IOL Implantation Research Articles

Calculation of IOL Optical Power Using OKULIX Ray-Tracing Software in Real Clinical Practice

Purpose. Comparative analysis of the accuracy of IOL optical power calculation using different biometric devices.Patients and methods. The study included 30 patients (30 eyes) after monolateral implantation of different monofocal and multifocal IOL models with a mean follow-up of 3.0 ± 0.2 (3–4) months. The mean age was 63.5 ± 6.5 (48–84) years. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. For all patients, IOL optic power, axial length and keratometry data were obtained using IOLMaster 500, Pentacam HR, and Pentacam AXL+OKULIX devices. Clareon, IQ Vivity, Hoya 250/251, and XY1-SP Vivinex IOLs were implanted.Results. The mean optical power for all implanted IOLs was +21.38 ± 3.50 D, range of values was +10.0 to +29.0 D. The average values of axial eye length were 23.50 ± 0.90 mm (21.25 to 25.19 mm). The target refractive IOLs optic power calculated with the three biometric systems did not differ significantly and was -0.464 ± 0.120 D, -0.502 ± 0.140 D, and -0.400 ± 0.110 D for IOLMaster, Pentacam, and Pentacam+OKULIX, respectively (p > 0.05). The Pentacam HR and Pentacam AXL+OKULIX had slightly lower MAE values; however, no significant differences were found in calculating IOL optical power for the three devices used (p > 0.05). When comparing the devices under study, significant differences were found for the rate of refractive power within ±0.5 D when using the IOLMaster on the one hand and OKULIX on the other (p < 0.05). The refractive error rate of ±1.0 D using the biometric devices did not differ significantly (p > 0.05).Conclusion. This paper presents the first Russian experience of using OKULIX ray-tracing software in clinical practice to increase the accuracy of optical power calculation of various IOL models. The advantage of Pentacam AXL+OKULIX over the IOLMaster 500 biometer in achieving a target refraction of ±0.5 D is shown.

Strabismus development after pediatric cataract surgery associated with age at surgery, intraocular lens implantation, and visual acuity outcome

ABSTRACT Purpose Approximately half of the children operated on for cataracts develop strabismus. We determined what factors predict its development. Methods In a retrospective, cross-sectional study, children who underwent cataract surgery before age 5 between 2010 and 2017 in a tertiary center in Brazil were identified from medical records. Subsequently, patients were invited for an ophthalmological examination to assess visual acuity, refraction, and strabismus (constant or intermittent heterotropy of any magnitude). In addition, age at surgery, cataract laterality, intraocular lens implantation, surgical complications, nystagmus, anisometropia, and elapsed time between surgery and the present examination were assessed using logistic regression. Results Surgery was performed in 74 eyes of 46 patients (21 males). The median age at surgery was 6.4 (3.7–29.6) months, and the interval between surgery and this examination was 32.5 (18.0–53.0) months. Strabismus was present in 33 (72%) patients, 35% had esotropia and 33% exotropia. One patient had strabismus surgery before the examination. Age at surgery (OR 0.95; p-value .018), IOL implantation (OR 0.08; p-value .027), and current visual acuity on the worse eye (OR 1.16; p-value .036) were associated with strabismus. Conclusions Strabismus development after pediatric cataract surgery is associated with age at surgery, intraocular lens implantation, and visual-acuity outcomes of the worse eye.

Assessment of Safety, Efficacy and Predictability of a Trifocal Intraocular Lens

Purpose: To evaluate the performance and the visual outcomes of Acrysof PanOptix trifocal IOL in terms of safety, efficacy, predictability and assessment of the quality of vision after implantation as regards; contrast sensitivity and ocular aberrations. Study Design: Quasi experimental study. Place and Duration of Study: Dar el Ouyon hospital and Rowad Correction Center, Egypt, from September 2019 and January 2020. Methods: Forty eyes of twenty-one patients with senile cataract were included by convenient sampling. All eyes underwent phacoemulsification with IOL implantation. They were divided into two groups; group A included twenty eyes of eleven patients who were implanted AcrySof IQ PanOptix trifocal IOL Model TFNT00. Group B included twenty eyes of ten patients who were implanted monofocal AcrySof IOLs as a control group. A questionnaire was given to every patient after explaining to him\her the questions in Arabic, and clarifying the aim of evaluation. Results: Mean age was 56.6 ± 6.9 years in group A and 62.8 ± 7.1 years in group B, range 50 – 70 (P = 0.861). We found statistical significant difference between both groups with group A showing better post operative uncorrected distance, intermediate, near, and best corrected near visual acuity (P values were 0.001, 0.556, 0.001, 0.177, 0.001, 0.001 respectively). Group B showed statistically significant better post operative contrast sensitivity compared to group A. Conclusion: In this study, Acrysof PanOptix trifocal IOL showed excellent safety, efficacy, predictability and spectacle independence at all distances, However, contrast sensitivity was compromised in comparison to the monofocal group.

Use of Spectacles after Cataract Surgery.

The goal of this study was to investigate the use of spectacles in everyday life after bilateral cataract surgery with a preoperative refractive target of emmetropia in both eyes. In addition, we analyzed the total cost of spectacles and the patient's visual satisfaction at least 6 months after surgery. Patients after bilateral cataract surgery with implantation of an aspheric monofocal IOL (Tecnis 1, Johnson & Johnson) with a preoperative refractive target of emmetropia in both eyes and a documented refractive outcome were included in this prospective observational study. In a phone interview ≥ 6 months after surgery, the following items were assessed: type of spectacles purchased and overall cost, type of activity with and duration of spectacle wear, and satisfaction with the visual situation. Seventy patients were included in this study. Depending on their postoperative refraction, patients were divided into group A (n = 27) with perfect emmetropia in both eyes (i.e., spherical equivalent [SE] of ≥ - 0.25 D to ≤ + 0.25 D), group B (n = 21) with achieved emmetropia in one eye (i.e., SE of ≥ - 0.25 D to ≤ + 0.25 D) and a myopic refraction in the other eye (< - 0.25 D), and group C (n = 22) with bilateral myopic results (SE of < - 0.25 D). Overall, 84% of patients had purchased new spectacles, mostly varifocals (59%) or reading glasses (24%) at the median cost of 980 Swiss Francs (mean: CHF 912 ± 746). Despite patients' initial reasoning for their lens choice to require reading glasses only, varifocal glasses were worn for more than 50% or all of awake time by 48% of patients in group A, 43% in group B, and 68% in group C. Despite their regular spectacles use, patients' visual satisfaction was very high in all three groups. Most patients who achieve perfect bilateral emmetropia after implantation of monofocal aspheric lenses buy varifocal spectacles within 6 months, and more than half of all patients use their varifocal spectacles for more than 50% of their awakening time. The costs for such spectacles are high.

The utility of extended depth-of-focus intraocular lens in the management of higher-order aberrations and modulation transfer function in a case of Alport syndrome

This report describes the changes in the higher-order aberrations (HOAs) and modulation transfer function (MTF) in anterior lenticonus in a case of Alport syndrome managed by using extended depth of focus (EDOF) IOL. The patient was a 23-year-old male complaining of diminution of vision in both eyes and had a best-corrected visual acuity (BCVA) of 6/24 and 6/18 in the right and left eye, respectively. Slit-lamp examination revealed anterior lenticonus in both eyes. Optical coherence tomography showed temporal retinal thinning, and aberrometry revealed increased HOA and a reduction of MTF. The patient underwent sequential, bilateral, clear corneal phacoemulsification with EDOF IOL implantation. Postsurgery, improvements in BCVA and MTF with a significant reduction in HOA were noted. To conclude, the EDOF lens is a viable option for implantation in cases of Alport syndrome with anterior lenticonus.

Хирургическое лечение осложненной начальной катаракты вторым этапом после витреоретинальной хирургии у пациентов с пролиферативной диабетической ретинопатией

Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients. Material and methods. 124 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. Thier patients were divided into two 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. Results. In the long-term postoperative period, functional results were better in group I patients than in group II patients (p &lt; 0.001). Conclusion. Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. 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

Efficacy and safety of UT-DSAEK combined with Carlevale's sutureless scleral fixation IOL.

To evaluate a novel surgical combination of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and sutureless scleral fixation for Carlevale intraocular lens (SSF-Carlevale IOL) implantation to manage corneal endothelial decompensation when there is a concomitant need for secondary IOL fixation. Clinical data collected from 10 eyes of 9 patients with bullous keratopathy (BK) who underwent combined UT-DSAEK and SSF-Carlevale IOL implantation in a single procedure were retrospectively analyzed. Anterior chamber IOL (4 cases), aphakia (4 cases, 1 of which associated with PEX), and previous trauma (2 cases) were the conditions responsible for BK. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), graft thickness (GT) and complications were recorded over a 12-month follow-up period. In 90% (9/10) of eyes graft clarity was maintained during follow-up. The mean CDVA improved significantly (p < 0.0001) from 1.78 ± 0.76 logMAR preoperatively to 0.53 ± 0.3 logMAR at 12 months. ECD on average decreased from 2575 ± 125.3 cells/mm2 (donor tissue) to 1697 ± 133.3 cells/mm2 in 12 months. The mean CCT decreased from 870 ± 200 µm to 650 µm ± 9 at 12 months (ANOVA, p = 0.0005). Combined UT-DSAEK and SSF-Carlevale IOL implantation was associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a practical option for patients requiring both treatment for corneal endothelial dysfunction and secondary IOL implantation.

Combination of cataract surgery with intravitreal injection of dexamethasone intravitreal implant (Ozurdex) for uveitis-induced cataract.

To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone (DEX) intravitreal implant (Ozurdex). The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber reaction, central macular thickness (CMT), intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively. A successful surgery was performed in all patients. The average follow-up period was 12mo. The female/male ratio was 13/13. Mean age was 45.65±3.83y (range 26 to 65y). Etiologically, rheumatic arthritis occurred in 6 patients (18.75%), ankylosing spondylitis in 4 (12.50%), HLA-B27 associated uveitis in 3 (9.38%), Vogt-Koyanagi-Harada-associated uveitis in 4 (12.50%) , Behcet's disease in 2 (6.25%), and 7 (21.88%) suffered from unknown diseases. All 32 eyes had varying degrees of improvement at 12mo after surgery, with 2 eyes showing BCVA of 0.1 or below (6.25%), 6 having 0.1-0.5 (18.75%), 18 of 0.5-1.0 (56.25%), and 6 of 1.0 or above (18.75%). No cases with increased IOP were observed. The values of mean CMT was increased at day 1, decreased at 1, 3mo after surgery and increased at 6, 12mo after surgery. No severe uveitis reactions, such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL, were observed after surgery. The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.

COMPARISON OF SECONDARY AC-IOL IMPLANTATION ON APHAKIA PATIENTS WITHOUT CAPSULAR SUPPORT AFTER PARS PLANA VITRECTOMY VERSUS COMPLICATED CATARACT SURGERY

Introduction and objectiv: Capsular support is often absent in cases of aphakia secondary to ocular trauma or previous complicated intraocular surgery. This study aims to compare the short-term efficacy and safety of secondary AC IOL implantation for aphakia patients who underwent pars plana vitrectomy and complicated cataract surgery Method: Retrospective, comparative, case series of 72 aphakic eyes without capsular support after pars plana vitrectomy (Group 1 =37 eyes) and complicated cataract surgery (Group 2=35 eyes) who underwent secondary AC-IOL implantation (Iris Claw and Anterior Chamber) in Yap Eye Hospital and Air Force Central Hospital Hardjolukito. Basic characteristics such as age, sex, laterality, visual acuity, intraocular pressure (IOP), central corneal thickness, endothelial count, axial length, anterior chamber depth and keratometry were recorded Results: There were no statistically differences at baseline characteristics between the two groups. Despite the proportion difference of lens type used in both group (p=0.04), the mean visual acuity outcome at day 1 and month 3 were found similar. However, on day 7 and month 1 the difference of postoperative visual acuity showed a trend. The difference of postoperative mean IOP was also not significant at day 1, month 1 and month 3, but showed a trend in day 7 (p=0.06). The proportion of complication cases were found different in both group (p=0.01), with secondary glaucoma was found highest (18%). Conclusion: The outcomes of secondary anterior chamber IOL implantation after pars plana vitrectomy and complicated cataract surgery were found similar, although there was a significant difference in the proportion of complication in both groups

Management of Pediatric Traumatic Cataract With An Open Globe Injury

Introduction: Traumatic cataract is one of the leading causes of monocular blindness in children. The management of pediatric traumatic cataract is challenging; the growing size of the affected eyes and the risk of amblyopia further complicate things. The timing of cataract removal and IOL implantation remain controversial until today. Case Report: A thirteen-years-old boy came with his left eye punctured by a pencil tip. He came in with a visual acuity of 1/300, a full-thickness 5 mm paracentral corneal laceration and traumatic cataract. The patient went through a two-step surgery. Cataract surgery and IOL implantation was conducted one week following corneal laceration suture. Discussion: Two-step surgery was performed on this patient with consideration being cataract removal performed when the inflammation of the eye was subside and also a more accurate IOL calculation. One study stated, even with 43.4% of patient’s anterior capsule ruptures, it would postponed cataract surgery for 2 days up to 6 months. In this case, a week after first surgery, it revealed anterior capsule rupture and the lens material was touching corneal endothelium. Therefore, lensectomy was performed because it touches the corneal endothelium causing further damage Conclusion: The two-step procedure performed was a preferable surgery for a traumatic cataract in a quiet eye, because it has better potential for visual improvement and IOL calculation. However, since the anterior lens capsule ruptured and the lens material prolapsed into the anterior chamber, it would have been even better to perform lensectomy as an early procedure to prevent inflammation.

A 3D Video Overlay of Angularly and Linearly graduated scales for precisely indicating accurate measures on the Ocular surface in order to Guide Ophthalmic Surgeons during Toric IOL implantation and Squint Surgeries

A 3D Video Overlay of Angularly and Linearly graduated scales for precisely indicating accurate measures on the Ocular surface in order to Guide Ophthalmic Surgeons during Toric IOL implantation and Squint Surgeries

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

BackgroundEnhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision. MethodsThe study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between –0.25 and –0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months’ visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias. ResultsBinocular uncorrected visual acuities at 12 month’s visit were 0.13 ​± ​0.16, 0.06 ​± ​0.08, 0.07 ​± ​0.09 and 0.15 ​± ​0.09 logMAR for far distance, 80 ​cm, 66 ​cm and 40 ​cm respectively. Corrected binocular visual acuities at 12 months were 0.00 ​± ​0.00, 0.05 ​± ​0.07, 0.05 ​± ​0.06, 0.13 ​± ​0.16 respectively for distance, 80 ​cm, 66 ​cm and 40 ​cm. Automated refraction spherical equivalent at 12 months’ visit stood at –0.70 ​± ​0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled –0.49 ​± ​0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 ​± ​0.16 logMAR without correction and 1.81 ​± ​0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case. ConclusionsEDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.

Automatic measurement of anterior chamber angle parameters in AS-OCT images using deep learning.

The early assessment of angle closure is of great significance for the timely diagnosis and treatment of primary angle-closure glaucoma (PACG). Anterior segment optical coherence tomography (AS-OCT) provides a fast and non-contact way to evaluate the angle close using the iris root (IR) and scleral spur (SS) information. The objective of this study was to develop a deep learning method to automatically detect IR and SS in AS-OCT for measuring anterior chamber (AC) angle parameters including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), and anterior chamber angle (ACA). 3305 AS-OCT images from 362 eyes and 203 patients were collected and analyzed. Based on the recently proposed transformer-based architecture that learns to capture long-range dependencies by leveraging the self-attention mechanism, a hybrid convolutional neural network (CNN) and transformer model to encode both local and global features was developed to automatically detect IR and SS in AS-OCT images. Experiments demonstrated that our algorithm achieved a significantly better performance than state-of-the-art methods for AS-OCT and medical image analysis with a precision of 0.941, a sensitivity of 0.914, an F1 score of 0.927, and a mean absolute error (MAE) of 37.1±25.3 µm for IR, and a precision of 0.805, a sensitivity of 0.847, an F1 score of 0.826, and an MAE of 41.4±29.4 µm for SS, and a high agreement with expert human analysts for AC angle parameter measurement. We further demonstrated the application of the proposed method to evaluate the effect of cataract surgery with IOL implantation in a PACG patient and to assess the outcome of ICL implantation in a patient with high myopia with a potential risk of developing PACG. The proposed method can accurately detect IR and SS in AS-OCT images and effectively facilitate the AC angle parameter measurement for pre- and post-operative management of PACG.

Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants

Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications.

SURGICAL OUTCOME OF CORNEAL TRIPLE PROCEDURE IN THE MANAGEMENT OF CASES OF CORNEAL AND LENTICULAR OPACITIES IN A TERTIARY CARE HOSPITAL

We describe three cases of adherent leucoma with cataract who had unaided vision of hand movement close to face and were managed with relatively rare one step Triple procedure involving penetrating Keratoplasty, Extra-Capsular Cataract Extraction and IOL implantation(PKP-ECCE-PCIOL). Patients showed encouraging post-operative results, thereby providing impetus to study the role of this procedure in patients who are practically bilaterally blind in providing useful vision.

Case of Pierson syndrome presented with hyphema,vitrous haemorrhage and subsequent neovascular glaucoma

BackgroundPierson syndrome is a rare autosomal recessive disorder that causes congenital nephrotic syndrome, neurodevelopmental abnormalities, and several ocular signs. The Pierson syndrome is caused by a mutation of the LAMB2 gene, that encodes laminin beta 2, which is expressed in the glomerular basement membrane, in neuromuscular junctions, and within ocular structures. First described by Pierson et al., the ocular signs of Pierson syndrome include microcoria, which is most characteristic sign, as well as iris abnormalities, cataract, glaucoma, and retinal detachment.Case presentationHerein, we report the case of a young female who, at 16 months, was diagnosed with congenital nephrotic syndrome, subsequently underwent a kidney transplant at age 4,did cataract surgery with IOL implantation in both eyes at age of 2 years and presented with ocular signs including high myopia, band keratopathy, t, nystagmus, retina, and optic nerve atrophy, she did not show nor did the family report any neurodevelopmental abnormalities. her genetic studies this missense variant c.970T< C p. (Cys324Arg) of LAMB2, later she developed spontaneous hyphema along with vitreous haemorrhage and increased intra ocular pressure in her left eye, she underwent cyclophotocouagulation to treat her high IOP.ConclusionLAMB 2 mutations can be associated withmultiple ocular signs that varies from mild to severe form, we are her toreport our case who did not present with the typical ocular sign of microcoriafor PS, did not have any neurodevelopmental abnormality andpresented with hyphaemia 2ndry to iris neovascularisation with vitreous haemorrhagewith neovascular glaucoma.

Analysis of visual and functional results after implantation of toric IOLs using manual and digital VERIONÓ� marker

Analysis of visual and functional results after implantation of toric IOLs using manual and digital VERIONÓ� marker

Study on the Effect of Topical Pre-operative Nonsteroidal Anti-inflammatory Drugs in Maintaining Mydriasis during Small Incision Cataract Surgery

A prospective, randomized, double masked, single centered comparative study done in the Bangladesh Naval Ship Patenga, Chattogram, Bangladesh, from July 2021 to June 2022, to assess the clinical benefits and effectiveness of prophylactic pre-operative topical administration of NSAIDs in maintaining mydriasis during small incision cataract surgery. Thirty patients underwent small incision cataract surgery with intra ocular lens implantation were randomized to compare the efficacy of topical NSAIDs drops (Group-A) and placebo drops (Group-B) in maintaining peroperative mydriasis. Balanced salt solution containing non preservative adrenaline was used in all patients. Pupil size was measured prior to the corneal incision and after the completion of the operation. The two groups were analyzed with respect to the changes in pupillary diameter at the beginning and at the end of the operation. The change in pupil size was significantly different among the two groups at the end of the surgery. The mean vertical and horizontal diameter of the two groups were near about similar at the beginning of the surgery. Significant differences were seen after IOL implantation with the NSAIDs group having the larger mean diameter in both vertical (P=0.003) and horizontal (P=0.008) pupillary measurements at the conclusion of surgery. Topical NSAIDs has been shown to be a more effective inhibitor of meiosis during per operative uncomplicated small incision cataract surgery and provides a more stable mydriatic effect during surgery compared to the placebo group.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 22-26

Randomized multicenter trial to assess posterior capsule opacification and glistenings in two hydrophobic acrylic intraocular lenses

To evaluate the long-term posterior capsule opacification (PCO) formation, and glistening rate of the HOYA Vivinex (XY1) IOL compared to Alcon AcrySof (SN60WF). In this prospective, multicentric, randomized, paired-eye, open-label study, we included 87 subjects that underwent cataract surgery with IOL implantation, with 67 patients completing the 3-year follow-up. The completer population consisted of 32 subjects implanted with XY1 and 35 implanted with SN60WF. Primary endpoints consisted of the evaluation of glistenings and measurement of PCO. Secondary outcomes included Best Corrected Distance Visual Acuity (BCVA), Contrast Acuity (CA), uncorrected visual acuities, subjective refraction, medical and lens complication rates, adverse events, and optical/visual symptoms. Follow-up visits occurred at 6-months, 1-, 2- and 3-years. At 3-years follow-up, mean PCO score was 0.121 ± 0.193 for eyes implanted with Vivinex versus 0.239 ± 0.463 for AcrySof (p = 0.026). The Vivinex IOL showed statistically significantly lower glistening occurrence through 3-years postoperatively (0.14 ± 0.26) compared to AcrySof (1.79 ± 1.43; p < 0.0001). Postoperative visual acuities improved from baseline in both IOL groups (p < 0.0001), and remained stable through the 3-year follow-up period. Eyes implanted with a HOYA Vivinex IOL exhibited significantly lower occurrence of glistening at 3-years versus Alcon AcrySof (p < 0.0001). Incidence of PCO was very low and comparable in both Vivinex and AcrySof eyes.

Predictive Risk Factors for Retinal Redetachment Following Uncomplicated Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment

Purpose: To investigate clinical and surgical factors influencing the outcome after primary rhegmatogenous retinal detachment surgery. Methods: A retrospective, single-centre, case-control study of 274 eyes of 274 patients with primary rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) in the period between January 2019 and December 2021, were included in the study. Analysed surgical factors were: combined procedure with phacoemulsification, type of retinopexy (cryocoagulation, endolaser, combined), type of tamponade (gas, silicone oil), and anatomical factors: primary proliferative vitreoretinopathy (PVR) and macular detachment at the time of surgery. Results: Overall retinal re-detachment rate was 10.1%. The main reason for re-detachment was an insufficient retinopexy in 53.6%, followed by PVR (37.3%), and retinal detachment occurred at a different location caused by another break in 9.1%. No significant difference in the rate of re-detachment was found if a phacoemulsification with simultaneous IOL implantation was performed (p = 0.641). No significant difference between the various retinopexy techniques was found (p = 0.309). Risk factors re-detachment were primary PVR (p = 0.0003), silicone oil as initial tamponade (p = 0.0001) as well as macula off detachments (p = 0.034). Conclusions: The present study showed no significant difference between the types of retinopexy and if additional phacoemulsification was performed or not. Factors associated with a higher risk for re-detachment were detached macula at surgery, primary PVR and primary oil-filling.