Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report / Implantação intracorneana de uma lente intraocular dobrável direcionada incorretamente durante cirurgia de facoemulsificação: relato de caso

ABSTRACT A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

RESUMO Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

Calculation formulas and influence factors of effective lens position / 中华实验眼科杂志

Cataract extraction is often combined with the implantation of intraocular lens (IOL) with the diopter matching the operated eye to restore optimal visual function after surgery.However, there are often errors between the actual refractive power of the operated eye and the predicted value.One of the major causes of postoperative refractive error is the change in IOL position compared with the expected position.In order to improve the accuracy of postoperative refraction prediction, Holladay proposed to introduce the concept of effective lens position (ELP) into the IOL diopter calculation formula.The differences in the parameters and algorithms incorporated in the calculation of ELP lead to differences in the accuracy of IOL calculation formulas.With the application of multi-parameter calculation methods, especially the formula based on the artificial intelligence algorithm, the accuracy of IOL calculation formula has been significantly improved.ELP is also affected by various factors such as differences in ocular anatomy, IOL design and material, and surgical procedures, especially the factors affecting the stability of the capsular bag that increase the difficulty of accurately predicting ELP.Therefore, the changes in postoperative ELP need to be further discussed in order to obtain more accurate postoperative refraction.This article aimed to give a review of the development of calculation formulas and the influencing factors of ELP.

Accuracy of different intraocular lens power calculation formulas in cataract patients with shallow anterior chamber: a meta-analysis / 中华实验眼科杂志

Objective:To systematically compare the accuracy of intraocular lens (IOL) power calculation formulas in cataract patients with shallow anterior chamber.Methods:A comprehensive literature search was conducted in MEDLINE, EMBASE, Cochrane Library, and the Chinese databases including CNKI, Wanfang, and VIP databases.The peer-reviewed literature on the accuracy of IOL power calculation formulas in cataract patients with shallow anterior chamber was searched from the establishment of the database until August 2020.Literature screening, data extraction and quality assessment were performed according to inclusion and exclusion criteria.The mean difference ( MD) of mean absolute error (MAE) among different formulas was analyzed.Meta-analysis was performed using Revman 5.3 software. Results:Seven studies involving 499 eyes were included.The accuracy of six formulas, Barrett Universal Ⅱ, Haigis, SRK/T, Hoffer Q, Holladay 1 and Holladay 2, was evaluated.The MAE of Barrett Universal Ⅱ was significantly lower than that of Hoffer Q ( MD=0.11 D; 95% CI: 0.05-0.17 D; P<0.001), Haigis ( MD=0.08 D; 95% CI: 0.03-0.13 D; P=0.002), and Holladay 2 ( MD=-0.06 D; 95% CI: -0.11--0.01 D; P=0.020). No significant difference was found in the remaining pairwise comparisons (all at P>0.05). Conclusions:The Barrett Universal Ⅱ formula is more accurate than Hoffer Q, Haigis, and Holladay 2 formulas in predicting IOL power in cataract patients with shallow anterior chamber.

Status changes and influencing factors of intraocular lens implantation into capsule / 中华实验眼科杂志

Objective:To observe the unfolding status of foldable acrylic intraocular lens (IOL) of different materials, designs and refractive powers implanted in the capsular bag during cataract surgery, and to investigate its influence on the IOL implantation procedure.Methods:An observational case series study was conducted.A total of 1 005 patients who underwent routine phacoemulsification and IOL implantation in Shaanxi Eye Hospital from February to August 2021 were enrolled.The status and unfolding time of the leading haptic, optical region, and trailing haptic of the IOL in the capsular bag and the surgeon were recorded in real-time intraoperative video.Of the 1 005 IOL implants, 681 were hydrophobic, 324 hydrophilic, 733 C-loop, 272 plate-haptic, 909 single-piece, 96 three-piece, 620 preloaded, and 385 non-preloaded.The differences in unconventional implantation factors and IOL unfolding time were compared.The factors influencing IOL implantation status were analyzed by multivariate logistic regression.Multivariate logistic regression was used to analyze the relevant factors affecting IOL implantation status.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xi'an People's Hospital (Xi'an Fourth Hospital)(No.20200035). Written informed consent was obtained from each subject.Results:There were 14(1.4%) IOLs with unconventional leading haptic status during implantation, including 7 recurved, 4 folded, 2 twisted and 1 straightened.There were 101(10.0%) IOLs with unconventional trailing haptic status during implantation, including 49 stuck in the injector, 40 folded, 10 recurved and 2 broken.There were 22(2.2%) IOLs with overlapped leading and trailing haptic requiring additional separation.There were 4(0.4%) IOLs with reversed optical regions and 2(0.2%) with damaged optical regions.The occurrence rate of unconventional leading haptic status using C-loop IOL was higher than that using plate IOL, and the difference was statistically significant ( P<0.05). The occurrence rate of unconventional trailing haptic status using hydrophilic, non-preloaded, three-piece, and C-loop IOL was higher than that using hydrophobic, preloaded, single-piece, and plate IOL, respectively, and the differences were statistically significant ( χ2=9.100, 61.400, 81.885, 7.587; all at P<0.05). The 22(2.2%) IOLs with overlapped leading and trailing haptic were hydrophobic.The 4 (0.4%) IOLs with reversed optical region were non-preloaded.The results of multivariate logistic regression analysis showed that IOL material, loading method, design and surgeons were related to the unconventional trailing haptic status in implantation ( OR=9.894, 3.720, 6.810, 1.338; all at P<0.05). The average unfolding time of hydrophobic IOL was 26.12(21.21, 30.91)s, which was significantly longer than 3.03(2.16, 4.49)s of hydrophilic IOL ( Z=-25.603, P<0.05). The average unfolding time of C-loop IOL was 25.53(19.41, 30.25)s, which was significantly longer than 2.70(2.08, 3.69) s of plate IOL ( Z=-23.764, P<0.05). Conclusions:A variety of unconventional statuses of IOL can occur during implantation into the lens capsular bag.The use of hydrophobic, preloaded, single-piece, and plate IOLs can reduce the occurrence of unconventional status.The use of hydrophilic IOLs can reduce the overlap of leading and trailing haptic.The use of preloaded IOLs can reduce the occurrence of IOL optical region reversal.The use of hydrophilic and plate IOLs can shorten the operation time.

Analysis of the feasibility of measurements and characteristics of intraocular lens tilt using swept-source optical coherence tomography biometer / 中华实验眼科杂志

Objective:To evaluate the feasibility of measurement and characteristics of intraocular lens (IOL) tilt using the swept-source optical coherence tomography (SS-OCT) biometer (IOLMaster 700) and to explore its potentially relevant parameters.Methods:A cross-sectional study was conducted.Two hundred and forty-two eyes (119 right eyes, 123 left eyes) of 185 patients after phacoemulsification and IOL implantation were included in Beijing Tongren Hospital from July to September 2018.The IOL position, angle κ, angle α, corneal curvature, anterior chamber depth (ACD), pupil diameter (PD), and axial length (AL) were obtained by IOLMaster 700, and the IOL tilt direction and magnitude were calculated.The within-subject standard deviation and intraclass correlation coefficient were used to evaluate the repeatability of three IOL tilt measurements.Binocular symmetry of IOL tilt and the correlation between IOL tilt and different influencing factors were evaluated by Pearson linear correlation analysis or Spearman rank correlation analysis.Influencing factors for IOL tilt were assessed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2018-049). Patients were informed of the purpose and methods of this study and signed the written informed consent.Results:The repeatability of IOL tilt measurements was excellent with a within-subject standard deviation of 5.16° for IOL tilt direction and 0.13° for IOL tilt magnitude.IOL tilt was mirror symmetric in both eyes.The IOL tilt direction in right eyes ranged from -89.60° to 87.53° with a mean of (18.85±29.65)°, and the tilt magnitude ranged from 1.32° to 7.05° with a mean of (4.16±1.26)°.The IOL tilt direction in left eyes ranged from -84.30° to 89.44° with a mean of (21.17±32.38)°, and the tilt magnitude ranged from 0.58° to 7.40° with a mean of (3.80±1.31)°.There were moderate and weak positive correlations of IOL tilt direction and tilt magnitude between both eyes ( r=0.473, P<0.001; r=0.335, P=0.011). IOL tilt magnitude was weakly positively correlated with angle α and IOL diopter ( rs=0.272, P=0.003; r=0.285, P=0.002), and was weakly negatively correlated with ACD, PD and AL ( r=-0.303, P=0.001; r=-0.233, P=0.011; rs=-0.331, P<0.001). In backward stepwise regression analysis, the regression equation of IOL tilt magnitude, angle α, ACD, PD, AL and IOL diopter in multiple linear regression analysis was as follows: IOL tilt magnitude=10.503+ 1.456×angle α-0.532×ACD-0.196×AL ( R2=0.400; F=8.588, P<0.001). Conclusions:The SS-OCT biometer can be an effective method to assess IOL tilt.IOL tilt is mirror symmetric between the right eyes and left eyes.

Effect of pupil dilation on IOLMaster® measurements in Pakistani Eyes.

Objectives: To analyse the effect of pupil dilation on intraocular lens instrument IOLMaster 500 biometric measurements, and to determine the effect of these measurements on intraocular lens power calculations in Asian eyes. METHODS: The prospective study was conducted at the Aga Khan University Hospital, Karachi, between January and April 2017, and comprised all patients scheduled for cataract surgery who underwent scanning with IOLMaster 500. For each patient, pre-dilation and post-dilation measurements were taken. The intraocular lens power was determined through Sanders/Retzlaff/Kraff Theoretical, Holladay, and Hoffer Q formulae. Data was analysed using SPSS 24. RESULTS: There were 276 eyes of 138 participants who had a mean age of 59.7±11.1 years. Anterior chamber depth changed significantly with pupil dilation (p=0.001). No significant changes were observed in the axial length (p=0.410), keratometry measurements (p=0.931), and intraocular lens power calculations (p>0.05). CONCLUSIONS: The change in anterior chamber depth, though significant, was perhaps clinically non-significant.

[Dioptric power of intraocular lens and dilatation in patients with cataract]. / Poder dióptrico del lente intraocular y dilatación en pacientes con catarata.

Background: Cataract surgery with intraocular lens implant is, nowadays, the most frequent surgical procedure in all the world. Its success depends on a lot of factors, one of the most important is the calculation of the exact dioptric power of intraocular lens. Objective: To compare the calculation of dioptric power of intraocular lens with and without dilatation in patients with cataract. Material and methods: Longitudinal study, the calculation of the dioptric power of the intraocular lens was determined in patients without and with pupillary dilation. The variables were age, gender, eye to study, keratometry, axial length, anterior chamber depth and dioptric power of the intraocular lens. Descriptive statistics and Student t test were performed. Results: There were 37 patients, 23 females and 14 males. The average age was 68 + 7.87 years. Sixty-four eyes were studied, 30 were right and 34 left. Statistically, there was only significant difference in K2 of the ocular biometry between patients without and with pupillary dilation when obtaining a value of p < 0.05. Conclusion: There are no changes in the calculation of the dioptric power of the Intraocular lens without and with pupillary dilation.

Introducción: la cirugía de catarata con implante de un lente intraocular es, hoy en día, el procedimiento quirúrgico más frecuente en todo el mundo. Su éxito depende de muchos factores, uno de los más importantes es el cálculo exacto del poder dióptrico del lente intraocular. Objetivo: comparar el cálculo del poder dióptrico del lente intraocular en los pacientes sin y con dilatación pupilar. Material y métodos: estudio longitudinal, en el que se determinó el cálculo del poder dióptrico del lente intraocular en pacientes con y sin dilatación pupilar. Las variables de estudio fueron: edad, género, ojo a estudiar, queratometría, longitud axial, profundidad de cámara anterior y poder dióptrico del lente intraocular. Se realizó estadística descriptiva y t de Student. Resultados: se estudiaron 37 pacientes, 23 mujeres y 14 hombres. La edad promedio fue de 68 ± 7.87 años. Se estudiaron 64 ojos, 30 fueron derechos y 34 izquierdos. Estadísticamente solo hubo diferencia significativa en K2 de la biometría ocular entre pacientes sin y con dilatación pupilar al obtenerse un valor de p ≤ 0.05. Conclusión: no existen cambios en el cálculo del poder dióptrico del LIO sin y con dilatación pupilar.

Intraocular lens power estimation for future emmetropia in pediatric cataract surgery / Estimativa do poder da lente intraocular para emetropia futura em cirurgias de catarata pediátrica

ABSTRACT Purpose: Creating models, in pediatric cataracts, to estimate kerotometry and axial length values at future ages, based on kerotometry and axial length measured at surgery, to estimate the intraocular lens power for emmetropia in future ages. Methods: Eyes with bilateral cataract and kerotometry and axial length measured at surgery and at least one postoperative examination with kerotometry and axial length measurements, were considered for this study. The models to estimate future kerotometry and axial length values were created considering (1) kerotometry and axial length measured at surgery, (2) the average slope of kerotometry and axial length logarithmic regression created for every single eye and (3) age at surgery. The intraocular lens for future ages can be estimated using these values in third generation formulas. The estimation errors for kerotometry, axial length and intraocular lens were also calculated. Results: A total of 57 eyes from 29 patients met the inclusion criteria. The average age at the surgery and follow-up was 36.96 ± 32.04 months and 2.39 ± 1.46 years, respectively. The average slope of logarithmic regression created for every single eye were -3.286 for kerotometry and +3.189 for axial length. The average absolute estimation errors for kerotometry and axial length were respectively: 0.61 ± 0.54 D and 0.49 ± 0.55 mm, and for intraocular lens using SRK-T, Hoffer-Q and Holladay I formulas were: 2 . 04 ± 1 . 73 D , 2 . 49 ± 2 . 10 D and 2 . 26 ± 1 . 87 D, respectively. Conclusions: The presented models could be used to estimate the intraocular lens power for emmetropia at future ages to guide the choice of the intraocular lens power to be implanted in pediatric cataract.

RESUMO Objetivo: Criar modelos, em catarata pediátrica, para estimar valores futuros de ceratometria e comprimento axial, com base na ceratometria e no comprimento axial medidos na cirurgia, para previsão do poder da lente intraocular para emetropia em idades futuras. Métodos: Olhos com catarata bilateral, ceratometria e comprimento axial medidos na cirurgia e pelo menos um exame pós-operatório com medidas de ceratometria e comprimento axial foram considerados para este estudo. Os modelos para estimar futuras ceratometrias e comprimentos axiais foram criados considerando (1) ceratometria e comprimento axial medidos na cirurgia, (2) a inclinação média da regressão logarítmica da ceratometria e comprimento axial criada para cada olho e (3) a idade na cirurgia. A lente intraocular para emetropia em idades futuras pode ser estimada usando esses valores em fórmulas de terceira geração. Os erros de estimativa da ceratometria, comprimento axial e poder da lente intraocular, usando os modelos, também foram calculados. Resultados: 57 olhos de 29 pacientes preencheram os critérios de inclusão. A idade média na cirurgia e acompanhamento foram de 36,96 ± 32,04 meses e 2,39 ± 1,46 anos, respectivamente. A inclinação média da regressão logarítmica criada para cada olho foi de -3.286 para ceratometria e + 3.189 para o comprimento axial. Os erros médios de estimativa absoluta para ceratometria e comprimento axial foram respectivamente: 0,61 ± 0,54 D e 0,49 ± 0,55 mm, e para o poder da lente intraocular usando as fórmulas SRK-T, Hoffer-Q e Holladay I foram: 2,04 ± 1,73 D, 2,49 ± 2,10 D e 2,26 ± 1,87 D, respectivamente. Conclusões: Os modelos apresentados podem ser utilizados para estimar o poder da lente intraocular que levaria a emetropia em idades futuras e orientar a escolha do poder da lente intraocular a ser implantada na catarata pediátrica.

Correlation between intraoperative and postoperative vaulting of the EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system.

BACKGROUND: Implantable Collamer lens (ICL) vaulting is one of the most important parameters for the safety, aqueous humor circulation, and lens transparency after ICL implantation. This study aimed to investigate the factors associated with the actual vaulting after refractive EVO-ICL surgery. METHODS: This retrospective study included patients who underwent EVO-ICL surgery at a tertiary eye hospital between October and December 2019. A RESCAN 700 was used for the intraoperative and CIRRUS HD-OCT was used for postoperative observation of vaulting. Subjective and objective refractions, anterior ocular segment, corneal morphology, intraocular pressure (IOP), anterior chamber volume (ACV), crystalline lens rise (CLR), white-to-white distance (WTW), anterior chamber depth (ACD), axial length, corneal endothelial cell density (ECD), and fundoscopy were examined. A multivariable analysis was performed to determine the factors independently associated with 1-month postoperative vaulting. RESULTS: Fifty-one patients (102 eyes) were included. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P = 0.039), lower preoperative corrected visual acuity (P = 0.006), lower preoperative IOP (P = 0.029), higher preoperative ACD (P = 0.004), lower preoperative CLR (P = 0.046), higher ICL spherical equivalent (P = 0.030), higher intraoperative vaulting (P < 0.001), and lower IOP at 1 month (P = 0.045). The multivariable analysis showed that the only factor independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio = 1.005, 95% confidence interval: 1.002-1.007, P < 0.001). The intraoperative and 1-month postoperative vaulting values were positively correlated (R2 = 0.562). CONCLUSIONS: The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value of ICL at 1 month.

A comparative study on calculation of intraocular lens power using different formulas between IOLMaster 700 and IOLMaster 500 in cataract eyes / 中华实验眼科杂志

Objective:To compare the accuracy of IOLMaster 700 and IOLMaster 500 in intraocular lens (IOL) power calculation.Methods:A cross-sectional study was conducted.Two hundred and sixty-two eyes of 262 patients who underwent phacoemulsification combined with IOL implantation at the Eye Hospital of Wenzhou Medical University from November 2018 to November 2019 were enrolled.Preoperative biometry for cataract surgery was performed using IOLMaster 700 and IOLMaster 500.IOL power was calculated through the built-in formulas, Haigis, Holladay Ⅰ, Hoffer Q and SRK/T of the two devices.The difference in IOL power calculation between the two devices was analyzed through the prediction error of IOL power calculation using different formulas across different axial length (AL) ranges.This study complied with the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University (No.2020-038-K-33). Written informed consent was obtained from each patient before the surgery.Results:There was no significant difference in mean absolute error (MAE) between IOLMaster 700 and IOLMaster 500 using Haigis, Hoffer Q and SRK/T over the entire AL range (all at P >0.05). The MAE of IOLMaster 500 was 0.47 (0.24, 0.90) D, which was significantly lower than 0.50 (0.28, 0.99) D of IOLMaster 700 using Holladay Ⅰ formula ( Z=-3.120, P=0.002). When AL was <22.0 mm and ≥24.5 mm-<26.0 mm, there was no significant difference in MAE between the two devices using the four formulas (all at P >0.05). When AL was ≥22.0 mm-24.5 mm, there was no significant difference in the MAE between the two devices using Haigis, Hoffer Q and SRK/T (all at P >0.05), but 0.42 (0.18, 0.75) D from IOLMaster 500 was smaller than 0.45 (0.25, 0.79) D from IOLMaster 700 using Holladay Ⅰ, showing a statistically significant difference ( Z=-3.487, P <0.001). But the difference was negligible and therefore was of no clinical significance.When AL was ≥26.0 mm, there was no statistically significant difference in the MAE between the two devices using Haigis, Holladay Ⅰ and SRK/T, but 0.66 (0.38, 1.00) D from IOLMaster 500 was significantly smaller than 0.98 (0.62, 1.32) D from IOLMaster 700 using Hoffer Q ( Z=-3.046, P=0.002). Conclusions:The refractive prediction accuracy of IOLMaster 700 and IOLMaster 500 using Haigis, Hoffer Q and SRK/T is similar over the entire AL range.For patient with long AL, the IOL calculation from IOLMaster 700 using Hoffer Q is significantly larger than that from IOLMaster 500, which requires extra caution in clinical practice.The accuracy of IOLMaster 700 and IOLMaster 500 for IOL prediction is very similar.

Comparison of one-year postoperative visual quality between trifocal and monofocal intraocular lens implantation / 中华实验眼科杂志

Objective:To compare the one-year postoperative visual quality after trifocal intraocular lens (IOL) implantation and monofocal IOL implantation.Methods:A cohort study was conducted.Forty-one eyes from 41 age-related cataract patients who underwent phacoemulsification extraction combined with IOL implantation in Nanjing Drum Tower Hospital from May 2017 to June 2018 were enrolled.The patients were divided into trifocal IOL group (20 eyes) receiving ZEISS AT LISA tri 839MP trifocal IOL implantation and monofocal IOL group (21 eyes) receiving ZEISS 603P monofocal IOL implantation according to their willingness.One year after surgery, uncorrected distant visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity (BCDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were detected in both groups.The patient point spread function (PSF), modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), OQAS Ⅱ values at 100%, 20%, and 9% contrast (OV 100%, OV 20%, OV 9%) and objective scattering index (OSI) were measured by OQAS Ⅱ.Wavefront aberrations including total aberration (TA), total high order aberrations (tHOAs), spherical aberration, coma, trefoil aberration, total low order aberrations (tLOAs), defocus, and astigmatism were evaluated with the iTrace visual function analyzer.All aberrations were represented by root mean square.The visual acuity of operative eyes was measured with a phoropter, and defocus curves were drawn with visual acuity better than 0.5 LogMAR.The incidence of posterior capsular opacification (PCO) in the IOL region was quantitatively analyzed by Sellman method.Visual function was scored by visual function index (VF-14). This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (No.2018-219-01). Written informed consent was obtained from each subject prior to any medical examination.Results:One year after the operation, UCIVA, UCNVA, DCIVA, and DCNVA of trifocal IOL group were significantly better than those of monofocal IOL group, and the differences were statistically significant (all at P<0.001). OQAS Ⅱ visual quality indicators showed that the MTF cutoff frequency, SR, OV 100%, and OSI values of trifocal IOL group were significantly higher than those of monofocal IOL group, showing statistically significant differences (all at P<0.001). No significant difference in wavefront aberrations was found between the two groups (all at P>0.05). Defocus curve showed that the LogMAR visual acuity of patients at -1.0 D, -1.5 D, -2.0 D, -2.5 D, -3.0 D, and -3.5 D (namely, 1 m, 66 cm, 50 cm, 40 cm, 33 cm, and 29 cm) in monofocal IOL group were significantly better than those in trifocal IOL group (all at P<0.05). There was a higher incidence of PCO in trifocal IOL group than monofocal IOL group, with a statistically significant difference ( χ 2=41.0, P<0.001). The VF-14 score of trifocal IOL group was 87.99±1.09, which was significantly higher than 81.49±1.67 of monofocal IOL group ( t=10.301, P<0.001). Conclusions:One year after trifocal IOL implantation, the full range of vision, subjective and objective visual quality of eyes are better than eyes implanted with monofocal IOL.

Repeatability of CASIA2 for measuring the tilt and decentration of crystalline lens and intraocular lens under non-mydriatic and mydriatic conditions / 中华实验眼科杂志

Objective:To investigate the repeatability and correlation in tilt and decentration measurement of crystalline lens and intraocular lens (IOL) under non-mydriatic and mydriatic conditions using swept-source ocular coherence tomography CASIA2.Methods:A diagnostic test study was conducted.A total of 109 cataract patients (157 eyes) who received phacoemulsification with IOL implantation surgery in the Affiliated Hospital of North Sichuan Medical College from March to July 2020 were enrolled.The decentration and tilt of crystalline lens and IOL under non-mydriatic and mydriatic conditions were measured for three times by a single examiner using CASIA2 before and one week after surgery.The 0.5% compound tropicamide eye drops were used to dilate.Repeatability was evaluated by within-standard deviation, test-retest repeatability (TRT), coefficient of variation (CoV) and intraclass correlation coefficient (ICC). The correlation in decentration and tilt of crystalline lens and IOL between before and after mydriasis was assessed by Pearson correlation coefficient.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (No.2020ER030-1). Written informed consent was obtained from all subjects before any medical examination.Results:The decentration of crystalline lens under non-mydriatic and mydriatic conditions was (0.217±0.112)mm and (0.220±0.110)mm, respectively, and the tilt was (5.017±1.422)° and (5.310±1.645)°, respectively.The decentration of IOL under non-mydriatic and mydriatic conditions was (0.245±0.136)mm and (0.250±0.145)mm, respectively, and the tilt was (5.144±1.345)° and (5.437±1.646)°, respectively.No significant difference was found between non-mydriatic and mydriatic conditions (all at P>0.05). Under both non-mydriatic and mydriatic conditions, the crystalline lenses of both eyes decentered and tilted toward the inferotemporal direction, and the IOL of right eyes decentered toward the inferior and tilted toward the inferotemporal direction, and the IOL of left eyes decentered and tilted toward the inferotemporal direction.Except the crystalline lens decentration, the measurement repeatability of crystalline lens tilt, IOL decentration and tilt in cataract patients before and after mydriasis was good, with ICC range in 0.815-0.984, TRT<50% and CoV≤14.840%.The measurement repeatability of crystalline lens decentration was poor, and the measurement repeatability of decentration axis, tilt and tilt axis of crystalline lens, and the repeatability of decentration and tilt of IOL were good in both eyes, with ICC range in 0.757-0.998, TRT<50% and CoV≤17.763%.There were good correlations in decentration, decentration axis, tilt and tilt axis of crystalline lens and IOL between non-mydriatic and mydriatic conditions (all r≥0.679, all at P<0.01). Conclusions:The measurement repeatability of decentration axis, tilt and tilt axis of crystalline lens and IOL, as well as the decentration of IOL by CASIA2 before and after mydriasis is good.The correlations of the measured parameters before and after mydriasis are good.

Inhibition of lens epithelial cell migration using different square-edge intraocular lenses in an in vitro capsular bag model / 中华实验眼科杂志

Objective:To establish an in vitro capsular bag model and compare the inhibitory effects of different 360° square-edge intraocular lens (IOL) on lens epithelial cells (LECs) migration. Methods:In vitro capsular bag model with posterior capsule opacification (PCO) was established using Transwell compartment, cell climbing slices, human collagen type Ⅳ, and IOL.The models were divided into Plate-loop HydroSmart group, C-loop HydroSmart group, and C-compensation-loop Hydrophobic group according to the different square-edge IOL implanted.A blank control group was set using the Transwell compartment without IOL.The early PCO pathological manifestations in lens epithelial cell line SRA01/04 cultured in the Transwell compartment were observed with an inverted microscope.The cell morphology in different groups was observed by hematoxylin and eosin staining.The cell counting and cell migration inhibition rate of anterior capsule and posterior capsule were calculated by Transwell assay and cell-exclusion zone assay, respectively. Results:The early pathological characteristics of PCO, such as early Soemmering ring and small Elschnig pearl, could be found in cells in the in vitro capsular bag model after 48-hour culture.The migrating cells in model groups were fibrous.No changes mentioned above were found in blank control group.The number of migrating cells in the anterior capsule of Plate-loop HydroSmart group, C-loop HydroSmart group, C-compensation-loop Hydrophobic group was 18.80±5.53, 24.67±9.80, and 34.47±10.80, respectively, and the number of migrating cells in the optical area of the posterior capsule of the three groups was 56.43±9.00, 162.20±16.38, and 121.30±12.01, respectively.The cell migration inhibition rate in the anterior capsule of Plate-loop HydroSmart group, C-loop HydroSmart group, C-compensation-loop Hydrophobic group was (92.02±1.94)%, (89.76±3.10)%, (86.27±4.54)%, respectively, and the cell migration inhibition rate in optical area of the posterior capsule of the three groups was (91.60±3.65)%, (70.14±5.35)%, (78.43±3.48)%, respectively.The number of migrating cells in the anterior capsule was lower and the cell migration rate inhibition was higher in Plate-loop HydroSmart group than C-compensation-loop Hydrophobic group, with significant differences (both at P<0.05). The number of migrating cells in the optical area of the posterior capsule and the cell migration inhibition rate was greater than those of C-loop HydroSmart group and C-compensation-loop Hydrophobic group, showing statistically significant differences (all at P<0.001). Conclusions:The in vitro capsular bag model can be used in PCO research.Compared with C-loop HydroSmart IOL and C-compensation-loop Hydrophobic IOL, Plate-loop HydroSmart IOL can more effectively inhibit the migration of LECs to the optical area of the posterior capsule.

Characterization of ocular biometric parameters in Colombian candidates for cataract surgery / Caracterización de los parámetros biométricos oculares de pacientes colombianos candidatos a cirugía de catarata

Abstract Introduction: Intraocular lens (IOL) power calculation, based on ocular biometry, is a determinant for the success of cataract surgery. Objectives: To characterize the ocular biometric parameters of Colombian patients over 40 years of age who are candidates for cataract surgery and to determine the prevalence of the 9 clinical conditions proposed by Holladay according to the interaction between axial length (AL) and anterior chamber depth (ACD). Materials and methods: Analytical cross-sectional study. The ocular biometry results of 781 patients (831 eyes) who were going to be taken to cataract surgery between January 2014 and January 2015 in Medellín, Colombia, were reviewed. After applying exclusion criteria, 716 eyes were included for analysis. Data on age, sex, AL, keratometry (flat keratometry (K1) and steep keratometry (K2)), ACD and white-to-white distance were collected. Results are presented using descriptive statistics. Results: Most eyes were from women (62.3%). The mean values of AL, K1 and ACD were 23.37±1.51mm, 43.52±2.06 and 3.03mm±0.41, respectively. Mean AL in men was 23.62±1.37mm, and in women, 23.21±1.67mm. The highest mean AL was observed in patients <50 years old (23.84±2.41) and the lowest in patients ≥80 years old (22.96±1.03 mm). Regarding eye size according to their AL, 90.5% were normal, 4.89% long, and 4.61% short. Conclusions: 85% of the participants had normal biometric parameters. For the remaining 15%, it is necessary to take some precautions when calculating IOL power, such as using fourth-generation formulas like Holladay 2 in long eyes, because the same refractive behavior will not be obtained using traditional prediction formulas in these patients. Furthermore, according to the Holladay classification, excluding normal eyes, the most frequent eyes were those with myopia and axial hyperopia.

Resumen Introducción. El cálculo del poder del lente intraocular (LIO), basado en la biometría ocular, es un factor determinante del éxito en la cirugía de catarata. Objetivos. Caracterizar los parámetros biométricos oculares de pacientes colombianos mayores de 40 años candidatos a cirugía de catarata y determinar la prevalencia de las 9 condiciones clínicas propuestas por Holladay según la interacción entre longitud axial (LA) y profundidad de la cámara anterior (ACD). Materiales y métodos. Estudio transversal analítico. Se revisaron los resultados de biometría ocular de 781 pacientes (831 ojos) que iban a ser sometidos a cirugía de cataratas entre enero de 2014 y enero de 2015 en Medellín, Colombia. Luego de aplicar los criterios de exclusión, se incluyeron 716 ojos para análisis. Se recolectaron datos sobre edad, sexo, LA, queratometría (queratometría más plana (K1), queratometría más curva (K2)), ACD y distancia blanco-blanco. Los resultados se presentan mediante estadística descriptiva. Resultados. La mayoría de ojos eran de mujeres (62.3%). Las medias de LA, K1 y ACD fueron 23.37±1.51mm, 43.52±2.06 y 3.03±0.41mm, respectivamente. La media de LA en hombres fue 23.62±1.37mm, y en mujeres, 23.21±1.67mm. La media más alta de LA se observó en pacientes <50 años (23.84±2.41mm) y la más baja en aquellos ≥80 años (22.96±1.03mm). Respecto al tamaño de los ojos según su LA, 90.5% fueron normales; 4.89%, largos, y 4.61%, cortos. Conclusiones. 85% de los participantes tuvo parámetros biométricos normales. Para el 15% restante es necesario tomar precauciones al calcular el poder del LIO, tales como el uso de fórmulas de cuarta generación como la Holladay 2 en ojos largos, pues en estos pacientes no se obtendrá el mismo comportamiento refractivo con las fórmulas de predicción tradicionales. Además, según la clasificación de Holladay, excluyendo a los ojos normales, los ojos más frecuentes fueron aquellos con miopía e hipermetropía axial.

[Safety and efficacy of A1-UV aspheric intraocular lens implantation over the postoperative 5 years].

Objective: To evaluate the clinical safety and efficacy of A1-UV aspheric intraocular lens (IOL) implantation over the postoperative 5 years. Methods: Prospective cohort study. The subjects came from a finished multicenter, randomized and controlled clinical trial with a follow-up period of 1 year from April to November 2012. The clinical research centers were Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Peking University Third Hospital, Tianjin Medical University Eye Hospital, and Daping Hospital of Army Medical University. Cataract patients in the experimental group were implanted with A1-UV type IOL, while cataract patients in the control group were implanted with SN60WF type IOL, and monocular patients were enrolled. From April to May 2018, patients enrolled in the previous study were recalled for follow-up and continued observation. The visual acuity, spherical equivalent, postoperative complications, non-contact intraocular pressure and subjective evaluation results were statistically analyzed preoperatively, at 1 to 2 days, 1 week, 1 month, 3 months, 6 months, 1 year and 5 years after operation. The main statistical methods included Mann Whitney U test, Wilcoxon signed rank test, independent sample t test, chi square test and Fisher exact test. Results: A total of 42 subjects (22 in the experimental group and 20 in the control group) completed 5-year continuous observation. Among the 42 subjects, 28 were female and 14 were male. The age was (70±9) years, and the time from surgery to recall was (5.77±0.19) years. The age, gender distribution, left/right eye distribution, axial length, IOL power and nucleus hardness classification data of the experimental group and the control group were balanced and comparable (all P>0.05). At different visiting time points, there was no significant difference in the best corrected distance visual acuity (BCDVA), best corrected near visual acuity (BCNVA), uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNVA) between the groups (all P>0.05). At 5 years after operation, the UCDVA, BCDVA and BCNVA of the two groups were significantly improved compared with the baseline [all P<0.01; UCDVA was improved from 0.75 (0.30 to 1.30) to 0.10 (-0.10 to 0.70) in the experimental group and from 0.75 (0.30 to 1.60) to 0.20 (-0.10 to 0.80) in the control group; BCDVA was from 0.60 (0.10 to 1.00) to 0.00 (-0.10 to 0.54) in the experimental group and from 0.60 (0.10 to 1.60) to 0.10 (-0.10 to 0.50) in the control group; BCNVA was from 0.55 (0.00 to 1.10) to 0.10 (-0.10 to 0.60) in the experimental group and from 0.55 (0.10 to 1.60) to 0.10 (-0.20 to 0.60) in the control group], but there was no significant change in the UCNVA (both P>0.05). There were no significant differences in the spherical equivalent, intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence and comprehensive evaluation of satisfaction between the groups (all P>0.05). In the experimental group, one eye (4.5%) had an abnormal pupil, one eye (4.5%) had an abnormal IOL with a few particles on the surface of the IOL but no glistening, and 3 eyes (13.6%) had posterior capsular opacification (PCO); in the control group, one eye (5.0%) had an abnormal cornea, five eyes (25.0%) had abnormal IOLs [one eye (5.0%) had IOL calcification, and four eyes (20.0%) had IOL glistening], and one eye (5.0%) had PCO with posterior capsular folds and IOL tilt. There was no significant difference in PCO and IOL abnormality between the two groups (both P>0.05), but there was significant difference in the occurrence of IOL glistening (P=0.04). Conclusion: The long-term effect of A1-UV aspheric IOL on improving the UCDVA is stable and good, with high subjective satisfaction of patients, a low incidence of PCO, no glistening and good biocompatibility, over the postoperative 5 years. (Chin J Ophthalmol, 2021, 57: 41-47).

Comparison of prediction accuracy of five different biometric formulas / Comparação da acurácia preditiva de cinco fórmulas biométricas diferentes

ABSTRACT Objective To compare the performance of Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas to calculate intraocular lens power in eyes with normal axial length, in terms of predicting target refraction by using partial coherence interferometry technology. Methods Phacoemulsification and intraocular lens implantation were performed in 135 eyes of 135 patients with an axial length between 22 and 24.5 mm. Axial length, keratometry, and anterior chamber depth were measured by intraocular lens Master 500. Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas were used for intraocular lens power calculations. The difference between the expected postoperative refraction and the mean absolute prediction error was calculated for each eye. Statistical significance was evaluated at the level of p<0.05. Results The study included 135 subjects. The mean axial length, anterior chamber depth, keratometry, and intraocular lens power were 23.2±1.2 (22 to 24.5) mm, 3.2±0.4 (2.4 to 4.4) mm, 43.5±1.5 (40.8 to 46.2) diopter, 21.5±1.8 (18.5 to 25.5) diopter, respectively. The mean absolute prediction error for Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function was 0.306±0.291, 0.312±0.257, 0.314±0.268, 0.299±0.206 and 0.308±0.280, respectively (p>0.05). Conclusion The study showed the third-generation (Sanders-Retzlaff-Kraft/Theoretical and Hoffer Q), fourth-generation (Barrett Universal II) and new-generation (Kane and Hill-radial basis function) intraocular lens power calculation formulas had similar performances regarding calculation of intraocular lens power to predict target refraction after phacoemulsification in eyes with normal axial length.

RESUMO Objetivo Comparar o desempenho das fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function (RBF) para cálculo de poder dióptrico das lentes intraoculares, em olhos com comprimento axial normal, em termos de predição da refração alvo, utilizando a tecnologia de interferometria de coerência parcial. Métodos Facoemulsificação e implante de lentes intraoculares foram realizados em 135 olhos de 135 pacientes com comprimento axial entre 22 e 24.5 mm. Comprimento axial, ceratometria, e profundidade da câmara anterior foram medidos por lente intraocular Master 500. As fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foram empregadas para cálculo de poder dióptrico das lentes intraoculares. A diferença entre a refração esperada no pós-operatório e a média dos erros absolutos preditivos foi calculada para cada olho. Os valores de p<0,05 foram considerados estatisticamente significativos. Resultados O estudo incluiu 135 sujeitos. As médias de comprimento axial, profundidade da câmara anterior, ceratometria, e poder dióptrico das lentes intraoculares foram 23,2±1,2 (22 a 24,5) mm, 3,2±0,4 (2,4 a 4,4) mm, 43,5±1,5 (40,8 a 46,2) dioptria, 21,5±1,8 (18,5 a 25,5) dioptria, respectivamente. A média de erro absoluto preditivo para as fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foi 0,306±0,291, 0,312±0,257, 0,314±0,268, 0,299±0,206 e 0,308±0,280, respectivamente (p>0,05). Conclusão O estudo mostrou que as fórmulas de terceira geração (Sanders-Retzlaff-Kraft/Teórica e Hoffer Q), de quarta geração (Barrett Universal II) e as da nova geração (Kane e Hill-radial basis function) para cálculo de poder dióptrico das lentes intraoculares, têm desempenhos semelhantes para cálculo do poder dióptrico das lentes intraoculares, para predizer a refração alvo após facoemulsificação em olhos com comprimento axial normal.

Trocar-assisted, flanged haptics, sutureless intrascleral fixated intraocular lens implantation combined with Descemet membrane endothelial keratoplasty / Implante de lente intraocular assistida com trocarte, com háptico flangeado e fixação intraescleral sem sutura, combinada com ceratoplastia endotelial da membrana de Descemet

ABSTRACT This article reports a combined technique of sutureless intrascleral fixated intraocular lens implantation and Descemet membrane endothelial keratoplasty in a patient with anterior pseudophakic bullous keratopathy. Two scleral tunnels were created, corneal incisions were made, and a foldable intraocular lens was cut and removed from the anterior chamber. After performing anterior vitrectomy, a 3-piece foldable intraocular lens was implanted into the anterior chamber. One of the intraocular lens haptics was grasped with a forceps and pulled out from the scleral tunnel. Then, the end of the haptic was cauterized. Similar maneuvers were applied for the other haptic. Next, an 8-mm-diameter donor tissue was prepared, and the recipient endothelial tissue was peeled and removed from the center of the recipient cornea. The prepared donor tissue was injected into the anterior chamber. After proper opening and placement of the donor tissue, an air bubble was injected below the tissue. There were no postoperative complications during the 1-month follow-up.

RESUMO Relato de uma técnica que combina o implante de uma lente intraocular com fixação intraescleral sem sutura e uma ceratoplastia endotelial da membrana de Descemet em paciente com ceratopatia bolhosa pseudofácica anterior. Foram criados dois túneis esclerais. Foram feitas incisões na córnea e a lente intraocular dobrável foi cortada e removida da câmara anterior. Foi então efetuada uma vitrectomia anterior e uma lente intraocular dobrável de 3 peças foi implantada na câmara anterior. Um dos hápticos da lente intraocular foi pinçado com um fórceps e puxado para fora do túnel escleral. A extremidade do háptico foi cauterizada. Manobras semelhantes foram feitas no outro háptico. Foi preparado um tecido de doador com 8 mm de diâmetro e o tecido endotelial da área receptora foi removido do centro da córnea. O tecido preparado do doador foi injetado na câmara anterior. Após abertura e posicionamento adequados do tecido do doador, foi injetada uma bolha de ar abaixo do tecido. Não foi observada nenhuma complicação pós-operatória durante um mês de acompanhamento.

The evaluation of postoperative objective and subjective refraction for premium intraocular lenses / A avaliação da refração objetiva e subjetiva pós-operatória para lentes intraoculares premium

Abstract Purpose: To evaluate six different premium IOLs retrospectively in respect to both subjective and objective refraction after cataract operation. Methods: Five hundreds and seventy eyes of 285 patients with bilateral cataract who had undergone phacoemulsification and IOL implantation operation between February 2017 and September 2018 were enrolled in this study. The mean age of the patients was 57.78 ± 7.49 (41-71) years. Out of 285 patients 137 were male (48.07%) and 148 were female (51.93%). TheIOLsusedare: RayOne Trifocal (Rayner, Worthing, UK), Lucidis (Swiss Advanced Vision, Neuchâtel, Switzerland), PanOptix (Alcon, Fort Worth, USA), LentisMplus (Oculentis, Berlin, Germany), TecnisSymfony (Abbott, Illinois, USA) and Acriva Trinova (VSY Biotechnology, Istanbul, Turkey). Results: There were no significant differences among the groups regarding age, sex, axial length, the mean preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), the mean preoperative spherical equivalent (SE) and the mean postoperative SE (subjective measurement) (P> .05). The postoperative refractions measured with autorefractometer were more myopic than subjective refractions in all patients except the patients who had PanOptix IOL. In postoperative twelfth month, the mean UCVA arrived 0.00 logMAR in 405 eyes (78.48%) , however, the mean autorefractometric measurement was -1.28 ± 1.02 (0.00_-2.75) D. Conclusion: The autorefractometer measurements of all patients who had premium IOLs except PanOptix IOL were not coherent with their visual acuities postoperatively. The ophthalmologists and/or optometrists should be careful while examining these types of patients.

Resumo Objetivo: Avaliar retrospectivamente seis diferentes LIOs premium em relação à refração subjetiva e objetiva após operação de catarata. Métodos: Quinhentos e setenta (570) olhos de 285 pacientes com catarata bilateral submetidos a facoemulsificação e operação de implantação de LIO entre fevereiro de 2017 e setembro de 2018 foram incluídos neste estudo. A média de idade dos pacientes foi de 57,78 ± 7,49 (41-71) anos. Dos 285 pacientes, 137 eram do sexo masculino (48,07%) e 148, do sexo feminino (51,93%). As seguintes IOLs foram utilizadas: RayOne Trifocal (Rayner, Worthing, Reino Unido), Lucidis (Swiss Advanced Vision, Neuchâtel, Suíça), PanOptix (Alcon, Fort Worth, EUA), LentisMplus (Oculentis, Berlim, Alemanha), TecnisSymfony (Abbott, Illinois, EUA) e Acriva Trinova (VSY Biotechnology, Istambul, Turquia). Resultados: Não houve diferenças significativas entre os grupos em relação à idade, sexo, comprimento axial, média da acuidade visual não corrigida pré e pós-operatória (AVNC), melhor acuidade visual corrigida (MAVC), equivalente esférico pré-operatório médio (EE) e EE pós-operatório médio (medição subjetiva) (P > 0,05). As refrações pós-operatórias medidas com autorefratômetro foram mais míopes do que as refrações subjetivas em todos os pacientes, exceto naqueles que usavam LIO PanOptix. No décimo segundo mês pós-operatório, a AVNC média chegou a 0,00 logMAR em 405 olhos (78,48%); no entanto, a medição autorefractométrica média foi de -1,28 ± 1,02 (0,00_-2,75) D. Conclusão: As medições autorefractométricas de todos os pacientes que usavam LIOs premium, exceto LIO PanOptix, não foram coerentes com suas acuidades visuais no pós-operatório. Oftalmologistas e/ou optometristas devem ter cuidado ao examinar pacientes com esses perfis.

Análise da qualidade de vida antes e após cirurgia de catarata com implante de lente intraocular / Life quality assessment before and after cataract surgery with intraocular lens implantation

Resumo Objetivo: Analisar a qualidade de vida dos pacientes antes e após cirurgia de remoção da catarata associada ao implante de lente intraocular (LIO). Metodos: Este é um estudo observacional, prospectivo, de série de casos. Os dados foram coletados em um serviço privado de oftalmologia em Aracaju - SE, de agosto de 2018 a julho de 2019. A avaliação da qualidade de vida de pacientes antes e após 4 meses da cirurgia de catarata, pela técnica de facoemulsificação associada ao implante de LIO, foi realizada aplicando a versão brasileira validada do Questionário de Função Visual de 25 itens do National Eye Institute (NEI-VFQ-25) e realização do teste de acuidade visual com a tabela de Snellen. Resultados: O grupo final foi constituído por 41 pacientes, com média de idade de 72 anos (DP: 9,01), sendo 14 do sexo masculino e 27 do feminino. Além disso, dos 41 pacientes, 37 foram submetidos à facectomia em ambos os olhos, 03 apenas no olho direito e 01 apenas no olho esquerdo. Diante da coleta e da análise dos dados, notou-se melhora na qualidade de vida dos pacientes submetidos ao procedimento cirúrgico proposto. Houve um aumento estatisticamente significativo (p<0,001) na acuidade visual binocular, na acuidade visual monocular e nas pontuações de 11 dos 12 subdomínios do NEI-VFQ-25. Não foi observada significância estatística no subdomínio "Dor ocular" (p=0,934). Conclusão: Houve melhora significativa na qualidade de vida dos pacientes submetidos à cirurgia de catarata com implante de LIO.

Abstract Objective: To analyze patients' quality of life before and after cataract removal surgery associated with intraocular lens (IOL) implantation. Methods: This is an observational, prospective, case series study. Data were collected at a private ophthalmology service in Aracaju - SE, from August 2018 to July 2019. The quality of life assessment of patients before and after 4 months of cataract surgery, using the phacoemulsification technique associated with IOL implantation, was performed by applying the validated Brazilian version of the 25-item Visual Function Questionnaire from the National Eye Institute (NEI-VFQ-25) and performing the visual acuity test with the Snellen chart. Results: The final group consisted of 41 patients, with a mean age of 72 years (SD: 9.01), of which 14 were male and 27 female. In addition, out of 41 patients, 37 underwent facectomy in both eyes, 03 only in the right eye and 01 only in the left eye. Given the collection and thorough analysis of the data, the improvement in the quality of life of patients submitted to cataract surgery with intraocular lens implantation was noticed. There was a statistically significant increase (p<0.001) in binocular visual acuity, monocular visual acuity and scores in 11 of the 12 subdomains of the NEI-VFQ-25. No statistical significance was observed in the subdomain "Eye Pain" (p=0.934). Conclusion: There was a significant improvement in the quality of life of patients who underwent cataract surgery with intraocular lens implantation.

Spontaneous repositioning of posterior chamber intraocular lens: a mere coincidence? / Reposicionamento espontâneo de uma lente intraocular na câmara posterior: uma mera coincidência?

ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.