2021 ASCRS Annual Meeting

Authors

Presenting Author
Phillip Qu, MD    Email the author
Authors
Catherine J. Culp, MD, Maceda Gurabardhi, MD, Liliana Werner, MD, PhD

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Paper Abstract

Purpose
Vision-impairing opacification related to postoperative calcification is a well-known complication after the implantation of hydrophilic acrylic intraocular lenses (IOLs). We examined IOLs that had been explanted for reasons other than opacification to look for signs of calcification that were not considered visually significant.

Methods
This is a retrospective case series consisting of 146 IOLs explanted between February 2005 and December 2016 at a single surgical center in Germany. The explanted IOLs were analyzed by gross and light microscopy. Specimens suspected to present calcification were stained with alizarin red stain and the von Kossa method for calcium.

Results
Of the 146 explanted IOLs analyzed, 25 were composed of a hydrophilic acrylic material. Thirteen hydrophilic acrylic IOLs were found to have evidence of opacification under microscopic evaluation. Eleven out of these 13 lenses were explanted for reasons other than postoperative opacification. Staining of the 11 lenses confirmed calcification mostly in the optic periphery and/or haptics in all lenses, and the time from implantation to explantation ranged from 3-15 years with a mean of 7.55 years.

Conclusion
Previous studies showed that explantation of hydrophilic acrylic lenses because of calcification occurs mostly within the second year after implantation. This study shows that calcification may remain visually insignificant for many years after implantation or develop much later postoperatively.

Authors

Presenting Author
Mitchell A. Jackson, MD, ABO    Email the author

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Paper Abstract

Purpose
To characterize early real-world outcomes in patients undergoing cataract surgery treated with dexamethasone intraocular suspension 9%.

Methods
Data were collected retrospectively at multiple US sites from records of patients who received dexamethasone intraocular suspension 9% at the conclusion of cataract surgery, between March 12 and December 15, 2019. Where available, data on anterior chamber cell (ACC), anterior chamber flare (ACF), and intraocular pressure (IOP) at postoperative days 1, 8, 14, and 30 were summarized for the study population as a whole and for a single surgical site.

Results
Overall, 641 eyes of 527 patients were included in the study; of these, 37 eyes of 28 patients received dexamethasone intraocular suspension 9% at Jacksoneye, the author’s practice. In eyes from this site with a record at each postoperative visit, ACC clearing was present on day 8 in 49% and day 30 in 92%, and ACF clearing was present in 95% and 97%, respectively. Target visual acuity was achieved in 97% of eyes. Mean (SD) IOP at postoperative days 1, 8, and 30 was 21.4 (7.92), 15.3 (5.76), and 14.7 (5.51) mmHg. The product was well tolerated in all eyes at this study site, and data were comparable to the study population as a whole.

Conclusion
Real-world data from a single surgical site reflects early experience with dexamethasone intraocular suspension 9% in cataract surgery, with favorable efficacy and tolerability.

Authors

Presenting Author
Eric D. Rosenberg, DO, MSE    Email the author
Authors
Alanna S. Nattis, DO, Richard J. Nattis, MD, ABO

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Paper Abstract

Purpose
This study evaluated the ability of the Vivity extended depth of focus intraocular lens (IOL) to provide a significant impact on patient lifestyle (independence from spectacles with a low rate of visual disturbances) in a ‘real-world’ setting.

Methods
This prospective, nonrandomized study assessed the impact of pre-and-perioperative factors, (IOL formulae used, use of femtosecond laser, intraoperative aberrometry, pupillary expansion devices) on surgical success in patients undergoing bilateral sequential cataract surgery with spherical and/or toric Vivity IOL implantation across a diverse group of surgeons. Improvement in degree of spectacle independence, visual disturbance and visual quality was assessed at 3 months postoperative, as compared to baseline.

Results
Fifteen patients (30 eyes) underwent successful cataract extraction with Vivity IOL implantation. Mean UCVA & BCVA at distance, intermediate & near was 20/25 across all eyes & surgical techniques. At POM3, there was no loss of UCVA or BCVA. There was a significant increased degree of spectacle independence at distance, intermediate & near, with >85% of patients stating they had ‘no need for spectacle correction’ for most activities in dim and bright lighting conditions. Significant improvement in visual quality was found, with increased ease in performing daily activities. Rate of visual disturbance was less than 2%. No surgical complications or adverse events were recorded.

Conclusion
Our data demonstrated significant postoperative visual success of bilateral cataract surgery with Vivity IOL implantation across multiple surgeons, techniques and pre-and-perioperative variables. Our results reinforce that this non-diffractive extended vision IOL is an excellent option for cataract surgery patients, including those post-LASIK.

Authors

Presenting Author
John A. Hovanesian, MD    Email the author
Authors
Quentin B. Allen, MD, Michael Jones, MD

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Paper Abstract

Purpose
To determine the incidence of glare and haloes in dim light and the percentage of patients who require spectacles for intermediate tasks

Methods
We evaluated 60 patients who had undergone bilateral lens implants with the non-diffractive multifocal IOL (Vivity, Alcon) bilaterally and whose spherical equivalent refractive error was within 0.5D of plano and had cylinder ≤ 0.75 D. A validated questionnaire examined the incidence and severity of glare/haloes and evaluated patient-reported spectacle independence for intermediate vision and other tasks, such as driving, reading, and watching television.

Results
Sixty patients had Vivity, 59 had Panoptix, 102 had ActiveFocus 2.5 mini-monovision, & 89 had mixed ReSTOR 2.5 and 3.0 IOLs. Glare and haloes were reported as “Just a little” by 86% with Vivity, 69% with Panoptix, 74% with 2.5 mini-monovision, and 71% with 2.5/3.0 lenses (P<0.02). Spectacle freedom for computer work was reported by 95% with Vivity, 100% with Panoptix, and 100% and 80% with the other lens combinations, respectively.

Conclusion
Bilateral Vivity implantation yields significantly less glare and halo complaints relative to earlier multifocal and comparable spectacle independence for intermediate tasks.

★ This paper won Best Paper of Session (BPOS) at the 2021 ASCRS Annual Meeting

Authors

Presenting Author
Courtney F Goodman    Email the author
Authors
Elaine Han, MD, Elizabeth A Vanner, PhD, Ellen H. Koo, MD

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Paper Abstract

Purpose
To investigate the outcomes of intraocular lens (IOL) exchange and endothelial keratoplasty (EK), comparing staged versus combined surgical approach.

Methods
This is a retrospective cohort study evaluating 75 eyes from patients who underwent IOL exchange and EK over a 5-year period at the Bascom Palmer Eye Institute, comparing eyes that underwent staged IOL exchange and EK, versus eyes that underwent the combined surgical approach. The outcome measures included incidence of primary graft failure (PGF) and graft detachment, as well as corrected distance visual acuity (CDVA). Data was analyzed with Pearson’s chi-squared test, Fisher’s Exact test and Mann-Whitney Wilcoxon 2-sample test.

Results
CVDA for the 1-2 months’ follow-up period was significantly better in the staged group compared to the combined group (p = 0.0466). There was no significant difference in incidence of PGF or graft detachment between the two groups (p > 0.05).

Conclusion
The short-term visual outcomes were better in eyes that underwent staged IOL exchange and EK versus combined surgical approach. There was no difference in PGF or graft detachment between the two groups.

Authors

Presenting Author
Brandon J. Baartman, MD    Email the author
Authors
Russell Swan, MD, Michael D. Greenwood, MD

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Paper Abstract

Purpose
To report safety and visual outcomes for cataract surgeries performed one day apart ("close sequence") in a large patient population from a multi-state private practice.

Methods
This will be a retrospective chart review of consecutive patients having undergone cataract surgeries on back-to-back days at three surgical centers within the same private practice during the month of August, 2020 (August 1, 2020 to August 31, 2020). These dates were chosen to produce an n of approximately 300 patients (600 eyes) based on average surgeon volumes and back-to-back surgery percentages. Data to be collected will include patient demographics and distance traveled to surgery center, and primary outcome measures of best corrected visual acuity and refractive accuracy reported at 1 month postoperatively, and secondary outcomes of safety including complication rate.

Results
Data from 220 eyes were used in analysis of outcomes. Preoperative spherical equivalent ranged from -13.75 D to +7.25 D, and 18% had previous corneal refractive surgery. A total of 12.7% of surgeries were combined with a minimally invasive glaucoma procedure. No intraoperative complications were reported. IOP spike on POD1 was the most common post-operative complication, occurring in 6.4% of first eyes and 2.9% of second eyes (p=0.260). Of first eyes, 75.1% were within 2 lines of final UCVA on POD1 before proceeding with second eye. Mean BCVA improved significantly from logMAR 0.27 to 0.01 (p<0.05) and 0.17 to 0.01 (p<0.05) in first and second eyes, respectively at month 1 follow up.

Conclusion
Modern cataract surgical techniques produce relatively quick visual recovery and allow for shortening the interval between eye operations. Close sequential cataract surgery is a safe and effective means of approaching an overwhelmingly bilateral condition.

Authors

Presenting Author
Michael H. Goldstein, MD, MBA    Email the author
Authors
Deepinder K. Dhaliwal, MD, Srilatha Vantipalli, PhD, Jamie Lynne Metzinger, MSc, MPH, Andrew A. Moshfeghi, MD

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Paper Abstract

Purpose
Endophthalmitis is a vision threatening but rare event following cataract surgery with an incidence of ~0.5 to 3 per 1,000, requiring a large sample size to conduct studies. ~60% of ophthalmologists (~15000) contribute data to the IRIS registry, making it an ideal approach. This study evaluated risk factors for endophthalmitis using IRIS registry.

Methods
This retrospective study analyzed patient data from the IRIS Database Registry between January 1, 2016 to December 1, 2019 capturing the incidence of endophthalmitis following cataract surgery. Inclusion criteria for patients included having cataract removal via phacoemulsification with IOL insertion, at least one visit within 30 days after surgery, and being at least 22 years of age. Practices must have provided data for at least 30 days after each surgery. Results were stratified according to type of cataract surgery (simple or complex), cataract type, diagnosis of diabetes, age, sex, race of patients, and whether patients underwent concurrent ophthalmic procedures.

Results
Approximately 6 million eyes of 4 million patients were eligible for inclusion. Endophthalmitis rates were low (less than 1 per 1,000 surgeries), which is aligned with prior studies. Risk factors such as complex cataract surgeries, undergoing concurrent vitreous procedures, traumatic, nuclear sclerotic and posterior subcapsular cataract types, history of proliferative diabetic retinopathy and diabetic macular edema were associated with statistically significantly higher rates of endophthalmitis incidence. Other significant factors include male gender and multi-race.

Conclusion
Our study provides a summary of the risk factors for endophthalmitis between 2016-19 using data from the IRIS database registry. Identification of patients at high risk can be important in developing earlier intervention protocols.

Authors

Presenting Author
Roberto Gonzalez-Salinas, MD, PhD    Email the author
Authors
Pablo Baquero, MD, Roberto Aguilar-Díaz, MD, Uriel Fonseca-Aguirre, MD, Vidal F Soberón-Ventura, MD

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Paper Abstract

Purpose
To evaluate the clinical and refractive outcomes with the Four Point Scleral Fixation Technique Employing the Akreos AO60 Intraocular Lens in the absence of capsular support

Methods
This is a retrospective, case series of consecutive patients who underwent scleral fixation of Akreos AO60 IOLs by multiple surgeons at a single referral Eyecare center. Preoperative measurements were performed with optical biometry, and IOL power calculation was estimated using the SRK/T formula. Following surgery, the primary outcome measures included postoperative uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent deviation from target. The paired t-test was employed to assess significance according to data distribution. For repeated measurements, the RM one-way ANOVA test was used. Missing data were addressed, utilizing the maximum likelihood method.

Results
We examined the medical records of 15 total patients over the study period, and 15 eyes of 15 patients (4 male, 11 female) met the inclusion criteria with baseline characteristics. The median age was 62.2 +/- 18.96 (range 36-91) years old, and age did not significantly affect refractive outcomes (p = 0.84). Mean follow-up was 142 days, and length of follow-up did not significantly affect the refractive outcomes (p = 0.65). Most common indications for surgery included subluxated or dislocated pseudophakic lens (46.66%), Posterior capsule rupture (20.0%), Zonular pathology (13.33), Ocular trauma (13.33%), and endophthalmitis (6.67%).

Conclusion
The postoperative refractive outcomes and the uncorrected visual acuity after secondary implantation with Akreos AO60 are favorable in eyes with an optimal visual prognosis and mild ocular comorbidities.

Authors

Presenting Author
Jungyeob Han, MD    Email the author
Authors
Hun Lee, MD, PhD, So Young Park, MD, Jae Hyuck Lee, MD, Su Young Moon, MD, Sanghyu Nam, MD, Jae Yong Kim, MD, PhD, Hungwon Tchah, MD, PhD

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Paper Abstract

Purpose
To determine the association between cataract surgery and all-cause and cause-specific mortality in Korean elderly patients with cataract using the Korean National Health Insurance Service-Senior cohort database

Methods
In this nationwide, population-based, retrospective cohort study, elderly patients (≥60 years) diagnosed with cataract from 2002 through 2012 were included. The baseline characteristics included demographics, systemic comorbidities, and ocular comorbidities. Cox regression models with time-varying covariate cataract surgery status were used to assess the association between cataract surgery and mortality.

Results
The study cohort included 241,062 patients, of whom 127,491 were in the cataract surgery group and 113,121 were in the cataract diagnosis group. Mortality incidence was 3.62 deaths per 100 person-years in the cataract surgery group and 3.19 deaths per 100 person-years in the cataract diagnosis group. Cataract surgery was associated with a decreased hazard of all-cause mortality in the adjusted model that accounted for demographics, systemic and ocular comorbidities (hazard ratio [HR],0.93;P<0.001). There was a protective association between cataract surgery and mortality from vascular (HR,0.92;P<0.001) or neurologic (HR,0.64;P<0.001) causes in the adjusted model.

Conclusion
Cataract surgery was associated with decreased all-cause and cause-specific mortality (vascular and neurologic causes). Further studies are needed to examine the mechanisms surrounding the association between cataract surgery and mortality.