Journal of cataract and refractive surgery最新文献

Purpose: To explore the effects of the 2 surgical methods on the short-term and long-term visual outcome of patients with congenital ectopia lentis (CEL).

Setting: Eye & ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective comparative study.

Methods: All patients were divided into 4 groups according to age and operation method: children underwent in-bag or out-of-bag surgery and adult underwent in-bag or out-of-bag surgery. They were followed up 1 month, 3 months, and every 6 months postoperatively. Their corrected distance visual acuity (CDVA), axial length (AL) growth, prediction error (PE), and other parameters were recorded, compared, and analyzed.

Results: There was no significant difference between CDVA and PE in the same age group compared by surgical methods. CDVA in adults was better than that in children, but greater myopic drift occurred in PE. In general, CDVA of the 4 groups all showed a trend of improvement with the addition of follow-up years, while PE increased gradually. The rate of AL growth was lower in patients undergoing in-bag surgery than in patients undergoing out-of-bag surgery.

Conclusions: Both in-bag and out-of-bag surgeries are safe and effective for patients with CEL. CDVA and PE were not affected by the type of surgery and were only related to the patient's age. However, the growth rate of AL will slow down in in-bag surgery. No matter children or adults, half a year after surgery is the window period for recovery, and active amblyopia training has significant implication for the recovery of visual quality.

Purpose: To compare the prediction accuracy of new-generation and traditional intraocular lens (IOL) power calculation formulas in pediatric primary IOL implantation and identify factors influencing refractive prediction errors.

Setting: Zhongshan Ophthalmic Center, Guangzhou, China.

Design: Retrospective consecutive case-series study.

Methods: The prediction error (PE) was calculated for Holladay 1, SRK/T, Hoffer Q, Haigis, Barrett Universal II, Kane, Emmetropia Verifying Optical 2.0, and Ladas Super Formula (LSF) in pediatric primary IOL implantation. Subgroup analyses were conducted based on age, axial length (AL), average keratometry, surgical procedure, and IOL type. Multivariate regression analysis was used to identify factors associated with significant refractive surprise.

Results: 83 patients (108 eyes) were included in the study. Significant differences in both PE and absolute PE were observed among formulas ( P < .001). The SRK/T and Kane formulas demonstrated lower mean predicted error (ME) and median absolute error (MedAE), whereas LSF and Haigis formulas showed higher ME and MedAE, respectively. Patients who were older age and had longer AL exhibited improved predictive accuracy. No significant differences in prediction accuracy were found between eyes with different surgical procedures or different IOL types. Multivariate regression analysis showed that younger age and shorter preoperative AL were predictors of significant refractive surprise across formulas.

Conclusions: The predictive accuracy of IOL formulas in pediatric primary IOL implantation remains suboptimal, with the SRK/T and Kane formulas performing relatively better. Younger age and shorter AL remain major predictors of refractive surprise, while surgical procedure and IOL type show no significant association. Further development of pediatric-specific IOL power formulas is warranted.

Purpose: To investigate if patients had a subjectively inferior experience during second-eye surgery vs first-eye surgery during immediate sequential bilateral cataract surgery (ISBCS) as both operations were performed within the same surgical visit.

Setting: Multisurgeon ophthalmic surgical center.

Design: Survey-based prospective design.

Methods: Patients of the center undergoing routine cataract surgery who enrolled in the study completed a questionnaire immediately after surgery to describe their surgical experience for each eye. Survey questions measured patient pain, discomfort or pressure, comfort, relaxation, estimated length of surgery, and predicted visual outcome.

Results: Patient-reported level of pain during the second-eye surgery was significantly greater than for the first eye ( P < .001). Furthermore, the order of surgery was found to be a strong predictor of patient-reported pain ( P < .001), more so than surgical length ( P < .008), additional anesthesia ( P < .35), patient age ( P < .44), or patient sex ( P < .88). Overall, surgery during the first eye was reported as more comfortable ( P < .001) and shorter in duration ( P < .001), while discomfort and pressure were reported as worse for the second eye ( P < .001).

Conclusions: Understanding differential experiences between eyes can help surgeons when counselling patients regarding expectations for ISBCS and related visual outcomes.

Keratorefractive lenticule extraction (KLEx) is a cutting-edge refractive surgery technique that has garnered considerable attention in recent years due to its minimally invasive nature and the absence of a corneal flap both of which are notable advantages over traditional laser-assisted in situ keratomileusis surgery. Currently, the technology for myopia correction using KLEx has been refined and is widely recognized. Consequently, hyperopic KLEx surgery is highly anticipated, having undergone nearly a decade of evolution and development, and it seems to have finally achieved stable and reliable postoperative outcomes. This article reviews the emerging hyperopic KLEx in clinical outcomes, challenges, complications, and outlook.

Purpose: To use ray-tracing simulations to assess the dependency of add-power demand on ocular biometry.

Setting: David J. Apple Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

Design: Experimental study.

Methods: Optical biometry of 34 patients scheduled for routine cataract surgery was collected and the following parameters used to build a personalized eye model: keratometry (K), anterior chamber depth (ACD), and axial length (AL). Ray-tracing software was applied for pseudophakic-eye simulations. Each model featured a biconvex lens with radii of curvature adjusted for best distance vision. Trial spectacles with -4 diopters (D), -3 D, -2 D, and -1.5 D were placed in front of a virtual eye. The intraocular lens (IOL)-power change required to induce a desirable near/intermediate effect at the spectacle plane was calculated for the far-point condition.

Results: Mean values for K, ACD, and AL were 7.79 ± 0.24 mm, 3.22 ± 0.60 mm, and 23.77 ± 1.34 mm, respectively. The lowest and highest add power (IOL plane) varied by 0.39 D, 0.52 D, 0.76 D, and 0.98 D for -1.5 D, -2 D, -3 D, and -4 D trial spectacles, respectively. High correlation was found between the observed add-power change and the ACD, indicating a linear increase of the add-power demand for larger ACD values. The AL and the K demonstrated poor or no correlation with the required IOL-power adjustment.

Conclusions: The ACD, which determines the effective lens position in our model, has greater impact on add-power demand than AL or K. The reported change may contribute to interparticipant variability in defocus curves of multifocal patients.

Purpose: To describe and compare the efficacy and safety profile of posterior chamber implantable collamer lens (ICL) implantation in eyes with low-vault and non-low-vault over a 5-year follow-up period.

Setting: Hospital de Braga, Braga, Portugal.

Design: Retrospective, comparative, cohort study.

Methods: 2 groups were created based on the first postoperative vault measurement evaluation (1 month): group 1 (<250 μm) and group 2 (≥250 μm). Patients with previous ocular surgery or pathologies that would affect visual outcomes were excluded. The parameters evaluated were uncorrected and corrected visual acuity, subjective refraction, efficacy and safety index, predictability, endothelial cell density, central vault, and postoperative complications. 107 eyes from 67 patients in group 1 and 289 eyes from 164 patients in group 2 were evaluated.

Results: At 5 years, the safety and efficacy index was similar ( P = .224 and P = .390, respectively). Respectively, 80 (76.2%) and 201 (70.5%) eyes were within ±0.50 diopter of targeted refraction. There was a significant reduction in vault measurements in both groups ( P = .034 and P < .001, respectively). No significant differences between groups in endothelial cell density loss were noted ( P = .096). The low-vault group presented a higher incidence of crystalline lens opacities/cataracts (5.6% vs 1.7%), although only 1 patient in group 2 was submitted to cataract surgery.

Conclusions: ICL implantation for surgical correction of myopia yielded stable visual results with excellent safety and efficacy indexes in patients with low vault.

Purpose: To evaluate the clinical outcomes of scleral fixation using the flanged belt-loop technique in patients with in-the-bag intraocular lens (IOL) subluxation after cataract surgery.

Setting: Beyoglu Eye Training and Research Hospital, Turkey.

Design: Retrospective.

Methods: 23 eyes of 23 patients who underwent scleral fixation of subluxated in-the-bag IOLs using the flanged belt-loop technique, with a minimum follow-up of 6 months, were included. All surgeries were performed by a single experienced surgeon. The procedure involved transscleral fixation of the existing IOL using 6-0 polypropylene sutures with flanged ends, without conjunctival dissection or use of scleral flaps. Preoperative and postoperative data were collected, including corrected distance visual acuity (CDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and central corneal thickness (CCT).

Results: The mean postoperative CDVA improved significantly ( P = .001). IOLs remained well-centered in 91.3% of eyes. Mild, asymptomatic decentration occurred in 2 eyes. There were no significant changes in IOP, ECD, or CCT ( P > .05). No major intraoperative or postoperative complications were reported. The surgical time was relatively short, and the technique caused minimal trauma to anterior segment structures. Bilateral haptic fixation was associated with better centration, especially after the initial learning curve.

Conclusions: The flanged belt-loop technique is a safe and effective option for repositioning subluxated in-the-bag IOLs, avoiding the need for IOL explantation. Its minimally invasive nature, short operative time, and stable outcomes make it a favorable alternative. Larger studies with longer follow-up are necessary to validate these findings and compare efficacy with other fixation methods.