Journal of Cataract and Refractive Surgery (J CATARACT REFR SURG)
The Journal of Cataract & Refractive Surgery (JCRS), a preeminent peer-reviewed monthly ophthalmology publication, is the official journal of the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS). JCRS publishes high quality articles on all aspects of anterior segment surgery. In addition to original clinical studies, the journal features a consultation section, practical techniques, important cases, and reviews as well as basic science articles.
RG Journal Impact: 0.48*
RG Journal impact history
|2017 RG Journal impact||Available summer 2018|
|2015 / 2016 RG Journal impact||0.48|
|2014 RG Journal impact||0.46|
|2013 RG Journal impact||0.13|
|2011 RG Journal impact||1.41|
|2010 RG Journal impact||2.31|
|2009 RG Journal impact||2.49|
|2008 RG Journal impact||2.25|
|2007 RG Journal impact||1.96|
|2006 RG Journal impact||1.79|
|2005 RG Journal impact||1.98|
|2004 RG Journal impact||1.62|
|2003 RG Journal impact||1.50|
|2002 RG Journal impact||1.52|
|2001 RG Journal impact||1.60|
|2000 RG Journal impact||1.45|
RG Journal impact over time
|Website||Journal of Cataract & Refractive Surgery website|
|Other titles||Journal of cataract and refractive surgery, Journal of cataract & refractive surgery|
|Material type||Periodical, Internet resource|
|Document type||Journal / Magazine / Newspaper, Internet Resource|
Publications in this journal
Article: April consultation #6
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To evaluate and compare the predictability and safety of immediate small-incision lenticule extraction, also known as SMILE, after suction loss during the procedure with those of uneventful small-incision lenticule extraction. Setting Nunemiso Eye Center, Seoul, South Korea. Design Retrospective case series. Methods Patients who had immediate small-incision lenticule extraction using reapplied suction (study group) or uneventful small-incision lenticule extraction (control group) for myopia or myopic astigmatism were included. All patients were followed for at least 12 months. Demographic as well as visual and refractive outcomes were compared between the 2 groups. Results Twenty-three eyes were enrolled in the study group and 48 eyes in the control group. The overall cumulative incidence of suction loss was 0.2% (28 of 11 762 eyes). Twenty-two eyes (96%) in the study group had unchanged or improved decimal Snellen corrected distance visual acuity (CDVA). At 12 months, the mean uncorrected distance visual acuity, CDVA, and manifest refraction defocus equivalent in the study group and control group were 0.99 ± 0.17 (SD), 1.11 ± 0.14, 0.75 ± 0.50 diopters (D), and 1.25 ± 0.22 D, 1.26 ± 0.21 D, 0.35 ± 0.26 D, respectively (P = .000, P = .007, and P = .000, respectively). The correlation between the achieved and the attempted spherical equivalent refraction was slightly better in the control group (R² = 0.972) than in the study group (R² = 0.933). Conclusions Immediate small-incision lenticule extraction using reapplied suction resulted in safe and clinically predictable long-term outcomes. However, predictability was lower for immediate than for uneventful small-incision lenticule extraction.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To compare refractive outcomes of intraoperative computer-assisted registration and intraoperative aberrometry for the reduction of cylinder during toric intraocular lens (IOL) placement. Setting Bowie Vision Institute, Bowie, Maryland, USA. Design Prospective randomized case series. Method The patients were divided into 2 groups that had toric IOL implantation after phacoemulsification. The intraoperative computer-assisted registration group (Group 1) had preoperative toric calculations. The aberrometry group (Group 2) was guided by a vergence formula and intraoperative pseudophakic cylindrical measurements to determine the final IOL power and intended orientation. The primary outcome measure was the mean postoperative remaining refractive astigmatism, and it was compared with the predicted amount of cylindrical correction with the IOL. Results Fifty-two patients (104 eyes) had sequential cataract surgery. The mean amount of cylinder correction was 1.60 diopters (D) ± 0.70 (SD) (range 0.75 to 3.08 D) in Group 1 and 1.74 ± 0.79 D (range 0.72 to 3.08 D) in Group 2. The mean remaining refractive astigmatism was −0.29 ± 0.22 D in Group 1 and −0.46 ± 0.25 D in Group 2 (P = .0003). A difference vector of 0.1 @ 87 degrees (0.31 D arithmetic mean) was calculated in Group 1 and 0.0 @ 82 degrees (0.44 D arithmetic mean) in Group 2. The correction index was 1.03 in Group 1 and 0.95 in Group 2. Conclusion Intraoperative markerless computer-assisted registration and biometric guidance summarily yielded less remaining refractive cylinder than toric IOL placement guided by intraoperative aberrometry.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To determine the effects of topical 0.45% ketorolac tromethamine on intraoperative miosis and prostaglandin E2 (PGE2) release during femtosecond laser–assisted cataract surgery. Setting Seoul St. Mary's Hospital, Seoul, Korea. Design Prospective case series. Methods The study comprised the following 3 groups: conventional cataract surgery without topical NSAIDs (conventional group); femtosecond laser–assisted cataract surgery with preoperative topical ketorolac tromethamine 0.45% (femtosecond NSAID group), and femtosecond laser–assisted cataract surgery without topical NSAIDs (femtosecond no-NSAID group). To measure the aqueous humor PGE2 concentration, a 100 μL aqueous humor sample was collected from the anterior chamber after femtosecond laser pretreatment. The PGE2 concentration was measured using an enzyme immunoassay. Results Topical ketorolac tromethamine 0.45% led to a significant reduction in intraoperative miosis in the femtosecond NSAID group compared with the femtosecond no-NSAID group (P < .001). Absolute and relative reductions in pupil area in the femtosecond NSAID group were significantly lower than in the femtosecond no-NSAID group (P = .019 and P = .007, respectively). The mean aqueous humor PGE2 concentrations were 893.60 pg/mL ± 843.10 (SD) in the conventional group, 1911.43 ± 1178.63 pg/mL in the femtosecond NSAID group, and 743.63 ± 927.46 pg/mL in the femtosecond no-NSAID group (P < .001, conventional versus femtosecond NSAID and femtosecond NSAID versus femtosecond no NSAID; P > .05, conventional versus femtosecond NSAID). Conclusion Preoperative topical ketorolac tromethamine 0.45% reduced miosis induced by femtosecond laser pretreatment and inhibited aqueous humor PGE2 elevation.
Article: April consultation #3
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To compare the breaking force required to tear the explanted capsule after femtosecond laser–assisted cataract surgery in the worse eye and manual cataract surgery in the contralateral eye. Setting Personaleyes, Sydney, Australia. Design Prospective nonrandomized case study. Method Patients with bilateral cataract had femtosecond laser–assisted cataract surgery with the Lensx laser in the eye with worse vision and manual cataract surgery in the contralateral eye. Each explanted capsule was stretched mechanically, and the breaking force and strain in grams (g) were compared. When a large contralateral difference in capsule strength was found, scanning electron microscopy (SEM) was applied to determine whether morphologic imperfections were present in a case with a weak capsule. Results Paired samples of 78 eyes of 39 patients were tested. The mean breaking force was not significantly different between manual capsulorhexes (2.3 g ± 2.0 [SD]) and femtosecond laser capsulotomies (2.0 ± 2.2 g, P = .52). The breaking strain for the manual samples (33.8% ± 18.3%) and for the femtosecond laser samples (34.6% ± 18.6%) were also not significantly different (P = .81). In 5 patients, in the femtosecond group, the capsules required considerably less force to break than the capsules in the manual group. However, the SEM images of these samples did not show specific laser imperfections. Conclusion In paired human eyes, the capsulotomies created by a femtosecond laser with a contact lens interface were as strong as manual capsulorhexes.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To compare the outcomes between femtosecond laser–assisted cataract surgery (femtosecond group) and conventional phacoemulsification cataract surgery (conventional group) in patients with hard nuclear cataract. Setting Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China. Design Prospective consecutive nonrandomized comparative cohort study. Methods According to the Emery-Little classification, cataract patients with a grade 4 or 5 hard nuclei were assigned to 1 of the 2 groups. The endothelial cell density (ECD), central corneal thickness (CCT), and uncorrected and corrected (CDVA) distance visual acuities were evaluated preoperatively and 1 day, 1 week, 1 month, and 3 months postoperatively. Results The study comprised 95 eyes (47 in the femtosecond group; 48 in the conventional group). The effective phacoemulsification time, absolute phaco time, and mean ultrasound power were lower in the femtosecond group (P < .001, P = .001, and P < .001, respectively). The ECD in the conventional group was lower and the changes in endothelial cell loss was different between the 2 groups throughout the follow-up (both P < .001). The CCT increased after surgery, and the thickness was greater in the conventional group at 1 day postoperatively (P < .05); it then returned to preoperative levels 1 month postoperatively in the femtosecond group and at 3 months in the conventional group. The CDVA was stable by 1 month postoperatively in the femtosecond group and by 3 months in the conventional group. Conclusion Compared with conventional phacoemulsification, femtosecond laser–assisted cataract surgery for hard nuclear cataracts conserved phacoemulsification power, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation.
- [Show abstract] [Hide abstract] ABSTRACT: Small-incision lenticule extraction may be associated with complications such as partial lenticular dissection, torn lenticule, lenticular adherence to cap, torn cap, and sub-cap epithelial ingrowth, some of which are more likely to occur during low-myopia corrections. We describe sequential segmental terminal lenticular side-cut dissection to facilitate minimally traumatic and smooth lenticular extraction. Anterior lamellar dissection is followed by central posterior lamellar dissection, leaving a thin peripheral rim and avoiding the lenticular side cut. This is followed by sequential segmental dissection of the lenticular side cut in a manner that fixates the lenticule and provides sufficient resistance for smooth and complete dissection of the posterior lamellar cut without undesired movements of the lenticule. The technique is advantageous in thin lenticules, where the risk for complications is high, but can also be used in thick lenticular dissection using wider sweeps to separate the lenticular side cut sequentially.
- [Show abstract] [Hide abstract] ABSTRACT: We describe a technique to create a locking knot for iris reconstruction or intraocular lens fixation. A modified needle is prepared by straightening the tip of an ophthalmic viscosurgical device needle or a lacrimal cannula needle. After the suture is passed through 2 sides of an iris defect, the 2 ends are externalized and looped. One strand is then inserted into the needle from the tip out of the ferrule, and the knot is pushed into the anterior chamber by this needle in a controllable manner. Two other locking knots are then made by repeating the process. With this method, only 1 small corneal incision is necessary regardless of the number of knots required and only a small amount of anterior chamber space is needed during the knotting process.
Article: April consultation #2
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To evaluate the feasibility of robot-assisted simulated cataract surgery. Setting Institut de Recherche Contre les Cancers de l’Appareil Digestif, European Institute of Telesurgery, and Strasbourg University Hospital, Strasbourg, France. Design Experimental study. Methods Cataract surgeries were performed on a Kitaro cataract wet-lab training system simultaneously using the Da Vinci Xi robotic surgical system and the Whitestar Signature phacoemulsification system. For each procedure, the duration and successful completion of the surgery with or without ocular complications were assessed. Results Procedures were successfully performed on 25 lens nuclei. The feasibility of robot-assisted simulated cataract surgery was confirmed. The robotic surgical system provided the intraocular dexterity and operative field visualization necessary to perform the main steps of the phacoemulsification procedure; that is, corneal incisions, capsulorhexis, grooving, cracking, quadrant removal, and irrigation/aspiration of the ophthalmic viscosurgical device (OVD). The intervention of a second surgeon was required for the intraocular injections of OVD, balanced salt solution, and intraocular lenses. The mean operative time was 26.44 minutes ± 5.15 (SD). All lens nuclei were removed. Inadvertent enlargement of the main corneal incision caused by the phaco handpiece was observed in 2 cases. Conclusion Experimental robot-assisted cataract surgery was technically feasible using the new robotic surgical system combined with a phacoemulsification machine.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis function (RBF) formula with other formulas based on preoperative biometry in predicting residual refractive error after cataract surgery in eyes with axial myopia. Setting Private practice, Harrisburg, Pennsylvania, USA. Design Retrospective consecutive case series. Methods Eyes with an axial length (AL) greater than 25.0 mm had cataract extraction with intraocular lens implantation. For each eye, the 1-center Wang-Koch AL-optimized Holladay 1 formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Holladay 1 and 2, Barrett Universal II, and Hill-RBF formulas and intraoperatively using wavefront aberrometry. The postoperative refraction was compared with the preoperative and intraoperative predictions. Results The study comprised 37 patients (51 eyes). The mean numerical errors ± standard error associated with using the SRK/T, Holladay 1, AL-optimized Holladay 1, Holladay 2, Barrett Universal II, and Hill-RBF formulas and intraoperative wavefront aberrometry were 0.20 ± 0.06 diopters (D), 0.33 ± 0.06 D, −0.02 ± 0.06 D, 0.24 ± 0.06 D, 0.19 ± 0.06 D, 0.22 ± 0.06 D, and 0.056 ± 0.06 D, respectively (P < .001). The proportion of patients within ±0.5 D of the predicted error was 74.5%, 62.8%, 82.4%, 79.1%, 73.9%, 76.7%, and 80.4%, respectively (P = .090). Hyperopic outcomes occurred in 70.6%, 76.5%, 49.0%, 74.4%, 76.1%, 74.4%, and 45.1% of the eyes, respectively (P = .007). Conclusions Intraoperative wavefront aberrometry was better than all formulas based on preoperative biometry and as effective as the AL-optimized Holladay 1 formula in predicting residual refractive error and reducing hyperopic outcomes. The Hill-RBF formula's performance was similar to that of the fourth-generation formulas.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To compare the ability of 3 clinical corneal topographers to describe the posterior corneal shape. Setting University Medical Center Groningen, the Netherlands. Design Prospective observational study. Methods Corneas of healthy participants were measured twice with a dual Scheimpflug instrument (Galilei G2), a scanning-slit system (Orbscan IIz), and a single Scheimpflug instrument (Pentacam HR). Height data describing the posterior corneal shape were fit with Zernike polynomials. Mean values with standard deviations (SD), test–retest variability (coefficient of repeatability [CoR]), and interdevice variability were determined for the defocus Z(2,0), astigmatism Z(2,−2) and Z(2,2), and higher-order terms coma Z(3,−1) and Z(3,1), trefoil Z(3,−3) and Z(3,3), and spherical aberration Z(4,0) coefficients for 5.5 mm and 8.0 mm diameters. Results For the 5.5 mm diameter, CoRs ranged from 0.3 to 4.3 μm with the dual Scheimpflug instrument, 1.6 to 5.2 μm with the scanning-slit system, and 0.3 to 2.0 μm with the single Scheimpflug instrument. The CoR was similar for the Scheimpflug instruments (P = .43) but poorer for the scanning-slit system (P < .001). The CoRs of the Scheimpflug instruments were smaller than the corresponding population SD for defocus, cardinal astigmatism, coma, and spherical aberration. The scanning-slit system failed to provide 8.0 mm diameter data. There was a significant bias (interdevice variability) between the Scheimpflug instruments in the higher-order coefficients at both diameters. Conclusions Repeatability in assessing the posterior corneal shape was generally good for the Scheimpflug instruments but poor for the scanning-slit system. Interdevice variability between the Scheimpflug instruments compromised the interchangeability of higher-order coefficients. For astigmatism, CoR and 95% limits of agreement of the Scheimpflug instruments typically corresponded to 0.1 diopter per astigmatism term.
- [Show abstract] [Hide abstract] ABSTRACT: We present 2 cases in which a femtosecond laser was used in vitro to transect hydrophilic acrylic intraocular lenses (IOLs). At 8 μJ with 3 μm spot separation and 6 μm line separation, no charring occurred and there was no increase in total organic carbon. In vivo, the IOLs were successfully transected in the capsular bag (Case 1, opaque IOL) and the sulcus (Case 2, subluxated IOL post-pneumatic displacement of submacular hemorrhage) and explanted through a clear corneal incision (∼3.0 mm). At 3 months, in Case 1, the corrected distance visual acuity (CDVA) improved from 6/24 to 6/5, astigmatism improved by 0.23 diopters, and endothelial cell density (ECD) remained unchanged (1935 to 2210 cells/mm²); in Case 2, the CDVA was hand motion, astigmatism remained unchanged, and ECD decreased (1960 to 1600 cells/mm²), possibly as a result of complex surgery. Femtosecond IOL transection and explantation may be a clinically safe and feasible option for surgeons.
- [Show abstract] [Hide abstract] ABSTRACT: We describe a technique for suture-guided sulcus implantation of a foldable acrylic posterior chamber IOL (PC IOL). A 10-0 monofilament nylon suture is used to control insertion of the PC IOL over the ciliary sulcus and enable safe retrieval if the PC IOL drops during insertion, stabilization, or centration. In this technique, the 10-0 monofilament nylon suture acts as a guy rope to hold onto the PC IOL, enabling the surgeon to inject the IOL into the sulcus, unfold it in the iris plane, dial it in the appropriate meridian, and stabilize it.
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