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    Complication Rate During Cataract Surgery After IVT Injections

    Eye
    Published online May 27, 2016

    In a retrospective cohort analysis, Hahn et al. examined the effect of prior intra­vitreal (IVT) injections on intraoper­ative and postoperative complications of cataract surgery. They found an increase in intraoperative, but not post­operative, complications in patients who had received IVT injections.

    The authors reviewed 10,105 cat­aract surgery procedures performed at the Duke Eye Center from Jan. 1, 2005, to Dec. 10, 2012. From these, they compared 197 eyes that had undergone IVT injections against an equal number of matched control eyes that had not been injected.

    The analysis included baseline demographics, preoperative clinical characteristics, prevalence of intraop­erative complications, preoperative and postoperative intraocular pressure (IOP), glaucoma surgery, and the use of glaucoma medication through year 1 after cataract surgery.

    The researchers identified an in­creased rate of intraoperative complica­tions in eyes that had undergone prior IVT injections compared with control eyes (3% vs. 0%; p = .030). Intraop­erative complications were defined a priori as posterior capsular rupture and/or anterior vitrectomy and/or unplanned placement of a 3-piece IOL. Injected eyes required more glaucoma medications at 1 year, but there was no difference when steroid injections were excluded. No differences were seen in postoperative IOP or glaucoma surgery, and no cases of endophthalmitis were reported.

    The authors hypothesized that the increased complications might be the result of inadvertent needle-induced trauma to the posterior capsule of the lens during IVT injection. However, they noted that the retina physicians had not documented lens trauma in any of these eyes.

    They added that with increasing need and indications for IVT therapy, treatment may be administered by non-retina specialists. The authors emphasized that all physicians who perform IVT injections should have a thorough understanding of intraocular anatomic relationships. This is particu­larly important with the posterior seg­ment and the lens, whose relationships are altered as the eye is torqued during the injection procedure.

    Similarly, cataract surgeons should perform careful preoperative assess­ments of the posterior capsule in patients with a history of IVT injec­tion. Further, they should understand precautions and surgical procedure modifications that can minimize com­plications associated with preexisting posterior capsule defects.

    Adult Strabismus Surgery Can Improve QOL and Mood

    Eye
    Published online April 29, 2016

    McBain et al. conducted a longitudi­nal study to assess the impact of adult strabismus surgery on clinical and psychosocial well-being and to deter­mine the factors associated with patient satisfaction and quality of life (QOL) after surgery. They found that a large majority of patients were satisfied with their surgery and experienced psycho­social improvement, but a minority of patients had a deterioration in QOL.

    The 210 participants in this study were adults (mean age, 46 years) who had strabismus surgery between November 2010 and April 2012 at Moorfields Eye Hospital in London. Preoperatively and at 3 and 6 months postoperatively, participants completed the AS-20 (a validated strabismus-spe­cific QOL assessment of functional and psychosocial measures) as well as sur­veys of mood, expectations for surgery, and beliefs about their disease, appear­ance, and social and intimate relation­ships. They also underwent a complete orthoptic assessment at their preop visit and again at 3 months postoper­atively. The researchers classified the clinical outcomes as successful, partially successful, or failure, based on largest remaining angle of deviation, diplopia, and need for further therapy.

    Satisfaction was high with strabismus surgery: More than 80% of patients did not regret having had surgery, and only 1% to 4% would not go through the surgery again. Overall, strabismus surgery led to statistically significant improvements in psychosocial and functional QOL. Paradoxically, how­ever, the authors found that surgery deemed to be partially successful was more psychologically detrimental than that classified as successful or a failure.

    The statistically significant predic­tors of QOL and psychosocial im­provement were participants’ beliefs about their disease, perceived visibility of strabismus, social support from significant others, and depression. The authors found that improvement in QOL after surgery was more likely in those who, preoperatively, held more positive beliefs about their strabismus and treatment, experienced less social anxiety and social avoidance, and had lower expectations about the outcome of their surgery. The authors concluded that recognition of clinical and psycho­social factors related to strabismus can help physicians and researchers develop interventions that can improve postsur­gical QOL.

    Nuclear Cataract Is an Early Predictor of Recalcitrant JIA-Associated Uveitis

    Journal of AAPOS
    2016;20(3):232-238.e1

    Suelves et al. analyzed factors predictive of treatment-resistant uveitis among patients with juvenile idiopathic arthritis (JIA)–associated uveitis. They found that the presence of nuclear cataract at the baseline evaluation is a risk factor for recalcitrant uveitis, defined as requiring biologic disease-modifying antirheumatic drugs or alkylating agents for management.

    The investigators retrospectively re­viewed the medical records of patients diagnosed with JIA-associated uveitis who were treated at a single tertiary re­ferral center between October 2005 and March 2013. The study’s main outcome measures were demographic charac­teristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies.

    A total of 96 patients (175 eyes), aged 1 to 12 years, were included in the study. Of these, 58 patients (108 eyes) were classified into the recalci­trant group, and 38 patients (67 eyes) into the nonrecalcitrant group. The eyes of the recalcitrant group had a higher incidence of cataract at baseline (49%; p < .0001), and these cataracts tended to have a nuclear component. In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%).

    In this exploratory study of risk factors, univariate analysis showed that having posterior synechiae, active uve­itis, cataract, or any ocular complica­tion at presentation was associated with a recalcitrant course; however, after multivariate analysis was performed, the researchers found that only nuclear cataract was an independent risk factor for recalcitrance (adjusted odds ratio, 14.22; p = .002).

    The authors commented that despite improved screening guidelines and earlier initiation of immuno­modulatory drugs, 44% of eyes in the nonrecalcitrant group and 72% of eyes in the recalcitrant group had at least 1 ocular complication at presentation. Currently, ocular prognosticators are not included in screening guidelines or disease classification. They concluded that identifying patients at higher risk for recalcitrant JIA-associated uveitis is important in making informed treat­ment decisions and improving care.

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    Other Journals summaries are written by Marianne Doran and edited by Deepak P. Edward, MD.

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