Intraocular Lens Displacement Research Articles

Comparison of Safety and Efficacy of Four-Point Scleral Intraocular Lens Fixation and the Yamane Technique.

The purpose of our study was to compare the safety and efficacy of two scleral fixation intraocular lens (IOL) methods of four-point scleral fixation (Akreos AO60) and the Yamane technique (AcrySof MA60AC). This prospective, randomized study was conducted at the Military Institute of Medicine-National Research Institute in Warsaw between 2021 and 2023. We compared both groups for cause of aphakia, ocular history, refractive status, and complication. Our study included 50 eyes from 47 patients. Four-point fixation was performed in 25 eyes (group1), and the Yamane technique was used in 25 eyes (group2). Surgical time was 24.1min ± 8.9 in group1 and 25.1min ± 9.9 in group2 (p > 0.05). The postoperative BCVA (best-corrected visual acuity) for group1 and group2 at 1year's observation was 0.10 ± 0.15 and 0.09 ± 0.17 logMAR, respectively (p > 0.05). Postoperative total refractive error (RE) was - 0.06 ± 0.71 diopters (D) for four-point scleral fixation and 0.83 ± 0.70D for Yamane technique (p < 0.05). Endothelial cell density (ECD) loss was 0.9% in group1 and 3.5% in group2 (p > 0.05). Bleeding into the anterior chamber and vitreous body was more frequent in the group of patients operated on with the use of the Yamane technique (10 cases, 20%, p = 0.01). IOL displacement was found in one case (2%) in group2. Both analyzed techniques are well tolerated and ensure good refractive results (extremely predictable in four-point scleral fixation) and have a similar safety profile. Four-point scleral fixation of IOL would appear to be safe, effective and beneficial for young, active patients, especially after trauma or recurrent subluxation. ClinicalTrials.gov identifier NCT06389643.

Secondary piggyback intraocular lens for posterior microphthalmos

We describe a rare case of posterior microphthalmos (PM) submitted to cataract surgery and highlight the problem of high residual hyperopia in these eyes due to the limited commercial availability of a high-powered intraocular lens (IOL). A 50-year-old highly hyperopic man who pretended refractive surgery presented in our hospital. Pre-operative Snellen best-corrected visual acuity (BCVA) was 20/125 in the right eye with a spherical correction of +17.00 D and 20/40 in the left eye with a spherical correction of +18.75. The anterior segment and fundus exam were typical for PM. Optical axial length was 15.50 mm in the right eye and 15.53 mm in the left eye and anterior segment dimensions were within normal limits. IOL power calculation for emmetropia ranged between +51.5 and +62.5 D using modern IOL formulas. Cataract surgery was performed in a bilateral and sequential manner with the implantation of monofocal foldable acrylic +45.0 D IOL with the improvement of spherical correction to +11.00 D bilaterally. Secondary implantation of supplementary sulcus IOL with the maximum +10.0 D power was then performed bilaterally and sequentially with a final BCVA of 20/125 in the right eye with spherical correction of +5.75 D and 20/40 in the left eye with spherical correction of +5.25 D. Piggyback IOL implantation is beneficial and, in most times, necessary in PM since one IOL will not be sufficient to achieve emmetropia. Different piggyback strategies in regard to timing (primary vs. secondary) and chosen IOLs (in-the-bag, sulcus, and iris-claw) can be used.

Оценка смещений интраокулярной линзы по данным ультразвуковой биомикроскопии

Purpose. To analyze the postoperative IOL displacements toward the haptic plane using ultrasound biomicroscopy (UBM). Material and methods. Biometry data of 172 patients (211 eyes) 71.32 ± 7.75 years old were analyzed, among whom 41.25% were men. IOL position were analyzed at 1 and 3 months after standard phacoemulsification. Results. The IOL was visualized with UBM. Stabilization of lens position was observed by the 3rd month of observation. The displacement of optical part IOL in forward was determined in 24.95%, backward – in 16.57% of cases. Eyes with opposite IOL displacements differed significantly in crystalline lens diameter, ciliary sulcus diameter and the power of implanted IOL. Conclusions. An important technique in the search for possible causes of changes in postoperative refraction is visualization of IOL displacement. The number of displacements of the intraocular lens increases by 3 months, which may cause in visual acuity changes. Keywords: Intraocular lens (IOL) optical part displacement, ultrasound biomicroscopy (UBM), phacoemulsification

Comparison of a Presbyopia-Correcting Supplementary Intraocular Lens Combination and a Capsular-Bag Lens: An In Vitro Study

We evaluated the optical quality of two approaches to trifocality: polypseudophakia versus monopseudophakia. The combination (polypseudophakia) of a monofocal Basis Z B1AWY0 and AddOn Trifocal A4DW0M intraocular lens (IOL) was compared to using one Basis Z Trifocal B1EWYN IOL, all from 1stQ GmbH. In both approaches, we measured modulation transfer function (MTF) and Strehl Ratio (SR) values at 3.0 and 4.5 mm pupil sizes. We determined the through-focus (TF) MTF at 25, 50 and 100 lp/mm for the 3 mm aperture. United States Air Force (USAF) target images were recorded. MTF measurement of the trifocal lens and the combined monofocal and trifocal AddOn IOL showed good performance at the far and near focus for the 3 mm aperture. For the 4.5 mm aperture the MTF improved for the far focus but decreased for the intermediate and near focus. TF MTF showed better contrast at the far focus for the polypseudophakic setup but at the expense of the efficiency at the near focus. However, the USAF chart images revealed only minimal differences between both approaches. The optical quality of the polypseudophakic approach was not affected by the presence of two IOLs instead of one and proved to be comparable with the performance of one capsular-bag-fixated trifocal IOL. Differences between the single vs. two-lens approach seen in the TF MTF analysis could be attributed to the optical design that varied between the trifocal models.

Ultrabiomicroscopía ultrasónica y estabilidad de la lente intraocular en pacientes con miopía axial sometidos a cirugía de facoemulsificación.

To evaluate the stability and the refractive error of the different intraocular lens (IOL) after cataract surgery. Retrospective, observational and single-center study. Patients diagnosed with cataract and myopia who underwent a phacoemulsification surgery with intraocular lens placement without complications were included. All patients underwent a complete ophthalmological examination, ultrasound biomicroscopy was performed at 2 weeks, 1 and 3 months after surgery. Descriptive statistics were performed using measures of central tendency and comparative analyzes. A value of p < 0.05 was considered significant. Thirty-one subjects with a diagnosis of axial myopia and senile cataract were included, 20 women (64.5%) and 11 men (35.5%), with a mean age was 62.8 ± 13.14 years. The IOL displacement were not different for the upper, lower, temporal and nasal quadrants; however, we observed a tendency to inclination to the temporal sector (p = 0.054) between the first and third postoperative month. Therefore, the were no significant differences in spherical equivalent between groups postoperatively. The inclination of the IOL did not change over time after surgery, the changes were similar with the different three types of IOL.

Analysis of intraocular lens displacement relative to the haptic plane by ultrasound biomicroscopy data

This study analyzed cases with postoperative displacement of intraocular lens (IOL) relative to the haptic plane using ultrasound biomicroscopy (UBM). The study analyzed biometry data of 231 patients (277 eyes) aged 72.39±7.77 years, among them 43.25% were males. IOL position and refraction were analyzed at 1, 3 and 6 months after standard phacoemulsification. UBM was performed to analyze the position of the IOL. Stabilization of lens position was observed by the 3rd month of observation. Among the cases with displacement of the optical part relative to the haptic plane, the forward shift was determined in 24.85%, backward - in 16.67% of cases. Eyes with opposite IOL displacements differed significantly in lens diameter, ciliary sulcus diameter and the power of implanted IOL. IOL shift towards the retina produced significant hyperopic refractive error. A discriminant function was compiled using preoperative biometry data comprising the model for predicting backward IOL displacement with high probability. However, we failed to obtain a qualitative model for forward IOL displacements. Calculation error in modern formulas could occur because of IOL displacement, including the shift of the optical part relative to the haptic plane in postoperative period. Analysis of biometry data allows calculating IOL displacement towards the retina with a high probability, which could help avoid hyperopic refraction error postoperatively.

Clinical Outcomes in Patients After Duet Procedure for Reversible Trifocality Using a Supplementary Trifocal Intraocular Lens

We report the clinical outcomes of patients who had primary lens implantation in the capsular bag and subsequently a supplementary trifocal lens implanted in the ciliary sulcus (duet procedure) to create reversible trifocality. Retrospective interventional case series. This single-center clinical study included 25 patients who had undergone either refractive lens exchange for presbyopia correction or cataract surgery. All had lens removal by phacoemulsification and duet procedure to achieve reversible trifocality. Preoperatively and 3 months postoperatively, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were assessed, as well as uncorrected near visual acuity (UNVA), distance corrected near visual acuity (DCNVA), and corrected near visual acuity (CNVA). At the postoperative examination, uncorrected intermediate visual acuity (UIVA), distance corrected intermediate visual acuity (DCIVA), and corrected intermediate visual acuity (CIVA), defocus curve testing, and dysphotopsia evaluation were also performed. Monocular UDVA and CDVA improved from 0.71 ± 0.43 logarithm of the minimum angle of resolution (logMAR) and 0.12 ± 0.16 logMAR preoperatively to 0.04 ± 0.10 logMAR and -0.01 ± 0.09 logMAR postoperatively. Monocular UNVA and DCNVA were both 0.06 ± 0.08 logMAR and UIVA and DCIVA 0.00 ± 0.10 logMAR and -0.02 ± 0.10 logMAR postoperatively. Monocular defocus curve testing revealed a visual acuity of 0.2 logMAR or better from +0.75 to -3.5 diopters. Duet procedure using a trifocal supplementary intraocular lens provided excellent results for far, near, and intermediate distance, comparable to those reported for capsular bag fixated trifocal intraocular lenses. The duet procedure offers the advantage of an exit strategy in cases with a future loss of function or side effects associated with the optics.

Efficacy of Large Optic Intraocular Lenses in Myopic Eyes with Posterior Segment Pathology.

We report a case series of patients with high myopia (axial length 25.04–27.59 mm) diagnosed with cataract and maculopathy who underwent a combined procedure of phacoemulsification with implantation of a large optic intraocular lens (IOL) and intravitreal injection. Six patients with a mean (± standard deviation) age of 73.20 ± 7.19 years received the 7.0-mm optic ASPIRA-aXA IOL (HumanOptics AG, Erlangen, Germany) and intravitreal injection of aflibercept at the end of the surgery. The corrected distance visual acuity (CDVA) improved significantly (p = 0.001) from a preoperative logMAR of 0.87 ± 0.28 logMAR to 0.49 ± 0.18 logMAR at 10 weeks postoperatively. Even though all patients had a persisting central scotoma due to their maculopathy, there was a significant improvement in their subjective quality of life and self-autonomy. Patients reported no postoperative dysphotopsia. During surgery and postoperative examinations, the wide IOL optic permitted an enhanced view of the fundus. The IOLs remained stable after implantation, especially during the intravitreal injection at the end of the surgery. No IOL displacement or shift of the lens was observed. Retinal diseases are sight-threatening and diminish the patient’s quality of life due to reduced visual acuity and visual field defects. When cataract surgery is performed in this patient group, a reduced prognosis can be assumed. Our results show that implantation of the large optic IOL enables a wide view of the fundus during and after surgery without any additional risks or negative effects. It may also reduce the risk of dysphotopsia in cases of IOL decentration in large capsular bags, but comparative studies with a higher number of cases are needed to confirm this. A large rhexis and large IOL optic seem to be advantageous for the retinal surgeon in follow-up surgeries on the posterior segment of the eye.

Simulations of Decentration and Tilt of a Supplementary Sulcus-Fixated Intraocular Lens in a Polypseudophakic Combination Using Ray-Tracing Software

This study aimed to assess image quality after the tilt and decentration of supplementary intraocular lenses (IOLs) in a two-lens configuration. One was designed for sulcus fixation with a nominal power range of 1D–10D and was combined with a capsular fixation 20D IOL. The optical performance of a ray-tracing model was tested under IOL misalignment through the area under the modulation transfer function (MTFa) and wave aberrations. Tilting by 10° resulted in a 4% reduction of the MTFa for a 10D IOL as compared to 9% for the 20D lens. The two models demonstrated good tolerance to a 1 mm decentration; as for the 10D sulcus-fixated lens, the MTFa loss was 2%, and 4% for the capsular fixation lens. Coma and astigmatism increased three- and four-fold, respectively, after a 10° tilt compared to the aberration level induced by the 1 mm decentration. Both analyses showed a trend towards a lower MTF impact and fewer optical errors with decreasing nominal power. In conclusion, when misaligned, low-power sulcus-fixated IOLs might retain their good optical quality. An extreme tilt of 10° has a more detrimental effect on the IOL performance than a 1 mm decentration. The proper alignment of a high-power capsular fixation lens is important in achieving a desirable postoperative outcome.

Visual Outcomes and Patient Satisfaction After Bilateral Sequential Implantation of a Capsular Bag IOL and a Supplementary Sulcus-Fixated Trifocal IOL.

To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

Clinical and Surgical Outcome of a Supplementary Multifocal Intraocular Lens Implanted with a Bag-In-the-Lens Intraocular Lens: 5-Year Follow-Up

Introduction: To assess the postoperative outcome and patient-reported satisfaction, spectacle independence, and dysphotopsia after implantation with the mutifocal Rayner Sulcoflex supplementary intraocular lens (sIOL). Materials and Methods: We analyzed the outcome of all patients implanted with a multifocal sIOL between 2009 and 2011. In all cases, the sIOL was the Rayner Sulcoflex IOL (type 653F) and the primary IOL was a bag-in-the-lens (BIL) IOL. The data were obtained through a retrospective analysis of the patient records and by means of a questionnaire, 5 years after sIOL implantation. Results: This study included 31 eyes of 20 patients. In 13 eyes, the sIOL needed explantation (n = 13, 41.94%). Dysphotopsia is a frequent complaint (12/15 patients: 80.0%) after sIOL implantation. In 13 out of 31 eyes (41.94%), pigment deposits were found on the sIOL with variable clinical complaints. Five eyes required additional surgery because of clinically significant deposits. Discussion/Conclusion: Patients with a multifocal sIOL in combination with a BIL implantation have a higher incidence of dysphotopsia compared to previously published studies. Dysphotopsia was the main complaint and reason for explantation. We encountered a high incidence of pigmented IOL deposits. The sIOLs can be safely removed even years after implantation.

Visual performance and patient satisfaction following the implantation of a novel trifocal supplementary intraocular lens.

To evaluate the visual quality, visual performance, and patient satisfaction after the implantation of the last generation supplementary intraocular lens (1stQ AddOn Trifocal) for achieving near vision spectacle-independence in pseudophakic patients who had primary monofocal capsular bag implantation. Patients who underwent monofocal lens surgery in the past year, and who expressed their explicit desire to become spectacle-independent were included in this prospective observational study. Uncorrected and corrected distance, intermediate and near visual acuities (CDVA, UDVA, DCIVA, UIVA, CNVA, and UNVA), refractive outcomes, lens positioning, contrast sensitivity and patient satisfaction were assessed 6 months postoperatively. About 28 eyes of 18 patients were evaluated. No intra- or postoperative complications (iris chafing, iris capture, interlenticular opacification, IOL-dislocation, etc.) could be observed. The postoperative mean UDVA and CDVA were 0.05 ± 0.08 and 0.01 ± 0.03 (logMAR), respectively. The mean UNVA improved from the preoperative 0.50 ± 0.23 to 0.02 ± 0.05 (logMAR), postoperatively (p = 0.0104). The postoperative mean UIVA and DCIVA were 0.06 ± 0.020 and 0.01 ± 0.00 (logMAR), respectively. Twenty-five eyes (89%) had a residual spherical equivalent within 1.0 D from the target refraction, emmetropia. Contrast sensitivity measured in photopic and mesopic conditions were statistically indifferent from the preoperative curves. All patients had better visual function and quality scores compared to the preoperative responses. The highest improvement could be achieved in near vision activities, dependency, and limitation of social functioning. The 1stQ AddOn Trifocal lens represents a safe and effective option for pseudophakic patients aiming for high quality, spectacle-free vision.

Measurement of Force Required for Anterior Displacement of Intraocular Lenses and Its Defining Parameters.

Intraocular stability during or after cataract and glaucoma filtration surgeries and vitreous surgery with a gas/silicone oil tamponade might differ among intraocular lenses (IOLs). We used six different one-piece IOL models and measured the force that displaced the IOLs from the vitreous cavity to anterior chamber as a measure of stability against the pressure gradient between the anterior and posterior IOL surfaces. We measured IOL hardness, haptics junction area, and posterior IOL bulge to identify what determines the IOL displacement force. The KOWA YP2.2 IOL (1.231 mN) required significantly greater force than the HOYA XY1 (0.416 mN, p = 0.0004), HOYA 255 (0.409 mN, p = 0.0003), Alcon SN60WF (0.507 mN, p = 0.0010), and Nidek NS60YG (0.778 mN, p = 0.0186) IOLs; J&J ZCB00V IOL (1.029 mN) required greater force than the HOYA XY1 (p = 0.0032) and HOYA 255 (p = 0.0029) IOLs; the Nidek NS60YG IOL required greater force than the HOYA 255 (p = 0.0468) IOL. The haptics junction area was correlated positively with the IOL displacement force (r = 0.8536, p = 0.0306); the correlations of the other parameters were non-significant. After adjusting for any confounding effects, the haptics junction area was correlated significantly with the IOL displacement force (p = 0.0394); the IOL hardness (p = 0.0573) and posterior IOL bulge (p = 0.0938) were not. The forces that displace IOLs anteriorly differed among one-piece soft-acrylic IOLs, and the optics/haptics junction area was the major force determinant.

Variation in intraocular lens calcification under different environmental conditions in eyes with supplementary sulcus-supported lenses

PurposeAnalysis of explanted intraocular lenses (IOLs) from pseudophakic eyes with supplementary sulcus-supported IOLs. MethodsIn this laboratory investigation, ten supplementary and capsular bag IOLs were analyzed. All lenses were received between January 2012 and March 2018. Explants were examined morphologically with histological and electron microscopic techniques and patients’ medical history was evaluated. Additionally, we used a technique new to this field: Transmission Electron Microscopy and electron diffraction pattern analysis was performed to investigate the structure of the opacifying crystals in detail. ResultsEleven lenses were explanted due to IOL opacification from seven polypseudophakic eyes: In three cases the supplementary lens calcified, in three cases the capsular bag IOL (both lenses analyzed) and in one case both IOLs (only the supplementary was received). Additional surgical procedures and comorbidities included pars plana vitrectomy or Descemet stripping endothelial keratoplasty and diabetes mellitus. For each opacified lens, a varying layer of a Calcium phosphate beneath the optic surface was apparent. Crystal characterization revealed its composition to be Hydroxyapatite. Conclusions and ImportanceWe report on a series of secondary calcification in lenses explanted from polypseudophakic eyes. In some cases, calcification occurred in the capsular bag lens, in other cases in the supplementary lens, or in both. The severity of the morphological change could be related to the comorbidities and the presence of surgery subsequent to the lens implantations. Detailed morphology of the opacifying crystals was revealed.

Time course of changes in anterior chamber structures after Nd:YAG laser anterior capsulotomy for early-onset postoperative capsular block syndrome evaluated by AS-OCT

A 69-year-old man underwent uncomplicated 25-gauge pars plana vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for treatment of epiretinal membrane. On postoperative day 1, a shallow anterior chamber and an anterior displacement of the IOL with pigment dispersion were observed. Swept-source anterior segment optical coherence tomography (AS-OCT) revealed a capsular hyperexpansion with ciliochoroidal detachment, and the patient was diagnosed with early-onset postoperative capsular block syndrome (CBS). After peripheral anterior capsulotomy by Nd:YAG laser on postoperative day 1, the IOL displacement was resolved immediately, and a transient reverse pupillary block was detected by AS-OCT. A resolution of the reverse pupillary block and ciliochoroidal detachment was confirmed by AS-OCT on postoperative day 3. To our knowledge, this is the first case that describes the postoperative time course and a transient reverse pupillary block after Nd:YAG anterior capsulotomy for early postoperative CBS using swept-source AS-OCT images.

Spectacle Independence for Pseudophakic Patients - Experience with a Trifocal Supplementary Add-on Intraocular Lens.

PurposeTo evaluate the refractive and functional outcomes of the trifocal 1stQ AddOn® (Medicontur) supplementary intraocular lenses (IOLs) designed for implantation into the ciliary sulcus.Patients and MethodsThe study included 18 eyes of 11 pseudophakic patients with uncomplicated previous implantation of monofocal capsular bag IOLs. These patients had a desire for spectacle independence. Distance, intermediate and near visual acuities were measured, and defocus curves were plotted over a period of 6 months following implantation of the add-on IOLs. Intraocular pressure (IOP), endothelial cell density measurements and biomicroscopic evaluation were also performed.ResultsIn this study, 83.3% of eyes had spherical refractions within ±0.5 D from emetropia and 100% of eyes had spherical equivalent refractions that were within ±1.0 D of the target refraction. Visual acuities and defocus curves clearly confirmed trifocal optical performance (UDVA=0.03 ±0.05; UIVA=0.21 ±0.04; UNVA=0.12 ±0.04 logMAR; expressed as mean ±SD). Depth of focus showed identical results (DOF=0.486 D) compared to a trifocal capsular bag IOL, while the defocus curve was found to be superior in the intermediate and near ranges when compared to a trifocal capsular bag IOL. All patients achieved spectacle independence at all distances. All add-on IOLs were well positioned in the ciliary sulcus. No negative changes were noted in connection with endothelial cell counts, IOPs, the angle structure during surgery and during the follow-up period.ConclusionThe supplementary trifocal add-on IOL seems to be a safe, efficient and stable solution for achieving spectacle independence in pseudophakic patients with monofocal primary IOLs.

Prospective Comparison of Intraocular Lens Dynamics and Refractive Error between Phacovitrectomy and Phacoemulsification Alone

To compare intraocular lens (IOL) dynamics and refractive prediction errors between eyes that underwent phacovitrectomy and eyes that underwent phacoemulsification alone. Prospective, nonrandomized, comparative, observational study. Sixty eyes of 60 patients who underwent 25-gauge phacovitrectomy without gas injection for macular pathology and 60 eyes of 60 patients who underwent phacoemulsification alone for cataract were enrolled. Preoperative optical biometry was performed using the IOLMaster 700 (Carl Zeiss Meditec, Inc, Dublin, CA) to calculate the IOL power with the Barrett Universal II formula. Monofocal, nontoric, single-piece foldable aspherical IOLs were implanted in each patient. Comprehensive ocular examinations, including CASIA2 (Tomey Corp, Nagoya, Japan) evaluations of the preoperative crystalline lens and postoperative IOL positions (i.e., decentration, tilt, and aqueous depth), were performed before and 3 days, 1 month, and 3 months after surgery. Refractive prediction errors and IOL dynamics. Mean refractive prediction errors at 3 days, 1 month, and 3 months after phacovitrectomy were 0.51±0.59 diopters (D), 0.11±0.40 D, and 0.05±0.41 D, respectively, whereas those after phacoemulsification alone were 0.43±0.38 D, 0.11±0.37 D, and 0.07±0.34 D, respectively. There was no significant difference in the refractive error between the 2 groups at any time point. A myopic shift of-0.50 D or more negative refractive error occurred in 4 (6.7%) of 60 eyes with phacovitrectomy and 3 (5.0%) of 60 eyes with phacoemulsification alone; there was no significant between-group difference. At 3 months postoperatively, refractive errors within ±0.50 D and ±1.00 D were achieved in 49 (81.7%) and 58 (96.7%) of 60 eyes in the phacovitrectomy group and 52 (86.7%) and 60 (100.0%) of 60 eyes in the phacoemulsification alone group, again without any significant between-group differences. There were no significant differences in the preoperative lens and postoperative IOL positions between the 2 study groups, except for a significantly deeper mean aqueous depth at 3 days after surgery in the phacovitrectomy group. Neither myopic shift nor IOL displacement occurs after 25-gauge phacovitrectomy with a single-piece IOL without gas injection for macular pathology compared with phacoemulsification alone.

Correlative Comparison of Three Ocular Axes to Tilt and Decentration of Intraocular Lens and Their Effects on Visual Acuity

Purpose: To evaluate which ocular axis, the corneal topographic axis (CTA), pupillary axis (PA) or line of sight (LOS), for measuring the tilt and decentration of intraocular lens (IOL) is most relevant to correct distance visual acuity (CDVA). Methods: A Scheimpflug device (Pentacam HR) was prospectively used to determine the tilt and decentration of IOLs in vivo 3 months after cataract surgery. A new method was developed to reliably measure PA and LOS. We further evaluated CTA and then used Spearman correlation coefficient and linear regression to assess the correlation between CDVA and IOL displacement based on the data of three different ocular axes. Results: Forty-six eyes from 46 patients were evaluated. The majority of decentration and tilt of IOL with reference to CTA, PA and LOS were towards the subtemporal direction. We found that the horizontal meridian data measured using CTA and PA were statistically significantly different (p = 0.011 for tilt; p = 0.005 for decentration). The correlation between CDVA and the distance of decentration temporally (r = –0.344, p = 0.035) and inferiorly (r = –0.336, p = 0.042) of the IOL with regard to CTA was significant. PA and LOS measurements had no correlation with any indices. Conclusion: Assessment of tilt and decentration of the IOL with reference to different ocular axes was markedly different. IOL tilt and decentration measured by CTA were significantly correlated with CDVA.

Banded technique for pediatric traumatic cataract surgery

We describe a technique for pediatric traumatic cataract management in cases in which part of the anterior capsule has been ruptured. The technique requires creating a 2-incision push-pull capsulorhexis in the intact anterior capsule. The capsulorhexis is made in a manner that converts the edge of the ruptured anterior capsule into a band of capsule that holds the intraocular lens (IOL) in the bag, reducing the incidence of early, intermediate, or late postoperative lens-iris capture. It also reduces the chances of IOL displacement.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.