Retroillumination Images Research Articles

Revisiting fuchs endothelial corneal dystrophy clinical classification using innovative high‐resolution, far‐red, reflexion free retroillumination

Purpose: Fuchs endothelial corneal dystrophy (FEDC) is by far the most common corneal endothelial diseases in Western countries, and 50% of keratoplasties are carried out to treat endothelial diseases. New treatments are also emerging (Descemetorhexis only, rock‐inhibitors, mTor‐inhibitors, FGF‐1). It will therefore soon be vital to be able to determine the stage of each patient in a simple and reliable way, in order to personalize treatment. Visual acuity, retroillumination, specular microscopy and thickness mapping are the 4 pillars of the examination. However, current retro‐illumination images are of insufficient quality. Aim: to present the first series of FECD observed using new‐generation retroillumination.Methods: We developed a prototype retroilluminator by modifying a slit lamp with the aim of obtaining high‐resolution images, without parasitic reflection and without dazzling the patient. We then prospectively photographed 200 FECD patients. The images were then classified by 3 independent observers according to the modified Krachmer classification, which is the most widely used in the literature: it distinguishes patients according to the number of Guttae, the size of the area of confluent Guttae and the presence of oedema.Results: The prototype produced clear, glare‐free images in over 95% of cases. Persistent reflections were observed exclusively in pseudophakic patients. The high resolution made it possible to observe all the Guttae and to challenge Krachmer's grade 2 classification (more than 12 non‐confluent drops), which included a major diversity of patients, some of whom had thousands of non‐confluent Guttae. We also highlighted for the first time to our knowledge 2 new elements: the high frequency of radial alignment of Guttae, often over 360°, and the presence of Guttae in the periphery of the endothelium, suggesting that a cell migration anomaly is involved.Conclusions: Innovative retroillumination images challenge Krachmer's classification by providing exceptional precision. They will make it easier to distinguish between sub‐groups of patients with different visual repercussions and evolutionary profiles. Easy to use, this new device should help to improve both our understanding of FECD and its routine management.

Effect of Decentration, Rotation, and Tilt on Objective Optical Quality of Plate Haptic Toric Intraocular Lenses in the Early Postoperative Period.

This study aimed to determine the influence of decentration, rotation, and tilt on objective optical quality of plate haptic toric intraocular lenses (tIOLs). The area ratio of modulation transfer function (MTF), strehl ratio of point spread function (PSF), and higher order aberrations (HOAs) for 3 mm and 5 mm pupil diameter (PD) were evaluated at postoperative 1 month. The retroillumination images pictured by OPD-scan III were used to quantify the degree of decentration and rotation, whereas the tIOL tilt was directly obtained by the tilt aberration. Patients were separated into two subgroups based on tIOL misalignment cutoff values. There were 29 eyes (24 patients) in the study. The decentration of more than 0.25 mm did not substantially differ from those less than or equal to 0.25 mm. PSF of 3mm PD and MTF, intraocular HOAs, and trefoil aberration for 3 mm and 5 mm PD significantly deteriorated with a rotation of more than 3 degrees, whereas only intraocular HOAs for 5 mm PD and coma for 3 mm and 5 mm PD were significantly severe with a tilt of more than 0.1 µm and 0.25 µm in corresponding PD. Furthermore, tIOL rotation and tilt were highly correlated with intraocular trefoil aberration and coma, respectively. The decentration of the monofocal bitoric IOLs is more tolerant to optical quality degradation after 1 month of surgery but more sensitive to intraocular trefoil aberration caused by rotation and coma aberration induced by tilt. As far as we know, this is the first study to investigate the relationship between the plate haptic bitoric IOL misalignment and objective optical quality measured by OPD-scan III in the real world, which may provide reference information for IOL selection to improve surgical outcomes.

Rotational stability and capsular bag performance of a hydrophobic acrylic open-loop single-piece intraocular lens.

To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months. In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1 h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration. In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1 h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17 mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0. This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values.

Rotational Stability of Toric Capsular Bag–Fixated Intraocular Lenses in Duet Procedure for Reversible Trifocality

To evaluate the long-term rotational stability of capsular bag-fixated toric intraocular lenses (IOLs) in polypseudophakic eyes of patients who underwent duet procedure for reversible trifocality. Retrospective interventional case series. We included 34 eyes of 20 patients who underwent duet procedure with implantation of a monofocal toric IOL (RayOne toric, Hoya XY1AT, or a Tecnis ZCT800) into the capsular bag and a trifocal-diffractive Sulcoflex IOL into the ciliary sulcus. All toric IOLs were implanted with image-guided navigation. The manifest refraction and uncorrected and distance corrected visual acuity at far, intermediate, and near distance were measured. The position of the axis of the toric IOL was determined with the Pentacam device (Oculus GmbH) by evaluating retroillumination images. The results were compared with the preoperatively planned axis position. The median follow-up was 27 months. The spherical equivalent of manifest refraction was -0.04 ± 0.34 diopters (D) postoperatively, and the refractive cylinder was -0.14 ± 0.22 D on average. Binocular uncorrected and corrected distance visual acuity were 0.05 ± 0.11 logMAR and 0.02 ± 0.09 logMAR, respectively. The mean deviation from the calculated cylinder axis was 3.8° ± 3.5° with a median of 2.8° and a maximum deviation of 15.0°. Ninety-four percent of all eyes showed a deviation of less than 10°. The long-term axial alignment of capsular bag-fixated toric IOLs in polypseudophakic eyes was comparable to the results reported for single implantation of toric IOLs. The polypseudophakic approach did not affect the rotational stability of capsular bag-fixated IOLs.

Inhibition of anterior capsule opacification and contraction by the elevated anterior rim of the intraocular lens optic.

To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate. Retrospective cohort study. We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images. The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes. The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.

Isolated microspherophakia

This is a retro illumination image of right eye under 10x magnification of a 12-year-old girl with bilateral microspherophakia without any systemic association. You can see a clear crystalline natural lens in globular or spherical shape with intact and stretched zonules attached to the equator of the lens all around visible after full mydriasis.

Rotational Stability, Decentration, and Tilt of a New Hydrophobic Acrylic Intraocular Lens Platform

To evaluate rotational stability, decentration and tilt of the monofocal intraocular lens (IOL) Nanex (NC1-SP; HOYA Surgical Optics). Prospective interventional case series. The study was performed at the Department of Ophthalmology, Medical University of Vienna. The study population comprised 130 eyes of 68 patients with age-related cataract who underwent cataract surgery with implantation of a Nanex IOL. Baseline image for rotational stability evaluation was obtained at the end of surgery (EoS) and compared to retroillumination images taken at 1 hour, 1 week, 1 month, and 6 months after surgery. Axis alignment was assessed using nonmovable landmarks on the sclera and the optic-haptic junctions of the IOL. Anterior segment OCT images were performed to evaluate decentration and tilt. The main outcome measure was absolute rotation from EoS to 6 months postoperatively. Median IOL rotation of all eyes from EoS to 6 months was 1.9° (interquartile range 0.1°-37.5°). Ten eyes (9.71%) rotated more than 5° and 2 eyes (1.94%), more than 10°. IOL rotation did not correlate with axial eye length (Spearman r=-0.042, P=.46), crystalline lens thickness (Spearman r=0.134, P=.19), and crystalline lens equatorial diameter (Spearman r=0.101, P=.325). IOL rotation positively correlated with anterior fibrosis severity (Spearman r=0.321, P=.002). Preoperative decentration (0.2 ± 0.12 mm) and tilt (5.7 ± 1.6°) did not change significantly after surgery (0.22 ± 0.12 mm and 5.62 ± 1.49°, respectively). The investigated IOL presented good rotational stability and low decentration and tilt values. Nevertheless, anterior capsule fibrosis development led to a higher tendency of IOL rotation after 1 week.

Innovative Technologies in the Monitoring of the Age-Related Cataract

Literature review is devoted to modern high-technology instrumental methods of the lens evaluation, which have been developed to improve efficiency of the diagnostics and management of cataract in ophthalmological clinical practice. The slit-lamp examination of lens and retroillumination images are used for subjective assessment of cataract according to LOCS III grading system. Currently objective methods of lens evaluation have practical value and provide information about early age-related changes of crystalline lens with the quantitative assessment of the severity of opacities including the optical and ultrasound examinations. Optical methods include densitometry using Scheimpflug images obtained from applications to quantify the localization of lens opacities and their progression rate. Another method is the intensity distribution analysis of the wave front of the optical aberrations according to grading cataract severity with the objective scatter index (OSI) obtained by double-pass technology. Moreover the optical quantitative assessment of lens opacities is carried out by the Shack—Hartmann wave front sensor to identify the grade of nuclear opalescence (N-type) with the Lens Opacities Classification System III. This method is very helpful in nuclear cataract. Swept source optical coherent tomography (SS-OCT) with variable length of wave and high frequency detector is used for the density measurements of nuclear and cortical opacities of lens imaging in micro- and macro dimensional scale. Ultrasound biomicroscopy is the most informative ultrasonic diagnostic method for the evaluation of acoustic density and early age-related changes of lens. Current high-informative methods of quantitative assessment of the optical density of lens are helpful in determination of indications for surgery, the optimization of phacoemulsification settings and prevention of intraoperative complications. The use of high-technologic methods demonstrated the effectiveness of eye drops 0,005 % pirenoxine in early lens opacities management.

Diagnostic accuracy of code-free deep learning for detection and evaluation of posterior capsule opacification

ObjectiveTo train and validate a code-free deep learning system (CFDLS) on classifying high-resolution digital retroillumination images of posterior capsule opacification (PCO) and to discriminate between clinically significant and non-significant PCOs.Methods...

Early-Onset Posterior Capsule Opacification: Incidence, Severity, and Risk Factors.

IntroductionTo evaluate the incidence, severity, and risk factors of early-onset posterior capsule opacification (PCO) following uneventful phacoemulsification and intraocular lens (IOL) implantation.MethodsPatients with cataracts who underwent phacoemulsification and IOL implantation surgery for 3 months from September 2019 to April 2020 were enrolled. All the subjects completed a comprehensive ocular examination. Retroillumination images of the posterior capsule were obtained using a slit lamp with imaging system, and PCO was graded by two ophthalmologists. Univariate and multivariate logistic regression analyses were performed to assess the risk factors for PCO.ResultsA total of 1039 subjects were enrolled, with mean age 66.68 ± 11.43 years and 42.06% were male. The incidence of early-onset PCO in the 3 months after cataract surgery was 29.93%, and PCO of grade 3 and grade 4 was present in 31 patients (2.98%). Patients with complicated cataract had a higher incidence of PCO than age-related cataract, especially for patients with previous pars plana vitrectomy (PPV) surgery (P < 0.001). Moreover, the incidence of PCO increased with the deficiency of capsulorhexis–IOL overlap (P < 0.001). Multivariate logistic regression also showed that previous PPV surgery (OR 2.664, P = 0.003) and incomplete capsulorhexis–IOL overlap were risk factors for PCO (180–360° overlap: OR 2.058, P < 0.001; < 180° overlap: OR 5.403, P < 0.001).ConclusionsLarger capsulorhexis and PPV surgery history contribute to the occurrence of early-onset PCO, indicating that primary posterior continuous curvilinear capsulorhexis can be considered during cataract surgery for patients with PPV history.

Deep Learning-Based Cataract Detection and Grading from Slit-Lamp and Retro-Illumination Photographs: Model Development and Validation Study

Backgroud: Accurate detection and grading of cataract is pivotal in providing personalized precision treatment strategies for preventing visual loss. We develop and validate an automated deep learning (DL)-based artificial intelligence (AI) platform for diagnosing and grading cataracts, using slit-lamp and retro-illumination lens photographs based on the Lens Opacities Classification System-Ⅲ (LOCS-Ⅲ). Methods: Slit-lamp and retro-illumination lens photographs were graded by two trained graders using LOCS-III. Image datasets were labeled and divided into training, validation, and test datasets. We trained and validated AI platforms with four key strategies in the AI domain: (1) region detection network for redundant information inside data, (2) data augmentation and transfer learning for the small dataset size problem, (3) generalized cross entropy loss for dataset bias, and (4) class balanced loss for class imbalance problems. The performance of the AI platform was reinforced with an ensemble of three AI algorithms (ResNet18, WideResNet50-2, and ResNext50). Finding: The AI platform showed robust diagnostic performance (AUC of 0.9992 [0.9986-0.9998], 0.9994 [0.9989-0.9998]; accuracy of 98.82% [97.7-99.9], 98.51% [97.4-99.6]) and grading prediction performance (AUC of 0.9567 [0.9501-0.9633], 0.9650 [0.9509-0.9792]; accuracy of 91.22% [89.4-93.0], 90.26% [88.6-91.9]) for nuclear opalescence (NO) and nuclear color (NC) using slit-lamp photographs. For cortical opacity (CO) and posterior subcapsular opacity (PSC), the system achieved high diagnostic performance (AUC of 0.9680 [0.9579-0.9781], 0.9465 [0.9348-0.9582]; accuracy of 96.21% [94.4-98.0], 92.17% [88.6-95.8]) and good grading prediction performance (AUC of 0.9044 [0.8958-0.9129], 0.9174 [0.9055-0.9295]; accuracy of 91.33% [89.7-93.0], 87.89% [85.6-90.2]) using retro-illumination images. Interpretation: Our DL-based AI platform successfully yielded accurate and precise detection and grading of NO and NC in seven-level classification and CO and PSC in six-level classification, overcoming the limitations of medical databases such as small training data or biased label distribution. Funding: This work was supported by the National Research Foundation of Korea grant funded by the Korean government's Ministry of Education (NRF-2021R1C1C1007795; Seoul, Korea), which was received by D.H.L. Declaration of Interest: The authors declare no conflict of interest Ethical Approval: The study was approved by the Samsung Medical Center Institutional Review Board (IRB file number 2020-08-035)

Capsular bag performance of a novel hydrophobic acrylic single-piece intraocular lens: Two-year results of a randomised controlled trial.

To determine the visual outcome, intraocular lens (IOL) stability and posterior capsule opacification (PCO) rate of a hydrophobic acrylic intraocular lens. Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. This double-masked randomised study included patients who underwent standard cataract surgery. Patients received either the hydrophobic acrylic IOL (iPure, PhysIOL) or the hydrophobic acrylic control IOL (Tecnis ZCB00, Johnson&Johnson). Subjective refraction, uncorrected and corrected distance visual acuity (UDVA, CDVA), IOL tilt and decentration (Purkinje meter) and PCO intensity using retroillumination images with automated image analysis (automated quantification of after-cataract, AQUA), were evaluated for both groups 2 years after surgery. A total number of 31 patients completed the 2-year follow-up, 16 in the study group and 15 in the control group. The CDVA was 0.0 logMAR (standard deviation - SD: 0.1) for the study IOL and 0.1 logMAR (SD: 0.2) for the control IOL, p = 0.001. The AQUA PCO score for the study group was 2.1 and 1.4 for the control group, p = 0.44. Mean IOL tilt was 2.9° (SD: 1.8) in the study group and 5.0° (SD: 4.5) in the control group, whilst the mean decentration was 0.37 mm (SD: 0.18) and 0.45 mm (SD: 0.3), p = 0.610. The studied parameters revealed a good performance for both IOLs. Both IOLs had good CDVA, a small amount of tilt and decentration and none of the patients required laser capsulotomies during the follow-up time of 2 years after surgery.Presented at the 37th ESCRS Congress Paris, France, September 2019.

Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial

To compare the incidence and intensity of posterior capsule opacification (PCO) and neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy rates between 2 similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) that differ in the proprietary material characteristics and design features, over a period of 3 years. Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Eighty patients (160 eyes) had bilateral cataract surgery and received a Vivinex XY1 IOL in 1 eye and an AcrySof SN60WF IOL in the other eye. Follow-up examinations were performed 3 years after surgery. Digital retroillumination images were taken of each eye. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (AQUA). PCO score (scale, 0-10). The mean objective PCO score of the Vivinex XY1 IOLs was 0.9 ± 0.8 compared to the PCO score of 1.4 ± 1.1 for the AcrySof SN60WF IOLs (P < .001). Three years postoperatively, 11.4% of patients had an Nd:YAG capsulotomy in the Vivinex XY1 eye and 18.6% had a capsulotomy in the AcrySof SN60WF eye (P= .23). The new hydrophobic acrylic Vivinex XY1 IOL showed significantly lower PCO rates and lower YAG rates compared to the AcrySof SN60WF IOL. The interaction of various factors such as hydrophobic material, smooth optic surface, and sharp posterior optic edge plays a key role in PCO development.

Automated qualitative and quantitative assessment of posterior capsule opacification by Automated Quantification of After-Cataract II (AQUA II) system

BackgroundThe present study aims to investigate an automated qualitative and quantitative assessment system (Automated Quantification of After-Cataract [AQUA II]) of posterior capsule opacification (PCO) in high-resolution digital retroillumination images and consequently reduce observer bias and increase accuracy of PCO grading.MethodsA data set of 100 eyes with no to severe PCO was analysed. Ten eyes were consecutively photographed twice and ten images were rotated to give a total of 120 images for PCO assessment. Validity was determined by including subjective grading and repeatability was determined by evaluating the 20 additional images. Evaluation of posterior capsular opacification (EPCO), posterior capsule opacity (POCO) and AQUA I methods were included for comparative analysis of the data.ResultsThe system developed proved to classify six types of PCO. Validity was confirmed by a Pearson correlation coefficient of r = 0.95 (EPCO r = 0.93; POCO r = 0.72 and AQUA I r = 0.94). Repeatability was better in AQUA II (95% confidence interval [CI] for mean difference: 0.5 ± 1.2) than in subjective grading (95% CI for mean difference: 0.6 ± 1.7), in EPCO grading (95% CI for mean difference: − 0.2 ± 1.5), in POCO grading (95% CI for mean difference: 1.6 ± 2.7) and in AQUA I (95% CI for mean difference: − 1.1 ± 1.9).ConclusionsAQUA II is a system that for the first time not only objectively quantifies PCO, but also qualitatively assesses PCO in an automated manner with texture classification. AQUA II showed an excellent validity and repeatability.

Tear-film dynamics by combining double-pass images, pupil retro-illumination, and contrast sensitivity.

Tear-film dynamics were analyzed by a synchronizing recording of double-pass (DP) and pupil retro-illumination (RI) images with contrast sensitivity (CS) measurements. Simultaneous DP and RI images were acquired in three subjects wearing contact lenses while keeping the eye open. Changes in contrast sensitivity for an 18 c/deg green grating were also estimated. From the DP retinal images, the effect of the tear film is described through the objective scattering index (OSI). This presented a negative correlation with the increase in CS during tear-film deterioration (as observed by RI imaging). These results show a relationship between visual outcome degradation due to tear-film breakup and the increase in intraocular scattering. This work shows a combined methodology for the evaluation of tear-film dynamics.

Method to quantify the decentration of the multifocal intraocular lenses in relation to the visual axis

Since position and centration have shown to affect the effectiveness of multifocal intraocular lenses (MFIOLs), some authors have proposed using the "coaxially sighted IOL light reflex" as a landmark to allow consistent centration of MFIOLs. Postoperatively, assessing the location of the intraocular lens with respect to the visual axis is also important. Centration of the MFIOLs can be identified postoperatively by slit lamp biomicroscopy, but it is still a qualitative method. The Nidek OPD Scan III is used. The instrument obtains retro illumination images, which allows the observation of the diffractive rings of the multifocal intraocular lenses implanted following phacoemulsification. The retro illumination image describes the location of the visual axis (white cross with blue borders +), the center of the photopic (pink cross) and mesopic (turquoise cross) pupil, quantifies the distance between the center of the pupil and the visual axis, and places the visual axis in degrees. It is attempted to match the rings of the lens with that of the acetate grid. Once the best possible equidistance between the lens and grid rings has been achieved. This method can be useful to be able to have reference of a real value of decentration of the lenses and thus have a surgical plan and try to center the lenses. We are also creating a technique to properly center the lenses, in addition to performing an analysis of the results in terms of postoperative visual quality in relation to the lens's decentration and thus see how this really affects.

Application of Spectral Domain Optical Coherence Tomography to Objectively Evaluate Posterior Capsular Opacity In Vivo.

Objectives To objectively evaluate posterior capsular opacification (PCO) with RTVue-100 spectral domain-OCT and assess the agreement with the Pentacam system. Methods Sixty-seven eyes diagnosed with PCO were included. RTVue-100 SD-OCT was used to scan the IOL outline and PCO at horizontal and vertical meridians. PCO was also imaged with a Pentacam and slit-lamp photography system. With RTVue-100 SD-OCT, the PCO area, thickness, density, and objective scores were recorded and used to evaluate the severity of PCO at 3 mm and 5 mm diameter ranges of the IOL optic region. We assessed the correlation of visual acuity, PCO characteristics, and PCO scores. PCO scores acquired from RTVue-100 SD-OCT images were also compared with those from the Pentacam. Differences between pear-type and fibrosis-type PCOs were also compared using RTVue-100 SD-OCT cross-sectional images. Results The cross-sectional images of PCO acquired with RTVue-100 SD-OCT corresponded well to Pentacam and slit-lamp retroillumination images. IOL-posterior capsular space, area, thickness, and density of the proliferated and accumulated LECs could be clearly visualized and quantified with RTVue-100 SD-OCT. PCO scores were correlated with decreased visual acuity, which was in line with the outcomes using the Pentacam. Differences between the pear-type and fibrosis-type PCO were statistically significant; pear-type PCOs showed a wider and thicker opacification region with lower density compared with fibrosis-type PCOs. Conclusion RTVue-100 SD-OCT could be a powerful tool in PCO objective evaluation and classification. OCT could be used to visualize the morphology and outline of PCO. Thus, it could discriminate and quantify differences between different types of PCO. PCO scores seem to be a useful factor that could reliably reflect PCO severity.

PMD3 - METHODS FOR QUANTIFYING POSTERIOR CAPSULAR OPACIFICATION AND THE IMPACT OF INTRAOCULAR LENS MATERIAL ON SEVERITY SCORES - A SYSTEMATIC LITERATURE REVIEW

Posterior capsular opacification (PCO) results from the growth and abnormal proliferation of lens epithelial cells on the posterior capsule. Severity of PCO is assessed based on the presence or absence of opacification within the visual axis, subjective perception of reduced visual acuity and contrast sensitivity, and assessment of retroillumination images of the posterior capsule. The objective of this review was to identify the methods for quantifying PCO and assess the impact of intraocular lens (IOL) material and design on reported severity scores. A comprehensive literature search was performed for studies published in English between January 1996 and August 2017 in Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane library. Studies quantifying PCO using different scales were included and impact of lens material and design on the reported severity scores was assessed. A total of 63 RCTs were included in this review. Among the measurement systems used to assess PCO severity, Automated Quantification of After-cataract scale (AQUA; 20 studies), POCOman (13 studies) and Evaluation of Posterior Capsule Opacification scale (EPCO; 12 studies) were the most common. Other methods identified, included various subjective and objective scoring tools. Irrespective of the measurement system, severity of PCO increased with time and there is a trend in the literature to lower severity scores for eyes implanted with hydrophobic acrylic IOLs compared with IOLs of other materials. Furthermore, higher severity of PCO was observed with round optic edge IOLs compared to sharp optic edge IOLs of the same material. There is considerable heterogeneity in terms of the scoring systems used to quantify PCO. However, a trend exists in the available evidence suggesting that the lens material of the implanted IOL impacts on PCO severity. Moreover, sharp edge IOLs appear to provide a better barrier mechanism in preventing PCO than round edge IOLs.

Effect of number and position of intraocular lens haptics on anterior capsule contraction: a randomized, prospective trial

BackgroundThe present study aimed to evaluate the degree of anterior capsule contraction (capsulorhexis contraction) with three different single-piece, hydrophilic acrylic intraocular lenses (IOLs).MethodsPatients were prospectively randomized to be implanted with one of three types of IOLs during cataract surgery: the Ophtec Precizon (IOL A), the Lucid Korea Microflex (IOL B), and the Carl Zeiss Asphina (IOL C). One week, 2 weeks, and 6 months after surgery, the area of the anterior capsule opening was measured using digital retro-illumination images after dilation of the pupil. The data were then evaluated using POCOman software.ResultsThe study included 236 eyes of 202 patients. The area of the anterior capsule opening reduced by 3.53 ± 3.31 mm (17.06% ± 15.99%) between 1 week and 2 months post-operatively in the IOL A group, by 0.62 ± 1.32 mm (2.87% ± 6.03%) in the IOL B group, and by 1.09 ± 1.53 mm (4.72% ± 6.10%) in the IOL C group. The IOL B group showed minimal anterior capsule contraction 2 months after surgery (p < 0.001).ConclusionsIOLs with a four-plate haptic design (IOL B) showed more anterior capsular stability than those with a two-loop plate haptic (IOL A) or two-plate haptic (IOL C) design. The number and position of haptics in a capsular bag may affect anterior capsule contraction. We assume that supporting the zonules evenly may play a role in anterior capsular stability.Trial registrationCurrent Controlled Trials ISRCTN76566080, Retrospectively registered (Date of registration: 14 Feb 2018).

Occurrence of anterior and posterior capsule opacification after cataract surgery with implantation of acrylic hydrophobic heparinized lenses in patients with diabetes type 2

Wstęp: Obserwacje kliniczne wskazują, że u pacjentów z cukrzycą stwierdza się częstsze występowanie zmętnienia torebki soczewki po operacji fakoemulsyfikacji zaćmy z wszczepieniem soczewki. Nowe metody operacyjne i modyfikacje sztucznych soczewek wewnątrzgałkowych zmniejszają częstość występowania zmętnienia torebki tylnej soczewki (PCO) i wykonywania YAG – kapsulotomii z powodu zaćmy wtórnej. Wyniki przeprowadzonych dotychczas badań sugerują, że operacja usunięcia zaćmy z wszczepieniem soczewek pokrytych heparyną zmniejsza ryzyko PCO u pacjentów z cukrzycą typu 2.Celem pracy była ocena wpływu soczewki akrylowej hydrofobowej heparynizowanej na częstość występowania I stopnia zaawansowania zmętnienia przedniej (ACO) i tylnej torebki soczewki oraz ostrości wzroku u pacjentów z cukrzycą typu 2 po niepowikłanej operacji zaćmy.Materiały i metody: Do prospektywnego badania zakwalifikowano 18 pacjentów (36 oczu) z cukrzycą typu 2, bez cech retinopatii. Przeprowadzono standardową operację usunięcia zaćmy z wszczepieniem soczewki akrylowej hydrofobowej heparynizowanej (Polylens Y10AS) do jednego oka (grupa badana) i nieheparynizowanej (Alcon SA60AT) do drugiego oka (grupa kontrolna). Oceniano najlepiej skorygowaną ostrość wzroku do dali (DBCVA) oraz występowanie ACO i PCO w badaniu retroiluminacji. Otrzymane wyniki badań poddano analizie statystycznej.Wyniki: W okresie rocznej obserwacji nie stwierdzono różnic istotnych statystycznie w występowaniu ACO i PCO w oczach pacjentów z cukrzycą z wszczepionymi soczewkami heparynizowanymi w porównaniu z oczami tych samych pacjentów z implantami nieheparynizowanymi. Nie wykazano także znaczących różnic w DBCVA między omawianymi grupami w ciągu 12 miesięcy obserwacji.Wnioski: Wyniki przedstawionych badań sugerują, że soczewki akrylowe hydrofobowe heparynizowane i nieheparynizowane wykazują podobną biokompatybilność u pacjentów z cukrzycą typu 2.