[Paying attention to safety of posterior chamber phakic intraocular lens implantation].

Posterior chamber phakic intraocular lens implantation is a type of intraocular surgery. With advancements in implant materials and design, this procedure has seen rapid adoption and widespread use in ophthalmology clinics in recent years. However, the changes in surgical techniques and the occurrence of postoperative complications have raised safety concerns that require significant attention in clinical practice. This paper aims to address the key factors influencing the safety of posterior chamber phakic intraocular lens implantation, exploring relevant characteristics, mechanisms, and current challenges. By emphasizing the importance of this surgery and proposing effective measures, it aims to provide guidance for clinical practice, enhance the safety of posterior chamber phakic intraocular lens implantation, and foster the healthy advancement of this surgical technique.

[Cautious application of multifocal intraocular lenses in children with congenital cataracts].

Multifocal intraocular lenses (MIOLs) have demonstrated efficacy and safety in adult cataract surgery, yet they encounter many challenges in pediatric applications. This article elaborates on the difficulties in biometric measurements in children, the unpredictability of postoperative refraction outcomes, the lack of long-term spectacle independence in children with MIOLs, the absence of significant advantages in correcting childhood amblyopia, and the potential increase in the rate of secondary surgeries. Due to the insufficient clinical evidence supporting the use of MIOLs in children at present, it is proposed that MIOLs be cautiously applied to children with congenital cataracts in clinical practice. Further research in this area is encouraged.

[Efficacy of sutureless intrascleral intraocular lens fixation with the modified Yamane technique].

Objective: To evaluate the efficacy of sutureless intrascleral intraocular lens (IOL) fixation with the modified Yamane technique. Methods: It was a retrospective case series study. Patients undergoing sutureless intrascleral IOL fixation with the modified Yamane technique were included at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from January 2022 to September 2023. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), recorded as the logarithm of the minimum angle of resolution (logMAR), were measured before surgery and at 1 day, 3 days, 1 week, 1 month, and 3 months postoperatively. Refractive error and intraocular pressure were also checked. Anterior segment examination with a slit lamp microscope, fundus examination, anterior segment and posterior segment optical coherence tomography were performed. Intraoperative and postoperative ocular complications were documented. Results: A total of 53 patients (53 eyes) were included in this study, comprising 40 males and 13 females, with a median age of 60 (49, 68) years. Among them, the proportion of a history of trauma was 22.6% (12/53). There was 1 eye with intraoperative vitreous hemorrhage (1.9%). All eyes had no obvious hypotony, no obvious inflammation in the anterior chamber, and no pupillary abnormalities at 1 week after surgery. The mean follow-up time was (8.0±3.3) months (range, 3 to 16 months). There was no iris capture, re-dislocation, or haptic exposure of the IOL during the follow-up. The corneal endothelial cell density was (2 236±704) cells/mm2 preoperatively and (1 964±628) cells/mm2 at 1 month, with significant difference (P<0.001). The UCVA (logMAR) was 1.53±0.75 preoperatively, 0.18±0.17 at 1 month, 0.15±0.14 at 3 months, and 0.14±0.13 at the final visit (P<0.001). The UCVA (logMAR) at 1 month was significantly different from that at 3 months and the final visit (both P<0.05). At 1 month, 50.9% (27/53) of the eyes had an UCVA (logMAR)≤0.1, and the rate was 56.6% (30/53) at 3 months. The BCVA (logMAR) was 0.25±0.21, 0.03±0.06, 0.02±0.06, and 0.02±0.06 before surgery, at postoperative1 month, 3 months, and the final visit, respectively (P<0.001). The BCVA (logMAR) at 1 month was not significantly different from that at 3 months and the final visit (both P>0.05). The rate of the eyes with a BCVA (logMAR)≤0 was 81.1% (43/53) at 1 month and 83.0% (44/53) at 3 months. The IOL tilt was (5.18±2.60)° at postoperative 1 month and (5.08±2.48)° at postoperative 3 months, without statistically significant difference (P>0.05). The IOL decentration was (0.35±0.24) mm at postoperative 1 month and (0.32±0.24) mm at postoperative 3 months, without statistically significant difference (P>0.05). Conclusion: Sutureless intrascleral IOL fixation with the modified Yamane technique is simpler and more minimally invasive to achieve a stable and centered IOL implantation with fewer complications and good visual prognosis.

[Effect of femtosecond laser-assisted phacoemulsification on corneal endothelium and prognosis of diabetic patients with cataract with different nuclear hardness].

Objective: To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts, considering varying nuclear hardness. Methods: This non-randomized controlled trial involved 161 patients (161 eyes) with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022. The cohort comprised 73 males and 88 females, with an average age of (65.9±5.23) years. Based on patient preference, 101 individuals underwent conventional phacoemulsification (group A), while 60 chose femtosecond laser-assisted phacoemulsification (group B). Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1 (grade Ⅰ and Ⅱ), A2/B2 (grade Ⅲ), and A3/B3 (grade Ⅳ) subgroups. The study compared effective phacoemulsification time (EPT), cumulative energy release of phacoemulsification (CDE), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagon cell ratio (HEX) before and after surgery at 1 day, 1 week, 1 month, and 3 months. Results: The intraoperative EPT of patients in groups A and B were (6.52±4.93) and (5.63±4.31)s, respectively, and the CDE were 11.57%±5.21% and 10.68%±6.02%, respectively. The differences between them were not statistically significant (all P>0.05).There were no significant differences in EPT and CDE between groups A1 and B1 (all P>0.05), and there were statistically significant differences between groups A2 and B2, A3 and B3 (all P<0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery (all P>0.05), and there were statistically significant differences in CCT between A2 and B2, A3 and B3 groups at 1 day and 1 week after surgery (all P<0.05), and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery (P>0.05).ECD was reduced in both groups.There was no statistically significant difference in ECD at different time of operation between A1 and B1 groups (all P>0.05), while there was statistically significant difference in ECD at 1 day, 1 week, 1 month and 3 months after operation in A2 and B2, A3 and B3 groups (all P<0.05). Group B was significantly better than group A. There was no significant difference in coefficient of variation and HEX between the two groups at different time after surgery (P>0.05). Conclusion: Femtosecond laser-assisted phacoemulsification demonstrates benefits in preserving corneal endothelial cells, reducing early postoperative corneal edema, and minimizing corneal injury in type 2 diabetes patients with cataracts of high nuclear hardness.

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

PURPOSE: To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. METHODS: This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. RESULTS: We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5 months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2 years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. CONCLUSION: Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

Application of modified Yamane technique in intrascleral intraocular lens fixation combined with or without iris reconstruction.

AIMS: To explore the application and long-term clinical effects of modified Yamane technique in intrascleral intraocular lens (IOL) fixation combined with or without iris reconstruction. SETTINGS AND DESIGN: The data of patients receiving IOL fixation with modified Yamane technique in an ophthalmology department between December 2021 and August 2023 were analyzed retrospectively. The longest follow-up duration was > 12 months. METHODS AND MATERIAL: The trailing haptic was fixed with the needle before the leading haptic. The silicone haptic stoppers were used to stabilize the IOL when iris reconstruction was combined. Preoperative and postoperative best-corrected visual acuity (BCVA), corneal endothelial cells (CECs), postoperative intraocular pressure (IOP), surgical indications and methods, and postoperative complications were recorded. Anterior segment optical coherence tomography (OCT) was used to evaluate IOL decentration and tilt. The paired sample t-test or Wilcoxon rank sum test were used to compare the results of the same index before and after the operation. RESULTS: Twelve patients (12 eyes) were included in this cohort. There were 1 case of IOL dislocation, eight cases of lens dislocation or subluxation, and three cases of aphakia. Traumatic lens dislocation was the main cause of aphakia. Primary lens extraction was performed in previous surgeries, and all three were combined with pars plana vitrectomy (PPV). Four of 12 patients underwent IOL fixation and iris reconstruction. The mean age of participants was 63 ± 10.61 years. The mean BCVA increased from 0.89 ± 0.72 logMAR to 0.39 ± 0.56 logMAR at the last visit (p < 0.05). The postoperative relative refractive error was - 0.13 ± 0.42 D (-0.60 D to + 0.57 D). The OCT showed that the IOLs were well centered, with a mean decentration of 0.20 ± 0.13 mm and a mean tilt of 2.31°±0.93°. Ten patients did not experience any complications. CONCLUSIONS: The modified Yamane technique in IOL fixation surgery, especially combined with iris reconstruction, reduces operation difficulty, increases operational stability and safety, and improves postoperative visual acuity without serious intra- or postoperative complications. The long-term improvement effect was remarkable.

A New Method to Minimize the Standard Deviation and Root Mean Square of the Prediction Error of Single-Optimized IOL Power Formulas.

Purpose: The purpose of this study was to develop a simplified method to approximate constants minimizing the standard deviation (SD) and the root mean square (RMS) of the prediction error in single-optimized intraocular lens (IOL) power calculation formulas. Methods: The study introduces analytical formulas to determine the optimal constant value for minimizing SD and RMS in single-optimized IOL power calculation formulas. These formulas were tested against various datasets containing biometric measurements from cataractous populations and included 10,330 eyes and 4 different IOL models. The study evaluated the effectiveness of the proposed method by comparing the outcomes with those obtained using traditional reference methods. Results: In optimizing IOL constants, minor differences between reference and estimated A-constants were found, with the maximum deviation at -0.086 (SD, SRK/T, and Vivinex) and -0.003 (RMS, PEARL DGS, and Vivinex). The largest discrepancy for third-generation formulas was -0.027 mm (SD, Haigis, and Vivinex) and 0.002 mm (RMS, Hoffer Q, and PCB00/SN60WF). Maximum RMS differences were -0.021 and +0.021, both involving Hoffer Q. Post-minimization, the largest mean prediction error was 0.726 diopters (D; SD) and 0.043 D (RMS), with the highest SD and RMS after adjustments at 0.529 D and 0.875 D, respectively, indicating effective minimization strategies. Conclusions: The study simplifies the process of minimizing SD and RMS in single-optimized IOL power predictions, offering a valuable tool for clinicians. However, it also underscores the complexity of achieving balanced optimization and suggests the need for further research in this area. Translational Relevance: The study presents a novel, clinically practical approach for optimizing IOL power calculations.

Efficacy of the efficacy between dexamethasone versus triamcinolone acetonide after cataract surgery: A systematic review and meta-analysis.

PURPOSE: To evaluate the clinical effects between dexamethasone and triamcinolone acetonide (TA) after phacoemulsification and intraocular lens implantation among cataract patients. METHODS: Pubmed, Embase, and the Cochrane Library were searched for studies published up to August 2020. The primary outcome was intraocular pressure. The secondary outcomes were the logarithm of the minimum angle of resolution (logMAR), anterior chamber cell, and anterior chamber flare. The pooled effect sizes were expressed as weighted mean differences (WMDs) or standardized mean differences (SMDs) of 95% confidence intervals (95% CIs). Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale criteria were used for the quality assessment of included studies. RESULTS: Seven relevant studies met the inclusion criteria. For the primary outcome, there was no significant difference between TA injection and dexamethasone in comparing intraocular pressure (IOP) (SMD = 0.22, 95% confidence interval [CI] [-0.29, 0.73], P = .408; I²â€…= 86.9%) in the first day after treatment and last day of assessment. For the secondary outcomes, the logMAR (WMD = 0.01, 95% CI [-0.06, 0.08]) and the anterior chamber flare (SMD = 0.08, 95% CI [-0.01, 0.18], P = .087; I²â€…= 0%) showed no differences. However, the amount of anterior chamber cells (SMD = -0.21, 95% CI [-0.42, -0.01], P = .044; I²â€…= 0%) in the TA injection on the first day postoperative was higher than for dexamethasone. After treatment, there was no difference between the 2 groups. CONCLUSIONS: This study supports that there were no differences in IOP, logMAR, and anterior chamber flare between TA injection and dexamethasone among cataract patients. TA injection treatment on the first day showed higher amounts of anterior chamber cells than with dexamethasone.

Accuracy of 12 Intraocular Lens Power Formulas After Corneal Myopic Refractive Surgery.

PURPOSE: To assess the predictive accuracy of new-generation online intraocular lens (IOL) power formulas in eyes with previous myopic laser refractive surgery (LRS) and to evaluate the influence of corneal asphericity on the predictive accuracy. METHODS: The authors retrospectively evaluated 52 patients (78 eyes) with a history of laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) who subsequently underwent cataract surgery. Refractive prediction errors were calculated for 12 no-history new online formulas: 8 formulas with post-LRS versions (Barrett True-K, EVO 2.0, Hoffer QST, and Pearl DGS) using keratometry and posterior/total keratometry measured by IOLMaster 700 and 4 formulas without post-LRS versions (Cooke K6 and Kane) using keratometry and total keratometry. The refractive prediction error, mean absolute error (MAE), and percentages of eyes with prediction errors of ±0.25, ±0.50, ±0.75, ±1.00, and ±1.50 diopters (D) were compared. RESULTS: The MAEs of the 12 formulas were significantly different (F = 83.66, P < .001). The MAEs ranged from 0.62 to 0.94 D and from 1.07 to 1.84 D in the formulas with and without post-LRS versions, respectively. The EVO formula produced the lowest MAE (0.60) and MedAE (0.47), followed by the Barrett True-K (0.69 and 0.50, respectively). Each percentage of eyes with refractive prediction error was also significantly different among the 12 formulas (P < .001). CONCLUSIONS: The EVO and Barrett True-K formulas demonstrate comparable performance to the other existing formulas in eyes with a history of myopic LASIK/PRK. Surgeons should use these formulas with post-LRS versions and input keratometric values whenever possible. [J Refract Surg. 2024;40(6):e354-e361.].

Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation.

PURPOSE: To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS: PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS: Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS: Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].

Visual and Refractive Outcomes After Bi-aspheric Trifocal Toric Diffractive Intraocular Lens Implantation.

PURPOSE: To assess clinical outcomes after cataract surgery with bilateral implantation of a new bi-aspheric diffractive intraocular lens (IOL). METHODS: Thirty patients underwent bilateral implantation of the Asqelio Trifocal Toric IOL (AST Products, Inc) and were evaluated 3 months postoperatively. Main outcomes included refractive error, photopic monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CDIVA) at 60 cm, and near (UNVA, CDNVA) at 40 cm visual acuities. Mesopic monocular and binocular CDNVA were also measured. Defocus curves, binocular contrast sensitivity under photopic and mesopic conditions with and without glare and rotational stability were determined. Patients completed Catquest-9SF and visual symptoms questionnaires. RESULTS: Average values of binocular photopic CDVA, CDIVA, and CDNVA, and mesopic CDNVA were -0.04 ± 0.06, 0.02 ± 0.08, 0.02 ± 0.07, and 0.22 ± 0.11 logMAR, respectively. All patients achieved cumulative CDVA ⩾ 20/25, and CDIVA and CDNVA of 20/32 or better. Binocular depth of focus was approximately 3.25 diopters (D). Mean postoperative spherical equivalent was -0.08 ± 0.26 D, with 95% of eyes within ±0.50 D. Mean postoperative refractive cylinder was -0.22 ± 0.27 D, with 91.67% of eyes within 0.50 D or less, respectively. IOL rotation averaged 0.25 ± 0.65 degrees, all eyes having rotation of less than 5 degrees. Contrast sensitivity was within or above normal levels under photopic and mesopic conditions, with or without glare, except for 12 cpd under mesopic conditions with glare. Questionnaire responses indicated 96.67% of patients were satisfied or very satisfied with postoperative vision, and 80.00% to 96.67% reported no difficulty in different daily activities. CONCLUSIONS: The Asqelio Trifocal Toric IOL demonstrated favorable outcomes, providing excellent visual performance at all distances, precise refractive results, and remarkable rotational stability. Patients reported high satisfaction levels and minimal difficulty in daily activities. [J Refract Surg. 2024;40(6):e407-e419.].

Clinical Outcomes of a Toric Enhanced Depth-of-Focus Intraocular Lens Based on the Combination of 4th- and 6th-Order Spherical Aberration.

PURPOSE: To assess the visual and refractive outcomes of patients implanted with a toric extended depth-of-focus (EDOF) intraocular lens (IOL) following cataract surgery. METHODS: A total of 44 eyes implanted with the EDOF LuxSmart toric IOL were evaluated 4 to 6 months postoperatively. The main outcomes measurements evaluated were refractive error, rotational stability, distance, intermediate, and near visual acuities, defocus curve, photopic and mesopic contrast sensitivity, wavefront aberrations, and modulation transfer function, and the Catquest-9SF-questionnaire. RESULTS: The mean postoperative spherical equivalent and cylinder were -0.02 ± 0.26 and -0.17 ± 0.29 diopters (D), respectively. A total of 90.45% and 100% of the eyes had a postoperative spherical equivalent within ±0.50 and ±1.00 D, respectively (this being 93.18% and 100% for the refractive cylinder). The mean rotational stability was 0.61 ± 1.61 degrees. The mean binocular corrected distance visual acuity (CDVA), corrected distance intermediate visual acuity (CDIVA), and corrected distance near visual acuity (CDNVA) were -0.02 ± 0.06, 0.07 ± 0.08, and 0.26 ± 0.09 logMAR, respectively. The CDVA was 20/25 or better in 95.45% of patients, CDIVA was 20/25 or better in 72.73%, and CDNVA was 20/40 or better in 72.73%. The defocus curve showed good visual acuity at distance and intermediate vergences. The contrast sensitivity and optical quality outcomes were good with mean higher order, spherical, and coma aberration values of 0.161 ± 0.155, -0.019 ± 0.048, and 0.080 ± 0.065 µm, respectively. A total of 90.9% of patients were either fairly satisfied or very satisfied with their vision after the surgery, and 77.7% of patients reported no difficulties when reading text in newspapers. CONCLUSIONS: Implantation of the toric pure refractive EDOF technology IOL provides good refractive, optical, and visual quality at different distances, with high levels of patient satisfaction being reported. [J Refract Surg. 2024;40(6):e398-e406.].

The Long-term Visual Quality and Rotational Stability After ICL/TICL V4c Implantation in Individuals With High Myopia Older Than 40 Years.

PURPOSE: To investigate the long-term visual quality and rotational stability after the implantation of Implantable Collamer Lens (ICL) and toric ICL (TICL) (STAAR Surgical) in patients with myopia older than 40 years. METHODS: This study included 82 eyes of 41 patients older than 40 years with myopia who underwent ICL/TICL V4c implantation. The refraction sphere, refraction cylinder, spherical equivalent (SE), uncorrected and corrected distance visual acuity, and anterior segmental parameters were measured preoperatively and at the 1-month, 3-month, and last follow-up visits at 33 to 58 months postoperatively (mean follow-up: 42.56 ± 7.17 months). Wavefront aberrations and TICL rotation were measured using OPD-Scan III (Nidek Co Ltd) at the last follow-up visit. RESULTS: At the last follow-up visit, the overall safety and efficacy index were 1.22 ± 0.26 and 0.88 ± 0.34, respectively, without significant differences between the ICL and TICL groups. Postoperative refraction cylinder was -0.95 ± 0.64 and -0.71 ± 0.54 diopters in the ICL and TICL groups, respectively. The average vault was 467.44 ± 231.98 µm. The average TICL rotation was 5.45 ± 6.61 degrees, positively correlated with the preoperative anterior chamber volume (R2 = 0.1118, P = .026) and clockwise TICL alignment degree (R2 = 0.3110, P = .007) and negatively correlated with the 1-month vault (R2 = 0.1218, P = .008). There were no significant differences in the total, corneal, or internal aberrations and modulation transfer function AreaRatio between the ICL and TICL groups. CONCLUSIONS: Both ICL and TICL presented satisfactory long-term safety, efficacy, and visual quality in patients older than 40 years. Postoperative TICL spontaneous rotation was within the manageable range in the long term. [J Refract Surg. 2024;40(6):e381-e391.].

Immediate Sequential Bilateral Implantable Collamer Lens Surgery Is Safe and Effective.

PURPOSE: To assess the clinical outcomes and safety profiles of patients who underwent immediate sequential bilateral phakic lens surgery. METHODS: This retrospective multicenter study included 254 consecutive patients (508 eyes) who underwent bilateral same-day Implantable Collamer Lens (ICL) (STAAR Surgical) surgery. The authors focused on 1-year postoperative clinical outcomes and adverse events. RESULTS: In the initial cohort, 176 patients (352 eyes) met inclusion criteria. Of these, 335 eyes underwent myopic ICL placement, and 17 eyes received a hyperopic ICL. Notably, 87% of eyes achieved ±0.50 diopters (D) and 95% achieved ±1.00 D of the intended refraction. One year postoperatively, 78% of eyes demonstrated optimal vaulting (250 to 750 µm), with a significant 19% reduction in vaulting observed over the 12 months (P < .001). Only minor adverse events, including early cataract formation (1 case), secondary toric ICL rotation (3 cases), and ICL exchange due to inappropriate vaulting (6 cases), were noted. CONCLUSIONS: The findings corroborate the safety and efficacy of immediate sequential bilateral phakic lens surgery and indicate its potential as a treatment option. The low incidence of minor adverse events further reinforces its favorable safety profile. [J Refract Surg. 2024;40(5):e313-e320.].

Intraoperative Performance and Early Postoperative Outcomes Following Phacoemulsification With Three Fluidic Systems: A Randomized Trial.

PURPOSE: To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based fluidics. METHODS: In this prospective randomized trial, 200 eyes were randomized to the traditional and Active Sentry groups (n = 80 eyes each) where the Centurion Vision System was used with traditional or Active Sentry (Alcon Laboratories, Inc) hand-pieces, respectively, or the Infinit group (n = 40 eyes) where the Infiniti Vision System (Alcon Laboratories, Inc) was used. Within the traditional and Active Sentry groups, there were two subgroups with low (30 mm Hg) or high (55 mm Hg) intraocular pressure (IOP) used. Outcome measures compared were: cumulative dissipated energy (CDE), percentage change in central corneal thickness (CCT) at 1 day, 1 week, and 1 month, anterior chamber cells at 1 day and 1 week, rate of rise and fall of IOP following occlusion break, corneal endothelial cell density (ECD), and macular thickness 6 months postoperatively. RESULTS: CDE was significantly lower in group II compared to the traditional group (2.96 ± 1.4 vs 4.14 ± 2.2, P = .001). With 30 mm Hg IOP, the Active Sentry group had significantly less percentage change in CCT at 1 week postoperatively compared to the traditional handpiece group (0.01% vs 0.02%, P = .008). Incidence of anterior chamber cells less than grade 2 on day 1 was significantly higher in the Active Sentry group (82.9% vs 52%, P = .03). Percentage change in ECD was significantly lower in the Active Sentry group (-0.957 vs -0.98%, P = .005). Significantly faster rise of IOP to baseline following occlusion break was seen in the Active Sentry group. CONCLUSIONS: The use of Active Sentry handpiece was associated with lower CDE, less postoperative increase in CCT, fewer anterior chamber cells, and faster rise of IOP following occlusion break. [J Refract Surg. 2024;40(5):e304-e312.].

[Evaluation of the accuracy of modern intraocular lens calculation formulas when optical biometry is not possible]. / Otsenka tochnosti sovremennykh formul rascheta intraokulyarnykh linz pri nevozmozhnosti vypolneniya opticheskoi biometrii.

PURPOSE: This study evaluates the accuracy of modern intraocular lens (IOL) calculation formulas using axial length (AL) data obtained by ultrasound biometry (UBM) compared to the third-generation SRK/T calculator. MATERIAL AND METHODS: The study included 230 patients (267 eyes) with severe lens opacities that prevented optical biometry, who underwent phacoemulsification (PE) with IOL implantation. IOL power calculation according to the SRK/T formula was based on AL and anterior chamber depth obtained by UBM (Tomey Biometer Al-100) and keratometry on the Topcon KR 8800 autorefractometer. To adapt AL for new generation calculators - Barrett Universal II (BUII), Hill RBF ver. 3.0 (RBF), Kane and Ladas Super Formula (LSF) - the retinal thickness (0.20 mm) was added to the axial length determined by UBM, and then the optical power of the artificial lens was calculated. The mean error and its modulus value were used as criteria for the accuracy of IOL calculation. RESULTS: A significant difference (p=0.008) in the mean IOL calculation error was found between the formulas. Pairwise analysis revealed differences between SRK/T (-0.32±0.58 D) and other formulas - BUII (-0.16±0.52 D; p=0.014), RBF (-0.17±0.51 D; p=0.024), Kane (-0.17±0.52 D; p=0.029), but not with the LSF calculator (-0.19±0.53 D; p=0.071). No significant differences between the formulas were found in terms of mean error modulus (p=0.238). New generation calculators showed a more frequent success in hitting target refraction (within ±1.00 D in more than 95% of cases) than the SRK/T formula (86%). CONCLUSION: The proposed method of adding 0.20 mm to the AL determined by UBM allows using this parameter in modern IOL calculation formulas and improving the refractive results of PE, especially in eyes with non-standard anterior segment structure.

[Outcomes of extended depth of focus intraocular lenses implantation]. / Rezul'tat implantatsii intraokulyarnykh linz s rasshirennoi glubinoi fokusa.

Extended depth of focus (EDOF) intraocular lenses (IOLs) are the latest IOL designs. In recent years, several models of EDOF IOLs have become available in Russia, two of which (Tecnis Symfony and Acrysof IQ Vivity) are implanted in our clinic. Comparative studies devoted to the results of implantation of the new EDOF IOLs are rare in the available literature. PURPOSE: This article compares the outcomes of implantation of two EDOF IOLs in patients with presbyopia and/or cataract. MATERIAL AND METHODS: The prospective study included 60 patients (81 eyes) after implantation of EDOF IOL Tecnis Symfony (32 patients, 45 eyes; group 1) or EDOF IOL AcrySof IQ Vivity (28 patients, 36 eyes; group 2). The mean follow-up period was 3.9±1.3 months. RESULTS: All groups showed a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), intermediate visual acuity (UCIVA), and distance visual acuity (UCDVA) at the maximum follow-up time compared to preoperative values. In group 1, the best corrected near visual acuity (BCNVA) increased from 0.61±0.10 to 0.82±0.16 at the maximum follow-up time, and in group 2 - from 0.58±0.08 to 0.67±0.12 (p>0.05). Both groups showed a significant increase in best corrected intermediate and distance visual acuity (BCIVA and BCDVA) at the maximum follow-up time. The increase in the indicator compared to the preoperative period was not significant in both groups (p>0.05). The frequency of side optical phenomena was low in both groups. No significant differences were found between the groups (p>0.05). CONCLUSION: This study presents a comparative analysis of the results of implantation of two different EDOF IOLs. Both lenses were comparable in most of the studied parameters, including providing good distance and intermediate vision, functional near vision, as well as a low frequency of side optical phenomena. In all cases the patients were satisfied with the results of the surgical intervention.

A comparative study of two phakic posterior chamber implantable lenses.

This study aimed to compare the postimplantation clinical outcomes of 2 types of posterior chamber phakic intraocular lenses (IOLs): Visian™ implantable collamer lenses (ICL; EVO+ V5; Staar Surgical, Monrovia, CA) and an implantable phakic contact lens (IPCL) (IPCL V2.0, Care Group Sight Solution, India) to correct high myopia and myopic astigmatism. This retrospective study included patients who had undergone phakic IOL implantation performed by a single surgeon between March 2021 and March 2022. Preoperative assessments included slit-lamp examination, fundus examination, spherical equivalent, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), specular microscope parameters, and optical quality analysis system parameters. Postoperative assessments after 1 year included slit-lamp examination to detect adverse effects and spherical equivalent, UDVA, CDVA, specular microscope, optical quality analysis system, and anterior-segment optical coherence tomography. Eighty eyes from 42 patients (47 eyes from 24 patients in the ICL group and 33 eyes from 18 patients in the IPCL group) were included. No statistically significant differences were observed between the 2 groups regarding preoperative parameters. At 1-year postoperatively, the mean UDVA in the ICL and IPCL groups was 0.019 ±â€…0.040 logMAR and 0.019 ±â€…0.041 logMAR, respectively. The mean CDVA was 0.001 ±â€…0.008 logMAR and 0.001 ±â€…0.007 logMAR in the ICL and IPCL groups, respectively, showing no statistically significant differences. The postoperative parameters did not differ significantly between the 2 groups. The visual acuity and refractive results of both groups were excellent, and both groups exhibited similar efficacy and safety profiles.

Reverse pupillary block with pigment dispersion and elevated intraocular pressure following bilateral phakic intraocular lens implantation.

The authors describe a case of reverse pupillary block with pigment dispersion following sequential phakic intraocular lens (pIOL) implantation for high myopia, in a young female patient. The intraocular pressure (IOP) elevation began 3 weeks postoperatively, for which Nd-YAG laser peripheral iridotomies (PIs) were attempted elsewhere. Despite maximum medical therapy, the IOP was uncontrolled. She was referred to our institute for further management. Examination showed anteriorly displaced iris-pIOL diaphragm, iris pigment dispersion and raised IOP. The PIs were incomplete. Based on clinical evaluation and investigations, we concluded that the excess area of contact of the posterior iris over the pIOL caused a reverse pupillary block and pigment dispersion. The IOPs were controlled by repeating laser iridotomies and with medical therapy. Subsequently, the patient developed a low lens vault leading to bilateral cataract. Sequential explantation of the pIOL along with cataract extraction was performed and her vision was restored.

Surgical options and clinical outcomes for high myopia.

PURPOSE OF REVIEW: Higher degrees of myopia are currently being treated with refractive surgery. However, there is limited characterization and outcomes data for this cohort. This article aims to review the literature on highly myopic patients who had refractive surgery and present a retrospective analysis of 149 patients (270 eyes) with high to extreme myopia (≤-5.0D SE) who underwent refractive surgery [laser-assisted subepithelial keratomileusis (LASIK), photorefractive keratectomy (PRK), or implantable collamer lense (ICL)] at a single practice. RECENT FINDINGS: There is substantial literature on the efficacy of LASIK, PRK, and phakic intraocular lenses for refractive error correction, but a dearth of studies on patients with high to extreme myopia undergoing different types of refractive surgery. Our study reveals that this cohort of patients has excellent outcomes with minimal complications. SUMMARY: Our study reveals that the average preoperative myopia was highest in ICL patients (-10.03D), followed by PRK (-7.21D), and LASIK (-7.04D) patients. Not surprisingly, eyes with high myopia and thin corneas were offered and elected ICLs for their procedure. Highly myopic patients achieved outcomes consistent with data reported in the literature- average postoperative uncorrected visual acuity was 20/20 for LASIK and ICL eyes and 20/25 for PRK eyes.