Journal of cataract and refractive surgery最新文献

Purpose: To evaluate visual outcomes following bilateral implantation of the RayOne EMV intraocular lens with targeted micro-monovision.

Setting: Southend Private Hospital, UK.

Design: Retrospective cohort.

Methods: 50 subjects (100 eyes) assessed at 12 to 18 months post-operatively. Emmetropia was targeted in the dominant eye and myopia of -0.50 to -1.00D in the non-dominant eye. Uncorrected and distance corrected visual acuity was assessed monocularly and binocularly at distance (6m), intermediate (70cm) and near (40cm). Defocus was assessed from +1.50D to -4.00D monocularly and binocularly. Contrast sensitivity was assessed using a computerised Pelli-Robson chart.

Results: Mean Spherical Equivalent (MSE) was -0.05±0.34D and -0.91±0.60D in the dominant and non-dominant eyes respectively. Uncorrected distance visual acuity (UDVA) was significantly different in the dominant (0.08±0.10LogMAR) and non-dominant eye (0.29±0.17LogMAR). (p<0.01). Corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were similar between eyes. However, significant differences were found between binocular uncorrected intermediate visual acuity (UIVA) (0.16±0.11LogMAR) and DCIVA (0.31±0.11LogMAR) (p <0.01) also, binocular uncorrected near visual acuity (UNVA)(0.30±0.17LogMAR) and DCNVA (0.50±0.19 LogMAR) (p<0.01). The non-dominant eye shows superior acuity eye in both UIVA (p<0.01) and UNVA(p<0.01). Contrast sensitivity showed no significant difference between eyes (p = 0.06). Significant improvement binocularly compared to monocularly was seen through imposed defocus -0.50 to -2.50D.

Conclusion: The RayOne EMV with micro-monovision is a reliable method for improving intermediate and near visual acuity, by increasing the range of focus without compromise of distance acuity or contrast sensitivity.

Purpose: To compare structural and functional measures of meibomian gland dysfunction (MGD) in eyes with moderate to severe Demodex blepharitis (collarette grade 2-4) compared to those with collarette grade 0 (0-2 collarettes).

Setting: Private clinical practice.

Design: Retrospective, single-center, non-interventional, observational study.

Methods: In this study, case records of patients aged ≥18 years with data available for collarettes and MGD signs (telangiectasia, meibum expressibility, meibum quality, and meibography) were included. Outcome measures were the comparison of the mean telangiectasia score, meibum expressibility score, meibum quality score, and meibomian gland atrophy score between eyes with moderate to severe Demodex blepharitis (collarette grade 2 to 4, or >10 collarettes) and those with collarette grade 0 (0-2 collarettes). Right and left eyes were analyzed separately.

Results: The mean telangiectasia, meibum quality, and meibomian gland atrophy scores were statistically significantly worse in the collarette grade 2-4 group than in those in the collarette grade 0 group for both right and left eyes (even adjusting for age). There was a positive correlation between collarette grade and telangiectasia, meibum quality and meibomian gland atrophy scores.

Conclusion: Structural and functional measures of MGD were significantly worse in eyes with collarette grade 2-4 than in those with collarette grade 0. Clinicians should routinely examine their patients for Demodex infestation and signs of MGD and treat both conditions as needed, especially in the perioperative setting.

Purpose: To investigate the impact of the distance from the most-anterior surface of the optic to the principal object plane (POP) and from the foremost haptic to the principal object plane (H-POP) on the intraocular lens (IOL) power calculation.

Setting: A tertiary hospital.

Design: Optical simulation and retrospective cross-sectional study.

Methods: The optical simulation study plotted changes in the POP and H-POP as a function of IOL power using ICB00 IOL configuration data. The clinical study included 102 eyes of 102 patients implanted with ICB00 IOL to examine the correlation between changes in both the POP and the H-POP, and the prediction error calculated using the Barrett Universal II formula with varying IOL power.

Results: The ICB00 IOL showed minor fluctuations in the POP (0.21 mm to 0.30 mm) with changing IOL power. The H-POP increased stepwise from 5.0 D, peaking at 0.60 mm at 16.0 D, then decreased to a minimum of 0.14 mm at 34.0 D. The prediction error graph primarily mirrored the pattern of changes in the H-POP rather than the POP with varying IOL power. Linear regression showed a significant myopic shift in prediction error as IOL power increased beyond 16.0 D (Y = -0.069X+1.420, R2=0.178, p<0.001).

Conclusion: For the ICB00 IOL, the H-POP has more impact on IOL power calculation than the POP itself. For more accurate IOL power calculations, it is essential for all IOL manufacturers to provide comprehensive information on both optic and haptic geometries, which will enable the precise calculation of H-POP.

Purpose: To identify trends in the reporting of toxic anterior segment syndrome (TASS) to the American Society of Cataract and Refractive Surgery (ASCRS) TASS Force from 2012-2022.

Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.

Design: Cross-sectional study.

Methods: TASS questionnaires on instrument cleaning and sterilization, and extraocular and intraocular products used during cataract surgery were available on the American Society of Cataract and Refractive Surgery website. A retrospective analysis of questionnaires submitted by surgical centers reporting cases of TASS was performed between January 1, 2012, and December 31, 2022, to identify commonly held practices that could cause TASS.

Results: Data from 77 questionnaires were analyzed. The reporting centers performed 56,319 cataract surgeries and reported 539 cases of TASS from January 1, 2012, to December 31, 2022. Common practices associated with the TASS outbreaks in the surveys included re-use of single-use cannulas, phacoemulsification, and irrigation/aspiration tips (69%), use of enzymatic cleaners (40%), inadequate flushing of phacoemulsification and irrigation/aspiration handpieces (27%), reuse of phacoemulsification tubing (22%), use of preservative-containing intracameral anesthetic (18%), and addition of antibiotics to balanced salt solution (17%).

Conclusions: The surveys identified commonly held practices associated with TASS while showcasing trends over the past 10 years. Understanding these findings and the safe alternatives will allow surgical center personnel to change their practices as needed to prevent this complication.

Purpose: To compare visual and refractive outcomes and postoperative axis alignment for toric implantable collamer lens (ICL) implantation in astigmatic myopia using manual vs digital marking techniques.

Setting: Department of Ophthalmology, Medical University of Graz, Graz, Austria.

Design: Prospective randomized single-centered intraindividual comparison.

Methods: Patients undergoing bilateral toric ICL implantation for myopia with astigmatism ≥0.5 diopters (D) were enrolled. Patients received both marking techniques, and randomization was performed. Postoperative retroillumination photography assessed axis alignment, and visual and refractive parameters were evaluated. Duration of the surgeries was recorded.

Results: The study included 20 patients and 40 eyes. Preoperative visual and refractive parameters showed no significant differences. Postoperatively, residual astigmatism ( P = .824) and spherical equivalent ( P = .309) were comparable. No notable differences between right and left eyes in preoperative ( P = .371) and postoperative ( P = .824) astigmatism were observed. Although slight, corrected distance visual acuity (CDVA) increased in both groups postoperatively ( P = .381). Gain in CDVA was comparable between marking techniques ( P = .637). Safety and efficacy indices were comparable ( P = .991 and P = .189, respectively). Postoperative axial misalignment was 2.8 ± 3.1 degrees in the digital- and 4.4 ± 5.1 degrees in the manual group ( P = .260). Vector analysis showed no significant differences between manual and digital marking. Duration remained uninfluenced by the marking technique ( P = .970) and side of surgery ( P = .682).

Conclusions: Digital and manual marking techniques provided comparable results in axis alignment, surgical duration, and visual and refractive outcomes. Both methods were viable for precise axis alignment, with digital marking offering a potential advantage in efficacy.

Purpose: To compare the rotational stability and visual outcomes of plate-haptic toric intraocular lenses (IOLs) with and without a capsular tension ring (CTR) in paired eyes.

Setting: Eye and Ears, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Design: Prospective, randomized, paired-eye study.

Methods: Patients with bilateral cataracts and coexisting regular corneal astigmatism were enrolled. The 2 eyes of each patient were randomly assigned to the CTR or non-CTR (NCTR) group. Both eyes of each patient were subjected to phacoemulsification and toric IOL implantation. CTRs were implanted into the eyes of the CTR group. All patients were followed up for 12 months; uncorrected distance visual acuity (UDVA), residual astigmatism (RAS), and rotational degree of the toric IOL were recorded.

Results: 186 eyes of 93 patients were eligible for analysis. At each visit, UDVA improved significantly postoperatively in all eyes ( P < .001). The mean rotational degree and RAS were significantly smaller in the CTR group at the 2-week visit ( P < .05). The toric IOLs achieved rotational stability at 1 week postoperatively in the CTR group while at 2 weeks postoperatively in the NCTR group. In the subgroup analyses, CTR coimplantation significantly reduced the 2-week IOL rotation in eyes meeting specific ocular measurements.

Conclusions: CTR coimplantation could increase the rotational stability of plate-haptic toric IOLs, by reducing the amount of IOL rotation in the early postoperative period and accelerating the stabilization of IOLs in the capsular bag.

Purpose: To describe cases of hydrophilic acrylic intraocular lenses (IOLs) (Eyecryl, Biotech) exhibiting surface punctate deposits early postoperatively and provide laboratorial analyses of unused lenses of the same model.

Setting: Altino Ventura Foundation (FAV), Recife, Brazil, and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design: Observational, descriptive, clinical study with laboratorial analysis.

Methods: A thorough review of records of patients undergoing phacoemulsification with Eyecryl implantation in December 2022 at FAV was performed, with data collection. 5 Eyecryl IOLs (never implanted/unused) were removed from the original package and underwent gross examination, light microscopy, and ultrastructural analyses using scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS).

Results: Details on 5 clinical cases exhibiting surface IOL deposits on the first postoperative day after uneventful surgery and followed for at least 6 months were included. The deposits disappeared by the 60th postoperative day. No inflammatory or toxic reactions were noted, visual outcomes were favorable, and IOL explantation was not necessary. 3 of the 5 unused lenses undergoing laboratorial analyses revealed diffuse, star-like deposits that could not be removed by thorough irrigation with distilled water. SEM/EDS revealed a composition of the deposits that primarily consisted of carbon and oxygen.

Conclusions: Laboratorial findings suggest the etiology of the deposits might be related to the manufacturing/packaging process of lenses from specific lots. Although the deposits did not appear to be associated with inflammatory or toxic reactions in the clinical cases, further investigations are necessary to elucidate their precise origin.

Purpose: To design formulas for predicting postoperative vaults in vertical implantable collamer lens (ICL) implantation and to achieve more precise predictions using machine learning models.

Design: Retrospective, observational study.

Setting: Eye Clinic Tokyo.

Methods: We retrospectively reviewed the medical records of 720 eyes in 408 patients who underwent vertical ICL implantation. The data included age, sex, refractions, anterior segment biometric data, and surgical records. We designed 3 formulas (named V1 to V3 formulas) using multiple linear regression analysis and tested 4 machine learning models.

Results: Predicted vaults by V1 to V3 formulas were 444.17 ± 93.83 μm, 444.08 ± 98.64 μm, and 444.27 ± 108.81 μm, with a mean absolute error of 127.97 ± 107.92 μm, 126.41 ± 105.86 μm, and 122.90 ± 103.00 μm, respectively. There were no significant differences in error among the V1 to V3 formulas, despite the fact that the V1 and V2 formulas referred to limited parameters (3 and 4, respectively) and the V3 formula referred to all 12 parameters. 2 of 4 machine learning models-Extreme Gradient Boosting and Random Forest Regressor-showed better performance in predicted vaults: 444.52 ± 120.51 μm and 446.00 ± 102.55 μm, and mean absolute error: 118.31 ± 100.55 μm and 118.63 ± 99.34 μm, respectively.

Conclusions: This is the first study to design V1 to V3 formulas for vertical ICL implantation. The V1 and V2 formulas exhibited good performance despite the limited parameters. In addition, 2 of the 4 machine learning models predicted more precise results.

Purpose: To compare corneal endothelial loss in manual small incision cataract surgery (MSICS) following three different techniques of nucleus delivery (Viscoexpression, Irrigating Vectis, Phacosandwich).

Setting: Mahatma Gandhi Medical College and Research Institute, Puducherry, India.

Design: Prospective, single blinded, randomized controlled trial.

Methods: Willing patients > 40years of age with immature cataract and posted for MSICS were recruited for the study. Those with systemic or ocular comorbidities which may influence corneal endothelium, dilated pupil size of <5mm, intraoperative complications and postoperative corneal haze were excluded. They were randomly divided to one of the three groups (Group 1- Viscoexpression, Group 2- Irrigating Vectis, Group 3- Phacosandwich) for nucleus delivery. Visual acuity and corneal endothelial parameters were recorded preoperatively and postoperatively at 6-8weeks.

Results: A total of 90 patients with mean age of 59.13 ± 9.42 years (range 40-82years) were studied with 30 patients in each group. Following MSICS there was a 12.12% (p=0.001) endothelial cell loss. It was 10.81% in viscoexpression group, 11.3% in irrigating vectis group and 14.28% in phacosandwich group. Post hoc analysis with Dunn Bon ferroni test showed endothelial cell loss following viscoexpression and irrigating vectis methods of nucleus delivery were comparable (p=0.096) and significantly lesser (p<0.001) than in Phacosandwich group.

Conclusion: There was significant endothelial cell loss following MSICS. Nucleus delivery by viscoexpression and irrigating vectis had similar endothelial cell loss while it was greater with phacosandwich technique.

Purpose: To determine characteristics and differences in intraocular lens (IOL) exchange between eyes with an open (OPC) and closed posterior capsule (CPC).

Setting: Department of Ophthalmology, Goethe-University, Frankfurt, Germany.

Design: Retrospective case series and review of literature.

Methods: Charts of all cases of IOL exchange between January 2010 and May 2024 were retrospectively reviewed. Main outcome measures were indications for surgery, IOL implantation technique, and the necessity of anterior vitrectomy. MEDLINE database and Google scholar were used to identify relevant past publications.

Results: We included 37 eyes of 30 patients with a mean age of 62.1 ± 10.2 years, with 16 eyes (43.2%) with OPC undergoing IOL exchange. Mean interval between IOL implantation and IOL exchange was 61.50 ± 62.00 months in the OPC group and 15.81 ± 15.03 months in the CPC group. The most common indication was optical phenomena in 18 cases (48%). In the OPC group, intraoperative anterior vitrectomy was necessary twice as often (OPC nine cases (56%) vs. CPC five cases (24%)). Bag-to-bag IOL exchange was performed in all eyes with CPC, and in 10/16 (62%) with OPC (p=0.009). Postoperative complications were seen in a total of 7/16 eyes (43.7%) with OPC and 3/21 (14.3%) with CPC (p=0.012).

Conclusion: The success rate of repositioning an IOL within a bag with OPC is less than that achieved with CPC. A vitrectomy is typically required when attempting a bag-to-bag IOL exchange with an OPC. Capsulotomy should only be performed if the necessity of an IOL exchange is unlikely.