Preoperative Visual Acuity Research Articles

Changing patterns in cataract surgery indications, outcomes, and costs, 2012-2023: a retrospective study at Aravind Eye Hospitals, India.

Data on the evolving characteristics of patients seeking cataract surgery, surgical techniques used, preoperative vision, postoperative visual outcomes, and surgery costs provide critical insights for improving care delivery and making progress towards global eye care targets. We aimed to establish long-term trends in these factors. Retrospective analysis of all cataract surgeries performed at Aravind Eye Hospitals during 2012-2023. In 3.6M cataract surgeries, the mean preoperative uncorrected visual acuity improved from 1.32 logMAR units (Snellen fraction≈6/120) in 2012 to 1.15 (Snellen fraction≈6/85) in 2023. The trend was observed in females and males, with females presenting with worse vision than males, in all age groups, and among outreach, subsidized and paying patients. Postoperative visual acuity outcomes steadily improved, with larger gains in Manual Small Incision Cataract Surgeries than in phacoemulsification. Mean prices for paying patients rose slightly faster than the Consumer Price Index for health. Surgeries supported by insurance and government assistance increased from 4.4% in 2012 to 28.7% in 2023. Male patients consistently paid about 10% higher prices than female patients because they chose more expensive intraocular lenses. Over this period, patients sought cataract surgery sooner, received better surgical outcomes, and were willing to pay more for the improvements. However, female patients continued to face inequities, presenting with worse vision, and receiving lower expenditures for surgery, indicating the need for targeted approaches to address sex inequity both on the demand generation and treatment provision sides. None.

Assessment of clinical outcomes and prognostic factors following membrane peeling in idiopathic epiretinal membrane using EIFL staging system: an optical coherence tomography angiography analysis

BackgroundTo evaluate the associations between anatomical changes and visual outcomes after membrane peeling in eyes with different stages of idiopathic epiretinal membrane (iERM) using optical coherence tomography angiography (OCTA).MethodsAll iERM eyes were graded into four stages based on the presence of ectopic inner foveal layers (EIFL) and underwent 23-gauge vitrectomy combined with ERM and internal limiting membrane (ILM) peeling, while their fellow eyes were treated as the control group. OCTA was used to measure retinal thickness(RT), foveal avascular zone (FAZ)-related parameters and superficial and deep capillary plexus (SCP and DCP) layers using 6 × 6 mm scans before, 1 month and 3 months after surgery. In addition, best corrected visual acuity (BCVA), metamorphopsia and macular features were assessed.ResultsForty-six subjects were included in this study. In comparison to the preoperative data, visual acuity and metamorphopsia improvement was statistically significant in four stages(P < 0.05) and the higher stage (3 and 4) achieved more pronounced improvements (P = 0.002). For higher stage, RT reduced with an increase in stage(P < 0.001), superficial and deep foveal vessel density (SFVD and DFVD) and parafoveal vessel density (PRVD) in SCP declined remarkably, FAZ area was enlarged obviously, FAZ perimeter (PERIM), foveal vessel density (FD) and PRVD in DCP increased significantly after surgery (P < 0.05). Similar to high-stage patients, those with stage 2 iERMs demonstrated a decreasing trend in central macular thickness (CMT), paraRT (parafoveal thickness), SFVD, and DFVD(P < 0.05). Nevertheless, no notable alterations were observed in other indicators. Distinct from other groups, only CMT and FD increased slightly in stage 1 iERMs (P < 0.05). Post-LogMAR BCVA and LogMAR BCVA-d (pre-LogMAR BCVA –3-month post-LogMAR BCVA) were positively correlated with preoperative stages, CMT, pre-LogMAR BCVA, SFVD, and vascular tortuosity(P < 0.05). but negatively correlated with FAZ area and DFVD (P < 0.05). Preoperative and postoperative metamorphopsia had a certain positive correlation with preoperative CMT (P < 0.05).ConclusionsAccording to OCTA analysis, different EIFL stages of iERMs showed significantly functional and anatomic differences before and after membrane peeling. Low-stage patients have better post-op visual function, while high-stage patients benefit more from surgery. It also demonstrated EIFL staging system contribute doctors to manage iERMs.

The Effect of Cataract Surgery on Stereoacuity, Balance, and Falls in Patients With Senile Cataract.

To investigate the effect of cataract surgery on visual acuity, stereoacuity, balance, and falls in patients with senile cataract. Prospective, cross-sectional study. The patients were divided into group 1 if the first surgery was performed on the dominant eye and group 2 on the nondominant eye. After a complete ophthalmologic examination, all patients underwent stereoacuity tests (Titmus and TNO test); Berg Balance Scale and the number of falls in the last 36 months were recorded. All assessments were performed at three time points: the preoperative period, 6 months after the first surgery (primary endpoint), and 24 months after the second surgery (secondary endpoint). The mean number of falls was 4.95±2.6/year in the preoperative period and 1.43±0.59/year in the postoperative period. The incidence of falls after the second surgery decreased by 53.15% compared with the preoperative period. The number of falls and preoperative stereoacuity were negatively and moderately correlated (r=-0.546) (P=0.033). In univariate and multivariate analysis, only low preoperative corrected distance visual acuity in the dominant eye was associated with poor stereoacuity (P=0.001) and a high number of falls (P<0.001) in the preoperative period. Cataract surgery in patients with senile cataracts not only improves visual acuity but also increases stereoacuity level, improves balance, and decreases falls. These effects should be further studied in multicenter, large-participant studies.

Keratorefractive Lenticule Extraction: Early Postoperative Day 1 Outcomes in 1350 Consecutive Procedures.

To evaluate postoperative visual outcomes on postoperative day 1 (POD1) after lenticule extraction in myopia astigmatism in a large cohort of over 1350 consecutive treatments. A retrospective review chart identified 1357 eyes consecutively treated with SCHWIND ATOS using lenticule extraction for myopic astigmatism who had at least 6 months of follow-up completed and for which POD1 was completely recorded. The standard visual and refractive outcomes, and astigmatism outcomes, were analyzed on POD1. As a sanity check, the stability of defocus and uncorrected distance visual acuity (UDVA) were evaluated from day 1 to 1-year postoperative follow-ups. On POD1, 82% of the eyes achieved an UDVA of 20/20 or better, with 82% of the eyes with postoperative UDVA being the same or better than the preoperative corrected distance visual acuity baseline, and only 2% of eyes lost 2 lines of corrected distance visual acuity. Postoperative spherical equivalent (+0.15 ± 0.35D) was within 0.75 D in 98% of the cases, with excellent stability from 1-week to 1-year postoperative follow-ups (11% eyes changing by 0.5D of defocus). Postoperative refractive astigmatism at POD1 (0.01 ± 0.08 D) was highly accurate, with over 99% of the cases within 0.5 D, and 99% within 5 degrees of the attempted axis. The astigmatic correction index (1.00 ± 0.08) showed 98% of the cases within 10% deviation. In this large cohort of over 1350 cases, lenticule extraction using SCHWIND ATOS is safe and effective on POD1, shows stability from 1-week to 1-year postoperative follow-ups, and suggests accurate and precise corrections for both defocus and astigmatism.

Scleral Tattooing Complications: Surgical Management of Granulomas in a Cosmetic Procedure.

To report the surgical management and outcomes of a patient with granulomatous inflammation following scleral tattooing, emphasizing the associated risks and clinical implications. A 26-year-old woman with a history of multiple body modifications, including scleral tattooing, presented with bilateral ocular pain and discomfort. Clinical examination revealed corneal dellen and subconjunctival granulomas. The patient underwent surgical excision of the granulomas, with efforts to preserve the black conjunctival pigmentation. Histopathological analysis was performed on the excised tissue. The patient's visual acuity and ocular condition were monitored for 12 months postoperatively. Preoperative best-corrected visual acuity was 20/50 in the right eye and 20/60 in the left. Surgical excision of the granulomas was successfully performed, resulting in symptomatic relief and preservation of the black scleral coloration. Histopathological analysis confirmed the presence of exogenous pigment without hemosiderin or melanin deposits. Twelve months after surgery, the patient maintained a best-corrected visual acuity of 20/20 in both eyes, with no recurrence of granulomas or additional complications. This case highlights the serious risks associated with scleral tattooing, including granulomatous reactions and corneal complications. Surgical intervention effectively addressed the ocular issues while preserving the desired cosmetic outcome. Greater public awareness and stronger regulations are critical to prevent such complications, and to prepare ophthalmologists for managing cases of scleral tattooing-related injuries.

Combined Pars Plana Vitrectomy and Novel Scleral Fixation of the Light Adjustable Lens.

The light adjustable lens (LAL) (RxSight, Aliso Viejo, CA) is a premium intraocular lens that allows for correction of residual refractive error and astigmatism following implantation. Herein, we describe the surgical approach and evaluate the visual outcomes of patients following scleral fixation of the LAL. Retrospective, single-surgeon surgical case series of 3 patients (3 eyes) with intraocular lens complications, who underwent combined pars plana vitrectomy and sutureless needle assisted intrascleral haptic fixation of the LAL between April 2022, to August 2023. A total of 3 patients (73.3 ± 4.4 years) underwent off-label application of sutureless intrascleral haptic fixation of the LAL. Indications for surgery included pseudophacodonesis (N=1), dislocated subluxed IOL with secondary vitreous hemorrhage (N=1), and multifocal IOL intolerance (N=1). Preoperative average visual acuity of 0.2 ± 0.1 (20/30) LogMAR improved to 0.03 ± 0.03 LogMAR (20/20) at 1 month follow-up after LAL ultraviolet light treatments. Preoperative sphere of +0.25 ± 0.9 improved to +0.0 ± 0.0 and preoperative cylinder of +0.4 ± 0.4 improved to +0.0 ± 0.0 postoperatively. No surgical complications were noted. Scleral fixation of the LAL is a viable option for eyes without capsular support to maximize postoperative uncorrected visual acuity outcomes.

Evaluation of a modified sutureless technique for scleral fixation of one-piece posterior chamber intraocular lens: a retrospective study.

This study presents the one-year outcomes of a modified technique for transscleral suture fixation of a posterior chamber intraocular lens (PCIOL) in aphakic eyes. A retrospective chart review was conducted on 45 patients who underwent transscleral suture fixation of a foldable one-piece PCIOL through scleral pockets. Preoperative data and follow-up data for a minimum of 12 months were collected for all patients. The mean preoperative and postoperative uncorrected distance visual acuity (UDVA) in LogMAR was 2.49 ± 0.54 and 0.54 ± 0.25, respectively (p < 0.01). The mean preoperative and postoperative best-corrected visual acuity (BCVA) in LogMAR was 0.52 ± 0.22 and 0.45 ± 0.24, respectively (p < 0.01). The mean endothelial cell loss was 110.46 ± 11.5 cells/mm2. Postoperative complications included transient corneal edema (17.7%), transient elevated intraocular pressure (22.2%), and non-significant vitreous hemorrhage (11.1%). No severe complications were observed. The modified technique provides stable PCIOL placement in aphakic eyes with long-term follow-up.

Long-term outcomes of scleral fixated black diaphragm intraocular lens in eyes with combined aphakia and aniridia

Purpose To evaluate long-term anatomical and functional outcomes in eyes undergoing scleral fixation of aniridic black diaphragm intraocular lens (BDIOL). Methods Total 38 eyes that underwent scleral fixation of BDIOL for secondary aniridia following ocular trauma with aphakia with absent posterior capsule or primary congenital aniridia with subluxated lens were retrospectively analyzed. Final visual acuity, early and late complications were examined. Correlation analysis was done. Results The mean follow-up was 28 months (range 6 to 66 months). The mean preoperative visual acuity of 1.82 ± 0.90 logMAR improved to 0.69 ± 0.61 ( p = 0.00). The mean spherical equivalent refractive error of 7.88 ± 4.85 diopters improved to −0.69 ± 1.52( p = 0.00). Complications were seen in 9 eyes (23.6%). Early complications were raised intraocular pressure (IOP) in 2 eyes and one eye with suture site infection which were managed conservatively. Late complications were corneal decompensation 3eyes (7.8%), retinal detachment, hypotonic maculopathy and refractive surprise in 1 eye each (2.6%). None reported IOL tilt or dislocation. The patients noticed a significant reduction in glare disability and photophobia. No significant association was found between pre-operative factors such as prior surgical procedures, history of trauma and length of follow-up with surgical outcomes. Conclusions Scleral fixation of BDIOL is an effective option in eyes with aniridia and aphakia without capsular support that have undergone multiple previous surgeries. Despite severe damage, the BDIOL helps reconstruct the anterior segment and give a good quality of vision with minimal complications rate.

Combined pars plana vitrectomy, lensectomy, pars plana glaucoma drainage device, and scleral fixated intraocular lens implantation in aniridia-related glaucoma and subluxated cataract

We present a case series of three patients who had undergone combined pars plana vitrectomy, lensectomy, low-cost pars plana glaucoma drainage tube, and suture-less scleral fixated intraocular lens for aniridia-related glaucoma and subluxated cataract. Data on age, gender, laterality, concomitant ocular disorders, pre-operative and post-operative best corrected visual acuity (BCVA), pre-operative and post-operative intraocular pressure (IOP), and pre-operative and post-operative number of anti-glaucoma medications (AGM) used were collected. All patients had significant improvement in BCVA and reduction in intraocular pressure post-operatively.

Comparison of safety and effectiveness of micropulse transscleral cyclophotocoagulation and "slow cook" diode laser transscleral cyclophotocoagulation in patients with refractory open-angle glaucoma.

This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). Both techniques reduced intraocular pressure effectively.

Characteristics of Patients with Late-onset Intraocular Lens Dislocation: A Prospective Multicenter Clinical Cohort Study in Japan: Real-world data of late-onset IOL dislocation in Japan.

To evaluate the patients' characteristics and ocular features of those who underwent surgery for late-onset intraocular lens (IOL) dislocation from 2020 to 2021 at multiple surgical centers in Japan. We also assessed the factors influencing the duration between prior IOL implantation and IOL dislocation repair as well as the factors affecting visual prognosis after IOL dislocation repair surgery. A prospective multicenter clinical cohort study. The study included 712 eyes of 712 patients. We collected data on the patients' characteristics and ocular features and performed multivariable linear regression analyses. Factors influencing the duration between prior IOL implantation and IOL dislocation repair, as well as factors affecting visual prognosis after repair surgery. The average duration between prior IOL implantation and IOL dislocation repair surgery was 131.5 ± 85.7 months (approximately 11 years). The average age of the patients at IOL dislocation repair surgery was 67.2 ± 14.2 years. Male patients (n = 529, 74.3%) were significantly younger than female patients (P = <.0001). During IOL dislocation repair surgery, the dislocated IOL was extracted in 655 (92.0%) eyes, and a secondary IOL was implanted in 555 (77.9%) eyes using the IOL haptics scleral fixation technique. Multivariable linear regression analysis demonstrated that younger age at IOL dislocation repair surgery (P = .0008), shorter axial length (P = .0004), and use of a capsular tension ring during prior IOL implantation (P = .0004) were significantly associated with shorter duration until IOL dislocation repair surgery. Furthermore, older age at repair surgery (P = .0051), worse preoperative visual acuity (P = <.0001), being female (P = .0005), and history of vitrectomy (P = .0061) were significantly associated with worse postoperative visual acuity. IOL dislocation status did not affect visual prognosis after repair surgery. This study highlights significant factors that affect the duration until late-onset IOL dislocation repair surgery and postoperative visual acuity after repair surgery. While an optimal timing for IOL dislocation repair surgery has not been fully established, our study suggests that IOL dislocation status does not affect visual prognosis.

Clinical spectrum of bilateral microspherophakia and risk factors associated with poor visual outcomes following lensectomy surgery - A multicentric study.

To study the clinical profile of patients with microspherophakia and the factors associated with poor vision following lensectomy surgery. A multicenter, retrospective, cross-sectional analysis was conducted from January 2010 to June 2022 on patients diagnosed with microspherophakia. A total of 102 eyes from 51 patients were enrolled, of whom 24 (47.1%) were male and 27 (52.9%) were female. All patients presented with bilateral involvement. The most common presenting complaint was defective vision, affecting 98 (96.1%) eyes. Patients exhibited varying degrees of lenticular myopia, with a mean refractive error of -13.54 ± 11.92 D. Glaucoma was present in 36 (35.3%) eyes at presentation. Subluxation of the crystalline lens was observed in 50 (49.1%) eyes, dislocation of the lens into the anterior chamber in 24 (23.5%) eyes, and dislocation into the vitreous cavity in 4 (3.9%) eyes. Limbal or pars plana lensectomy was performed in 54 (52.9%) eyes. The mean corrected visual acuity improved from 1.05 ± 0.82 logMAR units to 0.82 ± 0.79 logMAR units after lensectomy (P = 0.029). Poor postoperative visual acuity (less than 20/200) was associated with poor preoperative visual acuity (P = 0.005), presence of glaucoma at the first visit (P = 0.013), and intraocular pressure >30 mmHg (P < 0.001). Microspherophakia is associated with high lenticular myopia, subluxation, and dislocation of the crystalline lens. Significant improvement in postoperative vision was observed after lensectomy. Factors associated with poor postoperative vision included poor preoperative corrected vision, presence of glaucoma, and high intraocular pressure.

Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Lamellar Macular Hole: Long-Term Follow-Up

Background: To investigate functional and anatomical outcomes after pars plana vitrectomy (PPV) for lamellar macular hole (LMH) with a long-term follow-up. Methods: An interventional study on 14 patients (16 eyes) with LMH was conducted. The inclusion criteria included a minimum 36-month follow-up after PPV. The preoperative and postoperative best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography parameters were examined. Results: Preoperatively, the mean BCVA was 0.46 ± 0.22 LogMAR. Epiretinal proliferation (ERP) was visible in 81.25% of eyes. Outer retinal disruption was present in 31.25% of LMH cases. The average central foveal thickness (CFT) measured 183.68 ± 61.73 microns. The mean BCVA improved at each follow-up time point: it was 0.24 ± 0.16 LogMAR at 1 month, 0.18 ± 0.15 LogMAR at 6 months, and 0.09 ± 0.11 LogMAR at the last follow-up. There was a statistically significant improvement between BCVA at 1 month and BCVA at 6 months and between BCVA at 6 months and BCVA at the last follow-up (p &lt; 0.001). BCVA improved in all eyes, with 87.5% achieving at least 0.3 LogMAR improvement. The mean CFT at the 1-month follow-up was 211.45 ± 43.55 microns, increased to 248.81 ± 48.51 microns at 6 months, and further increased to 278.37 ± 45.50 microns at the last follow-up. Foveal contour restoration was achieved in all eyes, and those with preoperative ellipsoid zone alterations demonstrated a complete repair of the external retinal layers. No intra or postoperative complications were recorded. Conclusions: In our series, PPV had a high success rate and was associated with a substantial functional improvement in LMH treatment, and this result was maintained and kept increasing until the last follow-up. Long-term follow-up is crucial for a comprehensive evaluation of the healing process and to assess the benefits of the surgical intervention.

Visual and Anatomic Outcomes From Ultracomplex Retinal Detachment Repair in a Large County Hospital.

To evaluate outcomes of ultracomplex retinal detachment (UCRD) repairs performed at a large county hospital. Retrospective chart review of patients who underwent a UCRD repair, defined as a funnel retinal detachment (RD), RD associated with ocular trauma, or RD requiring retinectomy, 5000 centistoke silicone oil or perfluorocarbon heavy liquid (PFO). The outcomes examined were visual acuity (VA), anatomic success, and phthisis development. Fifty eyes met inclusion criteria; 7 (14%) had a funnel RD, 14 (28%) had a history of ocular trauma, 34 (68%) had a retinectomy, 19 (38%) used 5000 centistoke silicone oil, and 12 (24%) used PFO. The mean follow-up time was 10.9±6.9 months. At 3 months, vision had remained stable or improved for 64% of eyes and the macula was attached for 66% of eyes. The mean preoperative VA was 2.5±0.5 logMAR, and the mean VA at 3 months was 2.4±0.7 logMAR with no statistically significant difference (P=0.30). With multivariate regression, preoperative VA was a statistically significant predictive factor of postoperative VA at 3 months. Nine (18%) of eyes developed phthisis, a mean of 11.4±5.1 months after UCRD repair. Surgical intervention for UCRD can stabilize vision and achieve anatomic success.

Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses.

To present a technique of transcapsular scleral fixation of the standard capsular tension ring (CTR) through equatorial capsulotomy and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction, transcapsular scleral fixation of the standard CTR through equatorial capsulotomy, in-the-bag IOL implantation and with at least 6mo follow-up. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), complications, and postoperative IOL tilt and decentration were recorded. Nine eyes of 7 patients with a mean follow-up of 11.0±3.7mo were included in this study. The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively (P<0.001). The IOP was within the normal range postoperatively. The mean tilt of the IOL was 4.30°±2.31° (range, 1.0° to 8.9°) and the mean decentration of the IOL was 0.37±0.12 mm (range, 0.14 to 0.50 mm). No visually threatened intraoperative and postoperative complications were detected during the follow-up period. This is a safe and effective surgical technique for managing patients with severely subluxated lenses. It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

A Comparative Study of Planned and Unplanned Manual Small Incision Cataract Surgery (MSICS) Outcomes at Nan Hospital, Thailand: A Retrospective Study

Objective: To compare the visual outcomes and complications of planned and unplanned manual small incision cataract surgery (MSICS) using Ruit technique in cataract patients. Materials and Methods: The medical records of 3,107 eyes for 2,642 patients with cataracts who underwent MSICS using the Ruit technique at Nan Hospital between January 2016 and April 2023 were retrospectively reviewed. MSICS used a temporal scleral tunnel incision. All 3,107 surgeries were performed by a single surgeon. Out of these 908 eyes of 719 patients, 411 eyes missed the six-week follow-up, the data were incomplete on 195 eyes, 58 eyes underwent combined ocular procedures, and 244 eyes had preoperative vision impairing pathology or previous ocular surgeries. Medical records of 2,199 eyes from 1,923 patients were analyzed, including data on preoperative and postoperative uncorrected visual acuity (UCVA), operative time, intra- and postoperative complications, and astigmatism at the second and sixth weeks after surgery. Results: MSICS using Ruit technique was performed on 2,199 eyes of 1,923 patients. Both groups achieved excellent surgical outcomes with low complication. The postoperative UCVA at the sixth-week follow-up was 20/70 or better in 96.2% (1,467 out of 1,526 patients) in the planned group and 94.7% (637 out of 673 patients) in the unplanned group. At the sixth week after treatment, the median postoperative astigmatism of both groups were –1.0 (IQR –1.5 to –0.5) D. Hyphema was the most frequent intraoperative complication found in both groups, equating to 5.9% (90 out of 1,526 patients) in the planned group and 8.2% (55 out of 673 patients) in the unplanned group. There was no significant difference in the visual results and complication rates between the groups (p&lt;0.05). Conclusion: The present study demonstrates that cataract surgery in the unplanned group was safe, and the outcomes in terms of visual results and complications were comparable to those of the planned group. The findings revealed that favorable visual outcomes could be achieved with Ruit technique MSICS. Keywords: Ruit technique; Manual small incision cataract surgery

Long-Term Treatment Outcomes of Micropulse Transscleral Cyclophotocoagulation in Primary and Secondary Glaucoma: A 5-Year Analysis.

To investigate 5-year outcomes on intraocular pressure (IOP) and safety of micropulse transscleral cyclophotocoagulation (TSCPC) in patients with glaucoma. Patients with mild to advanced glaucoma who underwent a standardized micropulse TSCPC procedure at the University Eye Clinic Maastricht from November 2016 to February 2019 were included. A total of 165 eyes were included, with outcomes for 112 eyes available after 5-year follow-up. Mean age was 67.3 ± 13.9years; 58.2% were male. Glaucoma subtypes were primary glaucoma (n = 108) and secondary glaucoma (n = 57). Prior glaucoma surgery was performed in 65 of 165 eyes (39.4%). In the primary glaucoma group, mean preoperative IOP was 20.7 ± 7.1mmHg. Mean postoperative IOP at 1, 2, 3, 4, and 5years significantly reduced to 15.2 ± 6.5, 14.3 ± 5.0, 14.0 ± 4.9, 13.5 ± 4.1, and 12.9 ± 4.3mmHg, respectively. Preoperatively, the mean number of IOP-lowering medications was 3.3 ± 1.3, which changed to 2.8 ± 1.3, 2.8 ± 1.2, 2.8 ± 1.2, 2.9 ± 1.2, and 2.7 ± 1.3 at 1, 2, 3, 4, and 5years, respectively. In the secondary glaucoma group, mean preoperative IOP was 28.7 ± 10.3mmHg, dropping significantly to 19.3 ± 10.4, 18.6 ± 11.3, 17.8 ± 9.8, 18.1 ± 12.0, and 15.5 ± 7.6mmHg at the same intervals. The number of IOP-lowering medication was significantly reduced from 3.5 ± 1.1 to 2.5 ± 1.5, 2.2 ± 1.5, 2.6 ± 1.4, 2.6 ± 1.5, and 2.5 ± 1.7. In the total group, mean IOP reduction was 32.5% after 5years. Postoperative complications included cystic macular edema (n = 3), fibrinous/uveitic reaction (n = 1), and rejection of corneal graft (n = 2), all reversible after treatment. One patient developed late and persisting hypotony. Other adverse events were retinal venous occlusion (n = 1) and retinal vasculitis (n = 1), unrelated to the laser treatment. In patients with a preoperative Central Distance Visual Acuity (CDVA) > 0.05 on the Snellen chart, more than two lines of visual acuity (VA) loss were attributed to cataract (n = 10), retinal disease (n = 5), glaucoma progression (n = 3), corneal decompensation (n = 2), or other factors (n = 11). Micropulse TSCPC is a safe and effective treatment for reducing IOP and the number of IOP-lowering medications after a 5-year follow-up period. It is a viable alternative for patients after failed incisional glaucoma surgery or high-risk patients.

Epiretinal Membrane: Correlations Among Clinical, Immunohistochemical, and Biochemical Features and Their Prognostic Implications.

To investigate correlations among clinical, immunohistochemical, and biochemical characteristics of epiretinal membranes (ERMs) and their prognostic implications. This prospective study included 120 patients with idiopathic ERM who underwent vitrectomy. Preoperative and postoperative best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) were measured. Surgical ERM tissues underwent immunohistochemistry (IHC) analysis, and vitreous samples were analyzed for cytokine levels. Statistical analysis assessed associations among BCVA, OCT metrics (ERM stage, inner-retinal irregularity index [IRII], ellipsoid zone disruption [EZD]), IHC features (cell density, protein expression), and cytokines. The average age of the participants was 70.2 ± 7.6 years, and ERM stages were distributed as Stage 2 in 34 eyes (28.3%), Stage 3 in 54 eyes (45.0%), and Stage 4 in 32 eyes (26.7%). Advancing ERM stage was linked with worsening visual outcomes, higher preoperative IRII, increased EZD incidence, increased ERM cellularity, and elevated TGF-β1 level. Protein expression for myofibroblasts (αSMA), glial cells (GFAP), hyalocytes (CD45), and retinal pigment epithelium (RPE) cells (PRPH2) correlated positively with ERM stage. Multivariate analysis showed preoperative IRII significantly correlated with preoperative BCVA, GFAP, PRPH2, and type I collagen. TGF-β1 was significantly associated with preoperative IRII, αSMA, type I collagen, and N-cadherin, but not with postoperative BCVA. Postoperative BCVA was significantly correlated with preoperative BCVA, preoperative IRII, preoperative EZD, αSMA, and PRPH2. Early-stage ERM is associated with better visual prognosis, fewer inner and outer retinal changes in OCT, and fewer epithelial-mesenchymal transition-related alterations in ERM tissues. Key prognostic indicators for postoperative BCVA include preoperative BCVA, IRII, EZD, myofibroblasts, and RPE cells. TGF-β1 promotes the transdifferentiation of intraocular cells, impacting OCT features directly and visual outcomes indirectly.

Sparing versus Removal of Epiretinal Proliferation in the Surgical Repair of Full-thickness Macular Holes.

To evaluate the efficacy of vitrectomy with epiretinal proliferation (EP) sparing for full-thickness macular hole (FTMH) accompanied by EP. A multicenter, retrospective study. Eyes were divided into two groups: the sparing group (Group S) included eyes in which the EP around the hole was peeled and preserved, whereas the removal group (Group R) included eyes in which the EP was partially or completely removed. The internal limiting membrane was peeling in all eyes. Forty-six eyes were included. Twenty-five eyes were in Group S, and 21 eyes were in Group R, with no difference in preoperative best-corrected visual acuity (BCVA) (P = 0.96). After primary surgery, MHs were closed in all eyes, and there were no complications in either group. Postoperative 12-month BCVA significantly improved in both groups (both P < 0.01), while Group S had better 12-month BCVA than Group R (P = 0.016). In the multivariable analysis, EP sparing was associated with better BCVA at 12 months (P = 0.006) after accounting for the minimal macular hole size and preoperative BCVA. EP sparing and removal were both safe and effective techniques, while EP sparing may provide a favorable outcome for eyes with FTMH and EP.

Clinical Characteristics and Prognostic Factors of Patients with Intraocular Foreign Bodies from a Tertiary Eye Center in North China.

This study aims to describe the epidemiology and clinical features of patients with intraocular foreign bodies (IOFBs) and analyze the prognostic factors influencing final vision. We retrospectively reviewed medical records of patients with IOFBs admitted to Qingdao Eye Hospital of Shandong First Medical University between January 1, 2014, and December 31, 2021. Inclusion criteria involved complete clinical data details of patients diagnosed with intraocular foreign bodies in our hospital who were treated with concurrent surgery and based on IOFB position and characteristics, different surgical methods were employed. The minimum follow-up duration was 6 months. Exclusion criteria were foreign bodies retained in the orbit, organ failure, surgical contraindications, coagulation abnormalities, autoimmune diseases, history of ocular surgery, and ocular space-occupying lesions. Based on IOFB position and characteristics, different surgical methods were employed. Multivariate logistic regression analysis was performed to predict independent factors influencing final visual acuity after IOFBs. This study analyzed 159 patients (159 eyes) with IOFBs. Based on discharge and follow-up results, IOFB removal was performed through pars plana incision in 105 (67.9%) eyes, corneoscleral limbus incision in 24 (15.1%) eyes, and original wound in 27 (17.0%) eyes. Of these, 44 eyes underwent IOFB removal without vitrectomy, while 55 (34.6%) eyes were treated with silicone oil. Post-vitrectomy, three cases showed secondary macular membrane, five cases exhibited retinal detachment, and enucleation was necessary in three cases. The final best corrected visual acuity (BCVA, logMAR) was 1.06 ±0.88, significantly better than preoperative visual acuity of 1.65 ±0.87 (t = 8.21, p < 0.01). Multi-factor logistic regression analysis revealed that the length of corneal/scleral wound (OR=0.6 P < 0.05), maximum size of IOFB (OR=0.585 P < 0.05), initial presenting VA (OR=0.900 P < 0.05), and macular lesions(OR=0.400 P < 0.05) were risk factors for postoperative vision prognosis after intraocular foreign body surgery. In a tertiary eye center in northern China, IOFBs predominantly affected the working-age group, particularly males. Factors such as wound length, IOFB size, initial presenting VA, and macular lesions might impact the final visual outcome.