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

BACKGROUND: To prospectively evaluate visual functions and patient satisfaction after bilateral implantation of diffractive continuous depth-of-focus intraocular lens (CDF IOL) compared with trifocal IOLs. METHODS: This 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. RESULTS: Twenty-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. CONCLUSIONS: The 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 REGISTRATION: This clinical trial was registered in the Japan Registry for Clinical Research (identifier: jRCTs032210305) on September 13, 2021.

Customization of a passive surgical support robot to specifications for ophthalmic surgery and preliminary evaluation.

PURPOSE: To customize a passive surgery support robot for ophthalmic surgery and preliminarily evaluate its performance. STUDY DESIGN: Prospective observational study. METHODS: The range of motion of the arm was analyzed during ophthalmic surgery and, based on this analysis, a commercially available passive robot was customized for surgical support for ophthalmic surgery; following which a prototype robot was constructed. To examine the effects on the brachial muscle during surgical operations with and without the prototype robot, surface electromyograms of the biceps and triceps were analyzed after performing continuous curvilinear capsulorrhexis (CCC) and suturing the sclerocorneal wound in a cataract surgery simulation. Six surgeons performed cataract surgery, and the degree of arm stability and muscle fatigue during surgery were evaluated using a visual analog scale. RESULTS: During surgery, the prototype robot enabled fixation of the elbow and wrist at any position within the surgeon's range of motion, expanding the range of motion of the hand and fingers and stabilizing operability. Surface electromyography showed a significant decrease in the mean amplitude value of the biceps brachii during both CCC and suturing (p < 0.0001). No significant difference was observed in the triceps brachii. The arm stability and muscle fatigue were improved by 83.3% on the visual analog scale with the prototype robot compared with that without protpotype robot. CONCLUSION: The use of a passive prototype robot may improve arm stability and reduce muscle fatigue during ophthalmic surgery.

Effects of Image Processing Using Honeycomb-Removal and Image-Sharpening Algorithms on Visibility of 27-Gauge Endoscopic Vitrectomy.

Endoscopic vitrectomy with small gauge probes has clinical potentials, but intraocular visibility is inherently limited by low resolution and dim illumination due to the reduced number of optic fibers. We investigated whether honeycomb-removal and image-sharpening algorithms, which enable real-time processing of live images with a delay of 0.004 s, can improve the visibility of 27-gauge endoscopic vitrectomy. A total of 33 images during endoscopic vitrectomy were prepared, consisting of 11 original images, 11 images after the honeycomb-removal process, and 11 images after both honeycomb-removal and image-sharpening procedures. They were randomly presented to 18 vitreous surgeons, who rated each image on a 10-point scale. The honeycomb-removal algorithm almost completely suppressed honeycomb artifacts without degrading the background image quality. The implementation of image-sharpening algorithms further improved endoscopic visibility by optimizing contrast and augmenting image clarity. The visibility score was significantly improved from 4.27 ± 1.78 for the original images to 4.72 ± 2.00 for the images after the honeycomb-removal process (p < 0.001, linear mixed effects model), and to 5.40 ± 2.10 for the images after both the honeycomb-removal and image-sharpening procedures (p < 0.001). When the visibility scores were analyzed separately for 10 surgeons who were familiar with endoscopic vitrectomy and 8 surgeons who were not, similar results were obtained. Image processing with honeycomb-removal and image-sharpening algorithms significantly improved the visibility of 27-gauge endoscopic vitrectomy.

Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens.

PURPOSE: To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL). SETTING: Four ophthalmic surgical sites in Japan. DESIGN: Prospective case series. METHODS: The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons). RESULTS: The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004). CONCLUSIONS: Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.

Diagnosis and clinical course of ocular ischemic syndrome with retinal vascular abnormalities due to unilateral ocular artery and internal carotid artery stenosis in a child with neurofibromatosis type 1: a case report.

BACKGROUND: Neurofibromatosis type 1 (NF1) is a hereditary disease that causes neurofibromas generally, but it has been reported to sometimes be associated with various forms of blood vessel stenosis, occlusion and vascular abnormalities of unknown mechanism. However, a symptomatic case with simultaneous ophthalmic artery stenosis and internal carotid artery stenosis is an extremely rare pathogenesis in a child with NF1. In this report, we performed the diagnosis and observation using various imaging modalities for this rare pediatric case. CASE PRESENTATION: A 6-year-old girl diagnosed with NF1 presented with gradual visual loss in the right eye. Best corrected visual acuity (BCVA) was 20/40 OD and the intraocular pressure (IOP) was normal in both eyes. Retinal vascular abnormalities with tortuous vessels and optic disc pallor were observed in the right fundus. Widefield fluorescein angiography revealed multiple sites of neovascularization and a large non-perfusion area in the peripheral retina. Optical coherence tomography angiography showed retinal vascular abnormalities in the right eye and revealed differences in inner retinal thickness and blood flow signal between the left and right eyes. Laser speckle flowgraphy showed that chorioretinal blood flow was significantly decreased in the right eye. Cerebral angiography revealed the right ophthalmic artery was significantly narrowed throughout. In addition, Magnetic resonance angiography revealed that the right internal carotid artery was significantly narrowed in the ophthalmic segment. We diagnosed ophthalmic artery and internal carotid artery stenosis with retinal vascular abnormalities and ocular ischemic syndrome in NF1. Because IOP increased to 35 mmHg, due to neovascular glaucoma in addition to mild vitreous hemorrhage occurred, panretinal photocoagulation was performed after intravitreal bevacizumab injection. After treatments, IOP normalized, but BCVA decreased to 20/100 OD. Arterial spin labeling showed normal cerebral blood flow. The patient is currently being carefully monitored. CONCLUSIONS: We have described the diagnosis and treatment of ocular ischemic syndrome due to multiple arteries stenosis in a child with NF 1. Utilization of various imaging modalities was helpful in diagnosing the complicated pathogenesis. However, since direct intervention by neurosurgery is not possible in this case, it is expected that treatment will be extremely difficult in the future.

Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses.

PURPOSE: To compare the incidence of re-orientating surgery to improve misalignment of three models of acrylic toric intraocular lenses: AcrySof toric intraocular lens (Alcon Laboratories, Inc.), TECNIS toric intraocular lens (Johnson & Johnson Vision, Inc.) and HOYA 355 toric intraocular lens (HOYA). METHODS: In this retrospective, multicenter case series, medical charts were reviewed for collecting data on realignment surgery of toric intraocular lenses at 10 ophthalmic surgical sites in Japan. RESULTS: Over all, intraocular lens repositioning surgery was conducted in 89 of 9430 eyes (0.944%) at an average of 10.5 ± 9.7 days after the initial cataract surgery. The incidence was 0.213% (11/5155), 1.797% (62/3451) and 1.942% (16/824) with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively. The incidence was significantly lower with AcrySof than with other two brands of toric intraocular lenses (p < 0.0001). In those eyes which underwent reorientation surgery, the amount of misalignment was 26.4 ± 21.9°, 29.7 ± 15.4° and 28.1 ± 20.7° with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively; there was no significant difference among groups (p = 0.821). The repositioning surgery significantly reduced misalignment in all three groups. CONCLUSION: The rotational stability was considerably different among toric intraocular lenses of different manufacturers. The incidence of repositioning surgery was significantly lower with AcrySof than with TECNIS and HOYA toric intraocular lenses.

Influence of surface light scattering and glistenings of intraocular lenses on visual function 15 to 20 years after surgery.

PURPOSE: To assess the long-term influence of surface light scattering and glistenings of hydrophobic acrylic (Acrysof), silicone, and poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) on visual function. SETTING: Eleven surgical sites, Japan. DESIGN: Retrospective case series. METHODS: Patients who had cataract surgery with implantation of a hydrophobic acrylic, silicone, or PMMA IOL from 1994 to 2000 were examined. Silicone and PMMA IOLs were not restricted to specific manufacturers or models. Patients were included if their corrected distance visual acuity (CDVA) within 3 months postoperatively (baseline CDVA) was 20/25 or better. The CDVA, contrast sensitivity, degree of surface light scattering measured with Pentacam densitometry, and glistening grades were recorded at the patient's latest visit. RESULTS: Of the eyes, 31 had a hydrophobic acrylic IOL, 37 a silicone IOL, and 30 a PMMA IOL. Surface light scattering and glistenings were significantly greater with the hydrophobic acrylic IOL than with silicone and PMMA IOLs (P < .0001). The CDVA at the latest visit as well as the changes in CDVA from the baseline to the latest visit did not differ between the IOLs and was unaffected by surface light scattering and glistenings, as was the contrast sensitivity. CONCLUSIONS: The hydrophobic acrylic IOL was associated with a significantly greater level of surface light scattering and glistenings than the silicone IOLs and PMMA IOLs 15 to 20 years postoperatively. However, the optical phenomena within the optics of the hydrophobic acrylic IOL did not influence the patients' visual function.