Clinical results with a multifocal intraocular lens with a novel optical design.

BACKGROUND: To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. METHODS: In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. RESULTS: Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. CONCLUSION: The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high.

Management of Dry Eye Disease for Intraocular Lens Power Calculation in Cataract Surgery: A Systematic Review.

Cataracts are characterized by the crystalline lens of the eye becoming cloudy, and dry eye disease (DED) is a multifactorial disease in which the homeostasis of the tear film is lost. As the prevalence of both diseases increases with age, there is a high prevalence of DED among patients who are candidates for cataract surgery. In recent years, cataract surgery has evolved from vision restoration surgery to refractive surgery. To achieve good surgical outcomes, it is necessary to minimize postoperative refractive error in intraocular lens (IOL) power calculation, which requires accurate preoperative keratometry measurements. A stable tear film is important for the accuracy and reproducibility of keratometry measurements, and DED may have a deleterious effect. In this study, original articles that focused primarily on findings related to this topic were evaluated. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Although appropriate DED diagnoses were not presented in the articles evaluated in this review, it was confirmed that the clinical signs of DED, particularly the shortening of the tear film break-up time (TBUT), negatively impact IOL power calculations. Improvement in these clinical signs might mitigate the negative effects on these calculations.

In-vitro assessment of a novel intraocular lens made of crosslinked polyisobutylene.

PURPOSE: To describe and analyse the particularities of the material and the optical quality of the first intraocular lens (IOL) (Eyedeal® lens) made of crosslinked polyisobutylene (xPIB). METHODS: We assessed the material quality using an accelerated ageing process (to provoke glistenings) and compared values with a control, AcrySof® lens. Using the sessile drop method, the contact angle of the new IOL was measured. Images of the lens surface were recorded by scanning electron microscopy (SEM). Optical quality was assessed by measuring the labeled power and modulation transfer function (MTF) using standard metrology equipment (OptiSpheric IOL PRO2). RESULTS: The Eyedeal® lens had an average glistening density result of 7.46 ± 3.78 MV/mm2 compared to the control AcrySof® whose glistenings number was 142.42 ± 72.47 MV/mm2. The contact angle was 97.2° whereas the angle of AcrySof material is between 73.3 ± 2.4° and 84.4 ± 0.1°. Using SEM, Eyedeal® lenses were examined and all appeared to be comparable to modern IOLs made of acrylic materials. The power and MTF values were normal and conformed to ISO standards. CONCLUSIONS: In the laboratory, the new Eyedeal® lens showed equivalence to current hydrophobic- or hydrophilic-acrylic lens models. It showed superiority in its glistening density result compared to the control lens.

Image-Guided Marking versus Manual Marking in Phacoemulsification with Toric Intraocular Lens (IOL) Implantation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

PURPOSES: The purpose of this meta-analysis is to systematically compare the alignment accuracy and post uncorrected distance visual acuity (UDVA) between image-guided marking and manual marking for toric intraocular lens (IOL) in cataract surgery. METHODS: This work was done through the data searched from the PubMed, EMBASE and the Cochrane Library. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. RESULTS: A total of 6 randomized controlled trials (RCTs) were included. Compared with manual marking group, image-guided marking group had less toric IOL axis misalignment (MD, -1.98; 95%CI, -3.27 to -0.68; p = .003), less postoperative astigmatism (MD, -0.13; 95%CI, -0.21 to -0.05; p = .001), better postoperative UDVA (MD, -0.02; 95%CI, -0.04 to -0.01; p = .0003) and smaller difference vector (MD, -0.10; 95%CI, -0.14 to -0.06; p(0.00001). For the proportion of patients with residual refractive cylinder within 0.5 D, there was no difference between two groups (p = .07). CONCLUSION: Image-guided marking is prior to manual marking. As it can bring less toric IOL axis misalignment, less postoperative astigmatism, better postoperative UDVA and smaller difference vector for the patients with toric IOL implantation.

Comparison of short-term visual acuity and visual disturbance phenomena and spectacle independence after implantation of three different intraocular lenses / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the short-term postoperative visual acuity, visual disturbance phenomena, and spectacle independence rate in patients who underwent monocular implantation with trifocal, multifocal, or extended range of vision intraocular lens(IOL).METHODS: A retrospective analysis was conducted on 67 cataract patients(67 eyes)who underwent phacoemulsification cataract extraction combined with IOL implantation from March 2019 to December 2022. A total of 35 cases(35 eyes)received Symfony extended range of vision IOL implantation, 21 cases(21 eyes)received AcrySof IQ ReSTOR +3D multifocal IOL, and 11 cases(11 eyes)received AcrySof IQ PanOptix trifocal IOL. The preoperative uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA)and 3 mo postoperatively were documented. Moreover, defocus curves, visual disturbance phenomena, and spectacle independence rates were recorded at 3 mo postoperatively.RESULTS: At 3 mo postoperatively, no statistically significant differences were observed in UDVA among the three groups(P>0.05). A comparison of UIVA showed superior results in the Symfony and PanOptix groups compared to the ReSTOR group(all P<0.01). The UNVA of both the ReSTOR and PanOptix groups outperformed the Symfony group(all P<0.01). The defocus curves indicated that in the intermediate vision range(-1.00 to -1.50 D), the Symfony group exhibited better performance than the ReSTOR group(P<0.05); while in the near vision range(-2.50 to -3.50 D), the ReSTOR group was superior to the Symfony group(P<0.05). The PanOptix group demonstrated superior visual acuity in the near vision range(-2.00 to -3.50 D)compared to the Symfony group(P<0.05)and was also superior in the intermediate vision range(-1.00 to -2.00 D)compared to the ReSTOR group(P<0.05). No significant differences were observed in the incidence of glare or halo and binocular interference phenomena among the three groups(P>0.05). The PanOptix and ReSTOR groups exhibited a higher spectacle independence rate compared to the Symfony group(P<0.0167).CONCLUSION: Compared to Symfony extended range of vision IOL and ReSTOR multifocal IOL, PanOptix trifocal IOL offers a balanced approach to distance, intermediate, and near visual acuity, without a high incidence of glare and halo, and with a higher spectacle independence rate. Caution is still advised when considering monocular implantation with presbyopia-correcting IOLs.

Long-Term Outcome and Complications of IOL-Exchange.

Purpose: To describe the long-term outcome after intraocular lens (IOL) exchange for IOL-opacification with a focus on any occurring complications. Patients and Methods: Patients with an IOL exchange for opacified IOLs (Lentis LS-502-1) were identified. Medical records and information from the treating ophthalmologists were reviewed. Visual outcomes and any occurring complications after the IOL exchange were analyzed. Results: IOL exchange was performed in 48 eyes of 46 patients and significantly improved best-corrected distance visual acuity from 0.42 ± 0.32 logMar (mean ± SD) in opacified lenses to 0.25 ± 0.28 logMar after IOL exchange. Nine of the 48 eyes (19%) underwent 11 further surgical procedures for complications due to four indications: IOL dislocation (n = 2, 4%), retinal detachment (RD) (n = 6, 12%), epiretinal membrane (n = 2, 4%), and pupillary block (n = 1, 2%). Three eyes (6%) developed a temporarily elevated intraocular pressure. Temporary postoperative cystoid macular edema was found in 2 eyes (4%). Conclusion: IOL exchange can restore vision owing to IOL opacification in most cases. Nonetheless, IOL exchange is not an easy or risk-free procedure. This may lead to sight-threatening complications, even in eyes without predisposing ocular comorbidities.

Flexural and Cell Adhesion Characteristic of Phakic Implantable Lenses.

Background and Objectives: In this study, we aimed to compare the physical properties of hole-implantable collamer lenses (H-ICLs) and implantable phakic contact lenses (IPCLs) and investigate their flexural and cell adhesion characteristics. Materials and Methods: Transverse compression load to achieve lens flexion and static Young's modulus were measured in H-ICLs and IPCLs using designated equipment. Load was measured both with and without restraining the optic section of the lenses. Adhesion of iHLEC-NY2 cells to the lens surfaces was examined using phase-contrast microscopy, and cell proliferation activity was evaluated using WST-8 assay. Results: The H-ICL showed a greater tendency for transverse compression load compared to IPCL, while the IPCL showed a higher Young's modulus with respect to the force exerted on the center of the anterior surface of the optic section. The joint between the optic section and haptic support in the IPCL was found to mitigate the effects of transverse compression load. Both lens types showed minimal cell adhesion. Conclusions: Our findings indicate that H-ICLs and IPCLs exhibit distinct physical properties and adhesive characteristics. The IPCL demonstrated higher Young's modulus and unique structural features, while the H-ICL required greater transverse compression load to achieve the flexion required to tuck the haptic supports into place behind the iris to fix the lens. The observed cell non-adhesive properties for both lens types are promising in terms of reducing complications related to cell adhesion. However, further investigation and long-term observation of IPCL are warranted to assess its stability and potential impact on the iris. These findings contribute to a better understanding of the performance and potential applications of H-ICLs and IPCLs in ophthalmology.

A Modified Formula for Intraocular Lens Power Calculation Based on Aphakic Refraction in a Pediatric Population.

Purpose: To investigate and optimize the accuracy of aphakic refraction (AR) techniques for secondary intraocular lens (IOL) power calculation in aphakic children. Methods: Thirty-three aphakic eyes of 18 patients who were candidates for secondary IOL implantation were enrolled in the present study. Axial length (AL) measured by optical biometry was used in the biometric formula (SRK-T, Holladay II, and Hoffer-Q). AR and spherical equivalent (SE) were used in two AR-based formulas (Ianchulev, Leccissotti). True power was calculated based on postoperative SE at three months' follow-up. Results: Regarding the postoperative SE, 13 (40%) eyes were within ± 1.00 diopters (D) and 22 (66%) were within ± 2.00 D. Median absolute error (MedAE) was predicted to be 4.4 and 7.3 D with the use of Ianchulev and Leccissotti formulas, respectively. The corresponding value was 0.8 D with the biometric formula. All eyes were deemed to have myopic refraction when using the AR-based formulas except one eye with the Ianchulev formula. The coefficient of our modified formula was 1.7 instead of 2.01 in the Ianchulev formula. MedAE with the use of new formulae was 0.5 D and was comparable with the true IOL power (P = 0.22). Conclusion: Both Ianchulev and Leccissotti formulas resulted in a significant myopic surprise in aphakic children aged between 4.5 and 14 years. The modified formula proved to determine a more accurate SE that is comparable with biometric formulas.

Comparison of the accuracy of nine intraocular lens power calculation formulas using partial coherence interferometry.

Cataract surgery is the most performed procedure in the world. To achieve the target refraction, several intraocular lens (IOL) power calculation formulas have been developed to improve the accuracy of IOL power predictions. We compared the accuracy of 9 IOL power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, Barrett Universal II, Kane, EVO 2.0, Ladas Super formula and Hill-RBF 3.0) using partial coherence interferometry (PCI). We collected data from patients who underwent uncomplicated cataract surgery with implantation of 1 of 3 IOL types currently used in our center. All preoperative biometric measurements were performed using PCI. Prediction errors (PE) were deduced from refractive outcomes evaluated 3 months after surgery. The mean prediction error (ME), mean absolute prediction error (MAE), median absolute prediction error (MedAE), and standard deviation of prediction error (SD) were calculated, as well as the percentage of eyes with a PE within ± 0.25, ± 0.50, ± 0.75 and ± 1.00D for each formula. We included 126 eyes of 126 patients. Kane achieved the lowest MAE and SD across the entire sample as well as the highest percentage of PE within ± 0.50D and was shown to be more accurate than Haigis and Hoffer Q (P<001). For an axial length of more than 26.0mm, EVO 2.0 and Barrett obtained the lowest MAEs, with EVO 2.0 and Kane showing a higher percentage of prediction at ±0.50D compared to old generation formulas except for SRK/T (P=04). All investigated formulas achieved good results; there was a tendency toward better outcomes with new generation formulas, especially in atypical eyes.

Predicting Residual Astigmatism in Cataract Surgery.

The purpose of this review is to evaluate the prediction of postoperative residual astigmatism and to determine the best prediction method for astigmatism correction. In recent findings for residual astigmatism in non-toric monofocal intraocular lens (IOL) implanted eyes, vector analysis can be used to correctly evaluate residual astigmatism by decomposing it. In predicting residual astigmatism, the with-the-rule (WTR) and against-the-rule (ATR) astigmatism components can now be almost predicted. This may be due to advances in inspection equipment and surgical technique. However, there are still issues with the oblique astigmatism component. In addition, corneal astigmatism is the most important predictor of postoperative residual astigmatism, and other predictors, such as refractive astigmatism, age, and lens thickness, have also been mentioned. However, all but corneal astigmatism are questionable because of the possibility of confounding variables. Total corneal astigmatism is more accurate in predicting residual astigmatism than anterior corneal astigmatism. Several predictions of residual astigmatism have been reported, but complete prediction has not been possible. Further research is needed, especially in predicting oblique astigmatism. However, I emphasize that the accuracy of predicting WTR and ATR astigmatism has improved considerably and can be predicted using regression equations with total corneal astigmatism.

Spectral domain oct for screening of macular diseases prior to multifocal intraocular lens implantation.

BACKGROUND: Cataract surgery with multifocal IOLs could give patients good vision and great satisfaction, at the same time generating high expectations; therefore, its precise indication is essential if we are to reach our goal. The use of optical coherence tomography may be a valuable tool in the screening of macular diseases, which often cannot be detected in routine clinical examinations. This study evaluates the benefit of including spectral domain optical coherence tomography (SD-OCT) in routine preoperative cataract surgery protocols for better case selection in multifocal IOLs. METHODS: Observational and retrospective clinical study that includes patients with an indication for multifocal IOL implantation who underwent retinal fundus exam and SD-OCT examination between 2018 and 2019. The clinical examination with ophthalmoscopy and SD-OCT imaging results were evaluated to observe their influence on the final choice of the lens implanted lens in cataract surgery. RESULTS: 405 eyes from 207 patients with multifocal IOL indication were included. It was found that 220 (54.2%) of all indicated multifocal or trifocal IOLs were in fact implanted. The most important reason for not implanting the indicated IOL was financial, in 116 (59.46%) eyes. The second cause were retinal abnormalities detected by SD-OCT, 63 eyes (15.6%). Those abnormalities included dry age-related macular degeneration (AMD) (50.7%), neovascular AMD (3.1%), vitreomacular adhesion (11.1%), diabetic macular edema (3.1%), epiretinal membrane (ERM) (25.3%) and other macular abnormalities (6.3%). Of the 63 eyes with an abnormal SD-OCT result, 44 (69.8%) were also identified by fundus examination. Nineteen (30.2%) eyes had abnormalities detected only by SD-OCT imaging with a normal clinical exam. CONCLUSIONS: Routine use of SD-OCT imaging may help diagnose pre-existing macular pathologies not identified by clinical exam, helping both physicians and patients choose the ideal IOL individually and has the potential to prevent unsatisfactory functional results.

[Refractive outcomes of out-of-the-bag intraocular lens implantation]. / Refraktsionnye rezul'taty vnekapsul'noi implantatsii intraokulyarnykh linz.

For the moment, the refractive outcomes of out-of-the-bag intraocular lens (IOL) implantation remain insufficiently studied. PURPOSE: To study and compare the refractive outcomes of retropupillary implantation of an iris-claw lens and transscleral suture fixation of IOL in complicated phacoemulsification. MATERIAL AND METHODS: The study included 70 patients (73 eyes) after complicated phacoemulsification in combination with grade 2 lens subluxation. The first group included 36 patients (39 eyes) who underwent complicated phacoemulsification using torsional ultrasound and retropupillary implantation of an iris-claw lens. The second group included 34 patients (34 eyes) after complicated phacoemulsification using torsional ultrasound and transscleral suture fixation of an elastic hydrophobic IOL. In the postoperative period we performed a comparative evaluation of uncorrected visual acuity and best corrected visual acuity, the average absolute error of IOL optical power calculation, the precision of postoperative refraction within ±0.5 diopters, the degree of induced astigmatism, and the tilt of the IOL. RESULTS: At three months after surgery uncorrected visual acuity of 0.8-1.0 was achieved in 33.3% of cases in the first group and 17.6% in the second group, the average absolute error of IOL optical power calculation was 0.34±0.08 diopters in the first group and 0.63±0.19 diopters in the second group, the precision of postoperative refraction within ±0.5 diopters was 94.9% in the first group and 85.3% in the second group, the tilt of the IOL was 0.69±0.21° in the first group and 3.19±0.97° in the second group (p<0.05). There were no significant differences in best corrected visual acuity and the degree of induced astigmatism 3 months after surgery. CONCLUSION: Implantation of an iris-claw lens in the course of complicated phacoemulsification in lens subluxation significantly improves refractive outcomes of the implantation in comparison with transscleral IOL fixation.

Traumatic superio-nasal subconjunctival dislocation of posterior chamber intraocular lens. A case report.

INTRODUCTION AND IMPORTANCE: Intraocular lens (IOL) implantation after cataract surgery is routine procedure. Traumatic dislocation of the posterior chamber IOL into the subconjunctival space following blunt ocular trauma is rare and it is considered an ophthalmic emergency. CASE PRESENTATION: We present a case of a 71-year-old male that presented to our institution with traumatic dislocation of a posterior chamber IOL into the superior-nasal subconjunctival space following blunt trauma to his left eye after an accidental fall on his head. DISCUSSION: Trauma in a pseduphakic eye can be devastating. Early recognition and treatment of IOL dislocation are of paramount importance to prevent further damage and infections. Half ring sign (Psudophacocele) recognition help in identifying and localizing the dislocated IOL in subconjunctival space. CONCLUSION: Traumatic dislocation of posterior chamber IOLs have been rarely reported in the literature. Nevertheless, it could happen years after implantation.

Toric intraocular lenses: Evidence-based use.

Uncorrected refractive astigmatism degrades visual acuity. Spherical intraocular lenses (IOLs) leave astigmatic errors resident in the cornea manifest in refractive astigmatism. Toric IOLs, correcting for this corneal astigmatism, contribute to spectacle-free vision in the pseudophakic eye. This review provides information to assist surgeons in a rational choice of eyes suitable for toric IOL implantation, methods of IOL cylinder power calculation, surgical techniques for toric IOLs and management of complications. With appropriate application of this information, correction of visually detrimental astigmatism can be achieved routinely.

A systematic review and meta-analysis on intraocular lens implantation with different performances for the treatment of cataract.

BACKGROUND: Cataract is one of the common eye diseases. At present, Phacoemulsification combined with traditional intraocular lens (IOL) implantation can achieve satisfactory rejuvenation effects. However, the correction of corneal astigmatism is limited, while Toric IOL implantation can provide good astigmatism correction treatment. METHODS: We retrieved randomized controlled trials (RCTs) on the treatment of cataracts published in the PubMed, EBSCO, MEDLINE, EMBASE, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases. Professional journals were searched manually to avoid omissions. The research subject search terms included cataract, astigmatism, IOL, and intraocular lens. The observation indicators search terms included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), residual corneal astigmatism, and cataract cure rate. RESULTS: A total of 12 articles were included. The articles were tested for heterogeneity of UDVA measured using the Logarithm of Mininal Angle Resolution (LogMAR) visual acuity chart, and the results showed that Chi-squared test (Chi2) =75.21, degree of freedom (df) =11, and I2=85%>50%, so the random effects model (REM) was adopted for analysis. The results indicated that the differences between the Toric and Non-Toric IOL groups statistically significant, and the Toric IOL group had a significant therapeutic effect [Z =2.18, mean difference (MD) =-0.05, 95% confidential interval (CI): -0.09, -0.00, P=0.03]. The fixed effects model (FEM) was adopted to analyze the determination of BDVA by LogMAR visual acuity chart in 6 articles. The results suggested that the difference between the Toric IOL and non-Toric IOL groups was not statistically significant (Z =0.29, MD =-0.00, 95% CI: -0.02, 0.01, P=0.77). Heterogeneity analysis was performed on three articles in terms of residual corneal astigmatism, which showed that Chi2=75.55, df =3, I2=96%>50%, and P<0.00001. The REM analysis results revealed that the difference between the two groups was not statistically significant, and the Toric IOL group had low residual corneal astigmatism (Z =1.35, MD =-0.34, 95% CI: -0.83, 0.15, P=0.18). DISCUSSION: The meta-analysis results confirmed that Toric IOL implantation showed obvious advantages in improving UDVA and corneal residual astigmatism in cataract patients.

Subjective visual quality, reading fluency and patient satisfaction with the extended depth of focus IOL / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the subjective visual quality, reading fluency and patient satisfaction after a unilateral or bilateral implantation of the Tecnis Symfony extended depth of focus intraocular lens(IOL)with cataract.<p>METHODS: The retrospective analysis on the 48 patients(71 eyes)with cataract phacomulsification surgery in our hospital, which were randomly divided into two groups. The bilateral group with 23 patients(46 eyes)bilateral implanted the Symfony extended depth of focus IOL, the unilateral group with 25 patients(25 eyes)implanted the Symfony IOL in one eye and an aspherical monofocal IOL in the other eye. The uncorrected distance visual acuity(UDVA), uncorrected intermediate distance visual acuity(UIVA), uncorrected near distance visual acuity(UNVA), and best corrected distance visual acuity(BCVA)were measured 3, 6mo after surgery. The contrast sensitivity, reading fluency, reading speed, patient satisfaction and the occurrence of complications were also observed.<p>RESULTS: In the unilateral group, there were no significant differences in the UDVA and BCVA between an eye with the Symfony IOL and an eye with monofocal IOL 3mo after surgery(P>0.05). After 6mo of surgery, UDVA were significantly better than pre-operation in two groups, average visual acuity of LogMAR was under 0.1. There were no significant differences in UDVA, BCVA, UIVA and UNVA between two groups(P>0.05). The patients'far, intermediate, and near distances satisfaction were higher after 3mo of surgery. There were no statistically significant differences in spatial frequency contrast sensitivity between the two groups under photopic/mesopic conditions and mesopic with glare 6mo after surgery. The scores of satisfactions for reading fluency were better in the bilateral group than in the unilateral group(P>0.05). After 6mo, the reading speed of binocular group was slightly higher than the unilateral group(P<0.05), but there was no significant difference between two groups(P >0.05).<p>CONCLUSION:The Symfony extended depth of focus IOL provides good far, intermediate, and near visual acuity in the bilateral group and the unilateral group, while maintaining the same level of visual quality. In both groups over 90% patients were spectacle independent. Symfony IOL has widely adaptability and highly predictability, patients can obtain better satisfactions for reading fluency and reading speed. It is more suitable for intermediate vision.

Comparison of Toric IOL alignment marking using Verion image guided system and conventional manual marker / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the accuracy of Toric intraocular lens(IOL)alignment using the Verion image guided system and conventional manual marker. <p>METHODS:Prospective randomized controlled study. A total of 56 eyes of 47 age-related cataract patients who underwent phacoemulsification combined with Toric IOL implantation in our hospital from June 2016 to December 2019 were randomly divided into two groups:In the image-guided group, Verion navigation system collected anterior segmental images before surgery, and Toric target was set to 27 eyes in axial direction. In the marker group, Toric target was marked at 0° and 180° levels before surgery, and Toric target was marked in 29 eyes in axial direction according to the labeling ring. At 1h, 1wk, 1 and 3mo postoperatively, the anterior segment of patients with dilated pupil was photographed. Photoshop software was used to analyze the deviation between the actual axial direction and the target axial direction of the two groups, and the patients' naked eye visual acuity(UCDVA), best corrected visual acuity(BCDVA)and residual astigmatism were recorded. <p>RESULTS: At 1h and 3mo postoperatively, the deviation between the actual axis and the target axis of IOL in the navigation group was less than that in the marker group(1.5°±1.8° <i>vs</i> 3.1°±2.1°; 1.9°±1.6° <i>vs</i> 3.3°±2.4°, all <i>P</i><0.05). There was no difference in UCDVA(LogMAR)between the navigation group and the marker group(0.04±0.08 <i>vs</i> 0.06±0.07, <i>P</i>=0.338)and there was no difference in residual divergence(-0.39±0.32 <i>vs</i> -0.45±0.31D, <i>P</i>=0.491)between two groups at 3mo after operation.<p>CONCLUSION:Verion digital marking and manual marking showed high accuracy in marking Toric IOL axial direction. Although the navigation group showed no advantage in UCDVA and residual astigmatism, the IOL misalignment in navigation group was significantly smaller than the marker group, and Toric IOL axial direction was implanted more accurately under Verion digital marking.

Effects of different viscoelastic agents on corneal endothelium of patients after phacoemulsification and foldable IOL implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effects of dual viscoelastic agents DisCoVisc and sodium hyaluronate on corneal endothelium of patients after phacoemulsification and foldable intraocular lens(IOL)implantation.METHODS: A total of 247 patients(285 eyes)with cataract treated in Jingmen Aier Eye Hospital between June 2017 and December 2019 were selected, and they were divided into DisCoVisc group(123 cases, 141 eyes)and sodium hyaluronate group(124 cases, 144 eyes)by random number table method. Both groups were treated with phacoemulsification and foldable IOL implantation. DisCoVisc and 1.7% sodium hyaluronate were used as viscoelastic agents in DisCoVisc group and sodium hyaluronate group, respectively. The two groups were compared in terms of intraoperative ultrasound time(UST), cumulative dissipated energy(CDE), time for aspiration of viscoelastic agents after IOL implantation, corneal edema at 1d, 1wk, 1 and 3mo after operation, corneal endothelial cell density(ECD)and ECD loss rates before operation and at 3mo after operation, coefficient variation of corneal endothelial cell size(CV), percentage of corneal hexagonal endothelial cells(6A), intraocular pressure, the proportions of patients with uncorrected visual acuity ≥0.5 and central corneal thickness(CCT)values before and after operation at 1d, 1wk and 1mo.RESULTS:There was no statistically significant difference between the two groups in UST, CDE, aspiration time of viscoelastic agents(P &#x003E;0.05)or corneal edema both rate on day 1 after operation(P&#x003E;0.05). Corneal edema disappeared at 1 wk after operation. The ECD loss rate in DisCoVisc group was significantly lower than that in sodium hyaluronate group at 3mo after operation(P&#x003C;0.05). Intraocular pressure, the proportion of patients with uncorrected visual acuity ≥0.5 and CCT values showed no statistically significant differences between the two groups before and after operation at 1d, 1wk and 1mo(P &#x003E;0.05).CONCLUSION: DisCoVisc, as the viscoelastic agent in phacoemulsification and foldable IOL implantation for patients with Emery-Little grade Ⅱ-Ⅲ lens nucleus hardness, can better protect the patients' corneal endothelium.

Clinical application of OPD-Scan Ⅲ aberration analyzer in evaluating the implantation of trifocal intraocular lens in patients with high myopia complicated with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the visual quality of patients with high myopia complicated with cataract after implantation of trifocal intraocular lens by OPD-Scan Ⅲ aberration analyzer.METHODS: Totally 32 patients(38 eyes)with high myopia complicated with cataract who underwent femtosecond laser assisted cataract phacoemulsification combined with trifocal intraocular lens implantation in Foshan Aier Eye Hospital from June 2018 to December 2020 were selected. Uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were compared before, and 1wk, 3mo after surgery; OPD-Scan Ⅲ aberration analyzer measured objective visual quality before, and 1wk and 3mo after surgery. RESULTS: There were significant differences in UCDVA, UCIVA and UCNVA before, and 1wk, 3mo after operation(<i>P</i><0.05). The average orientation and centration distance was 0.12(0.08-0.15)mm and the average axial was(212.68±90.45)°in 3mo postoperative. There were significant differences in spherical aberration(<i>P</i><0.05), Strehl ratio(SR)and area ratio(AR)before, and 1wk, 3mo after operation(<i>P</i><0.001). In comparison, SR at 1wk and 3mo postoperative was higher than that before operation, whereas AR in 1wk and 3mo postoperative were both higher than that before operation(all <i>P</i><0.001). There was a negative correlation between SR and spherical aberration at 3mo postoperative(<i>rs</i>=-0.420, <i>P</i><0.01); There was a negative correlation between SR and trefoil at 3mo postoperative(<i>rs</i>= -0.418, <i>P</i><0.01); There was a negative correlation between AR and trefoil at 3mo postoperative(<i>rs</i>=-0.400, <i>P</i><0.05).CONCLUSION: Femtosecond laser assisted cataract surgery combined with trifocal intraocular lens implantation can provide a comfortable and natural full-range vision. The orientation and centricity of trifocal intraocular lens using OPD-Scan Ⅲ has shown that there was a good reliability and consistency. The vision quality using OPD-Scan Ⅲ is satisfactory.

Clinical observation of 25G vitrectomy and phacoemulsification combined with intrascleral fixated IOL implantation for treatment of complete lens luxation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate efficacy, safety and complications of 25G vitrectomy, phacoemulsification combined with intrascleral fixated intraocular lens(IOL)implantation for treatment of lens luxation.<p>METHODS: Totally 20 patients(20 eyes)with complete lens luxation and the hardness of lens nucleus was grade 3 or above who underwent 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation between May 2018 and December 2020 were analyzed retrospectively. The uncorrected visual acuity, best corrected visual acuity, intraocular pressure, the count of corneal endothelium cell, central corneal thickness and complications were observed. <p>RESULTS: The uncorrected visual acuity and best corrected visual acuity after operation were improved than those before treatment(<i>P</i><0.05). The number of corneal endothelial cells in the central part of cornea after operation was lower than that before operation(<i>P</i> >0.05). There was no significant difference in central corneal thickness 2wk after operation compared with that before operation(<i>P</i> >0.05). There were 3 cases of low intraocular pressure and 2 cases of high intraocular pressure, but they all returned to normal at the end of follow-up. The IOL were all centered and there were no obvious eccentricity and inclination. No other complications such as vitreous hemorrhage and retinal detachment occurred.<p>CONCLUSION: 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation is a fast, safe and simple method for the treatment of complete lens luxation.