Journal of cataract and refractive surgery最新文献

Purpose: To use a combination of partial least squares regression and a machine learning approach to predict intraocular lens (IOL) tilt using preoperative biometry data.

Setting: Kepler University Clinic Linz, Linz, Austria.

Design: Prospective single-center study.

Methods: Optical coherence tomography, autorefraction, and subjective refraction were performed at baseline and 8 weeks after cataract surgery. In analysis I, only 1 eye per patient was included and a tilt prediction model was generated. In analysis II, a pairwise comparison between right and left eyes was performed.

Results: In analysis I, 50 eyes of 50 patients were analyzed. Difference in amount, orientation, and vector from preoperative to postoperative lens tilt was -0.13 degrees, 2.14 degrees, and 1.20 degrees, respectively. A high predictive power (variable importance for projection [VIP]) for postoperative tilt prediction was found for preoperative tilt (VIP = 2.2), pupil decentration (VIP = 1.5), lens thickness (VIP = 1.1), axial eye length (VIP = 0.9), and preoperative lens decentration (VIP = 0.8). These variables were applied to a machine learning algorithm resulting in an out of bag score of 0.92 degrees. In analysis II, 76 eyes of 38 patients were included. The difference of preoperative to postoperative IOL tilt of right and left eyes of the same individual was statistically relevant.

Conclusions: Postoperative IOL tilt showed excellent predictability using preoperative biometry data and a combination of partial least squares regression and a machine learning algorithm. Preoperative lens tilt, pupil decentration, lens thickness, axial eye length, and preoperative lens decentration were found to be the most relevant parameters for this prediction model.

Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.

Purpose: To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL).

Setting: Eye and ENT Hospital of Fudan University, Shanghai, China.

Design: Retrospective propensity score-matched cohort study.

Methods: This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM).

Results: This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group.

Conclusions: The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.

Purpose: To investigate the intraoperative performance and lens fragmentation efficacy of a non-cavitating handheld lensectomy system in mild, moderate, and severe cataract.

Setting: Ambulatory surgical centers.

Design: Retrospective consecutive case series.

Methods: 665 consecutive eyes underwent cataract surgery by 12 surgeons using a new handheld non-cavitating lensectomy system for nuclear fragmentations and extraction. Intraoperative measurements included surgical time, miLOOP pretreatment, and irrigation fluid use.

Results: Of the 665 eyes, 38 (6%), 468 (70%), 126 (19%), and 33 (5%) were of grade 1, 2, 3, and 4 nuclear densities, respectively, as graded by the surgeon intraoperatively. Successful nuclear fragmentation, lens extraction, and cortical removal were achieved in all eyes. Total nucleus fragmentation and extraction times were 70.1 seconds, 100.3 seconds, 132.6 seconds, and 287.9 seconds for grades 1, 2, 3, and 4, respectively ( P < .001). In addition, irrigation and aspiration cortical removal times were 64.1 seconds, 51.1 seconds, 48.5 seconds, and 59.0 seconds, respectively ( P = .14). There was a low rate of capsular tear (3 cases in 665 surgeries, 0.45%) and no other emergent adverse events.

Conclusions: The miCOR handheld non-cavitating lensectomy system demonstrated nuclear fragmentation and extraction in the absence of intraocular cavitation across all grades of nuclear densities.