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Purpose: To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. Methods: This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow?up. Results: At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow?up (P < 0.001, Wilcoxon signed?rank test). The mean refractive cylinder improved from ? 1.56 ± 1.25 D preoperatively to ? 0.12 ± 0.31 D at 3 months follow?up (P < 0.001) while the mean spherical equivalent value changed from ? 1.93 ± 3.71D preoperatively to ? 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 ?m while the average contrast sensitivity value (Pelli?Robson chart) was 1.56 ± 0.10 log unit, at the final follow?up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow?up. There were no intraoperative or postoperative complications. Conclusion: SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability
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Objective:To observe the unfolding status of foldable acrylic intraocular lens (IOL) of different materials, designs and refractive powers implanted in the capsular bag during cataract surgery, and to investigate its influence on the IOL implantation procedure.Methods:An observational case series study was conducted.A total of 1 005 patients who underwent routine phacoemulsification and IOL implantation in Shaanxi Eye Hospital from February to August 2021 were enrolled.The status and unfolding time of the leading haptic, optical region, and trailing haptic of the IOL in the capsular bag and the surgeon were recorded in real-time intraoperative video.Of the 1 005 IOL implants, 681 were hydrophobic, 324 hydrophilic, 733 C-loop, 272 plate-haptic, 909 single-piece, 96 three-piece, 620 preloaded, and 385 non-preloaded.The differences in unconventional implantation factors and IOL unfolding time were compared.The factors influencing IOL implantation status were analyzed by multivariate logistic regression.Multivariate logistic regression was used to analyze the relevant factors affecting IOL implantation status.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xi'an People's Hospital (Xi'an Fourth Hospital)(No.20200035). Written informed consent was obtained from each subject.Results:There were 14(1.4%) IOLs with unconventional leading haptic status during implantation, including 7 recurved, 4 folded, 2 twisted and 1 straightened.There were 101(10.0%) IOLs with unconventional trailing haptic status during implantation, including 49 stuck in the injector, 40 folded, 10 recurved and 2 broken.There were 22(2.2%) IOLs with overlapped leading and trailing haptic requiring additional separation.There were 4(0.4%) IOLs with reversed optical regions and 2(0.2%) with damaged optical regions.The occurrence rate of unconventional leading haptic status using C-loop IOL was higher than that using plate IOL, and the difference was statistically significant ( P<0.05). The occurrence rate of unconventional trailing haptic status using hydrophilic, non-preloaded, three-piece, and C-loop IOL was higher than that using hydrophobic, preloaded, single-piece, and plate IOL, respectively, and the differences were statistically significant ( χ2=9.100, 61.400, 81.885, 7.587; all at P<0.05). The 22(2.2%) IOLs with overlapped leading and trailing haptic were hydrophobic.The 4 (0.4%) IOLs with reversed optical region were non-preloaded.The results of multivariate logistic regression analysis showed that IOL material, loading method, design and surgeons were related to the unconventional trailing haptic status in implantation ( OR=9.894, 3.720, 6.810, 1.338; all at P<0.05). The average unfolding time of hydrophobic IOL was 26.12(21.21, 30.91)s, which was significantly longer than 3.03(2.16, 4.49)s of hydrophilic IOL ( Z=-25.603, P<0.05). The average unfolding time of C-loop IOL was 25.53(19.41, 30.25)s, which was significantly longer than 2.70(2.08, 3.69) s of plate IOL ( Z=-23.764, P<0.05). Conclusions:A variety of unconventional statuses of IOL can occur during implantation into the lens capsular bag.The use of hydrophobic, preloaded, single-piece, and plate IOLs can reduce the occurrence of unconventional status.The use of hydrophilic IOLs can reduce the overlap of leading and trailing haptic.The use of preloaded IOLs can reduce the occurrence of IOL optical region reversal.The use of hydrophilic and plate IOLs can shorten the operation time.
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Purpose: To evaluate a single surgeon’s experience with an automated preloaded intraocular lens (IOL) delivery system and a nonpreloaded system. Methods: This was a prospective, observational case series. Phacoemulsification was performed under topical anesthesia by creating a temporal clear corneal incision. Patients were consecutively assigned to either the Clareon group (n = 50; the IOL was injected into the capsular bag by using an automated injector system) or the AcrySof group (n = 50; the IOL was injected into the capsular bag by using a conventional injector system). The main outcome measures were ease of implantation, intraoperative complications, postoperative centration, and visual acuity. Results: Additional manipulation in the anterior chamber was not required in 38 (74%) eyes in the Clareon group and 41 (82%) eyes in the AcrySof group. However, seven eyes in the Clareon group and one eye in the AcrySof group required trailing haptic dislodgement from the optic. Furthermore, two eyes in the Clareon group and five eyes in the AcrySof group required injector rotation (varying from 10° to 90°) in the wound. Moreover, in two eyes of the Clareon group, the silicon plunger of the injector system crossed over the optic. None of the patients developed iris trauma and PCR during IOL manipulation. All the IOLs were centered in the capsular bag. Conclusion: The automated IOL delivery system enables the controlled delivery of an IOL in the capsular bag. The effect of carbon footprints created by plastic generated from the delivery system and the implications of the CO2 cylinder on the environment should be addressed.
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Purpose: To evaluate and compare the biomechanical properties of the eye bank?prepared and surgeon prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. Methods: In this laboratory study, corneal tissues for research were randomly allocated in the following groups: a) surgeon?cut DSAEK and b) eye bank?prepared (pre?cut and pre?loaded) DSAEK. Endothelial cell loss (ECL), immunostaining for tight junction protein ZO?1, elastic modulus, and adhesion force were investigated. Results: ECL was not found to be significantly different between surgeon?cut DSAEK (7.8% ±6.5%), pre?cut DSAEK (8.6% ±2.3%), and pre?loaded DSAEK (11.1% ±4.8%) (P = 0.5910). ZO?1 was expressed equally across all groups. Surgeon?cut DSAEK grafts showed a significantly higher elastic modulus compared to pre?cut and pre?loaded DSAEK groups (P = 0.0047 and P < 0.0001, respectively). Adhesion force was significantly greater in the surgeon?cut DSAEK compared to pre?cut (P < 0.0001) or pre?loaded DSAEK groups (P = 0.0101). Conclusion: The laboratory data on the biomechanics of DSAEK grafts suggests that surgeon?cut DSAEK grafts present higher elastic modulus and adhesion force compared to eye bank?prepared DSAEK grafts.
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PURPOSE: We compared the clinical results after implantation of the newly-developed aspheric intraocular lens iSert 250 NC60 (Hoya Corporation Ltd., Tokyo, Japan) with 2 other types of widely used intraocular lenses, AcrySof IQ SN60WF (Alcon Laboratories, INC., Fort Worth, TX, USA) and TECNIS 1-piece ZCB00 (AMO Inc., Santa Ana, CA, USA). METHODS: Seventy cataract eyes were implanted with 1 of 3 aspheric intraocular lenses (Hoya iSert 250 NC60, TECNIS 1-piece ZCB00 or AcrySof IQ SN60WF) by the same surgeon. Uncorrected vision, best corrected vision, spherical equivalent, higher order aberrations, and modulation transfer function were measured 1 and 3 months after the cataract surgery. RESULTS: Uncorrected vision and best corrected vision were not significantly different among the 3 groups; however, eyes implanted with iSert250 NC60 showed more hyperopic-shifted postoperative spherical equivalents than expected compared to the other 2 groups. Total ocular aberrations and internal optics aberrations were similar among the 3 groups while the root mean square of the corneal aberrations showed differences. Eyes implanted with iSert 250 NC60 showed superior results in modulation transfer function compared with the other 2 groups in a majority of spatial frequencies 3 months postoperatively. CONCLUSIONS: The newly developed aspheric intraocular lens iSert 250 NC60 showed clinically equal results compared with 2 other verified intraocular lenses AcrySof IQ SN60WF and TECNIS 1-piece ZCB00 in vision, higher-order aberrations, and modulation transfer functions.