Lens Implantation Research Articles

Dysfunctional lens syndrome: a literature review

Introduction. The term “Dysfunctional Lens Syndrome” (DLS) refers to age-related changes in the lens, including early cataracts and presbyopia, that do not significantly reduce visual acuity. This syndrome is characterized by a decrease in accommodative amplitude, an increase in light scattering, and a reduction in contrast sensitivity. With rising life expectancy, the prevalence of DLS is increasing, necessitating a more in-depth study of the pathogenic mechanisms underlying the syndrome and the refinement of its diagnostic criteria to establish standards for treatment correction. Aim: to summarize information on the pathogenesis of DLS, the potential for staging the syndrome using objective examination methods, and to provide treatment recommendations. Materials and methods. A bibliographic study of scientific publications was conducted using the Pubmed, ScienceDirect, and Cyberleninka databases. Literature sources were searched using the following keywords: dysfunctional lens syndrome (DLS), presbyopia correction, cataract, age-related lens changes. A total of 32 publications, primarily from the last 10 years, were included in the study from more than 100 viewed sources. Results. The DLS encompasses a wide range of conditions, from early stages characterized by a loss of accommodative amplitude and minor refractive anomalies to later stages involving a decrease in visual acuity and quality due to increased light scattering and aberrations. Currently, the evaluation of age-related lens changes involves assessing visual acuity and determining the degree of lens opacification using slit-lamp examination. Additionally, objective instrumental methods, such as optical coherence tomography and Scheimpflug imaging, can be used to assess the degree of lens opacification. Various methods are employed for the correction and treatment of DLS, ranging from glasses and contact lenses to surgical interventions, such as lens extraction and intraocular lens implantation. Research is also ongoing into drugs aimed at slowing the progression of lens changes. Conclusion. The term “Dysfunctional Lens Syndrome” is currently used to describe early cataracts and presbyopia, where the reduction in visual acuity is still minor, but patients experience visual complaints due to age-related lens changes. Further research is necessary to develop and standardize diagnostic criteria and to evaluate the effectiveness of new treatment methods and interventions in order to create the most effective and adequate approach to correcting DLS and alleviating the associated visual complaints.

Phacoemulsification with Either Endocyclophotocoagulation or Ab-Interno Canaloplasty with or without Trabeculotomy in Uveitic Glaucoma

ABSTRACT Purpose Understanding the current role and efficacy of endocyclophotocoagulation (ECP) compared to ab-interno canaloplasty with or without trabeculotomy (OMNI), combined with cataract extraction and lens implantation (CEIOL), for the management of uveitic glaucoma (UG) is limited. Methods All UG patients ≥18 years old with ≥6 months of follow-up data (15.2 ± 5.9 months) after CEIOL combined with either ECP or OMNI from August 2019 to May 2022 at a single academic center were retrospectively reviewed [22 eyes of 15 patients (8 ECP, 14 OMNI)]. Surgical success was considered intraocular pressure (IOP) ≤21 mmHg and a reduction of baseline by ≥20% for two consecutive final visits without hypotony, additional surgery, or loss of light perception. Uveitic control was considered a <2-step increase in anterior chamber (AC) cell grade, <3+ AC cell grade, and no increase in steroid drop use at 3 months postoperatively. Secondary outcome measurements included postoperative change in IOP, glaucoma medications, best corrected visual acuity (VA), AC cell grade, and steroid drop frequency. Results Baseline ocular and preoperative characteristics of eyes (age, sex, laterality, uveitic location, systemic immunomodulating therapy, visual acuity, IOP, number of glaucoma medications, AC cell grade, and steroid drop frequency) did not significantly differ except for greater racial diversity in the ECP group. 62.5% eyes were surgically successful in the ECP group and 85.71% in the OMNI. Between-group analysis showed greater IOP reduction in the OMNI group (p < .05), but no difference in reduction of glaucoma medications (p = .33). No eyes displayed a two-step increase in or >3+ AC cell grade, however, 50% and 64.29%, respectively, increased steroid drop use. Between groups, no difference in the change of AC cell grade (p = .98) or steroid drop use (p = .84) was seen. Conclusions Both interventions improved visual acuity, IOP, and glaucoma medication use, however, OMNI was more successful at reducing IOP long term. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to underlying uveitis regardless of surgical approach.

Using First Eye Early Vault to Determine ICL Size for the Second Eye: A Retrospective Analysis of Bilateral Phakic Intraocular Lens Implantation.

To evaluate the role of the first eye vault after the implantation of implantable collamer lens (ICL) V4c in selecting ICL size for the second eye and analyze the changing characteristics of the vault. Qingdao Eye Hospital of Shandong First Medical University. Retrospective case series. In this retrospective study, 509 patients (1018 eyes) receiving bilateral ICL V4c implants were evaluated. Surgical management method was as follows: the vault was measured at 2 hours after the first eye surgery, and we selected ICL size for the second eye based on the vault of the first eye. The bilateral vault was measured and evaluated between different periods of follow-up. The rate of ICL re-alignment or exchange due to abnormal vault was 1.47% (15/1018), with the second eye showing a significantly lower incidence (0.39%) compared to the first eye (2.55%)(P<0.01). Patients were categorized into four groups based on the vault value obtained at 2 hours postoperatively (baseline). There was significant difference in the value of vault decrease among the four groups at 1day, 1week, 1month, and 3months follow-up(all P<0.01). There was a significant positive correlation between the decrease in the vault and the baseline vault(all P < 0.01). Selecting the ICL size for the second eye based on the first eye's vault measurement 2 hours postoperatively can effectively minimize the need for further surgeries. Notably, eyes with a higher initial vault experienced a more pronounced decrease.

Refractive Error after Toric Intraocular Lens Implantation in a Patient with Bilateral Posterior Keratoconus

Refractive Error after Toric Intraocular Lens Implantation in a Patient with Bilateral Posterior Keratoconus

Assessing the clinical efficacy of phacoemulsification cataract extraction in treating acute primary angle closure and fellow primary angle closure suspect eyes using AS-OCT.

This study aimed to compare anterior segment parameters pre-and postoperatively in acute primary angle closure (APAC) and fellow primary angle closure suspect (PACS) eyes using anterior segment optical coherence tomography (AS-OCT) and evaluate the clinical effectiveness of cataract extraction in the treatment of APAC and fellow PACS eyes. Quantitative measurements of various parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), iridocorneal angle contact index (ITCI), iris thickness (IT), iris volume (IV), and iris curvature (IC), were obtained using Tomey CASIA2 AS-OCT on 60 eyes from 30 patients (APAC eyes and their fellow PACS eyes) before and after surgery. Simultaneous analysis of the differences between the APAC eyes and fellow PACS eyes in these parameters, visual acuity (VA), and intraocular pressure (IOP) were performed. After surgery, both the APAC eyes and fellow PACS eyes (a total of 60 eyes) showed a significant increase in ACD and ACV, compared to preoperative measurements. Furthermore, LV and ITCI significantly decreased postoperatively. In the PACS group, IC significantly decreased postoperatively, while there was no statistically significant difference in the APAC group. In the APAC group, there was a significant decrease in IOP and improvement in VA at 1 day, 1 week, and the final follow-up compared to preoperative levels. The IOP values in the PACS group were within the normal range across various time points. VA in the PACS group showed significant improvement at 1 week postoperatively and at the final follow-up compared to preoperative levels. Significant differences of VA were observed in the initial, preoperative, first postoperative day, first postoperative week, and final follow-up, with better outcomes observed in the PACS group compared to the APAC group. Lens extraction surgery can significantly improve anterior segment crowding in APAC and PACS eyes. For APAC eyes, combined cataract extraction with intraocular lens implantation and gonioscopy-assisted goniosynechialysis under direct visualization is feasible and safe. Further, in the fellow PACS eye of APAC patients with either significant or mild cataracts, phacoemulsification can maintain or improve preoperative visual acuity to varying degrees and stabilize IOP.

Digital versus manual axis marking for toric phakic intraocular lens alignment: a prospective randomized intraindividual trial.

This study compares visual and refractive outcomes and postoperative axis alignment for toric Implantable Collamer Lens (ICL) implantation in astigmatic myopia using manual versus digital marking techniques. Department of Ophthalmology, Medical University of Graz, Austria. Prospective randomized single-centered intraindividual comparison. Patients undergoing bilateral toric ICL implantation for myopia with astigmatism ≥ 0.5 diopters (D) were enrolled. Patients received both marking techniques and randomization was performed. Postoperative retroillumination photography assessed axis alignment, and visual and refractive parameters were evaluated. Duration of the surgeries was recorded. The study includes 20 patients and 40 eyes. Preoperative visual and refractive parameters showed no significant differences. Postoperatively, residual astigmatism (p=0.824) and spherical equivalent (p=0.309) were comparable. No notable differences between right and left eyes in terms of preoperative (p=0.371) and postoperative (p=0.824) astigmatism were observed. Although slight, corrected distance visual acuity (CDVA) increased in both groups postoperatively (p=0.381). Gain in CDVA was comparable between marking techniques (p=0.637). Safety and efficacy indices were comparable (p=0.991 and p=0.189, respectively). Postoperative axial misalignment was 2.8±3.1 degrees in the digital- and 4.4±5.1 degrees in the manual group (p=0.260). Vector analysis showed no significant differences between manual and digital marking. Duration remained uninfluenced by the marking technique (p=0.970) and side of surgery (p=0.682). In conclusion digital and manual marking techniques provided comparable results in axis alignment, surgical duration and visual and refractive outcomes. Both methods are viable for precise axis alignment, with digital marking offering a potential advantage in efficacy.

Evaluation of refractive surgery with posterior chamber intraocular lenses in patients with high myopia treated in an Ophthalmologic Center of the city of Rosario, years 2019-2022

Introduction: Myopia is an ametropia that is highly prevalent and causes loss of visual acuity, characterized by having diopters greater than -5.00. The implantation of a posterior chamber intraocular lens represents a treatment option for those patients who cannot undergo the Excimer Laser technique.Objective: To describe the results achieved with the placement of posterior chamber intraocular lenses in patients with high myopia treated in an ophthalmologic center in the city of Rosario between the years of 2019-2022.Materials and Methods: Quantitative, descriptive, observational, retrospective, retrospective, cross-sectional, non-probabilistic study by convenience. Conducted at Centro Oftalmología Global, a private center specialized in ocular pathologies, located at Bv. Oroño 1003 in the city of Rosario - Santa Fe. Data were collected by review of medical records. The data obtained were entered into a Microsoft Excel database. The data were tabulated for presentation and analysis. Summary measures of central tendency (arithmetic mean, median and mode) and dispersion (standard deviation) and descriptive statistical techniques (frequency distributions, averages and percentages) were used.Results: A total of 38 medical records were studied, of which n=23 (60.5%) were female and n=15 (39.5%) were male. The mean age was 31.2 (SD ±2.84 years; min. 24 and max. 35). The age group with the highest frequency was 30 and 35 with 25 patients (65.8%). Of the total, n=21 (55.3%) were patients with high myopia and n=17 (45.7%) with high myopia and astigmatism. Of n=38, 44.7% presented preoperative visual acuity less than 1/10 and 26.3% of 1/10. Refractometry showed results between -3.00 to -20.00 diopters of sphere and -1.00 to -6.00 diopters of cylinder.Conclusion: It was possible to assess that 86.8% of the patients who underwent refractive surgery were able to achieve an optimal visual quality (10/10) after LCI placement, and of the total number of patients (n=38) studied, only 5 (13.2%) presented complications in the postoperative period

Miniscope Recording Calcium Signals at Hippocampus of Mice Navigating an Odor Plume.

Mice navigate an odor plume with a complex spatiotemporal structure in the dark to find the source of odorants. This article describes a protocol to monitor behavior and record Ca2+ transients in dorsal CA1 stratum pyramidale neurons in the hippocampus (dCA1) in mice navigating an odor plume in a 50 cm x 50 cm x 25 cm odor arena. An epifluorescence miniscope focused through a gradient-index (GRIN) lens imaged Ca2+ transients in dCA1 neurons expressing the calcium sensor GCaMP6f in Thy1-GCaMP6f mice. The paper describes the behavioral protocol to train the mice to perform this odor plume navigation task in an automated odor arena. The methods include a step-by-step procedure for the surgery for GRIN lens implantation and baseplate placement for imaging GCaMP6f in CA1. The article provides information on real-time tracking of the mouse position to automate the start of the trials and delivery of a water reward. In addition, the protocol includes information on using an interface board to synchronize metadata describing the automation of the odor navigation task and frame times for the miniscope and a digital camera tracking mouse position. Moreover, the methods delineate the pipeline used to process GCaMP6f fluorescence movies by motion correction using the NorMCorre algorithm followed by identification of regions of interest with EXTRACT. Finally, the paper describes an artificial neural network approach to decode spatial paths from CA1 neural ensemble activity to predict mouse navigation of the odor plume.

Corneal Endothelial Cell Loss During Uneventful Cataract Surgery in Hispanics Versus Non-Hispanics.

Limited information exists on the possible effects of ethnicity on corneal endothelial cell parameters and their changes during cataract surgery. Thus, we evaluated corneal endothelial cell density (ECD) and endothelial cell loss (ECL) during surgery for senile cataract in Hispanic and non-Hispanic White adults. This retrospective study included 312 eyes of 227 patients ≥50 years who underwent phacoemulsification with intraocular lens implantation for senile cataract. Preoperatively and 1 to 2 months after surgery, specular microscopy was performed to measure ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX). Regression analysis was used to compare baseline values as well as surgery-related changes in corneal endothelial cell parameters between Hispanic and non-Hispanic patients considering demographics, biometric parameters, and intraoperative cumulative dissipated energy (CDE). There were 109 Hispanics and 118 non-Hispanics. Anterior chamber depth (ACD) was significantly lower in Hispanics (3.12±0.36 mm) compared with non-Hispanics (3.25±0.37 mm, P=0.009). There were no significant differences in baseline ECD between Hispanics (2,547±365 cells/mm2) and non-Hispanics (2,483±380 cells/mm2, P=0.17). There were also no significant differences in ECL (16.8%±17.0% vs. 17.4%±18.1%, P=0.46), increase in CV (3.8%±20.7% vs. 1.5%±21.6%, P=0.51), and decrease in HEX (-2.7%±8.5% vs. -1.8%±7.0%, P=0.33) between these two groups. Regression analysis showed that ECL was associated with a shallower ACD (P=0.003), a higher CDE (P<0.001), but not with ethnicity (P=0.46). There are no significant differences in ECD and ECL between Hispanics and non-Hispanics undergoing cataract surgery. Although Hispanics have a shallower ACD, the ethnic difference seems to be clinically insignificant.

Comparing clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis for myopia

BackgroundTo compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK).MethodsA retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence.ResultsA total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night.ConclusionsCataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients’ satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups.

Effect of posterior chamber phakic refractive lens implantation on the ocular surface and tear film

To evaluate changes in dry eye-related parameters after posterior chamber phakic refractive lens (PC-PRL) implantation. This prospective study included 21 highly myopic patients (39 eyes) who underwent PC-PRL implantation at Lanzhou Huaxia Eye Hospital between January 2021 and June 2022, with a 3-month postoperative follow-up. In addition to routine preoperative examinations, dry eye assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These assessments included the Ocular Surface Disease Index (OSDI) questionnaire score, non-invasive first tear break-up time (NIF-BUT), non-invasive average tear break-up time (NIA-BUT), tear meniscus height (TMH), meibomian gland loss (MGL) rate, and Schirmer I test (SIt). Repeated measures ANOVA was used to compare the differences in parameters across different time points, with pairwise comparisons conducted using the LSD-t test. After grouping, the Student's t-test was applied to compare normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-square test. A total of 21 patients (39 eyes) were included, comprising 10 males (19 eyes) and 11 females (20 eyes), aged 19 to 49 years (33.76 ± 7.87). All patients completed the 3-month follow-up. Significant differences in OSDI scores were observed pre- and post-surgery (P = 0.008), with a peak at one week post-surgery (P < 0.001), then stabilizing at one and three months post-surgery. Postoperative NIF-BUT and NIA-BUT significantly decreased (P < 0.001 for both) but returned to preoperative levels within three months. There were no significant changes in TMH, MGL, or SIt postoperatively (P > 0.05). Significant differences in dry eye parameters were observed between the dry eye and control groups before and after surgery (P < 0.001). PC-PRL implantation impacts tear film stability on the ocular surface after surgery, leading to varying degrees of dry eye symptoms in patients. After surgery, all dry eye parameters return to their preoperative levels within three months.

Comparison of two digital alignment systems for toric intraocular lens implantation

PurposeTo compare the two most used digital alignment systems regarding precision, repeatability and loss of track.Methods15 eyes of 15 patients older than 21 years with cataracts were included in this...

A clinical study on evaluation of risk factors and visual outcome after phacoemulsification in presenile cataract patients

To evaluate the risk factors, types of pre senile cataract and to assess the visual outcome after phacoemulsification and intraocular lens implantation in pre senile cataract.This was a hospital based cross sectional study of 90 patients who presented to Ophthalmology OPD of a tertiary care hospital and was diagnosed to have pre senile cataract. The study was done from June 2020 to November 2021. Patients who gave written informed consent were included in the study. Detailed history was taken regarding the age, gender, risk factors such as diabetes mellitus, myopia, occupation, smoking, corticosteroid use, dermatological disease etc. All the patients were subjected to routine ophthalmological evaluation. All the patients underwent phacoemulsification and IOL implantation. Visual acuity was noted before and after the surgery. The risk factors for pre senile cataract and visual acuity before and after cataract surgery was statistically analysed.Out of 90 patients included in the study, 60% were females Mean age at presentation was 42.94 ±5.93 years. Most common cause of pre senile cataract was diabetes mellitus (42.2%) followed by tobacco consumption (20%) and dermatological diseases (15.6%). Posterior subcapsular cataract was the most common type of cataract seen among young population and it has been significantly associated with diabetes mellitus. 87.8% had a best corrected visual acuity of 6/6-6/9 after phacoemulsification surgery. In this study diabetes mellitus and tobacco consumption are the two strongest modifiable risk factors for cataractogenesis in younger working population which is mainly because of the lifestyle changes. Majority of the patients attained a good visual acuity post phacoemulsification and IOL implantation surgery.

Visual outcome of cataract surgery by phacoemulsification in diabetic versus non-diabetic patients: A comparative study

This study aims to evaluate and compare the results of phacoemulsification cataract surgery performed on diabetic patients with those of non-diabetic patients. The primary objective was to compare the visual outcome of phacoemulsification cataract surgery in diabetic patients and non-diabetic patients, and the secondary objective was todetermine the final visual outcome following phacoemulsification cataract surgery in diabetics and non-diabetics.A comparative study of the overall 300 eyes of the patients, in which 150 eyes were diabetic and 150 eyes were non-diabetic, underwent phacoemulsification cataract surgery with posterior chamber intra ocular lens implantation. Age, sex, follow-up, preoperative and postoperative best corrected visual acuity and post-operative complications were evaluated. Out of the 300 eyes of the patients, 150 eyes were diabetic and 150 eyes were non-diabetics. Phacoemulsification with posterior chamber intra ocular lens implantation was done in all patients. Follow up duration was 6 weeks. Postoperatively, 6 weeks after surgery, 31.7% of patients had BCVA of 6/9 or better in diabetic group while 36.3% of patients had BCVA of 6/9 or better in non-diabetic group. The difference in BCVA between two groups at postoperative 6 weeks was found to be statistically significant p value of &amp;#60;0.001. Post-operative complications included wound leak, striate keratopathy, folds in descemets membrane, corneal haze or edema, iritis, posterior capsular rent, cystoid macular edema, iridodialysis. The incidence was higher in the diabetic group as compared to non-diabetics. Overall, the final visual outcome was better in non-diabetic group as compared to diabetic group. Diabetics are more likely to develop intra operative and postoperative complications. Thus, special care should be used both throughout the surgical procedure and the post-operative period.

The impact of postoperative nasal oxygen therapy on early-stage corneal edema in cataract patients with dynamic Scheimpflug analyze: A retrospective study.

This study aimed to assess the impact of 6 hours of postoperative nasal oxygen therapy on early-stage corneal edema in patients with nuclear cataracts of grades 3 to 4. A retrospective study involved 49 patients (49 eyes) with grades 3 to 4 nuclear cataracts undergoing phacoemulsification and intraocular lens implantation from September 2021 to September 2022. The oxygen group (27 cases) received postoperative nasal oxygen therapy for 6 hours, while the control group (22 cases) received no additional treatment. Corneal edema was evaluated 24 hours postoperatively using a slit lamp microscope, recording the edema degree. The Pentacam anterior segment analyzer measured central corneal thickness (CCT), corneal volume (CV), and corneal optical density (COD) values preoperatively and 24 hours postoperatively. The study enrolled 49 patients. Preoperatively, there were no significant differences between the 2 groups. The oxygen group and the control group exhibited significant differences in CCT, CV, and corneal optical density values before and after surgery for intragroup comparison (all P < .05). At 24 hours postoperatively, the proportion of grade 0 corneal edema in the oxygen therapy group was 59.3%, compared to 31.8% in the control group, with no statistically significant difference (P > .05). The postoperative logMAR visual acuity in the oxygen therapy group was 0.0969 (0.0969, 0.2218), and in the control group it was 0.0969 (0.2218, 0.3979), with a statistically significant difference (P < .05). In oxygen group, the CCT, CV were 585.00 (553.00, 604.00), 68.0 (61.9, 71.3) respectively, all significantly lower than 603.50 (578.50, 788.25), 73.05 (65.3, 75.73) (all P < .05). Statistically significant differences were found in overall COD, COD within specific depth and thickness ranges, and COD within the anterior layer (120 μm thickness) at 24 hours postoperatively (all P < .05). No significant difference was observed in COD values within the central and posterior layers (60 μm thickness) between the 2 groups (all P > .05). Postoperative nasal oxygen therapy for 6 hours immediately after surgery could alleviate the severity of early-stage corneal edema in patients with nuclear cataracts of grades 3 to 4.

Clinical effect of XEN gel stent implantation or combined with phacoemusification and intraocular lens implantation on glaucoma

Objective: To evaluate the efficacy and safety of internal XEN gel stent implantation or combined with phacoemusification and intraocular lens (IOL) implantation in the treatment of glaucoma. Methods: It was a retrospective case series study. Forty-five patients (28 males and 17 females; 52 eyes) who had different types of glaucoma treated at the Shenzhen Eye Hospital from December 2021 to June 2023 were included. XEN gel stent implantation (the XEN group) or XEN implantation combined with phacoemusification and IOL implantation (the combined group) were performed in these patients. The postoperative follow-up was 18 months. The observational indexes included the best corrected visual acuity (recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), XEN implantation quadrant, number of IOP-lowering medications, corneal endothelial cell count, operation success rate and surgical complications. The one-way repeated measures of variance, LSD-t test, and rank sum test were used for statistical analysis. Results: There were 28 patients (33 eyes) in the XEN group and 17 patients (19 eyes) in the combined group. The postoperative best corrected visual acuity had no significant change in the XEN group, but improved significantly (0.21±0.30 at 6 months; P<0.05) in the combined group, compared with the preoperative value. The IOP of the two groups at 18 months after surgery [(12.2±3.1) and (11.9±3.9) mmHg (1 mmHg=0.133 kPa)] was significantly lower than that before surgery [(22.1±8.5) and (19.4±10.2) mmHg; P<0.05]. The average number of IOP-lowering medications in all patients was 3 (2, 3) before surgery and 0 (0, 0) at 18 months after surgery. The difference was statistically significant (P<0.05). In the XEN group, the corneal endothelial cell count was (2 387.37±478.22) cells/mm² preoperatively and (2 193.89±311.96) cells/mm² at 12 months. The decrease showed no statistical significance. The XEN gel stent was implanted in the supranasal quadrant in 8 eyes (15.4%), in the inferonasal quadrant in 36 eyes (69.2%), and in the infratemporal quadrant in 8 eyes (15.4%). The operation success rate [complete success rate, 86.5% (45/52); conditional success rate, 9.6% (5/52)] was 96.2% (50/52). The filtering bleb scarring occurred in 9.6% (5/52) of eyes. A small amount of hyphema, postoperative shallow anterior chamber, transient hypertension, and intraoperative drain breakage were found in 7.7% (4/52) of eyes, respectively. A small amount of subconjunctival bleeding was observed in 5.8%(3/52) of eyes. Re-implantation of an XEN gel stent was performed in 5.8% (3/52) of eyes. The intraoperative conjunctival tissue rupture, hypotony macular edema, and drain exposure were observed in 1.9% (1/52) of eyes, respectively. Conclusion: The XEN gel stent implantation or combined with phacoemusification and IOL implantation was effective and safe in treating different types of glaucoma, but its long-term clinical efficacy needs further follow-up observations in multi-center, larger-scale research.

Focusing on issues about phacoemulsification lens extraction combined with goniosynechialysis

Angle closure is a basic pathological process in primary angle-closure glaucoma. Unlike filtration anti-glaucoma surgery, goniosynechialysis is a treatment for the cause of primary angle-closure glaucoma by reconstructing the physiological aqueous outflow pathway. In the past 10 years, phacoemulsification lens extraction with posterior chamber intraocular lens implantation in combination with goniosynechialysis for the treatment of primary angle-closure glaucoma has become a hot topic of clinical research and discussion. This article points out the issues that need to be paid attention to in the clinical practice of the combined surgery, including the relationship between phacoemulsification surgery and goniosynechialysis, the effectiveness and influencing factors of the combined surgery, and how to avoid the postoperative re-adhesion of the angle, in order to provide reference and guidance for better goniosynechialysis.

Clinical efficacy evaluation of the implantation of a diffractive trifocal intraocular lens in high myopia eyes: Two-year follow-up.

To evaluate the long-term subjective and objective visual quality after implantation of a diffractive trifocal intraocular lens (IOL) in high myopic eyes. A total of 53 eyes from 38 patients with high myopia who underwent phacoemulsification and trifocal IOL implantation were investigated. The visual acuity, contrast sensitivity, diopter, defocus curve, and objective visual quality at 1 month, 3 months, 1 year, and 2 years after surgery, as well as the satisfaction questionnaire and VF-14 scale, were statistically analyzed. The average age was 53.14 ± 4.70 years. The average preoperative spherical equivalent was -10.77 ± 3.98 D. Two years after surgery, 94.3% of the patients achieved an uncorrected distance visual acuity of 0.1 (LogMAR), and 84.9% and 94.3% of the patients had SE within ±0.50 D and ±1.0 D, respectively. The defocus curve was smooth and at a high value within the range of 0 D to -2.50 D. In CS or objective visual quality, there was no significant difference at 3 months, 1 year, and 2 years after operation (all P > 0.05). The rate of spectacle independence was 100%. The proportion of patients with moderate or severe glare and halo was 10.5% and 13.2%, respectively. Furthermore, 23.7%, 26.3%, and 18.4% of the patients had difficulties in reading small font, doing delicate tasks, and driving or riding at night, respectively. The diffractive trifocal IOL implantation provided good distance, intermediate, and near uncorrected visual acuity for patients with cataracts and high myopia. It was safe, effective, predictable, and stable. It provided long-term good visual quality after surgery, with high spectacle independence and high patient satisfaction.

Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study

Plain Language SummaryIn this study, we analyzed the occurrence of acute endophthalmitis following secondary intraocular lens (IOL) implantation in South Korea. Using data from the National Health Insurance Service (NHIS)-National Health Information Database (NHID), we identified patients who underwent secondary IOL implantation or IOL exchange between 2002 and 2021 due to IOL dislocation or mechanical IOL complications. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. Out of 39,364 patients who received secondary IOL implantation during the study period, acute POE was diagnosed in 62 patients, resulting in an overall incidence of 0.16%. The majority of POE cases were identified within the first-week post-surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in patients with pre-existing glaucoma and those who underwent concurrent vitrectomy. Our findings suggest that the incidence of acute endophthalmitis following secondary IOL implantation in South Korea was similar to that of other nations. This study, based on retrospective claims data, represents the largest study of its kind in South Korean patients.

Functional outcomes and quality of life after AcrySof IQ Vivity intraocular lens implantation in a real-world study

The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden’s Quality of Vision test and Morlock’s Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients.