JCRS Highlights edited by European Editor Thomas Kohnen

TREATING KERATOCONUS AND CATARACT A new treatment algorithm aims to optimise refractive outcomes for keratoconus patients undergoing cataract surgery. Australian researchers describe an approach that involves cataract extraction with small aperture IOL insertion using an IC-8 IOL (Acufocus). The next step is to perform topography-guided photorefractive keratectomy (PRK) with simultaneous corneal collagen cross-linking (CXL). The PRK is performed using the Schwind excimer laser, aiming for low myopia. CXL follows, using the LIGHTLink system (Lightmed). Results of a retrospective case series analysis showed that all eyes achieved rigid gas permeable contact lens independence, with improved corrected and uncorrected distance visual acuity. Postoperative uncorrected near visual acuity ranged from N.8 to N.12. L Northey et al., “A new treatment algorithm for keratoconus and cataract, small aperture intraocular lens insertion with sequential topography guided photorefractive keratectomy and simultaneous accelerated corneal collagen crosslinking”, March 18, 2021, Published ahead of print, doi: 10.1097/j.jcrs.0000000000000642. CHANGING PRACTICE PATTERNS IN EUROPE The latest results from the EUREQUO database suggest that cataract surgery is being performed in younger patients with better preoperative visual acuity. A review of more than two million cataract procedures performed between January 1, 2008 and December 31, 2017 shows a decline in the rate of surgical complications with patients experiencing better predicted refractions and visual outcomes. Researchers attribute these improvements to refinements in surgical techniques IOLS, as well as better machines and improved intraocular lenses. The researchers note that the 30-day follow-up used in the EUREQUO protocol would not represent late complications such as posterior capsule opacification. While endophthalmitis rates did appear to decline over time, the current study would also not catch cases that occurred after the 30-day period. M Lundström et al., “Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017”, Vol. 47, #3, p 373-378. PREOPERATIVE TELEMEDICINE Preoperative telephone screening of patients undergoing ophthalmic surgery can streamline an otherwise cumbersome and lengthy process, saving patients both time and money, a US study concludes. Researchers conducted a retrospective cohort study at a single ophthalmic ambulatory surgery centre to evaluate the efficacy of preoperative telephone medical clearance for patients undergoing ophthalmic surgery. All patients receiving non-laser ophthalmic surgery were initially screened by phone. A vast majority, 97.76%, were cleared for surgery. Cardiovascular conditions were a common cause for referral for further preoperative medical clearance. The same-day surgery cancellation rate was only 0.19% with telemedicine clearance. AG Miller et al., “Preoperative Telephone Medical Clearance for Ophthalmic Surgeries”, March 9, 2021, published ahead of print, doi: 10.1097/j.jcrs.0000000000000548.