Population-based analysis of intraocular lens exchange and repositioning
Notice bibliographique
Résumé
We read the article by Szigiato et al.1 with interest, and we believe that some further discussion might be of benefit. The authors present a data-analysis study to determine the incidence and trends in intraocular lens (IOL) repositioning, exchange, and explantation in Ontario, Canada. Their Figure 2 presents the cumulative risk for secondary procedures after cataract surgery, reaching 2.84% in the 5-year period in the patients younger than 45 years. Most of the secondary procedures during the 5-year period were performed in the first year after cataract surgery, with the highest rate of 60.29% in women. These results are in contrast to those of Dabrowska-Kloda et al.,2 who reported a very low IOL dislocation risk during the first 3 years after surgery in Sweden. The cumulative risk 5 years, 10 years, 15 years, and 20 years after cataract surgery was 0.09%, 0.55%, 1.00%, and 1.00%, respectively. How would the authors explain these differences? Furthermore, posterior chamber IOL subluxation or dislocation can be divided into early cases (up to 3 months after cataract surgery) and late cases (3 or more months after surgery). This categorization is essential because tearing of the posterior capsule and rupture of the equatorial zonule is a predisposing factor for early dislocation. Late dislocation is associated with progressive zonular insufficiency and capsular bag contraction, with pseudoexfoliation syndrome as the most common risk factor.3 Would it be possible to assess the data within these timeframes because doing so could lead to additional conclusions? The authors found a 75.6% increase in secondary procedures from 713 performed in 2000 to 1252 in 2013. Dabrowska-Kloda et al.2 state that the increasing number of late in-the-bag IOL dislocations cannot be explained by the growing pseudophakic population only. The increase in the incidence was primarily the result of the longer duration of pseudophakia in the population and to a greater dislocation risk with recent cataract surgery. The optimum management for late in-the-bag IOL dislocation is still being questioned. The authors found that from 2000 to 2013, sutured repositionings and explantations increased by 568% and 531%, respectively, whereas exchanges without suturing decreased by 22.6%. This issue is particularly interesting because of the development of open-loop haptic anterior chamber IOLs and the introduction of iris-claw IOLs; both IOL types have shown their efficacy in the overwhelming majority of such cases. In a recent study, Kristianslund et al.4 compared the efficacy and safety of IOL repositioning by scleral suturing versus IOL exchange with an iris-claw IOL. The group comparison showed that IOL repositioning had a longer surgical time and a tendency toward more intraocular hemorrhage, whereas IOL exchange required more anterior vitrectomies or removal of vitreous strands from the incision and such patients had more iris injuries. Both operations were found to be safe with few serious complications and no significantly different outcomes in corrected visual acuity 6 months after surgery. Furthermore, with proper IOL calculation, it is possible to achieve ±1.00 diopter of postoperative spherical equivalent in up to 100% of cases.5
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,002 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».