Abstract
The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered ‘sooner rather than later’ as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients’ best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
摘要
本文旨在探讨在合并年龄相关性黄斑变性 (age-related macular degeneration, AMD)、 痴呆进行白内障手术以及即刻连续性双侧白内障手术(Immediate Sequential Bilateral Cataract Surgery, ISBCS)时存在的一些问题, 讨论在国家医疗服务制度 (National Health Services, NHS) 和基于生物轴向长度公式计算眼内人工晶体的选择。每组作者针对每个话题进行独立工作。我们发现, 白内障手术确实能提高AMD患者的视力, 但是否需要行白内障手术应因人而异。对于痴呆患者, 白内障手术应该被认为“更早而不是晚”, 因为病情进展可能会妨碍患者接受手术。这应在与医疗人员讨论病人的最大利益后进行安排和计划;尚未证明多焦IOLs是这些患者的最佳选择。与延迟连续手术相比, ISBCS双侧眼内炎的风险较低, 并且其成本更低及高效。患者有权获知所有可以改善其生活质量的合适的IOL选择方面的信息, 故意隐瞒这些信息或强迫患者选择非标准IOL是不妥的。然而, 在NHS系统中人们应该注意不要花过多的时间讨论这些, 因为这可能会影响NHS其他患者的护理。证据表明Hoffer Q、Haigis、Hill-RBF和Kane公式适用于眼轴较短的眼;较长眼轴的眼使用Barrett Universal II (BU II)、Holladay II、Haigis和Kane公式, 中等眼轴的眼使用BU II、Hill-RBF和Kane公式。
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SC, SS: contributed to the section of “Age-related macular degeneration and cataract”. PU: contributed to the section of “Dementia and cataract”. KN, DO: contributed to the section of “Immediate Simultaneous Bilateral Cataract Surgery”. AA: contributed to the section of “The ethical dilemma of discussing non-standard intraocular lenses within the National Health Service setting”. ZA, MAN: contributed to the section of “Intraocular lens calculation formulas for short, long and medium axial length eyes”
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SC, SS, PGU, KN, AA, ZA: No conflict of interests to disclose. DO: Non-commercial research grants with Rayner Ltd., Alcon Inc. and Avedro Inc. Consultant to Zeiss and Sparca Inc. MAN: Research grants from Alcon Laboratories, USA; European Society of Cataract & Refractive Surgery; Johnson & Johnson, USA; NuVision Biotherapies, UK; Rayner Intraocular lenses, UK. Lecture fees from Alcon Laboratories, USA & Bausch & Lomb, USA. Consultant to Hoya. Travel grant from Alcon Laboratories, USA & Bausch & Lomb, USA.
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Chandra, S., Sivaprasad, S., Ursell, P.G. et al. Recurring themes during cataract assessment and surgery. Eye 35, 2482–2498 (2021). https://doi.org/10.1038/s41433-021-01548-4
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DOI: https://doi.org/10.1038/s41433-021-01548-4
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