09)。(3)Humphrey视野计检测结果术前平均偏差(meandeviation,MD)为-12.2±7.8,术后为-9.6±8.8,术后与术前MD差异有统计学意义(P<0.001);而模式标准差(patternstandarddeviation,PSD)术前为6.5±3.2,术后为6.3±4.0,差异无统计学意义(P=0.748)。(4)ASI与MD比较术前、术后ASI分别与MD具有相关性(Pearson相关分析,术前P=0.013,术后P<0.001);且术后与术前ASI的变化与MD的变化也具有相关性(Pearson相关分析,P=0.017)。结论AccuMap视野检测法显示晶状体混浊影响青光眼患者的视野检测结果,其中振幅受影响更明显。与Humphrey视野检测结果比较,AccuMap检测的ASI与MD具有相关性。(中华眼科杂志,2006,42972-976)     

Toric IOL植入术与PCRI联合传统IOL植入术矫正白内障患者角膜散光的Meta分析

目的：:系统评价Toric人工晶状体（Toric IOL）植入术与传统IOL植入联合角膜缘松解术（PCRI）在矫正年龄相关性白内障患者合并≤3 D角膜散光的有效性、安全性以及对视功能的影响。方法：:循证医学研究。采用Cochrane系统评价方法,计算机检索PubMed、EMBASE、Cochrane图书馆、Clinic...     

Variability of the eyeballs axial length in children with pseudophakia

PURPOSE: The aim of the study is to evaluate the dynamics of axial elongation of pseudophakic eyes and changes in refraction pseudophakic eyes in children after monocular or binocular cataract surgery. MATERIAL AND METHODS: the observations of 79 children (158 eyes) aged from 4 to 18 years (mean 9.7 +/- 0.55) after cataract surgery were conducted. The examined group consisted of 105 pseudophakic eyes, the comparative group consisted of 53 eyes without surgery in the same observed group of children. Moreover, the patients were evaluated in the following group: moncular - binocular cataract, primary or secondary IOL implantation, the age in groups were between 4-7 and between 8-18 years. Analysis statistically: STATGRAPHICS and SIMSTAT programs, p (alpha) = 0.05. RESULTS: In the examined group (105 eyes) the mean follow-up time was 4.2 years (+/- 0.3), the average age of patients was 9.7 years (+/- 0.7). Improvement of visual acuity was achieved mean 0.5 in 52.4% post operative eyes observed, myopic shift was -0.7D (+/- 0.52). The anatomic eyeball length increased up to 0.5mm (+/- 0.27). The average age of patients of the control group was 9.7 years (+/- 0.83), follow-up 4.3 years (+/- 0.44), visual acuity 0.8 (+/- 0.03). Mean elongation of the axial length was 0.56 mm(+/- 0.26), mean refraction of the eyeball was +0.38 D (+/- 0.54). The difference of the changes of refraction between examined and control group was statistically significant. The comparison of final refraction in optical pathway (p = 0.32) and the growth of anatomic eyeball length (p = 0.14), proved no significant differences in the group with monocular and binocular IOL. The comparative analysis of final refraction in optical pathway (p1 = 0.36), and the growth of anatomic eyeball length (p2 = 0.26) in the group with primary or secondary IOL and in the younger or older children (p1 = 0.52; p = 0.98) in the both groups, did not significantly differ. CONCLUSIONS: The dynamics of axial elongation of pseudophakic and phakic eyes in children is similar. The myopic shift of pseufophakic eyes is bigger than in phakic eyes. It should be undertaken in calculation of the refractive power of intraocular lenses.     

青光眼白内障联合术后SITA视野变化的临床观察

目的 评价青光眼合并白内障患者,青光眼白内障联合术后SITA(瑞典交互式阈值算法)视野变化情况.方法 回顾性非对照性研究,32例(37只眼)原发性开角型或闭角型青光眼,合并白内障行白内障青光眼联合手术患者手术前后行标准SITA24-2视野检查.评估平均偏差(MD)及模式标准差(PSD)的变化,同时观察手术前后最佳矫正视力、眼压及青光眼用药情况.结果 32例(37只眼)最佳矫正视力从术前0.32±0.16提高至0.58±0.21(P<0.05),抗青光眼用药量从术前2.16±0.73降至术后0(P<0.05),眼压从术前(23.32±10.69)mmHg降至(11.73±3.28)mmHg,(P<0.05).手术前后比较具有统计学意义.视野平均偏差(MD)从术前(-14.12±9.37)增加至术后(-13.61±9.21)(P<0.05).模式标准差(PSD)从术前(6.41±3.92)至术后(6.38±3.89)(P>0.05).结论 青光眼合并白内障患者青光眼白内障联合术后MD变化差异有统计学意义,但PSD变化差异无统计学意义,青光眼患者SITA检测的PSD值未受晶状体混浊的影响.数值相对稳定,可以在青光眼合并白内障患者的随访中作为观察青光眼进展的重要指标.     

A comparison of higher order aberrations in eyes implanted with AcrySof IQ SN60WF and AcrySof SN60AT intraocular lenses

PURPOSE: To evaluate the efficacy of AcrySof SN60WF aspheric intraocular lens (IOL) in decreasing spherical aberration and total higher order aberrations (HOAs) after cataract surgery compared to the spherical SN60AT lens. METHODS: Wavefront analysis was conducted on 28 eyes of 28 patients that underwent un-complicated phacoemulsification with implantation of either SN60WF (15 eyes) or SN60AT lenses (13 eyes). Eyes with a history of uveitis, retinal diseases, and previous surgery were excluded. RESULTS: SN60WF eyes had less mean absolute spherical aberration than SN60AT eyes both at 4 mm (0.04+/-0.03 vs 0.11+/-0.03 RMS, p<0.0001) and 6 mm pupils (0.09+/-0.04 vs 0.43+/-0.12 RMS, p<0.0001). Mean total HOAs was lower in the SN60WF group at 6 mm pupils (0.44+/-0.14 vs 0.56+/-0.13 RMS, p=0.0274), while no difference was seen at 4 mm pupils (0.20+/-0.10 vs 0.25+/-0.08 RMS, p=0.160). There were no clinically significant differences between the SN60WF and SN60AT IOLs both at 4 and 6 mm pupils in terms of coma (0.16+/-0.07 vs 0.18+/-0.09 RMS, p=0.514 and 0.25+/-0.12 vs 0.23+/-0.12 RMS, p=0.664) and trefoil (0.14+/-0.09 vs 0.10+/-0.05 RMS, p=0.167 and 0.28+/-0.12 vs 0.23+/-0.07 RMS, p=0.199). There were no differences be-tween groups in mean age, axial length, postoperative spherical equivalent, IOL power, or corneal curvature. CONCLUSIONS: An aspheric posterior optic IOL design with thinner center effectively reduces the positive ocular spherical aberration observed in the pseudophakic and elderly eyes, especially at larger pupillary diameters (6 mm), with no notable increase in coma. However, reduction in total ocular HOAs was only significant at 6 mm pupils.     

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM: To evaluate the postoperative intraocular lens (IOL) rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL. METHODS: In this retrospective case series, 32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter (D). A plate haptic toric IOL (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted in all eyes. The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity (BCVA). RESULTS: Preoperative refractive astigmatism was 2.14±1.17 D, which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period (0.67±0.44 D at three months and 0.75±0.25 D at six months; for all groups: P<0.0001 compared to baseline). BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery (P=0.02). Mean IOL axis deviation from the target axis was 3.4°±2.9° after six to eight weeks and significantly decreased over time (2.4°±2.6° six months after surgery; P=0.04). In one patient IOL, re-alignment was performed. CONCLUSION: Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery. The plate haptic toric IOL position and axis remain stable during the observation period of six months.     

Effects of dexamethasone,diclofenac, or placebo on the inflammatory response after cataract surgery

AIM: To compare the inflammatory response after phacoemulsification and intraocular lens (IOL) implantation using postoperative treatment with dexamethasone, diclofenac, or placebo. METHODS: A prospective, randomised, controlled double masked study including 180 patients enrolled for cataract surgery. The patients were 64-85 years old and had no eye disease other than cataract. After phacoemulsification and IOL implantation the patients were randomised to topical treatment with dexamethasone phosphate 0.1% (group I), diclofenac sodium 0.1% (group II), or placebo (saline 0.9%) (group III). The drops were administered four times daily during the first week and twice daily during the second, third, and fourth weeks. The inflammatory reaction in the anterior chamber was measured with laser flare photometry preoperatively and 1, 3, and 8 days, 2 and 4 weeks, 2 and 6 months, and 1, 2, and 4 years postoperatively. Inflammatory symptoms were registered. Biomicroscopy and visual acuity determinations were performed. The rate of Nd:YAG laser posterior capsulotomies after 2 and 4 years was determined. RESULTS: After 3 and 8 days (p <0.0001), 2 weeks (p <0.0001), and 1 month (p = 0.0013) median flare was highest in group III. There were no significant differences between group I and II. Inflammatory symptoms and striate keratopathy were more common in group III. CONCLUSION: Dexamethasone and diclofenac were equally effective in reducing postoperative inflammation after phacoemulsification and IOL implantation in eyes with no other disease than cataract. Both substances were more effective than placebo.     

Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma

OBJECTIVE: To examine the changes in anterior chamber angle width and depth induced by intraocular lens (IOL) implantation in eyes with angle-closure glaucoma (ACG), in eyes with open-angle glaucoma (OAG), and in eyes with no evidence of glaucoma or ocular hypertension. DESIGN: A comparative, nonrandomized, interventional study. PARTICIPANTS: Seventy-seven eyes with ACG, 73 eyes with OAG, and 74 control eyes undergoing cataract extraction and IOL implantation. INTERVENTION: All eyes underwent phacoemulsification and soft acrylic IOL implantation. MAIN OUTCOME MEASURES: The angle width and depth of the anterior chamber were measured using a Scheimpflug videophotography system before surgery, and at 1 week and at 1, 3, 6, 9, and 12 months after surgery. RESULTS: Before surgery, the mean anterior chamber angle width and depth in the ACG group was less than that in either the OAG or control groups by approximately 10 degrees in angle width and 1.0 mm in depth (P < 0.0001). After cataract extraction and IOL implantation, the angle width and depth increased significantly in all three groups (P < 0.0001). Although the width and depth in the ACG group were still smaller than that in the other groups, the differences decreased to 2 degrees for angle width and 0.3 mm for depth. In addition, no significant differences were found in these values between the OAG and control groups before or after surgery. Furthermore, no significant changes were observed in the angle width or depth in any of the three groups throughout the postoperative observation period. As expected, the mean preoperative intraocular pressure (IOP) in the ACG and OAG groups was higher than that in the control group. After cataract surgery, however, the mean IOP decreased significantly and was almost the same in all three groups at 1, 6, and 12 months after surgery. CONCLUSIONS: The width and depth of the anterior chamber angle in eyes with ACG increased significantly after cataract extraction and IOL implantation and became similar to that in eyes with OAG and that in normal eyes, which may lead to the decrease in IOP seen in the postoperative period. No significant changes were observed in angle width and depth in any of the three groups after surgery.     

【In Press】 Comparison of visual outcomes with implantation of trifocal versus bifocal intraocular lens after phacoemulsification: a Meta-analysis

AIM: To compare a trifocal intraocular lens (IOL) and a bifocal IOL implantation in improving visual function after cataract surgery. METHODS: Eligible literatures were systematically searched through EMBSE and PubMed databases. The inclusion criteria were prospective comparative clinical trials on cataract surgery comparing trifocal IOL with bifocal IOL implantation that assessed visual acuity, contrast sensitivity and subjective vision quality. The effects were computed as standardized mean differences and pooled using fixed-effect or random-effect models. RESULTS: Four prospective randomized controlled trials (RCTs) and five cohorts provided data and were included by a systematic review, comprising 265 eyes implanted with trifocal IOLs and 264 eyes implanted with bifocal IOLs. Monocular distance visual acuity (VA) showed a statistically significant but small difference that favored trifocal IOLs (MD=-0.06; 95%CI, -0.10 to -0.02; Z=2.90, P=0.004 for UDVA and MD=-0.02; 95%CI, -0.03 to -0.00; Z=2.02, P=0.04 for CDVA), but the data did not suggest that the effect of trifocal IOL implantation would clinically outperform bifocal IOL implantation. There was no significant difference in monocular near VA (MD=-0.01; 95% CI, -0.07 to 0.04; Z=0.42, P=0.68 for UNVA, and MD=-0.01; 95% CI, -0.06 to 0.03; Z=0.55, P=0.58 for DCNVA) or refraction between two groups. Contrast sensitivity and subjective visual quality had no conclusive results. CONCLUSION: All results indicate that trifocal IOL and bifocal IOL had similar levels of monocular distance and near visual acuities. Besides, contrast sensitivity and subjective visual quality have no conclusive results.     

Effects of implementing clinical pathways for the care of patients undergoing ophthalmic surgery for cataract, glaucoma, and vitreoretinal disorder

PURPOSE: To evaluate the actual use of clinical pathways and variances, and compare the length of hospital stay for surgery of cataract, glaucoma, and vitreoretinal disorder. METHODS: We designed eight types of clinical pathways for the treatment of cataract, glaucoma, and retinal-vitreous disease. We performed 102 phacoemulsifications and intraocular lens (IOL) implantations, 19 glaucoma or combined trabeculotomy and phacoemulsification/IOL, and 69 retinal-vitreous surgeries during a 1-year period from February 2002. We compared the length of the hospital stay before and after clinical pathway implementation. RESULTS: We applied the clinical pathways to 102 eyes (100%) of 67 patients undergoing phacoemulsification/IOL, to 17 eyes (89.5%) of those undergoing glaucoma surgery, and to 69 eyes (100%) of those undergoing retinal-vitreous surgery. The vaiances occurred in 20 eyes (29.9%) of 67 phacoemulsification/IOLs, 6 eyes (31.6%) of glaucoma, and 24 eyes (34.2%) of retinal-vitreous surgery. The length of hospital stay was shortened in phacomulsification/IOL after clinical pathway implemenation: 7.8 +/- 3.3 to 6.7 +/- 2.5 (mean +/- standard deviation) days. Glaucoma patients had a significantly shorter stay, from 16.4 +/- 5.0 to 12.6 +/- 3.3 days Mann-Whitney U test ; p = 0.032), and the hospital tay for retinal-vitreous surgery was shortened rom 22.8 +/- 11.1 to 17.9 +/- 6.2 days (p = 0.001). CONCLUSIONS: The application of clinical pathways resulted in substantially reduced hospital stay.