Intraocular Lens Implantation Research Articles

Effect of direct oral anticoagulants on bleeding during and after cataract surgery

PurposeTo assess the risk for intraoperative and postoperative ocular bleeding associated with direct oral anticoagulant treatment in patients undergoing phacoemulsification surgery.MethodsConsecutive patients had phacoemulsification and intraocular lens implantation while taking uninterrupted direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban). Gender and age-matched patients without antithrombotic therapy were used as the control group. Patients were examined one week postoperatively. Intraoperative and postoperative hemorrhagic and non-hemorrhagic complications were assessed.ResultsForty patients (56 eyes) on direct oral anticoagulants and 120 patients (172 eyes) without anticoagulation, at a mean age of 77 years, had phacoemulsification. There was no significant difference between the groups in the rate of intraoperative and postoperative bleeding. One eye (1.8%) in the treatment group and 3 eyes (1.7%) in the control group had hyphema (p = 0.72). No patient had thromboembolic event during or after surgery.ConclusionsCataract surgery was safely performed while continuing direct oral anticoagulation.

Accuracy of intraocular lens formulas in combined phacovitrectomy.

To assess the refractive accuracy of eight intraocular lens (IOL) formulas in eyes that underwent combined phacovitrectomy. A retrospective chart review of 59 eyes that underwent uncomplicated phacovitrectomy between 2017 and 2020 at the Johns Hopkins Wilmer Eye Institute. Inclusion criteria were postoperative best corrected visual acuity of 20/40 or better within 6months of surgery and IOL implantation in the capsular bag. The Barrett Universal II (BUII), Emmetropia Verifying Optical (EVOv2.0), Hill-Radial Basis Function (Hill-RBFv3.0), Hoffer Q, Holladay I, Kane, Ladas Super Formula (LSF), and SRK/T formulas were compared for accuracy in predicting postoperative spherical equivalents (SE) using Wilcoxon rank sum tests. Pearson's correlation coefficients were used to assess correlations between biometric parameters and errors for all formulas. Prediction errors of SE ranged from -1.69 to 1.43 diopters (D), mean absolute errors (MAE) ranged from 0.39 to 0.47 D, and median absolute errors (MedAE) ranged from 0.23 to 0.37 D among all formulas. The BUII had the lowest mean error (-0.043), MAE (0.39) and MedAE (0.23). The BUII also had the highest percentage of eyes with predicted error within ± 0.25 D (51%) and ± 0.50 D (83%). Based on MedAE however, no pairwise comparisons resulted in statistically significant differences. Axial length (AL) was positively correlated with the error from the Hoffer Q and Holladay I formulas (correlation coefficients = 0.34, 0.30, p values < 0.01, 0.02 respectively). While all eight IOL formulas had comparable accuracy in predicting refractive outcomes in eyes undergoing combined phacovitrectomy, the BUII and Kane formulas had a tendency to greater accuracy.

Comparative Proteomic Analysis of Aqueous Humor Reveals Biochemical Disparities in the Eyes of High Myopic Patients.

Myopia accounts for a significant proportion of visual lesions worldwide and has the potential to progress toward pathological myopia. This study aims to reveal the difference in protein content in aqueous humor between high myopic and nonhigh myopic patients, as well as better understand the dysregulation of proteins in myopic eyes. Aqueous humor was collected for liquid chromatograph mass spectrometer (LC/MS) analysis from 30 individual eyes that underwent phacoemulsification and intraocular lens (IOL) implantation. Results showed that a total of 190 differentially expressed proteins were identified, which revealed their involvement in cell metabolism, immune and inflammatory response, and system and anatomical structure. Further analysis focused on 15 intensively interacted hub proteins, encompassing functions related to complement cascades, lipoprotein metabolism, and fibrin biological function. Subsequent validations demonstrated elevated levels of APOE (apolipoprotein E), C3 (complement 3), and AHSG (α-2-HS-glycoprotein) in the high myopia group (31 eyes of cataracts and 45 eyes of high myopia with cataracts). AHSG had a significant positive correlation with axial length in high myopic patients, with good efficacy in distinguishing between myopic and nonmyopic groups. AHSG may be a potential indicator of the pathological severity and participator in the pathological progress of high myopia. This study depicted differential expression characteristics of aqueous humor in patients with high myopia and provided optional information for further experimental research on exploring the molecular mechanisms and potential therapeutic targets for high myopia. Data are available via ProteomeXchange with the identifier PXD047584.

Comparative Analysis of Iris Claw Anterior Chamber Fixation Versus Suture less Intrascleral Intraocular Lens Implantation in the Management of Aphakia

Purpose: To determine the efficacy of iris claw anterior chamber fixation versus suture less intrascleral intraocular lens implantation in terms of visual recovery and complications during and after surgery. Method: The present prospective observational study was conducted in the Postgraduate Department of Ophthalmology at SMHS Hospital, Govt. Medical College, Srinagar over a period of one and half year. Results: A total of 30 patients were studied and divided equally into two groups with patients age ranging between 19-70 years with mean age of 49.5+17.41 years in iris claw anterior chamber IOL group and in suture less intrascleral fixated IOL group with age ranging between 24-70 years with a mean age of 51.9+15.94 years. Primary fixation of IOL was implanted in 8 (26.7%) patients, out of which 5 (33.3%) underwent iris claw anterior chamber IOL fixation and 3 (20%) patients underwent suture less intrascleral fixated IOL while the remaining 22 (73.3%) underwent secondary IOL.Mean preoperative BCVA improved from log MAR 0.78+0.251 in iris claw anterior chamber IOL to log MAR 0.85±0.241 in suture less intrascleral fixated IOL to log MAR {0.23±0.206 &amp; 0.18±0.191} in two study groups respectively. Eyes with iris claw IOLexperienced pigment precipates (73.3%) followed by ovalisation of pupil (26.7%) while as intraocular pressure (33.3%) followed by corneal edema (13.3%) and transient hypotony (6.7%) were seen in suture less intrascleral fixation of IOL. Conclusion: It was concluded that both irises claw anterior chamber IOL fixation and suture less SFIOL using flange are viable options for surgical correction of aphakia.

Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study

PurposeTo compare the rotational stability of a monofocal and a diffractive multifocal toric intraocular lens(IOLs) with identical design and material.MethodsThis prospective study enrolled patients who underwent plate-haptic toric IOL (AT TORBI 709 M and AT LISA 909 M) implantation. Propensity score matching (PSM) was performed to balance baseline factors. Follow-up examinations were conducted at 1 h, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was used to investigate the changes in IOL rotation over time. A 2-week timeframe was utilized to assess differences in IOL rotation between the two groups.ResultAfter PSM, a total of 126 eyes were selected from each group for further analysis. Postoperatively, the time course of IOL rotation change in the two groups remained consistent, with the greatest rotation occurring between 1 h and 1 day postoperatively. At the 2-week postoperative mark, the monofocal toric IOL exhibited a higher degree of rotation compared to the multifocal toric IOL (5.40 ± 7.77° vs. 3.53 ± 3.54°, P = 0.015). In lens thickness(LT) ≥ 4.5 mm and white-to-white distance(WTW) ≥ 11.6 mm subgroups, the monofocal toric IOL rotated greater than the multifocal toric IOL (P = 0.026 and P = 0.011, respectively).ConclusionThe diffractive multifocal toric IOL exhibits superior rotational stability compared to the monofocal toric IOL, especially in subgroups LT ≥ 4.5 mm and WTW ≥ 11.6 mm. Moreover, the time course of IOL rotation change is consistent for both, with the maximum rotation occurring between 1 h and 1 day postoperatively.

Clinical outcomes and rotational stability after implantation of a monofocal toric intraocular lens with textured haptics in normal vs high axial lengths.

To compare the clinical outcomes and rotational stability after implantation of a toric intraocular lens (IOL) with textured haptics in eyes with normal vs high axial lengths (ALs). Nethradhama Superspeciality Eye Hospital, Bangalore, India. 2-arm, retrospective comparative study. This retrospective study included 114 eyes of 114 patients who underwent femtolaser cataract surgery followed by implantation of the HOYA Vivinex Toric monofocal IOL (Model XY1A-SP), of which 62 and 52 eyes belonged to normal (≤23.9 mm) and high (≥24 mm) AL groups, respectively. 1 week and 3 months postoperatively, clinical outcomes and rotational stability of the toric IOL was evaluated. 3 months postoperatively, % eyes achieving refractive astigmatism accuracy within ≤0.50 diopter, was 100% (n = 62) in the normal vs 94% (n = 49) in the high AL group. All eyes that is, 100% (n = 62) in the normal and 96.15% (n = 50) eyes in the high myopia group were <5 degrees of the intended axis. The mean change in postoperative rotation from 1 week to 3 months was 0.28 ± 0.09 degrees in the normal, and 0.30 ± 1.11 degrees in the high AL group ( P = .80). No significant correlation was observed between AL and white-to-white diameter with 1-week postoperative rotation values. No eye required repositioning of toric IOL for significant misalignment. No significant differences were observed for clinical outcomes and postoperative rotational stability between eyes with normal and high ALs, suggesting excellent rotational stability of the Vivinex Toric IOL with textured haptics in all eyes, irrespective of the preoperative AL measurements.

Clinical outcome in patients with 4- point scleral fixated intraocular lens: Our experience

Visual rehabilitation following cataract surgery with compromised capsular bag includes various options like anterior chamber (ACIOL), fixation to the iris (Iris claw IOL), or fixation to the sclera (SFIOL), as a primary or secondary procedure. We studied the clinical outcome in patients who underwent 4- point fixation of SFIOLs. Retrospective data analysis of fourteen patients who underwent sclera fixated intraocular lens implantation from 2016 to 2018 at our institute under standard operative conditions was done. The postoperative vision by three months ranged from LogMAR 1.0 – 0.2, out of fourteen patients, BCVA in 60 % of the patients ranged from LogMAR 0.3-0.2 which was maintained at six months follow up with minimal complications. 4- point fixation of scleral fixated IOL is a good option with favourable outcome, in aphakics who are not ideal candidates for iris claw lens.

Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies.

Toric intraocular lenses (IOLs) have been developed to enhance visual acuity impaired by cataracts and correct corneal astigmatism. However, residual astigmatism caused by postoperative rotation of the toric IOL is an important factor affecting visual quality after implantation. To decrease the rotation of the toric IOL, significant advancements have been made in understanding the characteristics of toric IOL rotation, the factors influencing its postoperative rotation, as well as the development of various measurement techniques and interventions to address this issue. It has been established that factors such as the patient's preoperative refractive status, biological parameters, surgical techniques, postoperative care, and long-term management significantly impact the rotational stability of the toric IOL. Clinicians should adopt a personalized approach that considers these factors to minimize the risk of toric IOL rotation and ensure optimal outcomes for each patient. This article reviews the influence of various factors on toric IOL rotational stability. It discusses new challenges that may be encountered to reduce and intervene with rotation after toric IOL implantation in the foreseeable future.

THE DIFFERENCE OF PREDICTED REFRACTION AND FINAL REFRACTION USING BARRETT II UNIVERSAL FORMULA AND SRK/T FORMULA IN HIGH MYOPIA PATIENTS AFTER PHACOEMULSIFICATION AND IOL IMPLANTATION AT DR. KARIADI GENERAL HOSPITAL SEMARANG

Introduction and Objective&#x0D; Studies have shown that 38% of refractive errors after intraocular lens (IOL) implantation are caused by deviations in calculation of IOL power using formulas. The difference between the formula’s refractive prediction and patient’s final outcome highly increases in cases of high myopia, but there needs to be more research on this topic. This study aims to show the difference between the predicted and final refractive outcomes using Barrett II Universal (BUII) formula and the SRK/T in patients with high myopia who underwent phacoemulsification and IOL implantation.&#x0D; Method&#x0D; This analytical observational study with cross-sectional design was conducted on patients with high myopia (axial length ? 26.0 mm) who underwent phacoemulsification and intraocular lens implantation between January 2021 and January 2022 at Dr. Kariadi General Hospital Semarang. The data used in this study consisted of biometric measurements and the difference between the predicted refractive outcomes using the BU-II and SRK/T formulas and the final refractive outcomes of patients one month after the surgery. The data were analyzed using a one-sample T-test, and significance level of p &lt; 0.05 was considered statistically significant.&#x0D; Results&#x0D; Thirty-five eyes participated in this study, and the mean axial length was (29.33 2.01). The BU-II formula has a mean difference in the refraction prediction, with the patient's final refraction result being closer to zero (1.191.31) than the SRK/T formula (1.25 1,12). The refractive prediction difference between the two formulas was statistically significant (p &lt; 0.05).&#x0D; Conclusion&#x0D; The BU-II formula has a lower difference between predicted refractive outcomes and final refractive outcomes of high myopia patients after phacoemulsification and IOL implantation than the SRK/T formula.

THE DIFFERENCE OF PREDICTED AND FINAL REFRACTION USING BU-II AND SRK/T FORMULA IN HIGH MYOPIA PATIENT AT DR. KARIADI HOSPITAL

Introduction: Studies showed 38% refractive errors after intraocular lens (IOL) implantation are caused by deviations in calculation of IOL power. The difference between the formula’s refractive prediction and patient’s final outcome highly increases in cases of high myopia, but needs to be more research on this topic. This study aims to show difference between predicted and final refractive outcomes using Barrett II Universal (BU-II) and SRK/T in patients with high myopia who underwent phacoemulsification and IOL implantation. Method: This analytical observational study with cross-sectional design was conducted on high myopia patients (axial length ? 26.0 mm) who underwent phacoemulsification and intraocular lens implantation between January 2021 and January 2022 at Dr. Kariadi General Hospital Semarang. Data used in this study consisted of biometric measurements and difference between predicted refractive outcomes using BU-II and SRK/T formulas and final refractive outcomes of patients one month after surgery. Data were analyzed using one-sample T-test, and significance level of p &lt; 0.05 was considered statistically significant. Results: Thirty-five eyes participated in this study, the mean axial length was (29.33 2.01). BU-II formula has mean difference in refraction prediction with patient's final refraction result closer to zero (1.191.31) than SRK/T formula (1.25 1,12). The difference between two formulas was statistically significant (p &lt; 0.05). Conclusion: The BU-II formula has lower difference between predicted and final refractive outcomes of high myopia patients after phacoemulsification and IOL implantation than SRK/T formula.

Profile of Unilateral Cataract in Pediatric Patients: A 3 Year Retrospective Study

Abstract&#x0D; Introduction &amp; Objectives : Unilateral cataract presents from 19.6% to 55.5% of pediatric cataract in children by many previous reported studies. This condition is treatable, but delayed treatment may cause visual impairment. This study aims to understand characteristic and treatment of unilateral cataract in children.&#x0D; Methods : The study involved a retrospective review of medical records of patients aged 0-17 years with unilateral cataract who presented to Dr. Kariadi Hospital Semarang from 2019 to 2022. Cases of cataract secondary to causes such as trauma or uveitis were excluded.&#x0D; Results : Thirty-five patient was included in this study, 51% of whom were male and 49% female. The mean age at presentation is 60.49  48.23 months and mean age of onset is 36.77  45.94 months. The most common presenting complaint was whitish eye (81%) while others presented with blurred vision. All the patients had leukocoria, 28% have microcornea, 3% have persistent pupillary membrane. Half of patient (51%) have strabismus, with exotropia being the most common type (34.17%). Eight patients had congenital rubella syndrome, one patient had cytomegalovirus infection while others did not have any systemic condition related to cataract. Majority of patient (17%) treated with phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation. Intraocular lens was implanted in 71% patient and 54% patients given spectacles.&#x0D; Conclusion : Unilateral cataract is disease with isolated and sporadic incident. The majority of patients did not have systemic condition related to unilateral cataract. The most common treatment is phacoaspiration, primary posterior capsulotomy, anterior vitrectomy and intraocular lens implantation.

Cataract Progression dan Lens Drop after Pars Plana Vitrectomy and Gas Tamponade : A Case Report

Introduction : Vitreous Hemorrhage (VH) in proliferative diabetic retinopathy (PDR) is common cause of acute vision loss.If the retina cannot be visualized and the etiology of the VH is unknown, pars plana vitrectomy (PPV) is indicated. 1Intraocular gases like SF6 or C3F8 are one of the most useful adjuncts in vitreoretinal surgery. Exposure to intraocular gases additionally increases retrolental oxygen levels, resulting in development of lens opacities.&#x0D; Case Illustration : Patient female 52 y.o, came with sudden blurry vision in the left eye since two weeks ago. History of Diabetes Mellitus 10 years with insulin treatment. From the examination left eye visual acuity 1/60, zonulysis, VH, and negative fundus reflect. On ultrasonography found vitreous opacity. The patient was diagnosed with left eye VH ec advanced PDR and scheduled PPV with C3F8 gas tamponade. Patient difficult to maintain prone position after surgery. 2 month after the surgery the patient scheduled with phacoemulsification surgery because progressive lens opacity. While prepare to the second operation, the lens found drop to the vitreous. The second surgery done with lens evacuation and Intraocular lens implantation. Last follow up, best correction visual acuity was 6/18.&#x0D; Discussion : PPV and Gas tamponade are presdisposing lens opacity progression. Lens opacity after gas tamponade include longer intraocular longevity gas and patients who fail to maintain a prone position. Risk factors for zonulysis in this patient increase the occurrence of lens drop after PPV with gas tamponade.&#x0D; Conclusion : Regular slit-lamp examination needs to be performed for early detection of cataract after PPV with gas tamponade.

Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.&#x0D; Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.&#x0D; Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.&#x0D; Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.

Secondary Piggyback Intraocular Lens for Correcting Refractive Surprise Post Silicone Oil Removal

Introduction : Pseudophakic refractive error can be caused by IOL malposition and inaccurate biometric examination. Treatment consists of IOL exchange, refractive laser correction, and secondary piggyback IOL. Secondary Piggyback IOL consist of customized IOL implantation on ciliary sulcus.&#x0D; Case Illustration : A Male, 62 years old, complains of blurry right eye. He underwent retinal surgery with silicone oil tamponade surgery 5 years ago and underwent silicone oil evacuation, phacoemulsification, and intraocular lens implantation one year later. The visual acuity of the right eye was 1/60 with BCVA of 0.2. He was diagnosed with Pseudophakia of both eyes and Hypermetropia Surprise of the right eye. He was planned to undergo piggyback intraocular lens implantation in the right eye (Figure 1). The visual acuity one week after operation of the patient's right eye was 0.32 (Figure 2).&#x0D; Discussion : Biometric examination in eye with silicon oil tamponade have longer axial length, causing pseudophakic refractive errors. Treatments consist of IOL replacement, refractive laser correction, and piggyback IOL implantation. IOL replacement has a high risk and requires quite high operator skills. Refractive laser correction is performed in small refractive errors. Piggyback IOL implantationis easier, safer, have more accurate IOL power, and reversible.&#x0D; Conclusion : Power of the intraocular lens is influenced by axial length, keratometry reading, lens thickness, and other parameters. Axial length measurement in patients with silicone oil tamponade requires greater accuracy to prevent pseudophakic refractive errors. IOL Piggyback implantation procedure is an alternative in person that can’t undergo laser correction or IOL exchange.

Bilateral Hypocalemic Cataract Post Thyroidectomi : A Case Report

Introduction : Young adult cataracts are negligible, and their prevalence is rarely reported in Indonesia. We reporta rapidly developing cataract in a 25-year-old woman due to secondary hypoparathyroidism. Cataracts in this case, progress remarkably fast compared to primary cataracts.&#x0D; Case Illustration : A twenty-five-year-old female patient presented bilateral vision loss and a history of a total thyroidectomy caused by diffused toxic goiter 7 years before admission. Postoperative calcium levels were extremely depleted. The uncorrected visual acuity examination measured 1/300 in the right eye and 20/200 in the left. Slit lamp examination revealed cortical opacities in both eyes. We diagnosedit as bilateral hypocalcemia cataracts. Patient has undergone bilateral phacoemulsification and intraocular lens implantation. The day following surgery visual acuity in the right eye was 20/30 and the left eye was 20/30 without correction. After one year of evaluation the visual acuity in RE become RE was 20/20 with a correction of -0.50 D sphere and the LE was 20/20 with a correction of -1.0 D sphere.&#x0D; Discussion : Patients with hypoparathyroidism risk developing cataracts due to chronic hypocalcemia, which inhibits the lenticular Na/K pump and induces intracellular sodium flux. This high sodium level triggers the osmosis process, followed by swelling of the lens fibers to form dystrophic calcifications. Thyroid surgery procedures suspectedly involving the parathyroid gland may cause hypocalcemia, thus leading to development of cataract.&#x0D; Conclusion : Clinicians should always consider hypoparathyroidism as the cause of bilateral cataracts in patients with a previous total thyroidectomy.

Blindness Management for Retinitis Pigmentosa with Cataract senile immature : A Case Report

Introduction : Retinitis Pigmentosa (RP), also called pigmentary retinal dystrophy, is the term of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors. The most common complication of RP is cataract. Cataract formation is most likely the result of retinitis pigmentosa-related inflammation response. Cataract is an important secondary cause of visual impairment in RP.&#x0D; Case Illustration : A 39-year old female came to the Hospital with complaint of having blurred vision in both eyes since four years ago. Ophthalmologic examination revealed that visual acuity for her right and left eye was 1/300. Anterior segment examination was revealed lens opacification in right and left eye. Funduscopy examination was revealed bone spicula in right and left eye. Patient was diagnosed with retinitis pigmentosa with cataract senile immature in both eyes. Phacoemulsification with intraocular lens (IOL) implantation were done as surgical management for the right eye.&#x0D; Discussion : RP is one of the leading causes of irreversible blindness. The possible explanation of reduced vision in RP can be photoreceptor cell death and treatable complications of RP. Cataract is the most common anterior segment complication described in RP. Visual acuity in RP could be improved for the complications that receive effective treatment, especially with the improvement of the cataract surgery. However, the visual prognosis and surgical risk following cataract surgery is uncertain, the cataract surgery should still be considered in patients with RP. Phacoemulsification with IOL implantation remains the most preferred method to manage cataracts.&#x0D; Conclusion : Cataract surgery in patients with RP leads to significant improvements in visual acuity

Ab Externo Scleral-Fixated Intraocular Lens As A Management in Aphakic Eye

Introduction : Varied technique of secondary intraocular lens (IOL) implantation are exist. Scleral-fixated IOL implantation become popular both with or without sutures. The one of sutures technique is ab externo&#x0D; Case Illustration : A 68 year old man came with blurry vision on left eye (LE) since one month ago. He had history of primary angle closure suspect and posterior subcapsular cataract on LE and managed with Intracapsular Cataract Extraction in January 2021. Ophthalmology examination of LE revealed uncorrected visual acuity (UCVA) 1/60, irregular updrawn pupil with diameter 7.4mm x 5.3 mm, and aphakic lens. The best corrected visual acuity (BCVA) with S+12.00 C-0.75 x 80 was 0.4f. The patient underwent secondary IOL by using 3 pieces IOL with ab externo scleral- fixated on his left eye (Figure 1). Power IOL determined was +24.00 diopter with target of refraction was emmetropia. One day postoperatively, the UCVA was 0.08 pinhole 0.125 with good centration of scleral fixation IOL. First month postoperatively, BCVA with S-1.75 C-1.00 x 50 was 0.4 on snellen chart.&#x0D; Discussion : Aphakia with inadequate capsular support can be seen in several conditions. Technique of introducing two suture loops for scleral fixation of an IOL by ab externo procedure, which proved safe and effective. Scleral fixation of IOL in the posterior chamber, although technically demanding, allows good visual outcomes.&#x0D; Conclusion : Ab externo scleral-fixated IOL implantation is an effective rescue procedure for eyes with deficient capsular support.

MONOVISION VERSUS MULTIFOCAL INTRAOCULAR LENS IMPLANTATION IN CATARACT PATIENTS:A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: With the aim to increase spectacle independence, recent approaches to repair cataracts include the implantation of premium intraocular lenses (IOLs), such as multifocals. Another approach is monovision techniques achieved by monofocal IOL implantation, which is more cost-effective, although it has the same good outcome as multifocal IOLs. This meta-analysis aimed to compare monovision versus multifocal IOL implantation in cataract patients. Method: Systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacles independence, visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) and The Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Result: Ten studies satisfying the inclusion criteria were included. Pooling analysis for BCVA and BNVA showed no difference between monovision vs multifocal IOL (95% CI at -0,10 to 0,73; I2=79% (p=0,14) and 95% CI at -0,27 to 1,37; I2=94% (p=0,19), respectively). Spectacle independence showed monovision was inferior to multifocal IOL (RR 0,53; 95% CI at 0,34 to 0,82; I² 83% (p=0,004)). Conclusion: Current evidence showed monovision was comparable to multifocal IOL in terms of visual acuity. While multifocal IOL achieved more spectacle-free patients than monovision, many patients in the monovision group also achieved spectacle-free condition. Keywords: cataract, monovision, multifocal intraocular lens, visual acuity, spectacle independence.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis

Abstract&#x0D; Introduction &amp; Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.&#x0D; Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.&#x0D; Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).&#x0D; Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability.

The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8(Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.