Phakic Eyes Research Articles

Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment Outcomes: IRIS® Registry (Intelligent Research in Sight) Analysis

PurposeTo determine treatment patterns and outcomes of pneumatic retinopexy (PnR) for rhegmatogenous retinal detachments (RRD). DesignRetrospective cohort analysis using IRIS® Registry (Intelligent Research in Sight) database. ParticipantsPatients with RRD treated by PnR from 2013-2022. MethodsCases were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9, ICD-10) diagnostic codes. Surgical procedures were identified using Current Procedural Terminology (CPT) codes for type of RRD repair. Baseline demographic information included age, sex, race and ethnicity, geographic region, smoking status, and health insurance type. Main Outcome MeasuresPrimary outcomes for PnR included single-operation success (SOS) and failure (SOF), change in visual acuity at 9-12 months, rates of complications, rates of secondary procedure following SOF, and outcome by phakic status. Results13,302 unique eyes were analyzed (median age, 64 years, 61.56% male). Overall SOS for primary PnR was 59.82%. The mean BCVA at 9-12 months following PR was LogMAR 0.44 (95% CI: 0.42, 0.46) for SOF eyes, compared to 0.23 (95% CI: 0.22, 0.25) for SOS eyes (P < 0.001). Complications of PR included vitreous hemorrhage (9.1%), ERM (45.17%), proliferative vitreoretinopathy (0.98%), and endophthalmitis (0.14%). Of the 40.18% of eyes with SOF, 81% required either secondary PnR, scleral buckle (SB), vitrectomy (VTX), or complex detachment repair (CDR), whereas the remaining eyes required more than one of these secondary procedures. SOS for phakic eyes was 64.50% versus 53.93% for pseudophakic eyes (P < 0.001). ConclusionsIRIS Registry data reveal real-world outcomes and utilization patterns of PnR for RRD. Overall SOS for primary PnR was 59.82%, which is lower than other cited rates in the literature. Pseudophakic eyes were more likely to fail primary PnR. It is important to counsel patients on risks of the procedure when obtaining informed consent.

Does Laser Iridotomy Cause Secondary Epiretinal Membrane?

This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT). This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not. After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045). LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery.

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report

BackgroundPosterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.Case presentationA 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.ConclusionsThis case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

INTRAVITREAL 0.18-mg FLUOCINOLONE ACETONIDE IMPLANT FOR PEDIATRIC UVEITIS.

This study reports the outcomes of the 0.18-mg intravitreal fluocinolone acetonide implant in the treatment of pediatric noninfectious uveitis. A retrospective cohort study was performed on patients under 18 years old who received fluocinolone acetonide implant between June 1, 2020 and March 1, 2023. Data collected included demographics, uveitis diagnosis, use of anti-inflammatory therapy, visual acuity, intraocular pressure, and grading of uveitis activity. Uveitis recurrence was defined as increased inflammation that required additional anti-inflammatory therapy. Eleven eyes from seven patients were included in this study. One patient (one eye) had a diagnosis of immune recovery uveitis and the remaining six patients (10 eyes) had pars planitis. The rate of remaining recurrence-free was 82% at 6 months, 60% at 12 months, and 60% at 24 months. Two of the six phakic eyes at baseline required cataract extraction during follow-up. Two of the four eyes that did not have intraocular pressure-lowering surgery before implantation required surgery in follow-up. The 0.18-mg fluocinolone acetonide implant has a similar efficacy for the treatment of pediatric uveitis, particularly pars planitis, as in the adult population, although with higher rates of ocular hypertension requiring intervention.

Impact of quality indicators on variability of keratometry measurements using a swept-source OCT based optical biometer.

To characterize the variability of keratometry measurements on the IOLMaster 700, and relate it to device image quality indicators (QI). Two academic centers and one private practice. Multicenter, retrospective consecutive case series. Measurements from three sites, obtained between December, 2015 and July, 2023 were included. Surgery-naïve phakic eyes with same-day sequential measurements on the same eye were identified. Repeat measurement pairs were grouped by IOLMaster QIs (success vs. warning), and changes in mean standard (∆Kmean) and total (∆TKmean) keratometry as well as standard (∆Kastig) and total (∆TKastig) astigmatism vectors were calculated. Analysis was performed on 3,222 eyes of 1,890 patients. Measurement 'success' was associated with a smaller ΔKmean (0.09 ± 0.14 D) and ΔTKmean (0.11 ± 0.16 D) when compared to pairs in which both measurements had a 'warning' [0.25 ± 0.32 D and 0.14 ± 0.17 D, respectively; (p < 0.0001)]. A similarly smaller ∆Kastig (0.26 ± 0.28 D) and ∆TKastig (0.28 ± 0.30 D) was observed with measurement 'success' versus 'warning' [0.77 ± 0.79 D and 0.42 ± 0.41 D, respectively (p < 0.0001)]. Even when both measurements were successful, the proportion of measurement pairs that had a ∆Kastig > 0.50 D increased from 14% to 24% to 32% when Kmean standard deviation (SD) was ≥ 0.01, 0.05, and 0.10 D, respectively. When measurement quality is poor, total keratometry varies less than standard keratometry measurements. Clinicians may use the SD of Kmean/TKmean to estimate the repeatability of measurements and balance this against their tolerance for performing repeat measurements.

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective: To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism. Methods: From May 2023, the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism. By May 2024, 310 cases were included, all of which were treated with posterior chamber intraocular lens implantation. The visual acuity, astigmatism and axial position of the intraocular lens were observed before and after treatment. Results: At different time points after the operation, the patient’s vision was significantly improved compared with that before the operation (P &lt; 0.05), and the vision level was equal to or greater than the best-corrected vision before the operation. At different time points after the operation, the average rotation of the intraocular lens was less than 5 degrees. Astigmatism was significantly lower than that before the operation (P &lt; 0.05). After the operation, the intraocular pressure increased in 11 cases, accounting for 3.55%, with no adverse complications such as lens turbidity, glare and obvious halo occurring. Conclusion: The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism, which can effectively improve the vision level of patients and reduce the degree of astigmatism, and has high effectiveness and safety.

Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes

PurposeTo investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.MethodsThis retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from − 4.50 to -17.00 diopters (D) and cylindrical refraction from − 0.75 to -5.50 D.ResultsFifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was − 10.06 ± 2.69 D and − 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was − 2.06 ± 1.16 D and − 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.ConclusionThe Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

Relationship between genotype, phenotype, and refractive status in patients of inherited retinal degeneration.

To elucidate the relationship between inherited retinal disease, visual acuity and refractive error development in Asian patients. Five hundred phakic eyes with refractive data were analysed in this retrospective cohort. Diseases were categorized by clinical phenotypes, and the prevalent genotypes identified in the Taiwan Inherited Retinal Degeneration Project were analysed. Consecutive surveys in Taiwan have provided the rates of myopia in the general population. No differences were observed among the disease phenotypes with respect to myopia (P = 0.098) and high myopia rates (P = 0.037). The comparison of refractive error between retinitis pigmentosa and diseases mainly affecting the central retina showed no difference, and the refraction analyses in diseases of different onset ages yielded no significance. Moreover, there was no difference in the myopia rate between the diseases and general population. Among the genotypes, a higher spherical equivalent was seen in RPGR and PROM1-related patients and emmetropic trends were observed in patients with CRB1 and PRPF31 mutations. Furthermore, significantly poorer visual acuity was found in ABCA4, CRB1 and PROM1-related patients, and more preserved visual acuity was seen in patients with EYS, USH2A, and RDH12 mutations. No significant differences were observed in visual acuity, refractive state and myopia rate between patients with inherited retinal disease and the general population, and different subtypes of inherited retinal disease shared similar refractive state, except for higher cylindrical dioptres found in patients with Leber's congenital amaurosis. The heterogeneity of disease-causing genes in Asian patients may lead to variable refractive state.

Preoperative intravenous mannitol administration and its rationale before cataract surgery.

The purpose of this study is to assess the variations in anterior chamber depth (ACD), axial length (AXL), and intraocular pressure (IOP) in both phakic and pseudophakic eyes undergoing preoperative intravenous mannitol infusion. The study was conducted at the Ophthalmology Department of IRCSS Humanitas in Milan, Italy. This is a prospective and non-randomized study. 40 patients with phakic eyes and 40 patients with pseudophakic eyes scheduled for cataract surgery in their fellow eye were included. Prior to the surgery, comprehensive ophthalmic examinations were conducted, including IOP measurement, and bilateral biometry performed with Anterion® (Heidelberg Engineering GmbH, 69,115, Heidelberg, Germany). All patients received intravenous infusion of mannitol before the surgery. One hour after cataract extraction, the patients underwent the same set of examinations. We analyzed the changes AXL, ACD and IOP in the eye opposite to the one that underwent surgery. The comparison between preoperative and postoperative parameters showed no differences in AXL (p = 0.34 and p = 0.53) and in ACD (p = 0.38 and p = 0.31) in the phakic and in the pseudophakic group, respectively. Instead, a statistically significant difference was found between the mean preoperative and postoperative IOP (p = 0.02) for the phakic group and (p = 0.03) for the pseudophakic group. The administration of mannitol does not lead to any changes in the ACD and AXL, regardless of whether the eyes are phakic or pseudophakic. However, there is a statistically significant reduction in IOP. Nonetheless, it is important to consider the various side effects associated with mannitol infusion.

Risk Factors for Progression of Vitreomacular Traction to Macular Hole.

Purpose: To evaluate the clinical and optical coherence tomography (OCT) characteristics associated with progression of vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) and lamellar macular hole (LMH). Methods: A retrospective cohort study of patients with an OCT-confirmed diagnosis of idiopathic VMT and 6 or more months of follow-up was performed. Clinical data included age, sex, race, systemic comorbidities, hormone replacement therapy, corrected visual acuity (VA), subjective visual symptoms, OCT signs, and the presence of or progression to FTMH or LMH. Results: Of the 287 eyes with VMT, 48 (16.7%) progressed to MH. Twelve eyes (4.2%) progressed to LMH, and 36 eyes (12.5%) progressed to FTMH. Female sex (P = .02), myopic refractive status in phakic eyes (P = .02), subjective decreased VA (P = .01), and the presence of an inner segment-outer segment junction disruption on OCT (P = .003) were risk factors for progression from VMT to FTMH. Subjective metamorphopsia was a risk factor for progression to FTMH (P = .001) and LMH (P = .01). In a subgroup analysis, patients who had an FTMH in the fellow eye were significantly more likely to have VMT progress to FTMH in the study eye (24.0% vs 8.7%; P = .04). Having an LMH in the fellow eye was not a risk factor for progression to LMH in the study eye (P = .47). Conclusions: Risk factors were found for the progression of VMT to MH that may be clinically relevant for risk-stratifying patients presenting with VMT.

Axial length adjustment in eyes with silicone oil endotamponade reduces overestimation by a swept-source optical coherence tomography-based biometer.

To assess changes in ocular biometry of the phakic eye after pars-plana-vitrectomy (PPV) and silicone oil (SO) endotamponade in eyes with a retinal detachment. This retrospective, consecutive case series included 72 eyes of 72 patients who underwent PPV with 5000-centistokes SO endotamponade between July 2018 and June 2023. Pseudophakic eyes and eyes with a combined phacovitrectomy were excluded. Primary endpoints were keratometry values, anterior chamber depth (ACD), lens thickness (LT), horizontal corneal diameter (HCD), and axial length (AL) measured by swept-source optical coherence tomography-based biometry (IOLMaster 700) preoperatively and six weeks postoperatively. A recently described formula was used to adjust the AL (aAL) in eyes with SO endotamponade and a theoretical intraocular lens (IOL) calculation was performed. The mean age was 62.1 ± 8.3 years (range: 37-85). After PPV with SO fill, there was an increase in Kmean (0.19 ± 0.51D), while ACD (0.05 ± 0.13 mm), LT (0.03 ± 0.14 mm), and HCD (0.02 ± 0.24 mm) decreased. Preoperatively, the mean AL was 25.22 ± 1.78 mm, while postoperatively the AL was overestimated by 0.12 ± 0.42 mm on average (p = 0.04). By adjusting the AL, the mean difference could be reduced to -0.002 ± 0.41 mm. The aAL resulted in a difference in the refractive outcome in eyes with an AL > 25 mm of 0.34 ± 0.10D in the IOL calculation. While changes in biometry after PPV with SO endotamponade in the anterior segment are clinically less relevant, a considerable overestimation of AL with IOLMaster 700 was found. We recommend the use of a recently introduced formula for adjusting AL in eyes with SO, allowing overestimation to be minimised considerably.

Real-World Experience of Fluocinolone Acetonide 0.19 mg in the Management of Non-Infectious Uveitis

ABSTRACT Purpose This study aims to evaluate the real-world efficacy and safety profile of fluocinolone acetonide (FAc) implants for the treatment of non-infectious uveitis (NIU). Methods A retrospective, observational study was conducted at Moorfields Eye Hospital, London, involving patients who received FAc 0.19 mg implants (Iluvien®) for NIU. 2-year follow-up data on baseline characteristics, indications, and outcomes was collected. The primary indicator for treatment failure was defined as the need for rescue treatment with dexamethasone (DEX) implants, while secondary indicators included changes in steroid and systemic immunosuppression requirements, or the need for a second FAc implant before 3 years. The occurrence of complications was collected. Results Of the 146 eyes treated with FAc implants, 24.0% experienced treatment failure requiring DEX implant within 2 years. About 42.9% required this within the first 6 months. There was an increase in the number of patients requiring steroids and/or systemic immunosuppression. Within the first 2 years post-FAc implant, only 13.7% experienced an IOP rise, with 4.1% requiring IOP-lowering surgery. About 57.9% of the phakic eyes developed cataracts. Conclusion This study provides valuable real-world evidence supporting the efficacy of FAc implant in NIU. It demonstrates a good safety profile at 2 years, with a significant reduction in uveitis recurrence rate and treatment burden. Our results are especially pertinent to the treatment of uveitic cystoid macular oedema (CMO), which was the primary indication in over 75% of our patients. Furthermore, it suggests that while FAc implant controls retinal inflammation effectively, choroidal inflammation would require alternative treatment.

Two-Year Results of XEN Gel Stent Implantation for Pseudoexfoliative Glaucoma in Phakic versus Pseudophakic Eyes.

Objectives: To investigate whether phakia affects the outcome of XEN-45 gel stent implantation in the treatment of pseudoexfoliative glaucoma (PXG). Methods: A retrospective, comparative cohort study of 30 phakic and 55 pseudophakic PXG patients who received the XEN-45 gel stent at a tertiary centre. The primary outcome measure was two-year success defined as a ≥20% lowering of intraocular pressure (IOP) and a target IOP of 6-21 mmHg. Success was complete without and qualified irrespective of antiglaucoma medication use. Further glaucoma surgery other than needling was regarded as a failure. The secondary outcome measures included changes in IOP, revision and complication rates. Results: The complete two-year success rates were 70% and 59% in the phakic and pseudophakic groups, respectively (p = 0.75, log-rank test), and the qualified rates were 80% and 72%, respectively (p = 0.89). The median IOP reduction from baseline was 54% in phakic, and 46% in pseudophakic eyes. While needling rates were similar, the incidence of early incisional bleb revisions was significantly higher in the phakic eyes (13% vs. 0% within 3 months; p = 0.0098, chi-square). Increasing after a year, significantly more pseudophakic eyes failed due to secondary glaucoma surgery (16% vs. 0%; p = 0.0191). Conclusions: The XEN-45 gel stent offers equally effective IOP control for both phakic and pseudophakic patients. However, the onset of bleb revisions and the necessity for secondary glaucoma surgery differed significantly between the groups.

SUPPLEMENTAL DEXTROSE IN THE INFUSION FLUID DURING DIABETIC VITRECTOMY.

Historically, supplemental dextrose to infusion fluid has been used to reduce the need for intraoperative lensectomies to maintain visualization during diabetic vitrectomy. Valved, small-gauge vitrectomy has reduced surgical time and decreased intraoperative fluid flow. Assessment of supplemental dextrose in modern vitrectomy is presented in this study. A retrospective cohort study of diabetic patients undergoing vitrectomy was conducted. The dextrose group received supplemental dextrose in the infusion fluid, while the nondextrose group used a standard balanced salt solution (BSS Plus). Group assignment was per surgeons' typical practice patterns. Eyes with tractional retinal detachments were also evaluated as a subgroup. Three hundred thirty phakic eyes were included. Supplemental dextrose was used in 199 eyes (60.3%). One unplanned lensectomy was performed in this series, in the nondextrose group, not statistically different from the dextrose group, with zero lensectomies (P = 0.4). Cataract survival curves overlapped for all eyes and for the tractional retinal detachment subgroup. In modern vitrectomy, unplanned lensectomy is rare. No difference was observed in the rate of intraoperative lensectomies or overall postoperative cataract course with or without dextrose supplementation to the infusion fluid. Standard solutions appear to be adequate for infusion, even for diabetics.

Effect of Retinectomy with Pars Plana Vitrectomy in Proliferative Vitreoretinopathy: Surgical Success and Recurrence Rate (A Comparative Study)

Purpose: To assess anatomical and functional success of pars plana vitrectomy with retinectomy in cases of proliferative vitreoretinopathy (PVR grade C). Study Design: Retrospective chart review. Place and Duration of Study: AL-Ferdous Private Eye Hospital, Baghdad, from July, 2019- June, 2023. Methods: Thirty eyes of thirty patients with PVR grade C were included in the study. One group (n=15) underwent pars plana vitrectomy (PPV) without retinectomy, while the other group (n=15) underwent PPV with retinectomy. Complications, anatomic success, and visual acuity were documented and evaluated. The relationship between retinectomy duration and postoperative visual acuity was examined using a chi-square test, with a p-value less than 0.05 considered statistically significant. Results: Mean age of the patients was 46.13±13.95 years. Retinectomy group had 8 (53.3%) males and 7 (46.7%) females. The other group had 10 (66.7%) males and 5 (33.33%) females. In group 1 there were 5 phakic and 10 pseudophakic eyes while in group 2, there were 4 phakic and11 pseudophakic eyes. Postoperative complete retinal re-attachment was achieved in 100% eyes in retinectomy group. After six months, the first group had 5 eyes (33.3%) with improved visual acuity, stable visual acuity in 7 eyes (46.6%) and worsening of vision in 3 eyes (20%). For the second group, 8 eyes (53.3%) showed improvement, stability in 4 eyes (26.7%), and worsening vision in 3 eyes (20%) with p-value &gt; 0.05. Conclusion: Retinectomy is beneficial in treating severe PVR and improves, ultimate retinal reattachment rate.

Retinal Tear and Retinal Detachment after Cataract Surgery in Eyes with a Previous History of Treated Phakic Retinal Tears

ObjectiveTo investigate the incidence and outcomes of retinal tear (RT) and retinal detachment (RD) after cataract extraction in patients with a history of previous phakic RT. DesignRetrospective case series. SubjectsPhakic eyes with RT that were successfully treated with laser photocoagulation or cryotherapy and subsequently underwent cataract surgery. MethodA retrospective review of phakic eyes treated for RTs between April 1, 2012 and May 31, 2023 was performed. Exclusions included prior vitreoretinal surgery before cataract removal and follow-up of less than 6 months post-cataract surgery. Main outcome measuresThe incidence of RTs and RDs after cataract surgery, along with visual and anatomic outcomes. ResultsOf 12,109 phakic eyes treated for RTs, 1039 (8.6%) eyes underwent cataract surgery. After exclusions, 713 eyes of 660 patients were studied. The mean (standard deviation, SD) follow-up period post-cataract surgery was 34.8 (24.6) months with a median of 239 and 246 days to a new RT or RD development. The overall incidence for diagnosis of post-cataract surgery RT and RD was 7.3% (52/713) (2.9% and 4.3%, respectively), with a one-year incidence of 5.6% (2.2% and 3.4%, respectively). Multivariable regression analysis identified a higher risk of RT/RD among younger individuals (odds ratio [OR] 1.034; 95% confidence interval [CI] 1.004-1.065, P=0.028), males (OR 2.058; 95% CI 1.110-3.816, P=0.022), and those with shorter interval between laser treatment and cataract surgery (OR 1.001; 95% CI 1.001-1.001, P=0.011). Single surgery anatomic success for the RD repair was achieved in 25 eyes (80.6%) at 3 months, with a 100% final reattachment rate. The median final logMAR visual acuity was 0.10 (20/25) for RT, showing no significant change from post-cataract surgery, and 0.18 (20/30) for RD, a significant worsening from after cataract surgery. ConclusionOne year post-cataract surgery, the rate of diagnosed RT and RD in patients with previously treated RTs was relatively high, occurring in nearly 1 in 18 eyes. Higher risk was noted among younger individuals, males, and patients with a shorter interval between initial treatment for RT and cataract surgery. RD repair achieved good anatomical results, but vision declined.

Macular perfusion, thickness, and sensitivity in phacovitrectomy versus lens-sparing vitrectomy in rhegmatogenous retinal detachment

Purpose The aim of this study was to compare phacovitrectomy (phacoPPV) to lens-sparing pars plana vitrectomy (PPV) with respect to macular perfusion, thickness, and sensitivity in phakic patients with rhegmatogenous retinal detachment. Patients and methods This is a prospective, comparative, nonrandomized, interventional study that included 31 phakic eyes with primary rhegmatogenous retinal detachment. The patients were divided into two groups according to the preoperative lens status: group A who had significant cataract and group B who did not have significant cataract. Group A included 17 eyes for which phacoPPV was performed, while group B included 14 eyes for which lens-sparing PPV was performed. All patients were preoperatively evaluated clinically and with A-scan ultrasonography and were followed up for 4 months after surgery. Optical coherence tomography angiography (OCTA) and microperimetry were done at 2 and 4 months, postoperatively. Results The OCTA showed that the lens-sparing PPV was associated with significantly larger foveal avascular zone area (0.4±0.2 mm2) compared to the phacoPPV (0.2±0.1 mm2) at 2 months (P=0.048), as well as at 4 months (0.4±0.1 mm2vs. 0.2±0.1 mm2, respectively, P=0.044). However, the foveal avascular zone perimeter showed no statistically significant differences between the two groups at 2 and 4 months postoperatively. At 2 months, the deep vascular plexus (DVP) parafoveal vessel density was statistically significantly higher in the phacoPPV group (47.9±4.7%) compared to the PPV group (36.4±11.9%) (P=0.048), while at 4 months it was the DVP foveal vessel density that showed a significantly higher mean in the phacoPPV group (35.4±11.9%) compared to the PPV group (20.3±16.1%) (P=0.036). No other statistically significant intergroup differences were found with respect to other parameters for macular perfusion, and other DVP parameters. Similarly, the macular sensitivity, as well as the ganglion cell complex, and the central subfield thicknesses were comparable between the two groups. The visual outcome was also comparable at 2 and 4 months between the two groups. Conclusion PhacoPPV and lens-sparing vitrectomy were comparable with respect to OCTA, microperimetry, and visual acuity. The limited differences are too preliminary and the decision to do phacoPPV rather than lens-sparing PPV needs to be based on other determinants like the presence of preoperative lens opacity.

Descemet Membrane Endothelial Keratoplasty for Endothelial Failure in Primary Angle Closure Suspects.

To analyze the feasibility and outcome of Descemet membrane endothelial keratoplasty (DMEK) for treatment of endothelial failure in primary angle closure suspect (PACS) eyes. Retrospective, single-center case series of eyes treated by DMEK for endothelial failure caused by PACS. Main study parameters were success rate of DMEK, best-corrected visual acuity, anterior chamber depth, central corneal thickness, and endothelial cell density. Mean follow-up time was 16 ± 13 months. Ten eyes of 9 patients receiving DMEK for the treatment of corneal endothelial failure because of PACS were included. Except for 2 eyes that had undergone cataract surgery, none of the eyes had previous ocular surgery. DMEK combined with cataract surgery was performed in 5 eyes, DMEK alone with second-step cataract surgery in 2 eyes. The eyes with corneal edema after cataract surgery received DMEK only. DMEK surgery was successful in nine out of 10 eyes, 1 patient required repeat DMEK because of primary graft failure. In the group of phakic eyes, mean preoperative internal anterior chamber depth was 1.74 ± 0.18 mm. In eyes with corneal edema, central corneal thickness was 849 ± 205 μm before DMEK surgery, and 517 ± 24 μm at the final postoperative visit (P = 0.002). DMEK is a feasible option in eyes with endothelial failure because of primary angle closure. In case of advanced corneal edema, a second-step procedure (first DMEK, second cataract surgery) is a possible approach if visibility of the lens is too poor for simultaneous cataract surgery.

Implications of Ocular Confounding Factors for Aqueous Humor Proteomic and Metabolomic Analyses in Retinal Diseases.

To assess the impact of ocular confounding factors on aqueous humor (AH) proteomic and metabolomic analyses for retinal disease characterization. This study recruited 138 subjects (eyes): 102 with neovascular age-related macular degeneration (nAMD), 18 with diabetic macular edema (DME), and 18 with cataract (control group). AH samples underwent analysis using Olink Target 96 proteomics and Metabolon's metabolomics platform Data analysis included correlation, differential abundance, and gene-set analysis. In total, 756 proteins and 408 metabolites were quantified in AH. Total AH protein concentration was notably higher in nAMD (3.2-fold) and DME (4.1-fold) compared to controls. Pseudophakic eyes showed higher total AH protein concentrations than phakic eyes (e.g., 1.6-fold in nAMD) and a specific protein signature indicative of matrix remodeling. Unexpectedly, pupil-dilating drugs containing phenylephrine/tropicamide increased several AH proteins, notably interleukin-6 (5.4-fold in nAMD). Correcting for these factors revealed functionally relevant protein correlation clusters and disease-relevant, differentially abundant proteins across the groups. Metabolomics analysis, for which the relevance of confounder adjustment was less apparent, suggested insufficiently controlled diabetes and chronic hyperglycemia in the DME group. AH protein concentration, pseudophakia, and pupil dilation with phenylephrine/tropicamide are important confounding factors for AH protein analyses. When these factors are considered, AH analyses can more clearly reveal disease-relevant factors. Considering AH protein concentration, lens status, and phenylephrine/tropicamide administration as confounders is crucial for accurate interpretation of AH protein data.

Decrease in electrolyte after vitrectomy surgery may affect the results of forensic investigations using vitreous humor

PurposeVitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte concentrations in the VH from human eyes with and without a history of vitrectomy surgery.MethodsWe analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated.ResultsThe Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes.ConclusionsWith the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject’s VH in forensic examination.