Journal of cataract and refractive surgery最新文献

Purpose: Distinguishing early Keratoconus (KC) from normal corneas is challenging owing to their striking similarities. The aim of our study was to identify discriminating parameters to differentiate a normal cornea from a Form Fruste Keratoconus (FFKC) with the Swept-Source (SS) OCT-topography CASIA 2 (Tomey,Japan) using machine learning artificial intelligence algorithms.

Setting: The study was monocentric, carried out in Bordeaux.

Design: This was a retrospective study, case control.

Methods: Three groups were included: KC group (108 eyes), FFKC (88 eyes) and normal corneas (162 eyes).The data were analyzed and processed using the Dataiku data science platform. Machine learning models (Random Forest, Logistic Regression) were used to develop a multiclass classifier for automated early KC detection. The models were trained using a training database and tested using a test database. Then algorithms were compared to the Ectasia Screening Index (ESI), which is an OCT-topography inherent screening score for ectasia.

Results: The Logistic Regression (LR), and Random Forest (RF) detected FFKC with an AUC of 0,99, and 0,98 respectively. The sensitivities of LR (100%), RF (84%) were better than the ESI (28%) for the diagnosis of FFKC. However, ESI has a maximum specificity (100%) compared to the RL (100%) and 90% for RF.

Conclusion: This study identified discriminating topographic parameters to be considered in refractive surgery screening on SS-OCT CASIA 2. We developed an algorithm capable of classifying normal eyes versus FFKC cases, with improved performance compared to the ESI score.

Rotational stability is key for optimizing postoperative visual outcomes because even a small degree of rotation of a toric intraocular lens (IOL) from its target axis can result in a significant reduction in astigmatic correction. This systematic review and meta-analysis evaluated the rotational stability of toric IOLs of different lens models and haptic designs. All published studies and clinical trials that investigate postoperative rotation of toric IOLs were searched and evaluated. Quality of studies was assessed using the Methodological Index for Nonrandomized Studies scale. A single-arm meta-analysis was performed in R4.3.1 software with subgroup analysis performed based on lens model and haptic design. 51 published studies of 4863 eyes were included in the meta-analysis. The pooled mean absolute rotation of all toric IOLs was 2.36 degrees (95% CI, 2.08-2.64). Postoperative rotation is dependent on many aspects of lens material and design. Modern commercially available toric IOLs exhibit exceptional rotational stability.

Descriptive abstract: One of the most impactful recent developments in the glaucoma community has been the concept of interventional glaucoma. In brief, this paradigm shift involves proactive rather than reactive intervention to address glaucoma earlier in the disease process, including in both standalone and combination-cataract settings. By intervening earlier with minimally-invasive surgical, laser, or drug-delivery treatments instead of prolonged topical medications, interventional glaucoma aims to take the burden of medication compliance off the patient. It also allows for standalone surgical interventions rather than letting cataract surgery dictate the glaucoma treatment plan. This interventional mindset has been made possible by the increasing diversity and availability of effective minimally-invasive treatment options. With these options as a springboard, it is time to reevaluate and advance the traditional glaucoma treatment paradigm.

Purpose: To compare intraindividually the incidence and intensity of posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates between two similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) differing slightly in their particular material, optic surface and sharp posterior edge design over a period of 3 years.

Setting: Department of Opthalmology, Medical University Vienna.

Design: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison.

Methods: 100 patients randomly received a Vivinex XY1 IOL in one eye and a Clareon CNA0T0 IOL in the fellow eye. The amount of PCO (score: 0 - 10) was assessed subjectively and objectively with digital retroillumination picturs using automated image analysis software (AQUA). Best-corrected distance visual acuity (CDVA) as well as the presence of glistenings, subjective visual symptoms and Nd:YAG laser capsulotomy rate were noted.

Results: 67 of 100 patients were available for the 3-years follow-up examination. The objective PCO score of the Vivinex XY1 IOLs was 1.0 ± 1.0 compared to the PCO score of 1.5 ± 1.2 for the Clareon CNA0T0 IOLs (p < 0.001). 7.5% of patients had a neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy in the Vivinex XY1 eye, and 9.0% had a capsulotomy in the Clareon CNA0T0 eye (p = 1.0).

Conclusion: Both hydrophobic acrylic IOLs showed low PCO and YAG rates with a small but significant favor of the Vivinex XY1 IOL compared to the Clareon CNA0T0 IOL. The interaction of various factors such as hydrophobic material, smooth optic surface and sharp posterior optic edge is the major key for PCO prevention.

Purpose: To evaluate and compare the dynamic vault range (DVR) as well as the asymmetry of the vault during a 3-month follow-up after the implantation of two posterior chamber phakic intraocular lenses (pIOLs).

Setting: Aver Clinic, Madrid, Spain.

Design: Prospective comparative study.

Methods: One hundred and nineteen eyes (65 patients) that underwent refractive surgical correction with implantation of one of two distinct pIOLs were enrolled: Eyecryl Phakic from Biotech Vision Care (Eyecryl group, 72 eyes) and Evo Visian Implantable Contact Lens from Staar Surgical (ICL group, 47 eyes). Besides evaluation of visual acuity, refraction, and ocular integrity, the pIOL vault was measured centrally and at 2 mm nasally and temporally as well as the DVR from photopic (50 lux) to mesopic (10 lux) illuminations conditions.

Results: No significant differences were found between pIOL groups in visual and refractive outcomes (p≥0.454). No significant differences between groups were found in central (523.72±168.4 vs. 494.16±156.7 µm, p=0.248) and temporal vault (499.43±155.8 vs. 431.28±150.5 µm, p=0.067). However, nasal vault was significantly lower in ICL group (465.6±149.1 vs. 375.4±144.0 µm, p=0.045). A trend to a larger DVR was observed in the ICL group, although differences between groups did not reach statistical significance (54.00±36.39 vs. 86.5±57.9 µm p=0.070). The pIOL diameter only correlated significantly with vault measurements in ICL group (r≥0.650, p<0.001).

Conclusions: The Eyecryl pIOL shows more symmetric vaults and a trend to fewer light-induced changes in the central vault compared to the ICL pIOL. The clinical relevance of this finding should be investigated further.

Purpose: To report functional and refractive outcomes of manual arcuate keratotomy (AK) with compression sutures for high regular postkeratoplasty astigmatism.Setting: not specified (review).

Design: Retrospective analysis.

Methods: This study included 90 eyes with high regular postkeratoplasty astigmatism (>4 diopters, D) who received AK with compression sutures between 2010 and 2022. Functional and refractive outcomes were assessed by evaluating topographic indices and by performing vector astigmatism and Fourier analysis.

Results: At last follow-up (mean=13.7±16.6 months), BCDVA improved from 0.59±0.28 logMAR to 0.34±0.25 logMAR. Cylinder magnitude decreased from 9.91±2.88 D to 5.42±3.35 D. Surface Asymmetry Index, Irregular Astigmatism Index, Corneal Eccentricity Index were equal to preoperative values, whereas Surface Regularity Index approached normal values at last follow-up. Fourier analysis indicated a decrease in the regular astigmatic component, whereas non-regular components (asymmetry and higher-order irregularity) remained stable. In vector astigmatism analysis, Target Induced Astigmatism magnitude was 9.92±2.86 D and Surgically Induced Astigmatism magnitude was 10.16±4.86 D (Correction Index of 0.91±0.48) with a Difference Vector of 5.42±3.35 D at last follow-up. Correction of astigmatism magnitude was adequate in 40% of the eyes, under-corrected in 30% and over-corrected in 30%. Angle of Error was <|22.5°| in 88% resulting in a low risk of off-axis treatment.

Conclusion: AK with compression sutures is a simple, relatively effective and safe surgical procedure for astigmatism reduction after keratoplasty. In case of regular astigmatism, the procedure does not increase corneal irregularities. The remaining refractive error might be further corrected by spectacles, contact lenses or toric IOL implantation (in-the-bag / add-on), thus reducing the need for repeat keratoplasty.

Purpose: To investigate the extracellular matrix and cellular components in lens capsules extracted from patients with dead bag syndrome (DBS) through immunohistochemistry.

Setting: Department of Ophthalmology, Wakayama Medical University School of Medicine, Wakayama, Japan, and Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design: Immunohistochemical experimental study.

Methods: 9 capsular bag specimens from DBS cases, as well as 2 control specimens from late-postoperative in-the-bag intraocular lens dislocation cases related to previous vitrectomy, pseudoexfoliation, and blunt trauma were included. They were processed for histopathology; unstained sections were obtained from each one and analyzed by immunohistochemistry targeting collagen type IV, laminin, vimentin, collagen type I, and fibronectin.

Results: Immunohistochemistry in DBS showed lens capsule stained for basement membrane components. The outer part of the anterior capsule that was split from the inner part was more markedly stained for type IV collagen as compared with the posterior part. Faint staining for fibrous posterior capsular opacification (PCO) components, for example, collagen type I and fibronectin, was detected in limited areas, but the major portion of the capsule was free from these components. Small spotty vimentin-positive materials, suggesting the presence of cell debris, were also detected in limited samples.

Conclusions: Small amounts of fibrotic PCO components were detected in capsules extracted from patients with DBS, but their major parts were free from PCO components. Current findings suggest small amounts of lens epithelial cells were present after surgery and secreted fibrous components before undergoing cell death process.

A 65-year-old man had uneventful cataract surgery in the right eye with a toric diffractive intraocular lens (IOL) placed fully within the capsule bag. On postoperative day 1 and week 1, the IOL was well positioned and his eye was healing normally. The plan was to proceed with cataract surgery in the left eye in the near future. One month postoperatively, he presented with blurred vision, glare, and halos and was noted to have iris prolapse out of the temporal clear corneal main incision. Of interest, the patient reported some itching and eye rubbing in the early postoperative period. He was taken back to surgery by the referring doctor, and despite 2 heroic attempts to reposit and save the iris tissue, there was significant iris loss causing transillumination defects and debilitating glare and halos. Ocular examination revealed an uncorrected distance visual acuity (UDVA) of 20/40 - 2 J3 and binocular corrected distance visual acuity (CDVA) 20/30 J1 in the right eye and UDVA of 20/60 J3 and binocular CDVA of 20/25 J1 in the left eye. Manifest refraction was -0.25 -1.25 × 155 in the right eye and plano -2.25 × 090 in the left eye. Fortunately, there was no relative afferent pupillary defect, and intraocular pressures were normal off all drops. On slitlamp examination of the right eye, pertinent findings revealed a protective ptosis, trace conjunctival injection with 1 large subconjunctival polypropylene flange at 8:30 o'clock 1.5 mm from the limbus and 1 exposed irregular polypropylene flange eroded through the conjunctiva at 10 o'clock 0.5 mm from the limbus (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202408000-00019/figure1/v/2024-07-30T221851Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202408000-00019/figure2/v/2024-07-30T221851Z/r/image-tiff). There was a localized area of erythema and scleral thinning surrounding the exposed flange. The cornea was edematous over the main incision. The iris was disinserted with atrophic changes and a residual iridodialysis extending from 8:30 to 10 o'clock. The trifocal IOL was fully in the capsule bag with trace fibrosis of the capsule and rotated approximately 7 degrees off the capsulotomy tab, designating the intended axis of 1 degree. The anterior chamber was deep and quiet, and the posterior segment was unremarkable with a 0.45 cup-to-disc ratio. Pertinent examination findings in the left eye included a 2 + NS cataract and a 0.45 cup-to-disc ratio. The remainder of the examination was otherwise unremarkable. What testing and surgical plan would you offer this patient? How would you counsel regarding postoperative expectations?