Pseudophakic Eyes Research Articles

Hybrid Contact Lenses in Children: a Case Series

Introduction : Refractive errors in children have experienced a significant increase in recent years. Contact lenses are a therapeutic option when spectacles can no longer provide maximum results. One of the most advanced design than suitable for children is Hybrid Contact Lenses (HCL). HCL feature a Rigid Gas Permeable (RGP) center surrounded by a soft ridge or skirt. This design enable the hard center to provide clear vision while the soft skirt offers the comfort and ease of a soft lens. However, this type of contact lens has not been widely used in Indonesia.
 Case Illustration : Three patients were prescribed HCL to correct their high refractive errors and amblyopia; 1. 5 years old female: OD: S-14.50 C-3.25x180 6/24 OS: S-12.5 C-3.50x10 6/24; 2. 5 years old female with anisometropia: OD: S-6.00 C-2.50x180 6/12 OS: S-0.75 C-2.000x170 6/6; 3. 8 years old male with pseudophakic eyes: OD: S-9.00 C-2.00x180 6/30 OS: S-8.00 C-2.00x175 6/30. Visual Acuity after 1 month of HCL average from 6/9 to 6/6 both eyes (BE).
 Discussion : In this study, we can notice several advantages of using HCL. The main outcome are significantly increased visual acuity and reduced amblyopia. HCL also has a higher comfort level compare to RGP Lenses, the soft hydrogel skirt really help the neophyte patient to ease their initial adaptation.
 Conclusion : Contact lenses are a mainstay of optical correction options for children with special refractive needs. Due to it's design and comfort, HCL is one of the most suitable contact lenses for children. Therefore, socialization and further introduction about this contact lens is needed.

Outcomes of Chandelier-Assisted Scleral Buckling in Rhegmatogenous Retinal Detachments: Systematic Review and Meta-analysis.

Purpose: To examine the outcomes of chandelier endoillumination-assisted scleral buckling (chandelier scleral buckling) for rhegmatogenous retinal detachments (RRDs) and compare them with those of standard scleral buckling using indirect ophthalmoscopy. Methods: A literature search was performed on April 15, 2023. Outcomes analyzed included the primary anatomic success rates, surgical duration, and complication rates. A meta-analysis of proportions estimated the pooled success rate of chandelier scleral buckling. In addition, meta-analyses compared the success rates between pseudophakic eyes and phakic eyes having chandelier scleral buckling and compared success rates and surgical duration between standard scleral buckling and chandelier scleral buckling. Results: Thirty studies with 1133 eyes were included. The pooled primary anatomic success rate of chandelier scleral buckling was 91.7% (95% CI, 89.6%-93.6%). In studies comparing success rates between the 2 techniques, there was no significant difference (risk ratio, 1.01; 95% CI, 0.94-1.08; P = .80). The surgical times were significantly shorter with chandelier scleral buckling than with standard scleral buckling (mean difference, -18.83; 95% CI, -30.88 to -6.79; P = .002). There was no significant difference in the success rate between pseudophakic eyes and phakic eyes (risk ratio, 0.99; 95% CI, 0.91-1.08; P = .89). No cases of endophthalmitis were reported. Conclusions: Chandelier endoillumination-assisted scleral buckling may be a promising technique given its high rate of primary anatomic success for RRDs and success rates similar to those of standard scleral buckling. There was no significant difference in the efficacy of chandelier scleral buckling between pseudophakic eyes and phakic eyes.

SF 6 COMPARED WITH C 2 F 6 FOR INFERIOR RHEGMATOGENOUS RETINAL REPAIR : The Manchester Pseudophakic Retinal Detachment Study.

To compare SF 6 relative with C 2 F 6 in the anatomical and functional outcomes following pars plana vitrectomy for uncomplicated primary pseudophakic rhegmatogenous retinal detachment with inferior causative breaks. This is a retrospective, comparative study on eyes with pseudophakic rhegmatogenous retinal detachment with inferior causative breaks that had small-gauge pars plana vitrectomy repair using SF 6 and C 2 F 6 tamponade between 2011 and 2020 at a tertiary centre in the United Kingdom. Primary outcome was single surgery anatomical success, and the secondary outcome was best-corrected visual acuity. Propensity score matching, using preoperative findings as covariates to account for relevant confounders, was performed. From 162 pseudophakic rhegmatogenous retinal detachment eyes with inferior causative breaks, the median (interquartile range) follow-up was 82 (52-182) days. The single surgery anatomical success was 156 (96.3%) overall: 47 of 47 (100.0%) and 109 of 115 (94.8%) in the SF 6 and C 2 F 6 groups, respectively ( P = 0.182). Relative to the SF 6 group, the C 2 F 6 group had a higher mean number of tears (SF 6 : 3.1[2.0], C 2 F 6 : 4.5[2.7], P = 0.002) and greater retinal detachment extent (SF 6 : 5.3[2.9], C 2 F 6 : 6.2[2.6] clock hours, P = 0.025). Following propensity score matching analysis, 80 eyes were matched with 40 in each group to homogenize preoperative factors. No significant difference was found in single surgery anatomical success and best-corrected visual acuity between the groups following propensity score matching. Primary pars plana vitrectomy with gas tamponade leads to a high single surgery anatomical success rate in uncomplicated pseudophakic rhegmatogenous retinal detachment with inferior causative breaks with no additional benefit associated with long-acting tamponade when comparing C 2 F 6 with SF 6 .

Flare levels after intravitreal injection of brolucizumab for diabetic macular edema

PurposeThis study aimed to evaluate anterior flare intensity (AFI) after intravitreal injection of brolucizumab (IVBr) in patients with diabetic macular edema (DME), and to identify the factors associated with the change of AFI after IVBr.MethodsThis prospective multicenter study was conducted at five sites in Japan for patients with DME who underwent a single IVBr. AFI and central retinal thickness (CRT) were measured using a laser flare meter and spectral-domain optical coherence tomography, respectively, at weeks 0 and 6.ResultsSixty-five patients (phakia, 37 eyes; pseudophakia, 28 eyes) were enrolled. Six weeks after IVBr, CRT and best-corrected visual acuity significantly improved (p < 0.0001). AFI (p = 0.0003) and age (p = 0.0054) were significantly higher in patients with pseudophakic eyes than those with phakic eyes. The AFI of the phakic eyes decreased after IVBr (p = 0.043). As the AFI before injection is higher (p = 0.0363) and the age is lower (p = 0.0016), the AFI decreases after IVBr. There was a significant positive correlation between the rates of change in CRT and AFI (p = 0.024).ConclusionAfter IVBr, AFI decreases in phakic eyes but not in pseudophakic eyes. The age, AFI and CRT before injection and changes of CRT are involved in the change in AFI after IVBr.

FemtoLASIK clinical case of laser visual correction of residual myopia in the eye with IOL by using MEL-90 and VisuMax 500

The authors describe their experience of successful laser additional correction of residual myopic refractive error (Vis OD = 0.04; Sph –5.75 D, Cyl –2.00 D, ax 25° = 0.4) using the FemtoLASIK method with the MEL-90 excimer laser and the VISUMAX femtosecond laser (Carl Zeiss Meditec) in a 15-year-old patient on a pseudophakic eye (Acrysof® Natural, model SN60AT), with moderate glistening and refractive amblyopia after phacoemulsification of congenital posterior capsular cataract with IOL implantation performed at the age of 7 years. Moreover, the very next day after present surgery, the patient’s maximum distance visual acuity without correction increased to 0.5, but she still had the ability to read ordinary magazine text at close distance. Thus, the described clinical case confirms that FemtoLASIK technology can be successfully used as the second stage of bioptics (laser correction of myopia in pseudophakic eyes) in young patients.

Secondary cataract in patients after traditional phacoemulsification in comparison with femtolaser extraction

BACKGROUND: Secondary cataract is a frequent complication of the postoperative period of cataract surgery.&#x0D; AIM: To evaluate the timing of secondary cataract formation in pseudophakic eyes after cataract extraction phacoemulsification, carried out as traditional phacoemulsification in comparison with femtolaser cataract surgery.&#x0D; MATERIALS AND METHODS: We conducted a retrospective study of patients who underwent YAG laser posterior capsulotomy (98 people, 108 eyes). All patients were divided into two groups. First group (54 people, 58 eyes) consisted of patients in whom secondary cataract occurred after traditional phacoemulsification. In the second group (44 people, 50 eyes) secondary cataract occurred after femtolaser-assisted cataract surgery. All patients were implanted with a monofocal intraocular lens MIOL-2.&#x0D; RESULTS: The data analysis revealed that the period of secondary cataract formation in the first group was 2.83 ± 1.25 years, in the second group 3.75 ± 1.0 years.&#x0D; CONCLUSIONS: The analysis showed that the secondary cataract after traditional phacoemulsification occurs earlier by an average of 1 year than after femtolaser-assisted cataract surgery.

Mid-term real world outcomes of the Hydrus® Microstent in open angle glaucoma.

To evaluate the mid-term clinical results and the safety aspects of the Hydrus® Microstent (Ivantis, Inc, Irvine, CA) in a real-life setting. Retrospective case series. Hydrus® Microstent was implanted in phakic eyes (88 eyes, 87.1%) and in pseudophakic eyes (13 eyes, 12.9%), respectively. Mean follow-up time was 16 ± 9 months with 27 eyes having a follow-up time of more than 24 months. The primary endpoint was reduction in IOP compared to baseline. Target IOP levels were set at ≤20 mmHg, ≤18 mmHg and ≤15 mmHg. Kaplan-Meier survival was defined as a reduction in IOP of ≥20% compared to baseline. Secondary endpoints were reduction in number of glaucoma medications and safety assessments addressing visual acuity, adverse events, re-surgery rate and identification of factors that made the implantation more difficult. 101 eyes underwent Hydrus® implantation. The mean preoperative IOP was 21.60 mmHg (SD 6.6) on 2.18 (SD 1.3) medications. After a mean follow up time of 16 months, the mean IOP was reduced to 14.61 ± 3.7 mmHg on 1.12 (SD 1.1) medication classes (p < 0.001). Mean decrease in IOP was 26.7%. Analysis of the target IOP levels showed that in 29%, 34% and 35% of cases an IOP of ≤15 mmHg, ≤18 mmHg and ≤20 mmHg respectively could be achieved. BCVA improved from 0.56 ± 0.3 at baseline to 0.85 ± 0.3 more than 24 months after surgery (p < 0.001). The rate of re-operation was low at <3%. Adverse events occurred in 4 eyes (<4%). This study underlines the effectiveness and the safety of the Hydrus® Microstent in an elective setting, but it also demonstrates certain limits and risk factors of this procedure.

Comparison of intraocular pressure fluctuation and glaucoma progression rate between phakic and pseudophakic eyes in pseudoexfoliation glaucoma

The management of patients with concurrent pseudoexfoliation glaucoma (PXG) and cataract is challenging given its worse prognosis compared to other glaucoma types and the increased risk associated with cataract surgery. In this retrospective study, we investigated the long-term outcomes of cataract surgery in patients with PXG. We enrolled patients with PXG who had undergone cataract surgery at least 2 years previously and compared them with mean deviation (MD) matched patients with phakic eyes. The results showed that both groups experienced a decrease in MD, with the group of pseudophakic eyes exhibiting a significantly higher rate of decline (−2.15 ± 2.66 dB/year vs. −0.86 ± 0.95 dB/year; P = 0.040). Similarly, there was a trend towards more rapid thinning of the retinal nerve fiber layer in the pseudophakic group (−2.92 ± 2.34 μm/year vs. −1.79 ± 1.71 μm/year; P = 0.074). No significant differences in the intraocular pressure parameters were observed between the two groups. Multivariate analysis revealed that pseudophakic lens status was significantly associated with a faster rate of MD decline in patients with PXG (regression coefficient, −1.391; P = 0.022). These findings underscore the importance of close monitoring of patients with pseudophakic PXG to effectively manage glaucoma progression.

Effect of spherical aberration on visual acuity and depth of focus in pseudophakic eyes.

To assess the performance of 4 intraocular lenses (IOLs) in various spherical aberration (SA) conditions, using the VAO adaptive optics simulator. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Prospective case series. Distance-corrected visual acuities at distance (CDVA), intermediate (DCIVA), and near (DCNVA) were measured in 42 dilated pseudophakic eyes at baseline and with ocular SA ranging from -0.4 to +0.4 μm in increments of 0.2 μm (6.0-mm pupil). 4 IOL types were assessed: monofocal IOLs with zero-SA, enhanced-monofocal, extended depth-of-focus (EDOF), and continuous range-of-vision. Compared with SA = 0 μm, significant changes (all P < .05) were: (1) zero-SA monofocal IOLs' DCNVA at high contrast improved by 0.13 logMAR with SA = -0.4 μm and worsened by 0.09 and 0.10 logMAR with SA = +0.2 and +0.4 μm, respectively. DCNVA at low contrast worsened by 0.09 logMAR with SA = +0.4 μm; and (2) with SA = -0.4 μm, the enhanced monofocal IOL lost 0.06 logMAR of CDVA at high contrast and gained 0.09 logMAR of DCNVA at low contrast. There were no significant changes from SA = 0 μm for EDOF and continuous range-of-vision IOLs. Zero-SA and EDOF IOLs were the most and least sensitive to SA modulation, respectively. In perfect optical systems where all the optical elements are aligned, induction of targeted amounts of negative SA improved the depth of focus of some IOL types. No benefit was found with positive SA.

Drusen classification and quantification in pseudophakic postmortem eyes implanted with or without blue-light filtering intraocular lenses

Abstract Purpose: To investigate the effect of blue-light filtering intraocular lenses on drusen formation in postmortem eyes via histopathological analysis. Materials and Methods: One hundred and ninety-three postmortem pseudophakic eyes (100 with a clear intraocular lenses [cIOL] and 93 with a yellow, yellow intraocular lenses [yIOL]) were obtained from the Lions Gift of Sight eye bank. Sex, age-at-surgery, age-at-death, surgery-to-death time, and clinical history were collected. Eyes were sectioned on their coronal and sagittal axes, and formalin-fixed paraffin-embedded macular cross sections were obtained. Sections were stained with hematoxylin and eosin and scanned with the Zeiss Axio Scan. Z1 scanner. Drusen were classified by type, size or subtype, and quantity. Results: Large, soft drusen were present in 49% (n = 95) of eyes, 9% (n = 17) had cuticular drusen, 16% (n = 30) had hard drusen, and 26% (n = 51) had no drusen. There were significantly more cIOL eyes with large, soft drusen (P &lt; 0.001). There were significantly more yIOL eyes with no drusen (P &lt; 0.0001). No significant differences in the presence of hard or cuticular drusen were found. yIOL eyes had significantly higher mean age-at-surgery (P &lt; 0.001) and mean age-at-death (P &lt; 0.05), while cIOL eyes had a significantly higher mean surgery-to-death time (P &lt; 0.05). Finally, significantly more yIOL eyes had a history of smoking (P &lt; 0.01) and hypertension (P &lt; 0.05), while significantly more cIOL eyes had a history of glaucoma (P &lt; 0.05). Conclusions: Large, soft drusen were significantly less prevalent in yIOL eyes than in cIOL eyes and significantly more yIOL eyes had no drusen. These findings suggest that yIOLs may prevent the incidence and development of age-related macular degeneration after cataract surgery.

Simulation of the effect of capsular opacification on retinal illumination

Posterior capsular opacification is the most common complication after cataract surgery with intraocular lens implantation. Different strategies have been proposed to avoid PCO including 360° continuous sharp edges of the posterior IOL optics rim, haptics angulations, or surface modification of the optics. However, depending on the IOL material and surgical technique 20 to 60% of eyes require Nd:YAG laser capsulotomy in the first 2 years after cataract surgery. In this talk we would like to define a scattering model for the posterior lens capsule and perform raytracing through the pseudophakic eye with a scattering capsule to investigate the impact of biometric parameters on the scatter characteristics and contrast transfer of the eye.

Direct observation of negative dysphotopsia in a physical model of the pseudophakic eye

Introduction: Negative dysphotopsia (ND) is a phenomenon affecting pseudophakic eyes where a dark crescent or shadow is perceived in the peripheral temporal visual field. Although is it understood that the size and position of the intraocular lens (IOL) creating a space between the IOL's optic and the iris are involved, the exact aetiology and conditions remains unclear. The purpose of this study was to develop a physical model of the pseudophakic eye and to record ND at the retinal plane in a variety of conditions.Methods: The eye model resembles anatomically the human eye with an aspheric cornea made of PMMA (R = 7.73 mm, Q = −0.24) an exchangeable iris and an IOL holder with variable distance (0.5 to 1.5 mm) from the pupil, representing a pseudophakic anterior chamber depth (pACD) ranging from 4.05 to 5.05 mm. The eye model is filled with distilled water. A camera, in a water‐tight housing is used to record images at the retinal plane. Negative dysphotopsia was investigated using both point sources and extended surfaces for two different pACD values (4.05 and 5.05 mm) and two pupil diameters (3 and 6 mm).Results: A characteristic crescent appeared next to the point spread function (PSF) in the periphery, representing light that was propagated beyond the edge of the IOL. This crescent was more prominent in greater pupil diameters and greater pACD values. When testing with an extended field, a relatively dark band appeared at a specific location at approximately 75 degrees of field angle. Various optical strategies to eliminate negative dysphotopsia can be envisaged including inverted meniscus lenses that ‐naturally‐ have a narrower peripheral gap and allow optical propagation until greater field angles as well as formations that block peripheral light.Conclusion: A peripheral crescent, corresponding to light that misses the IOL's optic results to a double‐peaked PSF for field angles as small as 45 degrees in some conditions (large pupil diameter, deep pACD). Yet, a dark band does not appear until much greater angles, where effectively the part of light passing through the IOL is eliminated while the peripheral crescent persists.

Changes in peripheral visual field perception after intraocular lens implantation

Aims/Purpose: To assess whether the eccentricity of the perception of objects in the peripheral visual field changes when a crystalline lens is replaced by an intraocular lens (IOL).Methods: The effect of the IOL on the eccentricity at which peripheral objects are perceived was assessed using phakic and pseudophakic versions of the same eye model. Non‐sequential ray tracing simulations were used to determine the relation between the input eccentricity at which an object was positioned in the visual field and the corresponding eccentricity at which the object was perceived by the eye in every eye model. Two different IOL designs were evaluated in the pseudophakic eye model. For each IOL design five different axial positions and seven different intrinsic powers were tested. Subsequently, the results of the pseudophakic eye models were compared to the results of the phakic model.Results: For central vision, the perceived eccentricity differed less than 1 degree between the phakic and pseudophakic models. For peripheral vision, the light rays were refracted to a more central retinal location in pseudophakic eyes than in phakic eyes, therewith shifting perceived eccentricity. The amount of the perceived shift depended on the IOL design and its axial position. The maximal shift within the evaluated pseudophakic models was 5.4 degrees towards central vision.Conclusions: IOL implantation has a minor effect on how the central visual field is perceived, but it can alter the eccentricity at which objects in the peripheral visual field are perceived by over 5 degrees. Such a shift in eccentricity can, for instance, affect how peripheral visual complaints, such as negative dysphotopsia, are experienced.

Evaluation of Visual Outcomes, Postoperative Angle Alpha, and Angle Kappa After Implantation of Isofocal Intraocular Lenses.

To evaluate the effect of angles kappa and alpha on the visual outcomes after implantation of isofocal intraocular lens (IOL) during cataract surgery. This prospective study involved 66 eyes undergoing cataract surgery with Isopure IOLs. Exclusion criteria comprised irregular corneal astigmatism exceeding 1.0D, and ocular co-morbidities affecting visual outcomes post-surgery. Evaluation parameters included postoperative refraction, uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 cm. Additionally, postoperative angles alpha, kappa, and wavefront aberrations at a 3-mm pupil using ray tracing were assessed post-surgery at least 60 days later. Patients had a mean age of 64.48 ± 9.92 years. Mean postoperative manifest refraction spherical equivalent (MRSE) was -0.21 ± 0.27 D. Mean UDVA and CDVA were LogMAR 0.06 ± 0.04 and 0.02 ± 0.06, respectively. Mean UIVA LogMAR 0.32 ± 0.08 while mean DCIVA was LogMAR 0.29 ± 0.08. Postoperative angles kappa and alpha were 0.39 ± 0.14 mm and 0.45 ± 0.15 mm, respectively. Mean postoperative ocular RMS higher-order aberrations (HOAs) 0.23 ± 0.08. Spherical aberration, coma, and trefoil averaged 0.05 ± 0.07, 0.12 ± 0.03, and 0.07 ± 0.03, respectively. No significant correlations were observed between postoperative angle kappa and alpha with UDVA, CDVA, or HOAs. A non-significant weak positive correlation was noted between angle kappa and UIVA/DCIVA, while no correlation was found between angle alpha and UIVA/DCIVA. No substantial correlations were found between various postoperative angles kappa and alpha values and postoperative visual acuity metrics (UDVA, CDVA, UIVA, and DCIVA) or higher order ocular aberrations (including, spherical aberration, coma, and trefoil with a 3.0 mm diameter) in pseudophakic eyes implanted with isofocal intraocular lenses (IOLs).

Comparative Analysis of the Visual, Refractive and Aberrometric Outcome with the Use of 2 Intraocular Refractive Segment Multifocal Lenses.

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens.

Cystoid macular edema after vitrectomy and after phacovitrectomy for epiretinal membrane

ObjectifComparer l'incidence d’œdème maculaire cystoïde (OMC) après une vitrectomie et après une phaco-vitrectomie toutes 2 réalisées dans le but de retirer la membrane épirétinienne (MER). NatureÉtude comparative et rétrospective d'intervention. MéthodesOn a procédé à l'analyse rétrospective des dossiers médicaux des patients qui ont subi une vitrectomie ou une phaco-vitrectomie dans le but de retirer la MER aux mains d'un seul chirurgien. La phaco-vitrectomie a été réalisée dans tous les yeux phaques, tandis que la vitrectomie a été réalisée dans tous les yeux pseudophaques. On considérait qu'il y avait augmentation de l’épaisseur de la macula lorsque cette dernière avait augmenté de plus de 10 % lors de la visite postopératoire à la semaine 4, comparativement aux mesures initiales. RésultatsLe groupe phaco-vitrectomie comptait 214 yeux, et le groupe vitrectomie, 53 yeux. On a observé une augmentation de l’épaisseur de la macula dans 15,4 % des yeux du groupe phaco-vitrectomie, soit un taux plus élevé que celui du groupe vitrectomie, qui se chiffrait à 3,8 % (p = 0,023). ConclusionsL'augmentation de l’épaisseur de la macula, qui serait une forme d'OMC, n’était pas rare (15,4 %) après la phaco-vitrectomie dans des yeux phaques, mais peu fréquente (3,8 %) après la vitrectomie seule dans des yeux pseudophaques. Le syndrome d'Irvine-Gass semble être causé par le retrait du cristallin et non par l'intervention intraoculaire ou le traumatisme chirurgical en tant que tels.

Intravitreal Dexamethasone as a Rescue for Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration with Persistent Disease Activity and High Treatment Demand.

Purpose: To assess the impact of switching to, or adding, an intravitreal dexamethasone implant (Dex; Ozurdex®) in anti-vascular endothelial growth factor (VEGF) therapy on disease stability and treatment intervals in eyes with neovascular age-related macular degeneration (nAMD) and persistent disease activity and high treatment demand. Methods: This retrospective noncomparative multicenter longitudinal case series included pseudophakic eyes with nAMD and persistent retinal fluid despite regular anti-VEGF therapy (ranibizumab or aflibercept) that received at least 1 intravitreal Dex implant. Visual acuity, central retinal thickness (CRT), and intraocular pressure were recorded before, and after, the addition of Dex to anti-VEGF therapy. Results: Sixteen eyes of 16 patients met the inclusion criteria of persistent fluid despite anti-VEGF therapy, under treatment intervals of ≤7 weeks in 14 instances. Patients were 80.9 ± 7.4 years old and had received 25.5 ± 17.4 anti-VEGF injections before Dex over a period of 36.4 ± 21.9 months before switching. The treatment interval increased from 5.5 ± 3.2 weeks between the last anti-VEGF and first Dex injection to 11.7 ± 7.3 weeks thereafter (P = 0.022). CRT remained stable (385.3 ± 152.1, 383.9 ± 129.7, and 458.3 ± 155.2 μm before switching as well as 12 and 24 months after switching; P = 0.78 and P = 0.36, respectively). An insignificant mean short-term early increase in visual acuity was not sustained over time. Conclusions: The addition of Dex resulted in a relevant and sustained increase in treatment intervals, whereas CRT and visual acuity remained stable in these difficult-to-treat eyes. It may be discussed whether inflammation or other steroid-responsive factors play a significant role in cases of nAMD with nonsatisfactory responses to anti-VEGF.

Agreements' profile of Scheimpflug-based optical biometer with gold standard partial coherence interferometry.

To determine the agreement of ocular biometric indices including axial length, keratometric readings, anterior chamber depth, and horizontal corneal diameter between the Pentacam AXL and IOL Master 500. The study was a large cross-sectional population-based study (Tehran Geriatric Eye Study) conducted from Jan 2019 to Jan 2020. A total of 160 clusters were randomly selected proportional to size (each cluster contained 20 individuals) from 22 strata of Tehran city. All people aged 60y and above were invited to participate in the study. For all participants, preliminary ocular examinations were performed including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, anterior and posterior segment examinations. All participants underwent an ocular biometry using the Pentacam AXL and IOL Master 500. The 95% limits of agreement (LoA) between the two devices were -0.13 to 0.19, -0.15 to 0.17, and -0.13 to 0.19 in normal, pseudophakic, and cataractous eyes, respectively. With increasing the axial length, the difference between the two devices significantly increased in all three groups of normal, pseudophakic, and cataractous eyes (P<0.001). The 95% LoAs between the two devices regarding the mean keratometry shows that the best LoAs were seen in cataractous (-0.33 to 0.81) and followed by normal eyes (-0.36 to 0.86) and the pseudophakic eyes (-0.48 to 0.90) had the widest LoA. The 95% LoAs for horizontal corneal diameter measurements were -0.08 to 0.86, -0.03 to 0.83, and -0.07 to 0.87 in normal, pseudophakic, and cataractous eyes, respectively. The 95% LoAs of anterior chamber depth measurements between the two devices was -0.39 to 0.19 and -0.37 to 0.13 in normal eyes and cataractous, respectively. The Pentacam AXL has excellent agreement with the gold standard, IOL Master 500 in measuring axial length. In eyes with cataracts, the difference between the two devices is more scattered. With the increasing of axial length, the difference between the two devices increased, which should be considered when using Pentacam AXL.

Comparison of Automated Keratometer and Scheimpflug Tomography for Predicting Refractive Astigmatism in Pseudophakic Eyes.

To analyse the correspondence between refractive astigmatism and corneal astigmatism in pseudophakic eyes with non-toric intraocular lenses. Yeouido St. Mary hospital, Seoul, Republic of Korea. Evaluation of a diagnostic test instrument. This retrospective study included 95 eyes of 95 patients. Corneal astigmatism was measured with an automated keratometer (RK-5, Canon) and Scheimpflug tomography (Pentacam HR, Oculus). Refractive astigmatism was compared to keratometric astigmatism (based on anterior corneal measurements only), equivalent K-reading, and total corneal astigmatism (both based on anterior and posterior corneal measurements). Vector analysis was carried out by Næser's polar value method. The accuracy was defined as the average magnitude of the vectorial difference in astigmatism (DA). Each corneal measurement was optimized in retrospect by a multiple linear regression equation between refractive and corneal astigmatism. Keratometric astigmatism overestimated with-the-rule (WTR) refractive astigmatism and underestimated against-the-rule (ATR) refractive astigmatism. Several measurements based on both corneal surfaces' values did not show any statistically significant difference with respect to refractive astigmatism. The mean corneal astigmatism by total corneal refractive power (TCRP) at 4.0 mm (zone/pupil) produced the lowest mean arithmetic DA and the highest percentage of eyes with a DA ≤ 0.50 dioptre. After optimization, the accuracies of automated KA and TCRP 4.0 mm (zone/pupil) were similar. Total corneal astigmatism measured by Scheimpflug tomography at a 4.0 mm zone centered on the pupil accurately reflects the refractive astigmatism in pseudophakic eyes. However, the accuracy of total corneal astigmatism is not different from automated KA after optimization.

Long-term surgical outcomes of pediatric cataract—multivariate analysis of prognostic factors

We assessed the 10-year postoperative outcomes of pediatric cataract patients who underwent surgery at the age of 6 years or younger. A retrospective review of medical charts was conducted for 457 eyes of 277 patients, with the age at surgery averaging 1.3 ± 1.5 years (mean ± SD) and the follow-up duration averaging 12.8 ± 2.4 years (ranging from 10 to 17 years). The cohort included 250 eyes of 125 cases with bilateral aphakia (age at surgery 0.5 ± 0.8 years), 110 eyes of 55 cases with bilateral pseudophakia (1.9 ± 1.6 years), 42 cases with unilateral aphakia (1.1 ± 1.3 years), and 55 cases with unilateral pseudophakia (2.6 ± 1.7). A forward stepwise multiple regression analysis revealed that the best-corrected visual acuity at the final visit was significantly associated with laterality of cataract (with bilateral cases showing better results compared to unilateral cases), presence of systemic comorbidities, presence of ocular comorbidities, development of glaucoma, and phakic status (with better results in the pseudophakia group than the aphakia group). The age at surgery did not significantly affect visual acuity outcomes. A multiple logistic regression analysis demonstrated that the incidence of secondary glaucoma was significantly linked to younger age at surgery, phakic status (higher in aphakic than pseudophakic eyes), and presence of systemic comorbidities. In conclusion, after pediatric cataract surgery, final visual acuity was better in patients with bilateral cataracts, those treated with an intraocular lens, and cases without systemic or ocular comorbidities and secondary glaucoma. The development of secondary glaucoma was linked to younger age at surgery, aphakic status, and presence of systemic comorbidities.