Conventional Intraocular Lens Research Articles

In situ Scleral Suture Fixation of an Injector-delivered Intraocular Lens

Purpose: We evaluated a novel surgical technique for managing the intraocular lens (IOL) through in situ scleral fixation and its outcomes.Case summary: This retrospective case series included three eyes of three patients treated with the in situ scleral fixation technique for IOL. Our method involves suturing the haptics of an already intraocularly injected IOL in situ using a Siepser sliding knot suture, while the other haptic is tied externally. Notably, no intraoperative or postoperative complications, such as cystoid macula edema, were observed.Conclusions: This novel technique is a user-friendly and effective approach to improve IOL-capsular bag stability, requiring minimal intraocular intervention or preoperative preparation compared to conventional IOL scleral fixation methods. Furthermore, it is particularly effective for addressing concerns related to IOL-capsular bag stability following IOL insertion, as it eliminates the possibility of performing the typical IOL scleral fixation due to the absence of preoperative preparation and evaluation.

Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens

Introduction: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). Methods: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. Results: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). Conclusions: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

Comparison of short‐term clinical outcomes between sutured scleral fixation and modified Yamane sutureless scleral fixation

Aims/Purpose: To compare and investigate the short‐term clinical outcomes between 10‐0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analysed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for 1 week after surgery and IOL astigmatism for 1 week and 1 month after surgery were significantly lower in sutureless fixation group. There was no significant difference in post‐operative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Comparison of Short-term Clinical Outcomes between Sutured Scleral Fixation and Modified Yamane Sutureless Scleral Fixation

Purpose: To compare and investigate the short-term clinical outcomes between 10-0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analyzed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month, and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for one week after surgery and IOL astigmatism for one week and one month after surgery were significantly lower in sutureless fixation group. There was no significant difference in postoperative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

BackgroundTo compare the clinical outcomes of bilateral implantation of enhanced intermediate function intraocular lenses (IOLs) and standard monofocal IOLs.MethodsIn this prospective, randomized, comparative controlled study, we compared the visual outcomes of patients who underwent bilateral cataract surgery at the Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, with either enhanced monofocal IOLs (Tecnis Eyhance, ICB00, Johnson and Johnson Vision Care, Inc) (Group 1) or standard monofocal IOLs (Tecnis, ZCB00, Johnson and Johnson Vision Care, Inc) (Group 2). The assessment included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate (UIVA at 60 cm) and near (UNVA at 40 cm) visual acuity, uncorrected defocus curves, contrast sensitivity testing (CST), and reading speed test using Quality of vision was evaluated using the Visual Function Questionnaire (VFQ-25).ResultsAt 3-months postoperatively, monocular and binocular outcomes of UIVA and UNVA were statistically significantly better in Group 1 (P < 0.05). The binocular uncorrected defocus curve of Group 1 showed statistically significantly better outcomes at vergence ranges of -1.5 to -4.0 D (P < 0.05). Significantly higher reading speed test was also observed in Group 1 in all ranges tested (1.0 to 0.1 LogMAR) (P < 0.05). There were no statistically significant differences in CST between groups.ConclusionsBilateral implantation of enhanced monofocal IOLs provided better vision at intermediate and near distances compared to standard monofocal IOLs, while maintaining good distance vision and contrast sensitivity.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia.

This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA-assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal Ⅱ and Hill-RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Sixty-five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal Ⅱ (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill-RBF > Haigis > SRK/T > Barrett Universal Ⅱ). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill-RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal Ⅱ (53.84%). IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal Ⅱ although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift.

Geometric-phase intraocular lenses with multifocality

We demonstrate a new type of multifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) embedding μm-thin geometric phase (GP) lens layers. As an emerging approach for lens phase design, the GP modulated IOLs outperform conventional diffractive IOLs in multifocality while completely avoiding the clinically undesirable demand for additional surface patterns to standard monofocal IOL designs. The number of foci and light splitting ratio of the GP IOLs are adjusted by changing the number of stacked GP layers and the thickness of each layer. Bifocal and trifocal GP IOLs are fabricated by radial alignment of anisotropic orientation in UV-curable liquid crystal polymers. After characterizing the defocus image and modulation transfer function of the GP IOLs, it is expected that GP IOLs will alleviate the most common problems associated with multifocal and EDOF IOLs, blurred vision and photic phenomena caused by light scattering and posterior capsule opacification.

Complementary system vs conventional trifocal intraocular lens: comparison of optical quality metrics and unwanted light distribution.

To evaluate the ARTIS Symbiose complementary intraocular lens (IOL) system, consisting of the MID and PLUS models, in comparison with a conventional trifocal IOL (AcrySof IQ PanOptix). The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Laboratory investigation. Modulation and phase transfer functions were obtained in polychromatic light using an optical bench setup. Simulated visual acuity (VA) values were derived from optical quality metrics weighted by neural contrast sensitivity. United States Air Force (USAF) chart images were acquired and processed. Furthermore, the light distribution beyond the center of a polychromatic point spread function was assessed. The peak simulated VA values of ARTIS Symbiose MID were at 0 diopters (D) of defocus (-0.02 logMAR) and at -1.5 D (0.00 logMAR); of ARTIS Symbiose PLUS, they were at 0 D of defocus (-0.01 logMAR) and at -2.5 D (0.01 logMAR). AcrySof IQ PanOptix demonstrated 3 peaks: at 0 D of defocus (-0.02 logMAR), at -1.75 D (0.03 logMAR), and at -2.5 D (0.02 logMAR). The summation of USAF chart images in the simulated binocular IOL system produced a slightly better image quality at -1.0 D and -1.5 D than AcrySof IQ PanOptix. The IOLs yielded comparable light spread across the studied range except for a localized intensity spike of the ARTIS Symbiose IOLs. The complementary IOL system may yield better monocular intermediate VA compared with the conventional trifocal IOL. However, the effect of binocular summation in terms of VA and the perception of photic phenomena still needs to be investigated.

Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis.

To compare different outcomes of an enhanced monofocal intraocular lens (IOL) versus a conventional monofocal IOL implantation after cataract surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for abstracting data and assessing quality. Comparative studies between enhanced monofocal versus conventional monofocal IOL implantations reporting outcomes in monocular and binocular visual acuities at various distances, spectacle independence, contrast sensitivity, optical quality, and adverse effects were identified from three databases. Meta-analysis, sensitivity analysis, and subgroup analysis were performed. A total of 680 eyes implanted with an enhanced monofocal IOL (Tecnis Eyhance ICB00; Johnson & Johnson) and 647 eyes with a conventional monofocal IOL from 3 randomized controlled trials and 9 comparative studies were included. The enhanced monofocal IOL showed better monocular uncorrected intermediate visual acuity (UIVA) (mean difference [MD]: -0.11 logMAR; 95% CI: -0.12 to -0.09), binocular UIVA (MD: -0.17 logMAR; 95% CI: -0.23 to -0.11), and binocular uncorrected near visual acuity performance (MD: -0.17 logMAR; 95% CI: -0.29 to -0.04) than the conventional monofocal IOL. More patients were spectacle free at intermediate distance with the enhanced monofocal IOL (odds ratio: 12.9; 95% CI: 6.2 to 27.0). Both monocular (MD: -0.002 logMAR; 95% CI: -0.01 to 0.01) and binocular (MD: 0.01 logMAR; 95% CI: -0.02 to 0.03) uncorrected distance visual acuity revealed non-significant differences between the IOL designs. Contrast sensitivity, photic phenomenon, and adverse effects were comparable. Enhanced monofocal IOLs effectively improved unaided intermediate vision with similar distance performance relative to conventional monofocal IOLs. This was achieved without compromising the contrast sensitivity or inducing photic phenomena. [J Refract Surg. 2022;38(8):538-546.].

Enhanced Stereopsis of Rotationally Asymmetric Multifocal Intraocular Lens With + 1.5 Diopters Near Addition.

To the Editor: Stereopsis is the highest level of binocular vision and contributes to the determination of depth and distance in solid object recognition. Currently, multi-focal intraocular lenses (IOLs) with various added powers are selected based on patient preferences and lifestyles. The European Society of Cataract and Refractive Surgery (ESCRS) Functional Vision Working Group report1 emphasized the importance of the postoperative functionality of near and intermediate vision, which are necessary for everyday activities. Conventional multifocal IOLs with 2 distinct foci provide patients with good far and near vision, but unsatisfactory intermediate vision. The use of low-addition multifocal IOLs (low-add IOLs) can improve intermediate vision.2 Herein, we discussed the stereopsis from far to near in patients implanted with low-add IOLs. Twenty-one patients bilaterally implanted with the low-add IOL (Lentis Comfort LS-313MF15 IOL, Santen Pharmaceutical) (69.7 ± 5.2 years, Low-add group) and 22 with the aspheric monofocal IOL (Tecnis ZCB00 V, Johnson & Johnson Surgical Vision) (69.7 ± 5.2 years, Monofocal group) were examined. All surgeries were performed using a standard technique of sutureless phacoemulsification under topical anesthesia by the same experienced surgeon. The low-add IOL was a foldable plate-haptic, rotationally asymmetric, refractive multifocal IOL, combining an aspheric distance vision zone and a sector-shaped near vision zone with an add power of + 1.5 diopters (D) on the lens plane, that was positioned inferiorly. Inclusion criteria were: 1) having postoperative distance-corrected visual acuity (DCVA) of Snellen 20/25 or better in both eyes, 2) refraction difference of < 2.0 D between both eyes, and 3) without manifest strabismus. DCVA and stereoacuity were measured at far (5 m, 2 m), intermediate (1 m, 70 cm, 50 cm), and near (30 cm) using a Binoptometer 4 P (Oculus Optikgeräte GmbH) at 2 months postoperatively. Significantly better distance-corrected intermediate visual acuity, and distance-corrected near visual acuity were attained in the Low-add group than in the Monofocal group (P < 0.001 for 50 cm and 70 cm; P < 0.01 for 30 cm and 1 m) (Supplemental Digital Content Fig. 1A, http://links.lww.com/APJO/A122) Stereoacuity at 30 cm and 50 cm was significantly better in the Low-add group than in the Monofocal group (Supplemental Digital Content Fig. 1B, http://links.lww.com/APJO/A122). The rates of normal range3 (≤ 100 seconds of arc for 5 m, 2 m, 1 m, 70 cm, 50 cm, and 30 cm) were 85%, 77%, 81%, 58%, 53%, and 24% in the Low-add group, while they were 82%, 64%, 59%, 37%, 18%, and 0% in the Monofocal group. The rates of normal range at 30 cm (P = 0.002) and 50 cm (P = 0.017) in the Low-add group were significantly higher than those in the Monofocal group. Consistent with a previous study,4 a low-add IOL provided good postoperative far and intermediate visual acuity. Unlike the double-peak curve pattern observed with conventional far/near bifocal IOLs, the DCVA showed a gradual decrease from far to near. The Titmus stereoscopic test is the most common test measured at a standardized distance (40 cm) as near ster-eoacuity. The current study measured ster-eoacuity under binocular natural viewing conditions at several distances to assess stereopsis similar to those experienced in everyday life. In the Monofocal group, the DCVA and the rates of the normal range of stereoacuity decreased with a shorter target distance. At a distance of 30 cm, no patient showed a normal range of stereoacuity. The effects of optical blur on stereopsis5 have been reported and are comparable to the results in the Monofocal group. In contrast, a normal range of stereoacuity was attained for 1 m to 5 m in approximately 80% of patients in the Low-add group. The Cat-quest-9SF QoL questionnaire6 for assessing intermediate vision1 should have been utilized; however, its validated Japanese version is not currently available. In summary, the rotationally asymmetric multifocal IOLs with + 1.5 D near addition provided enhanced stereoacuity and vision at near and intermediate levels compared with monofocal IOLs. It may be an option for enhanced functional vision, leading to better overall patient satisfaction.

Intraocular lens power calculation in eyes with previous corneal refractive surgery.

Intraocular lens (IOL) power calculation after corneal refractive surgery (CRS) becomes an expanding challenge for ophthalmologists as more and more cataract surgeries after CRS are required. These patients typically also have high expectations as to visual performance. Conventional IOL power calculation schemes frequently provide inaccurate results in these cases. This review aims to summarize and recommend currently available IOL power calculation methods for eyes with the most common CRS methods: radial keratotomy (RK), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE). To this end, biometry measuring methods and IOL formulas will be explained and combinations of both are proposed. In synopsis, it is evident that the latest generation of vergence formulas exhibit favorable IOL power prediction accuracy in post-CRS eyes, even though the predictive precision of methods in eyes without CRS is not attained. Ray tracing computation, intraoperative aberrometry, and machine learning–based formulas hold potential to further improve refractive outcomes in post-CRS eyes.

Post‐operative outcomes in canine eyes receiving a rhexis‐fixated prosthetic intra‐ocular lens: 30 cases (2014‐2020)

To report the outcomes following the insertion of a rhexis-fixated prosthetic intraocular lens (IOL) in dogs undergoing lens removal. The results are from 30 eyes of 28 dogs, undergoing lendectomy, in which the lens capsule could not accommodate a conventional prosthetic endo-capsular IOL. The reported cases had sustained either spontaneous or traumatic lens capsule rupture, or accidental intra-operative iatrogenic lens capsule disruption, or had required a planned, large, anterior or posterior continuous curvilinear capsulorhexis, all of which precluded insertion of a prosthetic IOL within the lens capsule. An acrylic IOL (XVET; Medicontur) was modified and positioned across the anterior and/or posterior capsulorhexes. Other than haptic luxation in three cases, no complications were seen that were directly attributable to the rhexis-fixated lens. Over a follow-up period from three to 76 months (mean 20.7months) 26/30 eyes remained visual. Blindness developed in three eyes due to retinal detachment and one eye was enucleated due to regrowth of a ciliary body adenoma. Rhexis fixation provided an alternative method to implant a prosthetic IOL when the lens capsule was unable to accommodate a conventional endo-capsular IOL.

The use of polyisobutylene-based polymers in ophthalmology

A novel polyolefin called poly(styrene-block-isobutylene-block-styrene) (“SIBS”) originated from Joseph P. Kennedy's laboratory at the University of Akron (Akron, Ohio, United States) and was developed as a biomaterial for long-term implant applications by the author. SIBS has no cleavable groups on its backbone or sidechains, is comprised predominantly of alternating secondary and quaternary carbons on its backbone, which prevents embrittlement and cracking under flexion, and undergoes multiple purification steps which renders it extremely biocompatible and well-suited for long-term applications in the eye. This article explores two ophthalmic devices; 1) the PRESERFLO® MicroShunt (Santen Pharmaceutical Co. Ltd., Osaka, Japan) made from SIBS that lowers intraocular pressure to thwart progression of vision loss from glaucoma, and 2) a novel intraocular lens (IOL) made from crosslinked polyisobutylene, which is under-development by Xi'an Eyedeal Medical Technology Co., Ltd. (Xi'an, China) that does not glisten nor cloud over time, as do most conventional IOLs.

STUDY OF VISUAL OUTCOME IN PATIENTS AFTER AC-IOL (ANTERIOR CHAMBER INTRA-OCULAR LENS) IMPLANTATION DURING CATARACT SURGERY

Background: Following posterior capsular rupture (PCR) and vitreous loss during cataract surgery, sometimes there is inadequate support for implanting a conventional intra-ocular lens (IOL) in the capsular bag. Flexible openloop anterior chamber intraocular lens, trans-sclerally sutured posterior chamber intraocular lens and iris-claw lenses are the most acceptable alternatives in such a scenario. Objective: To review our experience with primary anterior chamber intraocular lens implantation at a District Hospital in Rajkot. Methods: Analysis of medical records of a consecutive series of primary anterior chamber intraocular lens implantations carried out at the G.T. Sheth Eye Hospital at Rajkot, from September 2011 to April 2013. Eyes with complicated or traumatic cataracts, ocular co-morbidity and cases of combined surgery were excluded from the analysis of visual outcome. Results: There were 70 cases of primary anterior chamber intraocular lens implantations during the study period. Posterior capsule rupture and resultant inadequate capsular support was the commonest indication for implanting the anterior chamber intraocular lens. Postoperatively 82.85% had a best corrected visual acuity of 6/12 or better. The commonest postoperative complications were cystoid macular oedema, recurrent iritis and persistent elevated intra-ocular pressure (IOP). Conclusion: Our results indicate a satisfactory visual outcome with primary implantation of anterior chamber intraocular lenses. Caution should be exercised when implanting an anterior chamber intraocular lens following complicated cataract surgery, particularly in the absence of appropriate capsular support.

Algorithmic intraocular lens power calculation formula selection by keratometry, anterior chamber depth and axial length.

PurposeTo compare the prediction accuracy of algorithmic intraocular lens (IOL) power calculation formula selection method using conventional formulas (Haigis, Hoffer Q, Holladay 1, SRK/T and/or Barrett Universal II) based on keratometry (K), anterior chamber depth (ACD) and axial length (AL).MethodsA total of 1653 patients (1653 eyes) implanted with Tecnis ZCB00 IOL during cataract surgery were enrolled in this study. Intraocular lens (IOL) power calculation formulas with a small absolute value in the sum of the area under the curve measured by K, ACD and AL subgroup were selected to calculate IOL power in the relevant biometry subgroup. The median absolute error (MedAE) calculated by the Haigis, Hoffer Q, Holladay 1, SRK/T and Barrett Universal II formulas individually was compared to that calculated by the algorithmic selection method using four formulas, Haigis, Hoffer Q, Holladay 1 and SRK/T, or five formulas when Barrett is included.ResultsThe MedAE was 0.27 D in the Haigis, 0.30 D in the Hoffer Q, 0.27 D in the Holladay 1, 0.29 D in the SRK/T and 0.26 D in the Barrett Universal II formulas. The MedAEs determined by the algorithmic selection method using four (019 D) and five (0.21 D) formulas were significantly lower than those by the conventional IOL power calculation formulas.ConclusionsThe IOL power calculation formula selection method by biometry subgroup combined with biometric parameters K, ACD and AL may offer a more superior postoperative refractive error prediction in cataract surgery.

Use of a Machine Learning Method in Predicting Refraction after Cataract Surgery.

The present study aims to describe the use of machine learning (ML) in predicting the occurrence of postoperative refraction after cataract surgery and compares the accuracy of this method to conventional intraocular lens (IOL) power calculation formulas. In total, 3331 eyes from 2010 patients were assessed. The objects were divided into training data and test data. The constants for the IOL power calculation formulas and model training for ML were optimized using training data. Then, the occurrence of postoperative refraction was predicted using conventional formulas, or ML models were calculated using the test data. We evaluated the SRK/T formula, Haigis formula, Holladay 1 formula, Hoffer Q formula, and Barrett Universal II formula (BU-II); similar to ML methods, we assessed support vector regression (SVR), random forest regression (RFR), gradient boosting regression (GBR), and neural network (NN). Among the conventional formulas, BU-II had the lowest mean and median absolute error of prediction. Therefore, we compared the accuracy of our method with that of BU-II. The absolute errors of some ML methods were lower than those of BU-II. However, no statistically significant difference was observed. Thus, the accuracy of our method was not inferior to that of BU-II.

Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens.

To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. Retrospective case-control study. This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group (p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group (p < 0.001). The reported dysphotopsia was not significantly different between both groups (p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

Evaluation of the Effectiveness of Preloaded IOL Injectors in Surgical Time

Background: The implantation of the intraocular lens (IOL) is still subject to error and complication, as it can result in traumatic opening of the IOL leading to rupture of the posterior capsule and zonular dialysis, it takes time to train paramedic teams to assemble such IOLs with the manual injectors. Moreover, there is a potential risk of comtamination and endophthalmitis as there is manipulation of the IOL and cartridge. The preloaded IOLs tend to reduce those unwanted results and may optimize the surgical time. Purpose: The aim of this study is to compare the effectiveness and implantation time between three injectors and three intraocular lenses, two pre-loaded and one conventional. Methodology: Videos of thirty patients undergoing cataract surgery from December 2019 to December 2020 at the Hospital Oftalmologico de Brasilia (HOB), Brasilia, Brazil were included in this observational, analytical retrospective study, non randomized. All patients had their surgeries recorded, from which the time of injection and opening of the intraocular lens (IOL) was extracted, 20 eyes were implanted with preloaded intraocular lens, and 10 eyes with conventional IOL implant. The patients were divided into three groups with similar eye characteristics. The first received the AutonoMeTM (CE) injector with the Clareon® IOL, the second the IsertTM injector (I) with the Hoya® IOL, and the third was injected with Johnson & Johnson Platinum 1 Series injector used to deliver Sensar® One AAB00 lens. The Welch test and Tukey’s Post Hoc test were used in the statistical analysis. Results: It was observed that there was a statistical significance regarding the presence of a haptic stuck (5 Clareon vs 0 Sensar and Hoya), between the mean opening time of the IOL optics Sensar One, Hoya and Clareon (25.00 vs 31.40 vs 11.70 s, p < 0.001) and between the total time (the injection time more the opening time of the IOL) in relation to Hoya and Clareon lenses (39.50 s vs 19.60 s, p < 0.001); the total time of the Sensar IOL was 31.30 s. The opening time of the IOL optics was significantly longer for the Sensar One and Hoya groups compared to Clareon group, and the total time of Hoya group was significantly longer compared to the total time of the Clareon group. Conclusion: The study demonstrated that the choice of injector and IOL set can significantly affect the total time of IOL implantation. However, there was no difference regarding complications and collateral damage depending on the set chosen for the implant.

Accuracy of the Kane Formula for Intraocular Lens Power Calculation in Comparison with Existing Formulas: A Retrospective Review.

PurposeTo evaluate the accuracy of the Kane formula for intraocular lens (IOL) power calculation in comparison with existing formulas by incorporating optional variables into calculation.Materials and MethodsThis retrospective review consisted of 78 eyes of patients who had undergone uneventful phacoemulsification with intraocular implantation at Severance Hospital in Seoul, Korea between February 2020 and January 2021. The Kane formula was compared with six of the existing IOL formulas (SRK/T, Hoffer-Q, Haigis, Holladay1, Holladay2, Barrett Universal II) based on the mean absolute error (MAE), median absolute error (MedAE), and the percentages of eyes within prediction errors of ±0.25D, ±0.50D, and ±1.00D.ResultsThe Barrett Universal II formula demonstrated the lowest MAEs (0.26±0.17D), MedAEs (0.28D), and percentage of eyes within prediction errors of ±0.25D, ± 0.50D, and ±1.00D, although there was no statistically significant difference between Barrett Universal II-SRK/T (p=0.06), and Barrett Universal II-Kane formula (p<0.51). Following the Barrett Universal II formula, the Kane formula demonstrated the second most accurate formula with MAEs (0.30±0.19D) and MedAEs (0.28D). However, no statistical difference was shown between Kane-Barrett Universal II (p=0.51) and Kane-SRK/T (p=0.14).ConclusionAlthough slightly better refractory outcome was noted in the Barrett Universal II formula, the performance of the Kane formula in refractive prediction was comparable in IOL power calculation, marking its superiority over many conventional IOL formulas, such as HofferQ, Haigis, Holladay1, and Holladay2.

Association between conventional or blue-light-filtering intraocular lenses and survival in bilateral cataract surgery patients

SummaryCircadian rhythms regulate adaptive alterations in mammalian physiology and are maximally entrained by the short wavelength blue spectrum; cataracts block the transmission of light, particularly blue light. Cataract surgery is performed with two types of intraocular lenses (IOL): (1) conventional IOL that transmit the entire visible spectrum and (2) blue-light-filtering (BF) IOL that block the short wavelength blue spectrum. We hypothesized that the transmission properties of IOL are associated with long-term survival. This retrospective cohort study of a 15-hospital healthcare system identified 9,108 participants who underwent bilateral cataract surgery; 3,087 were implanted with conventional IOL and 6,021 received BF-IOL. Multivariable Cox proportional hazards models that included several a priori determined subgroup and sensitivity analyses yielded estimates supporting that conventional IOL compared with BF-IOL may be associated with significantly reduced risk of long-term death. Confirming these differences and identifying any potential causal mechanisms await the conduct of appropriately controlled prospective translational trials.