IOL Implantation Research Articles

Comparative analysis of corneal versus scleral tunnel incision implantation of anterior artisan Aphakia intraocular lens

AbstractPurpose: To evaluate the surgically induced astigmatism (SIA), efficacy and safety of two distinct accesses for anterior Artisan Aphakia IOL implantation in patients without capsular support.Methods: Outcome data were collected for all patients who had undergone prepupillary Artisan Aphakia IOL insertion associated with pars plana vitrectomy from October 2016 and June 2022 at Puerta de Hierro‐Majadahonda University Hospital. All those with available preoperative and postoperative IOL master keratometry records were included in the analysis. The results were analysed by the incision type (corneal versus scleral tunnel).Results: Ninety‐seven eyes from 79 patients were included. Average follow up was 2 years. Forty‐five (48%) were corneal incisions and 53 (52%) were scleral tunnels. The main causes were: 33 (32%) eyes with Marfan syndrome, 27 (26%) eyes had a complicated cataract surgery and 23 (23%) eyes had luxation or subluxation of the IOL‐capsule complex. The mean surgically induced astigmatism (SIA) in the scleral tunnel group (1.28 ± 1.15 diopter [D]) was significantly lower than in the corneal incision group (2.20 ± 1.27 D) (p < 0.001). The mean BCVA was better in the scleral tunnel group (0.18 ± 0.33 logMAR) than in the corneal incision group (0.27 ± 0.53 logMAR), although the difference was not significant (p = 0.09). The rate of complications did not show differences between groups. Two eyes (2%) developed corneal decompensation. There were 20 (20.67%) cases of cistoid macular edema (11 in the scleral tunnel group and 10 in the corneal incision group). In the scleral tunnel group, there was a tendency to first day postoperative hypotonia (24.5%) (p = 0.06), in all cases it resolved with conservative measures within 1 week.Conclusions: Scleral‐incision approach is a safe technique that should be performed for anterior Artisan Aphakia IOL implantation in order to reduce SIA and improve BCVA. Intraocular pressure should be monitored throughout the first postoperative week.

EPH70 Transcription Errors in Ophthalmology: Current Burden and the Opportunity for Digital Technologies

Pre-operative work-up for cataract surgery is an intensive and complex process and ensuring accuracy is crucial to avoid IOL implantation errors and/or poor refractive outcomes. A literature review was conducted to understand the burden of transcription errors in ophthalmology and the impact of recent digital technologies.

Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia

A phakic intraocular lens (PIOL) of − 4.5 D was characterized from its wavefront aberration profile. A preclinical study was conducted using pre- and post-surgery data from four patients that had undergone myopic laser refractive surgery. All these patients would have needed a PIOL of − 4.5 D. Pre-surgery data were used to simulate the effect of a PIOL implantation. Post myopic refractive surgery data were used to calculate the post-LASIK eye model. Modulation transfer function (MTF), point spread function (PSF) and simulation of optotypes vision were obtained and compared. The PIOL did not worsen the optical quality of the eyes evaluated. High order Aberrations were always higher in the post-LASIK eye model. Optics quality trended to be better in PIOL implantation than post-LASIK surgery as pupil size increased.

Cost-benefit analysis of a trifocal intraocular lens versus a monofocal intraocular lens from the patient's perspective in the United States.

To conduct a cost-benefit analysis of AcrySof IQ PanOptix trifocal intraocular lens (TFNT00 IOL) versus AcrySof monofocal IOL (SN60AT) from the patient perspective in the United States (US). A de novo Markov model was developed to estimate the mean total lifetime patient costs and vision-related quality of life (measured as quality adjusted life-years (QALYs)) with each intervention (TFNT00 and SN60AT) and the incremental differences between these two treatments. The resulting incremental quality of life gain was mapped to the US patient willingness to pay threshold of $50,000 per QALY gain to estimate the lifetime net monetary value, measured as the net monetary benefit of TFNT00 IOL. Model inputs (transition probabilities, costs, discount rate, utilities, and event rates) were derived from the FDA IDE study (NCT03280108), published literature, clinical experience, and other relevant sources. Bilateral cataract surgery with implantation of the advanced technology IOL (AT-IOL) TFNT00 provides improved vision-related quality of life (QALY gain of 0.67) at an incremental lifetime cost of $2,783 compared to monofocal IOL. This incremental QALY gain translated into a lifetime net monetary benefit of $30,941 at the patient willingness to pay threshold of $50,000/QALY gain. Results were most sensitive to disutility due to wearing glasses, patient out of pocket costs for bilateral AT-IOL procedure, and post-operative spectacle dependence rates. AcrySof IQ PanOptix IOL provides greater improvement in vision related quality of life compared to no presbyopia correction with a monofocal IOL. This study shows PanOptix is a cost-beneficial treatment strategy for patients willing to pay out of pocket for cataract surgery.

Commentary: Changing trends and preferred surgeons' practice for nucleus delivery in manual small-incision cataract surgery-Haven't they changed?

Commentary: Changing trends and preferred surgeons' practice for nucleus delivery in manual small-incision cataract surgery-Haven't they changed?

Toric trans-scleral plugs IOL to correct aphakia with significant corneal astigmatism.

To describe the use of toric trans-plugs IOL to correct aphakia with significant corneal astigmatism. Case report and literature review. A 62-year-old man with an history of aphakia in his left eye after a traumatic cataract extraction and significant corneal astigmatism was referred to our clinic. Surgery plan was cataract remnants removal and secondary IOL implantation of toric sutureless trans-scleral plugs fixated IOL (FIL SSF, Soleko, Italy). The postoperative course was uneventful. At 12 months, the IOL was well-centered and the optic alignment remained stable with minimal total astigmatism. The e uncorrected distance visual acuity (UDVA) was 20/25 Snellen while correct distance visual acuity (CDVA) was 20/20 with a manifest refraction of -0.25-50 40° D; the patient was satisfied by the visual outcome. This novel toric trans-scleral plug fixated lens provides valuable outcomes also for astigmatic correction for a comprehensive correction of the aphakia in patients with poor zonular support and high expectations for postoperative visual quality.

Spectral domain oct for screening of macular diseases prior to multifocal intraocular lens implantation

BackgroundCataract surgery with multifocal IOLs could give patients good vision and great satisfaction, at the same time generating high expectations; therefore, its precise indication is essential if we are to reach our goal. The use of optical coherence tomography may be a valuable tool in the screening of macular diseases, which often cannot be detected in routine clinical examinations. This study evaluates the benefit of including spectral domain optical coherence tomography (SD-OCT) in routine preoperative cataract surgery protocols for better case selection in multifocal IOLs.MethodsObservational and retrospective clinical study that includes patients with an indication for multifocal IOL implantation who underwent retinal fundus exam and SD-OCT examination between 2018 and 2019. The clinical examination with ophthalmoscopy and SD-OCT imaging results were evaluated to observe their influence on the final choice of the lens implanted lens in cataract surgery.Results405 eyes from 207 patients with multifocal IOL indication were included. It was found that 220 (54.2%) of all indicated multifocal or trifocal IOLs were in fact implanted. The most important reason for not implanting the indicated IOL was financial, in 116 (59.46%) eyes. The second cause were retinal abnormalities detected by SD-OCT, 63 eyes (15.6%). Those abnormalities included dry age-related macular degeneration (AMD) (50.7%), neovascular AMD (3.1%), vitreomacular adhesion (11.1%), diabetic macular edema (3.1%), epiretinal membrane (ERM) (25.3%) and other macular abnormalities (6.3%). Of the 63 eyes with an abnormal SD-OCT result, 44 (69.8%) were also identified by fundus examination. Nineteen (30.2%) eyes had abnormalities detected only by SD-OCT imaging with a normal clinical exam.ConclusionsRoutine use of SD-OCT imaging may help diagnose pre-existing macular pathologies not identified by clinical exam, helping both physicians and patients choose the ideal IOL individually and has the potential to prevent unsatisfactory functional results.

Effect of Combined Surgery in Patients with Complex Nanophthalmos.

(1) Background: To evaluate the efficacy and safety of combined surgery (limited pars plana vitrectomy, anterior-chamber stabilized phacoemulsification, IOL implantation and posterior capsulotomy, LPPV + ACSP + IOL + PC) in complex nanophthalmos. (2) Methods: Patients with complex nanophthalmos were recruited to undergo LPPV + ACSP + IOL + PC from January 2017 to February 2021. Preoperative and post-operative intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and number of glaucoma medications were compared using the paired t-test or Wilcoxon signed rank sum tests. Surgical success rate was evaluated. Surgery-associated complications were documented. (3) Results: Forty-five eyes of 37 patients with complex nanophthalmos were enrolled. The mean follow-up period was 21.7 ± 10.6 months after surgery. Mean IOP decreased from 32.7 ± 8.7 mmHg before surgery to 16.9 ± 4.5 mmHg (p < 0.001) at the final follow-up visit, mean logMAR BCVA improved from 1.28 ± 0.64 to 0.96 ± 0.44 (p < 0.001), mean ACD significantly increased from 1.14 ± 0.51 mm to 3.07 ± 0.66 mm (p < 0.001), and the median number of glaucoma medications dropped from 3 (1, 4) to 2 (0, 4) (p < 0.001). The success rate was 88.9% (40 eyes) at the final follow-up visit. Two eyes had localized choroidal detachments which resolved with medical treatment. (4) Conclusions: LPPV + ACSP + IOL + PC is a safe and effective surgical procedure, which can decrease IOP, improve BCVA, deepen the anterior chamber, and reduce the number of glaucoma medications in patients with complex nanophthalmos. It can be considered as one of the first treatment in nanophthalmic eyes with complex conditions.

An unusual case of sequential corneal perforation in pellucid marginal degeneration

Spontaneous and sequential corneal perforation is rare in pellucid marginal degeneration (PMD) in the seventh decade of life. Hence, the importance of repeated follow-up, clinical examination along with serial corneal topography even in the seventh and eighth decades of life is of utmost importance in PMD. We report a case of spontaneous corneal perforation in a 64-year-old male patient with PMD having normal corneal thickness in the right eye which was managed with primary suturing and compression sutures. The other eye was absolutely normal with normal topographic findings. Over a period of four years of follow-up, the patient developed progressive diminution of vision in both eyes and was diagnosed with cataract. Temporal phacoemulsification with toric IOL implantation was done in both eyes, following which the left eye developed spontaneous perforation after a period of two months which was also managed with primary suturing and compression sutures.

Этапное хирургическое лечение осложненной начальной катаракты у пациентов с далекозашедшей стадией пролиферативной диабетической ретинопатии

Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients. Material and methods. 187 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into four groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the 3rd group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with gas tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and the IOL implantation. In the 4th group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with gas tamponade. Results. Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along on PDR patients with complicated primary cataract. Conclusions. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Keywords: diabetic retinopathy, cataract, vitreoretinal surgery.

Интраокулярная коррекция астигматизма у пациентов с измененной архитектоникой роговицы

Implantation of toric intraocular lenses (TIOL) currently occupies a leading place in the correction of astigmatism in cataract phacoemulsification. This procedure does not prolong the time of the operation itself, ensures the stability of the results obtained and the high speed of rehabilitation of patients. However, there are a small number of publications in the available literature on the implantation of toric IOLs in cases of altered corneal topography. The aim is to study the results of cataract phacoemulsification with implantation of toric IOLS in astigmatism and altered corneal architectonics. Material and methods. Phacoemulsification with TIOL implantation was performed in 49 patients (50 eyes) with cataract and regular corneal astigmatism. It was established from the anamnesis that radial keratotomy was performed in 20 patients (20 eyes), through keratoplasty – in 10 patients (10 eyes). Keratoconus was observed in 19 people (20 eyes). The average age of the patients was 57.3 ± 9.7 years. All patients were implanted with a toric lens (TIOL) Acrysof IQ Toric (SN6A T3-T9). Preoperative astigmatism varied in the range of 1.5-6.0 D Visual acuity – from light projection to 0.5 with correction. Additionally, patients underwent keratotopographic studies, anterior segment of the eye, endothelial biomicroscopy. The observation period was up to 6 months. Cataract phacoemulsification was performed on the Centurion (Alcon) device. Results. Intra- and postoperative complications were not noted. In all cases, the THIOL occupied a directional position and maintained rotational stability (the maximum rotation angle was 3°) for the entire observation period. The average the postoperative uncorrected distance visual acuity (UDVA) was 0.52 ± 0.11, there were no statistically significant differences in visual acuity between the three nosologies. The spherical component was 0.35± 0.05, the cylindrical component was 0.73 ± 0.12 D. Conclusion. In patients with cataracts and altered corneal topography, phacoemulsification + TIOL is an effective method of correcting ametropia. Keywords: toric intraocular lenses (TIOL), phacoemulsification, astigmatism, cataract.

Эффективность имплантации новой асферической гидрофобной акриловой монофокальной ИОЛ в краткосрочном периоде наблюдения

Perpose. To evaluate the results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system in the short-term follow-up period. Material and methods. The prospective study included 89 patients (114 eyes) after bilateral or monolateral Clareon IOL implantation with a mean follow-up of 2.1 ± 0.4 (1–4) months. The age range was 53 to 87 (71.1 ± 5.2) years. A corneal incision of 1.8 mm was used in all cases. For implantation using the AutonoMe® system, the incision was enlarged by 0.2 mm for implantation IOL 26 D and higher. IOL optical power was calculated using the SRK/T formula; retrospective analysis was performed using the Hoffer Q, Haigis, Holladay II, Olsen, Barrett Universal II, and Kane formulas. Results. In all studied periods (1 day, 1 week and 1 month) there was statistically significant (p &lt; 0.05) increase both of NCDVA (from 0.13 ± 0.02 in the preoperative period to 0.81 ± 0.07 in 1 month after surgical intervention), and BCDVA (from 0.32 ± 0.15 before surgery to 0.94 ± 0.11 after surgery). When assessing the percentage of eyes with an BCDVA of 0.9 or higher, a statistically significant (p &lt; 0.05) difference was shown in all studied periods. The lowest MAE was shown for the Barrett Universal II (0.292), SRK/T (0.312) Kane (0.301), and Olsen (0.325) formulas. For the Hoffer Q and Holladay 2 formulas, MAE values were significantly higher (p &lt; 0.05). The highest frequency of achieving the target refraction of ±0.25 D was shown for the Barrett Universal II and Kane formulas (68 and 69 %, respectively), and the lowest for the Hoffer Q and Holladay 2 formulas (28 and 35 %, respectively). The primary endpoint of the study (BCDVA =1.0) was achieved in 95.6 % (n = 109), with a deviation in BCVA of ±0.1 noted in 4 eyes (3.5 %). No glistening was detected in the follow-up period up to 4 months. Conclusion. The paper presents an analysis of the first experience with the implantation of new Clareon monofocal IOLs in Russian Federation. The results of implantation of a new hydrophobic acrylic monofocal IOL in an automated preloaded delivery system showed a good clinical and functional effect, a high frequency of achieving the target result and the absence of significant side effects. The Kane, Barrett Universal II, and SRK/T formulas, using the Verion diagnostic navigation system, are recommended for calculating the optical power of the new IOL. Keywords: cataract; monofocal IOL; Clareon; glistening.

Послеоперационная деформация ИОЛ, методика выявления и влияние на послеоперационную рефракцию

Purpose. To determine IOL deformation in patients after phacoemulsification using optical coherence tomography (OCT) and to identify associated shift of postoperative refraction. Results. A "deflection" along the axis was detected during the OCT data analysis. In 38 cases (17.27 %) the center of the optical part of the lens was shifted toward the retina. The amplitude of this shift was 8.41 ± 8.28 mkm (from 0.00 to 30.00 mkm). At the same time patients with the "deflection" of the optical part of the IOL have large values of axial length (AL) accompanied with a great corneal segment diameter size, a deeper anterior chamber of the pseudophakic eye and its larger volume after IOL implantation. The obtained subjective refraction and the autorefractometry data in the form of a spherical equivalent were compared with the expected value of the calculated refraction using standard formulas. The average amplitude of the refraction shift was 0.25 diopters towards hypermetropia. Mathematical models based of logistic regression were constructed to predict the probability of the lens "deflection". The model based on only IOL power value (AUROC = 0.89 ± 0.07) stood out with good predictive quality and the possibility of interpretation. A high probability of IOL "deflection" was revealed when its power was not greater than ≥ 18.5 diopters. Another models was built based on sets of biometry data measured with Lenstar LS900: the axial length and anterior chamber depth of of the phakic eye, the diameter of the corneal segment and the average keratometry data calculated within the main meridians. This one have also high predictive quality: AUROC = 0.93 ± 0.06. Conclusion. Based on the data of optical coherence tomography, it is possible to detect the axial "deflection" of the optical part of the intraocular lens. The deflection of the IOL is reflected in the hypermetropia refractive shift relative to that calculated by the formulas of Hoffer Q, Holladay I and Haigis, which requires correction. To calculate the probability of displacement of the implanted IOL towards the retina, 2 logistic regression models with good predictive quality and the possibility of interpretation for the have been developed. Keywords: cataract, "deflection" along the axis, phacoemulsification, IOL deformation, optical coherence tomography

Результаты имплантации и особенности расчета ИОЛ с расширенной глубиной фокуса vivity dft015: первый опыт

Purpose. To evaluate the results of implantation of the Vivity IOL in patients with cataract and refractive lensectomy. Material and methods. The study included 25 patients (42 eyes) who underwent phacoemulsification or refractive lens exchange with Vivity IOL implantation. The mean age of the patients was 56.4 ± 11.75 years. The results were evaluated 1 month after the surgery. Postoperative visual acuity was measured monocularly at a distance and at an intermediate. The IOL was calculated using three formulas: Kane, Hill-RBF, EVO. The mean absolute (MAE) and median (MedAE) calculation errors were calculated. Results. One month after the surgery patients with lens exchange and cataracts distance and intermediate visual acuity was 0.88 ± 0.17 and 0.76 ± 0.12, 0.91 ± 0.23 and 0.81 ± 0.11 respectively. The mean absolute error according to the formulas ranged from 0.31 to 0.33 D. Pairwise comparison of the calculation accuracy revealed no significant differences (p &gt; 0.05). Conclusion. The new non-diffractive EDOF IOL Vivity DFT015 demonstrated high visual functions at long and medium distances, as well as high calculation accuracy using three modern calculators. Keywords: phacoemulsification, IOL with extended depth of focus, cataract.

Клинический случай интраоперационной профилактики капсульного блока при цилиарно-капсульной фиксации трехчастной иол

Purpose. To evaluate the clinical efficacy of intraoperative peripheral capsulotomy of the anterior leaf of the preserved capsular sac for the prevention of capsular block during fixation of the haptic elements of a three-piece IOL in the ciliary sulcus and infringement of the optics in the anterior capsulorhexis. Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 58-year-old patient in the early postoperative period. In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, after filling the haptic elements of the three-part IOL into the ciliary sulcus, and the optics into the anterior capsulorhexis, 0.3 mm to the periphery from the edge of the IOL optics with a spear knife, two peripheral capsulotomies of the anterior capsule were performed opposite to each other. Results. On the 2nd day after the operation, BCVA increased and amounted to 1.0, IOP - 11 mm Hg. Art.; before surgery - 0.6 and 22, respectively. According to optical coherence tomography, a sufficient distance between the edge of the iris and the anterior surface of the IOL for free circulation of intraocular fluid was determined, and there were no signs of a capsular block. Conclusion. In the course of the study, it was found that intraoperative peripheral capsulotomy of the anterior leaf of the capsular bag provided natural leaching of viscoelastic from the capsular bag during implantation of a three-piece IOL into the ciliary sulcus with infringement of the optic part in the anterior capsulorhexis on the second day after the operation. Key words: capsular block, capsulotomy, three-piece intraocular lens, cilio-capsular fixation, pseudoexfoliative syndrome.

Prevention of Surgery-Induced Dry Eye by Diquafosol Eyedrops after Femtosecond Laser-Assisted Cataract Surgery.

Purpose: To analyze the protective effects of diquafosol eyedrops on the ocular surface following femtosecond laser-assisted cataract surgery (FLACS). Design: A prospective, randomized contralateral study. Methods: Bilateral FLACS with a trifocal IOL (PanOptix) implantation was performed in 40 eyes in 20 patients (10 males, 10 females, average age 68.8 ± 6.3 years old). Patients received 3% diquafosol eyedrops six times daily in one randomly chosen eye (diquafosol group), and physiological saline six times a day in the other eye (control group). Other medication included 1.5% levofloxacin, 0.1% dexamethasone and 0.1% diclofenac three times daily in both eyes. The pre and post-operative tear break-up time (BUT), superficial punctate keratopathy (SPK) scores and visual function were compared between both eyes, and all patients answered the dry-eye-related quality of life score (DEQS) questionnaire. Results: The BUT between groups was similar pre-operatively and on the first day post-op; however, the BUT was statistically longer in the diquafosol group compared to saline at 1 week (5.5/3.7 s) and 2 weeks (4.8/3.0 s) (p < 0.05). There was no difference in the SPK score, best corrected distance visual acuity, tear meniscus height, contrast sensitivity, DEQS and Schirmer test at all time points. Spherical aberration was statistically lower in the diquafosol group at 1 week. The protective effects of diquafosol on the BUT was more pronounced in patients with a pre-operative BUT of less than 5 s compared with those with a BUT longer than 6 s. Conclusions: Diquafosol eyedrops prevented the shortening of the BUT following FLACS, even in patients with short pre-operative BUT values.

Intraocular lens dislocation: manifestation, ocular and systemic risk factors

PurposeThe aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation.MethodsA retrospective case–control study were all patients presented in the period 2012–2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included.Results150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24–93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25–127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0–186 months).ConclusionPatients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes

PurposeTo evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract. Material and methodsData of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups. ResultsThe mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group. ConclusionTraumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.

Effect of cataract incision type on corneal spherical aberration.

Corneal spherical aberration (CSA) plays an important role in the ocular refractive system. However, ophthalmologists have not considered the effect of difference cataract incisions on it. The purpose of this study is to investigate the effect of transparent corneal incision (TCI) and scleral tunnel incision (STI) on CSA after the cataract phacoemulsification with foldable IOLs. One hundred ninety-three eyes (61 males and 79 females) for 1-month observation and 114 eyes (29 males and 51 females) for 3-month observation with age-related cataracts (ARC) were included in this study. CSA was measured with dilated pupil by Pentacam Scheimpflug system at 1 day preoperative and 1, 3-month postoperative. Preoperative CSA >1.00 μm was excluded. Both TCI and STI are 3 mm incisions with Infiniti system and Ozil handpiece. No significant difference of age or gender was found between TCI and STI groups in 1 or 3-month observation. In 1-month observation, preoperative CSA for TCI and STI are 0.31 ± 0.29 and 0.41 ± 0.19 μm, which of postoperative are 0.42 ± 0.17 and 0.44 ± 0.35 μm, respectively. The change of CSA is 0.11 ± 0.32 and 0.04 ± 0.33 μm (P = .233). For 3-month observation, preoperative CSA for TCI and STI are 0.32 ± 0.28 and 0.36 ± 0.23 μm, which of postoperative are 0.43 ± 0.16 and 0.39 ± 0.26 μm, respectively. The change of CSA is 0.10 ± 0.34 and 0.03 ± 0.21 μm (P = .312). For the phacoemulsification combined with foldable IOL implantation, STI has minimal effect on CSA, but TCI might increase postoperative CSA.

Варианты размеров переднего фемтосекундного капсулорексиса для фиксации капсульного мешка у пациентов с подвывихом хрусталика

Purpose: to determine the optimal size of anterior femtosecond capsulorhexis for stable capsular bag fixation in case of lens subluxation using iridocapsular retractors during cataract phacoemulsification with IOL implantation. Material and methods. 86 patients (86 eyes) with lens subluxation of I and II degrees according to Pashtaev's classification were examined. All patients were divided into three groups. Group I consisted of 28 eyes, group II – 36 eyes, group III – 22 eyes. In group I femtosecond capsulorhexis with a diameter of 5.5 mm was performed, in group II – with a diameter of 5.0 mm, and in group III – 4.5 mm. All patients underwent phacoemulsification with IOL implantation using iridocapsular retractors and a capsular ring. Results. The highest percentage of surgical complications 5.6 % was observed in group I, the average – 4.0 % in group III, the lowest – 1.3 % in group II. Conclusion. The optimal size of capsulorhexis for stable capsular bag fixation and comfortable phacoemulsification is 5.00 mm capsulorhexis. Keywords: capsulorhexis, iridocapsular retractors, capsular bag, lens.