Search Results (189)

Cataract surgery is the most common eye operation worldwide and is regarded as one of the safest procedures in medicine. Yet, despite its low complication rates, it generates a disproportionate share of litigation. The gap between excellent safety profiles and rising medico-legal claims is driven less by surgical outcomes than by patient expectations, often shaped by healthcare marketing and the promise of risk-free recovery. This narrative review explores the clinical and legal dimensions of cataract surgery, focusing on complications, perioperative risk factors, and medico-legal concepts of predictability and preventability. Particular emphasis is given to European frameworks, with the Italian Gelli-Bianco Law (Law No. 24/2017) providing a model of accountability that balances innovation and patient safety. Analysis shows that liability exposure spans all phases of surgery: preoperative (inadequate consent, poor documentation), intraoperative (posterior capsule rupture, zonular instability), and postoperative (endophthalmitis, poor follow-up). Practical strategies for risk reduction include advanced imaging such as macular OCT, rigorous adherence to updated guidelines, systematic video recording, and transparent perioperative communication. Patient-reported outcomes further highlight that satisfaction depends more on visual quality and dialogue than on spectacle independence. By translating legal principles into clinical strategies, this review offers surgeons actionable “surgical–legal pearls” to improve outcomes, strengthen patient trust, and reduce medico-legal vulnerability in high-volume cataract surgery. Full article

Retinal disorders, such as diabetic retinopathy, cataract, and glaucoma, are among the leading causes of vision loss and blindness worldwide. The use of normal data in diagnostic studies provides a basis for distinguishing between pathological and healthy conditions. Complete and accurate diagnosis of these conditions is essential for effective treatment and prevention of recurrence. This study focuses on the VGG19 model and transfer learning to classify retinal conditions such as normal, diabetic, cataract, and glaucoma. A publicly available dataset from Kaggle consisting of labeled retinal images is used for training and evaluation. The data used in this study consists of 400 retinal images, each consisting of 100 images per class, where there are four classes consisting of normal eyes, cataract, diabetic retinopathy and glaucoma. In 50 epochs of training, Adam optimization and softmax function activation, the modeling performance measured using the confusion matrix, including the accuracy, precision, recall and F1 score, achieves accuracy results of 0.91 for 320 training data and 0.88 for 80 validation data. The loss value is 0.18 for the training data and 0.31 for the validation data. Using the test data, the values of the cataract class are 0.94 for precision, 0.8 for recall, and 0.86 for the F1 score. The values are 0.91 for precision, 1.00 for recall and 0.95 for the F1 score in the diabetic retinopathy class. For glaucoma, the scores are 0.74 for precision, 0.85 for recall, and 0.79 for the F1 score. The normal class has scores of 1.00 for precision, 0.9 for recall and 0.95 for the F1 score. Given the performance test results shown above, VGG19 modeling for diagnosing retinal disease provides quite good results. Future research can expand this research by combining additional datasets and exploring other neural network architectures to improve the diagnostic performance. Full article

Background/Objectives: Cataract surgery often reveals preexisting corneal astigmatism, which can be corrected using a toric intraocular lens (T-IOL). However, postoperative T-IOL rotation may compromise correction. We investigated T-IOL rotation, focusing on deployment time and proximity to the posterior capsule (PC), using intraoperative optical coherence tomography (iOCT). Methods: Six different T-IOL models were inserted into acrylic simulated lens capsule models under different tacking durations (5 s, 30 s, and 60 s) and temperature conditions (23 °C, 28 °C, and 32 °C). The selection criteria for porcine lenses for examination required that they match human lens dimensions, typical of those used to train cataract surgeons. T-IOL misalignment due to vibration was assessed. Additionally, the impact of temporary intraocular pressure (IOP) reduction on T-IOL proximity to the PC was measured using iOCT in porcine eyes. Results: Tacking time and temperature independently affected T-IOL deployment, with shorter tacking durations and higher temperatures leading to faster deployment. Among lenses tested under identical tacking time and temperature conditions, iSert Micro Toric Aspheric 1-Piece IOL (355T3) had the slowest expansion time, while Avansee™ Preload 1-Piece Toric (YP-T3) had the fastest. Porcine eyes with a corneal white-to-white major axis < 16.0 mm fell within the 95% confidence interval for matching human lens size. Temporarily reducing IOP during surgery improved T-IOL adhesion to the PC, reducing both the occurrence and degree (from 14.0° to nearly 0°) of postoperative rotation. Conclusions: Optimal T-IOL deployment, temporary IOP reduction during surgery, and enhanced adhesion to the PC can reduce the risk and degree of T-IOL rotation. Intraoperative iOCT aids in monitoring T-IOL positioning, which is essential to prevent rotation. Accumulated fluid between the T-IOL and PC may contribute to rotation, which requires further investigation. These findings provide practical strategies for enhancing T-IOL stability and improving the effectiveness of astigmatism correction in cataract surgery. Full article

Background/Objectives: We report the development of a novel intraocular sustained-release implantable pharmaceutical formulation, designed to be placed in the anterior chamber of the eye after cataract surgery. The device is intended to reduce postoperative inflammation, and to prevent opportunistic bacterial infections that may lead to endophthalmitis. Methods: The implants were produced via hot-melt extrusion, using a twin-screw extruder to process a homogeneous mixture of polylactide-co-glycolic acid, moxifloxacin hydrochloride (MOX HCl) and dexamethasone (DEX). Quality control tests included drug content determination, release rate profile evaluation, and several instrumental characterization techniques (scanning electron microscopy (SEM), confocal Raman microscopy, differential scanning calorimetry, and X-ray diffraction). Long-term and accelerated stability tests were also performed, following ICH guidelines. Sterilization was achieved by exposing samples to gamma radiation. In vivo exploratory studies were carried out in healthy rabbits to evaluate the safety and overall performance of the implantable formulation. Results: In terms of quality control, drug content was found to be homogeneously distributed throughout the implants, and it also met the label claim. In vitro release rate was constant for MOX HCl, but non-linear for DEX, increasing over time. In vivo preliminary tests showed that the inserts completely biodegraded within approximately 20 days. No clinical signs of anterior segment toxic syndrome or statistically significant intraocular pressure differences were found between treatment and control groups. Conclusions: The implants developed in this study can act as sustained-release depots for the delivery of both DEX and MOX HCl, and are biocompatible with ocular structures. Full article

Background/Objectives: Oxidative stress plays a critical role in the development of ocular diseases such as cataracts. Selenium nanoparticles (SeNPs) offer antioxidant benefits with low toxicity. This study aimed to evaluate the antioxidant activity of SeNPs coated with D-α-tocopheryl polyethylene glycol succinate (TPGS) in human lens epithelial (HLE) cells. Methods: SeNPs were synthesised by reducing sodium selenite with ascorbic acid in the presence of TPGS. Physicochemical characterisation was carried out using dynamic light scattering to assess size and surface charge. Antioxidant activity was measured by a 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. Cytocompatibility was assessed on adult retinal pigment epithelial (ARPE-19) and HLE cells using PrestoBlue. Functional antioxidant performance was determined through enzymatic assays for glutathione peroxidase (GPx), thioredoxin reductase (TrxR), and glutathione (GSH), and lipid peroxidation was assessed using malondialdehyde (MDA) quantification. Catalase mimicry was evaluated under 3-amino-1,2,4-triazole (3-AT)-induced inhibition. Results: The optimal SeNP formulation had an average hydrodynamic diameter of 44 ± 3 nm, low PDI (<0.1), and a surface charge of −15 ± 3 mV. These TPGS-SeNPs demonstrated strong radical scavenging (EC₅₀ ≈ 1.55 µg/mL) and were well tolerated by ARPE-19 cells (IC₅₀ = 524 µg/mL), whereas HLE cells had a narrower biocompatibility window (≤0.4 µg/mL, IC₅₀ = 2.2 µg/mL). Under oxidative stress, SeNPs significantly enhanced GPx and TrxR activity but did not affect GSH or MDA levels. No catalase-mimetic activity was observed. Conclusions: TPGS-SeNPs exhibit potent antioxidant enzyme modulation under stress conditions in HLE cells. Although not affecting all oxidative markers, these nanoparticles show promise for non-invasive strategies targeting lens-associated oxidative damage, including cataract prevention. Full article

Although conventional medicine has seen substantial progress in recent years, there is a growing interest in nutraceuticals, bioactive compounds derived from natural sources such as plants, fruits, and cereals, due to their potential therapeutic applications. These substances have garnered increasing attention for their capacity to support ocular health and to aid in the prevention and management of age-related eye disorders, including age-related macular degeneration (AMD), cataracts, and glaucoma. This review provides a comprehensive and detailed analysis of selected nutraceuticals related to ocular health and diseases. It aims to define their pharmacodynamic properties, to elucidate the molecular and cellular mechanisms underlying their effects and to critically evaluate the current evidence regarding their potential clinical applications. By integrating findings from both preclinical and clinical studies, this review seeks to offer insights into the role of these nutraceuticals in the prevention, management, and adjunctive treatment of various ocular disorders, thereby suggesting future research directions and clinical practice. Notable attention is given to their antioxidant, anti-inflammatory, and neuroprotective properties, which are believed to contribute to the preservation of visual function and the deceleration of disease progression. Elucidating the medicinal benefits of these compounds may open new pathways for complementary or alternative strategies in the prevention and treatment of ocular diseases. Full article

Pseudophakic bullous keratopathy (PBK) is a vision-threatening corneal complication following cataract surgery, characterised by progressive endothelial cell loss, persistent corneal oedema, and painful epithelial bullae, leading to impaired vision. Corneal transplantation, either penetrating or endothelial keratoplasty, remains the primary treatment but faces challenges such as donor tissue shortages, graft rejection, and limited graft longevity. Recently, Rho-kinase (ROCK) inhibitors have emerged as promising pharmacological alternatives. These agents enhance corneal endothelial cell proliferation, migration, and adhesion, suppress apoptosis, and promote corneal deturgescence and wound healing. Several preclinical and clinical studies have demonstrated the efficacy of ROCK inhibitors in improving corneal clarity, endothelial function, and visual acuity in PBK. Their use has been associated with reductions in corneal oedema, improved endothelial cell density, and delayed or prevented the need for corneal transplantation. A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted, restricted to peer-reviewed English-language articles, ensuring comprehensive coverage. ROCK inhibitors represent a novel pharmacological strategy for PBK prevention and management, potentially reducing dependency on donor grafts. Further research is needed to determine long-term safety, optimal dosing, and efficacy. Full article

Background: Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects. Objectives: To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). Methods: In this retrospective case–control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. Results: On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls (p < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. Conclusions: In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals. Full article

Accurate and early classification of retinal diseases such as diabetic retinopathy, cataract, and glaucoma is essential for preventing vision loss and improving clinical outcomes. Manual diagnosis from fundus images is often time-consuming and error-prone, motivating the development of automated solutions. This study proposes a deep learning-based classification model using a pretrained EfficientNetB3 architecture, fine-tuned on a publicly available Kaggle retinal image dataset. The model categorizes images into four classes: cataract, diabetic retinopathy, glaucoma, and healthy. Key enhancements include transfer learning, data augmentation, and optimization via the Adam optimizer with a cosine annealing scheduler. The proposed model achieved a classification accuracy of 95.12%, with a precision of 95.21%, recall of 94.88%, F1-score of 95.00%, Dice Score of 94.91%, Jaccard Index of 91.2%, and an MCC of 0.925. These results demonstrate the model’s robustness and potential to support automated retinal disease diagnosis in clinical settings. Full article

Background/Objectives: The relationship between systemic health and ocular diseases is well-documented, with various body metrics potentially playing significant roles in the pathogenesis of cataracts, glaucoma, and age-related macular degeneration (AMD). However, comprehensive studies linking these metrics with ocular health are sparse. This study aims to explore the associations between height, weight, waist circumference, and BMI with the prevalence and current status of cataracts, glaucoma, and AMD in a large cohort. Methods: We used data from Korean National Health and Nutrition Survey (KNHANES 2015–2021), a national, cross-sectional health examination and survey, for which representative data on the health, nutritional status, and physical activities of the Korean general population are collected by the Korea Centers for Disease Control and Prevention (KCDC). We compared height, weight, waist circumference, and BMI among patients with diagnosed and current cataracts, glaucoma, and AMD versus those without these conditions. Statistical analyses included t-tests and Pearson correlation analyses to examine the relationships between body metrics and ocular diseases. Results: Our findings indicate that shorter height and lower weight are associated with diagnosed cataracts and glaucoma but not with their current status. A greater waist circumference was observed in patients with diagnosed cataracts, glaucoma, and AMD compared to controls, suggesting central obesity as a potential associated factor. No significant differences in BMI were found in patients with current ocular diseases. Additionally, certain body metrics were correlated with refractive errors and visual acuity, suggesting broader implications for ocular health. Conclusions: The study highlights significant associations between body metrics and the risk of developing cataracts, glaucoma, and AMD. AMD was found to be more closely related to systemic diseases, such as diabetes and hypertension, than to body metrics. These findings suggest that interventions targeting obesity and metabolic health could potentially reduce the risk or severity of these common ocular conditions. Further research is needed to confirm these relationships and explore underlying mechanisms. Full article

Levels of micro- and macroelements in the human organism change dynamically and undoubtedly remain critical for human health. Currently, much research is focused on searching for the concentrations of various metals (including toxic ones) in the tissues obtained from patients suffering from various diseases including ophthalmic diseases. However, the knowledge in this matter is still scarce and highly limited. Previous studies related to the changes in the levels of micro- and macroelements within the morphological elements of the eye and visual tract were performed on animal models in most cases, and only for the chosen elements. In addition, the majority of the studies performed on human samples were mostly focused only on the group of patients with chosen ophthalmic diseases such as glaucoma or cataracts. Moreover, usually, the results of the studies are contradictory, and some hypotheses are still unexplained. The understanding of the physiology and pathophysiology of the processes that lead to the changes in the distribution of the levels of micro- and macroelements that are crucial in the etiology of ophthalmic diseases might provide more effective prevention and better therapeutic strategies, or even improvements in the treatment of chosen ophthalmic diseases. In this paper, we summarized the current knowledge regarding the metallomic analysis of the human organ of vision and its relationship with chosen ophthalmic diseases. Full article

Congenital cataracts (CCs) are a leading cause of preventable childhood blindness, with genetic factors playing a crucial role in their etiology. Nance–Horan syndrome (NHS) is a rare X-linked dominant disorder associated with CCs but is often underdiagnosed due to variable expressivity, particularly in female carriers. Objective: This study aimed to explore the genetic landscape of CCs in a Swiss cohort, focusing on two novel NHS and one novel GJA8 variants and their phenotypic presentation. Methods: Whole-exome sequencing (WES) was conducted on 20 unrelated Swiss families diagnosed with CCs. Variants were analyzed for pathogenicity using genetic databases, and segregation analysis was performed. Clinical data, including cataract phenotype and associated systemic anomalies, were assessed to establish genotype–phenotype correlations. Results: Potentially pathogenic DNA sequence variants were identified in 10 families, including three novel variants, one in GJA8 (c.584T>C) and two NHS variants (c.250_252insA and c.484del). Additional previously reported variants were detected in CRYBA1, CRYGC, CRYAA, MIP, EPHA2, and MAF, reflecting genetic heterogeneity in the cohort. Notably, NHS variants displayed significant phenotypic variability, suggesting dose-dependent effects and X-chromosome inactivation in female carriers. Conclusions: NHS remains underdiagnosed due to its variable expressivity and the late manifestation of systemic features, often leading to misclassification as isolated CC. This study highlights the importance of genetic testing in unexplained CC cases to improve early detection of syndromic forms. The identification of novel NHS and GJA8 variants provides new insights into the genetic complexity of CCs, emphasizing the need for further research on genotype–phenotype correlations. Full article

We report a case of herpes simplex virus type 1 (HSV-1) anterior uveitis evolving into an acute iris transillumination-like syndrome with secondary pigmentary glaucoma, highlighting diagnostic challenges and treatment considerations. A 61-year-old immunocompetent woman presented with unilateral anterior uveitis characterized by keratic precipitates and mild anterior chamber inflammation. The condition was initially treated with topical and subconjunctival corticosteroids without antiviral therapy. After an initial resolution of symptoms, upon the cessation of treatment, the patient developed features resembling unilateral acute iris transillumination (UAIT) syndrome with elevated intraocular pressure, diffuse pigment dispersion, and progressive iris transillumination defects. Aqueous polymerase chain reaction (PCR) testing confirmed the presence of HSV-1. Despite the initiation of antiviral therapy, the condition progressed to severe pigmentary glaucoma, with unreliable intraocular pressure measurements due to prior LASIK surgery. Cataract extraction, pars plana vitrectomy, and Ahmed valve implantation were performed, with only partial recovery of visual acuity. This case illustrates that HSV-1 uveitis can mimic or transition into a UAIT-like syndrome, possibly due to steroid use without concurrent antiviral treatment, which may exacerbate viral replication and damage to the iris pigment epithelium. Aqueous PCR testing aids in differential diagnosis, but indicative medical history and clinical findings should remain instrumental. Clinicians should maintain a high index of suspicion for herpetic etiology in anterior uveitis cases and initiate prompt antiviral treatment to prevent potentially sight-threatening complications. Full article

Cataract surgery, while commonly considered a routine, highly effective, and generally low-risk ophthalmic procedure, has been associated with corneal endothelial cell loss (ECL), a phenomenon particularly pronounced in patients with type 2 diabetes mellitus (DM2). This increased susceptibility in diabetic patients is often attributed to pre-existing corneal abnormalities, including compromised structural integrity and reduced endothelial cell density. Additionally, metabolic stress factors inherent to diabetes, such as chronic hyperglycemia and associated oxidative stress, further exacerbate endothelial vulnerability. Consequently, diabetic patients may experience significantly greater endothelial cell loss during and after cataract surgery, necessitating targeted surgical strategies and careful perioperative management to preserve corneal health and visual outcomes. This paper aims to conduct an extensive and detailed review of the existing scientific literature to thoroughly investigate the relationship between ECL and cataract surgery in patients diagnosed with DM2. This study conducts a critical evaluation to elucidate the mechanisms contributing to high endothelial vulnerability in individuals with diabetes. It systematically compares the rates of ECL observed in diabetic and non-diabetic populations undergoing cataract surgery, examines molecular alterations following the procedure in patients with and without DM2, identifies key risk factors influencing surgical outcomes, evaluates the impact of various surgical techniques, discusses preventative measures, and examines the long-term consequences of ECL in this specific population. Furthermore, this review analyzes the existing research to identify gaps in knowledge and suggest potential directions for future investigations. Full article

Evidence based practice enhances healthcare delivery and prevents unsafe procedures. While competency based assessments of resident cataract surgery are standard, evidence based analysis of refractive outcomes remains underutilized in educational curricula. This retrospective single center study evaluated refractive outcomes from 21 novice ophthalmology resident surgeons. Three independent groups were compared based on formal constant optimization for intraocular lens (IOL) calculation: non-optimized Haigis (n = 216), a0-optimized (n = 94), and a0/a1/a2-optimized (n = 121). All surgeries were supervised by a single attending surgeon. Mean absolute error (MAE) and the percentage of eyes within ±0.25 D and ±0.50 D of predicted spherical equivalent (SEQ) were calculated. Also, systematic bias in effective lens position (ELP) was analyzed to update manufacturer IOL constants. MAE improved from 0.44 D (non-optimized) to 0.35 D (a0-optimized p = 0.009) and 0.19 D (a0/a1/a2-optimized p < 0.001). The percentage within ±0.50 D increased from 65.7% to 74.4% to 95.0%, respectively. With ELP bias correction, updated A constant and ACD were 119.266 and 5.755 mm. a0/a1/a2-optimized outcomes were comparable to ELP bias correction for the Barrett UII, Kane, and Hill-RBF formulas. Evidence based optimization of IOL constants significantly enhances novice resident surgical outcomes, achieving parity with prediction models. A formal curriculum on IOL calculation and optimization is warranted. Full article