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Papers in this Session
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Practice Patterns of Canadian Ophthalmological Society Members in Cataract Surgery – Survey 2019
Author
Lindsay Ong-Tone, FRCSC
Methods
In January 2019, the Canadian Ophthalmological Society (COS) office sent an email with a link to the 2019 survey on Red Cap to the 270 COS members with a primary focus on cataract surgery. Two reminders were sent at 2 weeks interval. Approval for the survey was obtained from the Regina Qu’Appelle Health Region Ethics Board. All responses were collected anonymously.
Results
All the respondents used povidone iodine preoperatively and waited before draping. 60.8% of the respondents corrected astigmatism at the time of cataract surgery. The majority (92.9%) used a Toric IOL. Of these, 80.3% corrected 1 Diopter or more of with the rule while 78.5% corrected 1 Diopter or less of against the rule astigmatism. 40% of the respondents used intracameral antibiotics. The most popular one was moxifloxacin (71.4%) followed by cefuroxime (17.9%). 49.3% of the respondents aimed for monovision and 27.3% of them aimed for 1.5 diopter of difference. Presbyopia correcting lenses were used by 56.3% of the respondents. Most would use these lenses up to 10% of the time only.
Conclusion
This survey gives valuable information to the COS membership as to how their peers are practising. Of note, over 66% of the respondents waited at least 1 minute for the povidone iodine to dry before applying the drapes. Presbyopia correcting lenses were used by more than 56% of the respondents while monovision was used by nearly 50%.
Lindsay Ong-Tone, FRCSC
Methods
In January 2019, the Canadian Ophthalmological Society (COS) office sent an email with a link to the 2019 survey on Red Cap to the 270 COS members with a primary focus on cataract surgery. Two reminders were sent at 2 weeks interval. Approval for the survey was obtained from the Regina Qu’Appelle Health Region Ethics Board. All responses were collected anonymously.
Results
All the respondents used povidone iodine preoperatively and waited before draping. 60.8% of the respondents corrected astigmatism at the time of cataract surgery. The majority (92.9%) used a Toric IOL. Of these, 80.3% corrected 1 Diopter or more of with the rule while 78.5% corrected 1 Diopter or less of against the rule astigmatism. 40% of the respondents used intracameral antibiotics. The most popular one was moxifloxacin (71.4%) followed by cefuroxime (17.9%). 49.3% of the respondents aimed for monovision and 27.3% of them aimed for 1.5 diopter of difference. Presbyopia correcting lenses were used by 56.3% of the respondents. Most would use these lenses up to 10% of the time only.
Conclusion
This survey gives valuable information to the COS membership as to how their peers are practising. Of note, over 66% of the respondents waited at least 1 minute for the povidone iodine to dry before applying the drapes. Presbyopia correcting lenses were used by more than 56% of the respondents while monovision was used by nearly 50%.
Retrocapsular Lens Fragments after Uneventful Phacoemulsification Surgery and Vitreous Hyperreflective Dots with Cystoid Macular Edema
Authors
Sally S. Park
Matthew S. Wieder, MD
Aazim A. Siddiqui, MD
Yael Steinberg
Umar Mian, MBBS, ABO
Jee-Young Moon, PhD
David C. Ritterband, MD
Jack M Dodick, MD
Eric D. Donnenfeld, MD
Roy S. Chuck, MD
Richard S. Koplin, MD, FACS
Jimmy K. Lee, MD
Methods
This prospective study noted the extent of RLFs at the conclusion of cataract surgeries performed by a single surgeon (JL). OCTs were taken postoperatively at 1, 4, and 6 weeks to track VHDs (number and size) and assess their association with CME. Intraoperative risk factors for RLFs, VHDs, and CME such as floppy iris, poor dilation, iris expansions device usage, or zonular weakness were also recorded. Exclusion criteria included evidence of diabetic retinopathy on fundus photography 1 week after surgery.
Results
A total of 73 eyes from 73 patients were analyzed. 16 (21.9%) eyes had RLFs observed, with an average count of 7.9+/-6.2. The presence of RLFs were associated with high cumulative dispensed energy (CDE), floppy iris, poor dilation and usage of hooks (p<0.05 for all). VHDs were observed in 40.5%, 52.5% and 45.7% of eyes at 1, 4, and 6-week respectively, with an average of 1.1+/-1.5 VHDs across visits. The number of VHDs were positively associated with the grade (rate ratio=1.32, 95% confidence interval 0.99-1.76, p=0.06) and number (RR=1.08, 95% CI 1.02-1.15, p=0.02) of RLFs. 4 (5.5%) eyes were diagnosed with CME within 6-week followup, but no significant association were found regarding CME.
Conclusion
With greater numbers of RLFs noted at the end of cataract surgery, patients were observed to have more VHDs on their postoperative OCTs. In addition, high CDE, floppy iris, poor dilation and iris expansion device usage have been identified as potential risk factors for RLFs. Further studies are needed to investigate the association of RLFs and CME.
Sally S. Park
Matthew S. Wieder, MD
Aazim A. Siddiqui, MD
Yael Steinberg
Umar Mian, MBBS, ABO
Jee-Young Moon, PhD
David C. Ritterband, MD
Jack M Dodick, MD
Eric D. Donnenfeld, MD
Roy S. Chuck, MD
Richard S. Koplin, MD, FACS
Jimmy K. Lee, MD
Methods
This prospective study noted the extent of RLFs at the conclusion of cataract surgeries performed by a single surgeon (JL). OCTs were taken postoperatively at 1, 4, and 6 weeks to track VHDs (number and size) and assess their association with CME. Intraoperative risk factors for RLFs, VHDs, and CME such as floppy iris, poor dilation, iris expansions device usage, or zonular weakness were also recorded. Exclusion criteria included evidence of diabetic retinopathy on fundus photography 1 week after surgery.
Results
A total of 73 eyes from 73 patients were analyzed. 16 (21.9%) eyes had RLFs observed, with an average count of 7.9+/-6.2. The presence of RLFs were associated with high cumulative dispensed energy (CDE), floppy iris, poor dilation and usage of hooks (p<0.05 for all). VHDs were observed in 40.5%, 52.5% and 45.7% of eyes at 1, 4, and 6-week respectively, with an average of 1.1+/-1.5 VHDs across visits. The number of VHDs were positively associated with the grade (rate ratio=1.32, 95% confidence interval 0.99-1.76, p=0.06) and number (RR=1.08, 95% CI 1.02-1.15, p=0.02) of RLFs. 4 (5.5%) eyes were diagnosed with CME within 6-week followup, but no significant association were found regarding CME.
Conclusion
With greater numbers of RLFs noted at the end of cataract surgery, patients were observed to have more VHDs on their postoperative OCTs. In addition, high CDE, floppy iris, poor dilation and iris expansion device usage have been identified as potential risk factors for RLFs. Further studies are needed to investigate the association of RLFs and CME.
ATP As an Endogenous Intralenticular Hydrotrope: Role in Protein Aggregation Associated with Cataractogenesis
Authors
Jack V. Greiner, MD
Thomas Glonek, PhD
Methods
Phosphorus-31 magnetic resonance (31P MR) permits calculation of ATP concentration and determination of the relationship between the amphiphilic ATP molecule and interstitial water in intact human lenses (n=12). Further analysis of the intact lens incubated in D2O was conducted to observe for changes in the 31P MR spectral line-width signals of the negatively charged triphosphate moiety of ATP. This analysis would verify the interaction of ATP with organization of intracellular interstitial water. Such organization coupled with the adenine moiety of ATP shielding the hydrophobic regions on intralenticular fiber cell protein molecules would prevent PA.
Results
An intralenticular millimolar concentration of ATP (2.5+/-0.1mM) exceeds by an order of magnitude the micromolar amounts required for the metabolic energy currency required in addition to all other ATP functions combined. This result in the intact functioning lens tissue is consistent with studies demonstrating that ATP at millimolar concentrations functions as a hydrotrope in cell and tissue homogenates preventing protein aggregation. This hypothesis is further supported by the observation herein that spectral line-width narrowing observed with 31P NMR in the γ-group phosphate (P <0.01) in contrast to the α-group phosphate, provides evidence indicative of interstitial water ordering.
Conclusion
Data presented herein support the hypothesis that ATP acts as a hydrotrope with its uncharged adenine moiety shielding lens protein hydrophobic segments while the negatively charged hydrophilic triphosphate group organized the rheologically active interstitial water layers preventing PA which is considered an underlying factor in cataractogenesis.
Jack V. Greiner, MD
Thomas Glonek, PhD
Methods
Phosphorus-31 magnetic resonance (31P MR) permits calculation of ATP concentration and determination of the relationship between the amphiphilic ATP molecule and interstitial water in intact human lenses (n=12). Further analysis of the intact lens incubated in D2O was conducted to observe for changes in the 31P MR spectral line-width signals of the negatively charged triphosphate moiety of ATP. This analysis would verify the interaction of ATP with organization of intracellular interstitial water. Such organization coupled with the adenine moiety of ATP shielding the hydrophobic regions on intralenticular fiber cell protein molecules would prevent PA.
Results
An intralenticular millimolar concentration of ATP (2.5+/-0.1mM) exceeds by an order of magnitude the micromolar amounts required for the metabolic energy currency required in addition to all other ATP functions combined. This result in the intact functioning lens tissue is consistent with studies demonstrating that ATP at millimolar concentrations functions as a hydrotrope in cell and tissue homogenates preventing protein aggregation. This hypothesis is further supported by the observation herein that spectral line-width narrowing observed with 31P NMR in the γ-group phosphate (P <0.01) in contrast to the α-group phosphate, provides evidence indicative of interstitial water ordering.
Conclusion
Data presented herein support the hypothesis that ATP acts as a hydrotrope with its uncharged adenine moiety shielding lens protein hydrophobic segments while the negatively charged hydrophilic triphosphate group organized the rheologically active interstitial water layers preventing PA which is considered an underlying factor in cataractogenesis.
Patient Perceptions of Second-Eye Cataract Surgery As Compared with First-Eye Cataract Surgery
Authors
Nandini Venkateswaran, MD
C. Ellis Wisely, MD
Brenton D. Finklea, MD
Terry Kim, MD
Methods
Prospective observational study. A voluntary survey was distributed to patients who underwent clear corneal cataract surgery (first eye and/or second eye surgery) under monitored topical anesthesia with a single surgeon at a single ambulatory surgical center between April and September 2019. Patients were asked to rate awareness of events in the pre-operative, operative and post-operative areas, level of discomfort during the surgical procedure, and if applicable, compare the overall experience of their second eye surgery to their first surgery.
Results
94 patients completed surveys (25 patients had both first and second eye surgery, 67 eyes had first-eye surgery, 52 eyes had second-eye surgery). Second-eye patients did not report significant differences recalling events preoperatively (p=0.51), intraoperatively (p=0.07), or postoperatively (p=0.13) compared with first-eye patients. First-eye patients were more likely to remember little/none of intraoperative events (27%) vs second-eye patients (13%). Mean intraoperative discomfort level (0-10) was 2.1 in first-eye patients vs 1.6 in second-eye patients (p=0.21). 68.6% of second-eye patients remembered more of their second-eye surgery vs 7.8% who remembered more of their first-eye surgery.
Conclusion
Patients tend to recall more of their intraoperative and postoperative experiences during their second-eye cataract surgery as compared with first-eye surgery despite similar anesthesia, surgical techniques, and pre-operative and post-operative care. More patients will be studied to further evaluate these differences in perceptions.
Nandini Venkateswaran, MD
C. Ellis Wisely, MD
Brenton D. Finklea, MD
Terry Kim, MD
Methods
Prospective observational study. A voluntary survey was distributed to patients who underwent clear corneal cataract surgery (first eye and/or second eye surgery) under monitored topical anesthesia with a single surgeon at a single ambulatory surgical center between April and September 2019. Patients were asked to rate awareness of events in the pre-operative, operative and post-operative areas, level of discomfort during the surgical procedure, and if applicable, compare the overall experience of their second eye surgery to their first surgery.
Results
94 patients completed surveys (25 patients had both first and second eye surgery, 67 eyes had first-eye surgery, 52 eyes had second-eye surgery). Second-eye patients did not report significant differences recalling events preoperatively (p=0.51), intraoperatively (p=0.07), or postoperatively (p=0.13) compared with first-eye patients. First-eye patients were more likely to remember little/none of intraoperative events (27%) vs second-eye patients (13%). Mean intraoperative discomfort level (0-10) was 2.1 in first-eye patients vs 1.6 in second-eye patients (p=0.21). 68.6% of second-eye patients remembered more of their second-eye surgery vs 7.8% who remembered more of their first-eye surgery.
Conclusion
Patients tend to recall more of their intraoperative and postoperative experiences during their second-eye cataract surgery as compared with first-eye surgery despite similar anesthesia, surgical techniques, and pre-operative and post-operative care. More patients will be studied to further evaluate these differences in perceptions.