Eyes Undergoing Cataract Surgery Research Articles

Biometric description of 34 589 eyes undergoing cataract surgery: sex differences.

To describe gender differences in the biometric parameters of a large sample of patients with cataract. Cataract surgery has evolved from a vision restoration to a refractive procedure, and population-based studies are vital to optimize normative databases and postsurgical outcomes. Miguel Servet University Hospital, Zaragoza, Spain. Retrospective single-center observational study. The study included 34 589 eyes (20 004 patients with cataract). Biometric data were obtained from IOL Master 700 and Pentacam HR. Linear mixed models were used to account for intereye correlation. HofferQST formula was used to calculate the hypothetical distribution of intraocular lens (IOL) power (arbitrary lens; A = 119.2). Most biometric variables showed significant differences between sexes ( P < .0001), such as 0.53 mm shorter eyes found in females, of which 0.16 mm are explained by shorter aqueous depth. Steeper anterior keratometries (∼0.75 diopter [D]) were found in women, to end up in no difference on anterior astigmatism magnitude, but different orientation ( P < .0001). The distribution of IOL power differed between sexes ( P < .001), with the interquartile range shifting 1 D toward more powerful lenses in women and odds ratio (power >26 D) = 2.26, P < .0001 (Fisher). Large sample size studies provide smaller margin of error, higher power, and controlled risk of reporting false (negative or positive) findings. Highly significant differences between sexes in ocular biometry were found; this supports the idea that including sex as a parameter in IOL calculation should be explored and may improve results. In addition, the distribution of IOL powers was provided, which may be useful for manufacturers and hospital stock planning.

Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration.

To compare 3 capsulotomy centration methods. Private clinic, Zlin, Czech Republic. Prospective, consecutive case series. 180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made. The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis. The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.

Predictability of Existing IOL Formulas After Cataract Surgery in Patients with a Previous History of Radial Keratotomy: A Retrospective Cohort Study and Literature Review.

This study aims to evaluate the accuracy of 12 different intraocular lens (IOL) power calculation formulas for post-radial keratotomy (RK) eyes. The investigation utilizes recent advances in topography/tomography devices and artificial intelligence (AI)-based calculators, comparing the results to those reported in current literature to assess the efficacy and predictability of IOL calculations for this patient group. In this retrospective study, 37 eyes from 24 individuals with a history of RK who underwent cataract surgery at Hoopes Vision Center were analyzed. Biometry and corneal topography measurements were taken preoperatively. Subjective refraction was obtained 6 months postoperatively. Twelve different IOL power calculations were used, including the American Society of Cataract and Refractive Surgery (ASCRS) post-RK online formula, and the Barrett True K, Double K modified-Holladay 1, Haigis-L, Panacea, Camellin-Calossi, Emmetropia Verifying Optical (EVO) 2.0, Kane, and Prediction Enhanced by Artificial Intelligence and output Linearization-Debellemanière, Gatinel, and Saad (PEARL-DGS) formulas. Outcome measures included median absolute error (MedAE), mean absolute error (MAE), arithmetic mean error (AME), and percentage of eyes achieving refractive prediction errors (RPE) within ± 0.50 D, ± 0.75 D, and ± 1 D for each formula. A search of the literature was also performed by two independent reviewers based on relevant formulas. Overall, the best performing IOL power calculations were the Camellin-Calossi (MedAE = 0.515 D), the ASCRS average (MedAE = 0.535 D), and the EVO (MedAE = 0.545 D) and Kane (MedAE = 0.555 D) AI-based formulas. The EVO and Kane formulas along with the ASCRS calculation performed similarly, with 48.65% of eyes scoring within ± 0.50 D of the target range, while the Equivalent Keratometry Reading (EKR) 65 Holladay formula achieved the greatest percentage of eyes scoring within ± 0.25 D of the target range (35.14%). Additionally, the EVO 2.0 formula achieved 64.86% of eyes scoring within the ± 0.75 D RPE category, while the Kane formula achieved 75.68% of eyes scoring within the ± 1 D RPE category. There was no significant difference in MAE between the established and newer generation formulas (P > 0.05). The Panacea formula consistently underperformed when compared to the ASCRS average and other high-performing formulas (P < 0.05). This study demonstrates the potential of AI-based IOL calculation formulas, such as EVO 2.0 and Kane, for improving the accuracy of IOL power calculation in post-RK eyes undergoing cataract surgery. Established calculations, such as the ASCRS and Barrett True K formula, remain effective options, while under-utilized formulas, like the EKR65 and Camellin-Calossi formulas, show promise, emphasizing the need for further research and larger studies to validate and enhance IOL power calculation for this patient group.

Evaluation of pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand

Background: Pseudoexfoliation (PEX) syndrome, an age related microfibrillopathy having varied prevalence and associated with dense cataract, poorly dilating pupil resulting in challenging cataract surgeries. The present study aimed to evaluate pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand. Materials and methods: A hospital based prospective study carried out from January 2021 to June 2022 and approved by the Institutional Ethical Committee. A total of 1000 eyes of 1000 patients to be operated underwent complete ophthalmic evaluation including refraction, tonometry, gonioscopy, slit lamp biomicroscopy for presence of pseudoexfoliation, cataract grading, and fundus examination. Patients with PEX were diagnosed and data analysed. Results: A total of 54 PEX cases were diagnosed with 29 (53.7%) males and 25(46.3%) were females having mean age of 67.48 + 9.79 years, mean CCT was 528.46 + 18.49 micron and mean IOP was 19.81 + 5.88 mmHg. Prior to cataract surgery, an IOP of more than 21 mm Hg was noted in 40.7% (n=54) of pseudoexfoliative eyes. PXM on pupillary margin present in 51 (94.4%), on anterior lens capsule in 37 (68.5%), on iris in 31 (57.4%), on cornea in 5 (9.3%), phacodonesis in 6 (11.1%), Iris transillumination defect in 3 (5.6%), PXM on trabecular meshwork in 24 (44.4%) and sampaolesi line in 13 (24.1%). Conclusion: PEX presents challenges that necessitate thorough preoperative planning for a safe surgery and a satisfactory postoperative result. Therefore, dilated anterior segment evaluation should be emphasised in daily practise to avoid early PEX patients from being undiagnosed.

Development of cystoid macular edema after uneventful cataract surgery in eyes with a history of vitrectomy using silicone oil versus gas tamponade.

The purpose of this study is to investigate whether history of silicone oil tamponade may predispose to the development of cystoid macular edema (CMO) following uneventful post-vitrectomy cataract surgery. This is a retrospective study that was conducted at a single academic institution. Records of patients who underwent pars plana vitrectomy (PPV) with or without silicone oil tamponade and subsequent cataract surgery between 2017-2020 were reviewed. Macular optical coherence tomography (OCT) findings up to 4 years after surgery were assessed. A total of 95 eyes were included. Forty-one eyes underwent cataract surgery and had a history of PPV with silicone oil tamponade (Group 1). Fifty-four eyes underwent cataract surgery by phacoemulsification and had a history of PPV with gas tamponade (Group 2). Average follow up time after cataract surgery was 41.1 months. In Group 1, the incidence of OCT-detected CMO was 39.0%, compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0%, compared to 18.5% in Group 2 (p = 0.679). The duration of CMO was significantly longer in Group 1 (p = 0.041) and cases were less likely to resolve by the last follow up visit (p = 0.040). The incidence of OCT-detected or clinically significant pseudophakic CMO is not significantly different between eyes with prior PPV with gas tamponade versus silicone oil tamponade. However, CMO after uneventful cataract surgery may have a prolonged course if there is history of silicone oil tamponade, requiring longer treatment.

Accuracy of intraoperative aberrometry versus modern preoperative methods in post-myopic laser vision correction eyes undergoing cataract surgery with capsular tension ring placement

PurposeTo assess the accuracy of intraoperative wavefront aberrometry (IWA) versus modern intraocular lens formulas in post-myopic laser vision correction (LVC) patients undergoing cataract surgery with capsular tension ring placement.MethodsThis is a retrospective chart review conducted at an academic outpatient center. All post-myopic LVC eyes undergoing cataract surgery with IWA from a single surgeon from 05/2017 to 12/2019 were included. All patients received a capsular tension ring (CTR). Mean numerical error (MNE), median numerical error (MedNE), and percentages of prediction error within 0.50D, 0.75D, and 1.00D were calculated for the above formulas.ResultsTwenty-seven post-myopic LVC eyes from 18 patients were included. In post-myopic LVC, MNE with Optiwave Refractive Analysis (ORA), Barrett True K (BTK), Haigis, Haigis-L, Shammas, SRK/T, Hill-RBF v3.0, and W-K AL-adjusted Holladay 1 were + 0.224, − 0.094, + 0.193, − 0.231, − 0.372, + 1.013, + 0.860, and + 0.630 (F = 8.49, p < 0.001). MedNE were + 0.125, − 0.145, + 0.175, + 0.333, + 0.333, + 1.100, + 0.880, and + 0.765 (F = 7.89, p < 0.001), respectively. BTK provided improved accuracy in both MNE (p < 0.001) and MedNE (p = .033) when compared to ORA in pairwise analysis. If the ORA vs. BTK-suggested IOL power were routinely selected, 30% and 15% of eyes would have projected hyperopic outcomes, respectively (p = 0.09).ConclusionsOur study suggests that in post-myopic LVC eyes undergoing cataract surgery with CTRs, BTK performed more accurately than ORA with regard to accuracy and yielded a lower percentage of eyes with hyperopic outcomes. Haigis, Haigis-L, and Shammas yielded similar results to ORA with regard to accuracy and percentage of eyes with hyperopic outcomes. On average, Shammas and Haigis-L suggested IOLs that would yield outcomes more myopic than expected when compared to BTK.

Comparison of corneal aberrations from anterior segment swept source OCT versus Placido-topography combined spectral domain OCT in cataract patients

BackgroundTo comprehensively evaluate the agreement of component corneal aberrations from the newly updated wavefront analysis software of a swept-source optical coherence tomographer (SS-OCT) and a referential Placido-topography combined OCT device in elderly cataract patients.MethodsRetrospective study including 103 eyes from 103 elderly patients scheduled for cataract surgery that were measured on the same day with a SS-OCT (Heidelberg Engineering, Germany) device and a Placido-topography combined OCT device (CSO, Italy). Anterior, total, and posterior corneal wavefront aberrations were evaluated for their mean differences and limits of agreement (LoA) via Bland-Altman plots. Vector analysis was additionally employed to compare corneal astigmatism measurements in dioptric vector space.ResultsMean differences of all corneal aberrometric parameters did not exceed 0.05 μm. Total corneal aberrations were not significantly different from 0 except for vertical coma (− 0.04 μm; P = 0.003), spherical aberration (− 0.01 μm, P < 0.001), and root mean square (RMS) higher-order aberration (HOA) (0.03 μm, P = 0.04). The 95% LoA for total corneal aberration parameters between both devices were − 0.46 to 0.42 μm for horizontal astigmatism, − 0.37 to 0.41 μm for oblique astigmatism, − 0.19 to 0.17 μm for oblique trefoil, − 0.33 to 0.25 μm for vertical coma, − 0.20 to 0.22 μm for horizontal coma, − 0.22 to 0.20 μm for horizontal trefoil, − 0.11 to 0.08 μm for spherical aberration, and − 0.22 to 0.28 μm for RMS HOA. Vector analysis revealed no statistically significant mean differences for anterior, total, and posterior corneal astigmatism in dioptric vector space.ConclusionIn eyes undergoing cataract surgery with a regular elderly cornea, corneal wavefront analysis from the SS-OCT device showed functional equivalency to the reference device. Nevertheless, clinically relevant higher order aberration parameters should be interpreted with caution for surgical decision-making.

Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

To evaluate the rate of, risk factors for, and outcomes of cataract surgery in patients with intermediate, posterior, and panuveitides treated with systemic corticosteroids and immunosuppression. Cohort study of participants from a randomized clinical trial. A multicenter clinical trial with extended follow-up comprised the study setting. From the cohort of participants assigned to systemic therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study, 125 phakic eyes of 74 patients with intermediate, posterior, or panuveitides treated with systemic therapy were included. The main outcome measures were cataract surgery and visual acuity after cataract surgery. The cumulative incidence of cataract surgery was 43% at 7 years of follow-up, and the risk did not plateau. Risk factors for cataract surgery included age >50 years (hazard ratio [HR] 2.86, 95% CI 1.52, 5.42; P=.001), topical corticosteroid use (time-updated HR 3.13, 95% CI 1.42, 6.94; P=.005), glaucoma medication use (HR 2.75, 95% CI 1.38, 5.47; P=.004), and possibly history of anterior chamber inflammation (HR 1.90, 95% CI 0.95, 3.84; P=.07). Median gain in acuity and median best corrected visual acuity 1 year after cataract surgery were 4.8 lines and 20/25, respectively, among 42 eyes undergoing cataract surgery with 1-year follow-up data. Among patients with intermediate, posterior, and panuveitides, treated with oral corticosteroids and immunosuppression, there is a substantial long-term risk of cataract surgery. Visual acuity outcomes after cataract surgery are generally good.

Comparison of Cataract Surgery Outcomes in Patients with Type 1 versus Type 2 Diabetes and Patients without Diabetes.

To report outcomes of cataract surgery in type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM) and patients without diabetes (DM). Academic tertiary referral university hospital eye center, Aurora, CO, USA. Retrospective chart review using the University of Colorado Cataract Outcomes Database for all cataract surgeries between 2014-2020. Demographics, ocular history, and postoperative outcomes were compared across groups using general linear and logistic regression modeling with estimating equations to account for some patients having two eyes included. A total of 8117 patients and 13,383 eyes were included. Compared to T2DM eyes undergoing cataract surgery (n=3115), T1DM eyes (n=233) were more likely to have a history of diabetic retinopathy (DR) (60.5% vs 23.6%), p<0.0001), of which proliferative DR was the most common (63.1% vs 42.4%, p<0.0001). T1DM eyes were also more likely to have a history of retinal detachment (RD) (9.0% vs 2.9%, p<0.0001) and prior vitrectomy surgery (12.9% vs 4.0%, p<0.0001). Despite having similar preoperative best-corrected visual acuity (BCVA) as T2DM eyes (logMAR 0.52 vs. 0.44, p=0.092), T1DM eyes had worse BCVA following cataract surgery (logMAR 0.27 vs 0.15, p=0.0003). In a multivariable analysis, a history of proliferative DR and prior RD were significant predictors of worse postoperative BCVA (p<0.0001) but type of DM was not (p=0.894). T1DM eyes have worse visual outcomes after cataract surgery compared to T2DM eyes. Worse postoperative visual acuity was associated with worse preoperative diabetic retinopathy and history of retinal detachment rather than type of DM.

The use of sub-Tenon's anesthesia versus a low-dose neuromuscular blockade for canine cataract surgery: Acomparative study of 224 eyes.

Assess the utility of a Sub-Tenon's anesthesia (STA) protocol to provide suitable operating conditions for canine cataract surgery and compare it to an alternative low-dose neuromuscular blockade (LD-NMB) protocol used for canine cataract surgery. Clinical study of dog eyes undergoing cataract surgery with either an STA or LD-NMB protocol. While intraoperative vitreal expansion scores and intraoperative complications were collected prospectively, globe position, intraocular pressure, return of vision, and postoperative complications were collected retrospectively. Statistical testing was used to compare results between the STA and the LD-NMB groups for the data available. A total of 224 eyes from 126 dogs were assessed, with 133/224 (59.4%) eyes from 99/126 (78.6%) dogs receiving STA and 91/124 (40.6%) eyes from 72/126 (57.1%) dogs receiving LD-NMB. Forty-five of these dogs (45/126; 37.7%) received STA for one eye and LD-NMB for the other eye. There was no significant change in intraocular pressure measurements following STA administration. This was not measured for the LD-NMB group. The globe achieved a central position in 110/133 (82.7%) of eyes that received STA. This was not measured for the LD-NMB group. Intraoperative vitreal expansion scores were slightly higher in STA-treated eyes compared to LD-NMB-treated eyes. The intraoperative complication rate for STA-treated eyes was higher (73/133; 54.8%) compared to NMB-treated eyes (12/91; 13.2%). The most common intraoperative complication for STA was chemosis (64/133; 48.1%), the risk of which increased with an increase in the volume of local anesthetic injected. The post-operative complication rate was higher in STA-treated eyes (28/133; 21.1%) compared to NMB-treated eyes (16/91; 17.6%). Post-operative corneal ulceration was the most common postoperative complication in STA-treated eyes (6/133; 4.5%). The STA protocol described resulted in suitable operating conditions, but more intraoperative and postoperative complications compared to the LD-NMB protocol. Despite these complications, the STA protocol did not cause a significant deleterious impact on post-operative outcomes as defined in the present study.

Total Keratometry Measured With a Swept-Source Optical Biometer Versus Anterior Keratometry: From Planning to Postoperative Results.

To compare the influence of total keratometry (TK) versus anterior keratometry (K) measured with the swept-source optical biometer IOLMaster 700 (Carl Zeiss Meditec AG) on the planning of toric intraocular lenses (IOLs), and the error in predicted residual astigmatism (PRA). This single-center retrospective study included 247 eyes of 180 patients. In eyes undergoing cataract surgery, the optimal toric IOL was calculated based on K or TK measured with the IOLMaster 700. Two formulas were used to estimate IOL power: Holladay and Barrett Toric. Optimal cylinder power and alignment axis change induced by using TK versus K were reported. PRA by each calculation method was compared with manifest refractive astigmatism. Postoperative refractive astigmatism prediction error was calculated using vector analysis. The optimal toric IOL based on TK compared with K was different in 39.3% of cases with the Holladay formula and 31.6% of cases with the Barrett Toric formula. The use of TK rather than K reduced the centroid error in PRA when calculated with the Holladay formula (P < .001), but not when calculated with the Barrett Toric formula (P = .19). The against-the-rule astigmatism subgroup analysis with the Barrett Toric formula showed a statistically significant decrease of centroid error in PRA with the use of TK compared with K (P = .01). TK compared with K measured with the IOL-Master 700 resulted in a change of optimal toric IOL in almost one-third of cases and decreased the error in PRA in patients with against-the-rule astigmatism. [J Refract Surg. 2023;39(4):257-264.].

Optical Biometry versus Ultrasonic Biometry in Intraocular Lens Power Calculations in High Axial Myopia

Background: IOL implantation is now seen as a type of refractive surgery rather than merely being used to improve visual rehabilitation. In this context, accurate pre-operative biometric measurement is a crucial requirement. Aim of the work: comparing the refractive predictability of optical biometry versus applanation ultrasonic biometry in high axial myopic eyes undergoing cataract surgery. Patients and Methods: A total of 50 eyes from 50 patients with axial lengths greater than 26.5 mm and just cataract were analyzed in this study. In this study, patients were randomly assigned to one of two groups. Twenty-five patients were split evenly between the two groups, with group 1 using optical biometry and group 2 using applanation ultrasound. Results: Group 1 mean age was 53.8 ± 8.9 years since it was 51.8 ± 10.8 years in group 2. There were 7 males (28%) and 18 females (72%) in group 1 while there were 11 males (44%) and 14 females (56%) in group 2. There was no statistically significant variation in axial length between groups (p-value = 0.101).Statistically significant increased K1 and K2 among group 1 when compared with group 2 (p-value =0.003 and 0.001 respectively). Statistically significant (p-value = 0.015) increased anterior chamber depth (ACD) in group 1 when compared with group 2. Significant differences in postoperative refraction were seen across the groups (p 0.001) (SE values). Conclusion: Optical biometry offers significantly more precise IOL power prediction and refractive outcomes in cataract surgery for high axial myopia than applanation ultrasound biometry.

Posterior Capsular Rupture during Cataract Surgery in Eyes Previously Treated with Intravitreal Injections

Introduction: Intravitreal injections (IVIs) are currently the most common intraocular surgical procedure worldwide. Some studies have reported a higher risk of intraoperative complications, namely, posterior capsular rupture (PCR), during cataract surgery. The aim of this retrospective and observational study, conducted at Department of Ophthalmology, Centro Hospitalar Universitário do Porto, was to assess the risk of PCR during cataract surgery in eyes previously treated with IVIs with anti-vascular endothelial growth factor (anti-VEGF) and/or corticosteroids. Methods: Eyes undergoing cataract surgery between June 2019 and May 2021 were included. Combined surgeries, such as glaucoma surgery and pars plana vitrectomy, were excluded. The occurrence of PCR during cataract surgery in treated and previously untreated eyes with IVI was analyzed. Results: A total of 5,813 cataract surgeries were analyzed; 4.1% of the cases had previously undergone IVI. The PCR rate in cataract surgery was 1.8%: 6.7% in eyes previously treated with IVI and 1.6% without previous IVI (OR = 4.5, 95% CI: 2.6–7.7, p < 0.001). The combined therapy (anti-VEGF with corticosteroids) presents a higher risk compared to the two therapies alone as monotherapy (OR = 11.6, 95% CI: 4.7–28.5, p < 0.001), as well as treated eyes treated with ≥10 IVI (OR = 2.1, 95% CI: 0.8–6.1, p = 0.144) and a time interval between the last IVI and cataract surgery was ≤6 months (OR = 1.9, 95% CI: 0.6–6.1, p = 0.296). Conclusion: These results demonstrate that eyes that require IV treatment prior to cataract surgery are at increased risk of CPA during cataract surgery, and careful assessment of the characteristics of the cataract and posterior capsule is critical.

Tolerance to lens tilt and decentration of two multifocal intraocular lenses: using the quick contrast sensitivity function method

BackgroundQuick contrast sensitivity function (qCSF) method is an advanced quick method for contrast sensitivity function (CSF) evaluation. This study evaluated the contrast sensitivity (CS) of eyes undergoing cataract surgery with multifocal intraocular lens (IOL) implantation and its tolerance to IOL tilt and IOL decentration using the qCSF method.MethodsPatients undergoing uneventful phacoemulsification and a trifocal IOL (Zeiss AT LISA tri 839MP, Carl Zeiss, Germany) or an extended depth-of-focus (EDOF) IOL (Tecnis Symfony ZXR00, Johnson & Johnsons, USA) implantation were included. Monocular contrast sensitivity was measured using the qCSF method at one month post-surgery. IOL tilt and decentration were measured using an optical aberrometer (OPD-Scan III, NIDEK, Japan).ResultsSeventy-two patients/eyes with the 839MP IOL and 64 patients/eyes with the ZXR00 IOL were included. Area under the log CSF (AULCSF) and CS acuity did not differ significantly between the two groups. The ZXR00 IOL group showed better CS at 1 cpd (1.137 ± 0.164 vs. 1.030 ± 0.183 logCS) and 1.5 cpd (1.163 ± 0.163 vs. 1.071 ± 0.161 logCS), while the 839MP IOL group had better CS at 6 cpd (0.855 ± 0.187 vs. 0.735 ± 0.363 logCS). In the 839MP IOL group, all CSF metrics were negatively correlated with IOL tilt (all P < 0.05), while in the ZXR00 IOL group, the CS at 3 cpd had no significant correlation with IOL tilt (P > 0.05). Among myopic eyes, fewer CSF metrics were negatively correlated with IOL tilt in the ZXR00 IOL group than in the 839MP IOL group. No significant correlation was found between CSF metrics and IOL decentration.ConclusionsThe ZXR00 and the 839MP IOL groups presented comparable CSF. CS was negatively correlated with IOL tilt, instead of decentration in multifocal IOLs, particularly among myopic eyes. The ZXR00 IOL had better tolerance to IOL tilt in myopic eyes.

Toric intraocular lenses for astigmatism correction after keratoplasty in phakic and pseudophakic eyes.

Residual astigmatism and anisometropia significantly affect patients' vision and quality of life even in clear grafts after corneal transplant. This study reviewed and summarized the role of toric intraocular lenses (IOLs) in phakic and pseudophakic eyes after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty in correcting residual astigmatism. 342 eyes from 20 studies with iris-clipped toric IOL, ciliary sulcus toric implantable collamer lens, piggyback sulcus toric IOL, or posterior chamber toric IOL implantations for phakic, pseudophakic, or eyes undergoing cataract surgery after keratoplasty were included. Visual, refractive, and predictability outcomes were encouraging. Secondary realignment rate and complications were low. Endothelial cell loss secondary to phakic toric IOLs might be a concern over the long-term, particularly in iris-clipped IOLs in PKP eyes. Toric IOLs represent a viable option in the treatment of residual astigmatism in postkeratoplasty eyes, resulting in improved visual acuity and reduced anisometropia.

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes.

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.

This issue of ACTA

This issue of ACTA

IOL Power Calculations and Cataract Surgery in Eyes with Previous Small Incision Lenticule Extraction.

Small incision lenticule extraction (SMILE), with over 5 million procedures globally performed, will challenge ophthalmologists in the foreseeable future with accurate intraocular lens power calculations in an ageing population. After more than one decade since the introduction of SMILE, only one case report of cataract surgery with IOL implantation after SMILE is present in the peer-reviewed literature. Hence, the scope of the present multicenter study was to compare the IOL power calculation accuracy in post-SMILE eyes between ray tracing and a range of empirically optimized formulae available in the ASCRS post-keratorefractive surgery IOL power online calculator. In our study of 11 post-SMILE eyes undergoing cataract surgery, ray tracing showed the smallest mean absolute error (0.40 D) and yielded the largest percentage of eyes within ±0.50/±1.00 D (82/91%). The next best conventional formula was the Potvin–Hill formula with a mean absolute error of 0.66 D and an ±0.50/±1.00 D accuracy of 45 and 73%, respectively. Analyzing this first cohort of post-SMILE eyes undergoing cataract surgery and IOL implantation, ray tracing showed superior predictability in IOL power calculation over empirically optimized IOL power calculation formulae that were originally intended for use after Excimer-based keratorefractive procedures.

Predictability of combined cataract surgery and trabeculectomy using Barrett Universal Ⅱ formula.

To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and trabeculectomy. We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas. The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula. The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.

Detection of Anterior Hyaloid Membrane Detachment Using Deep-Range Anterior Segment Optical Coherence Tomography.

The visibility of anterior hyaloid membrane (AHM) and Berger’s space in phakic eyes was investigated. In 624 eyes of 624 patients, the retrolental space was scanned with the deep-range anterior segment optical coherence tomography (AS-OCT, CASIA2, Tomey). Subgroup analysis was conducted in 223 eyes undergoing cataract surgery. The logistic regression analysis using the backward-elimination method was performed to evaluate the influence of various factors on the visibility of AHM (dependent variable). Explanatory variables included age, gender, axial length, corneal power, corneal cylinder, and the Co III gradings. Intrarater repeatability for AHM visibility was excellent with the prevalence-adjusted bias-adjusted kappa (κ coefficient) of 0.90. AHM was observed in 43 eyes (6.9%). The patients with visible AHM (68.1 ± 8.8 years) were significantly older than those without visible AHM (52.6 ± 25.6 years) (p < 0.001). The logistic regression analysis in the cataract surgery subgroup revealed that axial length (p = 0.030) and corneal power (p = 0.043) were significantly associated with AHM visibility. The mean absolute refractive error from target was significantly larger in eyes with visible AHM (0.670 ± 0.384 D) than with invisible AHM (0.494 ± 0.412 D) (p = 0.037). The postoperative refractive prediction was less accurate in eyes with visible AHM, but no significant tendency existed in terms of myopic or hyperopic shifts.