Commentary: Immediate sequential bilateral cataract surgery during the COVID-19 pandemic

Pandey, Suresh K

doi:10.4103/ijo.ijo_1093_21

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…Существенное ухудшение эпидемиологической ситуации привело к значительному пересмотру клинической эффективности НПДХК, так как данная технология обеспечивает сокращение использования средств индивидуальной защиты, минимизирует повторные посещения клиники и сопровождается более быстрым восстановлением бинокулярного зрения [9]. Наряду с этим были выполнены исследования, указывающие лишь на единичные случаи эндофтальмита после проведения НПДКХ, что полностью сопоставимо с данными при проведении традиционной монокулярной ФЭК [10,11].…”

Section: актуальность проблемыunclassified

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Medvedev

Pokrovskiy

2022

Oftalʹmologiâ

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Purpose. Analysis of two clinical cases of immediate sequential bilateral cataract surgery according to the developed modified algorithm (mаISBCS).Materials and methods. The results of two clinical cases of mаISBCS are presented. In both cases, ultrasonic cataract phacoemulsification (FEC) was performed with implantation of an intraocular lens (IOL) under local anesthesia according to the standard technique through a corneal incision of 2.2–2.4 mm. IOL calculation was performed for emmetropic refraction. The modification (compared to the traditional one) of the technology of surgical intervention was based on the inclusion in the algorithm of a long (at least 60 minutes) break between operations for the purpose of a comprehensive ophthalmological examination with a further decision to perform an operation on the second eye.Results. In the first clinical case, the patient failed to measure the anterior-posterior axis by optical biometry before surgery. In such situations, the A-scan is used, which is considered less accurate due to human error and often leads to errors in the calculation of the IOL. In addition, a certain alertness was introduced by the fact of a significant (4 diopters) difference in the preoperative refraction of both eyes. Considering these provisions, after the first operation, after 60 minutes, the correctness of the IOL calculation was monitored by two methods — by measuring (optical biometrics) the anterior-posterior axis of the eye (APA, while the differences were less than 0.3 mm, which confirmed the A-scan data), as well as autorefractometry, which showed almost no deviation from the “target”. The presented results allowed us to formulate a decision to carry out the second operation. In the second clinical case, despite the absence of risk factors (optical biometrics was taken in two eyes, similar APA values), a postoperative refraction of +1.5 diopters was determined in the operated eye, which, apparently, is associated with the identified decrease (by 0.93 diopters) corneal curvature due to hydration of the corneal stroma in the area of surgical accesses and (or) changes in the tear film. The presented results allowed us to formulate a decision to postpone the second operation. At the same time, after a week, the restoration of the corneal tissue was noted, which was proved by the required (0.37 diopters) deviation of refraction from the target values.Conclusion. The use of mаISBCS technology provides the required clinical efficacy and can be recommended taking into account the epidemiological situation, especially for people with visually strenuous work.

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Section: актуальность проблемыunclassified

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Medvedev

Pokrovskiy

2022

Oftalʹmologiâ

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“…Актуальность проведения БФЭК намного повысилась в существующей эпидемиологической ситуации, когда время ожидания пациентов для операции по удалению катаракты во многих медицинских учреждениях увеличилось [2]. При этом единственным изменением в практике катарактальной хирургии, обеспечивающим наиболее значительный эффект в отношении снижения риска заражения COVID-19, является БФЭК, которая способствует сокращению использования средств индивидуальной защиты, минимизирует повторные посещения клиники и сопровождается более быстрым восстановлением бинокулярного зрения [3]. Следует подчеркнуть, что проведение БФЭК на протяжении последнего десятилетия является достаточно дискуссионным аспектом катарактальной хирургии [4][5][6][7].…”

Section: Ophthalmology Inunclassified

Immediately Sequential Bilateral Cataract Surgery: the Opinion of Russian Ophthalmologists

Pokrovskiy

Medvedev

2022

Oftalʹmologiâ

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Purpose. A study of the attitude of Russian ophthalmologists to Immediately Sequential Bilateral Cataract Surgery (ISBCS).Methods. The study was carried out with the participation of 184 ophthalmologists actively performing cataract surgery, who were presented (in personal contact or via the Internet) a questionnaire developed by the authors, based on three main sections (“I use ISBCS in practice”; “I do not use ISBCS in practice”; “I don’t use, but I did ISBCS before”), which includes in each of the sections a number of clarifying questions and possible answers (“Doesn’t matter”; “Matters”; “Important”; “Very important”). At the same time, the analysis of possible answers was carried out by summing up two possible options — “Negative” opinion (“Not important” + “Matters”) and “Positive opinion” (“Important” + “Very important”). The age of the interviewed ranged from 26 to 58 years (mean age 36.2 ± 1.9 years), the experience of surgical activity in performing cataract phacoemulsification was predominantly (76 %) more than 5 years.Results. The data obtained indicate that 36 respondents (19.8 %) use ISBCS in their practice, 114 (61.8 %) do not use ISBCS; 34 (18.4 %) — do not use, but previously used ISBCS. At the same time, the volume of ISBCS performed on the same day is (for 84 % of respondents) no more than 20 % of the total number of operations performed. As part of the assessment of the main factors, in accordance with which (according to the ophthalmic surgeon), the patient is offered to perform ISBCS by the leader (in terms of the ratio of “positive” and “negative” opinions) is less clinic visits, and less time spent for the patient. The leading reasons for refusal to perform ISBCS by ophthalmic surgeons who do not use this technology are the possible occurrence of endophthalmitis, the risk of errors in IOL calculation, and medical and legal problems.Conclusion. The conducted questioning of domestic ophthalmologists testifies to the low prevalence of ISBCS technology, which is mainly associated with the possible risks of postoperative infectious complications, the lack of a standard protocol for surgical intervention, as well as medical and legal aspects. For the wider use of ISBCS, especially in a difficult epidemiological situation, it is necessary to carry out a set of measures of medical, educational and medical and economic orientation.

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“…In the last decade, multiple randomized controlled trials confirmed the safety and effectiveness of ISВCS. Besides, this procedure has become a common practice worldwide, especially in countries that do not impose financial sanctions for a simultaneous operation [1,2].…”

Section: Introductionmentioning

confidence: 99%

Developing the technology of immediate sequential bilateral cataract surgery and assessing its clinical effectiveness

Medvedev,

Pokrovsky

2022

Saratov Med J

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Objective: development of the technology of immediate sequential bilateral cataract surgery (ISВCS) and assessment of its clinical effectiveness. Materials and Methods. Our study was conducted in two stages. At stage I, we reviewed the published materials on traditional algorithm of conducting ISВCS, as a result of which, a modified algorithm for performing surgical intervention (mоISBCS) was developed. At stage II, 130 patients (mean age of 58.4±1.8 years) with uncomplicated binocular cataract were under observation. Patients were divided into two groups of similar age and eye condition. The main group included 67 people (134 eyes), who underwent mоISBCS. The control group comprised 63 subjects (126 eyes), who underwent surgery on the second eye (delayed sequential bilateral cataract surgery, DSВCS) 21–28 days after the first operation. Results. The analysis of traditional provisions served the basis for improving ISВCS technology by including a long (at least 60 min) pause between operations with a comprehensive examination of the patient in the algorithm of surgical intervention. The obtained data demonstrated similar clinical effectiveness of mоISBCS and DSВCS. Conclusion. The mоISBCS technology can be considered an effective and safe method of cataract surgical treatment, which is especially important for patients with occupation yielding a visual stress.

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Commentary: Immediate sequential bilateral cataract surgery during the COVID-19 pandemic

Cited by 6 publications

References 9 publications

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Immediately Sequential Bilateral Cataract Surgery: the Opinion of Russian Ophthalmologists

Developing the technology of immediate sequential bilateral cataract surgery and assessing its clinical effectiveness

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