Crystalline Lens Research Articles

Bilateral Anterior and Posterior Lens Dislocation in Marfan Syndrome in Teenager : A Case Report

Introduction : The zonular defect leads to ectopia lentis, which is a hallmark of Marfan ocular abnormalities. Bilateral dislocation of lens in marfan’s syndrome occurs frequently in same location. In this case the lens of RE dislocated in the anterior chamber and the lens of LE was found in vitreous cavity. Iris fixation IOL and Yamane’s scleral fixation technique are prompt treatment for crystalline lens displacement.
 Case Illustration : A 14 year-old male patient came with chief complaint a painless blurred vision on LE since 2 weeks before visit Ophthalmologist. The BCVA in both eyes was 6/30 RE and 1/60 LE. There was no history of ocular injury nor development disorder. Lens dislocation in anterior chamber was found in RE and aphakic lens was found in LE during slit lamp examination. The IOP ODS were 9.7 mmHg and 3.0 mmHg. Further examination from funduscopy showed the lens of LE was seen in vitreous cavity.
 Discussion : Bilateral dislocation of lens in opposite position are quite rare. To avoid many of the potential complications, Iris Fixation IOL placement is preferred choice to improve visual impairment on the right eye. Yamane’s Scleral Fixation technique has been performed on left eye however challenging and time consuming it is, to achieve excellent improvement with minimal or no intra- and postoperative complications.
 Conclusion : This case shows that manifest of crystalline lens in marfan syndrome could happen differently to each eye. Different surgical approach especially IOL placement technique is crucial and must be considered carefully depends on the condition during surgery.

Efficacy and Safety of Iris-Claw and Scleral Fixated Intraocular Lens in Pediatric Ectopia Lentis : A Systematic Review

Abstract
 Introduction & Objectives : Ectopia lentis is a condition that involves displacement of the crystalline lens because of weakened or damaged zonules. Surgical intervention is indicated in cases of poor best corrected visual acuity (BCVA) and progressive severity of subluxation. This systematic review aims to elucidate current evidence regarding the efficacy and safety of iris-claw and scleral-fixated intraocular lenses (IOLs) to treat children with ectopia lentis.
 Methods : A comprehensive search from multiple electronic databases such as PubMed, Cochrane Library, ProQuest, Scopus, EBSCO, Wiley, and Embase within the last ten years of publication. All seventeen studies matched with studies’ criteria were included in this review and assessed with eligibility assessment tools. The outcomes extracted and compared were BCVA, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure (IOP).
 Results : Seventeen studies were included in this review; three observational studies, nine retrospective studies and five interventional studies in which majority have a low risk of bias. Significant improvement of post-operative BCVA on both IOLs. The most frequent complications found on ICIOL was pupillary ovalization, while SCIOL was eye infection. Endothelial cell loss was higher in SCIOL, and both IOL showed no significant difference (p > 0,05) in terms of the post-operative IOP. Dislocation of IOL more frequently found on ICIOL. However, ICIOL much more preferred due to less manipulation and duration of surgery.
 Conclusion : ICIOL and SFIOL were both effective and safe for treating pediatric ectopia lentis. There was no superiority in which technique is better, technique varied according to each surgeon's preference.

Efficacy and Safety of Iris-Claw and Scleral Fixated Intraocular Lens in Pediatric Ectopia Lentis : A Systematic Review

Introduction & Objectives : Ectopia lentis is a condition that involves displacement of the crystalline lens because of weakened or damaged zonules. Surgical intervention is indicated in cases of poor best corrected visual acuity (BCVA) and progressive severity of subluxation. This systematic review aims to elucidate current evidence regarding the efficacy and safety of iris-claw and scleral-fixated intraocular lenses (IOLs) to treat children with ectopia lentis.
 Methods : A comprehensive search from multiple electronic databases such as PubMed, Cochrane Library, ProQuest, Scopus, EBSCO, Wiley, and Embase within the last ten years of publication. All seventeen studies matched with studies’ criteria were included in this review and assessed with eligibility assessment tools. The outcomes extracted and compared were BCVA, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure (IOP).
 Results : Seventeen studies were included in this review; three observational studies, nine retrospective studies and five interventional studies in which majority have a low risk of bias. Significant improvement of post-operative BCVA on both IOLs. The most frequent complications found on ICIOL was pupillary ovalization, while SCIOL was eye infection. Endothelial cell loss was higher in SCIOL, and both IOL showed no significant difference (p > 0,05) in terms of the post-operative IOP. Dislocation of IOL more frequently found on ICIOL. However, ICIOL much more preferred due to less manipulation and duration of surgery.
 Conclusion : ICIOL and SFIOL were both effective and safe for treating pediatric ectopia lentis. There was no superiority in which technique is better, technique varied according to each surgeon's preference.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis

Abstract
 Introduction & Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.
 Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.
 Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).
 Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.

The Distribution of Crystalline Lens Rise in High Myopia Population and Its Influence on Vault After Implanting Intraocular Collamer Lens.

As a result of the insufficient ocular anatomical parameters used to customize implantable collamer lens (ICL), many patients still cannot achieve a suitable vault after ICL implantation surgery. This study analyzed the characteristics of a new anatomical parameter crystalline lens rise (CLR) in a population with high myopia and explored the influence of CLR on the vault after ICL implantation. Patients (298 eyes) with high myopia who underwent ICL implantation were enrolled to study CLR characteristics. Postoperatively, patients (159 eyes) were divided into five groups according to the value of CLR (A, CLR ≤ - 150; B, - 150 < CLR ≤ 0; C, 0 < CLR < 150; D, 150 ≤ CLR < 300; E, CLR ≥ 300μm), and to investigate the correlation between CLR and vault. In the 298 eyes, the CLR had a normal distribution (P = 0.35) and the mean CLR was 67.93 ± 150.66μm. Ninety-nine eyes (33.22%) had a CLR ≤ 0μm, of which 20 eyes (6.71%) had a CLR ≤ - 150μm; 199 eyes (66.78%) had a CLR > 0μm, of which 20 eyes (6.71%) had a CLR ≥ 300μm. In 159 eyes, the CLR was negatively correlated with the vault at 1day (R = - 0.497, P < 0.001), 3months (R = - 0.505, P < 0.001), and 6months (R = - 0.505, P < 0.001) postoperatively. At 6months, the vault of groupA was statistically significantly different compared to groups B-E (all P < 0.05), and that of groupE was statistically significantly different compared to groupsA-D (all P < 0.001). The remaining groups did not show statistically significant differences (all P > 0.05). The CLR had a normal distribution in the high myopia population, and 13.42% of the CLR values were extreme (CLR ≤ - 150μm or CLR ≥ 300μm). A larger ICL diameter than that recommended by the manufacturer should be considered when the CLR is ≥ 300μm and a smaller ICL diameter should be considered when the CLR is ≤ - 150μm.

Senile Cataract

Cataracts may be described as the opacity of crystalline lenses present in the eye. The translucent crystalline lens is a part of the human eye. It possesses all the physical characteristics of a biconvex lens. The eye’s lens performs similar functions to a camera’s lens. The lens directs light rays entering the eye to the retina’s sensitive layers. Any factor that increases the absorption of scattering of light by the lens reduces its transparency. The opacity of the lens or its capsule, whether developmental or acquired, is called a cataract. Cataracts vary in degree of density and site and assume various forms. Cataract is the leading cause of reversible visual impairment and blindness globally. There are several classifications of cataracts based on morphologic and/or etiologic criteria. However, in epidemiologic studies, the simplified system of three types based on localization of lens opacities is most commonly used: Nuclear cataract is the most common type, followed by cortical cataract and posterior subcapsular cataract. This most prevalent form of acquired cataract, also known as an “age-related cataract,” affects people of both sexes equally and typically develops after age 50. More than 90% of people experience senile cataracts by age 70. Although one eye is almost always afflicted before the other, the disorder is typically bilateral. In the available literature, there is no mention of any such drug that could reverse the opacity of the lens (cataract) once it occurred and make it clear and transparent again. Only replacement of opaque lenses with artificial transparent Intraocular lens (IOL) is successful treatment of cataracts. This review focuses on senile cataracts and the best possible management of senile cataracts.

Influence of posterior capsule abnormalities in pediatric cataract surgery.

To report how to manage posterior capsule abnormalities (PCAs) in pediatric cataracts and evaluate the influence of PCAs during intraocular lens (IOL) optic implantation in Berger space surgeries. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. Retrospective case series study. Pediatric patients with PCAs who underwent cataract surgery were evaluated. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, types and management of PCAs, complications during primary posterior continuous curvilinear capsulorhexis (PCCC), need for anterior vitrectomy (AV), and feasibility of IOL optic capture. There were 227 pediatric cataract surgeries performed during the study period, and 76 eyes of 66 children with PCAs were evaluated (33.5%, 76/227). Unilateral cataract with PCAs were found in 50 eyes (22.0%, 50/227) and bilateral were found in 26 eyes (11.5%, 26/227). The PCAs were posterior capsule plaque (19.8%, 45/227), posterior capsule defect (6.2%, 14/227), posterior lenticonus (3.1%, 7/227), and persistent fetal vasculature (4.4%, 10/227). In the PCA cases, primary PCCC was successful in 44.7% of the cases (34/76). An unplanned AV during the surgeries was performed in 47.4% (36) of the 76 eyes. IOL optic implantation in Berger space was achieved in 63.2% of the eyes (48/76). PCAs are often encountered during pediatric cataract surgeries, especially in unilateral cases. The presence of PCAs may complicate a primary PCCC procedure, resulting in an unplanned AV in some cases. IOL optic implantation in Berger space can also be performed fortunately with well-designed and skilled operation.

Senile Cataract Formation Does Not Affect Crystalline Lens Thickness.

Characterizing lens thickness (LT) in patients with cataracts is important for better understanding the lens aging process and for designing new intraocular lens power formulas. This study aimed to analyze the influence of common senile cataract formation on the LT, anterior (ACS) and posterior (PCS) cortex space, and nuclear thickness (NT), controlling for sex, age, and axial length. A cross-sectional study was performed. A consecutive sample of 603 volunteers (403 women, 200 men) aged 59.1 ± 18.8years was recruited. The standardized Lens Opacification Classification System (LOCS)-III was used to classify eyes (randomly selected) into cataractous and non-cataractous groups. Also, they were classified according to the cataract location (presence or absence of cortical, nuclear, or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT, and PCS. Propensity score was used to match participants one-to-one for sex, age, and axial length. Groups were compared using the Student's ttest or Yuen's test. The four classifications divided unmatched eyes into: 361 cataractous lenses and 242 non-cataractous, 226 cortical and 377 non-cortical cataractous, 313 nuclear and 290 non-nuclear cataractous and 242 subcapsular and 361 non-subcapsular cataractous. Before matching, cataractous eyes showed significantly higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46mm, p < 0.001), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23mm, p < 0.001), NT (3.34 ± 0.23 vs. 3.18 ± 0.25mm, p < 0.001) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19mm, p = 0.003). Matched lens, cortical, nuclear, and subcapsular cataract samples comprised 146, 258, 182, and 226 eyes, respectively. After matching, no significant differences were observed in LT (4.34 ± 0.37 vs. 4.33 ± 0.36mm, p = 0.94), ACS (0.72 ± 0.20 vs. 0.76 ± 0.19mm, p = 0.08), NT (3.31 ± 0.22 vs. 3.30 ± 0.23mm, p = 0.24) and PCS (0.42 ± 0.19 vs. 0.43 ± 0.16mm, p = 0.79). The presence of senile cortical, nuclear, and posterior subcapsular cataract have no effect on LT, ACS, NT, and PCS. Confounding factors should be controlled for when measuring LT and its main components.

Research progress on prediction of postoperative intraocular lens position.

With the progress in refractive cataract surgery, more intraocular lens (IOL) power formulas have been introduced with the aim of reducing the postoperative refractive error. The postoperative IOL position is critical to IOL power calculations. Therefore, the improvements in postoperative IOL position prediction will enable better selection of IOL power and postoperative refraction. In the past, the postoperative IOL position was mainly predicted by preoperative anterior segment parameters such as preoperative axial length (AL), anterior chamber depth (ACD), and corneal curvature. In recent years, some novel methods including the intraoperative ACD, crystalline lens geometry, and artificial intelligence (AI) of prediction of postoperative IOL position have been reported. This article attempts to give a review about the research progress on prediction of the postoperative IOL position.

Mitigation of lens opacification by a functional food in a diabetic rodent model

The current study was designed to test a functional food (FF) mixture containing aldose reductase inhibitors and antiglycation bioactive compounds for suppressing the onset and progression of cataracts in a diabetic rat model. Two-month-old Sprague Dawley rats were grouped as control (C), diabetes untreated (D), and diabetic rats treated with FF at two doses (FF1 = 1.35 g and FF2 = 6.25 g/100g of diet). Diabetes was induced by a single injection of streptozotocin. The FF is a mixture of amla, turmeric, black pepper, cinnamon, ginger, and fenugreek added to the rodent diet. The status of cataracts was monitored weekly by a slit lamp examination for 20 weeks, after which animals were sacrificed to collect eye lenses. Feeding FF1 and FF2 to diabetic rats yielded a significant anti-hyperglycaemic effect and marginally prevented body weight loss. FF delayed cataract progression, and FF2 showed better efficacy than FF1. FF prevented the loss of lens crystallins and their insolubilization in diabetic rats. The antioxidant potential of FF was evident with the lowered protein carbonyls, lipid peroxidation, and prevention of altered antioxidant enzyme activities induced by diabetes. These studies demonstrate the efficacy of plant-derived dietary supplements against the onset and progression of cataracts in a well-established rat model of diabetic eye disease.

Adult stem cells in the eye: Identification, characterisation, and therapeutic application in ocular regeneration - A review.

Adult stem cells, present in various parts of the human body, are undifferentiated cells that can proliferate and differentiate to replace dying cells within tissues. Stem cells have specifically been identified in the cornea, trabecular meshwork, crystalline lens, iris, ciliary body, retina, choroid, sclera, conjunctiva, eyelid, lacrimal gland, and orbital fat. The identification of ocular stem cells broadens the potential therapeutic strategies for untreatable eye diseases. Currently, stem cell transplantation for corneal and conjunctival diseases remains the most common stem cell-based therapy in ocular clinical management. Lens epithelial stem cells have been applied in the treatment of paediatric cataracts. Several early-phase clinical trials for corneal and retinal regeneration using ocular stem cells are also underway. Extensive preclinical studies using ocular stem cells have been conducted, showing encouraging outcomes. Ocular stem cells currently demonstrate great promise in potential treatments of eye diseases. In this review, we focus on the identification, characterisation, and therapeutic application of adult stem cells in the eye.

The Influence of Lens Position, Vault Prediction, and Posterior Cornea on Phakic Posterior Chamber Intraocular Lens Power

BackgroundAchieving precise refractive outcomes in phakic posterior chamber intraocular lens (pIOL) implantation is crucial for patient satisfaction. This study investigates factors affecting pIOL power calculations, focusing on myopic eyes, and evaluates the potential benefits of advanced predictive models. DesignRetrospective, single-center, algorithm improvement study MethodsVarious variations with different effective lens position (ELP) algorithms were analyzed. The algorithms included a fixed constant model, and a multiple linear regression model and were tested with and without incorporation of the posterior corneal curvature (Rcp). Furthermore, the impact of inserting the postoperative vault, the space between the pIOL and the crystalline lens, into the ELP algorithm was examined, and a simple vault prediction model was assessed. ResultsIntegrating Rcp and the measured vault into pIOL calculations did not significantly improve accuracy. Transitioning from constant model approaches to ELP concepts based on linear regression models significantly improved pIOL power calculations. Linear regression models outperformed constant models, enhancing refractive outcomes for both ICL and IPCL pIOL platforms. ConclusionsThis study underscores the utility of implementing ELP concepts based on linear regression models into pIOL power calculation. Linear regression based ELP models offered substantial advantages for achieving desired refractive outcomes, especially in lower to medium power pIOL models. For pIOL power calculations in both pIOL platforms we tested with preoperative measurements from a Scheimpflug device, we found improved results with the LION 1ICL formula and LION 1IPCL formula. Further research is needed to explore the applicability of these findings to a broader range of pIOL designs and measurement devices.

The long and short of it: a comprehensive assessment of axial length estimation in myopic eyes from ocular and demographic variables.

Axial length, a key measurement in myopia management, is not accessible in many settings. We aimed to develop and assess machine learning models to estimate the axial length of young myopic eyes. Linear regression, symbolic regression, gradient boosting and multilayer perceptron models were developed using age, sex, cycloplegic spherical equivalent refraction (SER) and corneal curvature. Training data were from 8135 (28% myopic) children and adolescents from Ireland, Northern Ireland and China. Model performance was tested on an additional 300 myopic individuals using traditional metrics alongside the estimated axial length vs age relationship. Linear regression and receiver operator characteristics (ROC) curves were used for statistical analysis. The contribution of the effective crystalline lens power to error in axial length estimation was calculated to define the latter's physiological limits. Axial length estimation models were applicable across all testing regions (p ≥ 0.96 for training by testing region interaction). The linear regression model performed best based on agreement metrics (mean absolute error [MAE] = 0.31 mm, coefficient of repeatability = 0.79 mm) and a smooth, monotonic estimated axial length vs age relationship. This model was better at identifying high-risk eyes (axial length >98th centile) than SER alone (area under the curve 0.89 vs 0.79, respectively). Without knowing lens power, the calculated limits of axial length estimation were 0.30 mm for MAE and 0.75 mm for coefficient of repeatability. In myopic eyes, we demonstrated superior axial length estimation with a linear regression model utilising age, sex and refractive metrics and showed its clinical utility as a risk stratification tool.

A new exceptionally well-preserved basal actinopterygian fish in the juvenile stage from the Upper Triassic Amisan Formation of South Korea

The study of the large paraphyletic group of extinct ‘palaeoniscoid’ fishes has shed light on the diversity and evolutionary history of basal actinopterygians. However, only a little ontogenetic information about ‘palaeoniscoids’ is known because their records in the early stages of development are scarce. Here, we report on a growth series of ‘palaeoniscoids’ in the juvenile stage from the Upper Triassic Amisan Formation of South Korea. Fourteen specimens, including five counterpart specimens, represent a new taxon, Megalomatia minima gen. et sp. nov., exhibiting ontogeny and exceptional preservation with the eyes possibly containing the crystalline lens, the otoliths, and the lateral line canals without covering scales. This discovery allows us to discuss the adaptations and evolution of basal actinopterygians in more detail than before. The otoliths in situ of Megalomatia support the previous interpretation that basal actinopterygians have a sagitta as the largest otolith. The trunk lateral line canal, which runs under the scales instead of passing through them, represents a plesiomorphic gnathostome trait. Notably, the large protruded eyes suggest that Megalomatia probably has binocular vision, which would have played a significant role in targeting and catching prey with the primitive jaw structure. In addition, the firstly formed skeletal elements such as the jaws, pectoral girdle, and opercular series, and the posteroanterior pattern of squamation development are likely linked to the adaptation of young individuals to increase their viability for feeding, respiration, and swimming.

Isolated Unilateral Temporal Coloboma of the Lens

Lens coloboma is a rare congenital anomaly that occurs due to failure of the foetal fissure to close completely causing an incomplete formation of the lens, so usually inferonasal. Temporal lens coloboma is extremely rare; reported cases were associated with ocular or systemic anomalies. We report a rare case of unilateral atypical temporal lens coloboma without any iris abnormality and posterior segment coloboma or any other ocular or systemic anomaly.&#x0D; An 18-year-old female presented with a gradually progressive painless diminution of vision in her left eye for two years. There was no history of trauma, and family history was non-contributory. The systemic examination was normal. Ocular examination revealed a vision of 6/6 in the right eye and 6/60 in the left eye improving to 6/24 with pinhole and unilateral atypical temporal coloboma of the crystalline lens in the left eye after dilatation. The rest of the anterior segment and fundus examination was normal. No abnormality was detected in the right eye. The best corrected visual acuity of 6/6 OD and 6/9 OS was achieved with spectacle correction at 6 months of follow-up. This case is a rare presentation of unilateral atypical coloboma located temporally without any iris abnormality and posterior segment coloboma or any other ocular or systemic anomaly. Early correction of refractive error and astigmatism results in good prognosis.

Fabrication of a 3D bioprinting model for posterior capsule opacification using GelMA and PLMA hydrogel-coated resin.

Posterior capsule opacification (PCO) remains the predominant complication following cataract surgery, significantly impairing visual function restoration. In this study, we developed a PCO model that closely mimics the anatomical structure of the crystalline lens capsule post-surgery. The model incorporated a threaded structure for accurate positioning and observation, allowing for opening and closing. Utilizing 3D printing technology, a stable external support system was created using resin material consisting of a rigid, hollow base and cover. To replicate the lens capsule structure, a thin hydrogel coating was applied to the resin scaffold. The biocompatibility and impact on cellular functionality of various hydrogel compositions were assessed through an array of staining techniques, including calcein-AM/PI staining, rhodamine staining, BODIPY-C11 staining and EdU staining in conjunction with transwell assays. Additionally, the PCO model was utilized to investigate the effects of eight drugs with anti-inflammatory and anti-proliferative properties, including 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR), THZ1, sorbinil, 4-octyl itaconate (4-OI), xanthohumol, zebularine, rapamycin and caffeic acid phenethyl ester, on human lens epithelial cells (HLECs). Confocal microscopy facilitated comprehensive imaging of the PCO model. The results demonstrated that the GelMA 60 5% + PLMA 2% composite hydrogel exhibited superior biocompatibility and minimal lipid peroxidation levels among the tested hydrogels. Moreover, compared to using hydrogel as the material for 3D printing the entire model, applying surface hydrogel spin coating with parameters of 2000 rpm × 2 on the resin-based 3D printed base yielded a more uniform cell distribution and reduced apoptosis. Furthermore, rapamycin, 4-OI and AICAR demonstrated potent antiproliferative effects in the drug intervention study. Confocal microscopy imaging revealed a uniform distribution of HLECs along the anatomical structure of the crystalline lens capsule within the PCO model, showcasing robust cell viability and regular morphology. In conclusion, the PCO model provides a valuable experimental platform for studying PCO pathogenesis and exploring potential therapeutic interventions.

A rare occurrence of superior retinochoroidal coloboma: A case report

Purpose: To brief a rare case of superior retinochoroidal coloboma and to analyze the possible embryogenic aspects involved in its provenance. Method: A case report. Result: This case report highlights an 11-year-old myopic girl who presented with diminution of vision in both eyes for the past 1 year. She had no other specific ocular complaints. The best corrected visual acuity was 6/18p and N24 in the left eye (OS) and 6/6 and N6 in the right eye (OD) at 30 cm. On detailed examination, all ocular structures were found to be normal except the fundus, which showed superior choroidal coloboma with foveal involvement in OS, with OD being normal. This is a rare phenomenon as most often, ocular coloboma is located in the inferior nasal quadrant with the involvement of the iris and/or crystalline lens. Conclusion: The rare finding in this case is the location of coloboma at the superior quadrant. Moreover, this coloboma case spares the iris and crystalline lens, making it even rarer in the category, considering the uncommonness of such cases.

Combined cataract and glaucoma surgery

Cataracts and glaucoma commonly co‐exist, largely due to both being associated with older age. The crystalline lens can however cause glaucoma by phacomorphic or phacolytic processes, or by contributing to pupil block leading to primary angle closure. Medical and surgical treatments for glaucoma can also result in accelerated cataract formation. Cataract surgery in patients with glaucoma provides an opportunity to reduce medication burden and improve intraocular pressure control but has a higher risk than surgery in non‐glaucomatous eyes. Special consideration should be given to those with pseudoexfoliation (e.g. zonular instability), advanced glaucoma (e.g., risk of pressure spike and wipe out) or in those with short axial length or angle closure (e.g., shallow anterior chamber and risk of malignant glaucoma). Cataract surgery in eyes with previous subconjunctival glaucoma surgery is a particular challenge as it increases the risk of wound healing and failure of the filtering procedure. This presentation will outline steps for success in cataract surgery in patients with glaucoma and will also present recent evidence regarding the efficacy of phacoemulsification combined with minimally invasive glaucoma surgery (MIGS).

Toward optical correction of cataract opacities

Cataracts is a common pathology where the crystalline lens tends to become opaque, degrading the quality of the retinal images because of the increase of scattering. This leads to a deterioration of visual quality affecting the life of patients. The widely used solution is cataract surgery, replacing the natural lens with artificial intraocular lenses. Although surgical approaches are very successful, it would be useful to have alternative non‐invasive approaches based in optics to correct the retinal images in cataract patients. There are different options, some of them already tested in my laboratory. In this presentation, I will describe some of those based in wavefront shaping technologies. Results in simulations and using excised crystalline lenses will be shown and the prospects and limitations for practical in vivo implementations will be discussed.

Quantitative analysis of crystalline lens and vitreous opacities

Intraocular light scattering affects the contrast of the image created on the retina thus reducing the vision quality. Although one can consider the ocular components transparent, the microstructural changes (that are associated with aging or other factors) lead to the increase in intraocular light scattering. Therefore, the opacification of ocular structures is associated with vision‐affecting diseases such as corneal dystrophies, crystalline lens cataracts, vitreous floaters etc.Optical coherence tomography (OCT) is a non‐invasive imaging modality enabling generation of micrometre resolution, two‐dimensional (2‐D) cross‐sectional images and three‐dimensional (3‐D) volumetric data presenting internal structure of optically scattering tissues. OCT detects light that is back‐scattered/back‐reflected at the optical in homogeneities within the ocular structures. Due to its high sensitivity, OCT enables detection of ultralow scattered light levels obtained from weakly scattering tissues such as the vitreous body.In this talk, we will demonstrate in vivo enhanced three‐dimensional visualization of vitreous and lens opacities in normal subjects and cataract patients of different ages using a swept source OCT (SS‐OCT) system deployed to the Laboratory of Optics at the University of Murcia, Spain. The instrument operated at the central wavelength of 1050 nm and was optimized to image the anterior segment of the eye. Volumetric images were used to effectively map the opacities and to generate en‐face projection images of opacities.The results revealed the changes in the transparency of the crystalline lens showing lens micro‐ and macro‐scale features related to cataract such as cortical spokes, water clefts and enhanced scattering in the lens nucleus. On the other hand, vitreous imaging with SS‐OCT allowed for visualization of gel vitreous, liquefied lacunae, Berger's space, retrolental laminae and fibrous opacifications.Volumetric OCT data of the lens and retrolental vitreous were used to perform quantitative analysis of light scattering (transparency). We introduced indices describing transparency and optical homogeneity of ocular structures. Later on, we showed that those biomarkers correlate with age. Finally, statistical association between transparency of crystalline lens / vitreous and degradation of visual function was performed.The proposed imaging platform can be a new‐generation ophthalmic diagnostic tool in the fundamental studies as well as for objective clinical evaluation and management of eye diseases.