Journal of cataract and refractive surgery最新文献

Purpose: To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation after secondary scleral-fixated IOL (SF IOL) surgery.

Setting: 2 tertiary referral hospitals.

Design: Retrospective case series.

Methods: Patients undergoing SF IOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SF IOL surgery between June 2014 and December 2019 at 2 tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded.

Results: 237 eyes of 225 patients (169 [75.1%] men) were included. The redislocation group was more likely to have a younger mean age at the initial SF IOL surgery (redislocation vs no-redislocation, 55.4 vs 62.0 years, respectively; P = .008), have a prior history of a previous suture break (23 eyes, 52.3% vs 1 eye, 0.5%; P < .001), and have undergone the initial SF IOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P = .002) than was the no-redislocation group. In addition, the redislocation group had a higher occurrence of complications ( P < .001). Multivariate regression revealed that younger age, left eye involvement, aphakic status before the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P < .05) associated with redislocation.

Conclusions: Younger age, left eye involvement, postoperative complications such as ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions.

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: XXXX (anonymized for review).

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 three formulas (named V1-V3 formulas) using multiple linear regression analysis, and tested four machine learning models.

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

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

Purpose: To assess the cost-effectiveness of the treatment of low corneal astigmatism (≤1.5 diopters) at the moment of cataract surgery.

Setting: Qvision, Ophthalmology Department, VITHAS Almería Hospital, Spain.

Design: Economic evaluation.

Methods: A decision tree was used to assess the cost-effectiveness of implanting spherical vs toric intraocular lenses (IOLs) or spherical lens combined with the following corneal incisions: limbal-relaxing incisions conducted manually (M-LRI) or assisted by femtosecond laser (F-LRI), arcuate keratotomies conducted manually (M-AK) or assisted by femtosecond laser (F-AK), and intrastromal arcuate keratotomies (F-iAK). Outcomes of cost were selected from a patient perspective considering the gross cost of each one of the surgeries at European centers, and the effectiveness variable was the probability of achieving a visual acuity of 20/20 postoperatively. A sensitivity analysis was conducted to assess the uncertainty considering the evidence retrieved from the transition probabilities of the model, effectiveness, and cost.

Results: F-AK or toric IOLs were the most effective treatments, increasing an 16% or 9%, respectively, in the percentage of eyes attaining 20/20 vision. The M-LRI, F-iAK, and F-LRI procedures were strongly dominated while the M-AK and toric IOL were weakly dominated by the F-AK. A patient with low corneal astigmatism would need to be willing to pay 360€ (95% CI, 231-1224) with F-AK and 472€ (95% CI, 149-4490) with toric IOLs for a 10% increase in the probability of achieving 20/20 vision.

Conclusions: From patient perspective, F-AK was generally the most cost-effective treatment, although toric IOLs can dominate in some countries.

In May 2023, a 36-year-old carpenter complained of a sudden decrease in visual acuity in both eyes after his fourth COVID-19 vaccination. He underwent extensive evaluation by ophthalmological, neurological, and internal medicine specialists elsewhere, which was unremarkable, except for a computed tomography scan of his brain showing minor occipital calcifications. In 2021, he had been diagnosed with anterior basement membrane dystrophy and treated with phototherapeutic keratectomy (PTK) of the left eye, leading to significant postoperative haze. On referral in July 2023, slitlamp examination showed significant anterior basement membrane dystrophy in the right eye, whereas the left eye had an extensive central scar in the anterior stroma, measuring up to 6 mm in width and 140 µm in depth (Figures 1-3JOURNAL/jcrs/04.03/02158034-202410000-00017/figure1/v/2024-09-18T130724Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202410000-00017/figure2/v/2024-09-18T130724Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202410000-00017/figure3/v/2024-09-18T130724Z/r/image-tiff). His corrected distance visual acuity was 20/80 in his right eye and 20/200 in his left eye, with a manifest refraction of -0.50 -3.75 × 170 and +0.00 -4.75 × 180, respectively. Corneal Scheimpflug topography showed regular corneal astigmatism of 3.3 diopters (D) and 5.5 D in the right and left eyes, respectively, with a corneal thickness of 550 and 566 µm (Figure 4JOURNAL/jcrs/04.03/02158034-202410000-00017/figure4/v/2024-09-18T130724Z/r/image-tiff). The Schirmer tear test was 20-20 mm. Fundoscopy, electrophysiological testing, and retinal optical coherence tomography (OCT) showed no abnormalities. The patient mentioned he had Crohn disease, managed with ustekinumab (a monoclonal antibody inhibitor of cytokines interleukin [IL]-12 and IL-23), but he had discontinued it because of the apparent remission of the disease. Attempts to improve visual acuity involved a soft bandage contact lens in the right eye, which was discontinued after 2 days because of the occurrence of a small corneal infiltrate that healed with a short course of topical antibiotics. Unfortunately, because of his vision, he cannot perform his tasks as a carpenter anymore. Which is your recommended treatment for both eyes?

Purpose: To evaluate the role of the first eye vault after the implantation of implantable collamer lens (ICL) V4c in selecting ICL size for the second eye and analyze the changing characteristics of the vault.

Setting: Qingdao Eye Hospital of Shandong First Medical University.

Design: Retrospective case series.

Methods: In this retrospective study, 509 patients (1018 eyes) receiving bilateral ICL V4c implants were evaluated. Surgical management method was as follows: the vault was measured at 2 hours after the first eye surgery, and we selected ICL size for the second eye based on the vault of the first eye. The bilateral vault was measured and evaluated between different periods of follow-up.

Results: The rate of ICL re-alignment or exchange due to abnormal vault was 1.47% (15/1018), with the second eye showing a significantly lower incidence (0.39%) compared to the first eye (2.55%)(P<0.01). Patients were categorized into four groups based on the vault value obtained at 2 hours postoperatively (baseline). There was significant difference in the value of vault decrease among the four groups at 1day, 1week, 1month, and 3months follow-up(all P<0.01). There was a significant positive correlation between the decrease in the vault and the baseline vault(all P < 0.01).

Conclusion: Selecting the ICL size for the second eye based on the first eye's vault measurement 2 hours postoperatively can effectively minimize the need for further surgeries. Notably, eyes with a higher initial vault experienced a more pronounced decrease.

Purpose: To assess the myopic shift in unilateral cataract children undergoing primary intraocular lens implantation and its association with preoperative ocular parameters.

Setting: Single center.

Design: Retrospective study.

Method: Children who underwent unilateral primary IOL implantation and followed up for 3 years were included. Myopic shift and preoperative ocular parameters were compared between the treated and the fellow eyes. The correlation between myopic shift and ocular parameters was assessed using partial correlation analysis. Potential factors influencing myopic shift were determined using linear regression analysis.

Results: A total of 126 patients (252 eyes) were included. Longer preoperative axial length (AL) and steeper average keratometry (AK) in the treated eyes were noted in the whole cohort and patients aged 2 to <4 years (all p < .05). At 3 years postoperatively, mean myopic shift ranged from 3.53 diopters for children aged 1 to <2 years to 1.99 diopters for the ≥6 years. A greater myopic shift in the treated eyes was found in all except children aged ≥6 years (p > .05). Preoperative interocular AL difference (IALD) was negatively correlated with myopic shift (r = 0.32, p < .001). Regression analysis revealed that younger age and smaller IALD were associated with greater myopic shift (p < .001 and p = .001, respectively).

Conclusion: A greater myopic shift was observed in children with younger age at surgery and smaller IALD. To mitigate long-term anisometropia, selecting target refraction for unilateral pediatric cataracts should consider children's age, refractions of the fellow eyes, and preoperative IALD.

Purpose: This study compares visual and refractive outcomes and postoperative axis alignment for toric Implantable Collamer Lens (ICL) implantation in astigmatic myopia using manual versus digital marking techniques.

Setting: Department of Ophthalmology, Medical University of 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 includes 20 patients and 40 eyes. Preoperative visual and refractive parameters showed no significant differences. Postoperatively, residual astigmatism (p=0.824) and spherical equivalent (p=0.309) were comparable. No notable differences between right and left eyes in terms of preoperative (p=0.371) and postoperative (p=0.824) astigmatism were observed. Although slight, corrected distance visual acuity (CDVA) increased in both groups postoperatively (p=0.381). Gain in CDVA was comparable between marking techniques (p=0.637). Safety and efficacy indices were comparable (p=0.991 and p=0.189, respectively). Postoperative axial misalignment was 2.8±3.1 degrees in the digital- and 4.4±5.1 degrees in the manual group (p=0.260). Vector analysis showed no significant differences between manual and digital marking. Duration remained uninfluenced by the marking technique (p=0.970) and side of surgery (p=0.682).

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

Purpose: To evaluate the rotational stability and visual performance of the enVista toric intraocular lens (IOL) (MX60ET) in cataract patients with pre-existing astigmatism.

Setting: 6 US sites.

Design: Prospective, multicenter.

Methods: Cataract patients ≥18 years with pre-existing astigmatism (0.77 D to 4.53 D) underwent phacoemulsification and implantation of enVista toric IOL (MX60ET). Outcome measures were the proportion of patients with absolute IOL axis rotation of ≤5°, uncorrected and corrected distance visual acuities (UDVA and CDVA) at 4 m, uncorrected intermediate visual acuity (UIVA) at 66 cm, manifest refraction, and adverse events (AEs). The patients were followed up on Days 1-2, 7-14, 30-60, and 120-180.

Results: Mean astigmatism of 101 eyes (101 subjects) reduced from 1.47 ± 0.64 D preoperatively to 0.38 ± 0.38 D at Days 120-180 (p <0.001) with 88.1% (N=89/101) of eyes achieving astigmatism within 0.75 D. Mean postoperative UDVA and UIVA were 0.10 ± 0.16 and 0.25 ± 0.15 logMAR respectively. While 79.2% (N=80/101) of patients had postoperative UDVA of 20/32 or better, 63.9% (N=62/97) had UIVA of 20/40 or better. The mean toric IOL rotation from the operative visit to Days 30-60 was 1.97 ± 2.06° with 97.4% (N=74/76) of eyes showing toric IOL rotation of 5˚ or less.

Conclusion: The enhanced enVista toric IOL (MX60ET) demonstrated excellent rotational stability and astigmatic outcomes indicating good efficacy of the IOL for the correction of astigmatism during cataract surgery.