Postoperative Visual Outcome Research Articles

Impact of central corneal astigmatism on postoperative visual outcomes in patients undergoing trifocal intraocular lens implantation

BackgroundTo investigate the impact of central corneal astigmatism on postoperative visual outcomes in patients with trifocal intraocular lens (IOL) implantation.MethodsThis retrospective study included 278 eyes of 278 patients who underwent uneventful cataract surgery with implantation of the trifocal IOL (AT LISA tri 839MP). Patients were divided into two groups according to the total corneal refractive power (TCRP) in 3 mm zone centered on the corneal apex: low astigmatism group, TCRP ≤ 0.75 diopter (D); high astigmatism group, TCRP > 0.75D. Postoperative evaluations were conducted at 3 months after surgery, including visual acuity, defocus curves, contrast sensitivity (CS), and objective and subjective visual quality.ResultsThe low astigmatism group exhibited significantly better uncorrected near and intermediate visual acuity than the high astigmatism group (both P < 0.05). Significantly higher percentages of eyes in the low astigmatism group achieved uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) of 0.00 logMAR or better compared to the high astigmatism group (UDVA: 67% vs. 54%, CDVA: 76% vs. 64%, both P < 0.05). Defocus curves revealed that the low astigmatism group showed better visual acuity at defocus levels of + 0.5D, 0D, -0.5D, -3.0D, and − 3.5D than the high astigmatism group (all P < 0.05). Moreover, the high astigmatism group showed significantly poorer CS, greater higher-order aberrations, and more symptoms of blurred vision and diplopia. Percentages of spectacle independence and patient satisfaction did not differ between groups.ConclusionsIn eyes with central corneal astigmatism above 0.75D, suboptimal postoperative visual outcomes may be obtained after trifocal IOL implantation.

Using a deep learning model to predict postoperative visual outcomes of idiopathic epiretinal membrane surgery

Using a deep learning model to predict postoperative visual outcomes of idiopathic epiretinal membrane surgery

Comparison of Visual and Refractive Outcomes Between Refractive Lens Exchange and Keratorefractive Lenticule Extraction Surgery in Moderate to High Myopia.

Background/Objectives: To evaluate the visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) surgery and refractive lens exchange (RLE) surgery in moderate to high myopia patients. Methods: A retrospective cohort study was performed, and patients receiving KLEx or RLE surgeries with myopia within -3.00 to -10.00 diopter (D) were enrolled. A total of 19 and 35 patients were put into the RLE and KLEx groups after exclusion. The main outcomes are postoperative uncorrected visual acuity (UDVA), the spherical equivalent (SE), and residual astigmatism via vector analysis. Fisher's exact test and the Mann-Whitney U test were utilized for the statistical analysis. Results: The percentages of patients who reached UDVA results of more than 20/25 and 20/20 were statistically similar between groups (both p > 0.05), and the percentages of patients who reached SE results within ±0.50 D and ±1.00 D were statistically similar between groups (both p > 0.05). The change in SE in the KLEx group was lesser compared to that in the RLE group (p = 0.021). The vector analysis showed a lower DV and ME and a higher CoI in the KLEx group than in the RLE group (all p < 0.05). The percentage of patients who reached specific UDVA and SE thresholds were statistically similar between groups with different myopia degrees (all p > 0.05). Conclusions: The postoperative visual and refractive outcomes between RLE and KLEx surgeries are grossly comparable, while the KLEx may have a slight advantage in astigmatism correction.

Retropupillary Iris Clip Intraocular Lenses: A Case Series of 57 Eyes.

To report visual and refractive outcomes and intraoperative and postoperative complications after pars plana vitrectomy (PPV) with retropupillary implantation of an iris clip intraocular lens (IOL). This is a retrospective case series of patients who underwent secondary retropupillary intraocular lens insertion combined with pars plana vitrectomy to treat aphakia secondary to a dislocated nucleus lens (group A); or IOL dislocation (group B). Patient demographics, preoperative visual and refractive outcomes, intraoperative factors, postoperative visual and refractive outcomes, and complications within the follow-up period ranging from 6 months up to 3 years postoperative, were recorded. In total, 57 eyes of 50 patients were included with a follow-up range of 6 months to 3 years. The overall mean age was 77.0 years (range 28 to 99 years), with 26/50 (52%) of patients being male. There were 13/57 (22.8%) patients in group A and 44/57 (77.2%) patients in group B. The single most common identifiable cause for lens dislocation was pseudoexfoliation, which was seen in 13/57 (22.8%) of eyes. The mean improvement in visual acuity (baseline and final follow) was 0.72 logMAR (1.09 logMAR to 0.37 logMAR) in all patients, 1.12 logMAR (1.64 logMAR to 0.52 logMAR) in group A, and 0.60 logMAR (0.91 logMAR to 0.31 logMAR) in group B. In 46 eyes (80.7%), postoperative refractive errors were within ±1.00 dioptres (D) of the target refraction, with a mean difference of 0.36D from target refraction. Complications included corneal edema (35.1%), hyphema (26.3%), anterior chamber inflammation (26.3%), vitreous hemorrhage (14%), elevated intraocular pressure (IOP, 12.3%) and cystoid macular edema (CME, 5.3%). All these complications were managed with topical medical therapy and did not require further surgical intervention. One eye from group A was the only eye that developed retinal detachment (RD) or endophthalmitis. No patients had IOL dislocation in the postoperative follow-up period, which ranged from 6 months to 3 years. Retropupillary implantation of an iris clip IOL with pars plana vitrectomy is an efficient, predictable, and stable surgical option for aphakic eyes without capsular support. Postoperative corneal edema, hyphema, and anterior chamber inflammation are common but usually resolve without the need for further surgical intervention.

Comparison of visual outcomes between corneal topography-guided FS-LASIK and SMILE for myopia and myopic astigmatism: a network meta-analysis

Objective: To compare the postoperative visual outcomes of corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia and myopic astigmatism. Methods: Embase and PubMed were searched for randomized controlled trials (RCTs), prospective comparative studies, observational studies and retrospective studies of patients with myopia and/or myopic astigmatism treated by corneal topography-guided FS-LASIK, the other FS-LASIKs or SMILE (inception to November 2023). The studies meeting the criteria were collected and underwent quality assessment according to the Jadad scale for RCTs and the Newcastle-Ottawa scale for non-randomized studies. RevMan4.3.0 was used for network meta-analysis. Results: A total of 17 studies were included for meta-analysis, including 7 RCT and 10 observational studies. For the percentage of surgical eyes with uncorrected distance visual acuity≥20/20 (≤3 months), there were no statistically significant differences among corneal topography-guided FS-LASIK, the other FS-LASIKs and SMILE. The surface under the cumulative ranking curve (SUCRA) ranking from best to worst was corneal topography-guided FS-LASIK (86.7%), the other FS-LASIKs (53.1%) and SMILE (10.2%). For the percentage of surgical eyes with postoperative manifest refraction spherical equivalent (MRSE) within ±0.50 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses disclosed the relative risk (RR) of corneal topography-guided FS-LASIK significantly increased by 14% (RR=1.14, 95%CI:0.78-1.59) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (90.4%), SMILE (31.7%) and the other FS-LASIKs (27.9%). For the percentage of surgical eyes with postoperative MRSE within± 1.00 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses showed the RR of corneal topography-guided FS-LASIK significantly increased by 15% (RR=1.15, 95%CI:0.93-1.61) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (94.5%), the other FS-LASIKs (53.9%) and SMILE (1.7%). For the percentage of surgical eyes with postoperative corrected distance visual acuity improved by 1 or more lines (combined follow-up measure timepoint), the main analyses showed no statistical difference between corneal topography-guided FS-LASIK and the other FS-LASIKs, while the RR of SMILE was slightly lower than that of the other FS-LASIKs (RR=0.86, 95%CI:0.65-1.14). The sensitivity analyses disclosed the RR of corneal topography-guided FS-LASIK significantly increased by 40% (RR=1.40, 95%CI:0.06-24.00) as compared to that of the other FS-LASIKs, while SMILE had a slightly lower RR as compared with the other FS-LASIKs (RR=0.77, 95%CI:0.17-2.74). The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (72.4%), the other FS-LASIKs (67.3%) and SMILE (10.3%). Conclusions: Compared with SMILE, FS-LASIK showed a similar postoperative visual acuity improvement. The corneal topography-guided FS-LASIK had better predictability with a higher rate of MRSE within ±0.50 D/1.00 D.

Through the fog: Systematic review and meta-analysis of the prevalence and associated factors of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa.

Cataract, despite being treatable, persists to have a devastating impact on people's health and livelihoods all over the world. In Sub-Saharan Africa (SSA), 1.7 million people are blind and 6.94 million are visually impaired due to cataract. Also, Cataract surgery outcomes remain below the World Health Organization (WHO) recommendations in SSA. Hence, this review aimed to estimate the pooled prevalence and associated factors of poor post-operative visual outcome in SSA. An intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences. Data were extracted by using a pre-tested and standardized data extraction format and analyzed by using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger's weighted correlation, and Begg's regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors. From 201 identified studies, 25 articles were included. The pooled prevalence of poor post-operative visual outcome of cataract surgery in SSA was 14.56% (95% CI 11.31, 17.81). The presence of intra-operative complications (AOR = 2.99, 95% CI: 1.79, 4.98) and the presence of post-operative complications (AOR = 3.56, 95% CI: 2.86, 4.43) were statistically significant with the pooled poor post-operative visual outcome. According to the subgroup analysis, the pooled prevalence of poor post-operative visual outcome was found lower in phacoemulsification, with a sub-pooled prevalence of 12.32% (95% CI 7.89, 16.74) compared to incisional with a sub-pooled prevalence of 16.28% (95% CI 10.98, 21.59). This meta-analysis revealed that a substantial proportion of cataract-operated patients had poor post-operative visual outcome. The presence of intra-operative complications and post-operative complications were independent predictors of poor post-operative visual outcome. Therefore, improvement of post-operative visual outcome through decreasing intra-operative complications, managing post-operative complications, and investing in specialized training and equipment for ophthalmic surgeons are pivotal and need significant emphasis.

Peripapillary and Macular Optical Coherence Tomography Angiography Predictors of Visual Improvement in Patients Treated with Vitrectomy for Idiopathic Epiretinal Membrane

Introduction: We investigated the changes of peripapillary and macular microvasculature in idiopathic macular epiretinal membrane (iERM) eyes before and after pars plana vitrectomy (PPV), aiming to identify potential optical coherence tomography angiography (OCTA) predictors of visual acuity improvement. Methods: Fifty-seven eyes diagnosed with iERM were enrolled and underwent PPV with ERM and internal limiting membrane (ILM) peeling. Data were collected before surgery and during the 12-month postoperative period. OCTA analysis focused on radial peripapillary capillary (RPC) vessel density (VD), superficial and deep capillary plexus (SCP and DCP, respectively). Functional and OCT structural outcomes, including best-corrected visual acuity (BCVA) and macular thickness, were also recorded. Results: Multivariate linear regression analysis revealed that higher preoperative RPC VD, lower SCP VD, and lower BCVA were predictors of postoperative BCVA improvement (p < 0.001, p = 0.047, and p < 0.001, respectively). Throughout the follow-up period, there was an observed increase in intradisc RPC VD, whole-disc VD, and parafoveal DCP VD (all p < 0.001). BCVA and central macular thickness demonstrated significant improvement (p < 0.001) within the first month following vitrectomy, which then stabilized from the third month onward. Conclusions: Preoperative microvascular measurements in iERM patients can forecast postoperative BCVA. OCTA findings reveal that both increased RPC density and reduced SCP density at baseline could serve as predictors of better visual outcomes after surgery. Enhanced RPC density may reflect a healthier optic nerve with greater potential for visual recovery, while a less dense SCP could indicate less iERM contraction, both contributing to more favorable postoperative visual results.

Outcomes of Proximal Row Carpectomy With Interposition Arthroplasty for Advanced Wrist Arthritis.

This study aimed to evaluate and compare the outcomes of proximal row carpectomy (PRC) with interposition arthroplasty using dorsal wrist capsule interposition, lateral meniscus allograft, or dermal allograft in patients with lunate facet/capitate degeneration. Patients who underwent PRC with interposition arthroplasty between 2010 and 2022 at a single institution were identified. Preoperative and postoperative visual analog scale (VAS) pain, functional outcomes, and complications were recorded. Twenty-one patients (11 dorsal capsule, 6 meniscus, 4 dermal matrix) were identified with a mean follow-up of 65.8 months. Postoperative pain and functional outcome scores significantly improved. The mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 20.3. In total, 89.5% of patients returned to work, including 75% of manual laborers. No significant differences were found between dorsal capsular flap versus allograft groups. Proximal row carpectomy with interposition arthroplasty is an effective motion-sparing procedure for patients with proximal capitate and/or lunate fossa arthritis, improving pain and function.

Dry Eye Treatment with Intense Pulsed Light for Improving Visual Outcomes After Cataract Surgery with Diffractive Trifocal Intraocular Lens Implantation.

Background/Objectives: Meibomian gland dysfunction (MGD)-related dry eye aggravates postoperative visual outcomes in cataracts. Diffractive trifocal intraocular lenses (IOLs) decrease contrast sensitivity (CS). Intense pulsed light (IPL) improves tear film stability and ocular surface conditions in MGD-related dry eyes. We investigated the effect of preoperative MGD-related dry eye treatment combining manual meibomian gland expression (MGX) with IPL (IPL-MGX) on visual outcomes post-cataract surgery with diffractive trifocal IOL implantation. Methods: In this single-center, prospective, and open-label study, we enrolled 67 patients (134 eyes) with MGD-related dry eye undergoing cataract surgery on both eyes. Preoperatively, IPL-MGX was performed on one eye (IPL-MGX group) but not the contralateral eye (control group). Tear break-up time, high-order aberrations, and central superficial punctate keratopathy (C-SPK) were assessed. CS and corrected distance visual acuity were analyzed. Differences between groups were analyzed at 1 week, 1 month, and 3 months postoperatively. Results: The IPL-MGX group showed greater mean tear break-up time and lower mean high-order aberration and C-SPK values after preoperative IPL treatment and postoperatively (all p < 0.01). Postoperative CS was higher in the IPL-MGX group at 1 week (all spatial frequencies) (p < 0.01 [cpd = 2.9, 4.5, 7.1, and 10.2] and p < 0.05 [cpd = 1.1 and 1.8]); 1 month [2.9-10.2 cpd] (p < 0.01); and 3 months [4.5-10.2 cpd] (p < 0.01 [cpd = 10.2] and p < 0.05 [cpd = 4.5 and 7.1]) postoperatively. Mean corrected distance visual acuity was higher in the IPL-MGX group only postoperatively (p < 0.01). Conclusions: Preoperative MGD-related dry eye treatment using IPL-MGX enhances tear film stability, ocular surface conditions, and visual outcomes, potentially improving postoperative vision quality and patient satisfaction.

Management of persistent exudative retinal detachment: exploring etiology and surgical outcomes

BackgroundThis report aims to present the causes, clinical features, and surgical outcomes of persistent exudative retinal detachment (ERD) in a single tertiary referral center experience.MethodsWe retrospectively analyzed 48 patients who underwent vitreoretinal intervention for persistent ERD between 2017 and 2024. The study assessed patient demographics, underlying causes of ERD, the success rate of surgical interventions, and postoperative visual outcomes.ResultsOf the 2040 eyes with retinal detachment treated at our center, 48 (2.35%) were diagnosed with ERD. Coats disease was the most frequent underlying cause, identified in 18 (37.5%) of ERD cases. Choroidal hemangioma (n = 6, 12.5%) and nanophthalmos (n = 5, 10.4%) were the next most common etiologies. The study population comprised 48 patients (30 males and 18 females) with a mean age of 37.48 years (range, 4–88 years). The mean best-corrected visual acuity remained stable from baseline to follow-up. The recurrence rate following primary surgery was 29.2%. Patients underwent a mean of 1.75 ± 1.00 surgeries. Globe preservation was achieved in 44 eyes (91.7%), while phthisis bulbi developed in 4 eyes (8.3%).ConclusionVitreoretinal surgery may be considered as a salvage procedure in cases where persistent ERD threatens the posterior pole. In our study, Coats’ disease, choroidal hemangioma, and nanophthalmos were identified as the most common etiologies associated with persistent ERD. Surgical intervention has the potential to preserve vision, but the high recurrence rate necessitates a cautious approach and the possibility of multiple surgeries.

Myoring implantation with and without cross-linking: Comparative study of pre and postoperative visual outcomes and pentacam indices.

Comparing the visual, topographic, and aberrometric changes following Myoring implantation alone or combined with corneal cross-linking (CXL). This retrospective, comparative study was conducted on keratoconus (KC) patients with moderate, central KC who sought medical advice at Watany Eye Hospital, Cairo, Egypt. Group 1 patients performed femtolaser-assisted Myoring implantation, while group 2 patients performed Myoring implantation with CXL. Group 1 included 44 eyes, and group 2 comprised 40 eyes. The mean follow-up interval was 2.34 years ± 2.25. There was a significant postoperative improvement in subjective refraction for both groups. Patients of group 1 showed statistically significant reductions in postoperative topographic astigmatism, K readings, Index of Surface Variance, horizontal coma, and spherical aberrations. In contrast, patients of group 2 only showed statistically significant improvements in K readings and horizontal coma. Patients of group 1 developed higher improvements in topographic astigmatism and K max compared to group 2. Although the combined technique was non-inferior to implanting the Myoring alone regarding visual, refractive, and keratometric improvements, Myoring implantation alone showed better results, mainly in topographic astigmatism. Hence, our study leans in favor of Myoring implantation without the need for additional CXL.

Outcomes, efficacy and risk factors of 27-Gauge vitrectomy for diabetic tractional retinal detachment in Japanese patients.

Diabetic retinopathy leads to vision-threatening complications, such as proliferative diabetic retinopathy and tractional retinal detachment (TRD) and is a major global health concern. Despite advancements in vitrectomy techniques, challenges exist in managing postoperative complications and long-term visual acuity. This study aimed to evaluate postoperative outcomes of 27-gauge pars plana vitrectomy (27g PPV) for diabetic TRD and identify associated risk factors. Retrospective study. This study included 94 eyes of 74 patients who underwent 27g PPV for diabetic TRD between July 2017 and September 2022 at Juntendo University Urayasu Hospital, Japan. Patient demographics, preoperative characteristics, intraoperative details, and postoperative outcomes were examined. Statistical analyses were performed to identify factors influencing postoperative visual acuity. Mean follow-up duration was 23.1 ± 14.6 months. Postoperatively, visual acuity (LogMAR) improved significantly from 1.34 ± 0.82 to 0.65 ± 0.79 (P < 0.0001). Postoperative complications included persistent vitreous hemorrhage (15%) and neovascular glaucoma (4%). Final retinal reattachment rate was 97%. Preoperatively, macular detachment (P < 0.0001) and Grade IV TRD (P < 0.0001) severity were significantly associated with poor final best corrected visual acuity (P < 0.0001). Preoperative macular detachment (P < 0.0001), Grade IV TRD (P < 0.0001), intraoperative iatrogenic breaks (P = 0.031), and postoperative neovascular glaucoma (P < 0.0001) were identified as significant predictors of poor postoperative visual outcomes through multivariate analysis. This study highlights the efficacy of 27g PPV in improving visual acuity in patients with diabetic TRD. Despite favorable outcomes, attention to preoperative risk factors and meticulous surgical techniques remain crucial for optimizing long-term visual prognosis in these patients.

Effects of clear corneal incision location and morphology on corneal surgically induced astigmatism and higher-order aberrations after ICL V4c implantation.

To evaluate the effects of clear corneal incision (CCI) location and morphology on corneal surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) in patients receiving implantable collamer lens (ICL V4c) implantation. This retrospective study classified right eyes that underwent ICL implantation into two groups based on temporal or superior CCI. The Pentacam HR analyzer was used to measure the corneal astigmatism and HOAs. Analysis of the clear corneal incision (CCI) morphology, including incision width (Angle-W), incision length (IL), incision angles (Angle-En/Ex), and distance from the incision to corneal apex (Dis-En/Ex), was conducted using anterior segment optical coherence tomography (AS-OCT). There were 75 eyes in the temporal CCI group and 47 eyes in the superior CCI group. Both groups showed satisfactory safety and efficacy postoperatively. In the temporal CCI group, Dis-En and Dis-Ex were considerably longer, whereas the superior CCI group displayed a significantly wider Angle-W. The anterior and posterior corneal SIA were comparable in both groups. Anterior corneal SIA was significantly correlated to Dis-En and Dis-Ex in the superior CCI group. Superior CCI caused a notable rise in corneal Z (3, 3), while temporal CCI led to increased Z (3, 1). CCI morphology was correlated to corneal Z (4, -4) and Z (4, 4) in the superior CCI group. CCI locations caused slight variations in postoperative corneal SIA and HOAs following ICL implantation. Optimal postoperative visual outcomes may be better achieved with a CCI design featuring an increased distance from the corneal centroid and a decreased Angle-W.

Effect of Belin-Ambrósio deviation index on 2-year refractive outcomes of PRK.

To assess the effect of preoperative Belin-Ambrósio deviation (BAD-D) index on 2-year visual, refractive, and tomographic outcomes, as well as the efficacy and safety of photorefractive keratectomy (PRK) surgery. Eye clinic, Mashhad, Iran. Prospective cohort study. This study included 66 patients (66 eyes) who underwent PRK surgery, with a minimum follow-up period of 2 years. Participants were divided into 2 groups: preoperative BAD-D ≥1.60 (high BAD-D) and preoperative BAD-D <1.60 (low BAD-D). Preoperative and postoperative visual, refractive, and tomographic parameters were evaluated, and the efficacy and safety of the procedure were compared between groups. 66 patients with a mean age of 35.50 ± 8.21 years (range 22 to 55 years) were included. Postoperatively, the mean spherical equivalent (SE) of refractive error was +0.32 ± 0.65 diopters (D) in the high BAD-D group and +0.18 ± 0.66 D in the low BAD-D group ( P = .40). In addition, at 2 years of follow-up, the mean uncorrected distance visual acuity was 0.98 ± 0.07 in the high BAD-D group and 0.97 ± 0.08 in the low BAD-D group ( P = .905). Among the postoperative tomographic parameters, front elevation thickness, maximum Ambrósio relational thickness, astigmatism, and central corneal thickness were significantly different between the 2 groups (all, P < .05). At the 2-year follow-up, the mean Safety Index was 1.02 ± 0.04, and 1.01 ± 0.04 in high and low BAD-D groups, respectively ( P = .37), and the mean Efficacy Index was 0.99 ± 0.07 and 0.98 ± 0.06 in high and low BAD-D groups, respectively ( P = .40). The preoperative BAD-D index does not predict postoperative visual, refractive, and tomographic outcomes in patients with low-to-moderate myopia. However, in patients with normal preoperative BAD-D values, higher agreement was expected between the attempted and achieved SE.

Early Visual Outcome of Surgically Treated Anterior and Middle Skull Base Meningiomas: A Prospective Multicenter Observational Study

Background: Meningiomas are the most common primary intracranial tumors. Visual deterioration is the first symptom for most patients with anterior and middle fossa meningiomas. The main aim of surgery is the total removal of the tumor, resulting in improvement or preservation of preoperative visual status. Objective: To assess a 30-day visual outcome after surgical treatment of anterior and middle skull base Meningiomas. Methods: Institution-based prospective cross-sectional study was conducted among hospitalized and operated patients from September 1, 2020, to August 31, 2020. Early postoperative visual outcome and associated factors affecting visual outcome were determined using the WHO visual criteria. Bivariate and multivariate correlation analysis was performed to identify associated variables. The p-value of &lt;0.05 was considered significant. Results: Among the 43 patients enrolled, the majority 40(93%) were females and 27(62.8%) of the patients were under the age of 45. The commonest presenting symptoms were headache and visual impairment in 41(95.3%) and 33(78.7%) of patients respectively. Postoperative visual improvement was found in 21(48.8%) of patients whereas 18(41.9%) of patients had a similar course and 4(9%) of the patients deteriorated. Age, duration of visual deterioration, peri-operative visual status, tumor size, optic canal extension, and Simpson grading of resection were found to have a significant association with visual outcome. Conclusion: Postoperative visual improvement was found in 21(48.8%) of patients, which is comparable with most studies. The postoperative visual outcome is favorably affected by a shorter duration of visual deterioration before surgery, better preoperative visual status, and tumor size less than 4cm.

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BackgroundTo evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.MethodsThis was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.ResultsThere were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.ConclusionsLess surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report

BackgroundApart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management.Case presentationA 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient’s history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0.ConclusionsOur report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

Distinction of papillary and adamantinomatous craniopharyngioma: Clinical features, surgical nuances and hypothalamic outcomes

ObjectiveUnderstanding the differences of suprasellar papillary and adamantinomatous craniopharyngiomas (PCPs/ACPs) is pivotal for target therapy, surgical strategy or postoperative management. Here, the clinical features, surgical nuances and postoperative hypothalamic outcomes of PCPs were systematically recapitulated. Methods24 PCPs and 52 ACPs underwent initial surgery were retrospectively reviewed. Clinical data, quantified third ventricle (3rd V) occupation and optic chiasm distortion were compared, as well as intra-operative findings, operating notes and prognosis. Moreover, analysis of tumor/3rd V relationship and hypothalamic outcomes were also performed. ResultsTumors were more likely to occupies the 3rd V cavity in PCPs. Chiasm distortion of “compressed forward” was the most common pattern (45.8 %) in PCPs, whereas “stretched forward” pattern accounted the highest (42.5 %) in ACPs. Besides, round-shaped with less calcification, duct-like recess, solid consistency, rare subdiaphragmatic invasion, visible lower stalk and improved postoperative visual outcome were more frequently observed in PCPs. The basal membranes of the tumor epithelium and the reactive gliosis were separated by a layer of collagen fibers in most PCPs, which differs from ACPs in the morphological examination of tumor/3rd V floor interface. In daytime sleepiness and memory difficulty, the PCPs showed significantly better outcomes than the ACPs groups, and PCPs suffered less postoperative weight gain (p < 0.05) than ACPs among adult-onset cases. ConclusionPCPs are different from ACPs regards the clinical features, operative techniques and outcomes. If necessary, PCPs are suggested more amenable to total removal since its less invasiveness to the 3rd V floor and better hypothalamic outcomes.

Description of a new method to calculate the equator of the crystalline lens using AS-OCT images: Accuracy in non-dilated measurements.

To establish a methodology for objectively estimating the Lens Equatorial Plane (LEP) from clinical images, comparing LEP with dilated versus non-dilated pupils. A cohort of 91 eyes from 60 patients undergoing preoperative assessments for cataract surgery was evaluated. Anterior Segment Optical Coherence Tomography (AS-OCT) images were analysed under conditions of pharmacologically induced pupil dilation versus a non-dilated pupil. Geometrical parameters, including LEP, intersection diameter (ID), lens thickness (LT), anterior and posterior lens thickness were automatically calculated by applying standard image processing techniques to clinical AS-OCT images. Significant differences in lens parameters, including LEP, were observed between dilated and non-dilated conditions (all p < 0.001). A strong linear correlation was found across all geometrical variables under both conditions (r[LEP] = 0.64, r[ID] = 0.78, r[LT] = 0.99, all p < 0.001); enabling reliable correction of these differences. The study introduces an objective methodology for LEP calculation, emphasising the need to consider the eye's physiological state during preoperative measurements. Incorporating LEP into future intraocular lens (IOL) power calculation formulas and replacing the habitual effective lens position may potentially improve the accuracy of IOL power estimation and thus postoperative visual outcomes.

Visual prognostic factors following surgery for stage 3 idiopathic epiretinal membrane by Govetto classification.

To investigate the visual prognosis of metamorphopsia in patients undergoing surgery for stage 3 idiopathic epiretinal membrane (ERM) by Govetto classification using preoperative optical coherence tomography (OCT) parameters. Retrospective clinical study. This study included 45 eyes of 45 patients with a minimum follow-up period of 3 months. The best-corrected visual acuity (BCVA) and metamorphopsia score using the M-CHARTS were recorded. Central foveal thickness (CFT), inner nuclear layer thickness (INL), ectopic inner retinal layer thickness (EIFL), outer retinal layer thickness, disruption of the ellipsoid zone, cotton ball sign, and intraretinal cystoid changes were measured based on spectral domain OCT. Preoperative and postoperative values and conditions were compared, and correlations between the preoperative values or conditions and postoperative metamorphopsia scores or BCVA were analyzed. After surgery, the horizontal, vertical, and mean metamorphopsia scores, as well as BCVA, CFT, INL, and EIFL significantly improved (p < 0.001). Using multivariate analysis, only preoperative CFT was a significant explanatory parameter for both the postoperative horizontal metamorphopsia scores and mean values of the postoperative horizontal and vertical metamorphopsia scores (p = 0.019 and p = 0.011, respectively). Age (p = 0.011) and preoperative CFT (p = 0.026) were significant explanatory parameters of postoperative BCVA. Preoperative CFT significantly correlated with postoperative metamorphopsia in patients undergoing surgery for stage 3 idiopathic ERM. This finding might help surgeons predict postoperative visual outcomes and make timely surgical decisions.