Type Of IOL Research Articles

Performance of formulas included in the ESCRS intraocular lens power calculator.

We wanted to compare the refractive prediction errors (PEs) of formulas included in the ESCRS IOL power calculator to aid in informed decisions on IOL power selection based on the output of this tool. Cullen Eye Institute, Baylor College of Medicine, Houston. Retrospective case-series. We have included 748 eyes of 748 patients following implantation of one of 3 lenses, single-piece: the SN60WF (Alcon, USA), PCB00/ZCB00 (Tecnis, USA) and 3-piece: MA60MA (Alcon, USA). IOL constants recommended by the calculator were utilized for the study. We performed analysis for the whole dataset, short (<22mm) and long eyes (>25mm) as well as in subgroups based on the type of the implanted IOL. SD and RMSAE were selected as the primary endpoints. Cooke K6 had the lowest SD of PEs in the whole dataset (p<0.05) when compared with Barrett, EVO, and Hoffer-QST. In the subgroup of long eyes, the Kane formula had the lowest RMSAE (p<0.05) when compared with Barrett and EVO. We did not find any significant differences in primary endpoints for implantation of the 3 types of IOL. However, the median absolute error following implantation of the MA60MA was significantly higher than for all other formulas except for Pearl-DGS. We found significant differences in the performance of formulas included in the calculator. In the whole dataset, Cooke K6 had the lowest SD of PEs among the analyzed formulas.

Nucleus drop following phacoemulsification surgery: Incidence, risk factors and clinical outcomes.

To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.

Первичный задний капсулорексис: исторические аспекты и современное состояние вопроса

Abstract Primary posterior capsulorexis: historical aspects and the current state of the issue E.V. Egorova, A.O. Direev, S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation Purpose. The paper analyzes the data of modern literature (published from 2008 to 2023) on the history and technique of primary posterior capsulorexis (PPC). The fields of application, variations, effectiveness and safety of the procedure are considered. Material and methods. A search for research on the subject of work from 2008 to 2023 was carried out. The search was carried out using Google Academy electronic databases (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm. nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) and foreign and domestic journals devoted to ophthalmology. Results. An analysis of the literature has shown that performing PPC provides high visual results both in comparison with standard cataract surgery and in the case of primary fibrosis of the posterior capsule. The key points of the PPC method are: intact anterior hyaloid membrane, continuous tear-resistant edge of capsulorexis and its size, which allows the preserved part of the PC to provide adequate support for the IOL and form a circular capsule barrier along the edge of its optical part. However, some studies have shown the possibility of partial or complete «closure» of the capsulorexis area by proliferating epithelial cells of the lens (ECL) in adult patients. In pediatric practice, it is well known that posterior hyaloid membrane (PHM) can act as a matrix for the migration of ECL, and the frequency of opacity of the optical axis after PPC reaches 60%. Therefore, in a number of clinics, the standard algorithm for cataract surgery in children includes not only PPC, but also anterior vitrectomy, although this complex approach is not always effective. As a solution to the problem of opacity of the optical axis after PPC, the technique of «capturing the optics» of the IOL was proposed, which permanently eliminates the opacity of the optical axis behind the IOL and significantly reduces fibrosis, especially in combination with polishing the anterior capsule. Conclusion. A large number of studies analyzing the clinical results of the PPC method, performed over several decades with various types of IOLs, leaves no doubt that performing posterior capsulorexis is a well-controlled method that significantly reduces the frequency of secondary cataracts, adding a «second line of defense» without reducing the barrier effect along the optical edge. Key words: anterior hyaloid membrane, Berger’s space, continuous curvilinear capsulorhexis, posterior optic capture

Higher-order Aberrations — the Choice of Optimal Intraocular Correction in the Surgical Treatment of Cataracts. Review of the Literature

The cornea is the most powerful refractive element of the eye and plays a fundamental role in the quality of vision. Imperfection of corneas shape leads to the focusing errors formation, known as optical aberrations, which are responsible for visual performance deterioration. Understanding and assessing wavefront errors in IOL selection and calculation is great importance to achieve maximum optical outcome in the postoperative period. The article presents literature data of the effect of higher-order aberrations on the vision quality in unoperated eyes, changes of the wavefront in the eyes after cornea surgical interventions, the effect of various types of IOLs (spherical, aspherical, multifocal and EDOF) on the total error of the eye wavefront, recommendations at their choice with different severity levels of optical aberrations, as well as promising areas of research on this issue.

К вопросу расчета ИОЛ у пациентов с витреоретинальной патологией

Purpose. To estimate the probability of a change in the calculated IOL after microinvasive vitrectomy 25G in patients with operated macular rupture. Methods. A retrospective analysis of patients operated on for a macular rupture with a diameter from 400 microns to 1000 microns was performed. The exclusion criteria were: the axial length of the eye is less than 22.0 mm and more than 26.0 mm, recurrence of previously operated macular ruptures, the presence of concomitant ocular pathology that can affect the final postoperative result (macular degeneration, glaucoma, diabetic and postocclusive retinopathy), the presence of previously performed surgical interventions on the retina. The study involved 64 eyes, of which 34,37 % (22 eyes) with a native lens; 14,06 % (9 eyes) with artifacia before vitrectomy; 6,25 % (4 eyes) vitrectomy with cataract phacoemulsification and IOL implantation and 45,31 % (29 eyes) cataract phacoemulsification with IOL implantation was performed within 4–9 months after primary vitrectomy. These patients were the study group. The comparison parameters are best corrected visual acuity, K1, K2, Ave. K1, Ave. K2, Axis, Ave. K2-K1, axial length of the eye, Ave. axial length of the eye, as well as calculated models of IOL and implantable after vitreoretinal surgery. Results. The change in the optical strength of the IOL occurred in 44,82 %. The change in the IOL model is 37,93 %. The change in the optical strength and model of the IOL is 20,68 %. The change in the optical strength of the previous IOL model is 24,1%. The change in the strong axis of more than 20 ° with the previous IOL parameters is 13,79 %. Only in 27,58 % there were no changes in the calculation of IOL. Conclusion. An individual approach to the calculation and selection of intraocular lenses in patients with vitreoretinal pathology allows implantation of all types of IOLs with maximum patient satisfaction with the functional result. Keywords: biometric indicators, IOL, vitrectomy, cataract, phacoemulsification, keratometry

The prevalence of visual axis opacification in the Swedish Pediatric Cataract Register.

To report on the occurrence of postoperative visual axis opacification (VAO) in children younger than 5 years of age operated for cataract in Sweden, and to analyse correlations with age at surgery and surgical method. Data were derived from the Swedish Pediatric Cataract Register (PECARE). All children operated on between 1 January 2007 and 31 December 2020 were included. Follow-ups at 1, 2 and 5 years of age were analysed. Cataract surgery were performed on 770 eyes belonging to 549 children (n = 282 boys, 51.4%); 327/770 (42.5%) of the children underwent surgery before 3 months of age and 216/770 (28%) before 6 weeks of age. Data on 881 follow-up visits were registered. At the follow up-visits at 1, 2 and 5 years of age, VAO was present in 154/349 (44.1%), 41/323 (12.7%) and 25/208 (12%). The majority of the children with VAO underwent cataract surgery before age 6 months, with a predominance before age 2 months. Primary IOL was implanted in 601/770 (78%) of eyes; 40.8% had an acrylic one-piece lens, 31.8% had a bag-in-the-lens IOL, 21.9% were aphakic and 5.2% had an acrylic three-piece lens. Implantation of a bag-in-the-lens IOL was related to a significantly lower occurrence of VAO compared to other types of IOL, including aphakia (p < 0.0002). Our results are in accordance with the literature. Primary bag-in-the-lens IOL implantation before 2 years of age seems adequate and safe, with a low occurrence of VAO, and can thus be continued as routine in Sweden.

Retrospective analysis of negative Dysphotopsia after cataract surgery

Purpose: To describe the incidence and characteristics of negative dysphotopsia (ND) as well as the risk factors contributing to it.Methods: In this retrospective study postoperative results of 8122 eyes after cataract surgery were analysed. Three different IOLs have been implanted (EyeCee® One by Bausch + Lomb, TECNIS® by Johnson &amp; Johnson, HOYA Vivienx™ by HOYA). Following parameters were studied: pupil size, axial length, anterior chamber depth, angle kappa, IOL power and other biometrical factors. The scotomas were depicted on a Harms tangent screen.Results: An incidence of 1.99% of ND was found, of which 1.58% was transient and 0.42% persistent. The average duration of the symptoms was 5.40 (±6.15) weeks in the transient ND group. In the total cohort of 8122 eyes, there was no difference in the distribution of implanted IOL types or IOL power; neither played the surgeon a significant role in the development of ND. There was no significant difference between ND and control eyes regarding pupil size, axial length, and angle kappa. The anterior chamber was significantly shallower in the ND group: 5.1 ± 0.58 mm vs. 5.41 ± 0.61 mm (p = 0.03).Conclusion: According to our findings, a shallower anterior chamber poses a risk to the development of ND.

Comparative Evaluation of the Defocus Curve of Monofocal IOL, Extended Depth of Focus IOL, and Trifocal IOL

Purpose. Comparative evaluation of the defocus curve (DC) of monofocal IOLs (MIOLs), extended depth of focus IOLs (EDОF) and trifocal IOLs (TIOLs). Patients and methods. We observed 90 patients (average age 57.8 ± 1.8 years) who underwent standard binocular phacoemulsification of cataracts in both eyes with emmetropic “target” refraction and postoperative monocular uncorrected distance visual acuity (UCVA) of at least 1.0 rel. units. All patients were divided into three groups equal in number of patients, age, gender and visual status, corresponding to three options of implantable IOLs: MIOL (“RayOne Aspheric”, model RAO600C); EDOF (RayOne EMV, model RAO200E) and THYOL (RayOne Trifocal). DC was performed binocularly based on a standard BCVA measurement with an optical load for defocusing from +3.0 D to -4.0 D with a “step” of +1.0 D and -0.5 D. Results. Under conditions of optical defocusing with positive lenses (1.0; 2.0; 3.0 D), all three types of IOLs maintained almost the same average BCVA (at +1.0 D, the BCVA range was 0.72–0.76 rel. units; at +2.0 diopters — 0.66–0.72 relative units; at +3.0 diopters — 0.52–0.56 relative units). In relation to the analysis of BCVA in conditions of defocusing with negative lenses, it was found that visual acuity was significantly better with EDOF than with MIOL, with a load from -1.0 to -4.0 diopters, while these differences were statistically significant and ranged from 0.14 to 0.27 relative units (p &lt; 0.01). Along with this, it was determined that UCVA was significantly better in the group with TIOL than in the group with EDOF, with a load from -2.5 to -4.0 D. Moreover, these differences were statistically significant and ranged from 0.09 to 0.14 rel. units (p &lt; 0.01). Conclusion. The design features of IOLs make it possible to consider implantation of EDOF as an option for an individual approach to the selection of IOLs, especially taking into account the possibility of use in patients whose professional activities involve long-term visual work at intermediate distances (for example, users of personal computers).

Clinical outcomes in eyes with diffractive continuous depth-of-focus intraocular lenses enhanced for near vision: comparison with trifocal intraocular lenses

BackgroundTo prospectively evaluate visual functions and patient satisfaction after bilateral implantation of diffractive continuous depth-of-focus intraocular lens (CDF IOL) compared with trifocal IOLs.MethodsThis investigator-initiated study was approved by a certified local review board (registered: jRCTs032210305). CDF IOL (Synergy, J&J, group S) and trifocal IOL (AcrySof PanOptix, Alcon, group P) were implanted bilaterally in 30 patients each. Three months postoperatively, binocular outcomes of uncorrected (BUCVA) and distance-corrected (BDCVA) visual acuities at distances of 0.3, 0.4, 0.5, 0.7, and 5 m were measured. Contrast sensitivities were binocularly measured using CSV-1000 (2.5 m) and Pelli-Robson charts at distances of 0.4 and 1 m. Symptoms of glare, halo, starburst, and waxy vision, and satisfaction for near, intermediate, and far visions were assessed with questionnaires. Differences between the two groups were examined.ResultsTwenty-seven patients each completed the follow-up. The mean age of the group S was lower than that of the group P (P < 0.001). The BUCVA at 0.4 m was better in the S group, while the mean manifest refraction of the P group showed a significant hyperopic shift (P < 0.001). BDCVA was significantly better in the S group. The contrast sensitivity results at three distances showed no discernible differences. Although more patients in the S group reported significant glare and halo, their satisfaction with near vision was higher.ConclusionsThe binocular visual function of patients with CDF IOLs was comparable to or better than that of patients with trifocal IOLs. The patients were satisfied with near vision, despite the enhanced glare and halo. Understanding the differences between the two types of presbyopia-correcting IOLs is important to ensure patient satisfaction.Trial registrationThis clinical trial was registered in the Japan Registry for Clinical Research (identifier: jRCTs032210305) on September 13, 2021.

Prospects for the Use of Monofocal IOLs with Extended Depth of Focus (EDOF) Instead of Traditional Multifocal (Trifocal) IOLs in Cataract Surgery

Purpose — a literature review of comparative studies of the clinical efficacy of IOLs based on extended depth of focus technology (EDOF) and trifocal IOLs (TFIOLs). Methods. Literature analysis was performed in the international database “PubMed”.The search keywords were “IOL with extended depth of focus (EDOF)”, “Trifocal IOL”, “Contrast sensitivity”, “Aberrometry”, “Defocus curve”. The choice of sources for the review was carried out in accordance with the criteria for prospective or retrospective studies. A total of 158 sources were analyzed, further using systematic review filters and the authors’ knowledge of the topic. The duration of the retrospective analysis was 8 years (2015–2022), some of the considered works were dated 2023. Results. The values of visual acuity for distance, near and at an intermediate distance in both studied groups did not differ significantly. When analyzing the defocusing curve, the preservation of visual acuity under load conditions from +1.0 to +3.0 diopters was determined for both types of IOL, respectively. At the same time, visual acuity was significantly better in the TPIOL group than in the EDOF group in the optical load range from -2.5 to -4.0 diopters. Most studies did not report significant difference between EDOF and TFIOL in terms of contrast sensitivity, the likelihood of postoperative “halo” effects, and “independence” of spectacle correction. The stated provisions are fully consistent with the results of the medical and technical evaluation of EDOF presented in the literature. Conclusion. The development of a new type of EDOF IOL seems to be a promising direction in cataract surgery, especially taking into account the possibility of using patients whose professional activities are associated with long-term visual work at intermediate distances (for example, users of personal computers). Further accumulation of clinical material is required in the context of the role and place of EDOF in the general system of aphakia correction, taking into account the IOL model and the conditions of the patient’s professional visual activity.

Наш опыт имплантации ИОЛ AcrySof IQ Vivity®. Предварительные результаты

AcrySof IQ PanOptix® multifocal IOLs provide patients with far, near and intermediate vision. But this type of IOL is characterized by various undesirable optical phenomena and a decrease in contrast sensitivity. A new type of IOL with an extended depth of focus, like the AcrySof IQ Vivity ® overcomes these disadvantages and should also give patients freedom from the use of glasses. Aim. The aim of our study was to analyze the results of implantation of the AcrySof IQ Vivity ® IOL with extended depth of focus up to 6 months after surgery аnd also to compare the studied parameters with those after implantation of the AcrySof IQ PanOptix ® IOL. Methods. The study group included 20 eyes (13 patients) with an implanted AcrySof IQ Vivity® IOL. Patients were examined for distance UCVA and BCVA, and, for a period of 6 months, UCVA for near (40 cm) and for intermediate distance (60 cm) were additionally studied. Patients' satisfaction was determined using the VF-14 questionnaire. Presence of undesirable optical phenomena was also determined. Spatial contrast sensitivity was determined under photopic and mesopic conditions. The comparison group of AcrySof IQ PanOptix ® is taken from a study by our colleagues (108 eyes of 71 patients). Comparison was carried out according to the specified parameters. Results. 6 months after IOL implantation, UCVA and BCVA in both groups was comparably high (in the study group AcrySof IQ Vivity ® UCVA 0.95±0.29; BCVA 1.06±0.1; in the comparison group AcrySof IQ PanOptix® – UCVA 0.93±0.18, BCVA 1.0±0.04). UCVA for near in the study group was 0.41±0.16; in the comparison group 0.85±0.22. UCVA for intermediate distance 0.52±0.17; in the comparison group 0.84±0.24. Satisfaction on the VF-14 scale: 83.0±6.5 points in the AcrySof IQ Vivity ® group, 97.9±1.2 points in the AcrySof IQ PanOptix ® group. In the study group, only one patient complained of glare, in the comparison group, such complaints were significantly more frequent. Spatial contrast sensitivity was superior in the AcrySof IQ Vivity ® group at all frequencies both under photopic and mesopic conditions. Conclusion. At a period of 6 months after phacoemulsification with implantation of the AcrySof IQ Vivity ® IOL, it is possible to achieve high distance visual acuity, as well as with the implantation of the AcrySof IQ PanOptix ® IOL. However, near visual acuity is significantly lower, which required the use of glasses by patients. Visual acuity at an intermediate distance is more comparable. In the AcrySof IQ Vivity® group, spatial contrast sensitivity is higher and the rate of optical adverse events is much lower. Key words: phaco emulsification; trifocal IOL; EDOF IOL; Vivity; PanOptix; contrast sensitivity

The Comparison of Results of Implantation in Two Groups with PanOptix IOL and Synergy IOL

Purpose: compare the results of implantation of two types of premium IOLs (Synergy and PanOptix) according to several criteria.Materials and methods. Patients were treated in the “EyeDoctor” ophthalmology clinic, Almaty, Kazakhstan. Synergy group: 8 people (4 men and 4 women.) PanOptix group: 25 people (9 men and 16 women).Results. A month after the operation, results were special but comparable.Conclusion. It can be concluded that the hybrid IOL Synergy is in not inferion in refractive results to well matched PanOptix.

CHANGES IN MACULAR THICKNESS FOLLOWING UNEVENTFUL CATARACT SURGERY AT A TERTIARY CARE CENTRE: 3 MONTHS FOLLOW UP STUDY.

Background: Cataract is globally a primary cause of preventable blindness and visual impairment with a prevalence of 47.8%. Small-incision cataract surgery (SICS) and phaco-emulsication are the most commonly performed cataract surgeries. However, they are often associated with postoperative risks like cystoid macular edema. In advent of same the current study aimed to identify the macular thickness following uneventful phacoemulsication &amp; small incision cataract surgery method (SICS) comparison with visual acuity. Material &amp; Method: A prospective observational study was undertaken for a period of 1 year from April 2022 to March 2023 on all cataract patients who presented to the OPD at Department of Ophthalmology, IMCHRC, Indore. 100 patients who qualied the inclusion criteria were enrolled with random allocation into 2 surgery group i.e., Group A (N=50); patients who underwent SICS for one eye with bag polymethacrylate IOL implantation and Group B (N=50); patients who underwent phacoemulsication method in one eye with in bag acrylic type of foldable IOL. Postoperative follow up was done on day 7, week 2 and week 4 and upto 3 months. The complete ophthalmological examination and OCT of macula was done at follow-up. Statistical analysis was done with data collected as per the objectives of the study. Results: Subclinical macular oedema noted in two cases at 1st, 2nd and 4th week follow-up, but i was reduced at 3rd month. A statistically signicant (P&lt;0.05) was observed in macular thickness between the preoperative &amp; post operative 1st week, post-operative 2nd week &amp; post-operative 4th week follow-up in Phacoemulsication group. Patients who underwent SICS procedure also showed statistically signicant difference (P&lt;0.05) between the preoperative &amp; postoperative macular thickness on follow-ups without affecting the nal visual acuity. Conclusion: Phacoemulsication procedure showed increased macular thickness without affecting the nal visual outcome postoperatively as compared to SICS. Subclinical macular edema was noted at 1st week which subsequently reduced at 3rd month.

Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants

Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications.

Decision taking in corneal refractive surgery.

A 27-year-old woman who wants to get rid of contact lenses and spectacles was seen at our clinic. She had strabismus surgery as a child and was patched for the right eye but now shows mild nondisturbing exophoria. Infrequently, she likes to box in the sports school. Her corrected distance visual acuity at presentation in the right eye was 20/16 with -3.75 -0.75 × 50 and in the left eye 20/16 with -3.75 -1.25 × 142. Her cycloplegic refraction in the right eye was -3.75 -0.75 × 44 and in the left eye was -3.25 -1.25 × 147. The left eye is the dominant eye. The tear break-up time was 8 seconds in both eyes, and the Schirmer tear test was 7 to 10 mm in right and left eyes, respectively. Pupil sizes under mesopic conditions were 6.62 mm and 6.68 mm. The anterior chamber depth (ACD) (measured from the epithelium) in the right eye was 3.89 mm and in the left eye was 3.87 mm. The corneal thickness was 503 μm and 493 μm of the right and left eye, respectively. Corneal endothelial cell density was on average 2700 cells/mm2 for both eyes. Slitlamp biomicroscopy showed clear corneas and a normal flat iris configuration. Supplemental Figures 1 to 4 (available at http://links.lww.com/JRS/A818, http://links.lww.com/JRS/A819, http://links.lww.com/JRS/A820, and http://links.lww.com/JRS/A821) show the corneal topography and Belin-Ambrósio deviation (BAD) maps at presentation of the right eye and left eye, respectively. Would you consider this patient a candidate for corneal refractive surgery (eg, laser-assisted subepithelial keratectomy, laser in situ keratomileusis [LASIK], or small-incision lenticule extraction [SMILE] procedure)? Has your opinion changed given the recent opinion of the U.S. Food and Drug Administration (FDA) regarding LASIK?1 The patient herself is slightly favoring an implantation of a phakic intraocular lens (pIOL), as she prefers something reversible. Would you implant a pIOL, and which type of IOL, for this level of myopia? What is your diagnosis or are additional diagnostic methodologies needed to establish a diagnosis? What is your treatment advice for this patient? REFERENCES 1. U.S. Food and Drug Administration, HHS. Laser-assisted in situ keratomileusis (LASIK) lasers-patient labeling recommendations; draft guidance for industry and food and drug administration staff; availability. July 28, 2022, Federal Register; 87 FR 45334. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/laser-assisted-situ-keratomileusis-lasik-lasers-patient-labeling-recommendations Accessed January 25, 2023.

Spectral-Domain OCT Lens Meridian Position as a Metric to Estimate Postoperative Anatomical Lens Position.

To evaluate the prediction of postoperative anatomical lens position (ALP) using intraoperative spectral-domain optical coherence tomography (SD-OCT) lens anatomy metrics in patients who underwent femtosecond laser-assisted cataract surgery. Intraoperative SD-OCT (Catalys; Johnson & Johnson Vision) and postoperative optical biometry (IOLMaster 700; Carl Zeiss Meditec AG) were used to assess anterior segment landmarks, including lens thickness, lens volume, anterior chamber depth, lens meridian position (LMP), and measured ALP. LMP was defined as the distance from the corneal epithelium to the lens equator, and ALP was defined as the distance from the corneal epithelium to the IOL surface. Eyes were divided into groups according to axial length (> 22.5 mm, 22.5 to 24.5 mm, and > 24.5 mm) and IOL type (Tecnis ZCB00 [Johnson & Johnson Vision]; AcrySof SN-60WF [Alcon Laboratories, Inc], or enVista MX60E [Bausch & Lomb]) to further analyze the correlation between LMP and ALP. Theoretical effective lens position was back-calculated using a specific formula. Primary outcome was correlation between postoperative measured ALP and LMP. A total of 97 eyes were included in this study. Linear regression analysis displayed a statistically significant correlation between intraoperative LMP and postoperative ALP (R2 = 0.522; P < .01). No statistically significant correlation was observed between LMP and lens thickness (R2 = 0.039; P = .06) or between ALP and lens thickness (R2 = 0.02; P = .992). The greatest predictor for ALP was LMP (β = 0.766, P < .001; R2 = 0.523). Intraoperative SD-OCT-measured LMP correlated better than anterior chamber depth and axial length to postoperative ALP. Further studies are necessary to analyze the impact of preoperative or intraoperative LMP measurements on postoperative refractive outcomes. [J Refract Surg. 2023;39(3):165-170.].

Visual Outcomes and Complications of Intraocular Lens Placement in the Absence of Capsular Support in a Philippine Tertiary Hospital.

Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia. This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support. We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted. Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.

Real world outcomes of the new Tecnis Eyhance IOL.

To compare the performance of Tecnis Eyhance ICB00 with Tecnis PCB00 IOL for far, intermediate, and near vision, in patients after bilateral cataract surgery. This study was done at Geneva University Hospitals. This is a retrospective study of 224 eyes that underwent cataract between May 2019 and June 2020. Visual acuity was assessed from month 1 to 12 after surgery for distance, intermediate and near visual acuity, by the same optometrist, which was blind regarding the type of IOL. The patients answered to a quality of life questionnaire. Patients were excluded for: monocular surgery, macular disease, other IOL type, or inability to reach 20/20 visual acuity in both eyes without correction. One hundred and fifty-two eyes were excluded. Three groups were then analyzed: PCB00 group (38 eyes), ICB00 group (22 eyes), and mismatch group (12 eyes). Monocular visual acuities (CIVA, UNVA and CNVA, in logMAR) were higher in the ICB00 group than the PCB00 group (respectively 0.3 vs 0.4, p = 0.0033; 0.3 vs 0.4, p = 0.0408; 0.3 vs 0.4, p = 0.0039). Binocular visual acuities, CIVA and CNVA were higher in the ICB00 group than the PCB00 group (0.2 vs 0.4, p = 0.0061; 0.15 vs 0.3, p = 0.018). This mirrored the findings of the quality of life questionnaire. There was no significant difference between PCB00 and mismatch groups. the Tecnis Eyhance was more effective for intermediate and near vision. The central defocus of the lens might help patients achieve spectacle independence and better quality of life.

The effect of hypotensive drugs on intraocular lenses clarity.

To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs. In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX). Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs. In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.

Deviation from the planned axis of three toric intraocular lenses

In this study, we retrospectively evaluated the deviation from the planned axis of 3 Toric intraocular lenses (TIOL). Included in the study 190 eyes, operated by two surgeons using two different manual marking techniques. The patients were implanted with either AcrySof IQ Toric SN6AT (Alcon) (n = 90), POD FT (PhysIOL) (n = 50), or TECNIS Symfony Toric (J&J) (n = 50). At least 1 month postoperatively, the IOL was photographed, and the axis was measured using a designed software. The difference between the planned and actual axis was defined as axis deviation. The effect of IOL type, astigmatism direction, and marking techniques on the average degree and direction of the IOL deviation were evaluated and compared. There was no significant difference in the average deviation between the IOLs (TECNIS Symfony: 4.03° ± 4.34, POD FT: 3.52° ± 3.38, and SN6AT: 4.24° ± 4.10), and its direction (55.8%, 39.0%, and 56.6% clockwise (CW) deviation, respectively). With the rule, astigmatism had significantly more CW deviation compared with against the rule and oblique astigmatism (64.3%, 43.8%, and 41.7%, respectively, P = 0.027), but the average deviation was similar. The marking techniques did not influence the degree or direction of the deviation.