Higher Order Aberrations in Femtosecond Laser-Assisted Versus Manual Cataract Surgery: A Retrospective Cohort Study.

Purpose: To evaluate differences in higher order aberrations (HOAs) between femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery.

Methods: In this retrospective cohort study, consecutive patients undergoing FLACS or manual cataract surgery with implantation of an intraocular lens from January 2017 to February 2018 were recruited. Patients underwent aberrometry testing at least 2 months postoperatively.

[Complementarity between randomised controlled trials and observational registries : the example of cardiovascular prevention with SGLT2 inhibitors].

Evidence-based medicine (EBM) is mainly supported by the results of randomised controlled trials (RCTs). If the latter offer guarantees of reliability, especially by minimizing the influence of confounding factors and potential biases, they also have limitations. Observational databases resulting from real life registries, if possible build in a prospective manner, may offer some solutions, but are also exposed to limitations.

[STRENGTHS AND WEAKNESSES OF RANDOMISED CLINICAL TRIALS: EVOLVING CHANGES ACCORDING TO PERSONALIZED MEDICINE].

Randomised Controlled Trials (RCTs) represent the cornerstone of Evidence-Based Medicine (EBM). Based upon the rules of Good Clinical Practice (GCP), they offer many strengths but also present some weaknesses. The rigorous methodology used allows avoid bias related to confounding factors (through a control group), selection bias (through randomisation) and interpretation bias (through double blinding).

Implantation of multifocal intraocular lenses using a magnification strategy in cataractous eyes with age-related macular degeneration.

Purpose: To examine visual function after targeting -2.0 diopter (D) spherical equivalent (SE) when implanting a multifocal intraocular lens (IOL) in eyes with cataract and age-related macular degeneration (AMD).

Setting: Three private practices.

A new system, the LipiFlow, for the treatment of meibomian gland dysfunction.

Purpose: To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress (WC) for adults with meibomian gland dysfunction (MGD).

Methods: This was a non-significant risk, prospective, open-label, randomized, crossover multicenter clinical trial. One hundred thirty-nine subjects were randomized between LipiFlow (n=69) and WC control (n=70).

[Strategies avoiding inertia and non compliance in clinical trials].

Randomised controlled trials play a key role in evidence-based medicine as far as the assessment of both efficacy and safety of drugs is concerned. Various strategies are used to avoid physician's inertia and to combat patient's non compliance, two pitfalls that may hinder the demonstration of the therapeutic efficacy of the drug. Clinical inertia may be limited by titration, forced or optional, driven by therapeutic targets, or by the use, if necessary, of rescue medications.

Severe photic phenomenon.

A 69-year-old man who had uneventful bilateral cataract surgery with visual acuity of 20/15 without correction presented with severe dysphotopsia. Treatment with brimonidine (Alphagan) or pilocarpine did not resolve the symptoms. A multipiece silicone intraocular lens was piggybacked into the sulcus, and the patient no longer reported dysphotopsia.

Light-transmission-spectrum comparison of foldable intraocular lenses.

Purpose: To compare the light transmittance of 4 currently marketed intraocular lenses (IOLs) with that of the new AcrySof Natural IOL (Alcon Laboratories, Inc.), which is designed to mimic the light-attenuating characteristics of the human crystalline lens.

Setting: Research laboratory, Alcon Research, Ltd.

Posterior capsule opacification and neodymium: YAG capsulotomy rates with AcrySof acrylic and PhacoFlex II silicone intraocular lenses.

Purpose: To compare the incidence and severity of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between AcrySof(R) MA30BA acrylic (Alcon) and PhacoFlex(R) II SI-40NB silicone (AMO) intraocular lenses (IOLs).

Setting: Outpatient Cataract Surgery Center, TLC Eyecare and Laser Center, Jackson, Michigan, USA.

Methods: AcrySof and PhacoFlex II IOLs were implanted in fellow eyes of 156 patients requiring bilateral cataract extraction.

[Prevention of type 2 diabetes: lifestyle changes or pharmacological interventions?].

The World Health Organisation strongly recommends strategies for the prevention of type 2 diabetes, knowing the epidemics of the disease and its strong association with that of obesity. Several intervention studies, in China ("Da-Qing Study"), in Europe ("Malmö study", "Finnish Diabetes Prevention Study") and in the United States ("Diabetes Prevention Program"), showed that lifestyle change are able to reduce by around 50% the incidence of type 2 diabetes in at risk individuals. Various pharmacological approaches have also proven their efficacy in preventing type 2 diabetes, but in most cases with less impressive reductions, between 25% and 35%.

New antiobesity agents in type 2 diabetes: overview of clinical trials with sibutramine and orlistat.

Besides genetic predisposition, obesity is the most important risk factor for the development of type 2 diabetes mellitus. Even modest weight reduction can improve blood glucose control in overweight subjects. After failure of lifestyle modifications, antiobesity drugs such as orlistat, a potent and selective inhibitor of gastric and pancreatic lipases that reduces lipid intestinal absorption, or sibutramine, a noradrenaline and 5-hydroxytryptamine reuptake inhibitor that regulates food intake, may be considered to favour weight loss and/or weight maintenance.

Cataract surgery after holmium:YAG laser thermal keratoplasty.

A 64-year old man had noncontact holmium:YAG (Ho:YAG) laser thermal keratoplasty (LTK) performed in the left eye on March 10, 1998, and in the right eye on January 11, 1999. The patient achieved 1.3 diopters (D) and 1.

Occurrence of pigment precipitates after small incision cataract surgery.

Purpose: To assess the incidence of pigment precipitates and potential association with glaucoma, diabetes, and/or intraocular lens (IOL) optic center thickness in patients having small incision cataract surgery and foldable IOL implantation.

Setting: Eye Care Physicians of Michigan, Jackson, Michigan, USA.

Methods: A retrospective data analysis was conducted of patients with a preoperative diagnosis of glaucoma or diabetes or in whom pigment precipitates had been reported after cataract surgery.

Posterior limbal incision.

Background: Sutureless cataract incisions should ideally remain sealed with increased intraocular pressure and be able to withstand increased external pressure to the posterior aspect. Cadaver eye studies have shown that meeting these criteria requires an internal corneal lip of at least 1.5 mm and a square wound.

Endothelial cell loss after 4 mm cataract surgery.

To assess whether a 4 mm scleral tunnel incision with a 1.5 mm internal corneal lip (three-step procedure) causes increased endothelial cell loss and damage to the cornea, we retrospectively evaluated the outcomes of 20 patients (40 eyes) who had a standard 4 mm scleral tunnel incision (two-step procedure) in one eye followed by a three-step incision in the second eye, with in situ phacoemulsification and insertion of a foldable silicone lens in each eye. Mean phacoemulsification time was 2.

Relative stability of clear corneal incisions in a cadaver eye model.

Three different clear corneal square incisions--beveled (or paracentesis), stepped, and hinged--were studied in a cadaver eye model to determine whether a critical width existed for each incision type at which resistance to external pressure changed substantially, given identical tunnel length (1.75 mm to 2.00 mm) for each incision.

Relative strength of scleral corneal and clear corneal incisions constructed in cadaver eyes.

Square scleral corneal, square clear corneal, and rectangular clear corneal incisions were constructed in six cadaver eyes that had no previous intraocular surgery. The 3.2 mm or smaller wounds had sutureless closures.

Corneal lip tunnel incision.

To evaluate whether the corneal lip tunnel incision or the sutureless closure causes any refractive problems, we performed a retrospective study on 387 cataract surgery patients who were divided into four groups based on type of wound closure and whether the corneal lip was made. The four groups consisted of patients who received an X-stitch closure without the corneal lip, a horizontal mattress stitch without the lip, a horizontal mattress stitch with the lip, and a sutureless closure with the lip. All patients had phacoemulsification in situ; implantation of a foldable silicone lens was performed through a scleral tunnel incision.

Scleral tunnel incision with internal corneal lip in patients with low preoperative corneal endothelial cell counts.

We studied 40 eyes from patients with pre-existing corneal endothelial cell dystrophy (endothelial cell counts of less than or equal to 1,200/mm2) to assess whether the scleral tunnel incision with internal corneal lip and phacoemulsification in situ procedure affected the cornea. Identification of endothelial cell dystrophy by measuring preoperative endothelial cell counts was important so minor modifications of decreased phacoemulsification power and frequent viscoelastic endothelial coating could be made to prevent damage to the eyes. The procedures had no effect on corneal thickness or endothelial cell counts.

Relative strength of scleral tunnel incisions with internal corneal lips constructed in cadaver eyes.

We constructed scleral tunnel wounds with internal corneal lips and sutureless closures in ten cadaver eyes without previous intraocular surgery. Each wound differed in width, total incision length, and internal corneal lip size. At a low and high range of initial intraocular pressure (IOP, 10 to 15 mm Hg or 20 to 25 mm Hg), we compared the wounds' resistance to leakage during application of external pressure.

Relative strength of cataract incisions in cadaver eyes.

We evaluated the strength of various incisions used in cataract surgery in cadaver eyes. Fluid was forced into the eye through a paracentesis incision and measured via a second paracentesis incision connected to a pressure transducer. In four eyes with the limbal, two-step procedure and radial sutures, leakage from the wound was seen at 100 mm Hg to 120 mm Hg, and iris prolapse through the wound occurred at 160 mm Hg to 400 mm Hg.