Journal of cataract and refractive surgery最新文献

Purpose: To evaluate how variations in suture type, suture length, and scleral outlet angle affect intraocular lens (IOL) positioning and fixation stability in the Canabrava technique, given ongoing concerns such as iris chafing and the lack of prior quantitative assessment.

Setting: Laboratory-based experimental study using 3D-printed model eyes.

Design: Experimental study using 3D-printed ocular models with controlled variation of fixation parameters.

Methods: Using 3D-printed eye models, IOL fixation was performed with the Canabrava technique using Artis PLE IOLs. Suture types (5-0 Prolene, 6-0 Prolene, 6-0 Pronova), suture lengths (8 mm, 10 mm), and scleral outlet angles (30°, 45°) were systematically varied. IOL tilt and optic-haptic distance were measured using ImageJ. Fixation strength was assessed using a universal testing machine (UTM) to measure the force required to produce a 2.5 mm linear displacement of IOL.

Results: IOL tilt was not significantly affected by suture type but increased with longer suture length (10.0 mm vs. 8.0 mm) for both 5-0 and 6-0 Prolene. Optic-haptic distance showed minimal variation, with differences noted only in the 5-0 Prolene and 6-0 Pronova groups at 8.0 mm. Scleral outlet angle also had no significant impact on optic-haptic distance. Displacement force did not differ significantly between suture types.

Conclusions: Caution is advised in patients with a predisposition to iris chafing as the risk may persist regardless of fixation parameters.

Purpose: To evaluate the effectiveness of astigmatism correction using low-cylinder-power monofocal toric intraocular lenses (IOLs) in eyes with mild corneal astigmatism.

Setting: Tertiary care center in Osaka, Japan.

Design: Single-center ambispective observational cohort study.

Methods: Eyes were categorized into the T2 group (toric IOL with 1.0 diopter (D) cylinder power at the IOL plane), nontoric IOL (T0) group, or Tx group (T3 or higher toric IOLs; ≥1.5 D cylinder power). Eyes with irregular corneal astigmatism or prior ocular surgery were excluded. Three-month outcomes included uncorrected distance visual acuity (UDVA), refractive and subjective astigmatism, and vector analysis.

Results: Seventy-five eyes (25 per group, 46 patients) were analyzed. At 3 months, the T2 group showed significantly lower mean refractive astigmatism (0.45 ± 0.25 D) and subjective astigmatism (0.28 ± 0.34 D) than the T0 group (0.92 ± 0.31 D and 0.69 ± 0.33 D; both P = .000), with better UDVA (logMAR -0.05 ± 0.12 vs 0.08 ± 0.15; P = .002). In paired-eye analyses, T0 eyes had greater refractive astigmatism (0.92 ± 0.32 D) and subjective astigmatism (0.69 ± 0.33 D) than their Tx fellow eyes (0.53 ± 0.33 D; P < .001 and 0.39 ± 0.32 D; P = .002). T2 achieved astigmatism correction comparable to that of Tx in mild-astigmatism eyes. Tx eyes trended toward better UDVA than their T0 fellows (P = .060).

Conclusions: Low-cylinder-power toric IOLs effectively corrected astigmatism and improved visual outcomes in eyes with mild corneal astigmatism, a population previously excluded from toric IOL implantation.

Purpose: To compare the visual and refractive outcomes of KLEx using the VISUMAX 800 femtosecond laser and FS-LASIK performed using the VISUMAX 800 femtosecond laser and the EX500 excimer laser in the treatment of myopic astigmatism.

Setting: Single-center, private ophthalmology center.

Design: Retrospective comparative study.

Methods: A total of 237 eyes (133 KLEx, 104 FS-LASIK) were evaluated. Cyclotorsion alignment in KLEx was achieved using the Callisto Eye system integrated with VISUMAX 800. Refractive outcomes, vector analysis (Alpins method), and safety and efficacy indices were compared between groups at 1 and 6 months postoperatively.

Results: At 6 months, both groups achieved comparable UDVA (0.01 ± 0.04 logMAR) and CDVA. Mean SE was closer to emmetropia in the KLEx group (-0.04 ± 0.18 D vs. -0.10 ± 0.15 D, p=0.007). Residual cylinder was lower in KLEx (-0.14 ± 0.19 D vs. -0.20 ± 0.20 D, p=0.010). Vector analysis showed lower DV in KLEx (0.14 ± 0.19 D vs. 0.21 ± 0.21 D, p=0.009), while FS-LASIK had a slightly higher correction index (CI: 1.02 vs. 0.97, p=0.005).

Conclusions: Both KLEx and FS-LASIK performed using the VISUMAX 800 achieved excellent refractive outcomes, with KLEx procedures incorporating an image-guided static cyclotorsion alignment strategy and demonstrating excellent refractive and vector analysis results.

Purpose: Purpose: To identify independent risk factors associated with significant postoperative rotation (≥10°) of plate-haptic toric intraocular lenses (IOLs) and to develop and externally validate a predictive nomogram.

Setting: Two independent eye centers in China.

Design: A prospective observational study with a training cohort and an external validation cohort.

Methods: A total of 805 eyes from 805 cataract patients with regular corneal astigmatism (≥0.75 D) who underwent phacoemulsification and plate-haptic toric IOL implantation between August 2021 and December 2024 were included. Patients from one center formed the training cohort, while patients from the second center served as the external validation cohort.LASSO regression followed by multivariable logistic regression was used to identify predictors of significant toric IOL rotation (≥10° at 2 weeks postoperatively). A predictive nomogram was developed and validated through receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA).

Results: Age (OR = 1.04, p = 0.002), anterior chamber depth (ACD) (OR = 7.71, p < 0.001), lens thickness (LT) (OR = 5.13, p < 0.001) and white-to-white (WTW) (OR = 2.36, p = 0.002) were identified as independent predictors. The nomogram demonstrated good discriminative performance with an AUC of 0.809 in the training cohort and 0.848 in the Validation cohort. Calibration and DCA analyses confirmed the accuracy and clinical utility of the model.

Conclusion: A validated nomogram based on age, ACD, LT and WTW provides a useful tool for individualized preoperative risk assessment of significant toric IOL rotation, aiding surgical decision-making.

Purpose: To evaluate surgical outcomes and visibility when mounting the Verion guidance system on the assistant microscope compared with the main microscope during toric intraocular lens (IOL) implantation.

Setting: ASUCA Eye Clinic, Sendai, Miyagi, Japan.

Design: Experimental study and retrospective observational study.

Methods: The influence of the Verion guidance system on surgical field image quality was evaluated in porcine eyes via luminance analysis in ImageJ. The clinical study included 201 eyes with grade 2 nuclear cataracts. Axis marking was done with the guidance system mounted on the assistant microscope using the Pivot technique (Pivot group; n = 105) or on the main microscope using the conventional technique (Conventional group; n = 96). The primary outcome was IOL rotational stability at 3 months post-operatively. Secondary outcomes included surgical time, visual acuity, and refractive results.

Results: The guidance system significantly reduced overall image brightness (mean luminance: 55.4 ± 15.4 vs. 84.8 ± 17.7) and obscured fine details. The Pivot and Conventional groups had no significant difference in absolute toric IOL misalignment at 3 months (P = .819). Surgical time was shorter in the Pivot group (226.8 ± 105.4 s vs. 233.6 ± 119.2 s; P = .024). Postoperative visual and refractive outcomes were comparable (P > .05) with no serious complications.

Conclusions: The Pivot technique achieved comparable IOL rotational stability and visual outcomes versus the conventional method. By circumventing light reduction induced by the guidance system, the Pivot technique represents a safe, useful, and efficient alternative in toric IOL implantation.

Purpose: To compare the capsulotomy rim morphology of anterior lens capsules obtained by 5 femtosecond laser-assisted cataract surgery (FLACS) platforms: Catalys, FEMTO LDV Z8, LensAR, LenSx, and Victus.

Setting: University of Basel, Basel, Switzerland.

Design: Experimental study.

Methods: Anterior lens capsules from 6 interventions per laser platform were collected (N = 30). 4 of each were assessed under light microscopy (LM; n = 20), and 2 were assessed under scanning electron microscopy (n = 10). A qualitative evaluation of all samples was conducted, as well as a semiquantitative analysis of the extent of irregularities present in LM samples. The Dunn multiple comparisons test was conducted to determine which lasers produced significantly smoother capsulotomies.

Results: Irregularities along the lens capsule rim were observed in all samples. Distinct irregularities were observed for Catalys (unconnected laser pulses bordering the capsulotomy), FEMTO LDV Z8 (numerous additional rows of laser pulses), and LensAR (at least one section with multiple rows of laser pulses). Victus demonstrated a significantly higher degree of smoothness of capsulotomy (median = 306 degrees) compared with Catalys (median = 171 degrees) ( P = .02). The medians for other laser platforms fell between these values.

Conclusions: Different laser platforms produce morphologically and quantitatively distinct irregularities, which may influence capsulotomy strength differently. FEMTO LDV Z8, a low-energy laser, did not produce a smoother capsulotomy than the high-energy lasers. Our results suggest that, with current technologies, the precision of the laser is more important than the pulse energy in determining the regularity of the capsulotomy surface.