Capsular Opacification Research Articles

Aspheric hydrophobic acrylic intraocular lens outcomes in patients with additional ocular pathology

Objectives: The objective of the study was to examine the real-world visual performance, refractive outcomes, and glistening occurrence of a hydrophobic acrylic aspheric monofocal intraocular lens (IOL) in patients with ocular comorbidities. Materials and Methods: All cases of cataract surgery with the implantation of a hydrophobic acrylic aspheric monofocal IOL in a single centre between September 2020 and March 2022 were reviewed in a retrospective cohort study. Refraction (autorefract), visual acuity, peri- and post-operative complications, and the presence of posterior capsular opacification (PCO) and glistenings were recorded. Due to facility and surgeon preference, this lens was utilised predominantly for younger patients with additional ocular pathology. Results: Data regarding 15 patients (21 eyes) were collected. The mean age was 57.3 years (Range: 37–70). Eleven patients (73%) had ocular pathology in addition to cataracts. One patient was excluded due to a lack of follow-up. Post-operative refraction was available for 13 eyes (61%). The median follow-up time was five months. Corrected distance visual acuity (logarithm of the minimum angle of resolution) improved from 0.52 ± 0.54 to 0.17 ± 0.21 (mean ± standard deviation; P = 0.01); 95% confidence interval 0.08–0.26). 77% of eyes were within 0.5 D of the refractive target, and 92% were within 0.7 D. Six patients (30%) had documented PCO, with two requiring YAG capsulotomy. No patients had IOL glistenings. Conclusion: The hydrophobic aspheric monofocal IOL performs well for young patients with ocular pathology in addition to cataracts. Further, long-term follow-up will help to support its use for patients who require greater than standard longevity from an IOL.

Conditions for modifying intraocular lenses as drug carriers for methotrexate using poly (lactic-co-glycolic acid).

The intraocular lens (IOL) can be used as a slow-release drug carrier in cataract surgery to alleviate posterior capsular opacification (PCO). The following is a systematic development of an IOL using methotrexate and the solvent casting process with poly (lactic-co-glycolic acid) (PLGA) as a carrier polymer. Different solvents for PLGA and methotrexate were tested for dissolution properties and possible damage to the IOL. The required biological concentration of methotrexate was determined in human capsular bags implanted with an IOL. To detect fibrosis, α-SMA, f-actin, and fibronectin were labelled by immunofluorescence staining. Cell proliferation and extracellular matrix contraction were observed in a lens epithelial cell line (FHL-124). Finally, the IOL was designed, and an ocular pharmacokinetic model was used to measure drug release. Solvent mixtures were found to allow coating of the IOL with drug and PLGA without damaging it. PCO in the capsular bag model was inhibited above 1 μM methotrexate (p = 0.02). Proliferation in FHL-124 was significantly reduced above a concentration of 10 nM (p = 0.04) and matrix contraction at 100 nM (p = 0.02). The release profile showed a steady state within therapeutic range. After determination of the required physicochemical manufacturing conditions, a drug releasing IOL was designed. A favourable release profile in an ocular pharmacokinetics model could be shown.

Overexpression of TRPV1 activates autophagy in human lens epithelial cells under hyperosmotic stress through Ca2+-dependent AMPK/mTOR pathway.

To explore whether autophagy functions as a cellular adaptation mechanism in lens epithelial cells (LECs) under hyperosmotic stress. LECs were treated with hyperosmotic stress at the concentration of 270, 300, 400, 500, or 600 mOsm for 6, 12, 18, 24h in vitro. Polymerase chain reaction (PCR) was employed for the mRNA expression of autophagy-related genes, while Western blotting detected the targeted protein expression. The transfection of stub-RFP-sens-GFP-LC3 autophagy-related double fluorescence lentivirus was conducted to detect the level of autophagy flux. Scanning electron microscopy was used to detect the existence of autolysosome. Short interfering RNA of autophagy-related gene (ATG) 7, transient receptor potential vanilloid (TRPV) 1 overexpression plasmid, related agonists and inhibitors were employed to their influence on autophagy related pathway. Flow cytometry was employed to test the apoptosis and intracellular Ca2+ level. Mitochondrial membrane potential was measured by JC-1 staining. The cell counting kit-8 assay was used to calculate the cellular viability. The wound healing assay was used to evaluate the wound closure rate. GraphPad 6.0 software was utilized to evaluate the data. The hyperosmotic stress activated autophagy in a pressure- and time-dependent manner in LECs. Beclin 1 protein expression and conversion of LC3B II to LC3B I increased, whereas sequestosome-1 (SQSTM1) protein expression decreased. Transient Ca2+ influx was stimulated caused by hyperosmotic stress, levels of mammalian target of rapamycin (mTOR) phosphorylation decreased, and the level of AMP-activated protein kinase (AMPK) phosphorylation increased in the early stage. Based on this evidence, autophagy activation through the Ca2+-dependent AMPK/mTOR pathway might represent an adaptation process in LECs under hyperosmotic stress. Hyperosmotic stress decreased cellular viability and accelerated apoptosis in LECs and cellular migration decreased. Inhibition of autophagy by ATG7 knockdown had similar results. TRPV1 overexpression increased autophagy and might be crucial in the occurrence of autophagy promoted by hyperosmotic stress. A combination of hyperosmotic stress and autophagy inhibition may be a promising approach to decrease the number of LECs in the capsular bag and pave the way for improving prevention of posterior capsular opacification and capsular fibrosis.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia.

To assess effectivity and safety of trifocal intraocular lenses (IOLs) and capsular tension rings in treating cataract patients with axial high myopia. A prospective nonrandomized controlled clinical trial was conducted. Totally 98 eyes (74 patients) who underwent femtosecond laser-assisted cataract surgery (FLACS) with trifocal IOLs were enrolled in the study and followed up for 2y after surgery: 46 eyes (33 patients) with capsular tension ring implantation in the long axial lengths (AL) group (26<AL<29 mm) and 52 eyes (41 patients) in the normal AL group (22<AL<24.5 mm). Postoperative outcomes about effectivity and safety, including the subjective and objective visual quality, and postoperative complications were assessed. Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively (P<0.05). The differences in reading speed, spectacle independence and potential visual complaints between the two groups were not statistically significant (P>0.05). The dysfunctional lens index and total modulation transfer function (MTF) average height were similar between the two groups. The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group (P<0.05). The total satisfaction score in the long AL group (91.32±2.76) was slightly higher than that in the normal AL group (90.36±3.47), but there was no difference (P=0.136). A statistically negative correlation was found between corrected distance visual acuity (CDVA) and dysfunctional lens index (r=-0.382, P=0.009), and between CDVA and the total MTF average height (r=-0.374, P=0.01). But there was no significant correlation between CDVA and total satisfaction score (r=0.059, P=0.696). Postoperative complications mainly presented as posterior capsular opacity (PCO), retinal detachment and cystoid macular edema. There was no difference in the incidence of fundus disease (6.5% vs 3.8%, P=0.663) or PCO (17.4% vs 7.7%, P=0.217) between the two groups at two years. The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS. This approach not only ensures excellent subjective feelings and objective visual quality, but also does not increase the incidence of postoperative complications.

T1D and T2D predispose to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases

PurposeTo assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery. DesignA retrospective cohort study. MethodsAll patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies. ResultsIncluded were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. ConclusionIn our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.

Visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery.

To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS). Tertiary-care eye hospital in southern India. Retrospective interventional case series. Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment-induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed. 191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes ( P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable ( P = .463). In 12 eyes (13.5%), improvement in vision was not significant. This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.

ASSESSMENT OF VISUAL ACUITY AND COMPLICATIONS POST CATARACT SURGERY IN PATIENTS WITH UVEITIS IN TERTIARY CARE HOSPITAL

Aim and Objectives Aim:To study the visual acuity and operative complications after cataract surgery in patients with uveitis in tertiary care hospital Objectives: 1.To study factors affecting visual acuity. 2.To study surgical complications post cataract surgery in uveitis patients. Materials and Methods:A total of 18 patients were taken, data was collected from all the selected patients using a structured proforma meeting the objectives of the study. • Inclusion Criteria:1.All complicated cataract patients attending ophthalmology OPD 2.A quite eye (without inflammation) for atleast 3 months • Exclusion Criteria: 1.Cataract due to causes other than uveitis 2.Patients with posterior segment pathology Patients were scheduled for follow up on post op day 1, day 3 , day 7 , day 15, day 30, day 60, day 90. Results: The prevalance was more common in males compared to females. Out of 18 patients, 14 (77%) underwent SICS with PCIOL implantation and 4 (22%) underwent phacoemulsification with PCIOL. Intra-operative complications were noted as small non-dilating pupil, peripheral anterior synechiae, pupillary membrane, incomplete capsulorhexis, iris prolapse. In 7 (38%) patients sphincterectomy was done and in 4 (22%) patients stretch pupilloplasty was done. Immediate post-op complications that were noted were anterior chamber reaction and pigment dispersion. Late post-op complications that were noted were posterior capsular opacification Dense posterior synechiae were encountered in 12 (66%) patients and excessive conjunctival bleeding in 6(33%) patients. There was improvement in visual outcomes as follows 8 patients had 6/6 vision, 6 patients had 6/18 vision where as remaining 4 patients had 6/36 vision due to early development of posterior capsular opacification. Conclusion: Cataract development is a very common occurrence in any form of anterior and intermediate uveitis because of chronic intraocular inflammation, long term use of corticosteroids. Reported incidence of cataract in uveitic patients is about 25% in juvenile rheumatoid arthritis and 75% in chronic anterior uveitis. It is possible to achieve successful visual outcomes following cataract surgery in uveitis by proper management of pre-operative inflammation and close post-operative observation. Management of uveitic cataract requires careful case selection, proper timing of surgery, and close monitoring with appropriate handling of complications that may occur.

Visual Outcome and Complications Following Nd: YAG Laser Capsulotomy in Postoperative Posterior Capsular Opacification- A Prospective Study

Aim of the study was to find out the visual outcome and complications following Nd YAG laser capsulotomy in postoperative posterior capsular opacification. Materials and Methods: consist of a prospective study including 100 eyes having postoperative Posterior Capsular Opacification (PCO), attending the Ophthalmology outpatient department of a Medical College in Bengaluru during January 2021 to June 2022. A complete physical and ophthalmological examination was carried out. After taking informed consent, patients underwent Nd YAG laser capsulotomy. Post-operative follow-up was done and observed for any complications till 6 weeks. Conclusion: Nd YAG laser capsulotomy is an effective, relatively safe and economical in the management of posterior capsular opacity. To minimise the complications, minimum energy combined with precisely focused shots of Nd YAG laser is needed for having a desired opening in the posterior opacified capsule. Keywords: Postoperative Posterior Capsular Opacification, Nd YAG Laser capsulotomy.

Improvements to a GLCM-based machine-learning approach for quantifying posterior capsule opacification.

Posterior capsular opacification (PCO) is a common complication following cataract surgery that leads to visual disturbances and decreased quality of vision. The aim of our study was to employ a machine-learning methodology to characterize and validate enhancements applied to the grey-level co-occurrence matrix (GLCM) while assessing its validity in comparison to clinical evaluations for evaluating PCO. One hundred patients diagnosed with age-related cataracts who were scheduled for phacoemulsification surgery were included in the study. Following mydriasis, anterior segment photographs were captured using a high-resolution photographic system. The GLCM was utilized as the feature extractor, and a supported vector machine as the regressor. Three variations, namely, GLCM, GLCM+C (+axial information), and GLCM+V (+regional voting), were analyzed. The reference value for regression was determined by averaging clinical scores obtained through subjective analysis. The relationships between the predicted PCO outcome scores and the ground truth were assessed using Pearson correlation analysis and a Bland-Altman plot, while agreement between them was assessed through the Bland-Altman plot. Relative to the ground truth, the GLCM, GLCM+C, and GLCM+V methods exhibited correlation coefficients of 0.706, 0.768, and 0.829, respectively. The relationship between the PCO score predicted by the GLCM+V method and the ground truth was statistically significant (p<0.001). Furthermore, the GLCM+V method demonstrated competitive performance comparable to that of two experienced clinicians (r=0.825, 0.843) and superior to that of two junior clinicians (r=0.786, 0.756). Notably, a high level of agreement was observed between predictions and the ground truth, without significant evidence of proportional bias (p>0.05). Overall, our findings suggest that a machine-learning approach incorporating the GLCM, specifically the GLCM+V method, holds promise as an objective and reliable tool for assessing PCO progression. Further studies in larger patient cohorts are warranted to validate these findings and explore their potential clinical applications.

Photo-controllable drug releasing bulk polyacrylic intraocular lens material for safer posterior capsular opacification prevention

Posterior capsular opacification (PCO) is the most common complication that occurs after intraocular lens (IOL) implantation in cataract therapy. In recent years, IOLs have been developed as drug delivery platforms, but concerns over the safety of uncontrolled proliferative drug release have arisen. Therefore, a controlled drug release strategy is needed for safer PCO prevention. In this study, a new monomer contained coumarin group was introduced in material preparation, and poly(ethylene glycol phenyl ether methacrylate-co-2-(2-ethoxyethoxy) ethyl acrylate-co-7-(2-methacryloyloxyethoxy)-4-methylcoumarin) (PEEC) acrylic IOL materials were synthesized. The antiproliferative drug 5-fluorouracil (5-FU) could be chemically grafted to the PEEC IOL materials easily via a light induced [2 + 2] cycloaddition reaction with the coumarin group, getting drug-loaded IOL (PEEC@5-FU IOL). The PEEC@5-FU IOL exhibited excellent optical and mechanical properties and biocompatibility. More importantly, the loaded 5-FU could be easily controlled from release by light irradiation via photo-dissociation of the cyclobutane ring that was obtained by the [2 + 2] cycloaddition reaction of 5-FU and coumarin. The in vitro and in vivo experiments demonstrated that such photo-controllable drug release IOL could effectively prevent PCO after implantation in a safe way.

A Comparative Study of Visual Outcome and IOP Changes in Postoperative PCO Cases Among Diabetics and Non Diabetics Following Nd: YAG Laser Capsulotomy

Background: Posterior capsular opacification is the most common long term complication of modern IOL surgery.ND: YAGlaserre mains the corner stone of its treatment. In this study, an attempt is made to study the visualoutcome and change in the intraocular pressure following Nd: YAG laser capsulotomy and compare the resultsbetween diabetic patients and non-diabetic patients.Method: This was a prospective study of 100 patients (50 diabetics and 50 nondiabetics), conducted in KhajaBanda Nawaz Teaching and General Hospital, Kalaburgai. All patients in the age group 45-75 years, attendingthe regular OPD who presented with visually significant posterior capsular opacification and were treated withNd:YAG laser capsulotomy. Patients were included in the study taking into consideration inclusion and exclusioncriterias. Patients were followed up on first day, first week and the four weeks and the improvement in the BCVAand the changein IOP (Intra Ocular pressure) were recorded.Results: All the patients treated for PCO with Nd:YAG laser capsulotomy showed an improvement in visualacuity. The visual outcome at four weeks (41%had &gt; 6/12) was found to be better than that at first week (34 % hadthe same) and first day (16% had the same). The final visualoutcome at 4 weeks was found to be better in nondiabetics(52% had&gt;6/12) compared to diabetics (30% had&gt;6/12). All the patients showed an increase in IOP atthe first day and first week of follow up and return to near normal of baseline values at four weeks of follow up,the pattern of change in IOP being similar in both the study groups.Conclusion: Nd:YAG laser capsule to May effectively improves the visualacuity inpatients with visually significantPCO. The comparatively poor outcome in the diabetic group can be attributed to the associated retinopathychanges. Nd:YAGl aser capsulotomy is associated with a transient rise in the intraocular pressure in all patientswhich can very rarely remain persistently high.

Simulation of the effect of capsular opacification on retinal illumination

Posterior capsular opacification is the most common complication after cataract surgery with intraocular lens implantation. Different strategies have been proposed to avoid PCO including 360° continuous sharp edges of the posterior IOL optics rim, haptics angulations, or surface modification of the optics. However, depending on the IOL material and surgical technique 20 to 60% of eyes require Nd:YAG laser capsulotomy in the first 2 years after cataract surgery. In this talk we would like to define a scattering model for the posterior lens capsule and perform raytracing through the pseudophakic eye with a scattering capsule to investigate the impact of biometric parameters on the scatter characteristics and contrast transfer of the eye.

Long-Term Outcomes of Phacoemulsification Surgeries at ECWA Eye Hospital: A Prospective Clinical Cohort Study.

Phacoemulsification has proven to be a breakthrough technique in cataract surgery. Its popularity has grown dramatically as procedures and equipment have advanced, improving both safety and efficiency. This study presents long-term outcomes from phacoemulsification surgeries performed at the Evangelical Church Winning All (ECWA) Eye Hospital, a tertiary eye care center. This prospective clinical cohort study followed standard practices for operations performed under local anesthesia. Ophthalmologists evaluated long-term outcomes and predictors of improved visual acuity after phacoemulsification cataract surgery. The visual recovery of the patients over time was evaluated, and the factors that influence the gains in vision were identified. A total of 177 patients were subjected to treatment at our facilities during the study period. There were 116 male and 61 female patients, which resulted to a male-to-female ratio of 1 : 0.53. The average age of the patients was 59.18 years with a standard deviation of 11.38 years. Of the 259 eyes treated, 249 eyes (96.1%) achieved a high success rate with visual acuity of 6/6 - 6/18. Ten (10) eyes (3.9%) had moderate acuity between <6/18 and 6/60. Follow-up examinations over five years after phacoemulsification showed poor vision outcomes among old patients. The primary factor that affected improvement in visual acuity among patients was amblyopia, present in 30% of cases. Posterior capsular opacification and macular edema collectively accounted for 20% of poor vision cases, while optic atrophy, glaucoma, and retinal hemorrhage each represented approximately 10% of poor vision cases. The phacoemulsification approach demonstrated a highly effective restoration of vision for the vast majority, while long-term data analysis indicated the potential for age-related variability in postoperative visual gains.

Recurrent posterior capsule opacification in an adult

A 59-year-old male presented with diminished vision in the right eye (OD) after undergoing cataract surgery 4 years back. One year later, he developed posterior capsular opacification, for which laser capsulotomy was done. He had good vision since then. His vision deteriorated again for the last 6 months. On examination, OD showed opacification of posterior capsule within the area of laser capsulotomy. A repeat laser capsulotomy was done in OD. Vision was 6/6 (OD) on the follow-up 2 weeks later.

IOL exchange for positive and negative dysphotopsia

Positive and negative dysphotopsia are complaints that sometimes occur after otherwise uneventful cataract surgery with intraocular lens (IOL) implantation. In positive dysphotopsia (PD), artefacts such as glare and halos are experienced around light sources, especially in scotopic conditions. In negative dysphotopsia (ND), a dark shadow or crescent is experienced in the temporal visual field, especially in photopic conditions. An IOL‐exchange, especially with an larger sized IOL, is one of the therapies of both conditions.In this presentation, first the surgical technique to perform an IOL‐exchange will be presented. In short, the initially implanted IOL is removed through a small corneal incision (3.0 mm) after luxation of the IOL in the anterior chamber and cutting it in half before extraction. Subsequently, the new IOL is injected directly into the bag through the 3.0 mm corneal incision that was used for the removal of the initial IOL.Subsequently the clinical results of such an IOL‐exchange, with the Aspira‐aXA, a monofocal, 1‐piece hydrophilic acrylic IOL with an optic diameter of 7.0 mm, will be presented. In total, 20 eyes of 16 patients with pseudophakic dysphotopsia were included in the analysis. Nine eyes suffered from PD, ten eyes from ND, and one eye from both complaints. 15 out of 20 eyes (75%) showed complete resolution of complaints after the IOL exchange and four eyes (20%) showed a partial resolution. Postoperatively, in one eye vitreous loss occurred and resulted in cystoid macular edema, and another eye developed posterior capsular opacification, all treated successfully.As the bag‐to‐bag IOL exchange with a 7 mm IOL resulted in partial or complete resolution of positive and negative dysphotopsia in the majority of patients (95%), it is a potential treatment for patients with dysphotopsia.

Cataract Outcomes Following Scleral Buckle Surgery for Retinal Detachment.

To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD). A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted. Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes. Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

Synchrotron‐based Fourier transform infrared microspectroscopy examined differences between the cultured and post‐operative human lens epithelial cells important for understanding posterior capsular opacification and lens regeneration

Aims/Purpose: To compare the bio‐macromolecular composition and the differences between the human cultured and post‐operative lens epithelial cells (LECs) on lens capsules (LCs) for a better understanding of posterior capsular opacification (PCO)—the most common complication of cataract surgery, and lens regeneration.Methods: The explants of the anterior portion of the LC containing the LECs, obtained from cataract surgery and cultivated under adherent conditions, as well as the post‐operative LC with LECs, were analysed by using synchrotron radiation‐based Fourier transform infrared (SR‐FTIR) microspectroscopy, a vibrational spectroscopic technique that allows monitoring of the entire biochemical status of the biological processes. The SR‐FTIR microspectroscopy setup installed on the beamline MIRAS at the Spanish synchrotron light source ALBA was used, where measurements were set to achieve single‐cell resolution, with high spectral stability and high photon flux.Results: We found that the differences exist between the composites of cultured and post‐operative LECs on LCs on the level of all chemical constituents: proteins, lipids, nucleic acids and carbohydrates as well as oxidative stress. The strongest differences are found in protein secondary structure contribution where the composite of primary LECs cultures on LC have more α‐helix (1652 cm−1) and post‐operative LC have more β‐sheet (1624 cm−1 and 1697 cm−1) secondary structures. The oxidative stress is more expressed in the composite of primary LECs cultures on LC and relatively less in the composite of post‐operative lens epithelium LECs on LC.Conclusions: Our results obtained by SR‐FTIR increase the knowledge about the total proteins, lipids, and nucleic acids in human primary cultures LECs while offering also evidence that SR‐FTIR is sensitive to the pathologic processes of LECs transdifferentiation. We showed that the composite of primary cultures LECs on LC have a distinct bio‐macromolecular composition compared to the composite of post‐operative LECs on LC, which gives additional information for a better understanding of PCO and lens regeneration.

Applications of Artificial Intelligence in Cataract Surgery: A Review.

Cataract surgery is one of the most performed procedures worldwide, and cataracts are rising in prevalence in our aging population. With the increasing utilization of artificial intelligence (AI) in the medical field, we aimed to understand the extent of present AI applications in ophthalmic microsurgery, specifically cataract surgery. We conducted a literature search on PubMed and Google Scholar using keywords related to the application of AI in cataract surgery and included relevant articles published since 2010 in our review. The literature search yielded information on AI mechanisms such as machine learning (ML), deep learning (DL), and convolutional neural networks (CNN) as they are being incorporated into pre-operative, intraoperative, and post-operative stages of cataract surgery. AI is currently integrated in the pre-operative stage of cataract surgery to calculate intraocular lens (IOL) power and diagnose cataracts with slit-lamp microscopy and retinal imaging. During the intraoperative stage, AI has been applied to risk calculation, tracking surgical workflow, multimodal imaging data analysis, and instrument location via the use of "smart instruments". AI is also involved in predicting post-operative complications, such as posterior capsular opacification and intraocular lens dislocation, and organizing follow-up patient care. Challenges such as limited imaging dataset availability, unstandardized deep learning analysis metrics, and lack of generalizability to novel datasets currently present obstacles to the enhanced application of AI in cataract surgery. Upon addressing these barriers in upcoming research, AI stands to improve cataract screening accessibility, junior physician training, and identification of surgical complications through future applications of AI in cataract surgery.

IOL's material and PCO

Posterior capsular opacification (PCO) is the most common of late post‐surgery complications and can lead to reduced visual acuity, diplopia, or glare. The different types of material used in intraocular lenses (IOLs) plays a significant role in possible post‐surgery complications, such as anterior capsule opacification (ACO) and phimosis, posterior capsule opacification (PCO), and the formation of IOL opacification. PCO incidence increases with time and varies from 10% to 50%. The incidence of PCO will rise in the nearest future since IOLs will stay longer in the eye, as people's lifespans are increasing. It was shown that hydrophilic IOLs had significantly more and denser PCO than hydrophobic or silicone IOLs. The higher incidence of PCO formation in hydrophilic than in hydrophobic IOLs should be considered as an important medical and health economic issue when choosing the IOL for implantation.

Cataract surgery in retinitis pigmentosa.

Retinitis pigmentosa (RP) is an inherited retinal dystrophy characterized by progressive vision loss due to photoreceptor degeneration. Complicated cataract formation, particularly posterior subcapsular cataract (PSC), frequently occurs in RP and exacerbates the visual impairment. Cataract surgery may improve vision; however, the distinctive challenges of RP require specific considerations. This mini-review aims to provide a comprehensive overview of the RP-related cataract. A comprehensive literature review was conducted via PubMed/MEDLINE, spanning the period from January 1976 to June 2024, using the keywords "cataract," "cataract surgery," "cystoid macular edema," "hereditary retinal dystrophy," "retinitis pigmentosa," "posterior subcapsular cataract," "posterior capsular opacification," "zonular weakness," and "artificial intelligence." We aimed to evaluate cataract surgery in patients with RP, focusing on cataract formation, its surgical management, postoperative complications, patient follow-up, and visual outcomes. Relevant review articles, clinical trials, and case reports with related reference lists of these articles were included. A total of 53 articles were examined in detail, including those identified through focused keyword searches and the reference lists of these articles. Cataract surgery in patients with RP generally results in substantial visual improvement. However, surgery can be complicated, particularly by zonular weakness and subluxation of the crystalline lens. These risks can be reduced by using capsular tension rings and employing meticulous surgical technique. Furthermore, postoperative complications, such as cystoid macular edema and posterior capsular opacification, are common. Despite these challenges, regular postoperative follow-up and appropriate management can help mitigate complications. Integrity of the ellipsoid zone and external limiting membrane on preoperative optical coherence tomographic examination are the main predictors of visual outcomes following cataract surgery; however, outcomes can vary. Though many patients experience significant visual improvement, some may experience limited benefits due to pre-existing advanced retinal degeneration. Cataract surgery may offer meaningful visual benefits in patients with RP; however, careful preoperative evaluation and meticulous surgical technique are required to address the possible challenges. Attentive postoperative care and follow-up are essential to optimize visual outcomes. Early surgical intervention can significantly improve the quality of life in selected candidates, and tailored approaches are necessary in patients with RP requiring cataract surgery. Further studies on the potential application of artificial intelligence to monitor postoperative recovery and detect complications may improve surgical outcomes and enhance patient care.