Refractive surprise after routine cataract surgery with multifocal IOLs attributable to corneal epithelial basement membrane dystrophy

Ho, Vivian; Stanojcic, Nick; O'Brart, Naomi A. L.; O’Brart, David

doi:10.1016/j.jcrs.2018.12.029

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…18 With modern aseptic techniques and intracameral antibiotics, rare bilateral sight-threatening complications are very unlikely, 11 whereas with modern biometric methodologies and careful preoperative patient selection and management, other complications are uncommon. [12][13][14] During the current COVID-19 pandemic, it would be hoped that the adoption of ISBCS would allow the provision of CS while limiting hospital attendances, thereby reducing COVID-19 contagion risks for both patients and medical personnel alike. For these reasons in the UK and globally, the introduction of more routine ISBCS into CS management pathways is under consideration.…”

Section: Discussionmentioning

confidence: 99%

“…10 In 95 606 ISBCS patients, no cases of bilateral endophthalmitis were reported with routine intracameral antibiotic usage. 11 Similarly, refractive surprise can be reduced by the exclusion of patients with risk factors, 12 management of the preoperative ocular surface disease 13 and usage of optical biometry/new intraocular lens calculation formulae. 14 Compared with DSBCS, ISBCS has been shown to be cost-effective for hospitals 15 and patient expenditure.…”

Section: Key Messagesmentioning

confidence: 99%

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Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

et al. 2020

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ObjectiveTo ascertain patient acceptance of immediate sequential bilateral cataract surgery (ISBCS) in the National Health Service (NHS).MethodsA survey was devised using a 5-point Likert scale for questions related to ISBCS, which patients undertook during their cataract outpatient appointment pre-COVID-19 lockdown and by telephone during the lockdown.ResultsQuestionnaires were completed for 267 patients. Most respondents were aged over 71 (51%) and were female individuals (60%). Forty-five per cent agreed/strongly agreed with opting for ISBCS. A positive correlation was identified between opting for ISBCS and convenience to the patient (r=0.76, p<0.01) and family/carer/partner (r=0.71, p<0.01) and wanting to limit numbers of hospital visits (r=0.57, p<0.01). Fifty per cent agreed/strongly agreed that they were worried about the risk of simultaneous bilateral ocular complications, with this correlating with being less likely to opt for ISBCS (r=−0.49, p<0.01) and being scared of ISBCS (r=0.67, p<0.01). During COVID-19 lockdown, patients were less likely to want to minimise the time taken off work (p<0.05) and less intolerant of a prolonged hospital visit (p<0.05). Only 23% of respondents agreed/strongly agreed that they had familiarity with ISBCS.ConclusionsISBCS was acceptable to 45% of our sampled population, suggesting limited routine implementation in the NHS is possible. Convenience and reduction in hospital visits appeared to contribute to this acceptance. Half of the patients expressed concern regarding bilateral complications and such concerns need addressing. Some attitudes did appear to change during the COVID-19 lockdown period. The familiarity of the concept of ISBCS is low suggesting the need for patient education.

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Section: Discussionmentioning

confidence: 99%

Section: Key Messagesmentioning

confidence: 99%

Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

et al. 2020

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“…► The introduction of ISBCS can potentially reduce costs to the public health without compromising patient safety. Open access allayed by excluding patients with risk factors, 8 identification and treatment of pre-existing ocular surface disease 9 and the use of optical biometry and modern intraocular lens calculation formulae. 10 It has been documented to be cost-effective compared with unilateral surgery in terms of hospital expenditure, 11 and such cost efficiencies are greater when patient travel, paid home care costs and loss of working time are taken into consideration.…”

Section: Key Messagesmentioning

confidence: 99%

Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency

et al. 2020

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ObjectiveTo test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS).Methods and analysisPreviously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS.ResultsBased on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted.ConclusionThe introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.

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“…22 Anterior basement membrane dystrophy can be subtle and, if overlooked, can affect the validity of biometric keratometric measurements before surgery, resulting in an inaccurate biometry measurement, incorrect IOL selection, and reduced visual performance and patient satisfaction. 23 Appropriate management of ABMD or SND before surgery can yield more reliable biometric data for cataract surgery planning. 24 Recommended treatment for ABMD and SND includes superficial keratectomy with or without phototherapeutic keratectomy.…”

Section: Discussionmentioning

confidence: 99%

Matching the Patient to the Intraocular Lens

Yeu

Cuozzo

2021

Ophthalmology

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The intraocular lens (IOL) selection process for patients requires a complex and objective assessment of patient-specific ocular characteristics, including the quality and quantity of corneal astigmatism, health of the ocular surface, and other ocular comorbidities. Potential issues that could be considered complications after surgery, including dry eye disease, anterior or epithelial basement membrane dystrophy, Salzmann nodular degeneration, and pterygium, should be addressed proactively. Aspheric IOLs are designed to eliminate the positive spherical aberration added by traditional IOLs to the pseudophakic visual axis. Spherical aberration may be a consideration with patient selection. Patient desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal IOLs and extended depth-of-focus (EDOF) IOLs. However, no one single multifocal or EDOF IOL suits all patients' needs. The wide variety of multifocal and EDOF IOLs, their optics, and their respective impact on patient quality of vision have to be understood fully to choose the appropriate IOL for each individual, and surgery has to be customized. Patients who have undergone previous LASIK or who have radial keratotomy and ocular pathologic features, including glaucoma, age-related macular degeneration, and epiretinal membrane, require specific considerations for IOL selection. Subjectively, patientcentered considerations, including visual goals, lifestyle, personality, profession, and hobbies, are key elements for the surgeon to assess and factor into an IOL recommendation. This holistic approach will help surgeons to achieve optimal surgical outcomes and to meet (and exceed) the high expectations of patients. Ophthalmology 2020;-:1e10

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Refractive surprise after routine cataract surgery with multifocal IOLs attributable to corneal epithelial basement membrane dystrophy

Cited by 9 publications

References 11 publications

Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency

Matching the Patient to the Intraocular Lens

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