ARVO 2015 Annual Meeting Abstracts

November 14, 2017 | Author: Benedict Cole | Category: N/A
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ARVO 2015 Annual Meeting Abstracts 141 Cataract surgery: Clinical outcomes Sunday, May 03, 2015 1:30 PM–3:15 PM Exhibit Hall Poster Session Program #/Board # Range: 650–687/B0216–B0253 Organizing Section: Lens Contributing Section(s): Eye Movements/Strabismus/Amblyopia/ Neuro-Ophthalmology, Visual Psychophysics/Physiological Optics Program Number: 650 Poster Board Number: B0216 Presentation Time: 1:30 PM–3:15 PM The effect of a structured surgical curriculum on outcomes from resident phacoemulsification surgery complicated by posterior capsular rupture Sylvia L. Groth, Robert Van der Vaart, Kenneth Cohen. Ophthalmology, University of North Carolina, Chapel Hill, Chapel Hill, NC. Purpose: To evaluate if a structured resident surgical curriculum improves outcomes following phacoemulsification (phaco) surgery complicated by posterior capsular rupture and vitreous loss requiring anterior vitrectomy. Methods: We performed a retrospective chart review including all patients operated on by PGY3 & PGY4 residents from Jan 2012 Nov 2014 with a single attending (KC) complicated by posterior capsular rupture requiring an anterior vitrectomy (CPT 67010) while undergoing phaco surgery. Primary outcome was visual acuity (VA), with secondary outcomes of intraocular pressure (IOP) and subsequent procedures required. Our primary analysis excluded patients with pre-existing ocular disease. Final VA of 20/40 or better was considered a success. Secondary analysis included all patients and 2 lines or greater improvement in VA was considered a success. Results: 50 eyes included 20 female, 30 male; 22 right eyes, 28 left eyes with mean age of 62.8 ± [sem]1.7 yrs. 16 eyes had pre-existing ocular disease and were excluded from subanalysis. 7 eyes had preop VA of 20/40 or better, 18 had 20/50 to 20/100 and 25 eyes were 20/200 or worse. Of the 36 eyes without ocular disease, final VA was 20/40 or better in 78% of patients. At day 1 post-op 21% (n=48) were 2 lines or more better in VA, at 1 week, 1 month, 6 months and 1 year they were, 43% (n=46), 61% (n=44), 69% (n=32) and 76% (n=17), respectively. Pre-op IOP was 14.4 ± 0.4 mm Hg, at 1 day post-op 20.2 ± 1.7 and at 1 week 17.4 ± 0.9. At 1 day post-op, 9 eyes had IOP > 25 mmHg. At 1 week 4 eyes had IOP < 25 mmHg. 11 eyes required secondary procedures related to the complication including pars plana vitrectomy/lensectomy (n=7), secondary IOL placement (n=3), retinal detachment repair (n=1). At post-op day 1, 7 patient required additional pressure medications, and at 1 week and 1 month, 9 and 5 patients, respectively. Conclusions: The University of North Carolina resident surgical curriculum includes lecture, wet lab practice and instruction, and surgical video review. At UNC, surgical outcomes of resident performed phaco complicated by vitreous loss requiring anterior vitrectomy are comparable to published data of similar cases performed by surgeons of all levels of experience. The presence of a structured resident surgical curriculum allows residents to achieve favorable outcomes in these complicated cases. Commercial Relationships: Sylvia L. Groth, None; Robert Van der Vaart, None; Kenneth Cohen, None Support: Research to Prevent Blindness

Program Number: 651 Poster Board Number: B0217 Presentation Time: 1:30 PM–3:15 PM Comparison of anterior capsule contraction between two different types of acrylic intraocular lenses Taiga Miyajima, Mayumi Nagata, Hiroyuki Matsushima, Koichiro Mukai, Masamoto Aose, Tadashi Senoo. ophthalmology, Dokkyo Medical University, Mibu, Japan. Purpose: The anterior capsule contraction is one of a complication after a cataract surgery which decreases visual functions according as their progression. In this study, we evaluate the ratios of anterior capsule contraction between two types of hydrophobic acryl intraocular lenses (IOLs). Methods: The subject were 15 cases, 20eyes who were performed phacoemulcifiction (average age 70.7±8.1) and IOLs (ZCB00V: AMO or PY-60AD: HOYA) were randomly implanted. Images were taken using an EAS-1000 (NIDEK) after 1 week and 3 months postoperatively and ratio of anterior capsule contractions were calculated. At the same time, area of fibrosis on surface of IOLs were also calculated using area analyzing soft were (Area Q). Welch’s t-test was performed for statistically analysis. To investigate the reasons of differences, we prepared white rabbit and performed cataract surgeries. Their tissue sections were obtained after 90 days and historical analysis were performed. Results: The anterior capsule contractions of ZCB00V and PY60AD were 0.88±1.25 % and 3.16±2.13 % respectively after 3 months. And there were statistically significance (P=0.04). The fibrosis area of ZCB00V and PY-60AD were 6.10±3.69 pixels and 37.65±10.21 pixels respectively. And there were statistically significance (P=0.0003). Histological studies show the hollow around the ZCB00V and it prevent the adhesion between anterior capsule and surface of IOL. The development of lens epithelial cells were prevented on ZCB00V. Conclusions: The ZCB00V has a hollow around the IOL and prevent adhesion between anterior capsule and surface of IOL, which inhibits fibroblastic changes and finally prevents anterior capsule contraction. Commercial Relationships: Taiga Miyajima, None; Mayumi Nagata, None; Hiroyuki Matsushima, None; Koichiro Mukai, None; Masamoto Aose, None; Tadashi Senoo, None Program Number: 652 Poster Board Number: B0218 Presentation Time: 1:30 PM–3:15 PM Management of Negative Dysphotopsia following Cataract Surgery Jewel Sandy1, Tyler Hall2, Marc Michelson2. 1Ophthalmology, University of Alabama Birmingham, Birmingham, AL; 2Alabama Eye and Cataract Center, Birmingham, AL. Purpose: To evaluate the benefit of various surgical interventions to treat negative dysphotopsia following uncomplicated cataract surgery. Methods: Restrospective review of patients with persistent pseudophakic negative dysphotopsia following uncomplicated cataract surgery. Negative dysphotopsia defined as: subjective complaint of dark temporal crescent that persisted for >1 month post-operatively. Patient were treated with either Neodymium:YAG (Nd:YAG) laser anterior capsulectomy or in-the-bag intraocular lens (IOL) exchange. Primary outcome was partial or complete resolution of negative dysphotopsia symptoms 3 months postoperatively. Results: 8 patients with negative dysphotopsia had surgical treatment. 3 of 4 patients who had in-the-bag IOL exchange had partial or complete resolution of symptoms by 6 months. 3 of 5 patients who had Nd:YAG laser anterior capsulectomy had partial or complete resolution of symptoms by 3 months. Conclusions: Modification of the anterior capsule-IOL relationship is important for the resolution of negative dysphotopsia symtoms.

©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]

ARVO 2015 Annual Meeting Abstracts No one treatment method yielded consistent results, suggesting a multifactorial etiology of negative dysphotopsia.

Results: The densities on surface of SP2 and FY-60AD were 1.59±1.07 CCT and 4.32±1.07 CCT after 3 years. The center were 1.09±1.07CCT and 1.77±0.82 CCT. The posterior were 8.55±7.54 CCT and 16.19±4.70 CCT respectively. There were statistically significances. The ratio of YAG laser capsulotomy were 3.3% in SP2 and 13.3% in PY-60AD. Conclusions: Surface modified hydrophobic acrylic IOL (SP2) is prevented PCO. And the development of whitening and glistening are also significantly less.

Table 1. Surgical Method and Outcomes.

Figure 1. Representative color photograph demonstrating after Nd:YAG laser capsulectomy to remove anterior capsule overlying the optic. Commercial Relationships: Jewel Sandy, None; Tyler Hall, None; Marc Michelson, None Program Number: 653 Poster Board Number: B0219 Presentation Time: 1:30 PM–3:15 PM Postoperative outcomes using surface modified intraocular lens Mayumi Nagata, Hiroyuki Matsushima, Koichiro Mukai, Norihito Gotoh, Wataru Terauchi, Tadashi Senoo. Ophthalmology, Dokkyo Medical University, Mibu, Japan. Purpose: Evaluation of postoperative outcomes using surface modified intraocular lens (IOL). Methods: Subjects comprised 60 eyes that underwent phacoemulsification. Surface modified hydrophobic acrylic IOL (SP2, HOYA) or three piece IOL (FY-60AD, HOYA) were randomly implanted. The mean age of patients is 70.8±8.6. Images were taken using an EAS-1000 (NIDEK) after 1, 2 and 3 year postoperatively. To analyze the whitening (sub-surface nano glistening), glistening and posterior sub-capsular opacification (PCO), The images were photographed from 2 directions (0 and 90 degree) and the densities on surface (whitening), center (glistening) and posterior (PCO) of IOLs were measured and compared. The probability of survival ratio about YAG laser capsulotomy were also measured.

Commercial Relationships: Mayumi Nagata, None; Hiroyuki Matsushima, HOYA (P); Koichiro Mukai, None; Norihito Gotoh, None; Wataru Terauchi, None; Tadashi Senoo, None Clinical Trial: HCT-041 Program Number: 654 Poster Board Number: B0220 Presentation Time: 1:30 PM–3:15 PM Outcomes of femtosecond assisted cataract surgery Timothy Soeken, Sumitra Khandelwal, Zaina Al-Mohtaseb, Li Wang, Mitchell Weikert, Douglas D. Koch. Baylor College of Medicine, Bellaire, TX. Purpose: To report the early experience, complications, phacoemulsification time, refractive prediction error, and visual outcomes of cataract surgery with the Catalys femtosecond laser system.

©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]

ARVO 2015 Annual Meeting Abstracts Methods: The initial 105 eyes undergoing cataract surgery between February 2014 and April 2014 by 4 surgeons were included in this review. All patients had anterior capsulotomy and lens softening performed by the Catalys femtosecond laser prior to phacoemulsification. Some patients also had main wounds, paracentesis ports, and corneal relaxing incisions (CRI) made by the Catalys femtosecond laser. Chart reviews were performed retrospectively to determine complication rates, phacoemulsification time, refractive prediction error, visual outcomes, and overall early experience. Results: One hundred five eyes were included in the review, all of which had anterior capsulotomy and lens softening. Ten (10%) had paired CRIs, 45 (43%) had single CRI, 25 (24%) had main wound creation, and one (1%) had paracentesis ports created by the Catalys femtosecond laser. Of the 105 eyes that underwent anterior capusolutomy, one eye (1%) had an anterior capsular tear, one eye (1%) had a posterior capsular tear, and three eyes (3%) had an incomplete capsulorhexis. Of the 25 eyes that had wounds created by the Catalys, five (20%) had to be manually recreated and two (8%) had to be sutured. In 77 (73%) eyes, the phacoemulsification time for the Stellaris averaged 3.2, and for the Infiniti averaged 5.6 in 27 (26%) eyes. In 97 eyes with available manifest refraction at postop 3 weeks or longer, using the Holladay 1 formula, the refractive prediction error was +0.13 ± 0.55 D (range -1.05 to +3.36 D), the median absolute prediction error was 0.30 D, and 42.3%, 81.4%, 90.7%, and 94.8% of eyes were within 0.25 D, 0.5 D, 0.75 D, and 1.0 D of refractive prediction errors, respectively. Conclusions: Cataract surgery with the Catalys femtosecond laser is a safe procedure with few complications. Care should be taken for anterior or posterior capsular tears, incomplete capsulorhexis, or the need to re-create the main wound. Commercial Relationships: Timothy Soeken, None; Sumitra Khandelwal, None; Zaina Al-Mohtaseb, None; Li Wang, Zeimer (R); Mitchell Weikert, Ziemer (C); Douglas D. Koch, Abbott Medical Optics (C), Alcon (C), Carl Zeiss Meditec (F), iOptics (F), True Vision (F), Ziemer (F) Program Number: 655 Poster Board Number: B0221 Presentation Time: 1:30 PM–3:15 PM Early clinical experience with femtosecond laser-assisted cataract surgery Elaine Williams1, Blake Williams2, Douglas Williams3. 1Georgetown University, Munster, IN; 2University of Chicago Pritzker School of Medicine, Chicago, IL; 3Williams Eye Institute, Hammond, IN. Purpose: Femtosecond laser technology was first used clinically for cataract surgery in 2008, and there is considerable interest in the ophthalmology community in expanding the use of this technology. However, there have been concerns about the learning curve associated with adopting this new technology after Bali et al. reported four dropped nuclei (requiring posterior vitrectomies) in their first 200 cases, along with other minor complications. We performed a retrospective, observational clinical study to assess the safety and visual outcomes of our first 500 cases of laser-assisted cataract surgery, when compared to surgery without the laser. Methods: We collected data on pre- and post-op best-corrected visual acuity (VA), post-op uncorrected VA, and post-op refractive astigmatism in patients receiving cataract surgery with the LenSx femtosecond laser at an outpatient ophthalmic ambulatory surgery center. Three surgeons performed the surgeries between 1/1/13 and 10/29/14. Results were compared to a randomly selected group of 500 non-laser cataract surgeries by the same surgeons over the same time period. All cases were reviewed for intraoperative complications. Patients with pre-existing pathology that prevented

best-corrected VA of 20/40 or better were excluded from VA analysis. Pearson’s chi-squared test was used for statistical analysis. Results: In each study group, 2/500 surgeries resulted in a torn posterior capsule with vitreous prolapse requiring anterior vitrectomy. No nuclei or fragments were lost into the posterior vitreous, and no return trips to the OR were required. Patients receiving laser surgery were more likely than the non-laser group to have a postop uncorrected VA of 20/40 or better (318/363 [87.6%] vs 254/392 [64.8%]; p
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