IOL Implantation Research Articles

Prediction of visual outcomes using virtual implantation of a trifocal intraocular lens in presbyopic lens exchange patients.

To assess the reliability of a novel virtual IOL implantation device to predict the outcomes of a trifocal IOL. Clinical sites in Spain and Germany. Prospective multicenter study. Preoperative measurements obtained by the virtual implantation of AT LISA tri 839MP IOL (Carl Zeiss Meditec AG, Jena, Germany) with VirtIOL device (10Lens S.L.U., Terrassa, Spain) were compared to postoperative (month 3) outcomes following the IOL implantation. Evaluated metrics were defocus curve, contrast sensitivity (both in photopic conditions), and visual phenomena (visual angle size of burst and annular pattern) in mesopic conditions. The study included 45 presbyopic non-cataract patients (mean age 56.16±5.03 years). VirtIOL device reasonably predicted the shape of the defocus curve, especially in the intermediate vision range, but underestimated postoperative visual acuities mainly at the defocus range between +1.0D and -3.5D. The difference between predicted and achieved visual acuity was -0.11±0.13 logMAR (p<0.001) for 0.0D defocus and -0.16±0.15D logMAR (p<0.001) for -2.50D defocus. The shape of the contrast sensitivity curve was almost identical for predicted and achieved measurements, but the device underestimated the values by ≈0.3 logCS units for each spatial frequency. Visual phenomena were similar between the predicted and achieved outcome (predicted vs. achieved: burst pattern 2.65±0.97° vs. 2.74°±0.95°, p=0.63; annular pattern: 0.88±0.42° vs. 0.93±0.49°, p=0.59). The device reasonably predicted the pattern of measured variables. Visual acuity/contrast sensitivity reduction might be attributed to viewing the objects through a more complex optical system and would need to be accounted for in clinical studies.

Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report

BackgroundApart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management.Case presentationA 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient’s history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0.ConclusionsOur report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

Reverse Pupillary Block after Implantation of a Sutureless Scleral Fixation Carlevale Intraocular Lens

PurposeTo describe the incidence, complications and management of reverse pupillary block (RPB) after implantation of Carlevale IOL. DesignMulticenter, retrospective, cross-sectional study. ParticipantsOut of a sample of 128 patients that had undergone Carlevale IOL implantation, 19 patients were found to present RPB. MethodsNineteen patients with RPB after Carlevale IOL implantation were evaluated and treated with laser peripheral iridotomy (LPI). Main Outcome MeasuresDemographic data (age, gender), data on preexisting medication, axial length (Zeiss IOLMaster 500 and Zeiss IOLMaster 700), presence of pseudoexfoliation material (PXF), presence of reverse pupillary block (Anterior segment swept-source SS-OCT Anterion, Heidelberg Engineering), presence of macular edema (Irvine Gass syndrome, OCT Spectralis, Heidelberg Engineering), anterior chamber depth (ACD) before and after LPI, best corrected visual acuity (BCVA) before and after LPI and intraocular pressure (IOP) before and after LPI were analyzed. ResultsAn incidence of RPB of 14.8% was found. The prevalence of pseudoexfoliation syndrome was 21.1% and 42.1% of patients presented an axial length >24.00 mm. Mean pre-LPI ACD was 4.78 ± 0.465 mm and post-LPI was 4.23 ± 0.404 mm, a statistically significant increase of 0.54 (p=0.000, IC 95% 0.26-0.83) mm of ACD was observed. There were no differences between pre- and post- LPI BCVA. Pre-LPI IOP was 17.10 (range 12-34) mmHg and post-LPI IOP was 14.47 (range 10-21) mmHg, (p= 0.391). Cystic macular oedema (Irvine Gass) was identified in 4 out of 19 patients, reporting an incidence of 21.1% in RPB cases. ConclusionReverse pupillary block is a relatively common complication after Carlevale lens implantation, which may be associated with an increase of macular oedema incidence but does not clearly correlate an increase of intraocular pressure. Our hypothesis is that indentation of the sclera induces a posterior rotation of the peripheral iris, causing RPB. Our results encourage to look over the Carlevale IOL implantation technique to consider a routinely intraoperative surgical peripheral iridotomy to avoid RPB and its further complications.

Evaluation of Intermediate Visual Outcomes in Eyes Implanted with Bilateral Advanced Monofocal Intraocular Lens Targeting for Mini-Monovision and Its Association with Age and Corneal Asphericity.

To assess the visualoutcomes in patients bilaterally implanted with novel Clareon® intraocular lens when targeting mini monovision post-operatively. The study was conducted at Laxmi Eye Institute; itis a tertiary care eye institution in Panvel, India. This is an investigator initiated, prospective, single-centre longitudinal study of 45 patients to assess the visual outcomes in patients who were implanted with Clareon ® IOL bilaterally. Patients with corneal astigmatism of ≤0.75 D who underwent bilateral cataract surgery with pseudophakic mini-monovision and implanted with novel Clareon® intraocular lens were included. Patients having post op manifest refraction >±0.25 D in the dominant eye and <-0.5 D or >-0.75 D in the non-dominant eye were excluded. The main study outcomes were assessed at 1 and 3 months; itincluded uncorrected visual acuities assessment, defocus curve, and patient reported spectacle use. The mean (SD) binocular distance corrected intermediate visual acuity at 3 months was 0.22 (0.09) LogMAR. At 3 months, 54% of patients enjoyed 0.4 LogMAR or better BUCNVA. The defocus curve showed good distance and intermediate visual acuity with >0.2 LogMAR vision from +0.50 D to -1.50 D. We found a positive correlation between the Q value of the dominant eye and the BCIVA at 3 months postoperatively, however it was not statistically significant. The Q value was more negative when the intermediate vision was closer to 0 LogMAR. Post operatively, at3 months,95% patients did not need glasses for distance and intermediate vision and 73% of patients were comfortable for intermediate vision without glasses all the time. Mini-monovision with Clareon® monofocal IOL implantation can offer overall satisfactory vision for far and intermediate distances with minimal need for use of spectacles for near vision.

Comparative Analysis of Refractive Outcomes Using Optical and Ultrasound Biometry in Phacoemulsification Cataract Surgery

Background: Accurate biometry is critical for optimal visual outcomes in cataract surgery. Both optical and ultrasound biometry are widely used, but their comparative effectiveness remains under evaluation.Objective: To compare the refractive outcomes of optical and ultrasound biometry in patients undergoing elective phacoemulsification cataract surgery.Methods: This prospective cohort study included 352 patients aged 30-60 years undergoing elective phacoemulsification with in-the-bag IOL implantation. Patients were randomly assigned to either optical biometry using the Zeiss IOL Master 700 or ultrasound biometry with Axis Nano contact A-mode echography. Visual acuity and spherical equivalent were measured at baseline and 4 weeks post-operatively. Data were analyzed using SPSS version 25, with independent t-tests comparing outcomes between groups.Results: The mean post-operative visual acuity was 0.83 ± 0.22, with a mean spherical equivalent of -0.88 ± 0.16. No significant difference was found between the ultrasound (-0.89 ± 0.17) and optical biometry (-0.87 ± 0.16) groups (p=0.152, 95% CI -0.06 to 0.01).Conclusion: Both optical and ultrasound biometry provide comparable refractive outcomes in cataract surgery, with no significant difference in post-operative spherical equivalent.

Analysis of the optical performance of intraocular lenses using profilometric measurements.

The aim of this study was to develop a methodology, based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls). The "Modulation Transfer Function through-object" (MTF through-object) based on vergence object displacement was calculated for different pupil sizes and pseudophakic eyes. Tilt and decentration were also analysed in a realistic cornea eye model. For comparison between the different IOLs, an optical quality criterion based on a minimum value the MTF through-object and the recognition of simulated vision optotypes was introduced. Five IOLs were used in this study: Tecnis Eyhance, Mini Well, Tecnis Symfony, Tecnis Synergy and RayOne EMV. The technique was validated with previous methodologies. A general narrowing of the through-object MTF curve compared to the through-focus MTF curve was shown, resulting in greater distances between near and intermediate points and less depth of field around the far peak. The comparison between the IOLs showed that variations in corneal aberrations, pupil size and decentration caused relevant changes in IOL performance. A decrease of the SA produced a hypermetropic shift of the far focus between + 0.3 D and + 0.4 D. Most of IOLs worsen the optical quality as pupil size increased, even the MTF through-object shape changed. Decentration was an important factor in IOL implantation, causing a significant change in MTF through-object shape in most of IOLs. This study highlights the need to evaluate pre-operative patients for corneal aberrations and pupillary size to have the best optical success after cataract surgery in multifocal or extended depth of focus IOLs. What is known MTF(Modulation Transfer Function)through-focus curves (calculated in image space by moving the detector plane) can be obtained from optical bench assembly or from commercial devices. Recently, some studies proposed to characterize the lens surface design based on the profilometric measurements What is new A novel methodology based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls) was shown. The "Modulation Transfer Function through-object" based on vergence object displacement was introduced in order to analyse five premium IOLs. MTF through-object curve is more appropriate for studying clinical behaviour, as it provides further near and intermediate points distances and lower depth of focus around far peak compare to MTF through-focus curves. The optical behaviour of the five IOLs can vary considerably depending on the eye model and pupil size. The effect of tilt and decentration on the MTF through-object the IOLs was analysed.

A clinical study on evaluation of risk factors and visual outcome after phacoemulsification in presenile cataract patients

To evaluate the risk factors, types of pre senile cataract and to assess the visual outcome after phacoemulsification and intraocular lens implantation in pre senile cataract.This was a hospital based cross sectional study of 90 patients who presented to Ophthalmology OPD of a tertiary care hospital and was diagnosed to have pre senile cataract. The study was done from June 2020 to November 2021. Patients who gave written informed consent were included in the study. Detailed history was taken regarding the age, gender, risk factors such as diabetes mellitus, myopia, occupation, smoking, corticosteroid use, dermatological disease etc. All the patients were subjected to routine ophthalmological evaluation. All the patients underwent phacoemulsification and IOL implantation. Visual acuity was noted before and after the surgery. The risk factors for pre senile cataract and visual acuity before and after cataract surgery was statistically analysed.Out of 90 patients included in the study, 60% were females Mean age at presentation was 42.94 ±5.93 years. Most common cause of pre senile cataract was diabetes mellitus (42.2%) followed by tobacco consumption (20%) and dermatological diseases (15.6%). Posterior subcapsular cataract was the most common type of cataract seen among young population and it has been significantly associated with diabetes mellitus. 87.8% had a best corrected visual acuity of 6/6-6/9 after phacoemulsification surgery. In this study diabetes mellitus and tobacco consumption are the two strongest modifiable risk factors for cataractogenesis in younger working population which is mainly because of the lifestyle changes. Majority of the patients attained a good visual acuity post phacoemulsification and IOL implantation surgery.

Functional outcomes and quality of life after AcrySof IQ Vivity intraocular lens implantation in a real-world study

The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden’s Quality of Vision test and Morlock’s Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients.

Adjustable flanged technique for secondary implantation of four-point scleral‑fixated posterior chamber intraocular lenses using two parallel 6−0 polyglactin sutures

ObjectiveTo assess the efficacy and safety of using the adjustable flanged technique for secondary implantation of four-point scleral‑fixated posterior chamber intraocular lenses with two parallel 6−0 polyglactin sutures.MethodsTwo parallel 6−0 polyglactin sutures were passed separately through the two haptics on the horizontal line of the 4-haptic IOL. The four externalized sutures were then trimmed and cauterized to form flanges. The best corrected visual acuity, intraocular pressure, and complications in all patients were observed and recorded.ResultsThe flanged technique using two parallel 6−0 polyglactin sutures was applied to 14 aphakic eyes. The average preoperative best corrected visual acuity was 1.00 ± 0.88 LogMAR (Snellen 20/200), which improved to 0.42 ± 0.38 LogMAR (Snellen 20/48) at the final follow-up (P = 0.004). None of the patients experienced vitreous hemorrhage, low intraocular pressure, or issues with exposed or broken sutures.ConclusionThe simplicity of the technique, along with its ability to accommodate adjustments post-implantation, allows for optimal positioning and reduces risks like IOL tilt or dislocation. Overall, this is a promising approach to secondary IOL implantation, with potential benefits for both patient outcomes and surgical efficiency.

Lens Factor Choice in IOL Power Calculation after Laser Refractive Surgery: The Right Constant for Advanced Lens Measurement Approach (ALMA).

Background/Objectives: To evaluate the advanced lens measurement approach (ALMA) formula accuracy using different lens constants available on the user group for laser interference biometry (ULIB) and IOL Con platforms. Methods: In this retrospective, comparative, case-series study, 150 eyes of 160 patients with previous myopic Photorefractive Keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), who underwent uneventful cataract surgery and IOL implantation, were examined. The ALMA formula was evaluated to calculate the refractive prediction error (PE), analysing four different categories of lens constants: both nominal and optimized A-Constant for SRKT, which are available on the ULIB and IOL Con platforms. An additional analysis was carried out in this study, evaluating if a decreased ULIB optimized constant (DUOC) with different fixed factors (-1.2 -1.3 -1.4 -1.5) could improve refractive outcomes. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of prediction error were measured as the main outcomes. Results: Comparing the lens factors available on ULIB and IOL Con platforms, the ALMA formula reported a lower MedAE and higher percentages of eyes with a refractive PE within 1.0 D using ULIB nominal constants (all p < 0.05). Using DUOC (-1.3), and there was a statistically significant improvement of both MedAE and of the percentages of eyes with PE within ±0.50 D with the ALMA method compared to nominal ULIB constants (all p < 0.05). Conclusions: The impact of different lens factors in the IOL power calculation after myopic LRS should be carefully evaluated. The ALMA formula, in the absence of optimized constants by zeroing the mean error, should be used by subtracting 1.3 from the optimized ULIB constants available on the IOL Con website. This finding suggests further studies to test which of these constants could work better with the other post-refractive surgery formulas.

Modified technique for sutured scleral fixated intraocular lens in a patient with post-traumatic aniridia and aphakia: a case report

BackgroundA modified surgical technique of sutured scleral fixated intraocular lens (SSF-IOL) was applied in a patient with post-traumatic aniridia and aphakia.Case presentationA 51-year-old man was referred to our clinic with decreased vision (finger count) in his right eye. This patient had previously undergone primary repair of the ruptured globe and pars plana vitrectomy to manage ocular trauma in the same eye. On presentation, the best corrected visual acuity in his right eye was 20/40. The slit lamp examination of his right eye revealed loss of total iris and lens. Corneal endothelial cell density was 1462 cells/mm2. Fundoscopic examination of the right eye revealed a retinal attachment. For IOL implantation, a rigid poly methyl methacrylate IOL was used with a 2-point scleral fixation performed using a polypropylene suture. One year postoperatively, the uncorrected distance visual acuity was 20/32, and the manifest refraction was − 0.5/–1.5 × 130 (20/20). Pentacam revealed that the astigmatism of the anterior corneal surface and the total cornea was 1.1 D (axis: 59.8°) and 1.0 D (axis: 35.6°), respectively. The horizontal (3°–183°) cross-section image displayed an IOL with a 1° tilt and 0.425 mm decentration. The patient reported no dysphotopsia or photophobia and was satisfied with the visual results. OPD-scan III revealed that higher-order aberrations in the right eye were slightly higher than those in the left eye. No suture-related or other serious complications were observed.ConclusionThe modified SSF-IOL technique can offer improved visual quality for patients with aniridia and aphakia by ensuring proper IOL positioning and reducing astigmatism.

Outcomes of manual arcuate keratotomy with compression sutures for high regular postkeratoplasty astigmatism.

To report functional and refractive outcomes of manual arcuate keratotomy (AK) with compression sutures for high regular postkeratoplasty astigmatism.Setting: not specified (review). Retrospective analysis. This study included 90 eyes with high regular postkeratoplasty astigmatism (>4 diopters, D) who received AK with compression sutures between 2010 and 2022. Functional and refractive outcomes were assessed by evaluating topographic indices and by performing vector astigmatism and Fourier analysis. At last follow-up (mean=13.7±16.6 months), BCDVA improved from 0.59±0.28 logMAR to 0.34±0.25 logMAR. Cylinder magnitude decreased from 9.91±2.88 D to 5.42±3.35 D. Surface Asymmetry Index, Irregular Astigmatism Index, Corneal Eccentricity Index were equal to preoperative values, whereas Surface Regularity Index approached normal values at last follow-up. Fourier analysis indicated a decrease in the regular astigmatic component, whereas non-regular components (asymmetry and higher-order irregularity) remained stable. In vector astigmatism analysis, Target Induced Astigmatism magnitude was 9.92±2.86 D and Surgically Induced Astigmatism magnitude was 10.16±4.86 D (Correction Index of 0.91±0.48) with a Difference Vector of 5.42±3.35 D at last follow-up. Correction of astigmatism magnitude was adequate in 40% of the eyes, under-corrected in 30% and over-corrected in 30%. Angle of Error was <|22.5°| in 88% resulting in a low risk of off-axis treatment. AK with compression sutures is a simple, relatively effective and safe surgical procedure for astigmatism reduction after keratoplasty. In case of regular astigmatism, the procedure does not increase corneal irregularities. The remaining refractive error might be further corrected by spectacles, contact lenses or toric IOL implantation (in-the-bag / add-on), thus reducing the need for repeat keratoplasty.

Anterior Chamber Intraocular Lens Implantation Versus Four-Flanged Scleral Fixation Technique for Patients With Loss of Capsular Support During Routine Cataract Surgery.

To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].

The Homburg-Adelaide toric IOL nomogram: How to predict corneal power vectors from preoperative IOLMaster 700 keratometry and total corneal power in toric IOL implantation.

The purpose of this study is to compare the reconstructed corneal power (RCP) by working backwards from the post-implantation spectacle refraction and toric intraocular lens power and to develop the models for mapping preoperative keratometry and total corneal power to RCP. Retrospective single-centre study involving 442 eyes treated with a monofocal and trifocal toric IOL (Zeiss TORBI and LISA). Keratometry and total corneal power were measured preoperatively and postoperatively using IOLMaster 700. Feedforward neural network and multilinear regression models were derived to map keratometry and total corneal power vector components (equivalent power EQ and astigmatism components C0 and C45) to the respective RCP components. Mean preoperative/postoperative C0 for keratometry and total corneal power was -0.14/-0.08 dioptres and -0.30/-0.24 dioptres. All mean C45 components ranged between -0.11 and -0.20 dioptres. With crossvalidation, the neural network and regression models showed comparable results on the test data with a mean squared prediction error of 0.20/0.18 and 0.22/0.22 dioptres2 and on the training data the neural network models outperformed the regression models with 0.11/0.12 and 0.22/0.22 dioptres2 for predicting RCP from preoperative keratometry/total corneal power. Based on our dataset, both the feedforward neural network and multilinear regression models showed good precision in predicting the power vector components of RCP from preoperative keratometry or total corneal power. With a similar performance in crossvalidation and a simple implementation in consumer software, we recommend implementation of regression models in clinical practice.

Improving the quality of visualization in phacoemulsification in the “triple procedure”

The so-called “triple procedure,” including penetrating keratoplasty in combination with cataract removal and posterior chamber IOL implantation, is the preferred treatment method for patients with combined pathology of the cornea and lens. Methods to reduce intraoperative complications and ensure rapid visual rehabilitation in patients with concomitant conditions are of particular importance when planning such surgeries. In this article, we describe a clinical case of a triple procedure, which involves a lamellar dissection of the damaged cornea of the recipient followed by exposure of the residual corneal stroma to a 40% glucose solution in combination with a viscoelastic, which allowed for optical clearing of the stroma and improved visualization of the anterior chamber structures for phacoemulsification with posterior chamber IOL implantation. This approach represents a safer alternative to the “cataract stage” of surgery, performed under “open sky” conditions.

Transient Macular Edema after Uncomplicated Cataract Surgery: Below the Surface

To present analysis of 17 case reports of 17 patients who had an acute transient macular edema appeared after uneventful cataract surgery. Observations: In literature about 12 case series of toxic macular edema development after cataract surgery are described and all of them were accompanied by the cefuroxime intracameral usage. Also, there are reports of macular edema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular edema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient acute macular edema with 3,8% incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or acute inflammation. Optical coherence tomography (OCT) was performed on patients complaining on blur vision and who had signs of macular edema by ophthalmoscopy. By OCT high and often extensive neuroepithelium and local pigment epithelium detachments were observed on the first day after surgery in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3-6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME) and vitreomacular traction syndrome. Conclusion: It’s obvious that observed case series are cefuroxime induced. But its comparison with CME in terms of morphology of the macula could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues.

Importance of Early Intervention of Traumatic Cataract in Children

Aim: To evaluate the intraoperative complications &amp; post- operative outcome of early intervention of traumatic cataract in children due to open globe injuries.  Materials and Methods: 40 cases of unilateral cataract having repair of open globe injuries previously were included in this prospective study. Primary repair of corneal injuries were done with 10-0 Nylon under general anesthesia. Secondary intervention with IOL implantation were done within 4 weeks of primary repair. Age range was 4-14 years and minimum follow up 3 months. Intraoperative and postoperative complications and final best-corrected visual outcome were recorded.  Results: All cases had pre-existing anterior capsular tear and flocculent lens matter in anterior chamber. IOL were implanted in the bag in 90% cases. Intra-operatively 4 cases revealed pre-existing posterior capsular hole and IOL were implanted in the sulcus. Synechiolysis was done in 3 cases. There was no iatrogenic PC rent. Postoperatively no cases showed synechiae formation, pupil capture and IOL displacement. Visual acuity was 6/9 to 6/60 in all cases and intraocular pressures were digitally normal. No optic atrophy and RD were noticed at last follow up. Most common causes of decreased vision were corneal scar and astigmatism.  Conclusion: Early cataract surgery with IOL implantation after repair of open globe injuries carries favorable intraoperative and postoperative outcome.

A simultaneous post-LASIK sequential bilateral implantation of multifocal IOLs aimed at refraction correction. A clinical case

The article presents a clinical example of intraocular presbyopia correction in a patient who previously underwent laser vision correction by LASIK for mild myopia. Before the surgery, the distance VA mono- and binocular was 1.0, ADD for reading distance 40 cm +2.0 D, objective refraction sph +0.5 D cyl -0.25 D ax 980, left eye sph +0.75 D cyl -0.25 D ax 660. The patient was given a simultaneous bilateral refractive lens exchange with an implantation of a trifocal aspheric intraocular lens in the right eye and a trifocal toric aspheric intraocular lens in the left eye. We used the following IOL calculation formulas: ASCRS mean IOL power, Shammas formula, Barrett true K formula, Masket formula, Modified Masket formula, Haigis-L formula. 1 week postop: UDVA OU = 1.0, UNVA 40 cm = 1.0, UVA 70 cm = 0.7. The objective refraction OD was sph +0.0, D cyl -0.75 D ax 163, OS sph +0.25 D, cyl -0.0 D. The compliance with the modified algorithms of pre-and intraoperative behavior of the operating team, thorough preparation of the patient, careful calculation of the IOL allowed us to obtain the predictive refractive result with a high level of visual satisfaction and absence of undesirable postoperative phenomena. The patient underwent the examination with Salzburg reading desk before and after the surgery, to confirm the excellent functional results of the treatment. Despite the fact that simultaneous same day IOL implantation in both eyes, especially in eyes with previously operated corneas, is still disputable, the above case confirms that with modern equipment, precise multi formula calculation, and ample experience help achieve excellent functional and refractive results.

Comparative Accuracy of Barrett Integrated Keratometry Toric Calculator With Predicted Versus Measured Posterior Corneal Astigmatism.

To compare the prediction accuracy of the Barrett toric calculator using standard or integrated keratometry (IK) mode in combination with predicted or measured posterior corneal astigmatism (PCA) in a group of patients with cataract implanted with non-toric IOLs. In this retrospective clinical cohort study, the medical records of patients with age-related cataract who underwent phacoemulsification with the implantation of an aspheric monofocal IOL were reviewed. Four methods, including standard keratometry with predicted PCA (PPCA), IK combined with predicted PCA (IK-PPCA), and IK combined with measured PCA derived from IOLMaster 700 (Carl Zeiss Meditec AG) or CASIA2 (Tomey) (IK-MMPCA or IK-CMPCA), were applied to the Barrett toric calculator to calculate the predicted residual astigmatism. The mean absolute prediction error (MAPE), centroid of the prediction error, and proportion of eyes within the prediction error of ±0.50, ±0.75, and ±1.00 diopters (D) were all ciphered out from the four methods, respectively. Data from 129 eyes of 129 patients were included in this study. The MAPE of the IK-PPCA method (0.57 ± 0.36 D) was significantly smaller than that of the PPCA (0.62 ± 0.38 D) and IK-CMPCA (0.63 ± 0.46 D) methods (P = .048 and .014, respectively). There were no significant differences in the centroid vectors of prediction errors and predictability rates among the four methods (all P > .05). In the current version of the Barrett toric calculator, the predictive accuracy of the IK mode incorporating PPCA was slightly superior to using the standard keratometry mode or incorporating MPCA. [J Refract Surg. 2024;40(7):e453-e459.].

Clinical Outcome of Manual Small-incision Cataract Surgery in Patients with Phacolytic Glaucoma

Abstract Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. Materials and Methods: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was &lt;30 mm Hg in 11 (22%), 30-40 mm in 17 (34%), 40-50 mm in 14 (28%) and &gt;50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was &gt;6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and &lt;6/18 in 15 patients (30%). Among the 15 patients with vision &lt;6/18, 14 had low vision due to aphakia, and 1 had cystoid macular edema which was treated with systemic and oral steroids and topical non-steroidal anti-inflammatory agents. Conclusion: We concluded that lens-induced glaucoma is a cause of preventable blindness, particularly in elderly patients. Factors such as ignorance, socioeconomic challenges, lack of awareness, absence of an escort, and good vision in the other eye contribute to delayed presentation. Early diagnosis and treatment, along with sequential cataract surgery, are crucial for achieving better visual outcomes and preventing complications like lens-induced glaucoma.