YAG Capsulotomy Rates in Patients Following Cataract Surgery and Implantation of New Hydrophobic Preloaded Intraocular Lens in an Australian Cohort: 3-Year Results.

Purpose: To assess the risk of posterior capsular opacification (PCO) following implantation of the Clareon lens. Materials and Methods: Retrospective analysis was performed for 484 consecutive eyes that had undergone phacoemulsification and implantation of a monofocal lens (CNA0T) between April 2018 and February 2020. Eyes with other ocular pathology that may affect outcomes, previous refractive surgery or eyes corrected for a near target were excluded. Incidence of PCO and YAG capsulotomy was recorded and regression analysis was performed to determine risk factors associated with PCO formation. Results: Overall incidence of PCO following implantation of the CNA0T monofocal lens was 3.7% (18 eyes) at 1 year with 1.9% (9 eyes) undergoing YAG capsulotomy. At 3 years, 8.7% (42 eyes) had developed PCO and 4.1% (20 eyes) had undergone YAG capsulotomy cumulatively. Primary open angle glaucoma (POAG; OR = 6.53; 95% CI = 18.68, 2.28; P = 0.0005), age-related macular degeneration (AMD; OR = 2.35; 95% CI = 5.21, 1.06; P = 0.036), vitreomacular traction (VMT; OR = 7.32; 95% CI = 45.08, 1.19; P = 0.032), retinal vein occlusion (RVO; OR = 8.42; 95% CI = 38.99, 1.82; P = 0.006) and history of anti-VEGF therapy (OR = 3.22; 95% CI = 10.26, 1.01; P = 0.048) were positively associated with an increased risk of PCO. Conclusions: Incidence of PCO requiring YAG capsulotomy was relatively low. However, certain co-morbidities were found to increase the risk of PCO development, most significantly POAG and RVO.

Early Outcomes of Two Treatment Modes of PresbyLASIK: Monocular vs. Micro-Monovision.

Purpose: To report the visual, refractive and subjective outcomes of presbyLASIK for the correction of presbyopia. Methods: Monocular (20 eyes) or micro-monovision (12 eyes) presbyLASIK was performed on a total of 32 eyes in 16 patients (50% female, average age 55±4.6 years) using the Zeiss VisuMax 400Hz femtosecond and Schwind Amaris 1050RS excimer laser platform. Predictability, safety and efficacy were assessed and compared at 4-6 weeks, 3 months and 6 months. Results were considered significant if P < 0.05. Results: For monocular treatments, average postoperative spherical equivalent (SE) was 0.1±0.1 D and -0.86±0.5 D at 4-6 weeks postoperatively for distance and near eyes respectively; 90% eyes achieved SE ±1.0 D of the target. Postoperative binocular uncorrected distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA) were -0.03±0.1 LogMAR (20/20), 0.09±0.26 LogMAR (N4) and 0.29±0.11 LogMAR (N6) respectively with 90% patients achieving binocular UDVA of 20/20 or better. For micro-monovision treatments, average postoperative SE was -0.33±0.51 D and -1.60±0.78 D at 4-6 weeks postoperatively for distance and near eyes respectively; 100% eyes achieved SE ±1.0 D of the target. Postoperative binocular UDVA, UIVA and UNVA were 0.05±0.16 LogMAR (20/20), -0.02±0.10 LogMAR (N3) and 0.23±0.08 LogMAR (N5) respectively with 67% patients achieving binocular UDVA of 20/20 or better. Conclusion: Monocular and micro-monovision presbyLASIK are both effective options for the treatment of presbyopia. Monocular treatments are more likely to be well tolerated by patients who prefer to preserve exceptional distance vision, while micro-monovision treatments may be better suited to patients who can tolerate compromises in distance vision in order to attain greater intermediate vision function.

Catquest-9SF questionnaire shows greater visual functioning in bilateral cataract populations: A prospective study.

Purpose: Visual functioning evaluated by the Catquest-9SF questionnaire has shown to be a valid measure for assessing a patient's prioritization for cataract surgery. This study adapted Catquest-9SF for visual function outcomes post uni-lateral cataract surgery or bi-lateral cataract surgery. Methods: Visual functioning was assessed before and after uni-lateral or bi-lateral cataract surgery using the Catquest-9SF questionnaire. Patients were enrolled to this study prior to their cataract surgery between March 29 and April 30, 2021 at Shellharbour Hospital, Australia. Catquest-9SF questionnaires were completed prior to and 3 months post surgery. Resulting data were assessed for fit to a Rasch model using WINSTEPS software (version 4.2.0). Catquest-9SF data analysis of Chi-square, Wilcoxon sum test, and Fischer's test were performed in R (version 4.1.0). P value <.05 was considered statistically significant. Results: Sixty-one patients (mean age = 73.2 years, 62% female) were included for analysis. Catquest-9SF response thresholds, adequate precision (person separation index = 2.58, person reliability = 0.87, Cronbach's alpha = 0.74), uni-dimensionality, and no misfits (infit range 0.65-1.33; outfit range 0.64-1.31) were recorded. The mean of item calibration for patients was -0.22 post-operatively. There was significant (P <.05) improvement (16.3%) in visual functions across all nine Catquest 9-SF items. There was a significant mean visual function difference between patients with uni-lateral (10.1%) and bi-lateral cataract surgery (22.3%) pre-operatively and post-operatively. Conclusion: The Catquest-9SF questionnaire showed excellent psychometric properties and can assess visual functioning in an Australian population. There was a significant improvement in patient visual function post cataract surgery and higher functioning with bi-lateral cataract surgery.

Incidence of Pseudophakic Cystoid Macular Oedema Post-Cataract Surgery in Illawarra Shoalhaven Local Health District, Australia.

BACKGROUND: Post-operatively, cataract surgery is associated with pseudophakic cystoid macular oedema (PCMO) causing vision disturbances. The presence of comorbidities may increase the incidence of PCMO post-cataract surgery. OBJECTIVE: This observational study aimed to assess the incidence of PCMO in Australia (Illawarra region) and identify risk factors for developing PCMO. METHODS: Retrospective analysis was performed on data from patients who underwent uncomplicated phacoemulsification and intraocular lens implantation between 1st March and June 30, 2016. Demographics, comorbidities, central subfield thickness (CST), visual acuity, and intraocular pressure (IOP) were collected preoperatively, day 1, and weeks 2, 4, and 6 post-operatively. Statistical analysis was performed using SPSS v.27.0 and GraphPad Prism v.9.0. The median and 95% confidence intervals were used to describe data. Logistic regression and χ2 tests were used to describe the associations. We followed the Declaration of Helsinki guidelines. RESULTS: Fifty right and 35 left cataract eyes were operated on (58.8% were females; average age 72.8 ± 8.146 years). Total PCMO incidence was 10.6%, and true PCMO incidence (removing PCMO risk factors) was 4.2% at week 6 post-operatively. CST was slightly increased between pre- and post-cataract surgery at week 4 (p = 0.002) and week 6 (p < 0.0001; median = 259 µm, 264 µm, and 263 µm, respectively). IOP was found to be decreased (p < 0.0001) compared to day 1 (median = 17 mm Hg) and week 6 (median = 13 mm Hg). The probability of developing PCMO (odds ratio [OR] = 3) and vitreomacular traction (OR = 2.9) was higher in diabetic patients compared to non-diabetic patients and in patients >65 years old (OR = 1.5). CONCLUSION: The true incidence of PCMO was found to be the greatest at 2-4 weeks post-operatively. Patients with diabetes or advanced age (>65 years) are at an elevated risk of developing PCMO after cataract surgery. The treatment regimens for the comorbid populations, especially diabetic patients, remain limited, and future efforts should target pharmaceutical management for these groups.

Spectacle Independence in Patients with Prior Radial Keratotomy Following Cataract Surgery: A Case Series.

PURPOSE: To assess if post-keratorefractive patients can achieve spectacle independence following cataract surgery with currently available presbyopia correcting intraocular lenses (IOLs). PATIENTS AND METHODS: Retrospective case series of unilateral implantation of the IC-8 IOL in two patients with history of bilateral myopic radial keratotomy (RK) and one patient with history of bilateral myopic RK and astigmatic keratotomy (AK), and bilateral implantation of AT Lisa 939M multifocal IOLs in one patient with previous history of RK and laser in situ keratomileusis (LASIK). RESULTS: Good uncorrected distance, intermediate and near visual acuity (VA) was achieved for most patients. Stereopsis and contrast sensitivity (CS) were maintained in patients that received the IC-8 IOLs, and two patients achieved full spectacle independence. The patient that received the trifocal lenses expressed satisfaction with their vision, but required long distance correction and experienced reduced CS. CONCLUSION: The IC-8 and AT Lisa 939M IOLs both offer satisfactory results and reduced spectacle dependence in post-keratorefractive patients. However, it is recommended to properly counsel visual outcomes and patient expectations before commencing surgery.

Small aperture IC-8 intraocular lens in cataract patients: achieving extended depth of focus through small aperture optics.

BACKGROUND: To investigate visual outcomes following cataract surgery in patients who were implanted monocularly with an extended range of focus IC-8 IOL. METHODS: A multicentre, non-randomised, retrospective case series of 126 consecutive patients implanted with the IC-8 IOL. Data were collected and pooled from six centres across Australia. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm and uncorrected near visual acuity (UNVA) at 40 cm were measured in eyes implanted with the IC-8 IOL. Adverse events, spectacle independence, visual symptoms and patient satisfaction were assessed at final follow-up. RESULTS: Over 90% of the patients without pre-existing ocular pathology (n = 109) achieved UDVA, UIVA and UNVA of 6/12 or better in the IC-8 eye. Binocularly, in this group, 98% achieved UDVA of 6/9, 94% UIVA of 6/12 and 91% UNVA of 6/12 or better. By final follow-up, over 50% of patients reported complete spectacle independence for distance, intermediate and near visual activity, with the remainder only using spectacles for specific tasks such as near-vision hobbies and reading in dim light. CONCLUSIONS: The IC-8 IOL is capable of providing extended depth of focus following cataract surgery. It allows complete spectacle independence in more than half of the patients implanted with the IC-8 IOL.

Refractive stability following uncomplicated cataract surgery.

BACKGROUND: Quality of life may be negatively impacted following cataract surgery if glasses prescription is delayed. This study aims to confirm the refractive stabilisation time in an Australian population to form the basis for suggesting an appropriate timeframe for spectacle prescription. METHODS: Participants (51 female and 35 male) were recruited one day after uncomplicated unilateral cataract surgery using a monofocal intraocular lens. Subjective refraction, automated refraction and central corneal thickness were measured at two, four and six weeks post-operatively. A short questionnaire assessing the impact of uncorrected near vision on daily activities was collected at two and four weeks. RESULTS: There was no significant change in the mean automated or subjective spherical equivalent refraction (peq < 0.001), mean corneal thickness (peq < 0.001), mean uncorrected distance visual acuity (peq < 0.001) or mean uncorrected near visual acuity (peq < 0.001) over the six-week study period. At week two, 59 per cent of patients stated that their uncorrected near vision affected their ability to perform daily tasks 'somewhat' or 'a lot', increasing to 75 per cent by week four. CONCLUSION: Uncorrected near vision affected quality of life for most participants. All measured visual and ocular parameters were stable from two weeks post-operatively. Patients need not wait longer than this for spectacle prescription following uncomplicated unilateral cataract surgery.

Cataract surgery with a small-aperture intraocular lens after previous corneal refractive surgery: Visual outcomes and spectacle independence.

Patients who have had previous refractive procedures often require cataract surgery at an early age; however, postoperative results are compromised by corneal aberrations and difficulties achieving a desired refractive endpoint. We describe the use of the IC-8 small-aperture intraocular lens (IOL) in 3 patients who had previous laser in situ keratomileusis (LASIK). Standard cataract surgery was performed in all cases. The small-aperture IOL was implanted in the patient's nondominant eye, and a clear aspheric monofocal IOL was implanted in the dominant eye. Visual performance was assessed between 1 month and 6 months after surgery. After surgery, all patients had good simultaneous near, intermediate, and distance visual acuities while maintaining stereoacuity and mesopic contrast sensitivity. This technique provided good visual outcomes in these patients who had cataract surgery after previous corneal refractive surgery.

Visual Outcomes and Higher Order Aberrations Following LASIK on Eyes with Low Myopia and Astigmatism.

BACKGROUND: Laser-Assisted in situ Keratomileusis (LASIK) can induce corneal aberrations that can impact vision and patient satisfaction. Recent developments in laser technologies have helped minimise these aberrations. OBJECTIVE: To assess the quality of vision and change in Higher-Order Aberrations (HOAs) following wavefront-optimized LASIK in low-myopic astigmatic patients. METHODS: LASIK was performed on a total of 76 eyes in patients with myopia <4.0 D and cylinder <2.0 D using the WaveLight® EX500 excimer and FS200 femtosecond laser platform. Visual acuity, contrast sensitivity and HOAs were measured at 1 and 3 months postoperatively and compared to preoperative values. Subjective quality of vision was assessed pre- and postoperatively using a VF14 questionnaire. RESULTS: Mean postoperative Spherical Equivalent (SE) was -0.09 ± 0.26 µm with 95% of patients within ± 0.5 D of attempted SE. Postoperative uncorrected distance visual acuity was 20/20 or better for 96% of patients. Contrast sensitivity increased against horizontal and vertical gratings at all spatial frequencies except for vertical gratings at 18 cycles/degree. Spherical aberration and total HOA increased by 0.085 µm and 0.13 µm respectively. The mean VF14 score increased from 89.2 ± 16.7% to 99 ± 1.4% postoperatively. CONCLUSION: LASIK performed using the WaveLight® EX500 excimer and WaveLight® FS200 laser platform provided improved contrast sensitivity and visual acuity with minimal introduction of HOAs, making it a suitable platform for low myopic astigmatic patients.

Regulation of αA- and αB-crystallins via phosphorylation in cellular homeostasis.

αA-Crystallin (αA) and αB-crystallin (αB) are small heat shock proteins responsible for the maintenance of transparency in the lens. In non-lenticular tissues, αB is involved in both maintenance of the cytoskeleton and suppression of neurodegeneration amongst other roles. Despite their importance in maintaining cellular health, modifications and mutations to αA and αB appear to play a role in disease states such as cataract and myopathies. The list of modifications that have been reported is extensive and include oxidation, disulphide bond formation, C- and N-terminal truncation, acetylation, carboxymethylation, carboxyethylation, carbamylation, deamidation, phosphorylation and methylation. Such modifications, notably phosphorylation, are alleged to cause changes to chaperone activity by inducing substructural changes and altering subunit exchange dynamics. Although the effect modification has on the activities of αA and αB is contentious, it has been proposed that these changes are responsible for the induction of hyperactivity and are thereby indirectly responsible for protein deposition characteristic of many diseases associated with αA and αB. This review compiles all reported sites of αA and αB modifications, and investigates the role phosphorylation, in particular, plays in cellular processes.