Intraocular Lens Implantation Research Articles

Extended Depth-of-Focus Intraocular Lens Implantation in Patients with Age-Related Macular Degeneration: A Pilot Study.

To assess visual outcomes of the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in patients with age-related macular degeneration (AMD). Ophthalmology practice, Sydney, Australia. Retrospective chart review. Patients with AMD undergoing cataract surgery and receiving non-diffractive EDOF AcrySof IQ Vivity IOL implantation over a 2-year period were identified. Corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA; 50 cm), contrast sensitivity, central foveal thickness, VF-14 questionnaire results, and quality of life where available were analyzed. A total of 28 sequential patients (51 eyes) were included in this pilot study (46% male, mean age 77.4 years). Of 27 eyes that had late AMD, 17 (63%) had wet AMD. Mean patient preoperative CDVA was logMAR 0.32±0.29. Postoperative monocular CDVA and DCNVA were logMAR 0.20±0.25 and N9±5 (range N5-N36), respectively. Eyes achieving postoperative CDVA of Snellen 6/5-6/12 (n=42, 82%), 6/15-6/24 (n=7, 14%), and greater than 6/24 (n=2, 4%) achieved a mean DCNVA of N8 (range N5-N10), N13 (range N10-N18), and N27 (range N18-N36), respectively. Eyes achieving CDVA of Snellen 6/5-6/12 showed contrast sensitivity within the normal range. On postoperative VF-14 questionnaire, patients with CDVA of Snellen 6/5-6/12 reported minimal visual impairment, while patients with CDVA greater than 6/15 reported mild impairment. A majority of patients (96%, n=27) were satisfied with the improvement in quality of life postoperatively. No intraoperative complications were reported. The EDOF AcrySof IQ Vivity IOL provides improved near vision proportional to distance vision in patients with early AMD.

Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture.

To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation. Tertiary eyecare hospital in India. Retrospective interventional noncomparative study. Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded. 64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis). Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.

3D monitoring of the microphase separations inside the intraocular lens

Glistenings often occur after implanting the intraocular lens (IOL) due to the formation of numerous microvacuoles (MVs) and may lead to deterioration of vision quality. Previous studies showed the formation of MVs was associated with the hydrophobicity of IOL materials. Yet, the mechanism remains an open question due to the complexity of IOL polymer networks. In this study, two commercialized IOLs with similar hydrophobicity are found distinct in the formation of MVs. The 3D growth kinetics of MVs during cooling processes are captured for the first time by digital holographic microscopy (DHM) and the components of MVs are measured by DHM and Raman spectroscopy. The results reveal that the growth of MVs stems from the microphase separation of water and surrounding IOL polymers. A polymer swelling model is thus proposed to describe the microphase separation process which is found dependent on the elasticity of IOL polymer networks. The total volume of MVs is determined by the IOL hydrophobicity, while the elastic force of IOL polymer networks determines the number density and size of MVs. This study demonstrates an approach for characterizing the phase separation of crosslinked polymeric materials in biosystems and sheds lights on the refinement of IOL materials. Statement of significanceGlistenings due to the formation of numerous microvacuoles (MVs) in intraocular lens (IOL) can occur after IOL implantation, which may induce poor quality of vision. However, the underlying mechanism of MVs formation is still an open question. This study establishes an in-situ 3D imaging platform to monitor growth kinetics of the MVs in IOLs, which allows to uncover the mechanism of glistenings formation resulting from the microphase separation. The findings imply the material hydrophobicity influences the total volume of MVs, while the local elasticity of IOL polymer networks determines the number density and the size of MVs. This study offers a new approach for characterizing phase separation in crosslinking biosystems and sheds lights on the refinement of IOL materials.

Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Clinical performance after implantation of an EDOF intraocular lens in the dominant eye and a presbyopia-correcting intraocular lens in the nondominant eye.

To evaluate subjective and objective outcomes after combined implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). 2 clinical practices (Carolina Eyecare Physicians, Center For Sight) in the United States. Prospective, unmasked, multicenter, nonrandomized bilateral eye study. Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the nondominant eye. Refractive and visual acuity (VA) data at various distances (4 m, 66 cm, 40 cm, and 33 cm) were collected 3 months postsurgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. Data from 37 participants were analyzed. The distance-corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 to -2.50 diopters (D). 36 participants (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. 70% of participants (26/37) reported never wearing spectacles at any distance, and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of participants. This combined EDOF/CT-IOL approach was well-tolerated by participants and provided some potential benefits relative to bilateral implantation of either lens.

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review.

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.

Long-Term Refractive Outcomes and Visual Quality of Multifocal Intraocular Lenses Implantation in High Myopic Patients: A Multimodal Evaluation.

To perform a multimodal assessment of refractive outcomes and quality of vision (QoV) in patients with high myopia submitted to multifocal intraocular lens (IOL) implantation. Retrospective study that included consecutive eyes with high myopia (axial length [AL] >26.00mm) submitted to multifocal IOL implantation between January 2014 and February 2020. Minimum follow-up time was 3 years. QoV was evaluated with the Objective Scatter Index (OSI) and the Modular Transfer Function (MTF) by HD Analyzer®. Two QoV questionnaires were applied to patients in which both eyes were included: the McAlinden and the Catquest-9 SF. We included 50 eyes (28 patients). The mean follow-up time was 5.4±1.0 years. Comparing to month 1 after surgery, at the last follow-up visit, there was a decrease in the uncorrected visual acuity (0.14±0.13 vs 0.08±0.09 LogMAR, p=0.024), a negative increase in the spherical equivalent (-0.31±0.60 vs -0.02±0.20, p=0.006) and no changes in the best-corrected visual acuity (p>0.999). An uncorrected near visual acuity of at least J2 was achieved in 89% of eyes one month after surgery and in 91% of eyes at the last follow-up visit (p=0.829). At the last follow-up, the mean OSI was 5.1±1.8 and the mean MTF was 17.5±10.6. Some degree of near vision difficulty was reported by 91% of patients, and 74% of patients reported photic phenomena (halos, glare, starbursts). However, most patients reported that these symptoms caused none to little bothersome. At the last follow-up, 87% of patients were at least fairly satisfied with the surgery. Even after a mean follow-up time of 5 years, patients maintained good uncorrected visual acuity. Even though most patients experienced some degree of near vision difficulty and visual symptoms, globally, our patients were satisfied with their current vision, and the experienced symptoms did not have a significant impact on their daily lives.

Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle.

To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques. Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. Prospective, randomized, comparative trial. For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). 90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales. All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.

Bilateral Femtosecond Laser-Assisted Clear Lens Extraction with Trifocal Intraocular Lens Implantation for Presbyopia Correction: A Short-Term Observational Study in Chinese Adults.

To observe the outcome of bilateral femtosecond laser-assisted clear lens extraction with trifocal intraocular lens (IOL) implantation for presbyopia correction and evaluate its feasibility in early presbyopic adults. Prospective case series of eyes with clear crystalline lenses that underwent femtosecond laser-assisted lens extraction and trifocal IOL (Acrysof IQ PanOptix, Model TFNT00, Alcon) implantation between 2021 and 2023 were followed up for at least 3 months after surgery. Outcome measures included monocular uncorrected visual acuity at near (UNVA, 40 cm), intermediate (UIVA, 60 cm), and distance (UDVA, 5 m), monocular manifest refraction, corrected distance visual acuity (CDVA), defocus curve assessment, and spectacle independence at both near and distance. A total of 60 eyes from 30 consecutive patients were included, and their mean age was 50.4±6.5 years. After surgery, the mean UNVA (LogMAR) increased from 0.28±0.16 to 0.08±0.07, UIVA increased from 0.25±0.12 to 0.09±0.06, and UDVA increased from 0.27±0.21 to 0.01±0.08. The enhancements of UNVA, UIVA and UDVA were all significant (P < 0.05). The optometric results showed that the mean postoperative spherical equivalent (SE) was -0.21±0.24 D, and the mean postoperative CDVA (LogMAR) was -0.00±0.06. The preoperative spectacle independences at near and distance were 46.7% (14/30) and 56.7% (17/30), respectively, and both increased to 100% at 3 months after surgery. Satisfactory visual outcomes and safe surgical procedures were observed in this study, which demonstrate that bilateral femtosecond laser-assisted clear lens extraction with PanOptix IOL implantation could be a feasible approach for presbyopia correction in working-age Chinese patients.

Effect of Capsule Thickness and Material Properties on the Central Optical Power of Natural Human Lens

Background: A thin membrane capsule covers the eye lens and links the lens and the applied forces by the ciliary muscles. The capsule converts the tension of the concentrated zonules to distributed surface tractions over the cortex surface during the lens accommodation. The gradual changes of the capsule geometry and material properties with age and its important role in the design of intraocular lens implants were the motivation of extensive researches on describing the capsule biomechanical behavior. Aim: The present work aimed to study the lens accommodation response to different capsule thicknesses and material properties at different ages. Materials and Methods: A material and geometry parametric study was performed, drawing some guidelines on the choice of lens capsule thickness and biaxial/uniaxial material parameters and exploring the response sensitivity of the finite element model at different age groups Results: The 16-, 35- and 48-year-old lenses were considered for lens accommodation simulation. The sensitivity of lens accommodation was studied at each age group by considering constant thickness (cnst-t) and variable thickness (var-t) capsules and biaxial (Biax) and uniaxial (Uniax) material characteristics tests. The lens was stretched through zonules, and corresponding absolute changes in central optical power (COP) were measured. Conclusion: After the stretch, the lens anterior and posterior curvatures increased, producing a change in COP. The Biax models underestimated the ΔCOP compared to the Uniax models. The 16-year lens model was more sensitive to material properties than thickness variation, while thickness variation was more relevant to the ΔCOP of the 35-year lens model. The 48-year model had the least sensitivity to capsule thickness and material property variations.

Intraocular lens tilt and decentration in secondary ciliary sulcus implantation in paediatric eyes: A 3-year prospective study.

The purpose of this study was to compare the tilt and decentration of one-piece anti-vaulting haptic intraocular lenses (IOL) and three-piece C-loop haptic IOLs in paediatric eyes undergoing secondary IOL implantation into the ciliary sulcus. Paediatric aphakic patients receiving either one-piece anti-vaulting haptic or three-piece C-loop haptic IOL implants into the ciliary sulcus were enrolled in this prospective non-randomized interventional study and followed up for 3 years. IOL decentration and tilt were measured using Scheimpflug images. Preoperative and postoperative information, including demographic data and ocular biometric parameters and complications, were collected and analysed. Among 123 eyes of 79 paediatric patients, there were 72 eyes (58.54%) in the anti-vaulting haptic IOL group and 51 eyes (41.46%) in the C-loop haptic group. The anti-vaulting haptic IOL group had a lower incidence of clinically significant vertical IOL decentration than the C-loop haptic IOL group (23.88% vs. 43.14%, p = 0.037). No intergroup differences were observed in vertical or horizontal tilt or in horizontal decentration (all p > 0.05). One-piece anti-vaulting haptic IOL implantation was associated with a lower risk of clinically significant vertical decentration than three-piece C-loop haptic IOL implantation (odds ratio: 0.42, p = 0.037). There was a higher incidence of IOL dislocation in the C-loop haptic IOL group (15.22% vs. 4.17%, p = 0.046). In paediatric aphakic eyes undergoing secondary IOL implantation into the ciliary sulcus, one-piece anti-vaulting haptic IOLs can reduce the risk of clinically significant vertical IOL decentration compared with three-piece C-loop haptic IOLs and may favour long-term IOL positional stability.

Pars Plana Vitrectomy in the Treatment of Rhegmatogenous Retinal Detachment.

The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD). The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results. In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8. In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.

Change in Corneal Astigmatism After Phacoemulsification with Rigid Intraocular Lens Implantation

Phacoemulsification with lens implant is the preferred method of cataract extraction nowadays. In resource-deficient settings, rigid polymethyl methacrylate (PMMA) lenses are implanted which require enlargement of corneal incision to 5.5mm. Objectives: We conducted this study to evaluate the effect of corneal incisions secured with a single suture on corneal astigmatism after routine cataract surgery. Methods: It was a quasi-experimental study conducted at tertiary care hospitals. Sixty patients were studied and preoperative visual acuity and keratometry readings were noted. After standard phacoemulsification, a 5.5mm rigid PMMA lens was implanted in the bag, and the corneal incision was sutured using a single central 10/0 nylon suture. Visual acuity and keratometry readings were noted on 1st postoperative day, 1-week postoperatively, and 6-weeks postoperatively and compared with pre-operative values. Results: The mean age was 59.27 ± 10.72 (range: 46 – 78) years. There were 32 (53.3%) males and 28(46.7%) females in the study. The mean preoperative keratometry reading was 0.89 ± 0.70 D, and the mean first-day postoperative cylinder was 1.94 ± 0.98 D (p &lt; 0.05). The mean astigmatism at the 6th week postoperatively was 0.96 ± 0.65 D, and its comparison with the pre-operative astigmatism was statistically not significant (p &gt; 0.05). Surgically induced astigmatism was found to be 0.07 diopters. Almost 60% of the patients achieved uncorrected 6/7.5 or better visual acuity, and more than one-third of patients achieved 6/6 best corrected visual acuity six weeks after the cataract surgery using the described technique. Conclusions: Phacoemulsification with 5.5mm PMMA IOL with a central single suture is an effective procedure for postoperative astigmatism and visual outcome.

Seven-Year clinical outcomes after implantation of Eyecryl posterior chamber phakic intraocular lenses for high myopia.

To evaluate the long-term clinical outcomes, safety and efficacy of Eyecryl posterior-chamber phakic intraocular lens implantation (pIOL) implantation in patients with high myopia. Patients with myopia between -6.00 and -20.00 dioptres and with endothelial cell density (ECD) was ≥2300 cells/mm2 were included. Preoperative and postoperative first, fourth, and seventh years of refraction, uncorrected/corrected distance visual acuity (UDVA/CDVA), ECD, central vault were detected. Thirty-six eyes were analyzed. The mean UDVA and CDVA in postoperative seventh years were 0.25 ± 0.31 and 0.13 ± 0.24 logMAR, respectively. The safety and efficacy indices were 1.55 ± 0.54 and 1.24 ± 0.53, respectively. The mean cumulative ECD loss was 6.96% (p < 0.001). The central vault at the 1st and the 7th year were 0.52 ± 0.14 and 0.49 ± 0.14 mm, respectively (p = 0.25). These findings supported the long-term stability, efficacy, safety of the Eyecryl pIOL for high myopia. Eyecryl posterior chamber pIOL is one of the effective refractive options in correcting high myopia.

Trifocal versus monofocal intraocular lens implantation in eyes previously treated with laser in situ keratomileusis (LASIK) for myopia.

To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL. Retrospective comparative cases series. This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal). A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost ≥1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group. Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.

ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

Screening of positive dysphotopsia before multifocal intraocular lens implantation.

To assess the photic phenomena (PP) and positive dysphotopsia in candidates for presbyopia or cataract surgery and to evaluate their relationship with cataract grading systems. Retrospective observational. Monocular data for 82 subjects measured during the preoperative screening were retrospectively retrieved from our database. The evaluated variables consisted of two methods for PP measurement: light distortion index (LDI) and parameters obtained from a simulator, both of which were combined with subjective bother related to PP. The cutoff for LDI that better predicted patients passing from slightly to moderately bothersome was estimated. The relationships between LDI and the following objective cataract grading methods were also assessed: objective scatter index (OSI), dysfunctional lens index (DLI), and Pentacam Nucleus Staging (PNS). LDI was the best method for measuring PP, which showed a significant correlation with the bothersome question (rho = 0.34, P = 0.002) and also with OSI (rho = 0.67, P < 0.0005), DLI (rho = -0.29, P = 0.007), and PNS (rho = 0.48, P < 0.0005). The number/percentage of patients who found it bothersome was as follows: "Not at all" (18/22%), "Slightly" (41/50%), "Moderately" (15/18.3%), and "Very" (8/9.7%). The cutoff value that predicted the transition from slightly to moderately bothersome was ≥15.20% according to LDI, which could be estimated with the following values for grading: ≥2.8 for OSI, ≤7.6 for DLI, and ≥2 for PNS. Patients reporting moderately or higher bothersome levels in the preoperative period and with LDI <15.20%, <2.8 for OSI, >7.6 for DLI, and <2 for PNS might deserve special attention in the multifocal intraocular lens selection.

A meta-analysis of sutureless scleral-fixated intraocular lens versus retropupillary iris claw intraocular lens for the management of aphakia

This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient’s conditions.

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

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

How to choose the intraocular lens power calculation formulas in eyes with extremely long axial length? A systematic review and meta-analysis.

To evaluate the accuracy of 10 formulas for calculating intraocular lens (IOL) power in cataract eye with an axial length (AL) of more than 28.0 mm. We searched scientific databases including PubMed, EMBASE, Web of Science and Cochrane Library for research published over the past 5 years, up to Sept 2023. The inclusion criteria were case series studies that compared different formulas (Barrett II, EVO, Kane, Hill-RBF, Haigis, Hoffer Q, Holladay 1, SRK/T, Holladay 1 w-k and SRK/T w-k), in patients with extremely long AL undergoing uncomplicated cataract surgery with IOL implantation. The mean difference (MD) of mean absolute error (MAE) and the odds ratio (OR) of both the percentage of eyes within ±0.50D of prediction error (PPE±0.50D) and the percentage of eyes within ±1.00D of prediction error (PPE±1.00D) among different formulas were pooled using meta-analysis. A total of 11 studies, involving 1376 eyes, were included to evaluate the 10 formulas mentioned above. Among these formulas, Barrett II, EVO, Kane, and Hill-RBF demonstrated significantly lower MAE values compared to SRK/T. Furthermore, Kane and Hill-RBF had lower MAE values than EVO. Additionally, Barrett II and Kane yielded significantly lower MAE values than Haigis while Hill-RBF showed significantly lower MAE values than Holladay 1. Moreover, Hill-RBF showed the highest values for both PPE±0.50D and PPE±1.00D, followed by Kane. Both EVO and Kane had higher values of PPE±0.50D and PPE±1.00D compared to Haigis and SRK/T. The Wang-Koch adjusted formulas and new-generation formulas have shown potential for higher accuracy in predicting IOL power for cataract patients with extremely long AL compared to traditional formulas. Based on the current limited clinical studies, Hill-RBF and Kane formulas seem to be a better choice for eyes with extremely long AL.