Prediction of visual function behind cataract using displacement threshold hyperacuity.

Vernier acuity, under optimal conditions, appears remarkably resistant to image degradation. This characteristic has been used to assess neural function in cataract patients who exhibit poor spatial resolution. Conventional resolution tests fail to differentiate between neural and optical causes of visual loss. The oscillatory movement displacement threshold--the smallest amplitude of oscillation which gives rise to the perception of movement--provides an alternative hyperacuity test. This may offer advantages over vernier acuity. The effect of image defocus upon displacement thresholds for a sinusoidal contrast grating of spatial frequency 2 c deg-1 was investigated for high (15 Hz) and low (2 Hz) oscillation frequencies. With visible stationary references, subjects were more sensitive to oscillation frequencies of 2 Hz than to 15 Hz (F 1,9 = 33.34, p less than 0.005) whilst blur of up to 2 dioptres had no significant effect (F3,27 = 1.73, p greater than 0.1). Simulating media opacities by spatial degradation affected both grating acuity and contrast sensitivity functions, whilst displacement thresholds remained largely unaffected. Results suggest that oscillatory movement displacement thresholds may be of value in assessing ocular neural dysfunction in the presence of media opacities.

Continuous Monitoring and Intrafraction Target Position Correction During Treatment Improves Target Coverage for Patients Undergoing SBRT Prostate Therapy

Rising Cataract Surgery Rates: Demand and Supply

Abscesos hepáticos recidivantes por Klebsiella pneumoniae

To evaluate the different ocular outcomes and the potential factors affecting visual acuity in bilateral congenital cataracts and developmental cataracts after intraocular lens implantation in preschool children. In a retrospective study, 86 eyes (51 congenital and 35 developmental cataract cases) of 43 children aged 6 years and younger who were diagnosed as having bilateral cataracts and underwent cataract aspiration combined with primary or secondary foldable intraocular lens implantation between 2003 and 2018 were reviewed. A minimum of 1 year of follow-up was required. The best corrected visual acuity (BCVA) and the factors associated with visual results were explored. The postoperative BCVA in the developmental cataract group (0.20 ± 0.19 logarithm of the minimum angle of resolution [logMAR]) was significantly better than that in the congenital cataract group (0.57 ± 0.31 logMAR) (P < .001). The mean refractive error was 3.61 ± 3.03 diopters in the congenital cataract group and 2.15 ± 1.82 diopters in the developmental cataract group. All cases of strabismus and nystagmus were found in the congenital cataract group. In the congenital cataract group, the variables age at cataract extraction and refractive error were significantly associated with BCVA (P < .001, P = .001, respectively). These variables had little effect on the developmental cataract group (P = .971, P = .576, respectively). Postoperative complications were recorded in 18 eyes: 4 in the developmental cataract group and 14 in the congenital cataract group. The BCVA in the developmental cataract group was significantly better than that in the congenital cataract group. The therapeutic effects of patients with congenital cataracts and developmental cataracts should be evaluated separately. [J Pediatr Ophthalmol Strabismus. 2021;58(3):180-187.].

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.

Objective To check the result of accommodation and fusion among patients with cataract extraction and intraocular lens implantation by using optometry uni and synoptophore, and discuss the recovery of binocular vision function. Methods 42 patients (42 eyes)with unilateral cataract, 40 patients (80 eyes)with binoculus cataract, and 35 gerontal patients in our hospital were chosen from August 2008 to August 2010. We used optometry uni routinely to check objective optometry and binoculus balance. At the same time, qualitatively or quantitatively analyze binoculus simultaneous perception, binocular integration function, accommodation, aggregation, and accommodative convergence/accommodation and so on. Results Statistical analysis showed that three groups were statistically significant in the factors of regulation, regulation near point, positive and negative relative accommodation, accommodative response and accommodative amplitude. No significant difference in the factors of the regulation and integration and the adjustment of the ratio (AC/A). The difference in scope of the integration was statistically significant between three groups of patients. Conclusions After cataract extraction and intraocular lens implantation, either one or both eyes after cataract surgery still retains some ability to regulate, and the integration of certain functions. Binocular cataract group has better accommodation and fusion than the unilateral cataract group, but still exists some difference compared with normal control. Key words: Aged; Cataract; Intraocular lens; Adjustment; Fusion

We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre- and postoperatively. Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003-0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64-57.24; p = 0.003). Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema.

Summary Introduction. Childhood cataracts have different morphologies and different presentation time. If clouding of the lens interferes with visual development, the only type of treatment is lens extraction surgery in order to prevent low vision or blindness development. Intraocular lens implantation is also successfully used in children to correct eye refraction after lens extraction surgery. After surgery combined correction using spectacles or contact lenses is frequently carried out. Aim of the Study. To analyze paediatric cataract morphology and cataract presentation time. To compare patients with different morphological types of cataract, as well as patients with different onsets of lens clouding.To compare vision outcomes in these two classification groups. Materials and methods. There was performed a retrospective analysis of 83 childhood cataract eyes, with the surgery being performed in the time period from 2006-2013. Visual acuity, contrast-sensitivity, binocular functions, and refraction were measured third month, 6th month, and 9th month after surgery, and then later once a year. Postoperative complications such as secondary cataract and secondary glaucoma were diagnosed. Visual development in different cataract groups was compared. The patients were divided into groups depending on cataract presentation time and the type of cataract morphology thus creating five major morphological groups and 12 sub-groups. Established groups were compared to each other by analysing visual development. Results. Pearson’s chi-square statistical analysis showed that there is a statistically significant correlation (p &lt;0.05) between morphological classification and cataract presentation over time. The analysis of variance (ANOVA) reveals that postoperative visual abilities (visual outcome)(p &lt;0.001) differ across morphological and cataract presentation groups. Conclusions. Visual development of childhood cataract patients is dependent on the onset of cataract and its morphology, it is affected by cataract surgery timeliness, quality of surgery, postoperative refractive correction possibilities and tolerability; myopic deviation; close patient monitoring; early diagnosis, and treatment of postoperative complications. Futher research is required in order to conduct mathematical modelling of the visual outcome after paediatric cataract surgery.

338 Qualité dans la chirurgie de la cataracte chez des patients : efficacité, défaut résiduel et meilleure acuité visuelle après un mois

SUMMARYThe aim of this prospective study was to determine changes in central macular thickness in the early postoperative period after uncomplicated phacoemulsification cataract surgery in diabetic patients using spectral domain optical coherence tomography (SD-OCT). Uncomplicated ultrasound phacoemulsification cataract surgery causes minimal changes of retinal layer thickness, which may result in subclinical cystoid macular edema development. This prospective study included 55 patients divided into two groups. Group 1 included diabetic patients with cataract, and group 2 included patients with cataract and without diabetes. All patients underwent uncomplicated ultrasound phacoemulsification cataract surgery at the Department of Ophthalmology, University Hospital Osijek in the period from November 2017 to January 2018. Patients were followed-up for one month after surgery. At each examination, OCT recording of the eye undergoing cataract surgery was performed. A statistically significant difference in central macular thickness in the diabetic group and control group (p=0.0005 both) was confirmed preoperatively and one month after cataract surgery. A statistically significant difference in central macular thickness was confirmed in diabetic group (p=0.006), as well as in the control group of patients (p=0.01) seven days and one month after cataract surgery. There was no statistically significant difference in macular thickness changes between the diabetic and control group of patients preoperatively (p=0.618), seven days (p=0.6848) or one month after cataract surgery (p=1). The effect of HbA1c on macular thickness change in diabetic patients was not statistically significant. The mean HbA1c in diabetic patients was 7.24±1.34%. There was no statistically significant difference in the effect of cumulative dissipated energy on macular thickness change in either group. This study confirmed a statistically significant correlation of the effect of fluid volume consumption on macular thickness changes in diabetic patients. There was no statistically significant effect of fluid volume consumption on macular thickness change in the control group of patients. Uncomplicated ultrasound phacoemulsification cataract surgery caused changes in cen-tral macular thickness in the early postoperative period in both patient groups. Changes in central macular thickness in the observed period were not manifested with clinically significant macular edema or by a more significant decrease in visual acuity. All patients had significant improvement in visual acuity seven days and one month after cataract surgery.

La phacoémulsification chez les patients atteints de cataracte blanche : résultats et complications

Contrast sensitivity and glare sensitivity are often abnormal in cataract patients. However, despite significant subjective complaints, relatively good visual acuities often are obtained with high-contrast optotypes. Using Variable-Contrast Visual Acuity Charts (VCVAC), we measured visual acuities of 40 eyes of 24 normal subjects (visual acuity greater than or equal to 1.0) aged 41 to 72 years, and 40 eyes of 28 cataract patients (visual acuity greater than or equal to 0.6) aged 44 to 81 years. The VCVAC consists of 4 different charts (1-4). The contrast is 90% in charts 1 and 4, 15% in chart 2 and 2.5% in chart 3. Chart 4 is the reverse polarity of chart 1. The decrease of visual acuity compared with the high-contrast chart (chart 1) was larger in the cataract group with both in the 15% contrast (0.52 vs. 0.71 octave) and the 2.5% contrast (1.21 vs. 1.75 octaves). In cataract group, 23/40 eyes (57.5%) showed better visual acuity with chart 4 than that of chart 1. In addition to high-contrast optotypes, acuity measurements using intermediate- to low-contrast optotypes, combined with the reverse polarity chart, seem effective in analyzing the visual disabilities caused by early cataract.

To evaluate the visual acuity of healthy and amblyopic children using sweep visual evoked potential and compare the results with those of Snellen visual acuity testing. A total of 160 children aged 6-17 years were included in the study. Of these, 104 (65%) were aged 7-17 years old, able to verbally communicate, and did not have any systemic or ocular pathology (Group 1). Group 2 included 56 (35%) children aged 6-17 years, able to verbally communicate, and had strabismus or anisometropic amblyopia whose best corrected visual acuity was between 0.1 and 0.8. All subjects underwent a detailed ophthalmological examination and sweep visual evoked potential measurement. Demographic characteristics, ocular findings, best corrected visual acuity, and sweep visual evoked potential results were recorded. In Group 1, the mean and maximum visual acuity values for sweep visual evoked potential were lower than the Snellen best corrected visual acuity (p<0.001, for both, respectively). Bland-Altman analysis revealed that in Group 1, the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.11 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.023 logMAR. In Group 2, the mean and maximum sweep visual evoked potential visual acuity were lower than the Snellen best corrected visual acuity (p<0.001 and p=0.009, respectively). Bland-Altman analysis revealed that the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.16 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.19 logMAR. Sweep visual evoked potential visual acuity measurements have comparable results with Snellen visual acuity measurements. This technique is an objective and reliable method for evaluating visual acuity in children.

Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia. To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among participants with presbyopia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 26 September 2019. We searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015. We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years or older with presbyopia undergoing cataract surgery. We used standard Cochrane methodology. We identified five studies conducted in Europe with a total of 175 participants. All five studies assessed uncorrected distance visual acuity (primary outcome of the review), while some also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 58 to 64 years. Only one study reported on gender of participants, and they were mostly women. We assessed all the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2= 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2= 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). In two studies, the investigators observed that participants' satisfaction or spectacle independence may be higher in the trifocal group at six months, although another study found no evidence of a difference in participant satisfaction or spectacle independence between groups. Adverse events Adverse events reporting varied among studies. Two studies reported information on adverse events at one year. One study reported that participants showed no intraoperative or postoperative complications, while the other study reported that four eyes (11.4%) in the bifocal and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The certainty of the evidence was low. There is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there is no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity and quality of life.