Accurate intraocular lens (IOL) selection in cataract surgery relies on precise ocular biometry, yet variability between patients remains a challenge in achieving optimal refractive outcomes. Sex-related differences in biometric parameters and age-related changes in corneal astigmatism may contribute to this variability. This study aimed to evaluate sex-related differences in ocular biometry and age-related astigmatic changes in Greek cataract candidates using swept-source optical coherence tomography (SS-OCT). This retrospective observational study included 6258 eyes from 3726 adult patients. Patients were scheduled for cataract surgery between July 2024 and July 2025 at a tertiary eye hospital in Athens, Greece. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), keratometry (K1, K2), corneal astigmatism (CA), and white-to-white (WTW) were measured using the Argos SS-OCT biometer. Predicted IOL power distribution was evaluated using the Hoffer Q formula for descriptive purposes, targeting emmetropia. Sex- and age-stratified analyses were performed. Male eyes demonstrated longer AL (by 0.46mm), deeper ACD (by 0.13mm), and larger WTW (by 0.20mm) (p < 0.01), whereas female eyes had steeper K1 (by 0.78D) and K2 (by 0.70D) (p < 0.01). An age-related shift from with-the-rule (WTR) to against-the-rule (ATR) astigmatism was observed in both sexes, occurring approximately one decade earlier in male eyes. Female eyes were overrepresented below the 5th (5.54% vs. 4.00%, p < 0.01) and above the 95th (4.42% vs. 2.88%, p < 0.01) percentiles of the predicted IOL power distribution. Sex-related differences in ocular biometry and age-related changes in corneal astigmatism were observed in this cohort. These findings provide population-specific data and highlight variability in biometric characteristics among patients with cataracts which may be relevant for preoperative assessment and surgery planning.

To determine which parameter best identifies those at risk of clinically significant postoperative residual astigmatism among eyes classified as low-astigmatism by SimK. Patients with preoperative simulated keratometric (SimK) astigmatism < 0.75 D were included. All participants underwent phacoemulsification and monofocal intraocular lens (IOL) implantation. Preoperative SimK astigmatism, total keratometric (TK) astigmatism, predicted refractive astigmatism (PRA) calculated by Barrett Toric with predicted posterior corneal astigmatism (PCA) and measured PCA were evaluated with a 0.75D indication for astigmatism correction. Receiver Operating Characteristic (ROC) curves were further constructed to determine whether a suitable indication was better than 0.75D. Sensitivity analysis was also conducted with 0.50 D as a threshold value. In total, 723 patients (723 eyes) were included with a mean age of 63.34 ± 10.26 years. Of these, 275 eyes (38.04%) had postoperative refractive astigmatism ≥ 0.75 D and 504 eyes (69.71%) had residual astigmatism ≥ 0.50 D when SimK was applied in preoperative evaluation. Using TK astigmatism and PRA yielded significantly lower mean centroid and mean absolute prediction errors than SimK astigmatism (P < 0.05). ROC curves indicated that by lowering the threshold value (range: 0.45-0.64D), the sensitivity of PRA and TK astigmatism raised significantly (TK: from 39.27% to 62.73%, PRA: from 50.55% to 65.45%). Among eyes preoperatively classified as low-astigmatism by SimK, PRA and TK showed better risk-stratification performance than SimK. Astigmatism correction should be considered when PRA or TK values exceed 0.6 D. The threshold of TK astigmatism and PRA can serve as a quick reference for risk identification of residual astigmatism.

Light-adjustable lens results of spherical equivalent and astigmatism correction from the U.S. Food and Drug Administration postapproval study.

Intracorneal Ring Segment Implantation with Epithelium-off Accelerated Cross-Linking for Pediatric Keratoconus: A 7-Year Retrospective Analysis.

To evaluate the changes in corneal astigmatism, axial length and anterior chamber depth following vitrectomy versus phacovitrectomy in patients with rhegmatogenous retinal detachment (RRD) under more detail group.To discuss how to avoid visual effect and improve visual quality after vitrectomy and phacovitrectomy by explore the mechanism of changes in corneal astigmatism, axial length and anterior chamber depth. A total of 96 patients who underwent retinal surgery for RRD in one eye, between August 2016 and January 2018, were enrolled and divided into three groups. In 18 eyes, 23-gauge transconjunctival sutureless vitrectomy (23G TSV) was performed (group A); 25G TSV was performed in 49 eyes (group B); and phacovitrectomy with 25G TSV was performed in 29 eyes (group C). Silicone oil was injected after the surgery in all three groups. Anterior and posterior corneal astigmatism, axial length (AL), and anterior chamber depth (ACD) were measured at baseline and postoperatively at 1week, 1month, and 3months. Anterior and posterior corneal astigmatism did not change, and AL continued to increase for 3months after surgery, whereas ACD decreased postoperatively but quickly returned to baseline in groups A and B. In group C, anterior and posterior corneal astigmatism, AL, and ACD increased postoperatively, and corneal astigmatism returned to baseline by 3months, but AL and ACD continued to increase for 3months. Vitrectomy alone does not affect anterior or posterior corneal astigmatism. Following vitrectomy, the AL increases, while the ACD decreases transiently. When vitrectomy is combined with phacoemulsification for cataract removal, the anterior and posterior corneal astigmatism increases transiently, while AL and ACD are enlarged for several months following surgery.

Comparison of corneoscleral topographic consistency in eyes with low-to-moderate and high astigmatism.

Diabetic patients are at an increased risk for cataract and may experience delayed postoperative recovery due to diabetes-related ocular tissue vulnerability. However, the impact of preoperative glycemic control on early surgical outcomes and quality of life remains to be fully elucidated. This study aimed to investigate the effects of preoperative fasting blood glucose (FBG) control on postoperative corneal recovery, visual function, and vision-related quality of life in type 2 diabetic patients undergoing phacoemulsification. In this retrospective analysis, 197 cataract patients with type 2 diabetes who underwent phacoemulsification between March 2023 and March 2025 were included. Based on their preoperative FBG levels, they were divided into a well-controlled group (FBG <6.1 mmol/L, n = 83) and a poorly controlled group (FBG ≥6.1 mmol/L, n = 114). National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), mean corneal astigmatism, corneal edema recovery, and best corrected visual acuity (BCVA) were compared between the two groups. Postoperatively, the well-controlled group had significantly higher total scores and scores on all dimensions of the NEI-VFQ-25 scale than the poorly controlled group (all p < 0.05). Regarding corneal recovery, the group with better control showed greater changes in mean corneal astigmatism on postoperative days 7 and 30 (p < 0.001). The corneal transparency ratio was higher on postoperative day 7 (p = 0.006), while there was no significant difference between the two groups on postoperative day 30. On postoperative day 7, the logarithm of the minimum angle of resolution (logMAR) BCVA of the well-controlled group was also significantly better than that of the poorly controlled group (p < 0.001). By postoperative day 30, the differences in corneal transparency and BCVA between the two groups became non-significant (p > 0.05). Good preoperative glycemic control in diabetic patients undergoing phacoemulsification is associated with faster early corneal edema resolution, better early visual recovery, and clinically meaningful improvements in vision-related quality of life. These findings underscore the importance of enhanced perioperative glycemic management to optimize short-term surgical outcomes and health-related quality of life in this population.

To evaluate associations between pterygium size parameters and corneal refractive properties and higher-order aberrations (HOAs). In 41 patients with unilateral pterygium, thickness, length, and width were measured by anterior segment optical coherence tomography(AS-OCT). Corneal refractive parameters, irregularity indices, and HOAs were assessed using Pentacam HR. Correlation analyses evaluated relationships between pterygium dimensions and corneal parameters. Pterygium length and width significantly correlated with multiple corneal parameters in the 3-7mm zone. Moderate correlations were found with K1 (length: |r| = 0.376-0.473; width: |r| = 0.361-0.415; all p < 0.05), and stronger correlations with corneal astigmatism (length: r = 0.582-0.642; width: r = 0.529-0.581; all p < 0.001) and irregularity indices (ISV, IVA, IHD) (length: r = 0.623-0.637; width: r = 0.566-0.596; all p < 0.001). Length positively correlated with total, third-, and fourth-order HOA RMS across the anterior and posterior surface, and entire cornea (r = 0.455-0.691, p < 0.05), primarily driven by vertical trefoil, vertical coma, and tetrafoil. Width also correlated with anterior and total corneal HOAs (r = 0.519 to 0.645, p < 0.05). Posterior surface correlations for width were weaker (r = 0.313 to 0.472, p < 0.05) but remained significant for total RMS, third-order RMS, and several specific aberrations. Pterygium length and width are key parameters associated with deteriorated corneal refractive status, irregularity, and HOAs. Width, being easily standardized, serves as a practical indicator for predicting pterygium-induced visual quality deterioration.

PurposeTo determine the frequency, magnitude, and direction of toric intraocular lens (IOL) planning discrepancies between the Johnson & Johnson (J&J) official calculator and European Society of Cataract and Refractive Surgeons (ESCRS)-hosted toric engines, and to identify preoperative predictors of clinically relevant disagreements.MethodsThis retrospective, single-center study included 182 eyes of 127 patients undergoing toric IOL implantation (TECNIS). For each eye, planning results were generated using identical biometric data (IOLMaster 700, CASIA2 keratometry) across all calculators. The primary comparison was J&J with posterior corneal astigmatism correction enabled (PCA-ON) versus ESCRS-Barrett – secondary comparisons included Kane, EVO 2.0, and Hoffer QST. Clinically relevant discrepancy (ClinRel) was defined as a toric cylinder step difference ≥ 1 and/or axis difference ≥ 10°. Logistic regression, including Firth-penalized estimation, identified predictors of ClinRel. The primary analysis set comprised one eye per patient (n=127).ResultsClinRel between J&J PCA-ON and Barrett occurred in 59.8% of eyes (76/127; 95% CI: 51.1–68.0%), driven almost only by step differences. J&J PCA-ON recommended a higher step in 56.7% of eyes, with only 2.4% showing the opposite. Discrepancies were concentrated in with-the-rule eyes (72.3%) and nearly absent in against-the-rule eyes (5.6%). Rates were higher for secondary engines (Kane 83.8%, EVO 74.4%, Hoffer QST 76.7%). An Alpins-style paired-planning analysis yielded a Correction Index of 1.20, with the Difference Vector concentrated at the vertical meridian (84°). Posterior corneal astigmatism grade was the strongest independent predictor (Firth-adjusted OR = 203.5; p=0.014). An empirical PCA threshold of 0.36 D (Youden index; sensitivity 91.6%, specificity 56.0%) identified eyes at elevated risk of calculator disagreement.ConclusionCalculators’ variability in toric IOL planning is substantial (~60% of eyes) and concentrated in with-the-rule eyes with elevated posterior corneal astigmatism. In this subgroup, consulting multiple calculators is recommended; in against-the-rule eyes, calculator choice rarely alters the recommendation.

Effects of botulinum toxin on tear film and corneal epithelial remodeling in patients with essential blepharospasm.

Agreement of anterior segment parameters measured by Scheimpflug-based Scansys and Pentacam HR: A prospective, cross-sectional comparative study.

To assess the short-term impact of stand-alone MINIject (iSTAR Medical SA) implantation on astigmatism in a single-center retrospective study. Refractive and corneal astigmatism was investigated based on preoperative and postoperative subjective refraction and Scheimpflug tomography measurements at 3 months (D90) using power vectors: the spherical equivalent M and the Jackson cross cylinder projections to the 0° and 90° (J0) and to the 45° and 135° meridian (J45). A total of 60 eyes with glaucoma or ocular hypertony from 54 patients were included. Refractive cylinder did not change after stand-alone implantation (CD0 = -1.48 ± 1.52 diopters [D] vs CD90 = -1.36 ± 1.20 D, P = .30) and, analogously, no time course was observed in three-dimensional vector analysis (P > .99). Anterior corneal surface astigmatism showed a near-significant change (P = .07) in the two-dimensional vector analysis (J0; J45), primarily driven by the J0 component (P = .03), whereas the posterior surface remained unaffected (P = .4). The mean absolute surgically induced astigmatism was 0.78 ± 0.53 D for the anterior surface and 0.22 ± 0.21 D for the posterior surface. Supraciliary MINIject implantation may induce minor short-term changes in anterior corneal astigmatism. However, when implanted as a stand-alone procedure, it does not affect refractive astigmatism. Therefore, astigmatic changes do not require specific emphasis during patient counseling.

Real-world outcomes of low-cylinder-power toric intraocular lenses in eyes with mild corneal astigmatism.

To compare the refractive prediction accuracy of two modern toric intraocular lens power formulas, using predicted or measured posterior corneal astigmatism, in eyes with a history of previous myopic laser vision correction (LVC). This retrospective case series included 182 eyes with a history of previous myopic LVC that underwent uncomplicated cataract surgery with implantation of a monofocal non-toric IOL. Preoperative biometry was performed with swept-source optical coherence tomography. Spherical equivalent and refractive astigmatism prediction accuracy of the Barrett True K Toric and Emmetropia Verifying Optical (EVO) Toric formulas, using predicted posterior corneal astigmatism (PPCA) or measured posterior corneal astigmatism (MPCA), was analyzed using vector analysis and the Eyetemis online tool (https://eyetemis.com/). For spherical equivalent prediction accuracy, the EVO Toric formula with MPCA had the highest proportion of eyes within ±0.50 diopters (D) (68%) and the lowest mean absolute error (0.419 D). The trimmed mean spherical equivalent prediction error for Barrett True K MPCA was significantly smaller than for Barrett True K PPCA (P < .01). With respect to refractive astigmatism, there was no significant difference in the absolute refractive astigmatism prediction error for EVO PPCA compared to EVO MPCA (P = .89). However, the refractive astigmatism prediction error for Barrett PPCA was smaller than for Barrett MPCA (P < .01). Measured posterior corneal astigmatism improves the prediction accuracy of both the EVO and Barrett True K toric formulas with respect to the spherical equivalent but has a detrimental effect on the refractive astigmatism prediction accuracy of the Barrett True K toric formula.

Nomogram for predicting significant rotation after plate-haptic toric intraocular lens implantation in a Chinese population.

The aim of this study is to compare the refractive outcomes in a large cohort with preoperative corneal astigmatism who underwent cataract surgery with toric intraocular lens (IOL) implantation assisted (study group) or no (control group) with an intraoperative image-guided cataract planning system (Callisto, Carl Zeiss Meditec, Jena, Germany). In this retrospective comparative database study, mean and centroid postoperative cylinder, mean absolute error (MAE) and the proportion of eyes with a prediction error (PE) within ± 0.25 D, ± 0.50 D and ± 1.00 D (both in cylinder and spherical equivalent (SE)) were compared between both groups. These endpoints were also compared depending on the type of preoperative astigmatism, i.e. against the rule (ATR), oblique or with-the-rule (WTR) astigmatism. In total, 31,176 cases were analyzed in this study. Mean (± standard deviation (SD)) postoperative cylinder was found to be significantly lower in the study group (0.419 ± 0.432 D) compared with the control group (0.443 ± 0.453 D, p < 0.001). This statistical difference was observed in eyes with ATR and oblique astigmatism when looking at subgroups. Postoperative centroid cylinder (mean @angle ± SD) was 0.042 @97° ± 0.600 D in the study group and 0.043 @100° ± 0.633 D in the control group. MAE in cylinder was significantly lower in the study group compared to the control group. A slight but significantly higher percentages (up to 3%) of eyes with a PE in cylinder within ± 0.25 D, ± 0.50 D and 1.00 D were observed in the study group compared to the control group. Results of this study showed that the use of CALLISTO surgical planning system can improve refractive outcomes after cataract surgery and toric IOL implantation in patients with preoperative corneal astigmatism, especially in terms of cylinder for ATR and oblique astigmatism.

To evaluate changes in corneal astigmatism after DMEK and determine the predictive value of preoperative central corneal thickness (CCT) for postoperative astigmatic change. Fifty-five eyes with Fuchs' endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) undergoing DMEK were analyzed. Auto kerato-refractometer (ARKRT)-derived anterior corneal astigmatic change was defined as the primary outcome in 55 eyes. Anterior-segment optical coherence tomography (AS-OCT)-derived anterior, posterior, and total corneal parameters were analyzed as secondary outcomes in 25 eyes. Vector analysis assessed magnitude and axis changes. Associations between preoperative CCT and postoperative astigmatic change were evaluated; an exploratory ROC analysis was performed for astigmatic change. Mean preoperative CCT was 738.7 ± 99.7μm, decreasing to 517.5 ± 37.3μm postoperatively (P < 0.001). Anterior astigmatism measured by ARKRT decreased significantly after DMEK, whereas anterior and total corneal astigmatism measured by AS-OCT showed a similar decreasing trend without statistical significance. Greater preoperative CCT showed a larger postoperative astigmatic change on ARKRT. In ROC analysis based on ARKRT measurements, a preoperative CCT of 790μm showed modest discrimination for postoperative astigmatic change > 3.0 D (AUC = 0.749; sensitivity 67%, specificity 81%). PBK eyes showed greater anterior flattening and larger reductions in absolute astigmatism than FED eyes. Preoperative corneal edema is associated with postoperative astigmatic change after DMEK. The 790μm CCT cutoff showed modest discrimination. In eyes with marked edema, staged astigmatic correction may improve refractive outcomes.

PurposeTo evaluate the corneal biomechanical and biometric properties in immunoglobulin G4-related ophthalmic disease (IgG4-ROD) patients.SettingEthnic Han Chinese biopsy-proven IgG4-ROD patients from a territory wide cohort and sex-, age-, smoking- and lens status-matched healthy controls.DesignA case-controlled (1:1) study.MethodsCorvis ST analyzer and IOL Master 700 biometry assessment.ResultsSixty-seven eyes from 67 patients with IgG4-ROD (41 = males), aged 63.9 ± 13.1 years and 67 right eyes from 67 healthy ethnically Han Chinese controls were recruited. IgG4-ROD eyes were associated with a more negative applanation 2 velocity (−0.30 versus −0.27 m/s, P = 0.0143), and reduced radius of curvature (7.48 versus 7.98 mm, P = 0.0136). There was no difference in intraocular pressure, applanation 1 length, applanation 1 velocity, applanation 2 length, deformation amplitude and peak distance. Corneal astigmatism was greater in IgG4-ROD eyes (−1.2 versus −0.9 D, P = 0.0132), and the deep axis is along 90.2 degree. There is no difference in the steep and flat keratometry, deep axis, lens thickness, cornea thickness, and anterior chamber depth.ConclusionsWe found multiple corneal changes in biomechanics and fine structures in a cohort of biopsy-proven IgG4-ROD with potential long-term implications in ocular surface functions. A longitudinal follow-up would be useful to identify the clinical implications and observe if these changes improve with treatments.

To evaluate the role of local oxygen supplementation in accelerated collagen cross-linking (CXL) in human subjects. Patients with progressive keratoconus were enrolled and randomized to undergo accelerated CXL in either local oxygen supplementation (Group 1, Cases, n = 10) or room-air oxygen (Group 2, Controls, n = 10). Baseline uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), corneal tomographic parameters, corneal biomechanics, and wavefront analysis were documented. Patients were followed up at 1 week, 1 month, 3 months, and 6 months. Twenty eyes of 20 patients (Group 1, Cases, n = 10; Group 2, Controls, n = 10) were enrolled. At 6 months, both groups exhibited significant flattening of steepest keratometry, increased corneal optical densitometry, and reduced thinnest pachymetry. No eye had keratoconus progression in either group. There was no significant change in UDVA, CDVA, and MRSE in both groups. No intergroup significant differences were found in UDVA, CDVA, MRSE, steepest keratometry (Kmax), or corneal astigmatism. Demarcation line depth was comparable between groups at 6 months. Accelerated CXL is a useful modality to manage progressive keratoconus. However, in short term, local oxygen supplementation does not seem to have any additional benefit over room-air oxygen. Larger studies with longer follow-up period are required to further investigate the same.

Purpose To evaluate the changes in aberrometry values on corneal topography and the function of the meibomian glands following therapeutic Botulinum toxin type A injections in patients with blepharospasm and hemifacial spasm. Materials and methods This retrospective interventional study included 24 eyes of 17 patients treated with Botulinum toxin type A for blepharospasm and hemifacial spasm. Corneal topography and meibography were performed before treatment and at 1 month. Results Botulinum toxin type A was injected bilaterally in seven patients and unilaterally in ten patients, totaling 24 treated eyes. There were no significant differences between pre- and post-injection measurements of flat keratometry (K1) (p = 0.585), steep keratometry (K2) (p = 1.000), mean keratometry (Kmean) (p = 0.809), corneal astigmatism (p = 0.641), astigmatism axis (p = 0.647), central corneal thickness (p = 0.631), anterior chamber depth (p = 0.127), and anterior chamber volume (p = 0.747). However, the root mean square of higher-order aberrations (RMS-HOA) (p = 0.018) and RMS-quadrafoil (Z4 4) (p = 0.012) significantly increased one month after the injection. Although increases were also observed in RMS-coma (Z3 1) (p = 0.225), RMS-trefoil (Z3³) (p = 0.147), secondary astigmatism (p = 0.433), and RMS-spherical aberration (Z4 0) (p = 0.150), these changes did not reach statistical significance. After the injection, there was a statistically significant reduction in tear break-up time (TBUT) (p = 0.041), Ocular Surface Disease Index (OSDI) score (p = 0.041), and the area of the meibomian glands (mm2) (p < 0.001). Conclusion Botulinum toxin A injection into the orbicularis oculi in both groups may decrease meibomian glands and tear function, increasing corneal aberrations and reducing visual quality after 1 month.