PIE Magazine Issue 03, distributed in Lisbon, Portugal, the venue of The XXXV Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2017) was one of the rare occasions we tackled issues where anterior and posterior segments collide.
EyeMax IOL: A New Approach to Macular Disease
The EyeMax™ IOL is a single piece acrylic IOL implanted during routine phacoemulsification surgery. Its hyper-aspheric optics project better focused images 10 degrees around the central macula compared to standard monofocal IOLs. In a study of 54 eyes with initial cataract and AMD, patients received phacoemulsification with EyeMax implant. The postoperative refractive target was +2.0 (with spectacles). Patients were followed-up at month 6, up to month 18. According to Dr. Federico Badala from the Micro Chirurgia Oculaire, Milano, Italy, visual acuity improved in all AMD patients at 6 months follow-up following the implantation of EyeMax IOL. Smaller macular lesions were associated with greater improvements postoperatively. In addition, visual acuity better than 1/10 showed significantly greater improvements on follow up. Furthermore, binocular implants of EyeMax were associated with greater than expected improvements in visual acuity. The EyeMax implant was developed by surgeon Bobby Qureshi and Professor Pablo Artal, an optics expert at the University of Murcia in Spain, and the procedure is only available privately.
Low Visual Acuity after Uncomplicated Phacoemulsification: Suspect an Acute Serous Macular Detachment
In a poster presented at ESCRS Congress in Lisbon, Portugal, last October 2017, Dr. Anna Nowinska and colleagues from the Medical University of Silesia, Poland, reported a case of early serous macular detachment and edema after uncomplicated phacoemulsification surgery. The case was reported in a 46-year-old patient who presented 10 years after ocular blunt injury. Documented preoperative findings were normal, and the retinal morphology was assessed normal by optical coherence tomography (OCT). Subsequently, patient underwent an uncomplicated phacoemulsification surgery (2.6mm) with intraocular posterior capsule acrylic lens implantation. OCT examination revealed an acute serous macular detachment and edema. By day 2 postoperatively, central macular retinal thickness had increased to 537 um. At this point patient received oral acetazolamide, nimesulidum, polphillin, topical dexamethasone and yellox. On day 7 postoperatively, OCT scan showed that central retinal thickness had reduced to 189 um. Further evaluation on day 10 postoperatively revealed that best corrected visual acuity (BCVA) had improved to 0.8 and OCT scan showed central retinal thickness of 189 um, and intra-/sub-retinal fluid fully reabsorbed. Subsequent follow-up at month 6 showed no recurrence of macular detachment or edema. The authors therefore concluded from this case report that “acute serous macular detachment should be considered on cases of low visual acuity during early postoperative period after uncomplicated phacoemulsification surgery” and that “OCT examination may be useful in early diagnosis”.
Is Phacoemulsification Safe in Patients Receiving Anti-VEGF for Neo-vascular AMD?
In recent years, interest has focused on the understanding of visual and anatomic outcomes of phacoemulsification surgery in patients receiving anti-VEGF therapy. Dr. David Ellis and colleagues from the East Sussex NHS Trust shared interesting data on this at the ESCRS 2017 in a poster titled Long term visual and anatomical outcomes in patients with active neovascular age-related macular degeneration (nAMD) following cataract surgery the authors conducted a retrospective review of clinical data from patients at
the East Sussex Healthcare NHS Trust. The study included nAMD patients receiving anti-VEGF therapy who had undergone phacoemulsification. Optical coherence tomography (OCT) scans, best corrected visual acuity (BCVA), central retinal thickness and macular volume was collected preoperatively and at month 1 and month 12 follow-up visits. In this study, the authors found significant improvements in BCVA at 1 month and further improvements at 12 months. There was a marginal central retinal thickening that increased at 1 and 12 months postsurgery. Macular volume was not significantly increased postsurgery. Based on these findings, the authors concluded that “overall,
it appears safe to perform phacoemulsification in patients with active nAMD when considering both visual outcomes and anatomical changes”.
Editor’s Note: The XXXV Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2017) was held in Lisbon, Portugal, on October 7-11, 2017. Reporting for this story also took place at ESCRS 2017.