To investigate the characteristics and associated factors of intraocular lens (IOL) tilt and decentration after transscleral suture-fixated IOL surgery in congenital ectopia lentis (CEL). CEL patients undergoing transscleral suture-fixated IOL surgery were divided into two groups based on implanted IOL type (three-piece IOL or one-piece IOL). The IOL tilt and decentration at 3-month and 1-year postoperative were measured. Multivariate regression analyses were performed to identify the associated factors of IOL tilt and decentration as well as longitudinal changes. The 61 CEL patients (mean age 9.07±5.05y) in three-piece IOL (M/F: 14/7) group had a greater tilt than those with one-piece IOL (M/F: 28/12) group both at 3-month postoperative (horizontal: P=0.024; vertical: P=0.048) and 1-year postoperative (horizontal: P=0.011; vertical: P=0.001). Three-piece IOL group had a greater longitudinal change between 3-month postoperative to 1-year postoperative in IOL tilt (horizontal: P=0.028; vertical: P=0.026) and a greater longitudinal change in horizontal IOL decentration than one-piece IOL group (P<0.05). The longer axial length (AL) was associated with the longitudinal changes in IOL tilt (P=0.039), while the three-piece IOL was associated with the longitudinal changes in horizontal IOL decentration 1-year postoperatively (P=0.011). IOL tilt is greater in the three-piece IOL group than that in the one-piece IOL group 1-year postoperatively. The three-piece IOL is associated with greater longitudinal changes of IOL decentration, while longer AL is associated with longitudinal changes of IOL tilt. For CEL patients, more stable IOL type should be selected and patients with longer AL warrant closer monitoring.

To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated four-haptic intraocular lenses (IOLs). This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress double-needle suture technique with intralamellar knot burial via Hoffman pockets. Clinical outcomes assessed included pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), spherical equivalent (SE), suture duration, IOL centration, and perioperative complications. A total of 10 eyes from 10 patients (6 males) were included. The mean age at the time of IOL refixation was 53.10±13.07y (range: 28-68y). The mean interval between initial IOL implantation and dislocation was 8.44±3.54y. The mean postoperative follow-up duration was 11.45±10.30mo. Surgical time averaged 15.3±1.77min, with no intraoperative complications. The mean axial length was 27.16±4.35 mm, with high myopia (HM) as the leading comorbidity (4/10 eyes). Postoperative BCVA significantly improved compared to preoperative values (P=0.025). Postoperative SE was significantly improved compared with preoperative (P=0.01). All IOLs remained centered throughout follow-up. This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs. The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration, avoids conjunctival dissection, and could be adopted into routine surgical practice.

To evaluate the differences and consistency of vault measurements obtained by Scheimpflug tomography (Pentacam), anterior segment optical coherence tomography (AS-OCT, CASIA II), and ultrasound biomicroscopy (UBM) following implantable collamer lens (ICL) V4c implantation. Vault measurements were acquired using three modalities: Pentacam, CASIA II AS-OCT, and UBM. Repeated-measures analysis of variance was used to compare the vault values obtained by the three devices. The correlation and consistency of measurements among the three instruments were assessed using the Pearson correlation coefficient, intraclass correlation coefficient (ICC), and Bland-Altman plots. This retrospective study enrolled 210 myopic eyes of 210 patients (158 women and 52 men) who underwent ICL implantation: 108 eyes had a myopic ICL V4c implanted, and 102 eyes had a toric ICL V4c implanted. The mean vault values measured by Pentacam, CASIA II, and UBM were 452.64±204.20 µm, 538.57±203.54 µm, and 560.95±227.54 µm, respectively, with statistically significant differences among the three groups (P<0.05). Pearson correlation analysis showed strong positive correlations between vault values measured by different instruments (all P<0.001). ICC results indicated good consistency among the three measurement modalities (all P<0.001). Stratified analysis revealed that when the vault value was ≤250 µm, the correlation and consistency of measurements across the three instruments were lower than those in the medium and high vault subgroups. Vault values measured by Pentacam are lower than those obtained by CASIA II and UBM, with UBM yielding the highest mean vault values. Measurements from the three instruments are not interchangeable but can serve as mutual references due to their significant correlation and good overall consistency. Pentacam and CASIA II demonstrate the highest consistency in vault measurement. Notably, when the vault value is ≤250 µm, the consistency between Pentacam and the other two instruments decreases significantly.

To compare the efficacy of goniosynechialysis (GSL) under a microscope alone (GM) and under direct gonioscopy (GG) for chronic angle-closure glaucoma (CACG) coexisted with cataract. A prospective, single-center, and randomized controlled trial was conducted. Patients diagnosed as CACG and cataract were randomly allocated into either GM group or GG group. In GM group, the range of peripheral anterior synechiae (PAS) was confirmed through gonio-lens after phacoemulsification with intraocular lens implantation (PEI). PAS was separated only under a microscope. After separating the closed angle of 360° by this method, we used a surgical gonioscope to confirm the PAS range. If any remaining PAS was present, we would separate them with an iris repositor under the direct gonio-lens until angle of 360° was reopened. In GG group, PAS was separated under direct gonioscopy after PEI until angle of 360° was reopened. The range of residual PAS after GSLs was the primary outcome. Intraoperative complications (hyphema), intraocular pressure (IOP) and anti-glaucoma medication usage after operation were the secondary outcomes. Sixty eyes were included, each group comprising 30 eyes. The average age [GM group: 66.3±6.8y (12 males), GG group: 67.6±8.9y (7 males), P=0.550], the baseline IOP (GM group: 29.6±11.5 mm Hg, GG group: 32.4±12.2 mm Hg, P=0.366) and the average initial PAS extent (GM group: 8.9±2.6h, GG group: 9.4±2.5h, P=0.425) were similar in the two groups. In GM group, the PAS range reduced from 8.9±2.6h before operation to 7.2±2.9h after PEI and 3.3±2.2h after GSL. In GG group, the PAS range reduced from 9.4±2.5h before operation to 7.5±2.9h after PEI and 0.1±0.3h after GSL. The PAS after PEI was significantly reduced compared to the pre-operative PAS in both groups (all P<0.001). The extent of residual PAS after GSL in GM group was larger than that in GG group with significant statistical difference (P<0.001). Patients who underwent GSL without a gonioscope were more likely to develop hyphema than those who underwent GSL under direct gonioscopy. The difference of hyphema grade between the two groups was statistically significant (P=0.019). PEI alone can not open 360° of angle completely. PEI+GSL significantly reduced PAS range. But for patients with CACG, GSL under a microscope alone is more difficult to separate stable PAS completely and adequately than GSL under direct gonioscopy.

Foldable acrylic lenses are the most extensively used 'in the bag' monofocal or multifocal intraocular lenses (IOLs) in cataract surgery, toric lenses in astigmatism, and refractive lens exchange surgeries. When subluxation or dislocation of these lenses is encountered, they must be explanted as they cannot be fixed with conventional scleral fixation techniques. The 'pierce' technique is a novel way of fixing these lenses to the sclera, wherein a 9-0/10-0 polypropylene suture with a straight needle is passed through the IOL at the haptic-optic junction. The ends of the threads are sutured under the scleral flaps in a vertical fashion. This case series highlights the merits of refixing subluxated or dislocated IOLs in a closed or open globe technique and its utility in eyes with weakened capsular bags as it provides good centration, minimal tilt, and applicability to a wider range of foldable IOLs without eyelets, including premium IOLs.

Visual and refractive outcomes of three distinct extended depth-of-focus (EDOF) intraocular lens technologies compared to a monofocal.

Comparison of predictive efficacy of Sirius and Pentacam in predicting postoperative vault height after ICL implantation: a propensity score matched study.

ABSTRACT Purpose Persistent anterior uveitis (PAU) following cataract phacoemulsification is a rare but clinically significant complication. This study evaluated PAU persisting beyond 12 months in an ethnically diverse (Global Majority) population in North West London, focusing on systemic associations and disparities in care. Design Retrospective observational case series. Subjects Sixteen patients (20 eyes) with PAU ≥12 months after uncomplicated phacoemulsification with intraocular lens implantation (2018–2022) were included. Inclusion criteria were no prior uveitis, minimum 12-month follow-up, and slit-lamp evidence of anterior chamber inflammation >0.5+ cells and flare (SUN criteria). Methods At 4 weeks postoperatively, patients underwent assessment of visual acuity, intraocular pressure, autorefraction, macular OCT, and anterior/posterior segment examination. Dexamethasone drops were tapered according to inflammation. Records were reviewed for demographics, comorbidities, intraoperative factors, postoperative complications, and systemic screening (treponemal serology, QuantiFERON Gold, serum ACE). Multidisciplinary referrals were made when systemic disease was suspected. Main Outcome Measure Incidence of PAU lasting ≥12 months and detection of underlying inflammatory or infectious disease. Results PAU occurred in 20 eyes of 16 patients; 69% of patients were female. Median age was 72 years (range 57–87). Ten patients (63%) were African-Caribbean, five (31%) South Asian, and one (6%) White. Bilateral PAU occurred in four patients (25%), and cystoid macular oedema (CMO) in seven patients (35%). Systemic screening identified treponemal antibodies in three patients (19%), positive QuantiFERON Gold in four patients(25%), and elevated serum ACE in six patients (38%). Multidisciplinary referrals were made for all positive cases. Conclusion PAU after uncomplicated cataract surgery disproportionately affects Global Majority patients, with undiagnosed systemic inflammatory or infectious disease contributing. Structured systemic screening and multidisciplinary management are essential. Further research is needed on immunopathogenesis, long-term outcomes, and optimal care models in diverse populations.

To evaluate the functional outcomes and complications of pars plana vitrectomy with scleral flaps covered with a two-point sutured scleral-fixated intraocular lens (SFIOL). A retrospective, single-center, single-surgeon case study, including 97 cases. About 25 G pars plana vitrectomy with a two-point sutured scleral-fixated IOL was used as a surgical modality. This study included 97 patients and eyes with scleral IOL fixation, with a mean follow-up of 6 months. The indications for SFIOL were divided into cases of surgical aphakia (63, 64.94%), hyper-mature cataract not suitable for routine procedure (5,5.15%), traumatic cataracts not suitable for routine procedures (18,18.5%), and other categories (11,64.94%). In this study, the median ± standard deviation of best-corrected visual acuity (BCVA) values in logarithm of the minimum angle of resolution (LogMAR) pre, post 1 month, 3 months, 6 months showed statistically significant improvement in VA with P value <0.001. The most common complications as number of cases seen in our study were cystoid macular edema (four cases), Descemet membrane folds (three cases), epiretinal membrane (five cases), exposed suture knots (one case), iatrogenic retinal break (two cases), iatrogenic retinal touch (two cases), IOL edge glare (one case), IOL tilt (one case), secondary glaucoma (three cases), post-op uveitis (one case), retinal detachment (one case), no complications 73 cases out of total cases. The mean BCVA improved from preoperative to postoperative 1 day, 1 month, 3 months, and 6 months (P < 0.001) using this technique. This technique, which is more time-consuming, offers advantages over other available options, including improved stability, reduced risk of complications, and enhanced visual outcome.

To study risk factors for Nd:YAG capsulotomy (YAG-CT) due to visually disturbing posterior capsule opacification (PCO) after combined cataract surgery and vitrectomy, phaco-vitrectomy (PhV). Single-center retrospective comparative cohort study. We included 196 patients (197 eyes) undergoing PhV. Electronic medical records provided baseline patient data, data on indication for vitrectomy, surgery data including intra-ocular lens (IOL) type, complications, and YAG-CT incidence during 6-year follow-up after PhV. Univariate and multivariate regression analyses assessed associations of various factors with YAG-CT incidence. Fifty-four eyes (27.41%) underwent YAG-CT during the follow-up period. One of the three hydrophilic acrylic IOLs showed the lowest YAG-CT incidence. Adjusted Odds Ratios (aORs) for YAG-CT were significantly higher for the hydrophobic acrylic IOL (aOR = 5.85, p < .05), and the two other hydrophilic acrylic IOLs (aOR = 29.0, p < 0.001 and aOR = 79.4, p < 0.001). Compared with PhV for macular hole, PhV for epiretinal membranes (aOR = 9.9, p < 0.01), retinal detachment (aOR = 25.4, p < 0.01), and silicon oil removal (aOR = 22.4, p < 0.05) correlated with higher YAG-CT incidence. Type 2 diabetes correlated with increased YAG-CT incidence (aOR = 6.7, p < 0.01). IOL type is a key factor in development of visually disturbing PCO after phacovitrectomy. One hydrophilic acrylic IOL outperformed other examined IOLs in reducing YAG-CT incidence after PhV. Retinal disease, as well as type 2 diabetes, correlated with YAG-CT, and should motivate a choice of an IOL type associated with a low YAG-CT incidence for PhV.

Objective: To report the recurrence of peripheral angle synechiae (PAS) in primary angle-closure glaucoma (PACG) after phacoemulsification combined with intraocular lens implantation and goniosynechialysis (PEI-GSL) during an intermediate-and long-term follow-up. Methods: This retrospective case series included patients with acute or chronic PACG who underwent PEI-GSL performed by the same surgeon at the Eye Hospital of Wenzhou Medical University between January 2017 and December 2019, with complete postoperative gonioscopic records. The primary outcome measures were the incidence and extent (in clock hours) of recurrent PAS at the last follow-up. The secondary outcomes included the surgical success rate, intraocular pressure, and the number of intraocular pressure-lowering medications. The intergroup comparisons were performed using the generalized estimating equation. The intragroup comparisons before and after surgery were analyzed using the Wilcoxon signed-rank test. The categorical data were compared using the Chi-square test or Fisher's exact test. Results: A total of 57 patients (69 eyes) were included, with a mean follow-up of 23.3±9.0 months. Among them, 37 patients (41 eyes) had acute PACG [9 males (24.3%), 28 females (75.7%); mean age, (68.6±8.6) years], and 20 patients (28 eyes) had chronic PACG [8 males (40.0%), 12 females (60.0%); mean age, (65.1±8.8) years]. There were no statistically significant differences in gender or age between the two groups (both P>0.05). At the last follow-up, 46.4% (32/69) of eyes maintained a full-circle anterior chamber angle opening or had only several spot adhesions, 82.6% (57/69) had PAS limited to one quadrant, and 89.9% (62/69) had PAS involving fewer than 6 clock hours. The recurrence rate of PAS was 31.9% (22/69) in all eyes, while it was 26.8% (11/41) in eyes with acute PACG, and 39.3% (11/28) in eyes with chronic PACG, with no statistically significant difference (χ²=1.92, P=0.165). However, the extent of recurrent PAS was greater in chronic PACG patients [4.50 (2.50, 8.50) clock hours] than in acute PACG patients [3.00 (1.50, 4.50) clock hours], and this difference was statistically significant (Wald χ²=5.39, P=0.020). Conclusions: Approximately 30% of eyes with PACG develop recurrent PAS after PEI-GSL, but 90% maintain an angle opening over 180°.

Generative Artificial Intelligence for Postoperative Parameters Prediction in Implantable Collamer Lens Surgery.

Cataract is the leading cause of treatable blindness worldwide. Cataract surgery has undergone significant evolution in recent decades, with phacoemulsification becoming the technique of choice in developing countries. This study aims to analyze the characteristics of cataract surgery techniques performed at Banten Regional General Hospital in 2024. This study used a descriptive research design with a cross-sectional approach. Data were obtained from medical records of patients who underwent cataract surgery at Banten Regional General Hospital from January to December 2024. Inclusion criteria included all patients who underwent cataract surgery at Banten Regional General Hospital in 2024. Exclusion criteria included incomplete medical records. Based on the research, a total of 631 cataract surgery cases were found in 2024. The distribution of surgical techniques showed phacoemulsification with intraocular lens (IOL) implantation as the dominant technique, with 625 cases (99.0%), followed by extracapsular cataract extraction (ECCE) with 3 cases (0.5%), and other procedures each with 1 case (0.2%). Monthly distribution showed the highest peak in August (96 cases, 15.2%) and the lowest in December (19 cases, 3.0%). In conclusion, phacoemulsification with IOL is the most dominant cataract surgery technique at Banten Regional General Hospital in 2024, demonstrating the adoption of modern technology in ophthalmology services at regional hospitals.

Objective assessment of accommodation with an accommodative intraocular lens: Development of methodology and case report.

Aphakia in the absence of adequate capsular or zonular support remains one of the most demanding challenges in anterior segment surgery. The condition may arise secondary to trauma, hereditary connective tissue disorders such as Marfan syndrome, complicated cataract surgery, or long-term pseudophakia with in-the-bag intraocular lens (IOL) dislocation. Our study describes outcomes of a modified two-point Canabrava scleral fixation technique, using 6-0 polypropylene sutures, combined with cerclage pupilloplasty for anterior segment reconstruction in eyes with zonular and iris damage. In our study, eight eyes have been treated with modified two-point scleral fixation between 2021 and 2025. The treatment involves external docking of the suture, elimination of intraocular docking combined with cerclage pupilloplasty, where it is indicated. Mean preoperative best-corrected visual acuity is 0.05 ± 0.04, improved to 0.80 ± 0.14 at 1 month. Mean intraocular pressure decreased from 21.0 ± 8.7 mmHg to 14.3 ± 1.2 mmHg. All IOLs remained well-centered, pupils were round and reactive, and no intraoperative/postoperative complications occurred. The main limitation of this case series is the retrospective design and limited sample size of eight cases using the modified technique. A larger, prospective comparative study with long-term follow-up is needed to confirm these preliminary results and to assess potential late flange degradation or suture-related changes beyond 2–3 years. This modification simplifies scleral fixation by externalizing the docking step, offering a safe, minimally invasive method in complex eyes with absent capsular support.

The aim of this study was to assess the effect of including lens thickness (LT) in modern intraocular lens (IOL) formulas and evaluate the influence of ocular biometric parameters on IOL power calculation accuracy in short and normal axial length (AL) eyes. This retrospective cohort study included 174 eyes (74 short AL < 22mm, 100 normal AL 22-24mm). Preoperative biometry was obtained using IOLMaster 700. Predicted refractions were calculated using SRK/T, Haigis, Barrett Universal II (BUII), Kane, and Emmetropia Verifying Optical (EVO) formulas, with and without LT. Spearman correlation and multivariate regression analyses were performed to identify biometric predictors of refractive error. Short eyes had significantly shallower anterior chamber depth (ACD), smaller white-to-white (WTW), thicker LT, and higher mean keratometry (Km) and corneal astigmatism (CA) (all p < 0.01). No significant differences in mean absolute error (MAE) were detected between most formula pairs after adjustment in either subgroup. LT inclusion resulted in a less myopic mean prediction error in both subgroups (all p < 0.01), but MAE improvements were only seen in normal eyes (p < 0.05). AL and WTW were consistent predictors of absolute prediction error (APE) overall, with shorter AL and smaller WTW associated with greater APE. In short eyes, AL showed the strongest association with APE, whereas in normal eyes, WTW was most strongly correlated with APE. Short eyes exhibited greater biometric variability. Incorporation of LT improved the overall prediction accuracy of modern IOL formulas, particularly in normal AL eyes. AL and WTW were the most influential biometric factors affecting refractive prediction outcomes. Chinese Clinical Trial Registry (ChiCTR), ChiCTR2600116749; retrospectively registered on 14 January 2026.

Accuracy of sixteen axial length adjusted intraocular lens power calculation formulas in long Caucasian eyes.

Background/Objectives: Standardized reporting of astigmatism outcomes is essential for comparability, reproducibility, and interpretation of refractive surgery studies. Vectorial analyses based on established metrics are increasingly required by major journals, yet no freely available tool exists for generating publication-ready vector analysis tables with statistical comparisons. This study presents AstigMETRICS, a standalone application for automated calculation, formatting, and statistical comparison of standard vector metrics in refractive surgery. Methods: AstigMETRICS was developed in MATLAB and compiled as a standalone executable requiring no programming knowledge. The software accepts preoperative, intended, and postoperative astigmatism data in spreadsheet format for both refractive and corneal measurements. It calculates seven standard vector metrics following the Alpins method: the target-induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), correction index (CI), magnitude of error (ME), angle of error (AE), and index of success (IOS). Statistical comparisons are performed automatically using appropriate parametric or nonparametric tests for paired and unpaired study designs, with p-values and Cohen's d effect sizes reported. Results: AstigMETRICS generates standardized tables reporting the means, standard deviations, and clinically relevant proportions (percentage of eyes with an ME within ±0.50 D or ±1.00 D, and an AE within ±15°). Three simulated datasets were created to validate the software functionality across common surgical scenarios: a contralateral eye laser vision correction, toric phakic IOL implantation, and cataract surgery with toric IOLs. The output tables are displayed in standardized format and saved as high-resolution TIFF images suitable for publication. The software is freely available and a download link is provided in this article. Conclusions: AstigMETRICS enables clinicians and researchers to perform standardized, reproducible astigmatism vector analyses with built-in statistical comparisons. This freely available tool simplifies outcome reporting and improves methodological consistency in refractive surgery research.

Reasons for dissatisfaction after implantation of extended depth-of-focus and trifocal intraocular lenses: a retrospective case series.

Purpose To assess the clinical performance and patient-reported outcomes of a new trifocal intraocular lens (IOL) over a 6-month follow-up period. Methods Prospective, non-comparative, single-center study including 20 eyes (10 patients, age, 47-79 years) undergoing bilateral cataract surgery with implantation of the trifocal diffractive IOL AT ELANA 841 P (Carl Zeiss Meditec, Jena, Germany). Visual acuity (VA) and refraction changes were evaluated over a 6-month follow-up period. Likewise, other clinical and patient reported outcomes were analyzed: binocular defocus curve (1 month), patient satisfaction and vision-related difficulties (Catquest 9SF, 3 months), photopic and mesopic contrast sensitivity (CS) and photic phenomena (6 months). Results The 6-month postoperative spherical equivalent was within ±1.00 and ±0.50 D in 100% and 85% of cases, respectively. Mean binocular 6-month postoperative uncorrected distance, intermediate and near VA of -0.12 ± 0.06, -0.02 ± 0.06 and 0.06 ± 0.09 logMAR, respectively. Mean binocular 6-month postoperative distance-corrected intermediate and near VA were 0.00 ± 0.05 and 0.04 ± 0.08 logMAR. VA in the defocus curve remained ≤0.10 logMAR across defocus levels ranging from +0.50 D to −3.00 D. All CS values fell within the normal range, except for the 18 cycles/° spatial frequency measured under mesopic conditions with glare. Postoperatively, 90% of patients reported no vision-related difficulties in daily life and all patients reported being "very satisfied" postoperatively. A web-based simulator confirmed that photic phenomena were minimally disruptive postoperatively Conclusions The trifocal IOL evaluated provides preliminarily a successful distance, intermediate and near visual rehabilitation, with high levels of patient satisfaction and visual quality associated.