Posterior capsule opacification in children: comparison of posterior continuous curvilinear capsulorhexis alone and pars plana posterior capsulectomy with anterior vitrectomy.

To evaluate the efficacy of the Tecnis® Symfony® ZXR00 lens in achieving optimal visual outcomes for cataract surgery patients with axial length (AL) shorter than 24 mm. A total of 21 subjects (37 eyes) were submitted to cataract surgery and implantation of Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) was assessed. Patients were examined at 5 m, 80 cm, and 40 cm for uncorrected distance visual acuity (UCDVA) and corrected distance visual acuity (CDVA), uncorrected intermediate (UCIVA), and uncorrected near visual acuity (UCNVA). Further, based on the optimal distance correction, the monocular defocusing curve in the range of +0.5 to -3.5 D was investigated. A simple patient-reported spectacle independence questionnaire (PRSIQ) was used to evaluate subjects' subjective feelings about their dependence on glasses at various distances. Multiple linear regression was employed to examine the association amony intraocular lenses (IOLs) diopter, AL, corneal curvature, anterior chamber depth, mean manifest refractive spherical equivalent, pupil, pupil/scan, target refraction, and near vision (logMAR). The study demonstrated enhanced UCNVA alongside comparable distant vision and UCIVA outcomes in eyes with AL shorter than 24 mm. Mean post-operative UCDVA significantly improved from preoperative levels 0.530±0.406 (P=0.000). Notably, 83.3% of eyes achieved 0.01 logMAR in UCNVA. Five unilateral cases with blended IOL implantation also showed satisfactory visual acuity and satisfaction. The 90.5% (19/21) achieved spectacle independence. The average score for self-reported spectacle-independence on the PRSIQ was 3.52 with a standard deviation of 0.98. The results of the regression analysis revealed that one predictor, the pupil/scan accounted for 27.6% of the variation in near vision [logMAR; F(1,35)=13.33, P<0.01]. The results affirm the effectiveness of the Tecnis® Symfony® ZXR00 lens in enhancing visual outcomes for cataract surgery patients with AL shorter than 24 mm. Additionally, the pupil/scan emerges as a critical factor influencing postoperative near vision.

PurposeTo evaluate the outcomes of lensectomy with and without intraocular lens (IOL) implantation in patients with Marfan syndrome and ectopia lentis.MethodsThis retrospective review included 55 patients (85 eyes) diagnosed with Marfan syndrome who underwent lens surgery at King Khaled Eye Specialist Hospital between 2014 and 2023. Preoperative lens status; surgical technique; use of capsular support devices and IOLs; and postoperative clinical, biometric, and refractive parameters were analyzed. The primary outcome was final best-corrected visual acuity. Secondary outcomes included refractive correction (spherical equivalent), axial length, intraocular pressure, IOL position and stability, and incidence of postoperative complications.ResultsAll eyes had subluxated crystalline lenses [predominantly inferotemporal lenses (52.9%)]. Surgical procedures included lensectomy with anterior vitrectomy (49.4%), lensectomy with IOL implantation (38.8%), pars plana vitrectomy with lensectomy (7.1%), and phacoemulsification with IOL (4.7%). Capsular support devices were used in 12 eyes. Secondary IOL implantation was performed in 12 eyes, with 91.7% scleral-fixated IOLs. At the final follow-up, 41.2% of the eyes were aphakic, 32.9% had scleral-fixated IOLs, 15.3% had posterior chamber IOLs, and 8.2% had anterior chamber IOLs. There was a significant association between phakic status and refractive correction (P<0.001). The final mean visual acuity improved significantly from 1.1±0.7 logMAR (20/250) at presentation to 0.3±0.3 logMAR (20/40) at the last visit (P<0.001). The IOL position was stable in 47.1% of the eyes and was significantly associated with IOL type (P<0.001).ConclusionLensectomy, with or without IOL implantation, is an effective and versatile approach for managing ectopia lentis in Marfan syndrome, with favorable long-term visual and anatomical outcomes. These findings emphasize the need for individualized planning based on subluxation severity and capsular support. Improved IOL stability and vision support the use of tailored techniques. Future studies should assess long-term safety and quality of life to guide standardized care.

Purpose : To assess the efficacy of image-guided limbal relaxing incisions (LRIs) in enhancing outcomes of cataract surgery with trifocal intraocular lenses (IOLs) implantation. Methods This prospective cohort study included consecutive cataract patients with predicted postoperative corneal astigmatism of 0.5–1.0 D and intended for cataract surgery with trifocal IOL implantation. The enrolled subjects were randomized into the non-LRI group, manual-marked LRI group and image-guided LRI group. Correction effect of corneal astigmatism, as well as visual outcomes at 3 months after surgery were compared among the three groups. Results Finally, 30 eyes of 30 patients in every group were included. The image-guided LRI group showed more corneal astigmatism correction (0.81 ± 0.32 D vs. 0.17 ± 0.22 D vs. 0.48 ± 0.37 D, p < .001) and less refractive postoperative cylinder (0.33 ± 0.29 D vs. 0.90 ± 0.25 D vs. 0.65 ± 0.31 D, p < .001) than the non-LRI group and manual-marked LRI group. The uncorrected near visual acuity and uncorrected intermediate visual acuity were significantly better in the image-guided LRI group and manual-marked LRI group than the non-LRI group (all p < .05). The image-guided LRI group also displayed significantly better ocular modulation transfer functions than the other two groups (all p < .05). Conclusion LRIs, especially image-guided LRIs, can effectively reduce corneal astigmatism and improve both near and intermediate vision, as well as visual quality of patients undergoing trifocal IOLs implantation.

PurposeTo report clinical (visual and refractive), spectacle independence, patient-reported outcomes following bilateral sequential implantation of a non-diffractive extended-vision intraocular lens (IOL): AcrySof IQ Vivity (DFT015 and DFTx15) in cataract surgery. This IOL provides continuous range of focus from distance to near, offering monofocal quality distance image and visual disturbances profile.MethodsRetrospective unmasked nonrandomized case series. Patients who underwent phacoemulsification and bilateral sequential implantation of AcrySof IQ Vivity, targeting minimonovision (nondominant eye targeted for between -0.25D and -0.50D). Clinical post-operative outcome measures were assessed 1-2 months postoperatively - binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity - 66 cm (UIVA), binocular uncorrected near visual acuity - 40 cm (UNVA), refraction, spherical equivalent (SE) and residual astigmatism (toric group). Spectacle independence and satisfaction systematic questionnaires (IOLSAT and Catquest-9SF) were performed. Visual disturbances were analyzed.Results181 patients were enrolled. 78 eyes were implanted with the DFTx15 (toric version). Binocular mean UDVA was -0.01 logMAR (± 0.05), binocular mean UIVA was 0.09 logMAR (± 0.08), binocular mean UNVA was 0.16 logMAR (± 0.12) and mean SE was -0.27D (± 0.36D). Mean residual astigmatism (toric group) was 0.3D (± 0.42D). Patient-reported outcomes for satisfaction and spectacle independence were excellent. Visual disturbances were rarely reported.ConclusionsImplanting this IOL using minimonovision strategy provides excellent binocular UDVA and UIVA, and good UNVA. It provides high patient satisfaction, spectacle independence (demonstrated excellent performance in systematic evaluations) and minimizes unwanted visual effects. Controlled designs and longer follow-ups are needed to confirm these findings.

BackgroundPhacoemulsification combined with intraocular lens implantation and goniosynechialysis (PEI + GSL) represents a mainstream ​surgical technique​for the treatment of primary angle-closure glaucoma (PACG). As the disease progresses, when the extent of peripheral anterior synechiae (PAS) gradually expands to 360°, whether PEI + GSL remains effective remains uncertain. This study aimed to investigate the long-term clinical efficacy​of PEI + GSL in treating PACG patients with 360° PAS.MethodsA case‒control study was conducted on PACG patients with 360° PAS (360° PAS group) and those with PASs ranging from 90° to 180° (90°≤ PAS ≤ 180° group). Patients underwent PEI + GSL and were followed up for 1–3 years. The data collected included intraocular pressure (IOP), glaucoma medications, visual acuity, PAS extent, complications, and other relevant parameters. Kaplan‒Meier curves were used to analyse the cumulative surgical success rates in both groups.ResultsThe 360° PAS group included 31 eyes (31 patients), and the 90°≤ PAS ≤ 180° group included 32 eyes (32 patients). At the final follow-up (36 months), the IOP was 14.8 ± 3.9 mmHg in the 360°PAS group and 15.5 ± 2.9 mmHg in the 90°≤ PAS ≤ 180° group (P = 0.507). The degree of IOP reduction was 47.9% in the 360°PAS group and 33.0% in the 90°≤ PAS ≤ 180° group (P = 0.272). The mean number of glaucoma medications decreased by 2.5 in the 360°PAS group and 1.1 in the 90°≤ PAS ≤ 180° group (P < 0.001). The complete plus qualified success rates at 3 years were 90.3% and 93.8%, respectively, with no significant difference (P = 0.970).ConclusionsPEI + GSL in PACG patients with 360° PAS resulted in a 47.9% reduction in IOP, a mean reduction of 2.5 glaucoma medications, and a high overall surgical success rate (90.3%), comparable to the 90°≤ PAS ≤ 180° group (93.8%).Trial registrationChiCTR2400086966 The study protocol was approved in the Chinese Clinical Trial Registry at 2024-07-16.

To compare structural and visual outcomes of anterior versus retropupillary iris-claw intraocular lens (IOL) implantation in aphakic children with inadequate capsular support. Thirty-two pediatric aphakic eyes with inadequate capsular support were prospectively randomized to anterior or retropupillary fixation. Outcome measures were evaluated at 1, 6, and 12 months. Visual acuity, refraction, central endothelial cell density (CECD), central corneal thickness (CCT), IOL tilt, and centration of both groups were compared. In the 32 eyes (18 children), mean age at implantation was 6.5 years. Mean best corrected visual acuity improved to 0.23 ± 0.24 and 0.18 ± 0.21 logarithm of the minimum angle of resolution at 12 months in the anterior and retropupillary groups, respectively (P = .32). There was a decrease in CECD that was significant in the anterior fixation group (P = .006), but not in the retropupillary fixation group (P = .154). The lower CECD in the anterior fixation group was statistically significant at 12 months (P = .018). Mean endothelial cell loss at 12 months was 17.4% and 5.6% in the anterior fixation group and the retropupillary fixation group, respectively. Haptic dis-enclavation occurred in 1 eye per group (6%). Pupillary block occurred in 1 eye (6%) and a significant anterior chamber (AC) reaction occurred in 2 eyes (12%) in the anterior fixation group. At 1 year of follow-up, differences in CCT and angle width between both groups were insignificant. IOL tilt and decentration were less than 4 degrees and less than 0.6 mm, respectively, in both groups. AC was significantly shallower (P < .001) in the anterior fixation group. Anterior fixation of iris-claw IOLs displayed higher endothelial cell loss than retropupillary fixation at 1 year of follow-up, higher incidence of inflammatory reaction, pupillary block, and shallower AC.

To prospectively evaluate bilateral visual function in Japanese patients implanted with nondiffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs). Multisite prospective observational study. This study included 48 eyes of 24 Japanese patients with cataracts (mean age: 68.7 ± 9.2years) who underwent bilateral implantation of nondiffractive EDoF IOLs CNAET0 (Clareon Vivity, Alcon), made of high-water-content hydrophobic acrylic material. Three months postoperatively, binocular uncorrected and distance-corrected visual acuities (BUCVA and BDCVA) were assessed at far, 66cm, and 40cm. Binocular photopic contrast sensitivity (CSV-1000), binocular defocus curves, spectacle independence, and photic phenomena (glare, halo, starburst, and waxy vision) were also assessed. The mean logMAR BUCVA/BDCVA was -0.11/-0.15 at far, 0.05/0.08 at 66cm, and 0.18/0.22 at 40cm. Binocular contrast sensitivity was within the normal range for individuals aged 60-69years across all spatial frequencies. The mean defocus curve demonstrated 0.1 logMAR or better between -2.0 and +1.0 D addition, with better performance of 0.0 logMAR or better between -1.5 and +0.5 D addition. All patients were spectacle-independent for distance and intermediate vision, whereas nine of the 24 patients (37.5%) required spectacles for near vision. None of the patients reported severe photic phenomena; 17 patients (70.8%) did not experience glare or starburst, and 20 patients (83.3%) did not report halo or waxy vision. Bilateral implantation of nondiffractive EDoF IOLs provided good binocular functional vision from far to near, although some patients may require spectacles for near vision. The photic phenomenon was minimal.

Retinitis pigmentosa (RP) is an inherited retinal degenerative disease that primarily affects rod cells and is associated with several ocular complications, including cataract. Cataract secondary to RP occurs at a younger age, with the most common type being the posterior subcapsular cataract. The inflammatory response associated with RP is believed to be the primary pathology responsible for the development of complicated cataracts. Although phacoemulsification and intraocular lens implantation are the preferred surgical methods for these patients, the incidence of intraoperative and postoperative complications is higher than in normal eyes. Furthermore, postoperative visual prognosis evaluation can be challenging due to the presence of retinal pathology accompanying cataract. In this review, we discuss the morphology and potential pathogenesis of cataract secondary to RP, preoperative and intraoperative precautions, cataract surgical procedure, assessment of visual prognosis, and complications management.

In benign tumors of the retina and optic nerve, observation is generally sufficient, and cataract usually develops independently of the tumor. In retinoblastoma, the most common intraocular tumor of childhood, cataracts may develop following radiotherapy and, more recently, commonly used chemotherapy regimens. In contrast, in medulloepithelioma, cataract typically develops as a primary consequence of the tumor itself. The type and location of the tumor, as well as the treatment process, are critical factors influencing cataract development and its management. Decisions regarding the timing of cataract surgery, choice of surgical technique, and intraocular lens implantation should be planned using a multidisciplinary approach, taking into account tumor remission status, risk of recurrence, and the patient's visual potential. This review aims to contribute to the development of safer and more effective patient-specific management strategies in clinical practice by summarizing the relationship between retinal and optic nerve tumors and cataract formation based on current literature.

This review provides a comprehensive overview of the surgical management of cataract in patients with uveitis associated with retinal autoimmune diseases. Cataract in uveitic eyes develop as a result of chronic intraocular inflammation and long-term steroid therapy and are one of the most common causes of vision loss. Cataract surgery in this patient group involves varying difficulties depending on systemic and ocular disease activity and accompanying ocular comorbidities. A detailed ophthalmologic and systemic evaluation should be performed before surgery, especially considering the status of the retina and optic nerve structures. Preoperative control of inflammation for at least three months is recognized as an important prognostic factor for reducing postoperative complications and enhancing surgical outcomes. Appropriate immunosuppressive therapy with local and systemic corticosteroids before, during, and after surgery plays a critical role in reducing postoperative inflammation and the risk of developing cystoid macular edema (CME). Phacoemulsification with intraocular lens implantation is the preferred surgical technique for most patients with uveitic cataract. Surgery in these cases is often challenging because of miotic pupil, posterior synechiae, iris atrophy, zonular weakness, and pupillary membranes. Therefore, the use of pupil dilators, iris manipulations, and additional procedures may be required. Patients should be closely monitored postoperatively for excessive inflammation, CME, increased intraocular pressure, hypotony, and other potential complications. Recent advances in surgical techniques, immunomodulatory therapies, and intraocular lens technologies have significantly improved the safety and visual outcomes of cataract surgery in patients with uveitis. However, an individualized approach should be adopted for each patient and it should be kept in mind that the risks of unforeseen complications are higher than those of traditional cataract surgery, and careful follow-up should be maintained after surgery.

Intraocular lens (IOL) implantation is currently the most effective method for restoring vision following cataract surgery and is also used in cases of high myopia or hyperopia. However, IOL implantation eliminates accommodation, forcing patients to choose between corrected distance vision, requiring reading glasses for near tasks, or near vision supplemented by distance correction with spectacles. This limitation underscores the need for fully customized, patient-specific IOLs. To address this challenge, we performed femtosecond laser ablation experiments on polymethyl methacrylate (PMMA) IOLs using 200 fs pulses at 513 nm to investigate controlled surface modification. Laser-induced surface structuring offers a pathway to inscribe micron-scale patterns, including apodized features, in transparent polymers. To our knowledge, this is the first demonstration of femtosecond laser irradiation at 513 nm applied to IOL surfaces. Furthermore, this study is the first to combine scanning electron microscopy (SEM) and optical coherence tomography (OCT) as detection technologies to analyze and quantify ablation morphology and depth. The formation of smooth craters with minimal surrounding thermal damage highlights the potential of femtosecond laser processing as a promising tool for the development of customized, patient-tailored intraocular lenses.

Cataract development in uveitis may develop early as a result of chronic inflammation and/or long-term steroid treatment and show rapid progression. It has been reported that cataract development occurs at earlier ages in uveitic patients compared to normal individuals and visual acuities are lower before and after surgery. Cataract surgery can be performed with methods such as extracapsular cataract surgery, small-incision manual cataract surgery, phacoemulsification (phaco) or pars plana lensectomy (PPL). Treatment of cataract with phaco and posterior chamber intraocular lens (IOL) implantation in uveitic patients is generally accepted as a reliable and effective treatment option. However, considering that uveitis patients are at higher risk for complications, it is extremely important to take individualized precautions for each patient before, during and after surgery for successful results.

Comparison of Surgical Methods for the Correction of Low Amounts of Corneal Astigmatism during Cataract Surgery.

To evaluate the prevalence of satisfaction, dissatisfaction, and intolerance after presbyopia-correcting intraocular lens (PrC-IOL) implantation, identify primary causes of dissatisfaction, and assess the rate of spontaneous resolution of photic phenomena in a clinical setting. This was a retrospective cross-sectional study of consecutive patients who had PrC-IOL implantation, including bifocal (ReSTOR; Alcon Laboratories, Inc), trifocal (Pan-Optix; Alcon Laboratories, Inc), diffractive extended depth-of-focus (EDOF) (Symfony; Tecnis), and non-diffractive EDOF (Vivity; Alcon Laboratories, Inc), at the Cole Eye Institute, Cleveland Clinic between January 2017 and December 2022. Evaluated variables included refractive outcomes, patient-reported satisfaction/dissatisfaction or intolerance, primary drivers of dissatisfaction, management strategies, IOL exchange rates, and spontaneous resolution of photic phenomena over time. A total of 493 patients (970 eyes) were evaluated. Overall, 87.2% reported satisfaction with their IOL outcomes, with 38% experiencing photic phenomena in the early follow-up. Dissatisfaction occurred in 12.8% of patients, with 7.7% of the total cohort reporting IOL intolerance. Blurry corrected vision (73%) and photic phenomena (50.8%) were the most common causes of dissatisfaction. Compared to satisfied patients, dissatisfied and intolerant patients had worse refractive outcomes and higher rates of photic phenomena. Among patients reporting photic phenomena at their initial stability visit and completing 1 year of follow-up, 43% experienced spontaneous resolution, most between 6 and 12 months. IOL exchange was performed in 2.4% of patients. Most patients were satisfied with PrC-IOLs; however, in this analysis 12.8% reported dissatisfaction and 7.7% were intolerant to the lenses. Blurry corrected vision and photic phenomena were the leading causes of dissatisfaction. Spontaneous resolution of photic phenomena occurred in approximately one-third of cases but is less frequent among dissatisfied patients. IOL exchange may be necessary to alleviate symptoms.

Distribution and inter-device agreement of chord mu/alpha lengths and axes between Pentacam HR, Sirius, and IOLMaster 700.

Introduction: Intraocular lens implantation combined with cataract extraction is arguably the most successful surgical technique in the history of medicine. Cataracts are one of the major causes of preventable blindness worldwide. Cataract surgery is by far the most frequently performed procedure under local anaesthesia. Therefore, it is imperative to develop anaesthetic techniques that are safe, efficient, and financially viable, particularly in India. Need of the study: The study aims to provide significant insights into enhancing cataract surgical procedures in rural regions by comparing Sub-Tenon’s anaesthesia, which may offer improved akinesia and patient comfort, with topical anaesthesia, which is less invasive and easier to administer. Aim: To compare and evaluate patients’ outcomes after topical and Sub-Tenon’s anaesthesia in Manual Small Incision Cataract Surgery (MSICS). Materials and Methods: A two-arm parallel randomised controlled trial will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from June 2024 to June 2026, including 56 patients in total (allocated to topical anaesthesia or Sub-Tenon’s anaesthesia). Before the intervention, demographic data will be collected on a pro forma, and after the surgery the Visual Analogue Scale (VAS) score and postoperative outcomes will be recorded. Statistical analysis will be performed using the Mann-Whitney U test. A p-value&lt;0.05 will be considered statistically significant.

Exudative AMD Risk Following Blue Light-Filtering IOL Implantation: A Population-Based Study According to Non-Exudative AMD Status.

To report the short- and long-term outcomes of sutured scleral-fixated capsular tension segments (CTS) in patients with lens instability. This retrospective study included 21 eyes of 21 patients who underwent scleral fixation of a CTS, with or without capsular tension ring (CTR) ± intraocular lens (IOL) implantation, between 2015 and 2023 at two academic centers. The primary outcome was stability of the IOL-bag complex, defined as centration without tilt or reintervention. Secondary outcomes included corrected distance visual acuity (CDVA), refractive stability, and postoperative complications, classified as early (≤ 4weeks) or late (> 4weeks). Minimum follow-up was 6months, with a subgroup of eyes ≥ 12months. Outcomes were compared between polypropylene and Gore-Tex sutures. Mean patient age was 59.1 ± 18.6years, and mean follow-up 28.6months (range 6-80). Mean zonular dialysis was 142° ± 41° (range 60°-210°), with two cases requiring two CTSs. At final follow-up, 85.7% of eyes achieved CDVA of 20/40 or better. Early complications occurred in 5 eyes (23.8%), including cystoid macular edema (14.3%), wound leak (4.8%), and posterior capsular rupture (4.8%). Late complications were limited to one haptic displacement and one polypropylene suture rupture; no late events occurred with Gore-Tex. Scleral fixation of CTSs is a safe and effective strategy for lens subluxation, providing stable long-term centration of the IOL-bag complex with good visual outcomes and low complication rates. Gore-Tex demonstrated superior long-term durability, supporting its use when extended stability is required, particularly in cases with ≥ 120º degrees of zonular dialysis.

This study evaluated the influence of the lenticular component on the formation of regular total AS in older patients. The potential impact of lenticular AS on total AS was assessed by analyzing the changes in parameters (magnitude and orientation of one of the principal meridians) after phacoemulsification with implantation of a monofocal intraocular lens (IOL). The study included 35 patients (41 eyes) aged 60-72 years. Preoperative AS ranged from 0.75 to 2.75 D. No significant changes in magnitude or orientation of one of the principal meridians of total AS were found postoperatively (p=0.737 and p=0.965, respectively). Analysis of potential differences between total and corneal AS after surgery showed the following: in 13 cases (31.7%) values were identical, in 14 (34.2%) they differed by 0.25 D, in 5 (12.1%) - by 0.5 D, in 4 (9.8%) - by 0.75 D, and only in 5 cases (12.1%) the difference exceeded 1 D. Greater variability was noted in the orientation of one of the principal meridians: no cases had results coincide, and differences of 0-10°, 11-20°, 21-30°, and >30° occurred in 19 (46.4%), 13 (31.7%), 6 (14.6%), and 3 (7.3%) cases, respectively. The clinical model of pseudophakia after implantation of a monofocal IOL can be considered as a method for eliminating the impact of the lenticular component on total (clinical) AS. The need to refine keratometry data using subjective tests when determining the axis for toric IOL implantation remains due to the identified significant postoperative discrepancies in the orientation of one of the principal meridians of corneal and total AS.