Surgically Induced Astigmatism Research Articles

Incidence and mechanism of conjunctival chemosis during phacoemulsification

BackgroundThis study aims to determine the incidence of conjunctival chemosis during phacoemulsification and to explore the possible mechanism and treatments.MethodsPatients with or without chemosis during phacoemulsification by the same operator within two years were included. The initial site of chemosis, the chemosis originated time, and the degree of chemosis at the end of the surgery were recorded. The differences in phacoemulsification energy/time and irrigation volume were compared between two groups. Meanwhile, the distance between the clear corneal incision (CCI) and the end of the Bowman’s layer, surgically induced astigmatism (SIA), intraocular pressure and central corneal thickness were also compared between the two groups.ResultsThe incidence of intraoperative chemosis was 9.17% (66/720). The distance between CCI and the end of the Bowman’s layer in the chemosis group was significantly longer than that in the non-chemosis group postoperatively (P < 0.0001). The initial sites of chemosis were located on both sides of the external opening of the CCI. The average time from the phacoemulsification probe introducing into the anterior chamber to the originating of chemosis was 30.23 ± 49.23s.ConclusionIntraoperative chemosis is related to the distance from CCI to the end of Bowmen’s layer. The residual conjunctiva around the incision wraps the phacoemulsification probe sleeve to form a passage, the leakage fluid enters the subconjunctiva through this passage, forming chemosis. Conjunctival incision on both sides of CCI can effectively prevent the development of chemosis.

Comparison of Mean Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery Using Frown Vs Chevron Incision

Purpose: To compare the mean surgically induced Astigmatism(SIA) in Manual Small Incision Cataract Surgery (MSICS) using frown (inverted U) versus inverted V (chevron) incision. Study Design: Quasi experimental study. Place and Duration of Study: Hayatabad Medical Complex from 27th July 2018 to 27th January 2019. Methods: This study included 148 patients who were distributed into the Frown group (F) and Chevron group (C) by convenient sampling. Each group had 74 patients through block operative randomization. To eliminate bias, all the surgeries were performed by one surgeon having more than 5 years’ experience of MSICS. Pre-operative and Post operative keratometric readings were taken. SIA calculator was utilized, and data was analyzed through SPSS 26. Means and standard deviation for continuous variables like age and surgically induced astigmatism were calculated. Results: In Group F, mean surgically induced astigmatism was 1.14±0.65D and in Group C it was 0.87±0.55D. The independent T test revealed that the mean SIA was significantly lower in the Chevron group compared to the Frown group.The post operative visual acuities showed that the proportion of patients with postoperative 6/6 vision in the Chevron group was more as compared to group F. Conclusion: Chevron (inverted V) incision induces less postoperative mean surgically induced astigmatism than Frown (inverted U) incision in Manual Small Incision Cataract Surgery. These findings may have implications for cataract surgery techniques and may help in reducing postoperative astigmatism.

Corneal Curvature Change After Strabismus Surgery: An Experience from a Single-academic Center

Objective: This study aimed to explore corneal curvature changes following strabismus surgery using a quadric surface fitting model to address ocular misalignment. Material and Methods: In this prospective cross-sectional study, 54 completed cases (84 eyes) of patients aged 6–60 years old (mean 10 years old) undergoing horizontal rectus muscle surgery were examined using placido-based keratometry with the Oculus Keratograph 5M system. Data on corneal curvature were collected one week pre-operation, and again one week, one month, and three months post-operation. Asphericity in the vertical meridian (Qy) and horizontal meridian (Qx), and surgical-induced astigmatism (SIA) were calculated. Results: The 84 eyes included were categorized into three groups: horizontal muscle surgeries, oblique muscle surgery, and combined horizontal and oblique muscle surgeries. Significant corneal prolation (steep central, flat peripheral) was revealed in the vertical meridian (Qy) at 3 months postoperatively for lateral rectus (LR) recession in the first group (p &lt; 0.001), and the mean SIA was 0.45 D (95% CI: 0.35–0.56 D). A similar effect was seen in the vertical meridian of the third group (p &lt; 0.01), with a mean SIA at 3 months of 0.27 D (95% CI: 0.23–0.32 D). Conclusion: Lateral rectus muscle recession induces corneal vertical prolation for up to 3 months post-operation. Surgeons are thus advised to re-evaluate refraction and defer contact lens refitting, refractive surgery, and intraocular lens calculations for at least 3 months after the procedure.

The outcomes of first-generation (visumax 500) and second-generation (Visumax 800) keratorefractive lenticule extraction surgeries for astigmatism

To evaluate the efficiency, predictability, and residual astigmatism between first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries in a prominent astigmatism population. A retrospective cohort study was conducted, and individuals who underwent first- and second-generation KLEx surgeries were enrolled. A total of 31 and 35 eyes were categorized into first and second KLEx groups, respectively. Visual acuity, refraction, topographic parameters, and surgical indices were recorded. Independent t tests were used to compare the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual astigmatism between the two groups. The difference in UDVA was not significant three months after KLEx surgery (P = 0.509), and the SEs three months after surgery also presented similar values between the two groups (P = 0.552). The first KLEx group demonstrated greater residual astigmatism than did the second KLEx group throughout the three-month follow-up period (all P < 0.05). The values of surgically induced astigmatism (SIA), difference vector (DV), magnitude of error (ME) and correction index (CoI) were significantly better in the second KLEx group via vector analysis (all P < 0.05). Old age, high steep keratometry (K), high topographic cylinder, large angle kappa, and a small optic zone were correlated with greater residual astigmatism in the first KLEx group (all P < 0.05), whereas only a small optic zone was significantly correlated with greater residual astigmatism in the second KLEx group (P = 0.047). The second-generation KLEx is correlated with a lower risk of residual astigmatism.

Comparative analysis of surgically induced astigmatism following cataract surgery: influence of previous myopic correction and corneal parameters.

This retrospective study investigated the impact of corneal parameters on surgically induced astigmatism (SIA) in eyes with prior myopic correction undergoing cataract surgery. Department of Ophthalmology, San Marino Hospital, San Marino, Republic of San Marino. This case-control study analyzed existing data retrospectively, without randomization or masking. Eighty eyes divided in group 1 (40 eyes previous underwent refractive surgery for myopia) and group 2 ( 40 myopic eyes) that underwent cataract surgery with intraocular lens (IOL) implantation were included. SIA was calculated using values from the IOL Master Zeiss 700 and mean pupil power (MPP) derived from the CSO Sirius Topographer (based on 3mm pupil size) with vectorial analysis from doctor Hill software. No significant difference in SIA was observed between eyes with prior myopic photorefractive keratectomy and the control group (p > 0.05). SIA calculations using the IOL Master and CSO Sirius Tomographer yielded similar results. There was no significant correlation between SIA and axial length, corneal curvature, peripheral corneal thickness, or anterior chamber depth (p > 0.05). However, an inverse correlation was found between SIA and horizontal corneal diameter (p < 0.05). Corneal parameters, such as axial length, corneal curvature, peripheral corneal thickness, and anterior chamber depth, showed no significant influence on SIA. The inverse correlation between SIA and horizontal corneal diameter in study group suggests potential influence of white-to-white distance on SIA. These findings highlight the importance of considering corneal parameters for optimizing surgical outcomes.

Refractive outcomes after V4c Toric collamer lens implantation over 1y of follow-up.

To evaluate refractive outcomes and corneal astigmatism changes after Toric implantable collamer lens with a central port (V4c T-ICL) implantation over 1y of follow-up. A retrospective study was performed including 50 eyes of 50 patients that underwent V4c T-ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, refractive and corneal astigmatism changes and corneal coupling correction were evaluated preoperatively, 1 and 12mo postoperatively. Vector analysis was used for astigmatism changes. Coefficient of adjustment (CAdj) was calculated for corneal coupling analysis. The mean UDVA achieved was 0.03 logMAR at 1mo and remained unchanged throughout the whole follow-up (P=0.193). At the last visit, 84% of the eyes achieved a CDVA of 0.00 logMAR or better. Regarding spherical equivalent refraction (SEQ), 96% of eyes were ranges of ±1.00 D and 84% of them within ±0.50 D. Also, 94% of eyes had a remaining refractive cylinder within ±1.00 D and 78% of them within ±0.50 D. Both, SEQ and refractive cylinder, remain stable over the postoperative follow-up (P=1.000 and P=0.660, respectively). In terms of surgically induced astigmatism (SIA), no statistically significant differences were found over the follow-up (P=0.102) and under correction was found with a correction index lower than the unit at each visit. A keratometric astigmatism induced of 0.59±0.53 (vector mean: 0.26×73°) D was reached at the last visit. No significant changes in terms of corneal astigmatism orientation were reported over post-surgery visits (P=0.129 and P=0.097 at 1 and 12mo respectively). No clinical significance was found for CAdj on with-the-rule astigmatism. No postoperative complications resulting from the surgery were found. Refractive outcomes suggest that the V4c T-ICL implantation for correction of myopic astigmatism was satisfactory in terms of effectiveness, safety, and stability during 1y of follow-up. Corneal astigmatism induced by the incision around 0.5 D is achieved according to the remaining refractive cylinder found at one-year post-surgery. Corneal coupling analysis results in no unexpected spherical change.

Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients.

To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.

Имплантация гидрофобной акриловой монофокальной интраокулярной линзы, предустановленной в инжектор

Aim. To evaluate clinical and functional results of implantation of a new hydrophobic acrylic monofocal IOL in a preloaded injector. Methods. The prospective study included 60 patients (66 eyes) after Hoya iSert® 250/251 IOL implantation (31 patients, 35 eyes, group 1) and a new Hoya Vivinex Multisert® XY1-SP IOL (29 patients, 31 eyes, group 2). IOL viscoimplantation was performed in 100 % of cases in group 1; in group 2 viscoimplantation was done in 45.1 % of cases and hydroimplantation in 54.9 %. Intraoperatively, corneal incision size was measured with a ruler before and after IOL implantation. Results In both groups, there was a statistically significant (p&lt;0.05) increase of UCDVA from 0.28±0.09 in the preoperative period to 0.7±0.17 3 months after surgery in group 1 and from 0.24±0.10 in the preoperative period to 0.84±0.18 3 months after surgery in group 2. Slightly lower values of UCDVA in group 1 may be associated with a higher level of surgically induced astigmatism (SIA) in this group. Similar dynamics was shown for BCDVA (from 0.52±0.21 before surgery to 0.95±0.19 after 3 months of follow-up in group 1 and from 0.55±0.20 before surgery to 0.98±0.21 after 3 months of follow-up in group 2). No difference was found between the studied groups. After IOL implantation, there was an increase in incision size to 2.4±0.12 mm in group 1 and 2.1±0.08 mm in group 2 (p=0.04). Mean SIA after 3 months of observation was 1.1±0.16 D in group 1 and 0.48±0.07 D in group 2 (p=0.0007). Conclusion. This study presents a comparative analysis of implantation results with monofocal hydrophobic acrylic Hoya Vivinex IOL in a Multisert® preloaded injector and monofocal Hoya 250/251 IOLs in an Isert® injector. The advantage of the new IOL implantation in reducing the incidence of surgically induced astigmatism was shown. Key words: cataract; monofocal IOLs; Vivinex; Hoya 250; Hoya 251; surgically induced astigmatism.

Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up.

To investigate the factors associated with and impact on the femtosecond-assisted (FS-assisted) limbal relaxing incision (LRI) combined with the steep-meridian tri-planar clear corneal incision (TCCI) to reduce astigmatism in patients undergoing Implantable Collamer Lens (ICL) surgery. Retrospective case series. The study reviewed patients with ICL surgery combined with FS-assisted LRIs paired with steep-meridian TCCIs. Correlation analysis examined the relationship between independent variables, including preoperative characteristics (intraocular pressure, corneal thickness, axial length, et al.), TCCI, and LRI surgical parameters. The predictors of surgically induced astigmatism (SIA) were determined using individual-level analysis and accounting for inter-eye correlation with the generalized estimating equation (GEE). The study enrolled 69 patients, with 114 eyes (55 right and 59 left). The mean spherical equivalent (SEQ) was - 10.29 ± 2.99D and - 9.99 ± 2.72D for the right and left eye, respectively, while the mean preoperative corneal astigmatism was - 1.54 ± 0.47D and - 1.54 ± 0.46D for the right and left eyes, respectively. After 12 months of follow-up, univariate analysis revealed significant correlations between SIA and intraocular pressure (IOP), astigmatism type, TCCI position (degree), peripheral corneal thickness (PCT), LRI arc incision diameter, post depth (%), and angle, respectively (P = 0.046, 0.016, 0.039, 0.040, 0.009, 0.000, 0.000). Multivariate analysis using GEE demonstrated that axial length (AL), astigmatism type, LRI arc diameter, and angle were independent predictors of SIA (P = 0.000, 0.005, 0.029, 0.000). The type of astigmatism and axial length were independent factors that affected SIA when modifying the LRI arc diameter and angle through FS-assisted steep-meridian TCCI paired with LRI in ICL surgery.

Analysis of surgically induced astigmatism of the anterior, posterior, and total cornea after implantable collamer lens implantation: a comparative study between temporal and superior clear corneal incisions

BackgroundTo comparatively analyze the surgically induced astigmatism (SIA) of the anterior, posterior, and total corneas of eyes undertaking implantable collamer lens (ICL) implantation with temporal or superior corneal incisions.MethodsOne hundred and nine eyes of 109 patients who received ICL implantation were recruited: 40 eyes had temporal incisions and 69 eyes had superior incisions. Total corneal refractive power (TCRP); simulated keratometry of the anterior (Sim-KAnt) and posterior (Sim-KPost) corneal curvature; and astigmatism of the anterior (CAAnt), posterior (CAPost), and total (CATCRP) cornea were recorded through a Pentacam preoperatively and 3 months postoperatively. The SIA of the anterior, posterior, and total cornea were also compared between the two groups.ResultsThere were no significant intergroup differences for TCRP, Sim-KAnt, Sim-KPost, CAAnt, CAPost, or CATCRP, preoperatively. However, values of CAAnt, CAPost, and CATCRP with temporal incision were significantly higher than those parameters with superior incision postoperatively. All of the SIA of the anterior, posterior, and total cornea were significantly lower for temporal incision than those with a superior incision (p < 0.001, p = 0.006 and p = 0.001 respectively). Meanwhile, the superior incisions created against-the-rule (ATR) astigmatism, and temporal incisions always induce with-the-rule (WTR) astigmatism in total cornea.ConclusionsA superior incision may be suitable for correcting WTR astigmatism, while a temporal incision for correcting ATR astigmatism when using a non-toric ICL. Meanwhile, temporal incision could be a better choice with little preoperative astigmatism or that preoperative astigmatism would be corrected with toric ICLs.Trial registrationRegistration number: ChiCTR2100051739. Prospectively registered: 01 October 2021.

Comparison of Surgically Induced Astigmatism Following Manual Sics: Superior and Temporal Approach

Aim: The operable cataract cases in the developing world is high compared to the cataract surgical rate, and economical and effective methods are required to deal with this curable blindness, in order to provide the highest achievable uncorrected distance visual acuity. This study aimed to compare the surgically induced corneal astigmatism in patients undergoing manual small incision cataract surgery by superior (s-MSICS) and temporal (t-MSICS) scleral tunnel incisions. Methods: Prospective, interventional cases series of 60 eyes of 60 patients. Uncorrected distance visual acuity (UDVA), mean keratometry (KMean) and surgically induced astigmatism (SIA) were the main outcome measures which were compared between the two groups, s-MSICS and t-MSICS. Results: The mean patient age was 58.60 ± 7.11 years and 59.63 ± 8.39 years in the s-MSICS and t-MSICS groups respectively. Uncorrected distance visual acuity (UDVA) on day 90 was 0.27 ± 0.14 logMAR in the s-MSICS group and 0.18 ± 0.16 logMAR in the t-MSICS group (p=0.05). At the final assessment s-MSICS had 1.43 ± 0.99D of SIA and t-MSICS had 0.76 ± 0.66D of SIA (p=0.02). Four patients in the s-MSICS group and 25 patients in the t-MSICS group had WTR astigmatism (p&lt;0.001). Likewise, there were 26 cases of ATR and one case of ATR in the s-MSICS and t-MSICS respectively (p&lt;0.001). Conclusion: In this prospective study, t-MSICS had significantly lesser surgically induced astigmatism than s-MSICS. The temporal incision decreased against the rule astigmatism, as well, which is the astigmatism prevalent in the adult population.

Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery

PurposeTo evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS).SettingDepartment of Ophthalmology, Shanghai Aier Eye Hospital, China.DesignA retrospective, observational study.MethodsPatients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months.Results101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group.ConclusionsPanoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient’s corneal astigmatism.

Surgically induced astigmatism in the scleral fixated 'Carlevale' IOL technique.

To evaluate the surgically induced astigmatism over a 6-month follow-up period in patients who underwent scleral IOL fixation using an acrylic single-piece IOL with special haptics designed for sutureless scleral fixation. We conducted a prospective longitudinal study at a single site with a single surgeon. We included patients who received transscleral IOL implantation following the Carlevale technique and were followed up post-operatively for 24 weeks. We measured the patient's refraction at baseline, week 12 and week 24 using the best corrected visual acuity at 4 m (EDTRS chart). We performed corneal tomography at every visit using an anterior segment optical coherence tomography (AS-OCT). We evaluated surgically induced astigmatism (SIA) and refraction during each follow-up visit and compared them to baseline. We then assessed changes in SIA over time. In total, 27 eyes of 27 patients consisting of 16 female and 11 male individuals were evaluated. The mean patient age was 71 ± 11.7 years, mean axial length was 24.30 ± 1.47 mm (range: 21.4-27.23) and mean white-to-white distance was 12.07 ± 0.40 mm (range: 11.4-12.7). The mean SIA decreased from 1.78 ± 0.96D at week 1 significantly to 0.80 ± 0.55D at week 12 (p < 0.001) and then stayed unchanged around 0.82 ± 0.72D at week 24 (p = 1.0). The scleral fixated Carlevale IOL and its implantation procedure were found to result in a predictable SIA of <1D after 24 weeks. However, the axis orientation of the SIA appeared to be random, making it unsuitable for implementation in toric IOL calculations.

Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection.

To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy. Hospital. Single-center, retrospective, case-control. The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes. 52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups. AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.

Comparison of Clinical Outcomes Among Sutured, Sutureless Scleral Fixation, and Retropupillary Fixation of Intraocular Lens

Purpose: To compare the short-term clinical outcomes (up to 3 months) after three different secondary intraocular lens (IOL) implantations in dislocated and aphakic eyes with insufficient capsular support.Methods: We retrospectively analyzed the medical records of 97 patients who underwent secondary IOL implantation (32 eyes with sutured scleral fixation, 21 with sutureless scleral fixation, and 44 with retropupillary IOL implantation) from March to December 2018. Uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA), spherical equivalent (SE), prediction error (PE), mean absolute error (MAE), surgically induced astigmatism (SIA), ocular residual astigmatism (ORA), and complications in the three groups were assessed before and 1 week and 1 and 3 months after surgery.Results: All groups had an improved BCVA beginning 1 month after surgery. The pre- and postoperative SE (&lt;i&gt;p&lt;/i&gt; = 0.857, &lt;i&gt;p&lt;/i&gt; = 0.263, and &lt;i&gt;p&lt;/i&gt; = 0.163) and PE (&lt;i&gt;p&lt;/i&gt; = 0.479, &lt;i&gt;p&lt;/i&gt; = 0.848, and &lt;i&gt;p&lt;/i&gt; = 0.128) did not differ in the sutured scleral fixation, sutureless scleral fixation, and retropupillary IOL implantation groups, respectively; MAE differed significantly among the procedures 1 week after surgery (1.33 ± 1.25, 1.40 ± 1.54, and 0.85 ± 1.25, &lt;i&gt;p&lt;/i&gt; = 0.044), but not 1 month after surgery (&lt;i&gt;p&lt;/i&gt; = 0.965, &lt;i&gt;p&lt;/i&gt; = 0.731). 3 months after surgery, there was no significant difference in SIA (&lt;i&gt;p&lt;/i&gt; = 0.140) or ORA (&lt;i&gt;p&lt;/i&gt; = 0.178) among the 3 groups. As a complication, intraocular pressure rise occurred more often in the sutured fixated group, while the retropupillary group had a higher dislocation rate.Conclusions: There was no significant difference in the SE, PE, MAE, SIA, ORA, or complications among the three procedures. Surgical skill is still required to minimize the chance of complications regardless of the implantation method.

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M &amp; J Western Regional Institute of Ophthalmology (M&amp;J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M &amp; J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value &amp;#60;0.05 was taken as significant.: MSICS &amp; phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS &amp; phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Measurement of the distance between corneal apex and pupil center in patients following small-incision lenticule extraction or implantable collamer lens implantation and its correlation with the surgical-induced astigmatism

BackgroundTo investigate the change in the distance between corneal apex and pupil center after small-incision lenticule extraction (SMILE) or implantable collamer lens (ICL) implantation and its correlation with surgical-induced astigmatism (SIA).MethodsThis study included patients who had undergone SMILE (n = 112) or ICL implantation (n = 110) to correct myopia and myopic astigmatism. The angle kappa was measured using a Scheimpflug imaging device (Pentacam) and represented as Cartesian values between the pupil center and the corneal vertex (X, Y) and chord u (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\sqrt{{X}^{2}+{Y}^{2}}@ $$\\end{document}orientation), and was compared pre- and post-operative.ResultsFollowing SMILE, the magnitude of chord u\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ (\\sqrt{{X}^{2}+{Y}^{2}}$$\\end{document}) significantly increased in both eyes (Wilcoxon signed-rank test, OD: P<0.001; OS: P=0.007), while no significant change was observed in the orientation. A significant correlation was found between the J0 component of SIA and the change in the magnitude of chord u for both eyes (OD: R2=0.128, P<0.001; OS: R2=0.033, P=0.004). After ICL implantation, the orientation of the chord u was significantly different in the right eye (Wilcoxon signed-rank test, P = 0.008), and the Y-intercept significantly decreased in both eyes (Wilcoxon signed-rank test, P<0.001). A significant correlation was found between J0 of SIA and the change in the magnitude of chord u for the right eyes (R2=0.066, P=0.002). A significant correlation was found between J45 of SIA and the change in the magnitude of chord u for the left eyes (R2=0.037, P=0.044).ConclusionsThe magnitude of the chord u increased following the SMILE procedure, whereas the Y-intercept significantly decreased after ICL implantation. SIA was related to the change in the magnitude of chord u.

The comparison of corneal higher-order aberration and surgically induced astigmatism between the clear corneal incision and the limbus tunnel incision of posterior chamber implantable collamer lens implantation

BackgroundThis study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation.MethodsA total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z40, coma coefficients (Coma RMS) Z3−1 Z31, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam.ResultsOne week after the operation, the corneal back Z31 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z40 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z31, Z40, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation.ConclusionOur data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation.

Long Term Evaluation of Surgically Induced Astigmatism and Corneal Higher-Order Aberrations After 2.2 Mm Clear Corneal Incisions in Femtosecond Laser-Assisted Cataract Surgery: Temporal versus Superior Approach.

To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in femtosecond laser-assisted cataract surgery and compare them between 2 types of CCIs: temporal and superior approach. Patients received the temporal CCIs (Group A) or the superior CCIs (Group B). Outcome measures included visual acuity, manifest refraction, corneal astigmatism, SIA, flattening effect, and corneal HOAs. Correlation between postoperative corneal HOA and SIA at each follow-up were analysed. This study assessed data from 106 eyes, of which 64 in Group A and 42 in Group B. The two groups had similar postoperative visual acuity of distance, intermediate and near (all P > 0.05). SIA and corneal HOAs were significantly lower in Group A than Group B in the early postoperative period, while there was no significant difference in the late postoperative period. At 6 months after surgery, the arithmetic mean of SIA over corneal 4mm zone was 0.33 ± 0.19D for temporal incision, and 0.37 ± 0.25D for superior incision. For Group A, the correlations of HOAs and SIA persisted from 1 week to 6 months after surgery. For Group B, the changes in corneal HOAs were significantly related to the SIA at 1 week and 1 month postoperatively. This study suggested the consistency of increasing and recovering process of corneal HOAs and SIA after surgery. Compared to the superior incisions, temporal incisions might induce quicker corneal recovery and less change in SIA and corneal HOAs.

Comparison of Surgically-induced Astigmatism using Topography and Keratometry in Patients undergoing Phacoemulsification and Small Incision Cataract Surgery: A Prospective Interventional Study

Introduction: Topographic measurement of corneal astigmatism is the current standard of care because, in addition to measuring corneal astigmatism, it identifies irregular astigmatism, which may limit optimum surgical results. The present study focuses on the use of topography to measure Surgically Induced Astigmatism (SIA), which is not a routine practice in most institutions, and compares it with keratometry values of corneal astigmatism. The present study highlights the accuracy of topography in the measurement of astigmatism, with its additional benefits being the measurement of irregular astigmatism and assessment of tear film status. Aim: To compare SIA using topography and keratometry in patients undergoing phacoemulsification and Small Incision Cataract Surgery (SICS). Materials and Methods: The present study was a prospective, interventional study conducted in the Ophthalmology Department of Bharti Vidyapeeth (deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India for 18 months (November 2019 to April 2021). A total of 100 cases (100 eyes) with cataracts were randomly divided into Group-A (n=50) and Group-B (n=50), respectively, underwent Phacoemulsification and SICS. Before the surgery, the astigmatism of each patient was noted by both topography and keratometry. On the 45th postoperative day, patients’ Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), automated keratometry readings, and corneal topography readings were taken, based on which SIA was calculated by SIA calculator version 2.0. The mean SIA in both groups was calculated and compared. An unpaired t-test was used to compare the mean of different variables in the two groups, Group-A and Group-B. A p-value of &lt;0.05 was considered statistically significant. Results: The majority of cases were in the age group of 61- 70 years, with 23 (46%) cases in Group-A and 27 (54%) in Group-B. In the study, the mean SIA by keratometry in Group-A was 0.43±0.02D and in Group-B was 1.24±0.04D (p&lt;0.0001), and the mean SIA by topography in Group-A was 0.49±0.02D and in Group-B was 1.28±0.03D (p&lt;0.0001), indicating that phacoemulsification causes less SIA compared to SICS. Upon comparing the mean SIA calculated by keratometry and topography in both study groups, it was found that p&lt;0.02 in Group-A and p&lt;0.4 in Group-B, suggesting that both p-values are not significant. This indicates that both keratometry and topography will give similar results and can be used for determining SIA. Conclusion: The study showed that phacoemulsification produces less mean SIA compared to SICS, leading to better visual outcomes and early visual rehabilitation in contrast to the SICS group. The present study also concluded that both keratometry and corneal topography can be used for the calculation of SIA as both give similar results, although topography remains an important tool in the calculation of Intraocular Lens (IOL) power in patients with corneal pathologies and post-refractive surgeries.