Journal of cataract and refractive surgery最新文献

Purpose: To evaluate intraocular lens (IOL) rotational stability and capsular fusion process after cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC).

Setting: Fujian Provincial Hospital, Fujian, China.

Design: Prospective, intraindividual, randomized clinical trial.

Methods: This study included 56 adult patients (112 eyes) with bilateral cataract undergoing phacoemulsification cataract surgery with PPCCC in one eye (PPCCC group) and conventional cataract surgery in the contralateral eye (NPCCC group). IOL axis orientation and fusion footprint length were measured at 1 day, 1 week, 1 month, 3 months, and 1 year after surgery using OPD-Scan III, while capsular bend index (CBI) was assessed at the same time points using Pentacam AXL.

Results: No between-group difference was found in the absolute rotation from 1 day to 1 year (2.93 ± 1.72 vs 2.66 ± 1.61 degrees, P=0.54). The absolute rotation from 1 week to 1 month in NPCCC group was higher than that in PPCCC group (1.65 ± 0.68 vs 1.27 ± 0.32 degrees, P=0.01). At 1 month after surgery, both fusion footprint length (9.11 ± 2.74 vs. 10.67 ± 2.06 mm, P = 0.02) and CBI (2.92 ± 0.60 vs. 3.25 ± 0.59, P = 0.03) were lower in NPCCC group.

Conclusion: Cataract surgery involving PPCCC demonstrates comparable outcomes to conventional procedures regarding long-term IOL rotational stability, therefore is a promising option for adult cataract patients scheduled for toric IOL implantation. PPCCC slightly reduces IOL rotation in the early postoperative period, which can be attributed to accelerated capsular fusion.

Purpose: To compare the efficiencies of the Active Sentry handpiece at low IOP (20 mmHg) to the Ozil handpiece at high IOP (50 mmHg).

Setting: Private practice (Medford, OR, USA).

Design: Single site, prospective, double-arm, randomized, contralateral eye study.

Methods: The first operated eye was randomized to receive phacoemulsification with either the Active Sentry handpiece at 20 mmHg (Active Sentry group) or the Ozil handpiece at 50 mmHg (Ozil group). The second operated eye was assigned to the other group. Outcome measures included phaco time, total aspiration time, aspiration time during phaco, fluid use, cumulative dissipated energy, total torsional time, total longitudinal time, and central corneal thickness.

Results: A total of 36 subjects (72 eyes) completed the study. Mean total aspiration time was 90.1 ± 16.4 s in the Active Sentry group and 85.1 ± 17.0 s in the Ozil group (p > 0.05). Mean aspiration time during phaco was 40.9 ± 8.5 s in the Active Sentry group and 40.4 ± 8.8 s in the Ozil group (p > 0.05).Mean total phaco time was 29.5 ± 7.3 s in the Active Sentry group and 31.0 ± 7.4 s in the Ozil group (p > 0.05). Mean total fluid volume was 32.8 ± 4.6 mL in the Active Sentry group and 33.8 ± 6.0 mL in the Ozil group (p > 0.05).

Conclusions: The results of this study suggest that the efficiencies of the Active Sentry handpiece at low IOP settings and the Ozil handpiece at high IOP are similar.

Purpose: To evaluate the risk of zonular dialysis (ZD) in fellow eye phacoemulsification cataract surgery and to identify risk factors, including prior first eye ZD.

Setting: 8 United Kingdom National Health Service clinical centers.

Design: Retrospective database study.

Methods: We calculated the overall risk of ZD in the fellow eye and reported the odds ratio (OR) for the various risk factors, including first eye ZD. The main outcome measures were the risk and the predictors of intraoperative ZD in the fellow eye.

Results: There was a total of 66,288 patients. At the time of the first surgery, the mean age of patients was 75.3±10.2 years, and 39.2% were males. Intraoperative ZD occurred during the first eye surgery in 333 patients (0.5%) and the fellow eye in 349 patients (0.5%). The risk of fellow eye developing ZD in patients with first eye ZD was higher than in patients without first eye ZD: 23/333 patients (6.9%) vs. 326/65,955 patients (0.5%) (p<0.001, unadjusted OR=14.9). In the adjusted logistic regression model, first eye ZD was the most significant risk factor (OR=13.3, 95% confidence interval (CI) =8.2-21.7). Other significant covariates of ZD in the fellow eye were pseudoexfoliation (OR=6, CI=3.8-9.7), previous pars-plana vitrectomy (OR=4.5, CI=1.1-18.5), and poor pupillary dilatation (OR=2.2, CI=1.4-3.3).

Conclusions: The most important risk factor for the development of ZD in the fellow eye during cataract surgery was the occurrence of ZD in the first eye. Our findings have implications for patient counseling and surgery allocation.

Purpose: To evaluate the accuracy of several intraocular lens (IOL) formulas for patients with endothelial dystrophy (ED) without edema treated with cataract surgery alone.

Setting: One academic, tertiary referral center.

Design: Comparative retrospective cohort study.

Methods: We assessed the predicted refractive results of ED patients who underwent cataract surgery and compared them to a matched control group. The accuracy of five different IOL formulas Haigis, Holladay 1, Barrett Universal II, SRK/T and Kane was evaluated and compared between the groups. The standard deviations of the prediction error of all formulas were compared.

Results: The study included 221 eyes. Fifty (23%) eyes of patients with ED and 171 (77%) control eyes. There was no significant difference between the two groups in clinical and demographical characteristics (P>0.05). The postoperative spherical equivalent was -0.37 D in the ED group and -0.30 D in the control group (P=0.8). Overall, both groups had a comparable standard deviation of the prediction error (PE) and absolute PE (APE) in all formulas (p>0.05). In the ED group, APE was 0.34 D for Haigis, 0.32 D for Holladay1, 0.32 D for Barrett Universal II, 0.38 D for SRK/T and 0.32 D for Kane formulas. No statistically significant difference between formulas was found.

Conclusion: The prediction accuracy of IOL power calculation in patients with ED was found comparable both between formulas and in comparison with healthy controls. This suggests that in patients with guttate without edema the IOL power calculations are as effective and accurate as in healthy eyes.

Purpose: AT ELANA is a recently introduced trifocal intraocular lens (IOL) made of a hydrophobic material. The new IOL's optical function was examined against an equivalent version made of hydrophilic material. .

Setting: The David J. Apple Center for Vision Research, Heidelberg, Germany.

Design: Laboratory investigation.

Methods: This optical investigation was conducted on +20D samples of the AT ELANA and the AT LISA tri. The area under the modulation transfer function (MTFa) served as a quality criterion. Simulated visual acuity (VA) and defocus curves across +1 to -3.5D range were derived from an empirical formula according to ANSI Z80.35. Susceptibility to photic phenomena was evaluated by assessing the light distribution around a point light source.

Results: The two models demonstrated comparable optical quality. While at distance, a 4% improvement was noted with the AT LISA tri, the AT ELANA's near MTFa was 5% higher. Only a marginal difference (1%) was noted at intermediate. Both IOLs reached simulated VA of 0.0 logMAR far vision, 0.10 logMAR at 80 cm, and 0.05 logMAR at 40 cm. Still, the near range was slightly expanded with the hydrophobic model. The light-spread profile was comparable between the two trifocals.

Conclusions: The AT ELANA and the AT LISA tri demonstrated comparable optical quality and similarities in the potential for inducing photic phenomena. This study suggests that the hydrophobic trifocal IOL may provide visual range comparable to its hydrophilic counterpart. However, the asphericity change may facilitate the selection of a model that more effectively addresses specific corneal aberrations.

Purpose: To investigate whether standard keratometry (K) or total corneal power (TCP) leads to more accurate refractive outcomes for intraocular lens (IOL) power calculation.

Setting: Public hospital.

Design: Retrospective evaluation of a diagnostic test instrument.

Methods: Preoperatively, all patients underwent optical biometry with Anterion, a swept-source optical coherence tomography device providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision, and accuracy were evaluated by means of the robust 2-sample t test. Cochran Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied.

Results: Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness because of constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: P = .02 and accuracy: P = .03) and Haigis ( P < .01 for both precision and accuracy) formulas. No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold.

Conclusions: With most formulas, IOL power calculation is not more accurate when TCP is used instead of K.

Purpose: To assess the reliability of a novel virtual IOL implantation device to predict the outcomes of a trifocal IOL.

Setting: Clinical sites in Spain and Germany.

Design: Prospective multicenter study.

Methods: Preoperative measurements obtained by the virtual implantation of AT LISA tri 839MP IOL (Carl Zeiss Meditec AG, Jena, Germany) with VirtIOL device (10Lens S.L.U., Terrassa, Spain) were compared to postoperative (month 3) outcomes following the IOL implantation. Evaluated metrics were defocus curve, contrast sensitivity (both in photopic conditions), and visual phenomena (visual angle size of burst and annular pattern) in mesopic conditions.

Results: The study included 45 presbyopic non-cataract patients (mean age 56.16±5.03 years). VirtIOL device reasonably predicted the shape of the defocus curve, especially in the intermediate vision range, but underestimated postoperative visual acuities mainly at the defocus range between +1.0D and -3.5D. The difference between predicted and achieved visual acuity was -0.11±0.13 logMAR (p<0.001) for 0.0D defocus and -0.16±0.15D logMAR (p<0.001) for -2.50D defocus. The shape of the contrast sensitivity curve was almost identical for predicted and achieved measurements, but the device underestimated the values by ≈0.3 logCS units for each spatial frequency. Visual phenomena were similar between the predicted and achieved outcome (predicted vs. achieved: burst pattern 2.65±0.97° vs. 2.74°±0.95°, p=0.63; annular pattern: 0.88±0.42° vs. 0.93±0.49°, p=0.59).

Conclusion: The device reasonably predicted the pattern of measured variables. Visual acuity/contrast sensitivity reduction might be attributed to viewing the objects through a more complex optical system and would need to be accounted for in clinical studies.

Purpose: To evaluate CT Lucia 602 intraocular lenses (IOLs) implanted in cases lacking capsular support, and explanted because of decentration/dislocation with subsequent pathological analysis. The main objectives were to a) document the status of haptics, and b) verify the presence of the "rotisserie" effect.

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

Design: Case series with clinicopathological correlation.

Methods: 13 explanted CT Lucia 602 lenses were included, 12 implanted via the Yamane technique, and 1 that was iris-fixated. Four lenses were explanted between October 2020 and February 2022. Nine lenses, explanted between November 2022 and February 2024 also exhibited severe optic tilt, leading to explantation. A chart review was performed to obtain clinical information from each case. Explanted lenses underwent gross and microscopic examination for haptic status and rotation, in the dry state (room temperature) and after hydration (body temperature).

Results: Time between implantation and explantation was longer for lenses explanted before November 2022 (without severe tilt). Among the 26 haptics evaluated, 15 were deformed, 6 were broken, 2 were detached, and 3 were unremarkable. Four haptics of Yamane lenses explanted between November 2022 and February 2024 showed free rotation within the optic insertion, after hydration at body temperature.

Conclusion: Anecdotal reports of the "rotisserie" effect of CT Lucia 602 lenses implanted via the Yamane technique appeared mostly during the second half of 2022, and suggested that affected lenses were from specific batches, which appears to be consistent with the findings of this study.

Topic: To examine the association between virtual postoperative follow-up care and patient outcomes after cataract surgery.

Clinical relevance: Cataract surgery is a safe and commonly performed surgery. Follow-up visits are used to monitor for complications. It is uncertain whether virtual follow-up provides a safe alternative to in-person review.

Methods: Medline, Embase and CINAHL were searched from inception to October 2023 for relevant articles containing original data. Studies that: 1) included patients that were seen in a virtual follow-up (i.e., telephone or video call) for postoperative appointments after cataract surgery, and 2) reported patient outcomes were included. Risk of bias was assessed using the Newcastle-Ottawa and ROB2 assessment tools. Descriptive statistics were used to summarize findings. The review was registered in PROSPERO (registration number, CRD42023477207) and PRISMA guidelines were followed.

Results: The search yielded 1710 records with seven studies included in this review. The seven studies reported on 2113 cataract surgeries in 1994 patients. The studies ranged between 2004 and 2020. Most of the studies (5/7) included only patients with uncomplicated cataract surgery. Virtual follow-ups were all conducted by telephone. The follow-up calls were made at varying timepoints including postoperative day 1 (n= 3), day 7 (n=2) and day 14 (n=1). Two observational studies directly compared patients who had a telephone follow-up to a control group who had an in-person follow-up. There were no significant differences in complication rates (p=0.22) or visual acuity (p=0.28) between these follow-up groups. None of the studies reported serious adverse outcomes from replacing in-person follow-up with telephone follow-up. One study used virtual follow-up in conjunction with in-person visits for elderly patients and found that additional telephone follow-up was associated with decreased surgical recovery time and decreased patient anxiety. Three studies reported on patient perceptions about telephone follow-up. A common theme was that patients preferred telephone reviews and found them to be more convenient than in-person follow-up.

Conclusions: For patients with uncomplicated cataract surgery, virtual follow-ups seem to be a safe alternative to in-person visits and were preferred by patients. These conclusions are preliminary given the limited literature base, and further study is needed.

Topic: To evaluate the complication rates of different IOL placement methods in adults with inadequate capsular bag support.

Clinical relevance: The surgical correction of inadequate capsular bag support for the intraocular lens (IOL) harbors several challenges, and there is a wide-range of surgical procedures.

Methods: For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (i) AC placement, (ii) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL (iii) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of two or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557).

Results: Fifteen studies were included in the final analysis, which reported results of 1,247 eyes. The overall complication rate was non-significantly lower in iris fixation (4.4%; 95%CI: 3.6-5.4%, P=0.150) than in AC placement (7.4%; 95%CI: 6.4-7.9%) and scleral fixation (7.4%; 95%CI: 6.5-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95%CI: 2.4-57.5%, P<0.001), compared to scleral fixation (11.9%; 95%CI: 2.6-21.2%) and iris fixation (4.1%; 95%CI: 0.8-7.3%;). Vitreous hemorrhages were more frequently reported following scleral fixation (8.5%; 95%CI: 6.3-11.2%, P=0.006) than in AC placement (5.4%; 95%CI 3.4-8.5%) and iris fixation, 1.4%; 95%CI 0.4-4.2%), and so was IOL decentration/dislocation (8.9%; 95%CI: 6.7-11.8%, P=0.047 compared to 1.1%; 95%CI: 0.4-3.4% and 4.0%; 95%CI: 2.2-7.3%, respectively).

Conclusion: The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.