Foldable Intraocular Lens Implantation Research Articles

A clinical study of the neodymium-doped yttrium–aluminium–garnet laser posterior capsulotomy: Visual outcome and early complications

Objectives: The objectives of this study were as follows: To study the efficacy of neodymium-doped yttrium–aluminium–garnet (Nd:YAG) laser capsulotomy in posterior capsular opacification (PCO) by analysing the visual outcome. To study any other early complications seen following Nd:YAG laser capsulotomy. Materials and Methods: A prospective interventional study was done in the Department of Ophthalmology of a tertiary care hospital in the Marathwada region of Maharashtra. A total of 55 eyes developing PCO after cataract surgery were included in the study from November 2022 to October 2023. Routine pre-laser evaluation using slit-lamp biomicroscopy, intraocular pressure (IOP) measurements and dilated fundus examination was done. Thirty-eight patients had undergone manual small incision cataract surgery with polymethyl methacrylate intraocular lens (IOL) implantation and 17 patients had undergone phacoemulsification surgery with acrylic foldable IOL implantation. The patient was then followed up on Days 2, 7, 30, and 3 months to look for any early post-laser complications. Results: A total of 55 eyes were included in the study. The age group of patients included in the study is from 50 to 75 years. Most of the patients 21 were in the age group of 56–60 years. Twenty (36%) were male and 35(63%) females; thus, female preponderance is seen. On retro-illumination of the slit lamp, 9 (16.3%) patients had severe PCO having vision ≤3/60, 24 (43.6%) patients had moderate PCO with vision 3/60–6/60 and 22 (40%) patients had mild PCO with vision 6/60–6/18. Forty-seven patients (85%) had visual acuity of more than 6/12 at the end of 3 months. In most patients, an appropriate central capsulotomy was achieved within the total energy of 60 mJ but in three cases more than 100 mJ energy was used due to the thick posterior capsule. About 6% of subjects showed increased IOP of more than 21 mm Hg but returned to normal level within 1 week. Mild uveal reaction in the form of anterior chamber flare and cells was seen in 2% of cases. IOL pitting was seen in 5 (8%) cases. One (2%) patient had a vision of 3/60 and a significant increase in macular thickness at day 7 post-laser which decreased at 1 month follow-up by appropriate treatment. No evidence of any retinal tears or retinal detachment seen. Conclusion: PCO is a common delayed complication seen after cataract surgery. This opacification decreases the vision of the patient to affect day-to-day activities. It can be easily managed on an outdoor basis by a non-invasive and effective Nd:YAG laser posterior capsulotomy procedure. This procedure has been shown to increase the visual outcome and has fewer complications which can be managed easily.

Intra-operative Intravitreal Bevacizumab For Patients With Diabetic Macular Edema Undergoing Phacoemulsification with Foldable IOL Implantation

Objective: To assess the efficacy of Intra-operative Intravitreal Bevacizumab in treating Diabetic Macular Edema in patients undergoing Phacoemulsification with Foldable intraocular lens (IOL) Implantation, in comparison to a control group.Methodology: This experimental study was performed in department of Ophthalmology, Madinah Teaching Hospital, Faisalabad from 5th October to 2022 – 5th March 2023. Sixty patients (30 in each group) were enrolled in the study. Patients in group “A” received Intravitreal Bevacizumab immediately after phacoemulsification with foldable IOL implantation.Whereas Intravitreal Bevacizumab was not given to patients in group B (control group). Best Corrected Visual Acuity (BCVA) and macular thickness using optical coherence tomography (OCT) were recorded within a timeframe of 7-30 days prior to surgery, as well as at 1 and 3 months after the surgery for comparison between the two study groups. Results: The study comprised 60 patients, with a mean age of 56.43 ± 5.90 years, representing both genders. Among the participants, males were predominant, accounting for 32 (53.3%) individuals, while females constituted 28 (46.7%) of the sample. The baseline best-corrected visual acuity (BCVA) measurements between group A and group B were 0.22 ± 0.68 and 0.21 ± 0.07, respectively. There was no statistically significant difference observed between the two groups (P = 0.677). However, significant disparities in BCVA were observed after one- and three-months post-surgery, favoring group A.Similarly, mean optical coherence tomography (OCT) at baseline was 271.09 ± 26.87 in group A and 307.57 ± 32.81 in group B, with no significant difference (P = 0.771). Nonetheless, significant differences in OCT were noted after one- and three-months post-surgery, with group A demonstrating superior results. These findings underscore the beneficial impact of intra-operative Bevacizumab in improving both BCVA and OCT outcomes post-surgery. Conclusion: The administration of intravitreal bevacizumab during phacoemulsification has been shown to yield notable improvements in Best Corrected Visual Acuity (BVCA) and Optical Coherence Tomography (OCT) among those with diabetes with macular edema who are undergoing cataract surgery.

Determination of the time of refractive stability after uneventful phacoemulsification in Indian eyes.

Knowledge about refractive stabilization and the accuracy of postoperative refractive error measurements are crucial for improved patient outcomes after phacoemulsification. Existing guidelines typically recommend waiting 4-6 wk before prescribing corrective lenses. Our research focused on identifying factors that influence refractive errors in the early stages of post-cataract surgery, thus contributing to the existing literature on this topic. To investigate the time required for refraction stability after uneventful phacoemulsification surgery. We compared the variation and statistical significance of the difference in spherical, cylindrical components, and the spherical equivalent between the 1- and 6-wk follow-up period in a group of 257 eyes that underwent uneventful phacoemulsification with foldable intraocular lens implantation, all performed by a single experienced surgeon. The Wilcoxon-Signed Rank Test was utilized to assess the magnitude of the change and determine its statistical significance. The refractive stability was defined as the point at which the change in spherical equivalent was within ± 0.5 dioptres for two consecutive visits. The average age of the patients was 64.9 ± 8.9 yr. The differences observed in both the visits in spherical power (0.1 ± 0.2), cylinder power (0.3 ± 0.4), and spherical equivalent (0.2 ± 0.2) were minimal and not statistically significant. The majority of eyes (93.4%) achieved refractive stability within 6 wk after the surgery. The cylindrical power differed between age groups at the 6th wk post-operative and the difference was statistically significant (P value 0.013). There were no significant differences in refractive stability when considering sex and axial length. Phacoemulsification with foldable intraocular lens implantation results in no significant changes in refraction for the majority of cases during the 6-wk follow-up period. Therefore, a spectacle prescription can be given at the completion of 1 wk.

Efficacy and safety of the implantation of a single-piece angulated foldable IOL in the sulcus.

To study the visual results and tolerance of a Zeiss CT Lucia 601P intraocular lens (IOL) implanted in the sulcus after complicated cataract surgery or during IOL exchange for clouded IOL. In total, 64 patients who underwent sulcus implantation were recalled to the hospital to undergo subjective and objective refraction, best corrected visual acuity measurement, tonometry, optical coherence tomography, laser flare photometry, biometry, and wavefront aberrometry. In spite of a large variation in preoperative refraction, the target refraction was obtained within 1.5 diopters in approximately 97% of patients and within 0.5 diopter in 53% of patients. Average BCVA was high (Snellen 0.86) and related to concomitant (mostly retinal) pathologies in eyes with poorer visual performance. Wavefront aberrometry showed no evidence of IOL tilting or decentration after long-term implantation in the sulcus. Tonometry was not different from the fellow eye of the patient (p > 0.5). In 53 patients with bilateral pseudophakia, the laser flare photometry was not significantly different from the fellow eye (p < 0.05). This study demonstrates that this single-piece angulated foldable acrylic IOL can be considered for implantation in the sulcus. The visual results are favorable, and the IOL can be well-positioned and tolerated in the sulcus. Moreover, there were no safety issues found since there was no evidence of elevated IOP or chronic uveitis.

Comparison of Clinical Outcomes of Implantation of Foldable Hydrophobic Acrylic Intraocular Lens With and Without Heparin Surface Modification in Indian Diabetic Patients.

Background This study aimed to compare the clinical outcomes of a heparin surface-modified (HSM) hydrophobic acrylic foldable intraocular lens (IOL) (CT LUCIA 601PY) and non-heparin-modified hydrophobic acrylic foldable IOL (AcrySof IQ SN60WF) in diabetic patients undergoingphacoemulsification. Methodology Thisrandomized, single-surgeon, double-masked controlled trial was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. In this randomized controlled trial, 100 eyes of 100 diabetic patients with or without mild-to-moderate diabetic retinopathy were enrolled (HSM IOL, n = 50; non-HSM IOL, n = 50). Outcome measures were aqueous flare, visual acuity, and anterior chamber depth (ACD). These were measured preoperatively as well as one day, one week, one month, three months, six months, and one year postoperatively. Results The HSM IOL group had significantly lower anterior chamber aqueous flare values (photon count/ms) than the non-HSM IOL group on postoperative day one (9.97 ± 5.2 vs. 17.56 ± 11.3, p < 0.001), postoperative week one (11.47 ± 7.78 vs. 17.06 ± 9.4, p = 0.02), and postoperative month three (7.7 ± 4.1 vs. 12.5 ± 5.6, p = 0.004) of phacoemulsification. The corrected distance visual acuity (CDVA) was significantly better in the HSM IOL group on postoperative day one (uncorrected distance visual acuity: p = 0.022; CDVA; p = 0.005), but there was no significant difference at any other follow-ups. ACD was significantly longer in the HSM IOL group at all follow-ups. Conclusions Theimplantation of HSM IOL resulted in significantly lower inflammatory reactions in the early postoperative period in diabetics.

A COMPARATIVE STUDY OF OPTICAL BIOMETRY AND IMMERSION A-SCAN ULTRASOUND IN PATIENTS UNDERGOING PHACOEMULSIFICATION WITH FOLDABLE INTRAOCULAR LENS IMPLANTATION SURGERY

Objective: The objective of this study was to compare optical biometry with immersion A-scan ultrasound biometry in terms of axial length (AL) and post-operative refractive error by assessing 1-month post-operative refraction in patients undergoing phacoemulsification with foldable intraocular lens (IOL) implantation surgery. Methods: The study was carried out in the Ophthalmology Department of Bharati Vidyapeeth (Demeed to be University) Medical College and Hospital Sangli, from November 2019 to April 2021. A total of 60 eyes of 60 patients were included in the study. All patients underwent both techniques of biometry, namely, optical and immersion A-scan biometry. Mean AL was calculated and compared between the two methods. Then patients were divided into two groups: Group A and Group B; randomization was done on the basis of odd and even numbers. All patients underwent phacoemulsification with foldable IOL implantation surgery and followed up on 1 week and then on 1 month. All patients were operated by single surgeon and a single technique was used. Actual post-operative refractive error, that is, mean of spherical equivalent was compared between two groups on 1-month follow-up. Results: At 1-month follow-up, actual post-operative refractive error was obtained after calculating spherical equivalent for all the patients and we found that, the mean of actual post-operative refractive error for Group A was higher (−0.371±0.24 D) compared to Group B (−0.264±0.16 D) and the comparison was statistically significant (p=0.049). Conclusion: Optical biometry is slightly more accurate than ultrasound biometry, in terms of accuracy and reproducibility of the IOL power calculation, but ultrasound biometry is adequate in case optical biometry is unavailable.

Study on Outcome of Phacoemulsification Cataract Surgery with Clear Corneal Steep Axis Incision

A prospective, observational study was conducted in the Department of Ophthalmology, Combined Military Hospital (CMH), Dhaka, Bangladesh, from April to October of 2019, to observe the outcome and determine the amount of surgically induced astigmatism in phacoemulsification cataract surgery done with clear corneal incision. A total of 60 patients were included in this study. Cataract extraction was done in all the patients by phacoemulsification through clear corneal incision with foldable intraocular lens implantation. All the surgeries were done with INTREPID Micro-Coaxial system using the INFINITI Vision system by the same surgeon under local anaesthesia. The patients were followed up on 1st, 7th, and 30th POD. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. Due to clear corneal incision on steep axis, the steep meridian became flat, from 44.329±1.473D (diopter) (as found in pre-operative keratometry) to 43.971±1.431D (on the 30th post-operative day). On the other hand, the flat meridian became steeper from 43.225±1.471D (pre-operative) to 43.225±1.501D (on the 30th day). At preoperative examination and 30th day follow-up visit, astigmatism was determined as 1.10±0.319 and 0.583±0.413 respectively. The change of astigmatism was statistically significant (P&lt;0.05). CBMJ 2024 January: vol. 13 no. 01 P: 41-45

The effect of intraocular lens and lens eye on the treatment of macular splits in high myopia.

Macular retinoschisis in patients with high myopia is one of the main reasons for a decline in visual function and the perceived deformation of visual objects. This study aimed to investigate the therapeutic effect of cataract phacoemulsification and foldable intraocular lens implantation (FILI) combined with internal limiting membrane stripping (ILMS) in the treatment of macular retinoschisis in patients with high myopia. A total of 52 patients (55 eyes) who had been diagnosed with macular retinoschisis with high myopia between June 2019 and June 2020 were enrolled in the present study. Patients in the control group (25 eyes) received 23G vitreous surgery and macular ILMS and long-term inert gas (C3F8) filling of the vitreous cavity; patients in the research group (30 eyes) were additionally treated with cataract phacoemulsification and soft intraocular lens on the same treatment basis as the control group. The difference in average BCVA between the control and the research groups was not statistically significant before the surgery (P> 0.05) but was statistically significant 12 months after the procedure (P< 0.05). The minimum foveal thickness was significantly decreased in the two groups after the surgery compared with before the procedure (P< 0.05). Cataract phacoemulsification and FILI further improved the therapeutic effect of ILMS in the treatment of macular retinoschisis in patients with high myopia.

Katlanabilir Göz İçi Lens İmplantasyonunda Viskoimplantasyon ve Hidroimplantasyon Tekniklerinin Anatomik ve Fonksiyonel Sonuçlarının Karşılaştırılması

Objective: The aim of this study was to compare the anatomical and functional results of viscoimplantation and hydroimplantation techniques in monofocal foldable intraocular lens implantation.&#x0D; Materials and Methods: The study included 387 patients older than 50 years who underwent surgery for senile cataract. They were divided into two subgroups as hydroimplantation (group 1) and viscoimplantation (group 2).&#x0D; Results: The mean implantation time was 397.5±44.3 s in group 1 and 580±105.1 s in group 2. During the follow-up period (12 months), 4 (2.1%) patients in group 1 and 28 (14.6%) patients in group 2 developed posterior capsular opacification. The implantation time was shorter and the rate of posterior capsular opacification was lower in group 1 compared to group 2 (p

Clinical study of functional visual recovery following phacoemulsification with IOL implantation

Aim To evaluate the functional visual recovery following phacoemulsification cataract surgery with foldable intraocular lens implantation through a temporal clear corneal incision. Methodology This prospective study was conducted at a tertiary health care centre in Western Maharashtra over a period of 2 years. Detailed history was taken and thorough ocular examination of was done. Visual Acuity, Color vision, Contrast sensitivity, Binocular vision was noted. Visual Fields were examined and Glare Disability was assessed. All patients underwent temporal clear corneal Phacoemulsification surgery through a 3.2 mm incision with implantation of an Aspheric Monofocal Foldable IOL under LA. All patients were started on tapering dose of antibiotic − steroid over 6 weeks and followed up post operatively on day 1, week 1, week 2, 6 weeks, 3months and at 6 months. Results 50 eyes of 46 patients with immature cataract aged between 40 to 80 years were included. At the end of 24 weeks the Distance Vision was ≥ 6/9 in 31 eyes, 6/18–6/12 in 17 eyes and &lt; 6/18 in 2 eyes. It was a statistically significant difference (P&lt;0.0001). No significant difference in near vision was seen at the end of 6 months. The difference in astigmatism post operatively in all 50 eyes was not statistically significant at the end of 6 months (P&lt;0.05). Significant improvement in contrast sensitivity was seen post operatively (P&lt;0.0001). The mean glare disability was 14.06 s at 24 weeks. No significant difference was seen (P&gt;0.05). Colour vision and Field of vision were similar postoperatively. All the patients maintained grade 3 binocular vision at end of the study. Conclusion Phacoemulsification with monofocal foldable intraocular lenses can be the choice of technique in treatment of cataract as being able to provide excellent visual results and also being cost effective.

Novel exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification.

To conduct a novel exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. Retrospective, laboratory observational case series. Eleven patients (11 eyes) who had implantation of foldable hydrogel posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH. Ten of 11 cases were female with unilateral opacification, and seven cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. Four types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in three random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon. More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.

Clinical Observation of Non-Staining Circular Capsulorhexis for Hypermature Cataract

Objective: To explore the circular capsulorhexis method and its clinical effect in phacoemulsification of hypermature cataract without staining. Methods: In this prospective randomized case-control study, 22 patients (22 eyes) with hypermature cataract were randomly divided into a staining agent group (10 cases, 10 eyes) and a non-staining agent group (12 cases, 12 eyes). Both groups underwent phacoemulsification with foldable intraocular lens implantation under topical anesthesia. In the staining agent group, 0.5% indocyanine green was used to stain the anterior lens capsule to assist in circular capsulorhexis; in the non-staining agent group, after puncturing the anterior lens capsule and aspirating the liquefied cortical material, the capsular bag was filled with viscoelastic agent to increase the contrast prior to circular capsulorhexis. The operability of the anterior capsule without staining in capsulorhexis was observed, and the effect of capsulorhexis, diameter of capsulorhexis opening, and operative time were compared and analyzed between the two groups. Results: Both groups successfully underwent circular capsulorhexis, with a success rate of 100%. The diameters of capsulorhexis opening in the staining agent group and non-staining agent group were 5.68 ± 0.15 mm and 5.54 ± 0.16 mm, respectively, without any statistical difference between the groups (P &gt; 0.05); the operative time of the staining agent group (40.40 ± 5.42 s) was shorter than that of the non-staining agent group (50.92 ± 3.97 s), and the difference was statistically significant (P &lt; 0.001). In both groups, phacoemulsification was successful, and intraocular lens were implanted into the capsular bags; their visual acuity showed significant improvement during the 1-month follow-up period after surgery, without any surgical complications. Conclusion: In hypermature cataract, injecting viscoelastic agent into the capsular bag for volume replacement, given a lack of capsule staining agent, can increase the contrast for capsulorhexis and reduce the risk of large capsular bag collapse on the zonular ligament. Thus, it is considered safe and effective. Circular capsulorhexis is conducive to a smooth phacoemulsification procedure.

The Incidence of Optic Cracks or Fractures During a Foldable AcrySof or Acriva BB Acrylic Monofocal Intraocular Lens Implantation via the Manual Monarch Injector System With the Cartridge in Phacoemulsification Surgery.

To evaluate the incidence of optic cracks and/or fractures during foldable acrylic intraocular lens (IOL) implantation via the manual Monarch delivery system with the cartridge and to determine factors that help to avoid such complications. Small-incision phacoemulsification surgery was performed in 702 eyes with visually significant cataract formation. A foldable acrylic soft IOL (AcrySofâMA60BM/MA30BA, Alcon, Fort Worth, TX, USA) or a single-piece acrylic soft IOL (Acriva BBâ, VSY Biotechnology, Amsterdam, The Netherlands) was inserted in all eyes using a cartridge and viscoelastic agents (sodium hyaluronate, Healon®, Advanced Medical Optics, Santa Ana, CA, USA). Postoperative central, paracentral, or peripheral optic cracks or fractures were encountered in a total of six of 702 eyes (0.85%). Four of six lenses (0.57%) had optic cracks within the IOL substance, whereas two of 702 cases (0.28%) had full-thickness IOL fractures in the substance in multiple locations. Three of the four lenses with optic cracks were noted to be handled by tying forceps during the cartridge insertion, and one of them was the complication of holding forceps. Two IOLs with full-thickness optic fractures were encountered during the insertion of the IOLs in the capsular bag as a result of direct trauma to the lens optic by the plunger of the injector system overriding the lens optic during cartridge passage. None of the patients suffered from glare or other visual disturbances postoperatively, and, therefore, none of the six eyes required lens replacement. The unintentional extensive pressure effect of the forceps during the holding process of the IOL or the direct trauma to the lens optic by the plunger of injector systems may cause optic cracks or fractures. Physicians should continue to monitor the eyes postoperatively regularly and must determine the benefits and risks to be derived from lens replacement, if such patients complain of significant glare, image degradation, and visual disturbances. We recommend the use of preloaded lenses, which have their own delivery systems and cartridges, to minimize the risk of such complications.

Microbiological Profile and Visual Recovery in Various Clinical Types of Endophthalmitis at a Tertiary Eye Care Hospital of Tamil Nadu, India: A Retrospective Cohort Study

Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery

Clear Lens Phacoemulsification with Implantation of Intraocular Lens in a Case of Bilateral Anterior Lenticonus Due to Alport Syndrome

Alport Syndrome (AS) is a rare disorder of basement membrane, which is progressive, hereditary and presents as nephritis associated with sensorineural hearing loss, and ocular abnormalities including anterior lenticonus. Anterior lenticonus secondary to Alport syndrome is difficult to correct, however clear lens phacoemulsification is a successful and safe treatment option for the anterior lenticonus associated with Alport Syndrome. We report visual status of a young patient with Alport Syndrome and bilateral anterior lenticonus, after clear lens phacoemulsification. A 17-year-old male with bilateral anterior lenticonus presented with decreased visual acuity. Systemic evaluation revealed Alport syndrome. Clear lens phacoemulsification and foldable acrylic intraocular lens implantation was done. Visual acuity improved after surgery. There were no notable complications. Clear lens phacoemulsification and foldable lens implantation are effective and safe procedures for individuals with this visual disorder.

Refractive changes following yttrium aluminum garnet laser capsulotomy in pseudophakic patients

Purpose To study the effect of neodymium-doped yttrium aluminum garnet (Nd : YAG) laser posterior capsulotomy on refraction and best-corrected visual acuity in pseudophakic eyes. Patients and methods This retrospective nonrandomized analytic study included 110 eyes (n=100 patients) with posterior capsular opacification following a phacoemulsification with foldable hydrophobic intraocular lens implantation surgery. Thorough ophthalmological examinations were performed for all subjects before and after YAG capsulotomy. The best-corrected visual acuity, refractive sphere, and refractive cylinder calculations before and one month after the capsulotomy were recorded. Results Patients’ mean±SD age at the time of surgery was 61.35±14.46 years. The mean±SD refractive sphere changed toward a myopic shift from 0.04±1.78 before capsulotomy to −0.40±1.43 after capsulotomy. The mean±SD refractive cylinder was −1.67±1.45 before capsulotomy and changed to −1.42±1.16 after capsulotomy, making a mild hyperopic shift. Changes in the axis of the cylinder were not statistically significant. A significant improvement was seen in the best-corrected visual acuity from 0.49±0.33 before capsulotomy to 0.23±0.22 after capsulotomy (P&lt;0.001). Conclusion Visual acuity (best-corrected visual acuity) was significantly enhanced following the Nd : YAG laser capsulotomy, and therefore, it is suggested that Nd : YAG laser capsulotomy is a safe and effective alternative treatment for posterior capsular opacification. There are significant changes in the refractive sphere toward a myopic shift following the YAG laser capsulotomy and a significant change in the refractive cylinder toward a hyperopic shift, whereas there were no significant changes in the cylinder axis.

Long-term results in patients with iris-fixated foldable phakic intraocular lenses for myopia and astigmatism.

To evaluate the long-term results of iris-fixated foldable phakic intraocular lens (pIOL) implantation for the management of myopia and astigmatism. Centro Hospitalar Universitário do Porto, Oporto, Portugal. Prospective clinical study. Patients who underwent Artiflex Myopia or Artiflex Toric iris-fixed pIOL implantation for the treatment of myopia or astigmatism between 2003 and 2011 were included. Refractive stability, refractive predictability, safety, efficacy, and cumulative probability of success were evaluated at 5 years, 10 years, and 15 years of follow-up. 5-year, 10-year, and 15-year follow-ups were completed by 199 of 217 (91.7%), 187 of 217 (86.2%), and 43 of 45 (95.6%) eyes implanted with pIOLs, respectively. The mean spherical equivalent was -8.36 ± 2.75 diopters (D), -0.11 ± 0.31 D, -0.33 ± 0.62 D, and -0.80 ± 1.32 D preoperatively and after 5 years, 10 years, and 15 years after surgery. At 5 years, 10 years, and 15 years after surgery, 100%, 95.6%, and 81.6% were within ±1.00 D. The safety and efficacy indexes were 1.07 and 1.06 at 5 years, 1.04 and 0.99 at 10 years, and 1.05 and 1.00 at 15 years of follow-up, respectively. Kaplan-Meier analysis showed survival rates of 97% at 5 years, 73% at 10 years, and 43% at 15 years of follow-up. Long-term results demonstrated that the implantation of Artiflex pIOLs was a stable, predictable, and effective procedure at 5 years, 10 years, and 15 years of follow-up. Annual follow-up visits to evaluate endothelial cell density and anterior chamber depth decrease, to alert patients to this need in the preoperative evaluation, is recommended.

What next and what to expect?

What next and what to expect? A 17-year-old female presented with painless progressive loss of vision in both eyes (OU) with multiple episodes of syncope and postural giddiness for 1 month. On ocular examination, best-corrected visual acuity (BCVA) was 1/60 in the right eye (OD) and finger counting close to the face in the left eye (OS); intraocular pressure was within normal limits in both the eyes. Slit-lamp examination revealed corkscrew conjunctival vessels [Fig. 1a), anterior chamber (AC) cells 1(+), and iris neovascularization. Pupils were mid-dilated and sluggishly reacting to light. Fundus examination revealed hyperemia and neovascularization of the disc, dilated retinal veins with a beaded appearance, patches of retinal whitening over the macula and peripapillary area, and arterio-venous (AV) anastomosis [Fig. 1b and 1c]. What is the Next Step? Systemic examination Computed tomography (CT)-angiography Fundus fluorescein angiography and optical coherence tomography All of the above Findings On systemic examination, the radial artery pulse could not be felt, and the carotid pulsations were felt very feebly on both sides. The pulse rate measured in the right popliteal artery was 80/min. Blood pressure (BP) was not recordable in the upper limbs. BP recorded in the right lower leg was 150/90 mm Hg. CT angiography revealed severe luminal narrowing involving the left common carotid artery and left subclavian artery at the ostial level, and juxta-ostial narrowing of the right brachiocephalic trunk with multiple enhancing collateral channels noted in the neck [Fig. 1d-f].Figure 1: (a) Slit-lamp photography showing corkscrew conjunctival vessels, (b) and (c) fundus images showing neovascularization of the disc, dilated retinal veins with beaded appearance, patches of retinal whitening over the macula and peripapillary area, and arterio-venous anastomosis, computed tomography (CT) angiography image showing (d) narrowing of the right brachiocephalic trunk (yellow arrow), (e) narrowing of the left common carotid artery (yellow arrow), (f) stenosed left subclavian artery, minimal contrast filled vessel seen (yellow arrow)Proliferative retinopathy in both eyes was treated with pan-retinal photocoagulation (PRP) and one intravitreal injection of bevacizumab (Avastin) in OS. She received oral prednisolone for the systemic condition. Subsequently, she underwent phacoemulsification with foldable intraocular lens implantation in OU. She had a BCVA of 20/120 in OD and 20/400 in OS at the last follow-up visit. Diagnosis: Takayasu arteritis (TA) with Takayasu retinopathy Correct Answer: B Discussion TA is a chronic inflammatory disease affecting the large and medium-sized vessels, predominantly in the aorta and its main branches leading to the arterial wall thickening, fibrosis, stenosis, and thrombus formation resulting in cerebral and ocular ischemia.[1] Ophthalmic features in TA result from either due to the obliteration of arteries causing ischemic ocular changes (hypotensive retinopathy) or due to renal artery stenosis causing uncontrolled hypertension (hypertensive retinopathy).[2] Manifestations due to retinal hypoxia are microaneurysms, AV anastomosis, retinal vein occlusion, proliferative retinopathy, cataract, neovascular glaucoma, ocular ischemic syndrome, ischemic optic neuropathy, optic atrophy, retinal detachment, etc.[3] Statement of ethics Written informed consent for publication (including the images) has been obtained from the parent of the patient. All procedures carried out were in accordance with the tenets of the Declaration of Helsinki. Institute Ethics Committee approval is not required for a case report according to Indian council of medical research guidelines. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Effects on ocular aberration and contrast sensitivity after implantation of spherical and aspherical monofocal intraocular lens - A comparative study.

Phacoemulsification with intraocular lens (IOL) implantation is the standard of care for cataractous eyes. Monofocal IOLs are spherical or aspheric. The aspheric design of IOLs reduces the spherical and higher-order aberrations and impacts contrast sensitivity post cataract surgery. There are some studies, but data in the Indian setting with the IOLs we used is lacking. We aimed to compare the effect of implantation of spheric and aspheric foldable intraocular lenses on postoperative quality of vision, spherical aberration, and contrast sensitivity. This prospective observational study was conducted at a tertiary care hospital with an ophthalmology specialty, data collection from January 2017 to May 2018 in 100 patients. Patients meeting the inclusion criteria were selected. Their preoperative and postoperative data were collected and divided into groups based on whether spherical or aspheric IOL was implanted after cataract surgery. Variables assessed were visual acuity on days 7 and 30, spherical aberrations, and contrast sensitivity was assessed at 1-month postoperative. The mean age of the patients in this study was 64 ± 8 years with a majority of patients (60%) being females. There is no significant difference in postoperative visual acuity between the two groups. Internal SA was significantly lower (~50%) in eyes implanted with aspheric IOLs (P value = 0.004, 0.0001) compared with the spherical group. Contrast sensitivity of patients of the aspheric group was significantly better (P value <0.05). The optical design of the aspheric IOLs reduced spherical aberrations and increased contrast sensitivity.

Cataract Surgery Results after Penetrating Keratoplasty

Objective. To compare clinical and refractive outcomes of cataract surgery by phacoemulsification and by extracapsular cataract extraction with implantation of foldable and rigid intraocular lenses in patients previously having undergone penetrating keratoplasty (PK).Patients and methods. This is a retrospective study. Medical records of all patients admitted for cataract surgery between 2010 and 2018 to the King Abdullah University Hospital (KAUH) were reviewed and medical records of patients who underwent cataract surgery after PK were analyzed. Medical records of 95 patients (58 males and 37 females; average age 40.0 ± 19.9 years) were selected. Depending upon the type of surgical technique applied, the cases were divided into two groups: first group included 60 patients who underwent cataract surgery by phacoemulsification with implantation of different foldable intraocular lenses (IOL), the second group included 35 patients who underwent cataract surgery by extracapsular cataract extraction (ECCE) with implantation of a polymethylmethacrylate (PMMA) IOL. The choice of ECCE technique with implantation of rigid IOLs was made if the endothelial cell density after PK was less than 2200 cells/mm2 and cataracts were of 4 and 5 grades to exclude additional trauma to the endothelium by ultrasound energy. Demographic and clinical data were collected. The R statistical program and SPSS were used for data analysis. The P value &lt; 0.05 was considered statistically significant.Results. Analysis showed that PK was performed mainly due to 4 indications: keratoconus (KC) — 77 % cases, herpetic keratopathy — 7 % cases, Eye trauma — 5 % cases, previous graft rejection — 5 % cases and Stevens–Johnson syndrome — 1 % cases. The mean best corrected visual acuity (BCVA) in the first group improved from 0.40 ± 0.05 to 0.80 ± 0.05 postoperatively. The mean BCVA in the second group improved from 0.30 ± 0.05 to 0.70 ± 0.05. In the late postoperative period BCVA with foldable IOLs was higher by 0.10 ± 0.05, as compared with the results obtained with the rigid IOLs. Mean intraocular pressure (IOP) changed from 15.1 ± 4.9 before PK to 16.3 ± 5.3 after PK.Conclusion. KC was the most common indication for PK in Jordan. Results of our analysis showed that cataract surgery could be successfully performed in eyes after PK with favorable results and improvement in patients’ quality of life. Cataract surgery by phacoemulsification with implantation of foldable IOLs results in higher (BCVA) compared to ECCE with implantation of PMMA IOLs. Unless contraindicated otherwise, phacoemulsification technique with foldable IOL implantation should be given preference over ECCE with implantation of rigid PMMA IOLs in visual rehabilitation of cataract patients after PK.