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BACKGROUND: To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection ("Viscolift technique") in patients with severely subluxated cataracts. METHODS: In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. RESULTS: Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The "Viscolift technique" resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p < 0.001) at the last follow-up. No major complications were noted. CONCLUSIONS: The "Viscolift technique" proved to be a safe and effective surgical approach for recentering and elevating subluxated cataracts, thus allowing the surgeon to perform an easier and better-centered capsulorhexis.

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Vogt-Koyanagi-Harada syndrome (VKH) is an uncommon multi-system autoimmune inflammatory disorder characterized by bilateral granulomatous panuveitis with serous retinal detachment accompanied by neurological, auditory, and cutaneous manifestations like headache, hearing loss, vitiligo, and poliosis. It has a female preponderance, usually in middle age. We report the case of a 20-year-old male who presented to us with rapidly progressive visual loss accompanying granular panuveitis, complicated cataract, and a mixed mechanism neovascular glaucoma with acute angle closure. He was treated for IOP control and underwent aggressive immunosuppression and, later, bilateral laser iridotomies. It wasn't until one month after the initial presentation that he presented with vitiligo and poliosis of the eyebrows and eyelashes, clinching the diagnosis of VKH syndrome. This case highlights the diagnostic challenge faced due to acute neovascular glaucoma being the initial presenting feature of VKH; hitherto not documented before, although acute angle closure glaucoma or crisis has occasionally been reported at presentation; the classical VKH presentation being an acute posterior segment uveitis or less commonly, a chronic, recurrent panuveitis presenting with/ without complications. This case underlines the importance of considering VKH syndrome in a patient with bilateral granulomatous panuveitis, as dermatological involvement can emerge later in the disease course, by which time vision might have already been compromised significantly.

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A 71-year-old, one-eyed female patient presented with a loss of vision in the right eye due to trauma 20 years ago and a progressive diminution of vision in the left eye over the past six years. An ambiguous history of some surgery performed on the left eye was elicited, with no available records, adding an element of uncertainty to this case. Visual acuity (VA) was noted as no light perception (No PL) in the right eye and light perception with accurate projection of rays (PL+, PR accurate) in the left eye. Anterior segment slit-lamp evaluation of the right eye showed a shrunken globe with low intraocular pressure (IOP). The left eye exhibited signs of chronic uveitis with occlusio pupillae, non-visualization of the lens, and a doubtful conjunctival bleb with scleral thinning superior to the limbus. B-scan evaluation was suggestive of phthisis in the right eye and an equivocal lens shadow in the left eye. A yttrium aluminum garnet (YAG) pupillary membranotomy was planned for the left eye under steroid cover and was cautiously attempted, successfully detaching the occlusio membrane and revealing an underlying complicated cataract beneath it. Post-laser, medical management included topical anti-glaucoma and steroid medications, along with systemic steroids. The VA improved from PL+, PR accurate to 3/60 (improving to 6/60 with a Retinal Acuity Meter). After stabilization of the uveitis over the next few weeks and under a steroid cover, a temporal clear-corneal phacoemulsification was cautiously performed with intra-operative management of the small pupil, and a hydrophobic lens was implanted. At one month post-surgery, the patient's best-corrected visual acuity had improved to 6/12 for distance and N6 for near. This report highlights a compelling instance wherein the neodymium:Yttrium-aluminum-garnet (Nd:YAG) laser was efficaciously employed for a lesser-known application in resolving a diagnostic dilemma and for instituting an interim treatment strategy in a challenging case involving a one-eyed patient prior to planning a definitive surgery. This case emphasizes the importance of thinking out of the box, ensuring comprehensive preoperative and careful intra-operative precautions in the management of patients diagnosed with complex ocular inflammatory conditions, so as to optimize visual outcomes, eventually resulting in achieving a gratifying reduction of visual disability and improvement of quality of life.

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PURPOSE: In the present study, we aimed to evaluate the efficacy of the bandage contact lens (BCLs) in the treatment of dry eye disease (DED) after complicated cataract or/and intraocular lens (IOL) surgery. METHODS: In this retrospective, single-centered, observational study, we collected data from 69 patients who underwent complicated cataract or/and IOL surgery. Of these, 35 cases wore their own BCLs immediately after the operation, while the other 34 cases did not have their own BCLs and were instead covered with gauze. The Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp microscope examination, keratograph analysis, and Schirmer I test were measured at baseline, 1 week and 1 month postoperatively. RESULTS: In the BCL group, the score of the OSDI questionnaire was significantly decreased at 1 week and 1 month postoperatively compared with baseline levels (P = 0.000, collectively). Moreover, the fluorescein staining score of the BCL group was remarkably decreased 1-week and 1-month postoperatively compared with the non-BCL group (P = 0.000 and P = 0.000, respectively). Furthermore, the redness score of the BCL group was also better compared with the non-BCL group at 1 week and 1 month postoperatively (P = 0.014 and P = 0.004, respectively). CONCLUSIONS: Complicated cataract or/and IOL surgery would intensify the DED. Early application of BCLs postoperatively improved patients' comfort and alleviated dry eye-related symptoms and signs. Furthermore, this mechanism might involve the acceleration of corneal epithelial healing, the alleviation of ocular stress response and the stabilization of the tear film. TRIAL REGISTRATION: Trial registration ClinicalTrials, NCT04120389. Registered 10 October 2019-retrospectively registered.

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INTRODUCTION: To describe a novel surgical approach in the management of subluxated cataracts. METHODS: A 70-year-old Caucasian male with a subluxated cataract in the left eye was referred to our clinic at the Azienda Ospedaliero-Universitaria di Bologna- Ophthalmology Unit. The ophthalmic examination revealed a best-corrected visual acuity (BCVA) of 20/200 in the left eye with monocular diplopia and a severely subluxated NO6/NC6 cataract and the fundus examination did not reveal any vitreoretinal abnormalities. The right eye had 20/20 BCVA and was pseudophakic. After a 300° conjunctival peritomy, a single 25-gauge valved trocar 4 mm was inserted from the limbus in the inferotemporal quadrant, where the cataract was mainly dislocated and a corneal paracentesis to reduce the anterior chamber intraocular pressure was performed. Subsequently cohesive viscoelastic was progressively injected in the retrolental space through the trocar, to recenter and elevate the subluxated cataract. Thereafter, a complete centered capsulorhexis was performed, four capsular hooks were inserted to stabilize the bag, and complete phacoemulsification was performed with intact posterior capsular support. In the end, given the lack of capsular support elements such as the Cionni ring or Ahmed segment, a sutureless scleral fixated intraocular lens was implanted. RESULTS: One week after surgery, the BCVA was 20/25, and the final BCVA at 6 months was 20/20, without any complications. CONCLUSIONS: Retrolental cohesive ophthalmic viscoelastic injection could represent a novel effective surgical approach in recentering and elevating subluxated cataracts, facilitating the capsulorhexis, and reducing the risk of a pars plana approach.

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A ten-year-old male child was referred with complaints of blurring of vision and deviation of the eye. On examination, the right eye has an esodeviation squint with a best corrected visual acuity of 6/60 Snellen's acuity and 6/6 Snellen's acuity in the left eye. Slit-lamp biomicroscope of the right eye showed coloboma at the 9 o'clock position with cataract. The rest of the anterior and posterior segments was normal in both eyes. Thus, a diagnosis of unilateral lens coloboma with amblyopia was made.

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Herpes simplex virus uveitis without corneal reactivation is more frequent than previously thought. Although herpes simplex virus has been implicated as a cause of postoperative uveitis and endophthalmitis, it has not been reported as a cause of acute postoperative endophthalmitis within the early postoperative period, specifically within one week following cataract extraction. A 55-year-old man with vascularized irregular central disc-shaped stromal corneal opacity with complicated cataracts underwent cataract surgery. Intraoperatively, there was posterior capsular rent, requiring anterior vitrectomy. On postoperative day three, the patient had an increase in inflammation in the anterior chamber (grade 4+) with marked vitreous haze (grade 4). Vitreous taps were negative for bacteria and fungi, and despite intravitreal injections of vancomycin and ceftazidime, the patient had worsening of inflammation with increasing exudates and the appearance of the fibrinous membrane in the anterior chamber. Polymerase chain reaction (PCR) of aqueous and vitreous samples at this point of time yielded positive serology for herpes viral DNA, and the patient was started on oral valacyclovir. The ocular inflammation resolved soon after switching to oral valacyclovir. Typical acute postoperative endophthalmitis starts two to seven days after surgery, and the most common isolate in vitreous biopsies is coagulase-negative staphylococci. We report a rare case of acute-onset herpetic endophthalmitis presenting within 72 hours following cataract surgery for a complicated cataract in a patient with a history of pre-existing healed viral keratitis. Our case highlights that a suspicion of viral endophthalmitis should be kept in mind as a cause of acute-onset post-cataract surgery endophthalmitis, especially in cases of surgery that fail to yield a positive result on Gram's stain, culture or PCR for bacteria and fungi.

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Purpose: To evaluate the outcomes of operating on "complex cataracts" by the glaucoma fellows. Patients and Methods: This was a retrospective study done at a tertiary referral eye care centre in eastern India. After obtaining IRB approval, a retrospective chart review of all patients who underwent "complex" cataract surgery by one of four long-term (2 years) glaucoma fellows between January 2016 and November 2020 was conducted. 'Complex' was defined as cataracts complicated with pseudoexfoliation syndrome, phacodonesis with or without blunt ocular trauma, posterior polar cataract, small pupil, co-existent corneal opacity or uveal coloboma, post-glaucoma filtering surgery, post-vitreoretinal surgery, co-existent glaucoma or post-laser iridotomy and monocular patients. Results: Out of a total of 677 eyes done by the glaucoma fellows during the study period, 83 eyes had complex cataract surgery and completed the six-week post-operative follow-up. Intraoperative surgical complications like posterior capsular rent or vitreous loss were noted in 36 of the cases. Thirty of the eyes were left aphakic. Despite a high rate of complications, the LogMAR best-corrected visual acuity (mean ± standard deviation) improved from the preoperative level of 1.7 (±0.5) to 1.0 (± 0.8) at post-operative six weeks, significant at p < 0.001. As far as the surgeon's experience was concerned-less than or more than a year since joining the fellowship-there was statistically no difference in the final visual acuity. The group with greater experience had shorter surgical time and lesser complications though this difference was not statistically significant. Conclusion: This is the first study in the literature reporting the outcomes of "complex" cataract surgery performed by glaucoma fellows. Though high rates of postoperative complications were noted in this study, the mean best-corrected visual acuity improved significantly in all eyes after the surgery.

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AIM: To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis (TGU). METHODS: Patients of cataract with TGU in the membranous (inactive) stage underwent cataract surgery with intraocular lens (IOL) implantation. Preoperative history and ophthalmic examination were conducted for all cases, whereas Schimphlug imaging and corneal topography were done for some patients. Postoperative follow up was done on the 1st, 2nd, and 5th postoperative days after surgery. Then, it was done at least at one, three, and six months postoperatively. Intraoperative and postoperative complications and the methods of their management were reported. RESULTS: Twelve eyes of 12 male children were included in this study ranging from 8 to 16y. The mean best corrected Snellen visual acuity (BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively (P<0.001). Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea. Intraoperative difficulties and complications included the poor dilatability of the drown down pupil, strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema. All cases underwent primary hydrophobic IOL implantation. CONCLUSION: Surgery for this type of cataract is relatively safe and effective. It is associated with some specific difficulties and complications that should be considered during surgery and follow up.

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Purpose: Cataract development is a common sequelae associated with uveitis. Despite phacoemulsification being the popular method of cataract surgery today, manual small-incision cataract surgery (MSICS) may still be a safe and effective alternative because of several inherent benefits. There is not much literature and studies on the efficacy and safety of MSICS under topical anesthesia in complicated cataract in patients with uveitis. We aimed to study the safety and visual outcome of MSICS under topical anesthesia for post uveitis complicated cataract. Methods: This was a retrospective observational study. The electronic medical records of adult patients who underwent MSICS under topical anesthesia for post uveitis cataract were reviewed. The records were reviewed and analyzed for preoperative clinical characteristics and visual acuity, intraoperative complications and postoperative visual acuity, and complications. Results: A total of 71 eyes of 59 patients were taken for final analysis. The average age of patients was 59.9 years. There was improvement in the best corrected visual acuity by 0.7 logMAR (P value <0.0001). Average follow-up period was 9.8 months. The mean gain in visual acuity in eyes that received preoperative steroids was 0.6 logMAR compared to the eyes that did not receive steroids (0.71 logMAR). The difference was not statistically significant (P = 0.407). Complications seen during long-term follow-up were recurrence (15.5%), cystoid macular edema (7%), Epiretinal membrane (8.5%), and posterior capsular opacification (5.5%). Conclusion: With proper technique and precautions, MSICS can be safely and comfortably performed under topical anesthesia even in complicated cataracts with excellent visual and safety outcomes.

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INTRODUCTION: In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations. METHODS: We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw "Artisan®" intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. RESULTS: In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema. CONCLUSIONS: This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.

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@#AIM:To evaluate the visual quality of different types of cataracts by double-pass optical quality analysis system(OQAS).<p>METHODS: A cross-sectional study was conducted. Totally 30 age-related cataract patients(30 eyes), which were aged group, with an average age of 71.69±3.79 years, thirty patients(30 eyes)with complicated cataract were in the complicated group with an average age of 61.00±4.56 years and 30 normal patients(30 eyes)were in the normal group, with an average age of 65.34±4.06 years old, both of which with naked eye vision(UCVA)≤0.5, and from June 2019 to June 2020 in the eye Center of Renmin Hospital of Wuhan University were collected. The ocular surface and optical quality examination on the patient's visual quality, including anterior chamber depth(ACD), ocular axis(AL), IOP, corneal curvature(K), objective scattering index(OSI), MTF cut off frequency(MTF cut off), Sterl ratio(SR), contrast sensitivity VA100%, VA20%, VA9% and other visual quality were operated by the same doctor. <p>RESULTS: Compared with glaucomatous cataract, the MTF cut off of uveitis cataract was lower(<i>P</i>=0.025), but higher than that of fundus cataract(<i>P</i>=0.013), and diabetic cataract(<i>P</i>=0.001). The MTF cutoff value of glaucomatous cataract was higher than that of fundus cataract(<i>P</i>=0.013), and diabetic cataract(<i>P</i>=0.007); the MTF cutoff of fundus cataract was higher than that of diabetic cataract and there was significant difference(<i>P</i>=0.010).<p>CONCLUSION: There are some differences in the ocular surface and visual quality parameters of each subtype of complicated cataract, especially MTF cut off, so we should paid attention to the cataract types before surgery.

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@#AIM: To explore the postoperative refractive error and influence factors using the Optical Biometry(IOL Master)in patients with silicone oil filled eye complicated cataract after silicone oil removal combined with cataract surgery.<p>METHODS: From August 2020 to November 2020 in the Affiliated Eye Hospital of Nanchang University, 41 patients with silicone oil removal combined with cataract surgery were divided into 2 groups: 18 patients(18 eyes)in high myopia group and 23 patients(23 eyes)in non-high myopia group. Collected and recorded the patients' IOL Master measurement data. Statistical analysis was performed in SPSS20.0.<p>RESULTS: The mean spherical degree or astigmatism of the IOL Master measurement and refraction in high myopia and non-high myopia group performed by paired <i>t</i>-test(<i>P</i>>0.05). The mean axial difference ΔAL were -0.28±0.29 and 0.05±0.31mm between the two groups has no difference(<i>P</i><0.05), while ΔK, mean absolute refractive error(MARE)and Δastigmatism(<i>P</i>>0.05). The preoperative and postoperative axial length(AL)in high myopia groups were 28.37±1.73 and 28.10±1.55mm(<i>t</i>=3.994, <i>P</i><0.05), yet the non-high myopia group(<i>P</i>>0.05). Bivariate linear correlation analysis: in the high myopia group, there was a moderate positive correlation between preoperative AL and MARE(<i>r</i>=0.742, <i>P</i><0.05), and a moderate negative correlation between ΔAL and MARE(<i>r</i>=-0.646, <i>P</i><0.05), but in non-high myopia group, preoperative AL, ΔAL, preoperative K, ΔK had no correlation(<i>P</i>>0.05).<p>CONCLUSION: IOL Master performed the small biostatistical error and high measurement accuracy of the intraocular lens in patients with silicone oil filled eye complicated cataract. The longer preoperative AL, the more changes in the axial length after silicone oil removal, and the greater the refractive error of patients with high myopia silicone oil filled eye complicated cataract.

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OBJECTIVE: To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees. METHODS: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20). MAIN OUTCOMES/MEASURES: Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression. RESULTS: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p<0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3). CONCLUSIONS/RELEVANCE: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.

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Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.

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@#AIM: To explore the effect of different intraocular irrigating solutions on lens opacity after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).<p>METHODS: Totally 48 subjects(48 eyes)patients with proliferative diabetic retinopathy from March 2018 to February 2019 were enrolled in this study, randomly divided into BSS intraocular irrigating solution group(23 cases and 23 eyes)and Shike intraocular irrigating solution group(25 cases and 25 eyes). LOCS grading system Ⅲ was applied to grade lens opacity. Pentacam occipital analyzer was applied to analyze the density and thickness of lens, and the results were compared and discussed.<p>RESULTS:Three months after PPV,NC, P score and the density of lens in LOCSIII grade in the two groups were significantly higher than those before surgery(<i>P</i><0.05), but the C score was not different significantly(<i>P</i>>0.05). In addition, the thickness of the lens in BSS intraocular irrigating solution group was significantly higher than that before PPV(<i>P</i><0.05), but there was no significant difference in the Shike intraocular irrigating solution group(<i>P</i>>0.05). NC, P score, the density and thickness of lens were significantly lower in Shike intraocular irrigating solution group than those in the BSS intraocular irrigating solution group. But the C score was not different significantly between the two groups(<i>P</i>>0.05).<p>CONCLUSION: Shike intraocular irrigating solution can delay the development of postoperative complicated cataract formation.

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BACKGROUND: Cataract is one of the reasons which causes impaired visual acuity (VA) of the eyes after penetrating keratoplasy (PK), which can be treated by cataract surgery after PK or triple procedure. Cataract surgery after PK has advantages that parameters of the eyes such as axial length, anterior chamber depth (ACD) as well as corneal curvature are stabilized after removing all sutures postoperatively, and intraocular lens (IOL) power can be calculated correctly. Therefore, postoperative VA will be improved significantly. In Vietnam, there have not been any study about cataract surgery after PK, therefore we conduct this research. AIM: To evaluate the outcomes of phacoemulsification cataract surgery following primary PK. METHODS: Non-randomized controlled intervention study. Ninteen eyes (19 patients) that underwent phacoemulsification plus IOL insertion after initial PK in Cornea department, Vietnam National Institute of Ophthalmology, from December 2013 to September 2014. RESULTS: All patients presented with reduced VA, including 17 eyes (89.9%) with VA ≤ 20/200, mean astigmatism was 7.9 ± 1.0 D. Clear corneal grafts in 16 eyes while corneal opacity was seen in 3 eyes. All eyes with cataract were diagnosed from grade 2. After cataract surgery, improved VA > 20/200 was achieved in 72.22% of cases. There was a markable reduce of postoperative astigmatism with 1.8 ± 0.8 D (p < 0.05). However, the immunologic graft reaction was presented in one eye, and two edematous corneas also reported after cataract surgery. After treatment, there was one cornea achieved its clarity. CONCLUSION: Phacoemulsification cataract surgery following initial PK showed good outcomes with improved postoperative VA, reduced astigmatism, and the ultimate graft survival rate was high.

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A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.

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OBJECTIVES: To determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery. MATERIALS AND METHODS: Retrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma. RESULTS: Mean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed. CONCLUSION: Prevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.

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PURPOSE: To study associations between intraoperative difficulties and changes in patient-perceived and postoperative visual function and visual satisfaction after cataract surgery. METHODS: Swedish multicenter, prospective, cross-sectional, nonrandomized, National Cataract Register study. A total of 10 979 patients (n = 10 979) who underwent cataract surgery from 2008 to 2011 completed the Catquest-9SF questionnaire before and 3 months postoperatively. Using Rasch analysis, we converted the nonparametric grading of the answers to parametric data and performed parametric statistical analyses. Multiple regression models were used to examine possible predictors associated with self-assessed visual function after cataract surgery. RESULTS: Greater improvement in self-assessed visual function was seen in patients in whom trypan blue dye was used; those without a posterior capsular tear or an ocular comorbidity; and those who were younger, female and had low preoperative corrected distance visual acuity (CDVA) or high postoperative CDVA compared with their counterparts. Significantly higher self-assessed postoperative visual function was seen in patients in whom trypan blue dye was used and those with no posterior capsular tear or ocular comorbidity and no use of capsular hooks; and those who were younger and had low preoperative or high postoperative CDVA compared with their counterparts. The risk of general dissatisfaction after cataract surgery was significantly greater in patients with a posterior capsule tear, ocular comorbidity or low postoperative CDVA, and those in whom mechanical pupillary stretching was performed. CONCLUSION: Several intraoperative difficulties, posterior capsular tear, ocular comorbidity, age, gender, and preoperative and postoperative CDVAs affect patient improvement and self-assessed visual function after cataract surgery.

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