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Purpose: The aim of this study is to compare optical quality results obtained in laboratory analysis (in vitro) versus clinical data (in vivo). Methods: The optical quality of ISOPure intraocular lens was assessed both in vitro and in vivo using the modulation transfer function (MTF) for 3.0 and 4.5 mm pupil diameters. In vitro measurements were obtained using deflectometer NIMO TRF1504, while in vivo measurements were taken with OPD-Scan III in a set of patients implanted with this lens. Ray tracing techniques were used to determine the MTF and area under MTF curve (MTFa) from the measured wavefront for the isolated lens and for the whole eye. Results: The MTF of the isolated lens obtained under both in vitro and in vivo conditions showed comparable results for both pupil sizes. However, differences were found when comparing the MTF of the whole eye with the lens implanted versus the MTF measured in vitro for 4.5 mm pupil size. Also, the MTFa defocus curve was compared with the defocus curve measured in vivo. Conclusion: The defocus curve from the in vivo study aligns closely with the MTFa of the in vitro model, with a useful defocus range of 0.40D. Thus, it is possible to anticipate the visual results of the implanted isofocal lens by using measurements on an optical bench and conducting optical simulations. Key messages: What is known • Extended depth of focus (EDoF) lenses are prominent for expanding vision range in pseudophakic eyes, exceeding traditional limits. • The ISOPure lens is characterized as a bi-aspheric refractive design that produces an extended depth of focus design. What is new • The MTF of the isolated lens obtained under both in vitro and in vivo conditions showed comparable results. • The defocus curve from the in vivo study aligns closely with the MTFa of the in vitro model, with a useful defocus range of 0.40D. [ABSTRACT FROM AUTHOR]

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Purpose: Uveitis-Glaucoma-Hyphema (UGH) syndrome results from contact between the intraocular lens (IOL) and the iris or ciliary body, leading to uveal structure erosion and blood-aqueous barrier breakdown. Treatment involves various drugs, with IOL removal often being necessary. Diagnosis relies on clinical signs, but imaging techniques like ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT) are crucial. AS-OCT accurately depicts IOL position and potential contact, emerging as a primary alternative to UBM in the diagnosis. Our study aimed to correlate AS-OCT findings with clinically detectable iris atrophy in pseudophakic patients with IOL-iris chafing and UGH syndrome. Methods: The study retrospectively analyzed patients diagnosed with UGH syndrome presenting at the Ocular Immunology Unit of Reggio Emilia, Italy, from January 2019 to August 2023. Patients' data were collected. Ophthalmological exams and imaging were performed. The peephole sign in AS-OCT images was evaluated. Statistical analyses were conducted, with a significance level of p ≤ 0.05. Results: The study reviewed 22 eyes of 22 patients with UGH syndrome. Four eyes were excluded, leaving 18 patients (8 females, 10 males). Common misdiagnoses included idiopathic anterior uveitis (55.5%) and herpetic anterior uveitis (16.7%). All patients had iris transillumination defects, mostly focal (77.8%). AS-OCT revealed IOL chafing in all the eyes, with peephole sign correlation. More peephole signs occurred with IOL in the sulcus (p-value = 0.08). Conclusion: The study recommends AS-OCT for UGH syndrome confirmation and UBM when IOL-iris chafing is not observed on AS-OCT scans. [ABSTRACT FROM AUTHOR]

Purpose: To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts. Design: Retrospective observational case series. Setting: MicroChirurgia Oculare, Italy. Methods: A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes. Results: 113 eyes of 86 patients (mean age 70.3± 7.9 years) were included (mean follow-up: 48.3± 25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53± 0.4 to 0.31± 0.3 (n=113, p< 0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45± 0.2 to 0.37± 0.2 (n=77, p< 0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported. Conclusion: Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL's ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: To share examination findings of the lens capsule which may act as an indicator for malpositioned intraocular lenses (IOL). Setting: Single large multi-specialty private practice, Houston, Texas, USA. Design: Focused, observational case series. Methods: A review of pre-operative images of malpositioned single-piece IOLs with at least one haptic in the ciliary sulcus was conducted. The review included five cases who were referred to a single large multi-specialty private practice from June 2023 to December 2024 for an evaluation of posterior capsular opacification (PCO) and potential Nd:YAG capsulotomy. Findings: A total of five eyes which previously had undergone cataract surgery and were referred for Nd:YAG capsulotomy for PCO were identified on slit lamp examination to have capsular waves, defined as a centripetal and circumferential striated pattern of PCO that results from a fused anterior and posterior capsule with at least part of the IOL anterior to the capsule. While one eye exhibited transillumination defects and pigment dispersion, the remainder of eyes did not. In some cases, the capsular wave was the only clue to IOL malpositioning due to a small pupil. These eyes had single-piece IOLs with at least one haptic in the sulcus and required subsequent IOL repositioning or exchange. Conclusion: If capsular waves are seen on slit lamp exam, a thorough inspection of IOL placement should be conducted, especially before treatment with Nd:YAG capsulotomy. Capsular waves result from anterior and posterior capsule contact with an anteriorly situated IOL. This finding is a potential indicator of at least part of an IOL positioned anterior to the anterior capsule. [ABSTRACT FROM AUTHOR]

Purpose: This study is to evaluate the optical characteristics of a non-diffractive wavefront-shaping intraocular lens which incorporates surface refractive modifications for shaping the wavefront in order to achieve extended depth of focus (EDoF) and to assess whether the nominal power of this IOL influences the attainable add power. Methods: A commercially available optical bench NIMO TR1504 device (LAMBDA-X, Nivelles, Belgium) was employed to obtain full optical characterization of three non-diffractive EDoF intraocular lenses with + 10 D, + 20 D, and + 30 D powers. After NIMO measurements, data were computed using a custom-made MATLAB program (Mathworks, Inc., Natick, MA, USA) to evaluate the optical quality functions, such as the point spread function (PSF), wavefront profiles, and modulation transfer function (MTF) for two pupil sizes: 3 mm and 4.0 mm. Results: The non-diffractive EDoF intraocular lens showed a central serrated power profile behavior with additions of + 2.00 to + 2.50 D over the nominal power. Higher order aberrations were found to be driven mainly by the spherical aberration, with almost null comatic influence. Optical quality metrics showed good values, better for a 3 mm pupil compared to a 4.5 mm one, as expected. The three IOL powers tested showed a very similar behavior in terms of power and aberrometric profiles, with minimal to null differences related to the nominal power. Conclusion: The non-diffractive wavefront-shaping EDoF intraocular lens achieves a near addition up to + 2.50 D aiming for an extended range of vision, almost independently of the base power. [ABSTRACT FROM AUTHOR]

Purpose: To compare intra‐ and postoperative results of sutureless scleral fixated Carlevale intraocular lens (IOL) with iris fixated Artisan IOL. Methods: Monocentre, retrospective analysis of refractive outcomes and intra‐ and postoperative complications of patients who received a Carlevale or Artisan IOL between January 2019 and March 2022. Results: 178 eyes of 169 patients were included (101 Carlevale and 77 Artisan IOLs). The standard follow‐up time was 1 month. Two statistically significant differences were found: in the deviation of the postoperative spherical equivalent of the refraction from the preoperative chosen IOL target (p = 0.019; mean deviation was −0.46 in the Carlevale and 0.08 in the Artisan group), and the number of eyes with complications between the Carlevale and Artisan groups (p = 0.003; 33 in the Carlevale and 42 in the Artisan group). Conclusion: The current study is the largest so far comparing both refractive outcomes and complications after implantation of Carlevale and Artisan IOL. The Carlevale IOL does not carry a greater complication risk on the short‐term follow‐up. This provides additional evidence that the Carlevale IOL has to be added to the armamentarium of the ophthalmic surgeon. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical outcomes, the rate of spectacle independence, and patient satisfaction of an enhanced depth of focus (EDOF) LuxSmart™ IOL targeted for mini-monovision in patients who had undergone bilateral cataract surgery. Methods: Twenty patients underwent bilateral LuxSmart IOL implantation with the non-dominant eye targeted for − 0.50 diopters. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, and defocus curve were assessed. Patient-reported visual function was inquired by Catquest-9SF, and the rate of spectacle independence in all daily-life activities was calculated. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered statistically significant. Results: The mean IOL power was +21.50 ± 4D (16.5– 26D), and all were non-toric. Thirty-seven (92.5%) eyes were within ± 0.5D of predicted target. The postoperative MRSE was 0.06 ± 0.42D and − 0.45 ± 0.22D in dominant and non-dominant eyes. Every patient achieved distance binocular vision better than 0.1 logMAR. The non-dominant eyes showed lower CDVA (p< 0.001). The UIVA was higher in non-dominant eyes (p< 0.001). Binocular uncorrected near visual acuity was 0.12 ± 0.1, and uncorrected near visual acuity was higher in non-dominant eyes (p< 0.001). LuxSmart IOL provided a sustained visual acuity of 0.3 logMAR or better between +1.00D and − 2.50D. A total of 25% of patients reported frequent halos and glare. Despite achieving higher degrees of satisfaction, seven patients (35%) denied total spectacle independence in their daily-life activities, particularly for activities requiring continuous near vision. Conclusion: This study shows that LuxSmart EDOF IOL in mini-monovision strategy performs well for distance and intermediate vision. Although visual acuity for near also achieved very good results, the considerable rate of spectacle dependence, in particular for near, and the rate of photic phenomena do not support this IOL to be safely implanted in patients desiring spectacle independence at time of cataract surgery. [ABSTRACT FROM AUTHOR]

The presented paper deals with the analysis of a two-stage constant power generation (CPG) interfaced with a grid-tied solar photovoltaic power system (GTSPPS). In earlier days, for extracting the maximum power point in GTSPPS, different types of MPPT controllers were used. These techniques fail whenever a change in solar irradiance takes place. A CPG technique was proposed that makes use of a single stage, but this technique still has a drawback as its operating area always lies to the right of MPPT, so whenever a sudden change in solar irradiance occurs, the robustness of the CPG algorithm decreases. Thus, there is a need for two-stage CPG so as to have a stable, constant power generation. Further, the performance of two-stage CPG has been compared with different control techniques under dynamic as well as steady-state conditions to know its suitability under practical conditions. [ABSTRACT FROM AUTHOR]

Purpose: To report patient satisfaction after unilateral/bilateral extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a young population after vitrectomy. Methods: Patients that underwent phaco-vitrectomy or phaco following vitrectomy with an AT LARA EDOF IOL, aged between 18 and 75 years, were asked to fill out a questionnaire to assess overall visual quality, near vision quality, and visual disturbances. The questionnaire was based on the Catquest, NAVQ, and APPLES questionnaires. Results: A total of 89 participants (average age 56.7 years) filled out the questionnaire of which 53.9% received a unilateral EDOF IOL. The most common indications for vitrectomy were retinal detachments (38.2%), floaters (36.0%), and epiretinal membranes (16.9%). The Catquest and NAVQ score respectively showed a good overall satisfaction (3.44/4.0), a good intermediate vision (3.55/4.0), and an average near vision (2.75/4.0). The APPLES score showed acceptable visual disturbances. There were no differences between the unilateral and bilateral group, except for a higher spectacle dependency in the unilateral group (40% vs. 10.6%). Participants that underwent vitrectomy in case of floaters reported lower satisfaction rates. Other variables, like the pre-operative refraction, had no impact on both satisfaction and visual disturbances. Conclusion: Both unilateral and bilateral implantation of the AT LARA EDOF IOL showed a high satisfaction with no differences between both groups, except for a lower spectacle use in the latter. Hence, The AT LARA seems to be a possible choice in patients undergoing vitrectomy at a younger age, even for unilateral use. [ABSTRACT FROM AUTHOR]

Modern technologies of examining cataract patients and phacoemulsification with implantation of the posterior chamber intraocular lens (IOL) commonly allow achieving the desired anatomical outcome and a high functional outcome after surgery. The development of postoperative dysphotopsias in patients with a posterior chamber IOL, however, requires a separate consideration. Dysphotopsia can develop practically in any eye with the IOL after cataract surgery and in some cases can affect postoperative vision, which hinders the patient from resuming working life as usual. Clear systemic guidelines for preventing postoperative dysphotopsia are still to be developed. [ABSTRACT FROM AUTHOR]

Background: The aim of this research was to see if a refractive enhanced monofocal IOL (Eyhance IOL, IOL Abbott Medical Optics, Inc., Santa Ana, CA, USA) can provide better intermediate vision in patients undergoing phaco-vitrectomy due to cataract and epiretinal macular membrane (ERM). Methods: A nonrandomized prospective observational comparative study enrolled patients affected by cataract and ERM undergoing phaco-vitrectomy. A follow up of 6 months was established. Corrected and uncorrected visual acuity of both monocular and binocular types were assessed regarding intermediate and far distances. The CATQUEST 9-SF questionnaire was administered preoperatively and at the last follow-up. Results: Twenty-three eyes of twenty-three patients were enrolled, with 11 in the enhanced monofocal group. The uncorrected and corrected distance visual acuity after 6 months was not statistically different. Both monocular and binocular uncorrected intermediate visual acuity after 6 months were higher in the enhanced monofocal group (p < 0.001). The corrected intermediate visual acuity after 6 months was higher in the enhanced monofocal group (p = 0.01). The CATQUEST-9SF questionnaire showed significant differences in the variation between the preoperative condition and six-month postoperative results (p < 0.001). Conclusions: This refractive enhanced monofocal IOL can provide better intermediate vision compared to a standard monofocal IOL in patients undergoing phaco-vitrectomy due to cataracts and ERM. Further studies are necessary to confirm these results. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra-ocular lenses (IOLs). Methods: This retrospective, observational study included 143 eyes of 141 patients who underwent phaco-emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post-op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed. Results: The mean pre-op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post-op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post-op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post-op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02). Conclusion: Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post-operative outcomes in terms of UCVA and residual astigmatism. The post-op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group. [ABSTRACT FROM AUTHOR]

Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty-two eyes of 42 patients, aged between 11 and 84 years, had a mean follow-up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre-op, 1.802 at the final follow-up, and 0.52 after excluding preexisting retinal pathologies. At the last follow-up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than -5.00 D and seven needed more than -3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four-point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow-ups will help understand the technique better. [ABSTRACT FROM AUTHOR]

Purpose: To compare visual performance and quality of life in patients who received either monofocal intraocular lenses (IOLs) or an enhanced monofocal IOL in a mini-monovision target approach. Background: Monofocal lenses are the most common intraocular IOLs employed during cataract surgery because of their relatively low cost and good performance for distance sight. However, these lenses, generally, do not exonerate patients from spectacle use for near or intermediate tasks. On the other hand, enhanced monofocal IOLs (e.g., Tecnis Eyhance®) feature optical properties providing patients with good intermediate visual outcomes. Satisfactory near visual acuity results, regardless of IOL type, may be achieved through mini-monovision. We assessed visual performance outcomes between these IOLs, in a mini-monovision approach. Methods: Retrospective case series of patients who underwent bilateral cataract surgery at our institution with implantation of Alcon SN60WF, J&J Tecnis DCB00 or J&J Tecnis Eyhance® DIB00 with a pre-operative mini-monovision target. The postoperative spherical equivalent was measured by a Nidek® auto-refractometer. Best-uncorrected binocular visual acuity (BUBVA) at far (3 m), intermediate (66 cm), and near (40 cm) distance and binocular contrast sensitivity (100%, 25%, and 5%, all at 1 m) were measured using Snellen and Pelli-Robson charts, respectively. Visual performance in daily life was evaluated with the Cataract VF-14 quality of life survey. Results: 71 patients (35 in the monofocal IOL and 37 enhanced IOL group) were enrolled. Patients implanted with enhanced IOL exhibited statistically significant better BUBVA results at 66 cm and 40 cm distances compared to patients in the monofocal group. Additionally, patients in the enhanced IOL group presented a better contrast sensitivity in lower contrast conditions (5%) than patients with monofocal IOL. The quality of life survey showed statistically significant higher scores in daily activities without spectacles for patients with enhanced IOL. Conclusion: Enhanced monofocal IOLs, combined with a mini-monovision approach, provided patients with good visual performance at all tested distances, with superiority of enhanced monofocal IOLs at near and intermediate distances. [ABSTRACT FROM AUTHOR]

Background: Standardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses. Results: The software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations. Conclusions: mEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare modified knotless transscleral suture fixation of intraocular lens (IOL) with traditional transscleral suture fixation for adolescents and young patients with congenital ectopia lentis (CEL). Methods: This retrospective cohort study included 49 patients with CEL (60 eyes) who underwent surgery at the Zhongshan Ophthalmic Center. Improvements based on knotless Z-suture fixation technique were made to form a modified knotless method, in which thicker 8–0 polypropylene sutures were used, and double parallel scleral grooves were constructed behind the limbus instead of triangular lamellar scleral flaps to cover suture stitches. Modified knotless transscleral fixation of IOL was conducted on 30 eyes, and the other 30 eyes underwent traditional transscleral fixation surgery. Pre- and postoperative best-corrected visual acuity (BCVA), refractive error, astigmatism, other ocular parameters, and complications were statistically analyzed. Results: For patients in the modified knotless group, the mean cylindrical refractive error and astigmatism at 1 month and 3 months postoperative were lower (all P < 0.05), and the mean IOL tilt degree was smaller at 3 months postoperative (3.21° ± 2.13° vs. 5.65° ± 3.66°, P = 0.032). The incidence of suture exposure in the modified knotless group was also lower than in the controls (0 vs. 16.7%, P = 0.026). No group differences were observed in mean BCVA, spherical equivalent, or other ocular biometric parameters between groups. Conclusion: Modified knotless technique was a valid method to achieve optimal IOL position and reduce postoperative astigmatism for adolescents and young patients with CEL. It effectively reduced the incidence of knot-related complications, greatly improved the postoperative comfort, and achieved aesthetic benefits. [ABSTRACT FROM AUTHOR]

This study compares the visual and refractive performance of the TECNIS Synergy (DFR00V-DFW150-225-300-375) multifocal intraocular lens (IOL) and the AcrySof IQ PanOptix (TFAT00-30-40-50-60) multifocal IOL. Patients who underwent phacoemulsification and cataract extraction and received either a multifocal Synergy or PanOptix IOL were included. Monocular uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance (CDVA) visual acuities were assessed at three and six months postoperatively. Secondary outcome measures of photic phenomena were also assessed. A total of 140 patients (224 eyes) were included in this study, with 69 patients (105 eyes) in the Synergy group and 71 patients (119 eyes) in the PanOptix group. There were no statistically significant differences in UIVA or CDVA measurements across all time points. When assessing UDVA, at three months postoperatively, there were more eyes in the PanOptix group with vision better than 20/40 (p = 0.04). At three and six months postoperatively, the average UNVA was superior in the Synergy group (p = 0.01, 0.002). While the Synergy group reported more night vision disturbances at one and three months (p = 0.01, 0.03), the PanOptix group had more night vision disturbances at six months (p = 0.02). Although not statistically significant, the AcrySof IQ PanOptix multifocal IOL demonstrated better UDVA and UIVA sooner postoperatively than the TECNIS Synergy multifocal IOL. The Synergy IOL provided statistically better UNVA compared to the PanOptix IOL at three and six months postoperatively. Synergy patients reported more early photic phenomena than PanOptix patients, which later diminished. [ABSTRACT FROM AUTHOR]

Purpose: Accurate intraocular lens (IOL) calculation in subjects with irregular astigmatism is challenging. This study evaluated the accuracy of using Scheimpflug-derived central 2-mm equivalent keratometry reading (EKR) values for IOL calculation in irregular astigmatism. Methods: This retrospective study included subjects (31 eyes of 30 patients) who underwent cataract surgery and IOL calculation using the 2-mm central EKR methods. We compared prediction error (PE) and absolute PE (APE) outcomes using SRK/T and Barrett Universal II formulas for keratometry data obtained from the IOLMaster 500 and Pentacam (anterior corneal sim k) devices. Results: Cataract surgery and IOL calculation using the 2-mm central EKR methods resulted in improved visual acuity (uncorrected: from 1.13 ± 0.38 to 0.65 ± 0.46 logMar, p < 0.01; best-corrected: from 0.45 ± 0.24 to 0.26 ± 0.20 logMar, p < 0.01) after surgery. The percentage of subjects with best-corrected visual acuity of 6/6 was 22%, < 6/9 was 58%, and < 6/12 was 71%. For both the SRK/T and the Barrett formulas, the PE was similar to those obtained by IOLMaster (> 0.14) but lower than those obtained by the anterior corneal sim k (p < 0.02). IOLMaster provided keratometry reading in only 23/31 (74.1%) of cases. Conclusions: The use of Scheimpflug central 2-mm EKR for IOL calculation in irregular astigmatism was beneficial in terms of visual acuity improvement. It had comparable refractive prediction performance to the IOLMaster 500 and better than the anterior corneal sim K. The 2-mm EKR method can be used when IOLMaster cannot provide a reliable reading in abnormal corneas. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a deep learning model to automatically segment three structures using an anterior segment optical coherence tomography (AS‐OCT): The intraocular lens (IOL), the retrolental space (IOL to the posterior lens capsule) and Berger's space (BS; posterior capsule to the anterior hyaloid membrane). Methods: An artificial intelligence (AI) approach based on a deep learning model to automatically segment the IOL, the retrolental space, and BS in AS‐OCT, was trained using annotations from an experienced clinician. The training, validation and test set consisted of 92 cross‐sectional OCT slices, acquired in 47 visits from 41 eyes. Annotations from a second experienced clinician in the test set were additionally evaluated to conduct an inter‐reader variability analysis. Results: The AI model achieved a Precision/Recall/Dice score of 0.97/0.90/0.93 for IOL, 0.54/0.65/0.55 for retrolental space, and 0.72/0.58/0.59 for BS. For inter‐reader variability, Precision/Recall/Dice values were 0.98/0.98/0.98 for IOL, 0.74/0.59/0.62 for retrolental space, and 0.58/0.57/0.57 for BS. No statistical differences were observed between the automated algorithm and the inter‐reader variability for BS segmentation. Conclusion: The deep learning model allows for fully automatic segmentation of all investigated structures, achieving human‐level performance in BS segmentation. We, therefore, expect promising applications of the algorithm with particular interest in BS in automated big data analysis and real‐time intra‐operative support in ophthalmology, particularly in conjunction with primary posterior capsulotomy in femtosecond laser‐assisted cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: Trifocal Intraocular Lenses (IOLs) were developed to provide patients with effective near, intermediate and distance vision, thus minimizing spectacle dependency. Residual astigmatism has previously been shown to impact unaided visual acuity across all distances; therefore, to optimise the expected outcomes, consideration of preoperative corneal astigmatism is essential. The purpose of this study was to provide a real-world, multi-site review of visual and refractive outcomes in eyes undergoing implantation with the Panoptix Trifocal toric IOL platform. Patients and Methods: This study represents a two-fold approach. Patients who had previously undergone routine cataract removal and IOL insertion with the Panoptix Toric IOL were retrospectively analysed for routine efficacy and safety endpoints ("Retrospective Cohort"). Data was retrieved from the preoperative, surgical and postoperative visits (range 2– 6 weeks). A further subset of patients undergoing lens removal and bilateral Panoptix Toric IOL insertion were identified at surgery ("Qualitative Cohort"). These patients underwent additional testing inclusive of quality of vision questionnaire and bilateral defocus curve. Results: A total of 466 eyes of 254 patients were included in the retrospective cohort. Between 91% and 98% of eyes, respectively, were within 0.50D and 1.00D of target. Mean absolute difference from Spherical Equivalent (SE) target was 0.22 ± 0.24Ds. Following surgery, 94% of eyes demonstrated a refractive astigmatism of 0.50D or less. Further, 61% eyes achieved uncorrected distance visual acuity (UDVA) of 20/20 or better, increasing to 94% achieving 20/32 or better. Seventy percent of eyes unilaterally achieved N5 unaided and 66.0% achieved N8 or better at intermediate. In the qualitative cohort, no patient described any symptom as significant or requested explant. Conclusion: In a real-world setting, the PanOptix toric trifocal IOL continues to demonstrate refractive accuracy and good visual performance at all focal distances. This IOL also exhibited good quality of vision, with minimally bothersome visual disturbances or photic phenomena. [ABSTRACT FROM AUTHOR]

Purpose: To determine the spectral transmittance of artificial intraocular lenses (IOLs) designed for various species (dog, cat, chinchilla, eagle, tiger) and compare them to the spectral properties of the biological lenses of these species. Methods: Twenty‐seven IOLs were scanned with a spectrophotometer fitted with an integrating sphere. Results: All IOLs transmitted long wavelengths well before cutting off sharply at short wavelengths, with insignificant transmission below ca. 340 nm. In comparison with the IOLs, the biological lenses of the cat, dog, and probably the chinchilla transmitted significantly more short wavelengths. The spectral properties of the biological lenses of eagles and tigers, while uncertain, may be a closer match to the IOLs made for these species. Conclusion: It is not known if there are any visual or behavioral consequences for animals caused by a mismatch between the spectral properties of their biological lenses and IOLs. However, following IOL implantation there might be a change in the perceived hue of objects due to the removal of UV wavelengths which form a normal part of the visible spectrum for these species and/or a decrease in sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: Comparative study of intraoperative and postoperative complications, visual outcomes, and cost-effectiveness between conventional and 4-mm manual small-incision cataract surgery with MVR blade.Methods: In total, 600 patients having nuclear sclerosis grade I-IV were operated under peribulbar anesthesia and were divided into two groups of 300 each. In group A (300), conventional small-incision cataract surgery was done, whereas in group B (300), 4-mm manual small-incision cataract surgery was performed through a 4-mm sclerocorneal tunnel. A wire vectis was passed through the 4-mm incision below the nucleus to stabilize it, and a 20-G MVR blade was introduced from 11o'clock limbus and nucleus was bisected into two halves, which were removed through main incision. Cortical wash was given, and foldable IOL was implanted. Intraoperative and postoperative complications between the two groups were compared. Postoperative visual outcome and surgically induced astigmatism between the two groups was studied.Results: The most common intraoperative complication was hyphema (11.33%) and irido-dialysis (8.00%), whereas postoperatively, striate keratopathy (36.33%) and hyphema (19.33%) were common. Short-term complications such as striate keratopathy, hyphema, and irido-dialysis were significantly more in group B, and long-term results in terms of visual outcome and surgically induced astigmatism were significantly less in group B.Conclusion: Although intraoperative and short-term postoperative complications were observed more in 4-mm manual small-incision cataract surgery, it was found to be more effective in terms of surgically induced astigmatism and final visual outcome. In addition, it is cost-effective as compared to phacoemulsification. [ABSTRACT FROM AUTHOR]

Soemmerring's rings consist of a ring of lens epithelial derived cells that grow along the periphery of an aphakic lens capsule, or around an intraocular lens. These rings when visualized frontally, appear opaque, however, in some cases the cells that compose these rings are organized in the same fashion as those in normal transparent adult lenses. Thus, our purpose was to test whether any part of the adult Soemmerring's ring could be transparent and how this related to morphological factors. To study this, 16 Soemmerring's rings were extracted from donor eye globes. After imaging, they were thickly sectioned sagittally in order to analyze the degrees of transparency of different areas. All samples were also histologically analyzed using alpha smooth muscle actin, Vimentin, wheat germ agglutinin and DAPI. Our results showed that many samples had some transparent areas, mostly towards the center of their cross-section. Of the factors that we analyzed, only lens fiber organization at the bow region and an increased area of mature lens fiber cells had a significant relation to the degree of transparency at the center. Thus, we can conclude that as Soemmerring's rings mature, they can develop organized and transparent areas of lens cells. [ABSTRACT FROM AUTHOR]

Purpose: To assess the refractive outcomes, intraocular centration and rotational stability of the enVista toric intraocular lens (IOL). Patients and Methods: This study was a prospective, multi-centre, double-masked, partially randomized and partially controlled clinical trial. A total of 191 participants were implanted with toric IOL (1.25, 2.00, or 2.75D) or non-toric IOL (control). The lowest range of corneal astigmatic eyes were randomized to 1.25D toric or control. Higher astigmatic powers were allocated to the treatment arm. Subjects were assessed immediately postoperatively, 1– 2 (V1), 7– 14 (V2), 30– 60 (V3) and 120– 180 (V4) days postoperatively. Unaided (UDVA) and distance corrected visual acuity (CDVA), manifest refraction and corneal curvature were assessed. Vector analysis was used to calculate surgically induced refractive correction (SIRC), correction ratio (CR), error magnitude (EM) and error vector (EV). Slit-lamp photography was used to measure centration and rotational stability. Results: UDVA was better in the low toric IOL group in comparison with the control group at V4 (p< 0.001). There was an undercorrection in the control group, whereas the average CR for all toric subjects was 1.00 ± 0.32: V2, 0.98 ± 0.34: V3 and 0.98 ± 0.35: V4. The absolute IOL rotational stability in comparison to the position of the IOL at V1 was 1.35° ± 0.97°: V2, 1.35° ± 1.07°: V3 and 1.38° ± 1.25°: V4. Decentration was generally inferior (V1: 0.04 ± 0.22mm, V2: 0.05± 0.20mm, V3: 0.08 ± 0.22mm, V4: 0.04 ± 0.21mm) and nasal (V1: 0.19 ± 0.23mm, V2: 0.20 ± 0.20mm, V3: 0.20 ± 0.21mm, V4: 0.17 ± 0.22mm). Conclusion: Participants with low levels of corneal astigmatism achieved superior vision and refractive outcomes in the low toric group over the control. Moderate and high levels of astigmatism achieved excellent refractive outcomes. The toric IOL demonstrated high levels of both rotational and centrational stability. [ABSTRACT FROM AUTHOR]

Iris-fixated intraocular lens (IOL) is considered a safe and effective option for the correction of aphakia in patients with insufficient capsular support. This systematic review aims to summarize the existing evidence about the Artisan/Verisyse IOLs and to assess the influence of the IOL position on the postoperative outcomes. Three different databases were used for this systematic review and metaanalysis (PubMED, Scopus, and Embase). We searched for case series or clinical trials comparing the prepupillary versus retropupillary Artisan/Verisyse implantation. The statistical analysis was performed with the programming language R (version 3.6.1 2019-07-05). The number of articles included in the meta-analysis was six, with 506 eyes included in total. We found no significant differences in postoperative corrected distance visual acuity (CDVA) (0.309 [0.089–0.528] vs. 0.32 [0.2–0.44]), spherical equivalent (SE) (0.0153 D [−0.362 to 0.393] vs. −0.329 D [−0.62 to − 0.038]), and central corneal cell density (CECD) (1669.85 cells [1605.949–2150.937] vs. 1635.99 cells [1413.64–1858.363]) between the prepupillary and the retropupillary implantation, respectively. There were no significant differences in the rates of cystoid macular edema (CME; 7.70% vs. 9.8%), pupil deformation (4.5% vs. 5.4% retropupillary), or IOL luxation (2.3% and 2.2%). We found little influence of the IOL position in the postoperative analyzed outcomes. Thus, the implant position should be based on the surgeon's technical experience. Double-blind randomized prospective studies would improve the available evidence on the best implant position for the Artisan/Verisyse IOL. [ABSTRACT FROM AUTHOR]

Introduction: In the context of managing patients' expectations and satisfaction regarding visual acuity after cataract surgery, we aimed to investigate the improvement in visual acuity and patient satisfaction after small-incision lenticule extraction (SMILE) in pseudophakic (trifocal intraocular lens, IOL) patients with residual myopic refraction after cataract surgery. Methods: Seventy-six patients (82 eyes) who underwent cataract surgery with ZEISS AT LISA tri 839MP IOL implantation were included in this retrospective study. The included patients were 56–79 years old, wanted spectacle independence, and had preoperative myopic refraction between − 1.0 and − 2.25 diopters (D) and astigmatism between − 0.75 and − 1.75 D. The treatment status of these patients was defined as trifocal IOL (n = 82). SMILE was performed in patients who were dissatisfied after cataract surgery, and these patients were followed up for 1 year on average. We evaluated visual acuity and satisfaction and further examined laser vision correction and satisfaction levels in patients who were dissatisfied after trifocal IOL implantation. Results: The possible reasons for patient dissatisfaction were reading books, using a computer, and driving at night. After SMILE, the residual myopic refractive error (spherical) decreased significantly from − 2.08 ± 0.28 [− 2.25 to − 1.0] preoperatively to − 0.25 ± 0.20 − 0.5 to 0] 1 year postoperatively (p < 0.001). Additionally, the uncorrected distance visual acuity increased from 0.65 ± 0.08 [0.52–0.7] logMAR preoperatively to 0.09 ± 0.02 [0.05–0.1] logMAR at 1 month postoperatively (p < 0.001), 0.09 ± 0.02 [0.05–0.1] logMAR at 6 months postoperatively, and 0.06 ± 0.02 [0.05–0.1] logMAR at 12 months postoperatively (p < 0.001). Patient satisfaction measures after SMILE (reading, night driving, and using a computer) were significantly improved. Conclusion: SMILE is a reliable method for treating residual refraction after cataract surgery, as it provides results in the shortest time without complications and increases patient satisfaction. Trial Registration: The protocol was registered on clinicaltrials.gov (NCT04693663). [ABSTRACT FROM AUTHOR]

Purpose: Phacoemulsification with intraocular lens (IOL) implantation is the standard of care for cataractous eyes. Monofocal IOLs are spherical or aspheric. The aspheric design of IOLs reduces the spherical and higher-order aberrations and impacts contrast sensitivity post cataract surgery. There are some studies, but data in the Indian setting with the IOLs we used is lacking. We aimed to compare the effect of implantation of spheric and aspheric foldable intraocular lenses on postoperative quality of vision, spherical aberration, and contrast sensitivity.Methods: This prospective observational study was conducted at a tertiary care hospital with an ophthalmology specialty, data collection from January 2017 to May 2018 in 100 patients. Patients meeting the inclusion criteria were selected. Their preoperative and postoperative data were collected and divided into groups based on whether spherical or aspheric IOL was implanted after cataract surgery. Variables assessed were visual acuity on days 7 and 30, spherical aberrations, and contrast sensitivity was assessed at 1-month postoperative.Results: The mean age of the patients in this study was 64 ± 8 years with a majority of patients (60%) being females. There is no significant difference in postoperative visual acuity between the two groups. Internal SA was significantly lower (~50%) in eyes implanted with aspheric IOLs (P value = 0.004, 0.0001) compared with the spherical group. Contrast sensitivity of patients of the aspheric group was significantly better (P value <0.05).Conclusion: The optical design of the aspheric IOLs reduced spherical aberrations and increased contrast sensitivity. [ABSTRACT FROM AUTHOR]

aims of this study were to test whether K mean values from the fellow eye can be used as substitute in lens power calculations and to determine if similarity in axial length (AL) in a patient's two eyes implies similarity also in the corneal curvature. Methods and Analysis: A retrospective study of optical biometry measurements in 500 adults (1000 phakic eyes) that was scheduled for cataract surgery. Inclusion criteria were complete recordings of all parameters in both eyes and a signal-to-noise ratio of at least 10. Similar AL was defined as less than 0.3 mm difference between the patient's two eyes. Results: The IOL power calculated with K mean from the fellow eye was 0.39 D (standard deviation (SD) 0.57) different from the calculation with both AL and K mean from the correct eye. The difference was larger than 1.0 D in 26 (5%) eyes. In patients with similar AL in their two eyes (n = 372), the interocular difference in K mean was 0.43 D (SD 0.67 D), compared to 0.45 D (SD 0.49 D) for the patients with an AL difference of 0.3 mm or more (n = 128) (p = 0.81). Conclusion: Lens calculations with keratometry values from the fellow eye as substitute yielded quite similar results as calculations with the correct values. Hence, this seems to be an acceptable approach in patients with incomplete keratometry recordings. Similarity in AL between a person's two eyes did not imply more similar corneal curvatures. [ABSTRACT FROM AUTHOR]

Myotonic dystrophy is the most common inherited muscular dystrophy in adults and presents as two forms, type 1, and type 2. Ocular manifestations such as premature cataract formation, may be the first diagnostic sign or symptom of the disease, offering ophthalmologists a unique diagnostic role. Fuchs' endothelial corneal dystrophy, ptosis and ocular melanoma are other possible findings. Systemic features can help providers better understand the disease and any accommodations to be made in clinical or surgical settings. Some patients with this disease may request evaluation of certain cataract or corneal refractive procedures. This article focuses on pertinent information for clinicians to utilize when evaluating and treating patients with myotonic dystrophy and specific surgical perspectives to consider prior to any ocular interventions. Hydrophobic intraocular lenses are still recommended in these patients with careful observation of capsular phimosis and posterior capsular opacities. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the power of an implanted intraocular lens (IOL) by measuring IOL thickness using anterior segment optical coherence tomography (AS-OCT) and to assess the repeatability of measurements. Methods: Ninety-seven eyes were studied one month after uneventful phacoemulsification within the bag Acrysof SA60AT IOL implantation (range +11 to +35). All eyes had postoperative refraction of ±0.5 D of target refraction. AS-OCT was used to measure the central thickness of the IOL. Correlation between labelled IOL power and central IOL thickness as well as the measure of repeatability, for example, intraclass correlation coefficient (ICC), were evaluated. IOL thicknesses were also calculated using a formula and compared with AS-OCT derived measurements. Results: IOL thickness correlated significantly with labelled IOL power (R² = 0.985, P < 0.001). The regression equation (IOL Power = [0.04 × IOL thickness in micron] -- 7.56) indicates 25 microns of central IOL thickness change per 1D power change. Over the studied range, IOL power could be estimated with a precision of 0.85 ± 0.02 D (95% confidence interval: 0.83--0.94D). ICC for repeated measurements was 0.999. There was a significant correlation between calculated and measured (AS-OCT) IOL thickness (R² = 0.984, P <0.001). Conclusion: Central IOL thickness measurements with the AS-OCT are highly repeatable and closely correlated with the labelled IOL power, which can predict the IOL power with ±0.85 D from the actual power. This method can be helpful in cases of postoperative IOL surprise. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the economic impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its related complications for five different intraocular lenses (IOLs) from the payer and hospital perspectives in Spain. Materials and Methods: The three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives. Results: The adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were € 261.90 for payers and € 19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between € 110,259.90 and € 205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and € 8415.79 compared to Zeiss Asphina to 429.40 hours and € 15,692.15 compared to AJL LLASY60 IOLs. Conclusion: Post cataract surgery, AcrySof IOLs were associated with a significantly lower incidence of Nd:YAG treatment and its subsequent complications compared to other IOLs. Our analysis shows that IOL choice is an important factor that can reduce the burden for patients, payers, and hospitals. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Spektrum der Augenheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Spektrum der Augenheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To assess the preliminary clinical outcomes and patient satisfaction of the new enhanced depth of focus (EDOF) LuxSmart™ intraocular lens IOL and to compare with a conventional monofocal IOL (Akreos™) in patients who had undergone bilateral cataract surgery. Methods: Twelve patients underwent bilateral LuxSmart IOL implantation, and twelve underwent bilateral Akreos IOL implantation. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66cm, uncorrected near visual acuity (UNVA) at 40cm and defocus curve were assessed. Patients-reported visual function was inquired by Catquest-9SF. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered for statistical significance. Results: The mean IOL power was +21.90D in LuxSmart group and +22.30D in Akreos. Monocular UDVA (p = 0.32) and CDVA (p = 0.52) did not differ between groups. The average binocular UIVA (0.18 ± 0.12 logMAR vs. 0.30 ± 0.13 logMAR, p < 0.001) and UNVA (0.38 ± 0.14 logMAR vs. 0.44 ± 0.17 logMAR, p = 0.02) were higher in LuxSmart IOL group. No patients reported disabling photic phenomena in either group. Conclusion: This study shows that new LuxSmart EDOF IOL achieved higher performance for intermediate and near vision compared with a conventional monofocal IOL, without increasing the risk of dysphotopsias. LuxSmart may be an attractive and safe option for patients who desire spectacle independence for distance and intermediate vision after cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: Extended depth-of-focus (EDOF) is a promising intraocular lens (IOL) technology for cataract surgery. The aim of the study was to report the real-life experience related to the implant of EDOF AcrySof® IQ Vivity® (Alcon Inc., USA) IOL. Methods: The study was designed as a interventional, prospective, case series with 3 months of follow-up. Patients needing cataract surgery, without any other kind of ocular diseases, were recruited and implanted with AcrySof® IQ Vivity® IOL. We evaluated the refractive success of this IOL through complete ophthalmologic assessments and the administration of the Quality of Vision test. The main outcome measures were the refractive outcome; far, intermediate, and near vision; and Quality of Vision score. Results: We included 108 eyes (54 patients; age 62 ± 5 years). Intra-operative and post-operative complications were 0%. Thirty out of 100 eyes (28%) required toric IOL. Best-corrected visual acuity improved from 0.4 ± 0.3 LogMAR to 0.0 ± 0.0 LogMAR (p < 0.01). Refractive outcome was very good for far and intermediate visions, whereas a spherical addition of at least + 1.0D was required for near vision. The mean Quality of Vision score was of 15.5 ± 6.5. The most complained visual disturbances were haloes and glares, although resulting well-tolerated. Dynamic pupillometry findings well-correlated with the amount of complained post-operative visual discomforts. Conclusions: AcrySof® IQ Vivity® IOL is a well-tolerated choice to correct far and intermediate vision. Spectacles are needed to optimize near vision. Our data strongly suggest dynamic pupillometry as a useful investigation to optimize post-operative refractive success. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes and patient satisfaction after implantation of Optiflex Trio, a new trifocal intraocular lens (IOL) following cataract surgery. Methods: Patients undergoing phacoemulsification for age-related cataracts and who satisfy the eligibility criteria underwent bilateral implantation with Optiflex Trio trifocal IOL. At follow -up visits of 1, 3, 6, and 12 months, binocular uncorrected and corrected distance, intermediate and near visual acuity, reading performance, contrast sensitivity (CS) and patient satisfaction for dysphotopsia and spectacle independence were evaluated using questionnaires. Results: A total of 54 eyes from 27 patients with mean age of 66.30± 7.48 years were included in the study. At 12 months, 78% (n = 21) patients had binocular cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ± 0.50 D for 93% (n = 50) eyes, and refractive cylinder accuracy was within ≤ 0.50 D in 94% (n = 51) eyes. The mean binocular UNVA was 0.01± 0.05 LogMAR, and the mean UIVA at 60 and 80 cm was 0.07± 0.06 and 0.03± 0.05 LogMAR, respectively, at 12 months. Reading speeds at 40, 60 and 80 cm showed improvement overtime. No patient had complained of severe dysphotopsia, and none of the patients required glasses for any activity. No eye underwent YAG-laser capsulotomy for significant PCO at the end of mean follow-up. Conclusion: After 12 months, Optiflex Trio trifocal IOL provided a complete visual restoration with good visual quality outcomes in terms of uncorrected distance, intermediate and near visual acuity. The incidence of dysphotopsia was low, and spectacle independence was high, resulting in good patient satisfaction. Trial Registry: CTRI/2019/10/021647 (www.ctri.nic.in). [ABSTRACT FROM AUTHOR]

Introduction: Several studies have shown comparable visual outcomes of SICS and phacoemulsification. Phacoemulsification is the standard surgical procedure for cataract in developed countries whereas the technique of cataract extraction varies in developing countries. Since the last decade small incision cataract surgery (SICS) has become a popular technique of cataract surgery in India and other developing countries. Anecdotally, it is believed that SICS is the appropriate technique for mature cataracts and phacoemulsification emulsification is more suitable for immature cataracts. Several comparable studies have shown similar visual outcome of the two surgical techniques but none of those previous studies had compared the surgical procedures on phacoemulsification suitable immature cataracts. Objective: To compare the safety and efficacy of different types of surgical procedures (phacoemulsification versus SICS) for cataract surgery in immature cataract. Material and methods: A prospective randomized controlled trial was carried out involving 339 and 394 patients with immature senile cataract selected for phacoemulsification and SICS, respectively. Statistics: Mean values with standard deviations were calculated. P value of less than 0.05 was considered significant. Results: There was no difference between the groups in terms of gender, age, and pre-operative visual acuity (p = 0.227). In group A, and in group B nearly 24.7% and 22.4% respectively of patients had good visual outcome (6/6-6/18). Poor outcome (unaided visual acuity <6/18) was noticed in 75.3% patients from group A and in 77.6% patients from group B. Statistics: Data were computed and analyzed using the SPSS software program vs 23. The p value of < 0.05 was considered significant. Conclusion: There was no significant difference in visual outcome on first post-operative day in between phacoemulsification and SICS technique. However, performing SICS was significantly faster. Small incision cataract surgery with implantation of rigid PMMA lens is a suitable surgical technique to treat immature cataract in developing countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the visual outcome of a new extended depth-of-focus (EDOF) intraocular lens (IOL) after bilateral implantation. A qualitative and quantitative analysis was performed and data were compared with those given by other studies regarding multifocal IOLs, which have the same purpose of giving spectacle independence to the patients.Methods: The study enrolled 40 eyes of 20 patients who underwent cataract surgery with bilateral implantation of an EDOF IOL (Evolve Soleko, Rome, Italy). The mean age was 74.5±9 years (range 59-83ys). Refractive outcomes and contrast sensitivity were evaluated preoperatively and at 6-month follow-up. We also examined reading speed, glare, halos, difficulties in the night driving, the requirement for spectacles, and overall satisfaction with vision. Two questionnaires were administered for this purpose.Results: At 6 months, the percentage of eyes within ±0.50 diopters (D) from emmetropia was 82.5%. Of all patients, 90% were satisfied with their vision. The percentage of spectacle-free for near and distance vision patients was 70% and 95%, respectively. A postoperative binocular uncorrected 60cm intermediate visual acuity (UI60VA) of 0.2 logMAR or better was achieved in 92% of patients. Contrast sensitivity significantly improved postoperatively (p<0.001) and mean reading speed was good.Conclusion: This new EDOF IOL seems to provide an effective alternative to patients who desire a spectacle-free lifestyle postoperatively. These lenses can supply a satisfactory distance, intermediate and near vision, and retain good contrast sensitivity, with most patients reporting excellent satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Monrovia, CA, USA) in mild to advance keratoconus patients with myopia and myopic astigmatism. Methods: This retrospective study evaluated all patients who underwent ICL implantation for the management of keratoconus at a tertiary care eye hospital from January 2012 to January 2018. The mean duration of follow-up was 15.3 months (range, 3.13 to 38.97 months). Data were collected on preoperative and postoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction was compared, and adverse effects were evaluated. Results: Thirty-two eyes (32 patients) were evaluated. The median CDVA was 20/30 preoperatively and 20/20 at last follow-up. The median UDVA was 20/25 at last follow-up. Thirteen patients (40.6%) had 20/20 UDVA in comparison to none at baseline. The median spherical equivalent in diopters (D) was −7.875 D (−4.125 to −10.0 D) preoperatively and decreased to −0.3125 D at last follow-up. The median manifest refractive cylinder was 3.00 D (2.25 to 5.25 D) preoperatively and decreased to 1.125 D postoperatively. Cylinder axis rotation of 10° or greater occurred in 3 eyes (9.375%) and required repositioning of the ICL. One patient (3%) developed nonvisually significant anterior subcapsular cataract. One ICL (3.125%) had to be explanted due to residual refractive error and unsatisfactory vision. Conclusion: ICLs are a suitable refractive option for the correction of refractive error associated with stable, nonprogressive keratoconus even in advance cases. However, the risk of ICL rotation and subsequent repositioning remain. Careful patient selection is necessary for achieving good outcomes and mitigating intraoperative and postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: The human eye is a complex optical system involving a variety of tissues, from connective to nervous. Implementation of individual layers and structures allows the biomechanical modelling of the istribution of tissue loading during selected loading events and can therefore be used to visualise changes in load and overload during injuries of selectable direction or intensity, as well as changes in the stability of the optical system following surgery or implantation of an artificial lens. Methods: The Abaquus program using finite element method (FEM) was used to create the model and simulate the loading. Additional structures relevant to the stability of the optical system of the eye under physiological conditions, in case of intraocular lens implantation and in case of blunt impact were implemented in the basic eye model. Results: A model of the eye was created that corresponds significantly better to its anatomical structure. The simulations demonstrated the loading of individual structures in various defined situations and described the risk of their mechanical failure in case of overloading, especially with regard to the time course of selected dynamic processes. Conclusion: We have verified the possibilities of biomechanical modelling of loaded anatomical structures in different situations. From a clinical point of view, this is important information that can be used not only in the diagnostic but also in the therapeutic process of various eye disorders, from changes due to simple ageing to post-operative changes or changes due to different types of trauma. [ABSTRACT FROM AUTHOR]

aim of the present study was to evaluate the stability of four different types of aspheric intraocular lenses (IOLs) after implantation. Methods: This retrospective study included 124 eyes implanted with four different types of aspheric IOLs including a one-piece four-loop fixed hydrophilic acrylic IOL, a one-piece flat fixed acrylic IOL, a one-piece two-loop fixed acrylic IOL, and a three-piece two-loop fixed silicone IOL. IOL decentration, tilt, and ocular coma‐like aberration (coma) at one-week, one-month, three-month, and one-year time points were evaluated postoperatively. Results: IOL decentration, tilt, and coma in the AO, 36A, IQ, and KS-AiN implantation groups were statistically significantly different one week and one year postoperatively (p < 0.01). There were significant differences between each of the pairs of groups (p < 0.01), except for coma between the AO and 36A implantation groups one week postoperatively (p > 0.05). When comparing the different time points (ie, one week, one month, three months, and one year postoperatively), IOL decentration, tilt, and coma were significantly different in each group (p < 0.05). IOL decentration, tilt, and coma in each group increased over the period from one week to one year postoperatively. A positive linear correlation was observed between IOL decentration or tilt and coma one year postoperatively (p < 0.01). Conclusion: One-piece multi-point fixed acrylic IOLs demonstrate better stability when compared with three-piece two-point fixed silicone IOLs. IOL decentration, tilt, and coma increase gradually over time. Ocular coma‐like aberrations are influenced by the stability of IOLs. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the accuracy of lens power calculation in highly myopic patients implanting plus and minus intraocular lenses (IOL). Methods: We included 58 consecutive, myopic eyes with an axial length (AL) > 26.0 mm, undergoing phacoemulsification and IOL implantation following biometry using the IOLMaster 500. For lens power calculation, the Haigis formula was used in all cases. For comparison, refraction was back-calculated using the Barrett Universal II (Barrett), Holladay I, Hill-RBF (RBF) and SRK/T formulae. Results: The mean axial length was 30.17 ± 2.67 mm. Barrett (80%), Haigis (87%) and RBF (82%) showed comparable numbers of IOLs within 1 diopter (D) of target refraction. Visual acuity (BSCVA) improved (p < 0.001) from 0.60 ± 0.35 to 0.29 ± 0.29 logMAR (> 28-days postsurgery). The median absolute error (MedAE) of Barrett 0.49 D, Haigis 0.38, RBF 0.44 and SRK/T 0.44 did not differ. The MedAE of Haigis was significantly smaller than Holladay (0.75 D; p = 0.01). All median postoperative refractive errors (MedRE) differed significantly with the exception of Haigis to SRK/T (p = 0.6): Barrett − 0.33 D, Haigis 0.25, Holladay 0.63, RBF 0.04 and SRK/T 0.13. Barrett, Haigis, Holladay and RBF showed a tendency for higher MedAEs in their minus compared to plus IOLs, which only reached significance for SRK/T (p = 0.001). Barrett (p < 0.001) and RBF (p = 0.04) showed myopic, SRK/T (p = 002) a hyperopic shift in their minus IOLs. Conclusions: In highly myopic patients, the accuracies of Barrett, Haigis and RBF were comparable with a tendency for higher MedAEs in minus IOLs. Barrett and RBF showed myopic, SRK/T a hyperopic shift in their minus IOLs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of mild cataract and its surgery on the ISCEV standard electroretinogram (ERG) by comparing pre- and postoperative ERGs elicited from fully dilated eyes. Methods: Twenty-two patients participated. Each eye had cataract of grade 2 according to Emery-Little classification. None had complications during and after phacoemulsification and intraocular lens implantation. According to the ISCEV standard, pre- and 1-week postoperative full-field ERGs, dark adapted (DA) 0.01, DA 3, DA 3 oscillatory potentials (OPs), DA 10, and light adapted (LA) 3, and LA 3 flicker, were elicited from fully dilated eyes using skin electrodes. Photopic negative response (PhNR) 1 amplitude was measured from the baseline to the trough before the i-wave in the LA 3 ERG waveform. Statistical analysis was performed using SigmaPlot version 11.0 (Systat Software, Inc., San Jose, CA, USA). Pre- and postoperative data were compared using a paired t-test. Non-normally distributed data were evaluated using the Wilcoxon signed rank test. Results: The pre- and 1-week postoperative amplitudes in each component were as follows: DA 0.01: 48.4 ± 19.5 μV and 57.1 ± 20.0 μV (p = 0.002), a-wave of DA3: 51.5 ± 14.8 μV and 58.3 ± 17.3 μV (p = 0.003), b-wave of DA3: 88.3 ± 27.5 μV and 101.5 ± 29.7 μV (p = 0.003), DA 3 ΣOPs (sum of DA 3 OP1, OP2, and OP3 amplitude): 30.7 ± 16.3 μV and 37.1 ± 21.9 μV (p < 0.001), a-wave of DA 10: 65.5 ± 18.8 μV and 74.2 ± 19.5 μV (p < 0.001), b-wave of DA 10: 95.5 ± 29.6 μV and 111.1 ± 29.9 μV (p < 0.001), a-wave of LA 3: 7.2 ± 2.6 μV and 8.2 ± 2.2 μV (p = 0.025), b-wave of LA 3: 30.6 ± 12.9 μV and 35.3 ± 12.7 μV (p = 0.003), PhNR1: 5.8 ± 2.5 μV and 5.5 ± 2.6 μV (p = 0.562), and LA 3 flicker: 25.4 ± 8.9 μV and 27.8 ± 8.6 μV (p = 0.039), respectively. The implicit time of all the components did not reveal significant differences before and after surgery. Conclusions: Cataractous lens removal and intraocular lens implantation may influence ISCEV standard ERGs, even if the cataract is relatively mild. [ABSTRACT FROM AUTHOR]

Aims: To compare the accuracy of IOL power calculations using ultrasound biometry and partial coherence laser interferometry based optical biometry Material and Methods: All cases of cataract with no other pathology involved presenting to, ophthalmology department at RNT Medical College and Hospital, Udaipur from august 2018 to December 2019.The patients are divided into two group 1st group IOL power calculated by optical biometer and 2nd group IOL power calculated by ultrasound biometry. Results: Significant p-value (0.01) was observed between Group 1 and Group 2 among pre operative and post-operative VS patients. Conclusion: optical biometry with the AL scan (Nidek) proved to be slightly more accurate than ultrasound biometry for IOL power calculation. [ABSTRACT FROM AUTHOR]

Purpose of the Study: To estimate and to compare the levels of cervical phIGFBP-1 among primigravida with prolonged pregnancy, with and without successful induction of labor (IOL). Methods: A diagnostic study (cross-sectional study design) was conducted in our institution from November 2016 to April 2018 on 84 primigravida at ≥ 41 weeks with uncomplicated singleton pregnancy. The results were analyzed using SPSS software and receiver operating characteristics curves to determine the best cutoff using Youden Index. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive (+ LR) and negative likelihood ratio (− LR) were calculated. P value < 0.05 was considered significant. Logistic regression analysis was used to determine the predictive ability of the three markers for successful IOL. Results: The cutoff level of phIGFBP-1, Bishop score (BS) and transvaginal cervical length (TVL) were 7.8 µg/l, 3 and 3.5 cm, respectively. The sensitivity, specificity, PPV, NPV, + LR and − LR of phIGFBP-1 (> 7.8 µg/l) were 0.87, 0.87, 0.89, 0.85, 6.76 and 0.15, respectively. Using logistic regression analysis, phIGFBP-1 was found to be the best predictor of successful IOL (OR 44.200; 95% CI 12.378–157.831, p < 0.001). Conclusion: phIGFBP-1 is a strong independent predictor successful IOL as compared to TVL and BS in primigravida with prolonged pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: To describe the occurrence and associated factors for "fibrin web" (FW) formation following phacoemulsification in dogs. Methods: A retrospective review of medical records of all dogs undergoing phacoemulsification (MU‐Veterinary Health Center, 2014‐2018) was conducted to associate FW formation with signalment, systemic co‐morbidities, cataract stage, surgeon (resident vs faculty), phacoemulsification time, IOL, and intracameral injections including viscoelastic type. Both univariate and multivariate statistical analyses were performed to evaluate associations among variables with FW formation. Results: Data from 398 eyes on 201 dogs were included; 4 left eyes (4 dogs) developed presumptive endophthalmitis and were excluded from further analysis. Forty‐eight eyes did not have cataract surgery. Hence, 350 eyes on 201 dogs were included in the analyses. Among these, 84 eyes (59 dogs) developed a FW. Univariate analyses showed that the odds of FW increased with age and phacoemulsification time. Additionally, FW web was associated lens type, lens brand, and viscoelastic type. Multivariate analyses showed that when comparing lens types in combination with a particular viscoelastic, viscoelastic impacted the estimated prevalence of FW formation the most. In contrast, when the data were analyzed by lens brand, lens brand impacted prevalence more than viscoelastic type. Diabetes mellitus was not associated with FW formation. Conclusions: Based on the available data, intraocular lens implantation, viscoelastic type, dog age, and phacoemulsification time were associated with FW formation. Diabetes mellitus, gender, cataract stage, surgeon, intracameral injections other than viscoeleastic, and intra‐ and postoperative complications were not associated with FW formation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular lens (IOL), AcrySof® IQ PanOptix® (TFNT00), in an Indian population. Patients and Methods: This prospective, multicenter, observational, single-arm, post-marketing study included 67 patients undergoing cataract surgery with bilateral implantation of TFNT00 across five Indian sites. Postoperative outcomes were assessed at 3 months after second eye surgery. Effectiveness outcomes included: mean binocular and monocular visual acuity (VA) at distance (4 m), intermediate (60 cm), and near (40 cm); binocular defocus curve; manifest refraction; and subjective symptom questionnaire evaluation. Safety outcomes included the rate of ocular adverse events and mesopic contrast sensitivity. Results: Mean binocular and monocular distance-corrected and uncorrected VAs of 0.1 logMAR or better (approximately 20/25 Snellen) were achieved at distance, intermediate, and near. Overall, ≥ 70% of patients achieved binocular 0.1 logMAR vision or better across all distances. TFNT00 maintained a mean VA of 0.1 logMAR or better at the defocus range of +0.5 diopters (D) to – 2.5 D (200 cm to 40 cm). The subjective symptom questionnaire-assessed frequency of halo visual disturbances was low at Month 3; halos were reported "none of the time" to "only some of the time" in 86.6% of patients. The large majority of patients (98.5%) were "satisfied" or "very satisfied" with their near, intermediate, and distance vision at Month 3, and ≥ 94.0% of patients reported spectacle independence for tasks at all distances. The adverse event rate was low; no patients discontinued due to an adverse event. Conclusion: TFNT00 provided a continuous range of vision of 20/25 or better for distance to near and performed effectively at an intermediate functional distance of 60 cm, resulting in high levels of spectacle independence and patient satisfaction. TFNT00 demonstrated a good safety profile and a low post-operative frequency of halo visual disturbances. [ABSTRACT FROM AUTHOR]