JCRS highlights selected by Professor Thomas Kohnen
Vol: 44 Issue: 12 December 2018
JCRS December 2018
Predicting posterior capsule rupture
Anterior segment OCT (AS-OCT) can successfully predict the risk for posterior capsule rupture during phacoemulsification in eyes with posterior polar cataract, a recent study suggests. The prospective observational study included 64 eyes of 62 patients with posterior polar cataract who had phaco. All underwent preoperative AS-OCT to assess the integrity of the posterior capsule. Phaco was performed by the same surgeon, who was masked from the AS-OCT findings, and who evaluated the integrity of the posterior capsule intraoperatively. Preoperative AS-OCT showed eight eyes (12.5%) to have probable posterior capsule dehiscence and 56 eyes (87.5%) to have intact posterior capsules. Intraoperatively, the surgeon noted posterior capsule dehiscence in five eyes (7.8%) and an intact posterior capsule in 59 eyes (92.2%). The sensitivity and specificity of AS-OCT for detecting posterior capsule dehiscence was 100% and 94.92%, respectively. The negative predictive value of AS-OCT was 100%. GP Kumaret al., JCRS, “Can preoperative anterior segment optical coherence tomography predict posterior capsule rupture during phacoemulsification in patients with posterior polar cataract?”, Vol. 44, Issue 12, 1441-4.
HOAs and high myopia
A new study looking at corneal aberrations in high myopes provides support for using aspheric IOLs in those cataract patients. The study of 287 high myopia patients found no negative primary spherical aberrations of the total or anterior corneal surface. The study did note differences between the myope group and control group in terms of central corneal thickness, astigmatism, primary spherical aberration, vertical coma and oblique trefoil. However, these differences were not consistent between different age subgroups. Higher-order aberrations were correlated with age. Posterior corneal vertical coma was correlated with axial length. M Zhang et al, JCRS, “Analysis of corneal higher-order aberrations in cataract patients with high myopia”, Vol. 44, Issue 12, 1482-90.
CXL – on or off?
Epi-off corneal collagen cross-linking might be better than the transepithelial technique for the treatment of progressive corneal ectasia in terms of steepest keratometry, a new meta-analysis concludes. The meta-analysis included seven randomised clinical trials involving 505 eyes that met eligibility criteria for the review. The epi-off CXL group showed significantly better outcomes in post-op changes in maximum keratometry during one-year observation periods. Transepithelial CXL resulted in significantly greater post-treatment central corneal thickness and best spectacle-corrected visual acuity. The presence of a post-op demarcation line was significantly more frequent after epi-off CXL than that after transepithelial CXL. H Kobashi et al., JCRS, “Transepithelial versus epithelium-off corneal crosslinking for corneal ectasia”, Vol. 44, Issue 12, 1507-16.