Eyeworld

In the journal: September 2019 Results from the U.S. cohort of the HORIZON trial: A randomized study of a Schlemm's canal microstent for reduction of IOP in primary open angle glaucoma Jason Jones, MD, Douglas Koch, MD, Steven Vold, MD, Cathleen McCabe, MD, Douglas Rhee, MD, Richard Lewis, MD, Stephen Smith, MD, Quang Nguyen, MD, Thomas Samuelson, MD, for the HORIZON U.S. investigators Stenting of Schlemm's canal in combination with cataract surgery resulted in a significant reduction in diurnal IOP, as well as reduced medication use, compared to phaco alone in U.S. patients with mild to moderate primary open angle glaucoma (POAG) who were part of the HORIZON trial. Of the 38 clinical centers that were part of the prospective, single-masked, randomized controlled clinical trial, 26 sites were in the U.S. Investigators in this study eval- uated the safety and efficacy of the Hydrus Microstent (Ivantis) to reduce diurnal IOP and medications among the U.S. cohort. A total of 219 eyes were randomized to receive the mi- crostent in combination with cataract surgery and 112 eyes received phaco alone, serving as a control. Diurnal IOP was reduced by 20% or more in 78.5% of eyes in the microstent group compared to 54.5% of control group eyes. More than 78% of eyes in the microstent group were medication-free at 24 months of follow-up, compared to 39.2% in the phaco group. The mean change in number of medications between the microstent and control group was –1.2 ± 0.9 and –0.8 ± 1.1, respectively. Comparative meta-analysis of toric intraocular lens alignment accuracy between image-guided system versus manual marking in cataract patients Fengqi Zhou, MD, Wu Jiang, MD, Zhuoling Lin, MD, Xiaoyan Li, MD, Jing Li, Haotian Lin, MD, Weirong Chen, MD, Qiwei Wang MD A meta-analysis of toric IOL alignment comparing accuracy of image-guided technology with manual marking found use of an image-guided system resulted in better alignment accuracy, a smaller difference vector, and reduced postop astigmatism. Five studies totaling 257 eyes were included in this analysis. Studies were assessed based on methodological quality from a modified QUADAS-2 tool; continuous variables were assessed with weighted mean differences and dichotomous variables were assessed with an odds ratio. Virtual-reality performance correlates significantly with real-life cataract surgical performance Mads Jacobsen, MD, Lars Konge, PhD, Daniella Bach-Holm, MD, Morten la Cour, Dr Med, Lars Holm, MD, Klavs Højgaard-Olsen, MD, Hadi Kjærbo, MD, George Saleh, FRCS, Ann Sofia Thomsen, MD Virtual reality simulators are increasingly being used for surgical training purposes, but how the skills demonstrated with these systems correlate with real-world surgical performance has not been widely documented. According to the investigators, there is a need for standardized, unbiased assessment tools in lieu of human raters. A prospective study evaluated 19 cataract surgeons with varying experience from nine ophthalmology departments in Denmark. Real- world phaco cataract surgery was videoed and surgeons also took a validated test with the Eyesi Surgical (VRmagic) simulator. The recorded surgeries were scored with the objective structured assessment of cataract surgical skills (OSACSS) system by masked raters. Accord- ing to the analysis, there was a significant correlation between surgeons' Eyesi Surgical scores and their mean OSACSS scores. The work herein also indirectly supports waiting minimally 4 weeks between succes- sive surgeries. It is unclear why the 4-week timeframe was chosen, but we postulate that the authors considered the passage of such time as necessary before stable refraction. At MEE, some surgeons find that even by the first postoperative week, a fairly stable refractive outcome can be achieved in a se- lected group of patients who have undergone uncomplicated cataract surgeries. 10 Patients expect faster recovery, an accurate refractive outcome and minimal disturbance in daily activity. Delaying the second eye surgery by more than 4 weeks may meet strong resis- tance as well as affect activities of daily living. Future research is needed to determine the optimal postoperative wait time for stable refraction. Bottom line Based on this study and specific recommen- dations from the authors, cataract surgeons can correct the second eye PPOR by applying 30% of the first eye PE to the second IOL calculation when employing the BUII formula and by 50% of the PE when using Hoffer Q, Holladay I, and SRK/T formulas. This recommendation is useful in the following circumstances: 1. First eye PE >0.5 D 2. Interocular symmetry: <0.7 mm differ- ence in axial length and <0.9 D differ- ence in mean corneal power 3. Biometry errors and IOL malposition are excluded Though this work included all eyes, irre- spective of interocular symmetry, we agree with the authors' warning to consider repeat- ing biometry in cases of asymmetry; caution should be used if applying a second eye correction factor under such circumstances. The clinicians at MEE would like to thank authors Turnbull and Barrett, as well as the EyeWorld Journal Club, for sparking lively and thoughtful discussion on how to think about second eye cataract surgery outcomes and provide the best possible care for our patients.

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