Journal of cataract and refractive surgery最新文献

Purpose: To investigate the accuracy of three distinct postoperative toric intraocular lens (TIOL) rotational stability measurement methods.

Setting: Department of Ophthalmology and Optometry, Medical University of Vienna, Austria.

Design: Single-center, prospective, interventional clinical trial.

Methods: 128 eyes of 81 patients with age-related cataract received a hydrophobic acrylic TIOL Clareon CNW0T3-9. To evaluate rotational stability, three distinct assessment methods were used: (Rotix) comparing the TIOL axis at the end of surgery (EoS) to 1 week (1w) and 6 months (6m) postoperatively using reference vessels at the sclera, (Slit-lamp) comparing the intended axis (IA) with the axis at 1w and 6m using slit-lamp photography using the horizontal axis as a reference and (Casia) comparing the IA with the axis at 1w and 6m using the axis determination tool of a swept-source anterior segment optical coherence tomographer (Casia 2).

Results: Mean absolute rotation from EoS/IA to 6m differed significantly among Rotix (1.33± 1.99° [0.01;19.80]), Casia (2.88± 2.64° [0.00; 19.00]), and Slit-lamp (4.38± 3.38° [0.02;19.38]), as indicated by Friedman's test (X2=71.852, p<0.001). Bland-Altman coefficients (CoR) of repeatability indicated the closest agreement of results between Casia and Rotix, with a CoR of ±3.95°, followed by Slit-lamp and Casia (±6.82°), and lastly, between the Slit-lamp and Rotix (±7.19°).

Conclusion: When assessing true TIOL rotational stability, it is imperative to use fixed anatomical landmarks as reference and establish a baseline at the end of surgery. When assessing TIOL rotation along the horizontal axis, considering cyclorotation of the eye is crucial and must not be underestimated.

Purpose: To compare the prediction errors of several thick IOL formulas to a thin lens approach using variations of the same paraxial vergence calculation formula.

Setting: Department of Ophthalmology, Randers Regional Hospital, Denmark.

Design: Prospective, non-interventional study.

Methods: We prospectively and consecutively performed optical low coherence reflectometry biometry in 132 eyes with subsequent phacoemulcification and insertion of the same aspherical IOL model. Clinical refraction was performed two months postoperatively. We retrospectively used the same paraxial vergence formula and varied only the methods for calculating the postoperative IOL position, thickness, and curvatures to construct four formulas: Næser I formula based on thick lens calculation using the manufacturer´s cutting card information; Næser II formula based on thick lens calculation using calculated IOL data from open sources; Næser III formula based on thick lens calculation and a fixed IOL thickness of 0.62 mm; Næser IV formula based on thin lens calculation with fixed IOL position 0.31 mm anterior to the postoperative capsule. Each formula was optimized separately, hereby assuring a mean error of zero. The prediction error (PE) was defined as the difference between the measured and predicted spherical equivalent refraction.

Results: Mean absolute error amounted to 0.30 (±0.26) D for all four formulas with no statistically significant difference. PE averaged zero for short, normal, and long eyes.

Conclusions: The additional optical information provided by thick IOL calculations appears insignificant compared to other sources of error, related to the accuracy of IOL manufacturing, natural lens refractive index, and postoperative refraction.

Purpose: To investigate the anterior segment morphology in cataracts with Retinitis Pigmentosa (RP).

Setting: XXXX (anonymized for review) University Hospital.

Design: A retrospective matched case-control study.

Methods: The analysis included 28 eyes of 28 patients with cataracts and RP and 28 eyes of 28 patients with cataracts but without RP, matched for age and sex. Lens thickness, anterior lens curvature (Front R), posterior lens curvature, anterior chamber depth (ACD), anterior chamber width, central corneal thickness (CCT), white-to-white distance (WTW), corneal curvature, and axial length (AL) were compared between the groups. Data were obtained from preoperative evaluations conducted before cataract surgery. The same set of comparisons was also conducted for 18 eyes of 18 patients with cataracts and RP and 18 eyes of 18 patients with cataracts but without RP, matched for age, sex, and AL. Cases including missing data, categorized as Emery-Little classification grade 4 or above, or those with a history of acute angle closure were excluded.

Results: In the age- and sex-matched analysis, cataracts with RP showed significantly a thicker lens, steeper Front R, shallower ACD, thinner CCT, and shorter AL. In the analysis matched by age, sex, and AL, cataracts with RP had a thicker lens, steeper Front R, and larger WTW.

Conclusions: Cataracts with RP demonstrated centripetal swelling of the lens, centrifugal corneal thinning, and AL shortening. A decrease in tension between the lens and eyeball wall due to zonular weakness in the RP may lead to swelling of the lens and horizontal flattening of the eyeball.

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 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.

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.

Purpose: To assess the power profile and optical performance of 2 extended range-of-vision (ERV) intraocular lenses (IOLs), TECNIS Eyhance (ICB00) and LuxSmart, and compare them with their monofocal counterpart lenses with similar platforms and materials: TECNIS 1-piece (ZCB00) and LuxGood, respectively.

Setting: Optics and Optometry Faculties of Complutense University (Madrid) and Universitat Politècnica de Catalunya BarcelonaTech (Terrassa) in Spain.

Design: Laboratory investigation on optical bench.

Methods: For each design, the power distribution and (fourth and sixth-order) spherical aberration (SA) across the lens aperture were measured as well as the optical performance using modulation transfer function-based metrics with through-focus evaluation. 3 nominal powers (+10.00 diopters [D], +20.00 D, and +30.00 D) and 3 pupil sizes (2.0 mm, 3.0 mm, and 4.5 mm) were considered to assess whether the base power of the lens and pupillary dynamics have an influence on the depth-of-focus extension.

Results: TECNIS Eyhance and LuxSmart IOLs had different power and SA profiles, but both designs shared a positive add power in their central region in comparison with their monofocal counterparts. LuxSmart had a greater add power while TECNIS Eyhance showed higher peak optical quality but smaller depth of focus.

Conclusions: Differences of focus extension between the 2 ERV IOL designs are related to differences of power and SA profile. The nominal base power of the IOLs has little effect on their optical quality. However, pupil dynamics plays a key role since it determines the effective add power and optical performance of the ERV IOLs.

Purpose: To explore the severity of posterior capsule opacification (PCO) using objective detection techniques and its relationship with visual acuity.

Setting: The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Design: Prospective cohort study.

Methods: All patients underwent slitlamp examination, intraocular pressure (IOP) measurement, and corrected distance visual acuity (CDVA) testing before Nd:YAG laser capsulotomy, and examination, after fully dilated, with: IOLMaster 700, optical coherence tomography (OCT), Sirius Topographer (CSO) anterior segment analysis, and color fundus photography (CFP). CDVA and IOP were taken post treatment. Thickness and density of the posterior capsule, CFP quality (CFPQ) and OCT signal strength (OCTSS) were recorded. Analysis used Spearman correlation, heatmaps, and receiver operating characteristic curves.

Results: 83 eyes in 78 patients were included in this study. Spearman correlation analysis revealed correlations between pretreatment CDVA and IOLMaster 700 PCO thickness (MT), IOLMaster 700 cumulative effect (MCE), Sirius PCO thickness (ST), Sirius maximum density (SMD), Sirius cumulative effect (SCE), OCTSS, and CFPQ (correlation coefficients were 0.500, 0.484, 0.465, -0.256, 0.317, -0.442, -0.412, all P < .05). The improvement of vision acuity (ImpVA) showed correlations with MT, MCE, ST, SCE, OCTSS, and CFPQ (correlation coefficients were -0.452, -0.471, -0.346, -0.278, 0.320, 0.381, all P < .05). For ImpVA, the predictive ability of IOLMaster 700 was superior to Sirius, and the joint model was significantly better than single factors.

Conclusions: Posterior capsule thickness and cumulative effect were reliable indicators for evaluating PCO. Compared with Sirius, the IOLMaster 700 demonstrated superior predictive ability and higher correlation.