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BACKGROUND: Cataract surgery is one of the most common surgical procedures performed in older adults in the United States and is generally considered to be extremely low-risk. As of 2019, routine preoperative evaluation within 30 days of surgery is no longer mandated by the United States of America (USA) Centers for Medicare & Medicaid Services (CMS) for ambulatory surgery centers, but it is unclear how primary care providers perceive this change. METHODS: We performed a qualitative analysis of semi-structured interviews with six primary care providers to explore primary care providers' perspectives on routine preoperative assessment for cataract surgery. RESULTS: Primary care providers commented on the large number of referrals they receive for preoperative assessment before cataract procedures. The analysis revealed an overarching sentiment of resentment over the time, effort, and resources expended on these assessments. Themes included the lack of awareness of the updated regulations that no longer require a history and physical to be completed within 30 days and the perception of a universal lack of medical necessity to perform preoperative assessment for cataract surgery. Providers also commented on the strain on limited resources and the burden on patients. The relationship between specialties and professional roles emerged as another important theme. CONCLUSIONS: Referrals for preoperative clearance for cataract surgery continue to burden providers, patients, and the health system, and represent an opportunity to streamline care in this patient population.

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PURPOSE: The impact of cataract surgery on diabetic retinopathy (DR) in patients with diabetes mellitus (DM) remains uncertain. This study aimed to investigate the incidence and progression of DR in patients with DM who underwent cataract surgery. DESIGN: Meta-analysis. METHODS: A systematic search of PubMed, Cochrane CENTRAL, and Embase databases was conducted from inception to April 2024. Randomized controlled trials or observational cohort studies involving adult patients with DM who underwent cataract surgery were included. Studies reporting data on the incidence or progression of postoperative DR were considered. Effect sizes were determined using risk ratios (RRs) with 95% confidence intervals (CIs), and meta-analysis was performed using a random-effects model. Subgroup analysis and meta-regression were conducted on perioperative demographic factors such as types of cataract surgery, DM durations, preoperative glycated hemoglobin A1c levels, and postoperative follow-up durations. RESULTS: Data from 15 studies, involving 7,287 patients were analyzed. Postoperative DR incidence was elevated compared to the control group (RR, 1.38; 95% CI, 1.16-1.63; p < 0.001), although not significantly different in paired studies (RR, 0.85; 95% CI, 0.39-1.83; p = 0.671). DR progression was significantly higher after cataract surgery (RR, 1.46; 95% CI, 1.28-1.66; p < 0.001), irrespective of cataract surgery type and study design. Our analysis also revealed a significant increase in DR progression to sight-threatening DR, which includes clinically significant macular edema and proliferative diabetic retinopathy, following cataract surgery (RR, 1.84; 95% CI, 1.21-2.81; p = 0.005). Additionally, various risk factors such as preoperative HbA1c level, duration of postoperative follow-up, duration of diabetic diagnosis, age, and use of insulin therapy were investigated, However, none of these parameters significantly influenced the incidence or progression of postoperative DR. CONCLUSIONS: Further research is needed to fully understand the incidence of DR after cataract surgery. However, our study provides moderate evidence supporting the progression of DR following such surgical interventions. Therefore, it is imperative to closely monitor DR progression within one year following cataract surgery in patients with DM.

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Purpose: This study aimed to analyze the incidence and characteristics of intraocular lens (IOL) dislocation after cataract surgery in South Korea. Methods: We retrospectively analyzed the incidence of IOL dislocation after cataract surgery in patients diagnosed between 2002 and 2021. Data of all pseudophakic patients who underwent secondary IOL or IOL exchange surgeries due to IOL dislocation were extracted from the Korean National Health Insurance System (KNHIS) database and the Korean Standard Classification of Diseases-7 codes. The incidence per 1,000,000 person-years and corresponding 95% confidence intervals (CIs) were calculated. Results: Between 2002 and 2021, 39,965 (0.82 %) of the 4,848,125 pseudophakic patients were diagnosed with IOL dislocation and surgically treated. The incidence of IOL dislocation requiring surgery in pseudophakic patients was 28,900/1,000,000 person-years (95% CI: 28,431-29,369), comprising 57,800 cases in male and 10,800 in female patients (95% CI: male: 56,730-58,870 vs. 95% CI: female patients: 10,523-11,077), and mean male-to-female ratio was 5.35. The incidence rate peaked in younger age group below 40 years, showing 107,000 per 1,000,000 person-years (95% CI: 102,900-111,100), and the average age of IOL dislocation requiring surgery was 68.1 ± 10.7 years. The average time lapse from cataract surgery to secondary IOL surgery due to IOL dislocation was 4.1±4.7 years (median, 2.2 years), and the number of secondary IOL surgery due to dislocation of artificial lens rapidly occurred 10 years after cataract surgery among all age groups. Conclusions: The incidence of IOL dislocation requiring surgery was higher in younger and male patients. Our findings could be expected to aid establishing future healthcare policies for South Korean populations with an increased risk of IOL dislocation after cataract surgery.

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Purpose: To present a series of 4 patients from the Ohio Amish or Mennonite populations with isolated ectopia lentis. Methods: A case series was evaluated. Results: Four cases with bilateral lens subluxations were diagnosed with a homozygous c.767_786del pathogenic variant in ADAMTSL4. Their ages ranged from 2 to 22 years. Three cases were symptomatic and were managed surgically with lensectomy, vitrectomy, and endolaser photocoagulation with or without secondary intraocular lens (IOL) implantation. One asymptomatic patient was observed. The postoperative visual acuity ranged from 20/20 to 20/60 in nonamblyopic eyes. Conclusions: The pathogenic homozygous c.767_786del variant in ADAMTSL4 may be a cause of bilateral isolated ectopia lentis in the Ohio Amish and Mennonite populations, likely as a result of a founder effect. Vitrectomy and lens extraction with or without secondary IOL implantation may lead to good visual outcomes. There were no cases of retinal detachment.

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PURPOSE: To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified. METHODS: Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D. MAIN OUTCOME MEASURES: The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm's canal stent (SCS) devices, as well as incidence of anisometropia. RESULTS: A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36 ± 0.91D, -0.31 ± 0.85D, and -0.39 ± 0.88D respectively (P = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (P = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P = 0.217). At POM6, mean SEs were -0.38 ± 0.97D (CE/goniotomy), -0.35 ± 0.81D (CE/SCS), and -0.40 ± 0.91D (CE alone; P = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was -0.36 ± 0.73D (CE/goniotomy), -0.24 ± 0.84D (CE/SCS), and -0.45 ± 0.81D (CE alone; P < 0.001). CONCLUSIONS: Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

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Background: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer. Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] -221.67 Cell/mm2; 95% Confidence Interval [CI] -401.68 to -41.66; p < 0.02; I2=73%); a shorter UST (MD -51.16 sec; 95% CI -99.4 to -2.79; p = 0.04; I2=98%); reduced CDE (MD -8.68 units; 95% CI -12.76 to -4.60; p < 0.01; I2=84%); a lower PT (MD -55.09 sec; 95% CI -99.29 to -12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD -3.86 min; 95% CI -9.55 to 1.83; p = 0.18; I2=99%). Conclusion: The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.

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Introduction: The production of ultrasonic energy during phacoemulsification is associated with heat generation that could damage ocular tissues, particularly at the corneoscleral wound site. Case Presentation: This study presents an 89-year-old patient with senile hypermature cataract and Fuchs endothelial dystrophy developing severe thermal corneoscleral injury during phacoemulsification. At presentation, visual acuity was finger count at 40 cm and there was a 1 × 2-mm area of corneal melting at the corneal tunnel with diffuse corneal oedema. After 1 month, a temporal circular corneal patch graft was applied to the corneal burn. A penetrating keratoplasty was performed 16 months after the first surgery. Conclusion: Corneal surgery, including lamellar patch grafts and full-thickness penetrating grafts, could be used, when necessary, to restore the cornea's integrity. These procedures could eliminate corneal scarring, decrease astigmatism, and improve vision in patients with phacoemulsification burns.

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Pseudoexfoliation syndrome (PEX) presents a significant clinical challenge due to its diverse ocular manifestations, including glaucoma and zonular weakness of the lens, which can lead to irreversible visual impairment if left untreated. We report a case of a 78-year-old male presenting with bilateral visual impairment persisting for four years, with a more pronounced decline in the right eye over the past six months. Examination revealed aphakia with pseudoexfoliative material in the right eye, a cataract with pseudoexfoliative material in the left eye, and a notable intraocular pressure (IOP) discrepancy. Surgical intervention was required for both eyes, with cataract extraction and IOP-lowering procedures performed to preserve vision and prevent further deterioration. This case underscores the importance of timely recognition and comprehensive management of PEX-related ocular complications to optimize visual outcomes and quality of life for affected individuals. Close collaboration between ophthalmologists and other healthcare professionals is essential to address the multifaceted nature of PEX and tailoring treatment strategies to individual patient needs. Further research is needed to elucidate the underlying pathophysiology of PEX and refine therapeutic approaches to mitigate its detrimental effects on vision.

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OBJECTIVE: In this study, we aimed to characterize the frequency and distribution of ocular surgeries in patients with inherited retinal diseases (IRDs) and evaluate associated patient and disease factors. DESIGN: Retrospective cohort. PARTICIPANTS: Subjects aged ≥ 18 years who were followed at the Johns Hopkins Genetic Eye Disease Center. METHODS: We studied a retrospective cohort of patients with an IRD diagnosis to analyze the occurrence of laser and incisional surgeries. Subjects were categorized into 2 groups: central dysfunction (macular/cone/cone-rod dystrophy, "MCCRD group") and panretinal or peripheral dysfunction (retinitis pigmentosa-like, "RP group"). Genetic testing status was recorded. The association of patient and disease factors on the frequency, distribution, and timing of surgeries was analyzed. MAIN OUTCOME MEASURES: Prevalence, prevalence odds ratio (POR), hazard ratio (HR) of ophthalmic procedures by phenotype. RESULTS: A total of 1472 eyes of 736 subjects were evaluated. Among them, 31.3% (n = 230) had undergone ocular surgery, and 78.3% of those (n = 180/230) had a history of more than 1 surgery. A total of 602 surgical procedures were analyzed. Cataract extraction with intraocular lens implantation (CEIOL) was the most common (51.2%), followed by yttrium aluminum garnet capsulotomy, refractive surgery, retinal surgery, and others. Cataract extraction with intraocular lens implantation occurred more frequently in RP than in MCCRD subjects (POR, 2.59; P = 0.002). Retinitis pigmentosa subjects underwent CEIOL at a younger age than patients with MCCRD (HR, 2.11; P < 0.001). CONCLUSIONS: Approximately one-third of patients with IRD had a history of laser or incisional surgery. Cataract extraction with intraocular lens implantation was the most common surgery; its frequency and timing may be associated with the IRD phenotype. This data may inform the design of prospective research. Such efforts may illuminate routine clinical decision-making and contribute to surgical strategy development for cell and gene therapy delivery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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INTRODUCTION AND OBJECTIVES: Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent. RESULTS: In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist. CONCLUSIONS: This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality.

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PURPOSE: To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. METHODS: A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. RESULTS: A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). CONCLUSIONS: Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

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Objective To explore the clinical efficacy of laser-assisted sclerectomy and cataract extraction combined with angle separation in the treatment of angle-closure glaucoma.Methods A total of 162 patients with angle closure glaucoma were selected as the research subjects.Eighty-one patients in the experimental group under-went laser-assisted sclerectomy and cataract extraction combined with angle separation,and another 81 patients in the control group underwent cataract extraction combined with angle separation.The therapeutic effects of two groups of patients were observed.Results The postoperative visual acuity,BCVA,angle width,and corneal endothelial cell count of the experimental group were higher than those of the control group,but the intraocular pressure,central anterior chamber depth,and corneal thickness were all lower than those in the control group.The incidence of adverse reactions in the experimental group(6.2% )was lower than that in the control group(13.6% ).During postop-erative follow-up,there was no further increase in intraocular pressure in the two groups,while the height of filtering blebs in the control group decreased significantly when compared with that in the experimental group.One month after surgery,the BCVA and corneal endothelial cell count in the experimental group were higher than those in the control group(P<0.05),and the corneal thickness was lower than that in the control group(P<0.05),but no statistical significance was found at 3 and 6 months after surgery.The astigmatism in the experimental group was better than that in the control group 3 months after surgery,but there was no statistically significant difference at 1 month and 6 months after surgery.Conclusion Laser-assisted sclerectomy and cataract extraction combined with angle separa-tion are effective and safe in the treatment of angle closure glaucoma.

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PURPOSE: To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS: Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS: For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS: The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.

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PURPOSE: The aim of this study is to investigate changes in intraocular pressure (IOP) and anterior-segment parameters before and after cataract surgery, vitrectomy, and combined surgery. METHODS: The records of patients who had undergone cataract surgery (cataract group), vitrectomy (vitrectomy group), or combined cataract surgery and vitrectomy (combined group) at our hospital were retrospectively examined. The vitrectomy group consisted of pseudophakic eyes. IOP and anterior-segment measurements, including anterior chamber depth (ACD), angle opening distance (AOD), trabecular-iris angle (TIA), and trabecular-iris space area (TISA), were measured using swept-source anterior-segment optical coherence tomography before and 6 months after surgery in 41, 15, and 40 eyes, respectively. RESULTS: In the cataract and combined groups, there was a decrease in IOP (cataract group: from 15.8 to 13.4 mmHg, p <0.001; combined group: from 15.8 to 14.2 mmHg, p = 0.002) and an increase in the central corneal thickness after surgery (p <0.001). The ACD increased in all groups, with a smaller increase in the vitrectomy group (p <0.03). Postoperative AOD, TIA, and TISA were significantly increased in the cataract and combined groups (p <0.02). Higher preoperative IOP and larger IOP reduction after surgery were correlated with smaller preoperative AOD, TISA, and TIA in cataract and combined groups (p <0.034). A small preoperative ACD was related to smaller preoperative AOD, TISA, TIA (r > 0.649, p <0.001), and postoperative IOP reduction in the cataract and combined groups (r = 0.377, p = 0.018 and r = 0.559, p = 0.001, respectively). CONCLUSIONS: Compared to the vitrectomy group, the cataract and combined groups showed reduced postoperative IOP and increased AOD, TISA, and TIA. In these two groups, patients with shallower preoperative ACDs showed greater changes in IOP after surgery. Changes in IOP after surgery are thought to be related to changes in the anterior segment caused by the removal of the crystalline lens.

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ABSTRACT Purpose: To evaluate the quality of life and stress level related to visual function following pediatric cataract surgery in a Brazilian public hospital. Methods: This prospective study analyzed children aged 6-14 years old who underwent cataract surgery. The Childhood Stress Scale and Children's Visual Function Questionnaire (CVFQ) were used to assess stress levels and quality of life, respectively. Both instruments were applied by two psychologists before and after the surgery. Eye examination was performed by two ophthalmologists. Preoperative and postoperative data were compared. Results: In total, 23 children (32 eyes) were enrolled in the study, of which 9 had bilateral cataracts. The average age group at the time of surgery was 9.65 ± 2.26 (6-14) years old. One month after the surgery, the spherical equivalent was -0.90 ± 1.66D, and the corrected distance visual acuity was 0.13 ± 0.10 (0-0.3) LogMAR in bilateral cases and 0.50 ± 0.39 (0-1.3) LogMAR in unilateral cases (p<0.01). According to the Childhood Stress Scale, 77.7% of the bilateral cases and 57.1% of the unilateral cases had stable stress levels, and 34.7% of the children improved their stress level. The analysis of the CVFQ was based on scores for general health, general vision health, competence, personality, and treatment. After cataract surgery, 78.2% of the patients had improved or maintained CVFQ scores in the general health domain; 82.6%, general vision health; 95.6%, competence; 56.5%, personality; and 78.2%, treatment. Conclusion: Pediatric cataract surgery improves the visual function and the quality of life even in patients undergoing surgical procedures, without increasing the stress levels.

RESUMO Objetivo: Avaliar a qualidade de vida e o nível de estresse relacionada à função visual após a cirurgia de catarata pediátrica em um hospital público brasileiro. Métodos: Estudo prospectivo em crianças de seis a 14 anos submetidas à cirurgia de catarata. A Escala de Stresse Infantil e o Questionário de Função Visual em Crianças foram usados para avaliar o nível de estresse e a qualidade de vida, respectivamente. Ambos os instrumentos foram aplicados por duas psicólogas antes e após a cirurgia. O exame oftalmológico foi realizado por dois oftalmologistas. Os dados coletados no pré e pós-operatório foram comparados. Resultados: Vinte e três crianças (32 olhos) foram incluídas no estudo, nove delas apresentavam catarata bilateral. A média de idade na cirurgia foi de 9,65±2,26 (6 a 14) anos. Um mês após a cirurgia, o equivalente esférico foi de -0,90 ± 1,66D e a acuidade visual corrigida a distância foi de 0,13 ± 0,10 (0-0,3) LogMAR em casos bilaterais e 0,50 ± 0,39 (0-1,3) LogMAR em casos unilaterais (p<0.01). De acordo com a Escala de Stresse Infantil, 77,7% dos casos de catarata bilaterais, e 57,1% dos casos unilaterais mantiveram o nível de estresse e 34,7% das crianças melhoraram o nível de estresse. A análise do Questionário de Função Visual em Crianças foi baseada em pontuações para saúde geral, saúde geral da visão, competência, personalidade e tratamento. Após a cirurgia de catarata, 78,2% dos pacientes melhoraram ou mantiveram o escore do Questionário de Função Visual em Crianças na saúde geral, 82,6% na saúde geral da visão, 95,6% na competência, 56,5% na personalidade e 78,2% no tratamento. Conclusão: A cirurgia de catarata pediátrica melhora a função visual e a qualidade de vida em pacientes submetidos a procedimento cirúrgico, sem aumentar o nível de estresse.

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ABSTRACT Purposes: This study aimed to determine the association of the long-term refractive outcomes of cataract surgery with self-reported visual function obtained using Catquest-9SF. Methods: Patients recruited from the cataract outpatient clinic of VER MAIS Oftalmologia underwent a complete ophthalmologic examination. Patients who were diagnosed with cataract with indications for phacoemulsification and intraocular lens implantation received the Catquest-9SF questionnaire before and after surgery at 30 days and 1 year. Results: A total of 133 patients were recruited, but 32 patients were lost to follow-up; finally, data from 101 patients (48 men, 53 women) were analyzed. The crude variance explained by the data was 69.9%, and the unexplained variance in the first contrast was 2.39 eigenvalues (>2); thus, these results are different from those expected from random data. The people separation index was 2.95 (>2), and the people trust value was 0.9 (>0.8). These indices were evaluated in the assessment of skill levels. Visual acuity was the main variable that correlated with the Catquest score. Conclusions: The Catquest-9SF translated into Portuguese proved to be a one-dimensional and psychometrically valid tool to assess visual dysfunction in patients with cataract, and it is successful in objectively quantifying improvements after surgery. The results of this tool could be predictive and concordant of visual acuity improvement.

RESUMO Objetivo: Associar os resultados refrativos a longo prazo da cirurgia de catarata e a função visual autorreferida pelo questionário Catquest-9SF. Métodos: Paciente recrutados no ambulatório de catarata da VER MAIS Oftalmologia, foram submetidos a exame oftalmológico completo. Após diagnóstico de catarata com indicação de tratamento cirúrgico com facoemulsificação e implante de lente intraocular, o questionário foi aplicado antes da intervenção, 30 dias após cirurgia e 1 ano após, novamente. Resultados: Foram recrutados 133 pacientes. No decorrer do seguimento, 32 pacientes foram perdidos e ao final foram analisados os dados de 101 pacientes, dos quais 48 foram homens e 53 foram mulheres. A variância bruta explicada por dados foi de 69,9% e a inexplicada em primeiro contraste por 2,39 eigenvalores, sendo maior que 2, o que nos mostra que são resultados differentes dos esperados de dados aleatórios. O índice de separação de pessoas foi de 2.95 (>2) e o valor de confiança de pessoas foi de 0,9 (>0,8). Estes índices são os valores mínimos aceitáveis na diferenciação de níveis de habilidade. Acuidade visual foi a principal variável correlacionada com o score do Catquest. Conclusões: O Catquest-9SF traduzido para o português se demonstrou unidimensional e uma ferramenta psicometricamente válida para avaliar disfunção visual em pacientes com catarata, além de ter tido sucesso para quantificar objetivamente melhoras após a intervenção cirúrgica. Essa ferramenta pode ser utilizada como preditiva e concordante da melhora da acuidade visual.

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ABSTRACT We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.

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RESUMO Objetivo: Avaliar o filme lacrimal e os sintomas de olho seco antes e após a realização da facoemulsificação. Métodos: Participaram deste estudo clínico 51 pacientes diagnosticados com catarata (55% mulheres; 78% brancos; 71,2 ± 6,5 anos de idade; sem uso de colírio lubrificante) que foram submetidos à facoemulsificação em um hospital na cidade de Aparecida (SP). A análise do filme lacrimal foi feita pelo teste de ruptura do filme lacrimal, e os sintomas de olho seco foram avaliados pelo Índice de Doença da Superfície Ocular, ambos antes da cirurgia e 30 e 60 dias de pós-operatório. Resultados: Na análise pré-operatória, 25,5% dos pacientes tinham olho seco pelo critério subjetivo (Índice de Doença da Superfície Ocular ≥ 25%), enquanto a proporção de pacientes com olho seco foi de 92,2% pelo critério objetivo (teste de ruptura do filme lacrimal < 10 segundos). Não houve correlação entre o teste de ruptura do filme lacrimal e o Índice de Doença da Superfície Ocular (r = −0,14; p = 0,33). Não foi observada redução dos sintomas de olho seco (15,9 ± 17,6 versus 12,2 ± 13,2 versus 7,8 ± 11,5; p < 0,001) e nem do tempo de ruptura do filme lacrimal (6,2 ± 2,2 vs. 4,3 ± 2,0 versus 6,9 ± 2,0 segundos; p < 0,001) no pré, 30 e 60 dias após a cirurgia. Conclusão: A facoemulsificação desencadeia sintomas de olho seco e altera os valores do teste de ruptura do filme lacrimal e do Índice de Doença da Superfície Ocular, havendo melhora depois da cirurgia, com o passar dos dias. Observou-se que, após os 60 dias, os sintomas de olho seco avaliados pelo Índice de Doença da Superfície Ocular apresentaram melhora. Em relação ao filme lacrimal, avaliado pelo teste de ruptura do filme lacrimal, observou-se que houve piora estatisticamente significativa aos 30 dias, seguida de melhora no pós-operatório de 60 dias. Os resultados sugerem que a análise clínica do olho seco deve ser realizada por diferentes métodos, preferencialmente objetivos.

ABSTRACT Objective: To evaluate the tear film and dry eye symptoms before and after phacoemulsification. Methods: Fifty-one patients diagnosed with cataracts participated in this clinical study (55% female; 78% white; 71.2 ± 6.5 years old; without the use of lubricating eye drops) and underwent phacoemulsification at a hospital in Aparecida (SP). Tear film analysis was performed by the tear film break-up test and dry eye symptoms were assessed by the Ocular Surface Disease Index, both before surgery and 30 and 60 days after surgery. Results: In the preoperative analysis, 25.5% of the patients had dry eye according to the subjective criterion (Ocular Surface Disease Index ≥ 25%), while the proportion of patients with dry eye was 92.2% according to the objective criterion (tear film break-up test < 10 seconds). There was no correlation between tear film break-up test and Ocular Surface Disease Index (r = −0.14; p = 0.33). There was no reduction in dry eye symptoms (15.9 ± 17.6 versus 12.2 ± 13.2 versus 7.8 ± 11.5; p<0.001) nor in tear film break-up time (6.2 ± 2.2 versus 4.3 ± 2.0 versus 6.9 ± 2.0 seconds; p < 0.001) before, 30 and 60 days after surgery. Conclusion: Phacoemulsification triggers dry eye symptoms and changes Ocular Surface Disease Index and tear film break-up test values, with improvement over the postoperative days. Sixty days after surgery, the symptoms of dry eye assessed according to the Ocular Surface Disease Index improved. Regarding the tear film, evaluated by tear film break-up test, it was observed that there was a statistically significant worsening at 30 days, followed by an improvement in the postoperative period of 60 days. The results suggest that the clinical analysis of dry eye should be performed using different methods, preferably objective ones.