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PURPOSE: To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. SETTING: Private clinics, United Kingdom. DESIGN: Retrospective case series. METHODS: A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. RESULTS: The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. CONCLUSIONS: Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

PURPOSE: To assess the accuracy of intraoperative wavefront aberrometry (IWA) versus modern intraocular lens formulas in post-myopic laser vision correction (LVC) patients undergoing cataract surgery with capsular tension ring placement. METHODS: This is a retrospective chart review conducted at an academic outpatient center. All post-myopic LVC eyes undergoing cataract surgery with IWA from a single surgeon from 05/2017 to 12/2019 were included. All patients received a capsular tension ring (CTR). Mean numerical error (MNE), median numerical error (MedNE), and percentages of prediction error within 0.50D, 0.75D, and 1.00D were calculated for the above formulas. RESULTS: Twenty-seven post-myopic LVC eyes from 18 patients were included. In post-myopic LVC, MNE with Optiwave Refractive Analysis (ORA), Barrett True K (BTK), Haigis, Haigis-L, Shammas, SRK/T, Hill-RBF v3.0, and W-K AL-adjusted Holladay 1 were + 0.224, - 0.094, + 0.193, - 0.231, - 0.372, + 1.013, + 0.860, and + 0.630 (F = 8.49, p

iStent (Glaukos, San Clemente, CA, USA), a minimally invasive glaucoma device, reduces intraocular pressure (IOP) by enhancing aqueous humor outflow when implanted into Schlemm's canal. Although it has demonstrated effectiveness in lowering IOP and slowing glaucoma progression, its applicability to the Taiwanese population, known for a higher incidence of normal‐tension glaucoma (NTG) cases, requires validation. This retrospective case‐control study, conducted from January 2018 to December 2020, aimed to assess the effectiveness of combining first‐generation iStent with phacoemulsification (phaco‐iStent) compared to phacoemulsification alone in Taiwanese patients diagnosed with primary open‐angle glaucoma (POAG) and NTG, involving 71 eyes (iStent group: POAG 16 and NTG 8; control group: POAG 28 and NTG 19). The primary outcomes included changes in IOP and the number of antiglaucoma medications, with subgroup analyses for POAG and NTG. Over the 18‐month follow‐up, the iStent group achieved a significantly greater reduction in antiglaucoma medications compared with the control group (p value = 0.003∼<0.001) without significant IOP rebound. After adjusting for confounding factors, the reduction in the number of antiglaucoma medications with iStent remained significant (β = −0.8, p < 0.001) according to the generalized estimating equation. At 18 months, the iStent group demonstrated higher qualified and complete success rates than the control group (73.3% vs. 16.7%, p value = 0.001% and 53.3% vs. 0%, p value = 0.002, respectively). Notably, the NTG‐iStent subgroup achieved the highest complete success rate (85.7% at 18 months). In conclusion, phaco‐iStent emerges as an effective standalone treatment for Taiwanese patients with POAG and NTG, providing substantial IOP reduction and higher success rates, especially in NTG cases. These findings propose that phaco‐iStent could be a promising intervention for managing POAG and NTG within the Taiwanese population. Trial Registration: ClinicalTrials.gov identifier: NCT06630546. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionCataract surgery is a common operation, typically carried out on older adults who have many comorbid medical conditions. Many of these patients may be undergoing aspirin therapy for diverse cardiovascular causes. Nevertheless, there is ongoing controversy regarding the administration of aspirin therapy during the perioperative period, as there are concerns regarding the risk of bleeding problems compared to thromboembolic events. Although aspirin is commonly used, there is no agreement on whether to continue or stop taking it before cataract surgery. This systematic review and meta-analysis attempt to assess the safety of continuing or discontinuing aspirin in the setting of cataract surgery.We conducted a systematic review and meta-analysis following PRISMA guidelines. Four databases were searched until January 25, 2024, for studies assessing the safety and efficacy of aspirin continuation or discontinuation before cataract surgery. The risk ratios (RR) of the extracted data and their 95% confidence interval (95% CI) were pooled using RevMan 5.4 software. We registered our protocol in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024529986).We included nine studies with a total of 65,196 patients comprising various study designs and global populations. The analysis revealed a significant increase in subconjunctival hemorrhage risk with aspirin continuation (RR: 1.74, 95% CI: 1.22, 2.50, p = .002). However, the risk of hyphema, retrobulbar hemorrhage, vitreous hemorrhage, intraocular pressure spike, corneal edema, posterior capsule rupture, and visual acuity changes did not significantly differ between aspirin continuation and discontinuation or aspirin and placebo groups.Although the use of aspirin before cataract surgery raises the likelihood of subconjunctival bleeding, it does not increase the risk of potentially sight-threatening bleeding events. We recommend continuation of aspirin in patients undergoing cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of superior and temporal clear corneal incisions, regardless of the steep axis, on postoperative changes in corneal higher order aberrations (HOAs) in patients with healthy corneas and mild preoperative corneal astigmatism. Methods: In this prospective cohort study, the right eyes of study participants were randomly assigned to one of two groups prior to cataract surgery: temporal incision (TI) and superior incision (SI). Preoperatively and 6 weeks after surgery, measurements were taken of corneal HOAs over a 6-mm optical zone. Results: The study included 102 eyes (50 eyes in the TI group and 52 eyes in the SI group) that underwent routine phacoemulsification using a 2.4-mm clear corneal incision. Significant changes in vertical coma (P =.019), horizontal coma (P =.042), and vertical trefoil (P =.001) were observed in the SI group. In the subgroup analysis of the SI group, significant changes in vertical coma (P =.025) and vertical trefoil (P =.047) were observed in the eyes with preoperative with-the-rule corneal astigmatism, and significant changes in horizontal coma (P =.038) were observed in eyes with preoperative against-the-rule corneal astigmatism. The TI group showed no significant difference between the preoperative and postoperative periods. Conclusions: The SI induced vertical and horizontal coma in accordance with the preoperative axis of the steep meridian. These alterations in corneal HOAs may affect the quality of vision after surgery. TI may potentially provide an advantage over SI in terms of corneal HOAs. [J Refract Surg. 2024;40(11):e792–e796.] [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsTo compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes.A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12–24 weeks and the rates of CME and additional associated complications.We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4–12 weeks and 12–24 weeks, respectively. At 12–24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal.The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation in pediatric uveitis. Methods: A retrospective analysis was conducted on pediatric uveitis patients undergoing phacoemulsification and intraocular lens implantation with intravitreal dexamethasone implantation. Patients with a minimum follow-up of 6 months were included. Primary outcome measures included ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. Results: 36 eyes of 28 patients were ultimately included in this study. The mean preoperative BCVA was 1.00 (0.40–1.50) LogMAR. BCVA significantly improved to 0.40 (0.20–0.54) LogMAR at 1 month postoperatively (P = 0.006), further improving to 0.30 (0.20–0.40) LogMAR at 3 months postoperatively (P = 0.001). BCVA remained stable at 0.30 (0.20–0.70) LogMAR at 6 months postoperatively (P = 0.005). Mean IOP showed no statistically significant difference during the follow-up period of three to six months after surgery. Eight children experienced recurrence of ocular inflammation during the 6-month follow-up period. No cases of worsening macular edema, glaucoma, or elevated IOP were observed in any patient. Conclusion: Intravitreal dexamethasone implantation during phacoemulsification and intraocular lens implantation is a safe and effective method for preventing and treating postoperative inflammation in children with uveitis. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo compare corneal endothelial changes in patients with Fuchs Uveitis Syndrome (FUS) undergoing phacoemulsification surgery using confocal and specular microscopy.We included 14 patients with unilateral FUS and cataracts who underwent phacoemulsification surgery in a Mexican referral center for inflammatory eye diseases. Preoperative confocal and specular microscopies were conducted, establishing baseline images for subsequent analyses. Surgery on the FUS eye was performed by a single surgeon and an intraocular lens was implanted in all cases. Both specular and confocal microscopy were repeated 6 months after FUS eye surgery and compared with baseline images. We used Image J to do a manual segmentation of KP and determine their density for further analysis hence developing a new tool for confocal microscopy image analysis.All patients underwent uneventful phacoemulsification surgery in the FUS eye. There was no significant change in endothelial cell density (ECD) from 2257 (±508.2) cells/mm2 preoperatively to 2214 (±535.1) cells/mm2 postoperatively (p = 0.809). Confocal microscopy revealed a decrease in Keratic Precipitate Density (KPD) from a median of 1413 (±2809.7) KPs/mm2 preoperatively to a median of 685.5 (1527.9) KPs/mm2 postoperatively (p = 0.036).Phacoemulsification surgery in patients with FUS produces no significant loss of endothelial cells and morphological changes that can be detected by confocal and specular microscopy. We found a reduction in KPD 6 months after surgery on confocal microscopy. Additionally, our manual segmentation technique for KPs utilizing Image J offers a novel and practical approach for confocal microscopy image analysis. [ABSTRACT FROM AUTHOR]

This prospective study aimed to investigate microvascular changes in diabetic patients undergoing cataract surgery. Foveal avascular zone (FAZ) area, as well as vessel density (VD) in the macula and radial peripapillary capillary plexus (RPC), were compared before and after surgery. Sixty eyes (72.3%) had no diabetic retinopathy (no DR group) and 23 eyes (27.7%) had non-proliferative diabetic retinopathy (DR group). In the no DR group, the FAZ area in the superficial capillary plexus (SCP) decreased from 0.41 ± 0.13 to 0.38 ± 0.11 mm2 (P = 0.036), while no significant change was observed in the DR group (0.33 ± 0.12 to 0.30 ± 0.12 mm2, P = 0.091) at 6 months postoperatively. VD in the RPC increased from 34.4 ± 2.3% to 35.6 ± 2.3% in the no DR group (P = 0.009), but there was no significant change in the DR group (33.0 ± 3.5% vs. 34.0 ± 2.3%, P = 0.051) after 6 months. VD in the macula did not change in either group. Phacoemulsification reduced the FAZ area in the SCP and increased the VD in the RPC in diabetic patients without diabetic retinopathy at six months postoperatively. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the incidence of conjunctival chemosis during phacoemulsification and to explore the possible mechanism and treatments. Methods: Patients with or without chemosis during phacoemulsification by the same operator within two years were included. The initial site of chemosis, the chemosis originated time, and the degree of chemosis at the end of the surgery were recorded. The differences in phacoemulsification energy/time and irrigation volume were compared between two groups. Meanwhile, the distance between the clear corneal incision (CCI) and the end of the Bowman's layer, surgically induced astigmatism (SIA), intraocular pressure and central corneal thickness were also compared between the two groups. Results: The incidence of intraoperative chemosis was 9.17% (66/720). The distance between CCI and the end of the Bowman's layer in the chemosis group was significantly longer than that in the non-chemosis group postoperatively (P < 0.0001). The initial sites of chemosis were located on both sides of the external opening of the CCI. The average time from the phacoemulsification probe introducing into the anterior chamber to the originating of chemosis was 30.23 ± 49.23s. Conclusion: Intraoperative chemosis is related to the distance from CCI to the end of Bowmen's layer. The residual conjunctiva around the incision wraps the phacoemulsification probe sleeve to form a passage, the leakage fluid enters the subconjunctiva through this passage, forming chemosis. Conjunctival incision on both sides of CCI can effectively prevent the development of chemosis. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsTo compare the impact of 8 mm versus 9 mm optical zone (OZ) diameters on corneal astigmatism correction and to evaluate the impact of incision depth percentage after femtosecond laser corneal relaxing incisions (CRIs) combined with cataract surgery.Thirty-nine eyes from 39 patients were enrolled and randomly assigned to two groups based on the OZ diameter: 8 mm and 9 mm. Corneal astigmatism and CRI depth were measured using Pentacam and anterior segment optical coherence tomography. Vector analysis was performed using Alpins method.In the 8 mm group, postoperative corneal astigmatism was reduced by 0.77 ± 0.61 diopters (D), significantly greater than the reduction of 0.42 ± 0.40 D in the 9 mm group (p < 0.05). The 8 mm group exhibited greater surgically induced astigmatism (SIA), net corneal changes, and a smaller angle of error (AE) (p < 0.05). At 3 months postsurgery, the correction index (CI) values were 0.84 ± 0.39 for the 8 mm group, exceeding the 0.52 ± 0.32 observed in the 9 mm group (p < 0.05). The mean incision depth percentage was significantly higher in the 9 mm group (79.30 ± 10.76%) compared to the 8 mm group (72.58 ± 8.73%) (p < 0.05). In the 8 mm group, CI values closer to 1.00 were associated with lower percentages of incision depth.CRIs with an 8 mm OZ diameter demonstrated superior efficacy in correcting corneal astigmatism with shallower incision depths compared to those with a 9 mm diameter. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical outcomes of canaloplasty performed with the iTrack microcatheter (Nova Eye Medical, Fremont, USA) as a standalone procedure and in combination with phacoemulsification in patients with primary angle-closure glaucoma (PACG). Methods: A single-center, retrospective case series of eyes undergoing canaloplasty via an ab-interno technique with a diagnosis of PACG based on gonioscopy findings (Shaffer grading). Patients were excluded if they had previously undergone a glaucoma procedure other than Laser Peripheral Iridotomy (LPI). Eyes were grouped by glaucoma severity based on mean deviation preoperative values. Outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Results: Sixty eyes (9 canaloplasty-standalone, pseudophakic, and 51 canaloplasty + phaco) were eligible. The mean baseline IOP was 21.9 ± 7.3 mmHg and number of glaucoma medications was 1.95 ± 1.4. At the latest follow-up (mean 26 ± 9.2 months), they were reduced to 14.6 ± 3.7 mmHg (p < 0.001) and 0.96 ± 1.2 (p < 0.001). IOP reduction was statistically significant when canaloplasty was performed as a standalone procedure (baseline 22.78 ± 6.72 vs 17.00 ± 3.42 at the latest follow-up) or combined with phacoemulsification (21.75 ± 7.43 vs 14.21 ± 3.66) or if canaloplasty was performed in mild (20.8 ± 4.93 vs 15.5 ± 3.63), moderate (21.9 ± 8.58 vs 13.9 ± 3.90) or severe (23.5 ± 11.3 vs 12.4 ± 3.20) glaucoma eyes, with no difference between the groups postoperatively. Medication reduction was significant when canaloplasty was performed in combination with phacoemulsification and in mild glaucoma eyes. No serious intraoperative or postoperative complications were reported. Conclusion: Canaloplasty via an ab-interno surgical technique, performed as standalone or combined with phacoemulsification, is a safe and clinically effective treatment in primary angle closure glaucoma patients up to 2 years. [ABSTRACT FROM AUTHOR]

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value<0.05). Results: In the present study, the mean±Standard Deviation (SD) age of patients was 64.34±8.09 years (range: 42-79 years), with a predominance of females, 29 (66%). All patients underwent unilateral manual small incision cataract surgery on their worse eye. The degree of strabismus among the patients varied: 27 (61.36%) exhibited a 15° deviation, 12 (27.27%) had a 30° deviation and 5 (11.36%) exhibited a 45° deviation. A total of 41 (93.1%) patients presented with exotropia, while 3 (6.9%) exhibited esotropia. The results demonstrated significant improvements in Corrected Distance Visual Acuity (CDVA) from the preoperative to postoperative period. The IND-VFQ-33 questionnaire revealed substantial reductions in scores for general functioning, mobility, activity limitation, psychosocial impact and visual symptoms across the entire study population and in all strabismus groups (15°, 30° and 45° deviations), with a p-value of <0.05. Overall, 84.09% of patients had no to mild visual impairment postoperatively, with 27 (100%) patients with 15° strabismus, 7 (58.3%) patients with 30° strabismus, and 3 (60%) patients with 45° strabismus reporting no to mild visual impairment. 3 (25%) patients with 30° strabismus and 1 (20%) patient with 45° strabismus had moderate vision impairment postoperatively. Two (16.66%) patients with 30° strabismus and one patient with 45° strabismus had severe vision impairment postoperatively. Conclusion: A significant proportion of strabismus patients with cataracts were elderly, predominantly females. Exotropia and 15° strabismus were the most common findings. Cataract surgery significantly improved VRQoL, with the most substantial benefits observed in patients with a 15° deviation and the least in those with a 45° deviation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not. Results: After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045) Conclusion: LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery. [ABSTRACT FROM AUTHOR]

Topic: To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser-assisted cataract surgery (FLACS) in patients with cataract. Clinical Relevance: Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes. Methods: The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of corrected distance visual acuity, endothelial cells reduction, central corneal thickness (CCT), and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% CI. The protocol was registered at the Prospective Register for Systematic Reviews (registration number CRD42023420173). Results: 11 studies were included in this meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at 6 months (P < .001) compared with CPS. It also exhibited a shorter effective phacoemulsification time (P < .001) and less balanced salt solution usage (P < .001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, CCT changes, or aqueous cytokine levels between the 2 groups. Conclusions: Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss. [ABSTRACT FROM AUTHOR]

Purpose: To assess the cost-effectiveness of the treatment of low corneal astigmatism (=1.5 diopters) at the moment of cataract surgery. Setting: Qvision, Ophthalmology Department, VITHAS Almer'ıa Hospital, Spain. Design: Economic evaluation. Methods: A decision tree was used to assess the costeffectiveness of implanting spherical vs toric intraocular lenses (IOLs) or spherical lens combined with the following corneal incisions: limbal-relaxing incisions conducted manually (M-LRI) or assisted by femtosecond laser (F-LRI), arcuate keratotomies conducted manually (M-AK) or assisted by femtosecond laser (F-AK), and intrastromal arcuate keratotomies (F-iAK). Outcomes of cost were selected from a patient perspective considering the gross cost of each one of the surgeries at European centers, and the effectiveness variable was the probability of achieving a visual acuity of 20/20 postoperatively. A sensitivity analysis was conducted to assess the uncertainty considering the evidence retrieved from the transition probabilities of the model, effectiveness, and cost. Results: F-AK or toric IOLs were the most effective treatments, increasing an 16% or 9%, respectively, in the percentage of eyes attaining 20/20 vision. The M-LRI, F-iAK, and F-LRI procedures were strongly dominated while the M-AK and toric IOL were weakly dominated by the F-AK. A patient with low corneal astigmatism would need to be willing to pay 360€ (95% CI, 231-1224) with F-AK and 472€ (95% CI, 149-4490) with toric IOLs for a 10% increase in the probability of achieving 20/20 vision. Conclusions: From patient perspective, F-AK was generally the most cost-effective treatment, although toric IOLs can dominate in some countries. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to report the visual and refractive outcomes of nanophthalmic eyes undergoing phacoemulsification at a tertiary cataract center. Methods: This is a prospective consecutive case series. Patients with an axial length of ≤20.5 mm who underwent phacoemulsification at a tertiary cataract center in Hong Kong were included. Eyes undergoing extracapsular cataract extraction or with a previous history of intraocular surgery including trabeculectomy were excluded. The outcome measures were the corrected distance visual acuity (CDVA) and refractive status at four months post-operation. Different intraocular lens formulas were used to compare the refractive outcomes. Results: Out of 22,847 cataract surgeries performed from May 2011 to March 2020, 14 eyes (0.06%) of 10 patients had axial lengths of ≤20.5 mm and underwent phacoemulsification. The mean axial length was 20.13 ± 0.44 mm. Out of these fourteen eyes, three (21%) had postoperative myopic shift with spherical equivalent refraction of more than or equal to 1D compared to the original target. Eleven eyes (79%) had postoperative refraction within 0.5D compared to the original target. Nine out of fourteen eyes (64%) had improvements in postoperative vision. There were no intraoperative complications. When comparing the Hoffer Q, Holladay 1, Holladay 2, Haigis and Hill-RBF 2.0 formulas, there was no significant difference in the absolute errors between the five formulas (p = 0.072). Conclusions: There was no significant difference in the mean absolute errors between the Hoffer Q, Holladay 1, Holladay 2, Haigis and Hill-RBF 2.0 formulas. Myopic shift was not uncommon, and more studies on intraocular lens (IOL) power calculation for short eyes are warranted. [ABSTRACT FROM AUTHOR]

Purpose: To compare anterior chamber stability and surgical efficiency in one-handed phacoemulsification, comparing Ozil and Active Sentry (AS) handpieces. Methods: Observational and comparative study. Selected patients were divided into two groups, AS and Ozil handpieces, and underwent one-handed phacoemulsification. Parameters like IOP per quadrant, vacuum, and aspiration flow were fixed in all surgeries. The study endpoints were intraoperative anterior chamber instability score (IACIS), cumulative dissipated energy (CDE), followability, and surgery duration. Results: Mean age was 71.42 years in the AS group vs. 73.97 in the Ozil Group. Mean Axial Length was 22.85 ± 1.21 mm with Active Sentry vs. 23.3 ± 1.29 mm with Ozil (p = 0.324). IACIS was 0.10 ± 0.30 with AS vs. 0.63 ± 0.71 with Ozil (˂0.001*). CDE was 9.95 ± 4.76 percent-seconds with AS vs. 10.89 ± 6.55 percent-seconds with Ozil (0.519). The followability score was 0.74 ± 0.855 with AS vs. 0.83 ± 0.874 with Ozil (p = 0.678). Surgery duration was 19.00 ± 5.44 min with AS vs. 24.57 ± 6.51 with Ozil (p < 0.001). Conclusions: The Active Sentry handpiece improves anterior chamber stability in one-handed phacoemulsification while maintaining surgical performance during nucleus removal without an auxiliary side-port. To the best of our knowledge, this is the first study demonstrating that the Active Sentry handpiece can increase anterior chamber stability not only in conventional phacoemulsification but also in one-handed phacoemulsification. [ABSTRACT FROM AUTHOR]

Aim: To explore the molecular mechanism underlying the protective effect of hypothermic perfusion on the corneal endothelium during phacoemulsification. Methods: Phacoemulsification was performed on New Zealand white rabbits. Perfusate at different temperatures was used during the operation, and the aqueous humor was collected for proteomic sequencing after the operation. Corneal endothelial cell injury was simulated by a corneal endothelial cell oxygen–glucose deprivation/reoxygenation (OGD/R) model in vitro. Flow cytometry and evaluation of fluorescent LC3B puncta were used to detect apoptosis and autophagy, and western blotting was used to detect protein expression. Results: A total of 381 differentially expressed proteins were identified between the two groups. In vitro, 4 ℃ hypothermia significantly reduced apoptosis and promoted autophagy. Apoptosis increased after autophagy was inhibited by 3-Methyladenine (3-MA). Furthermore, adiponectin (ADIPOQ) knockdown inhibited phospho-AMPK and blocked the protective effect of hypothermia on corneal endothelial cells. Conclusions: We investigated the differential expression of proteins between the hypothermia group and normothermia group by proteomics. Moreover, hypothermia-induced ADIPOQ can reduce apoptosis by promoting AMPK-mediated autophagy. Key Messages: What is known • During phacoemulsification, the corneal endothelium may be damaged by ultrasonic energy. • The use of hypothermic perfusion during phacoemulsification can reduce postoperative inflammation. What is new • Hypothermia protects corneal endothelial cells from apoptosis by promoting autophagy. • Hypothermia induces adiponectin expression and protects corneal endothelial cells through AMPK-mediated autophagy. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo quantify the risk of posterior capsule rupture (PCR) in fellow-eye phacoemulsification surgery and to determine risk factors.We pooled data from 8 United Kingdom sites for patients undergoing bilateral non-simultaneous phacoemulsification. Main outcome measures were the incidence and risk factors of the development of PCR during the fellow-eye phacoemulsification.We included 66,288 patients with a mean age of 75.3 ± 10.2 years. PCR during phacoemulsification occurred in the first eye in 932 patients (1.4%) and the fellow eye in 1039 patients (1.5%). The risk of fellow eye developing PCR in patients with PCR in the first eye was significantly higher than in patients without first eye PCR: 30 patients (3.2%) vs. 1009 (1.5%), respectively (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7). Other risk factors for fellow-eye PCR included zonular dialysis (OR = 5.4, CI = 3.3-7.8) and advanced cataract (OR = 2.8, CI = 2.1-3.7).History of PCR in the first-operated eye is an independent risk factor for PCR in the fellow eye. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to evaluate the long-term clinical outcomes of excisional goniotomy with the Kahook Dual Blade (KDB) in the management of various types of glaucoma. Methods: This was a retrospective, noncomparative chart review of 90 eyes of 53 patients with glaucoma that underwent standalone KDB goniotomy (KDB-alone group) or KDB goniotomy with concomitant phacoemulsification (KDB-phaco group) between October 2015 and October 2017. Surgical success was defined as an intraocular pressure (IOP) reduction by ≥ 20% at the last follow-up with no surgical reinterventions required and a final IOP ≥ 4 mmHg and ≤ 21 mmHg. We also report on changes from baseline in IOP, number of glaucoma medications, best-corrected visual acuity (BCVA), and visual field parameters, for up to 72 months. Results: At 72 months, mean (standard deviation [SD]) IOP was reduced from 17.5 (5.7) to 13.6 (3.0) mmHg (P < 0.0001) in the KDB-phaco group and from 23.3 (5.9) to 15.1 (6.2) mmHg (P = 0.0593) in the KDB-alone group. The mean (SD) number of glaucoma medications was reduced from 1.3 (1.0) to 0.8 (0.9) (P < 0.0001) in the KDB-phaco group and from 1.2 (1.0) to 0.7 (0.8) (P = 0.3409) in the KDB-alone group. During the 72-month follow-up, surgical success was achieved in 24 of the 52 available eyes (46.2%). Four eyes underwent a glaucoma surgical reintervention by 72 months. Conclusions: Excisional goniotomy with the KDB effectively lowered the IOP (by an average of 28.0% from baseline) and maintained or further reduced glaucoma medication burdens (by an average of 30.8% from baseline) under an excellent safety profile, independent of phacoemulsification status. The procedure exhibited favorable success for up to 6 years, providing valuable insights into its long-term efficacy as a glaucoma treatment. [ABSTRACT FROM AUTHOR]

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri 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 Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri 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.)

Background: To investigate the risk factors and prognosis of clinical pseudophakic cystoid macular edema (PCME) after uneventful phacoemulsification surgery in patients without pre-existing fundus diseases. Methods: This was a retrospective case-control study. Medical records between August 2020 and August 2023 were reviewed for patients who had no previous fundus diseases and developed clinical PCME. A control group was randomly chosen and the risk factors for PCME was analyzed by binary logistic regression. Structure and visual prognosis of the PCME cohort were observed and compared among subgroups undergoing different treatment measures. Results: Forty-seven eyes of 47 patients with PCME were included. The development of PCME was associated with higher systolic blood pressure (OR, 1.048; 95%CI 1.002, 1.097; P =.042), no posterior vitreous detachment (OR, 0.215; 95%CI: 0.553, 0.887; P =.032) and shorter axial lengths (OR, 0.401; 95%CI 0.161, 0.997; P =.049) compared to controls. During a mean follow-up of 8.26 months, 36 eyes (76.6%) showed visual improvement with decreased macular thickness. Different treatment modalities, including observation, topical NSAIDs, and intervention therapy, have no significant differences on the visual prognosis (P = 1.000). However, the intervention group had a shorter recovery time compared to the observation group (28.6 vs. 45.9 days, P =.037). Conclusion: PCME remains an encountered morbidity in patients without pre-existing fundus diseases. Shorter axial lengths, absence of posterior vitreous detachment, and higher systolic blood pressure are risk factors of PCME. Active intervention failed to improve the prognosis of PCME but could shorten the recovery time. [ABSTRACT FROM AUTHOR]

Background: To investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29. Methods: Preoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed. Results: Fifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted. Conclusions: The anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion. [ABSTRACT FROM AUTHOR]

Purpose: To report an unusual but important complication of routine cataract surgery, accidental intrastromal intraocular lens (IOL) implantation. Methods: During cataract surgery in a 66-year-old man, the IOL was delivered into the intrastromal space of the cornea accidentally. The lens was removed immediately and carefully by enlarging the corneal tunnel. Results: Anterior segment optical coherence topography (AS-OCT) was used for postoperative follow-up of the patient, which showed a viscoelastic substance in the stroma of the cornea that was washed out. Ther patient's final visual acuity was 20/20. Conclusions: A uniplanar corneal incision with wound-assisted IOL insertion can lead to intrastromal IOL injection. If a cataract surgeon encounters such a complication, AS-OCT could be a useful imaging technique for follow-up. [Journal of Refractive Surgery Case Reports. 2024;4(4):e36–e39.] [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsUnderstanding the current role and efficacy of endocyclophotocoagulation (ECP) compared to ab-interno canaloplasty with or without trabeculotomy (OMNI), combined with cataract extraction and lens implantation (CEIOL), for the management of uveitic glaucoma (UG) is limited.All UG patients ≥18 years old with ≥6 months of follow-up data (15.2 ± 5.9 months) after CEIOL combined with either ECP or OMNI from August 2019 to May 2022 at a single academic center were retrospectively reviewed [22 eyes of 15 patients (8 ECP, 14 OMNI)]. Surgical success was considered intraocular pressure (IOP) ≤21 mmHg and a reduction of baseline by ≥20% for two consecutive final visits without hypotony, additional surgery, or loss of light perception. Uveitic control was considered a <2-step increase in anterior chamber (AC) cell grade, <3+ AC cell grade, and no increase in steroid drop use at 3 months postoperatively. Secondary outcome measurements included postoperative change in IOP, glaucoma medications, best corrected visual acuity (VA), AC cell grade, and steroid drop frequency.Baseline ocular and preoperative characteristics of eyes (age, sex, laterality, uveitic location, systemic immunomodulating therapy, visual acuity, IOP, number of glaucoma medications, AC cell grade, and steroid drop frequency) did not significantly differ except for greater racial diversity in the ECP group. 62.5% eyes were surgically successful in the ECP group and 85.71% in the OMNI. Between-group analysis showed greater IOP reduction in the OMNI group (p < .05), but no difference in reduction of glaucoma medications (p = .33). No eyes displayed a two-step increase in or >3+ AC cell grade, however, 50% and 64.29%, respectively, increased steroid drop use. Between groups, no difference in the change of AC cell grade (p = .98) or steroid drop use (p = .84) was seen.Both interventions improved visual acuity, IOP, and glaucoma medication use, however, OMNI was more successful at reducing IOP long term. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to underlying uveitis regardless of surgical approach. [ABSTRACT FROM AUTHOR]

Introduction: Training novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents. Methods: This prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed. Results: Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the "emulsification" step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during "emulsification" and from 69 to 0% during "irrigation and aspiration". At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall. Conclusion: A training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. Trial registration: ClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023). [ABSTRACT FROM AUTHOR]

Background: To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection ("Viscolift technique") in patients with severely subluxated cataracts. Methods: In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. Results: Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The "Viscolift technique" resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p < 0.001) at the last follow-up. No major complications were noted. Conclusions: The "Viscolift technique" proved to be a safe and effective surgical approach for recentering and elevating subluxated cataracts, thus allowing the surgeon to perform an easier and better-centered capsulorhexis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between stromal cell-derived factor-1 (SDF-1), angiopoietin-like 4 (ANGPTL4), glucose-regulated protein 78 (GRP78) and postoperative macular edema (ME) in patients with type 2 diabetic cataract and their predictive efficacy analysis. Methods: 195 patients (195 eyes) with type 2 diabetic cataract who were admitted to our hospital from January 2020 to March 2023 were selected, all patients underwent phacoemulsification combined with foldable intraocular lens implantation, patients were divided into ME group (45 cases) and non-ME group (150 cases) according to whether ME occurred after operation. The levels of SDF-1, ANGPTL4 and GRP78 in aqueous humor were detected before operation, and clinical data were collected. The influencing factors of postoperative ME in patients with type 2 diabetic cataract were analyzed by multivariate Logistic regression analysis, the predictive value of preoperative aqueous humor SDF-1, ANGPTL4 and GRP78 levels in predicting postoperative ME in patients with type 2 diabetic cataract were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of SDF-1, ANGPTL4 and GRP78 in aqueous humor before operation in ME group were higher than those in non-ME group (P<0.05). High glycated hemoglobin, high SDF-1, high ANGPTL4, and high GRP78 were risk factors for postoperative ME in patients with type 2 diabetic cataract (P<0.05). The area under the curve (AUC) of preoperative SDF-1, ANGPTL4 and GRP78 levels in aqueous humor to predict postoperative ME in patients with type 2 diabetic cataract was 0.809, 0.801 and 0.760 respectively, the area under the curve predicted by combined SDF-1, ANGPTL4 and GRP78 was 0.896, which was higher than that of single detection (P<0.05). Conclusion: The increase levels of SDF-1, ANGPTL4 and GRP78 in aqueous humor of patients with type 2 diabetic cataract before operation are relate to the occurrence of postoperative ME, the combination of SDF-1, ANGPTL4 and GRP78 has high application value in predicting the occurrence of ME. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether it is better to perform minimally invasive glaucoma surgery (MIGS) when performing cataract surgery on glaucoma patients. Methods: The study enrolled a total of 159 eyes of subjects with mild-to-moderate glaucoma, including primary open angle glaucoma (POAG), normal tension glaucoma (NTG), and combined mechanism glaucoma (CMG) with visually significant cataract, who were treated with one or more ophthalmic antiglaucoma agents. Phacoemulsification and aspiration with intraocular lens insertion (PEA + IOL, phaco group) or MIGS with PEA + IOL (µLot-phaco group) was performed on patients with glaucoma. Age, sex, glaucoma type, pre- and postoperative IOP, and ratio of IOP reduction were estimated. Results: The rate of IOP reduction in the µLot-phaco group was found to be significantly higher than in the phaco group at the 6-month postoperative assessment. Specifically, a strong correlation was observed between preoperative IOP levels, the presence of POAG, and patient age within the µLot-phaco group, all of which contributed significantly to the IOP reduction observed at the 6-month follow-up. Conclusions: Simultaneous cataract and MIGS were found to be more effective in older POAG patients with higher preoperative IOP. [ABSTRACT FROM AUTHOR]

Objective Animal Studied Procedures Results Conclusions To evaluate whether intracameral tissue plasminogen activator (tPA) injection is effective in regulating posterior capsular opacification (PCO), fibrin formation and intraocular pressure (IOP) after cataract surgery.Prospective study involving 30 eyes of 21 dogs that underwent phacoemulsification.Thirty eyes were randomly divided into two groups of 15 eyes (control and tPA groups). Intracameral tPA (25 μg/0.1 mL) was injected into tPA group eyes before corneal incision closure but not into the eyes of the control group. The grades of anterior fibrin formation and PCO were compared based on slit lamp biomicroscope examination at 1 and 2 weeks, 1 month, and 2–3 months postoperatively. IOP was measured using applanation tonometry every 30 min for 4 h immediately after operation and on the following morning. The IOP of the two groups at each time was compared.The grade of anterior fibrin formation and that of PCO were not significantly different between the two groups at any time point (p > .05). However, the IOP of the tPA group was significantly lower than that of the control group at each point on the day of surgery (p < .05). No complications were observed with tPA injection, except for temporary hyphema (for 3 days) in one eye.Although the intracameral tPA injection did not affect anterior fibrin formation and PCO, it effectively maintained normal IOP immediately after phacoemulsification. Thus, our findings provide valuable insights into the potential benefits of intracameral tPA injection in achieving immediate IOP control after phacoemulsification. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta‐analysis quantitatively examines the efficacy of angle‐based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG). Methods: A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle‐based MIGS (trabecular‐bypass devices, excisional trabeculotomy, goniotomy and ab‐interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta‐analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti‐glaucoma medication (AGM) reduction post‐operatively. Results: Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle‐based MIGS were included for final meta‐analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post‐operatively at 6 months (2.44 mmHg, 95%CI: 1.83–3.06; 1.21 AGM, 95%CI: 0.99–1.44), 12 months (2.28 mmHg, 95%CI: 1.71–2.84; 1.18 AGM, 95%CI: 0.90–1.47), 24 months (2.10 mmHg, 95%CI: 1.51–2.68; 1.26 AGM, 95%CI: 0.85–1.68) and 36 months (2.43 mmHg, 95%CI: 1.71–3.15, 0.87 AGM, 95%CI: 0.21–1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification‐iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07–3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86–1.29, p < 0.001) at 12 months post‐operatively. Conclusions: Angle‐based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the improvement of the level of science and technology, diagnosis and treatment technology of ophthalmology has continuously improved, especially with the rise of optical coherence tomography. Alternative methods have enabled clinicians to obtain more information and make greater breakthroughs in the occurrence and development of many ophthalmic diseases. OBJECTIVE: To investigate changes in retinal structure in the macular area of senile diabetic cataract patients undergoing cataract phacoemulsification. METHODS: This was a prospective cohort study. A total of 68 cataract patients (78 eyes) who voluntarily received phacoemulsification combined with intraocular lens implantation in the Department of Ophthalmology of our hospital from December 2018 to December 2021 were selected. They were divided into A (diabetic) and B (non-diabetic) according to whether they were complicated with diabetes. There were 24 cases (28 eyes) in A and 44 cases (50 eyes) in B. Cataract patients were collected before and after surgery. Day, 1 week, and 1 month, data on the average thickness of the fovea retina and thickness of the retinal nerve fiber layer around the optic disc (average thickness, nasal thickness, topic side thickness, upper thickness, and lower thickness) were statistically analyzed analyze. RESULTS: The average retinal thickness of the macular fovea in Group A was found to be greater than that of Group B, however, there was no statistically significant difference between the two groups. At week one and week thirty, Group A's layer of retinal nerve fibers surrounding the optic disc thickened; there was no discernible difference between the two groups. One week and one month following surgery, however, showed a one-week difference in upper thickness compared to preoperative days. There was no discernible change between the preoperative and 1-day times. CONCLUSION: Both diabetic cataract patients and simple age-related cataract patients will have different degrees of increased foveal retinal thickness after surgery. However, the foveal retinal thickness of patients with diabetes increases more. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum hemoglobin A (HbA1c), 25 hydroxyvitamin D [25(OH)D], matrix metalloproteinase-9 (MMP-9) and postoperative dry eye in patients with type 2 diabetes mellitus (T2DM) complicated with cataract. Methods: 162 patients with T2DM complicated with cataract who underwent phacoemulsification combined with intraocular lens implantation in our hospital from January 2019 to December 2023 were selected, patients were divided into dry eye group (53 cases) and non-dry eye group (109 cases) according to whether dry eye occurred after surgery. The levels of serum HbA1c 25(OH)D and MMP-9 were detected. The factors of postoperative dry eye in patients with T2DM complicated with cataract surgery were analyzed by multivariate Logistic regression, the predictive value of serum HbA1c 25 (OH)D and MMP-9 levels for postoperative dry eye in patients with T2DM complicated with cataract were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with non-dry eye group, the levels of serum HbA1c and MMP-9 in dry eye group increased, and the level of 25(OH)D decreased (P < 0.05) Multivariate Logistic regression analysis showed that prolonged course of T2DM ( OR = 1.245 . 95%CI: 1.007~1.539), elevated HbAte (OR = 3.132, 95% CI: 1.745-5.624), and elevated MMP-9 (OR = 1.206 95%CI: 1.091~1.333) were independent risk factors for postoperative dry eye in patients with T2DM complicated with cataract surgery, Elevated 25 (OH) D ( OR = 0.854, 95% * CI 0.773~0.945) was an independent protective factor (P < 0.05) ROC curve analysis showed that, the area under the curve of combined prediction of serum HbA1c, 25(OH)D and MMP-9 levels for postoperative dry eye in T2DM patients with cataract was 0.921 (95%CI: 0.868~0.957), which was greater than 0.793 (95%CI: 0.723~0.853), 0.779 (95%CI: 0.707~0.840) and 0.783 (95%CI: 0.711~0.844) predicted by serum HbA1 25(OH)D and MMP-9 levels alone. Conclusion: Elevated preoperative serum HbAte and MMP-9 levels and the decrease of 25 (OH)D levels in patients with T2DM complicated with cataract are closely related to postoperative dry eye, and the combination of serum HbA1c 25 (OH)D and MMP-9 has a value in predicting postoperative dry eye in patients with T2DM complicated with cataract surgery. [ABSTRACT FROM AUTHOR]

Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the Hydrus® nickel–titanium alloy Microstent, helps lower IOP by improving aqueous humor outflow. The NIDEK GS-1 automated 360° gonioscope provides advanced imaging of the chamber angle for evaluation and documentation. The aim of this study was to test automated 360° gonioscopy for the detection of postoperative positional variations after Hydrus® Microstent implantation. This study is the largest to date to evaluate post-op positioning of the Hydrus® Microstent using the NIDEK GS-1. Materials and Methods: This study analyzed postoperative outcomes and stent location in eyes diagnosed with mild to moderate glaucoma that underwent Hydrus® Microstent implantation with or without phacoemulsification. Patients with prior IOP-lowering surgery or vitrectomy were excluded. Analyses of the postoperative Hydrus® Microstent position were based on the evaluation of automated 360° gonioscopy images. Results: Twenty-three eyes were included in the study, and all showed a reduction in IOP and a decrease in antiglaucomatous drop use postoperatively. Postoperative gonoscopic images showed variations in implant position. In all cases, the proximal inlet was clearly visible in the anterior chamber. The degree of protrusion into the anterior chamber was variable. The distal tip of the stent was visible behind the trabecular meshwork in Schlemm's canal in five cases, in the anterior chamber in one case, and not visible in seven cases. In no case did postoperative alterations in the position of the implant lead to explantation. Conclusions: This study demonstrated that the Hydrus® Microstent can effectively lower IOP even in the presence of postoperative positional variations. Automated 360° gonioscopy was found to be a useful tool to verify and document the postoperative position of the implant. Positional changes did not require device explantation in any of the cases evaluated. [ABSTRACT FROM AUTHOR]

Purpose: To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification. Setting: A multicenter database study across 8 ophthalmology departments in the United Kingdom. Design: Retrospective, nonrandomized, multicenter comparative study. Methods: We extracted data for patients who underwent Phaco- PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively. Results: The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) (P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ~20/200 vs 20/100) in the stand-alone phacoemulsification group (P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ~20/100 vs 20/32), P < .001). Conclusions: Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of optotype choice on the determination of defocus curve in patients with cataract implanted with presbyopia-correcting intraocular lens (IOL). Setting: Oftalvist Alicante, Alicante, Spain. Design: Observational case-control study. Methods: Patients implanted with Asqelio Trifocal IOL participated in this study. Uncorrected and corrected distance visual acuity (VA) and subjective refraction were determined. Monocular defocus curves were obtained 6 months postoperatively with the Clinical Trial Suite system using either Early Treatment Diabetic Retinopathy Study (ETDRS) or Landolt C charts under photopic conditions (85 cd/m2), and range of vergence from +2.00 to -5.00 diopters (D) in 0.50 D steps. Results: A total of 49 patients were enrolled in the study, 24 in the ETDRS group (7 male, 17 female) and 25 in the Landolt C group (5 male, 20 female). Nonsignificant differences were found between patients conforming both groups, except for preoperative intraocular pressure and white-to-white distance. All patients were within ±1.00 D from intended refraction after surgery. 75% of patients in the ETDRS group and 84% in the Landolt C group were within ±0.50 D. Average difference between the groups across vergences provided by the defocus curve was 0.12 ± 0.05 logMAR units, significant for all vergences (P < .05). Differences in VA were significant for distance, intermediate, and near between both groups, except for uncorrected distance VA. Conclusions: Defocus curves created using Landolt C charts yield significantly lower through-focus outcomes than those created with standard ETDRS charts. This should be taken into account when comparing the performance of presbyopia-correcting systems across studies where recognition charts might have been used because of patient characteristics. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the visual and refractive outcomes in eyes with a history of laser corneal refractive surgery implanted with the second-generation light-adjustable lens (LAL). Setting: Private practice, Sioux Falls, South Dakota. Design: Retrospective, consecutive case series. Methods: Eyes with a history of prior corneal refractive surgery that underwent cataract surgery with implantation of the LAL and were targeted for plano were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and the percentage (%) of eyes within ±0.25 diopter (D), ±0.50 D, and ±1.00 D of their refractive target. Results: 76 eyes from 70 patients were included. A total of 45 eyes with a history of 1 prior refractive surgery and 31 eyes with a history of ≥2 refractive surgeries were included. 74% (n = 56) of all eyes achieved UDVA of 20/20 or better, 88% (n = 67) achieved 20/25 UDVA or better, and 93% (n = 71) were correctable to 20/20 or better postoperatively. For refractive outcomes, 66%of eyes (n = 50) were within ±0.25 D and 86% (n = 65) were within ±0.50 D of refractive target. Conclusions: Patients with a history of laser corneal refractive surgery achieved favorable visual and refractive outcomes with the LAL. This intraocular lens (IOL), which affords postoperative adjustability, is a promising option for patients with a history of corneal refractive surgery who maintain high expectations for functional uncorrected acuity after cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare changes in corneal endothelial parameters after femtosecond laser--assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in different corneal regions. Setting: Chang Gung Memorial Hospital, Linkou, Taiwan. Design: Single-center, retrospective. Methods: Before and 1, 3, and 6 months postoperatively, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, position 2 was nearest to the main wound, and position 3 was at the peripheral zone diagonal to the main wound. Results: This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, position 1 had lower ECD and CoV and higher Hex compared with the peripheral regions. FLACS patients had a significantly less phacoemulsification time and cumulative dissipated energy. At 1 month, FLACS patients showed a significantly smaller increase in corneal thickness at positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at position 2 in both groups and was progressive up to 6 months. Conclusions: After phacoemulsification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of Bio-Hyalur LVD compared with Viscoat ophthalmic viscosurgical device (OVD) in patients undergoing routine cataract surgery. Setting: 2 tertiary eyecare hospitals in Italy. Design: Prospective randomized clinical trial. Methods: This study compared the outcomes of Bio-Hyalur LVD vs Viscoat OVD in patients undergoing standard cataract surgery with phacoemulsification and intraocular lens implantation from January 2021 to April 2022. The primary outcome was mean change in IOP at 6 hours. Secondary outcomes included 1-day, 7- day, 30-day, and 90-day mean intraocular pressure (IOP); 7-day, 30-day, and 90-day corrected distance visual acuity; endothelial cell density (ECD); change in central corneal thickness (CCT); and complications including intraocular inflammation. Results: 84 eyes of 84 patients (n = 41 in the Bio-Hyalur LVD group and n = 43 in the Viscoat group) were screened, enrolled, randomized, and included in the analysis. Mean change in IOP was significantly higher in the Viscoat group than in the Bio-Hyalur LVD group 6 hours (P = .034), 7 days (P < .001), 30 days (P < .001), and 90 days (P = .003) postoperatively. Mean change in uncorrected distance visual acuity and corrected distance visual acuity was significantly higher in the Bio-Hyalur LVD group 30 and 90 days postoperatively. No significant differences in ECD, CCT, and complication rates were observed between groups at any timepoint. Conclusions: Bio-Hyalur LVD OVD was safe and effective in patients undergoing routine cataract surgery. Bio-Hyalur LVD OVD did not confer a higher risk of postoperative increase in IOP. [ABSTRACT FROM AUTHOR]

Purpose: To investigate circumpapillary retinal nerve fibre layer (RNFL) thickness, pupillary function and diameter after phacoemulsification and lens implantation alone or combined with endothelial keratoplasty (EK). Methods: This study was a secondary analysis of data from a randomized, single‐masked trial, that included 72 patients with Fuchs' endothelial dystrophy and cataract, equally allocated (1:1) to ultrathin Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty. The cataract extraction (CE) group included 40 patients undergoing cataract surgery only. All patients were treated with phacoemulsification and lens implantation. Results: RNFL thickness was significantly lower in the CE group than after EK for the global (p < 0.01), nasal (p = 0.04), and temporal sectors (p = 0.01) 12 months after surgery. RNFL thickness was comparable between patients treated with rebubbling and others (p ≥ 0.16 for all comparisons) after 12 months. The CE group and patients treated with EK demonstrated a comparable scotopic (p = 0.34) and photopic pupil diameter (p = 0.95) as well as a comparable maximum (p = 0.83) and average pupillary constriction velocity (p = 0.95) after 12 months. In contrast, patients treated with rebubbling had a significantly smaller scotopic pupil diameter (p = 0.04). Conclusion: In this study, no evidence was found indicating a negative impact on the RNFL thickness after EK when compared to CE 12 months after surgery. Iris function and pupil diameter were comparable between the CE group and patients treated with EK after 12 months. [ABSTRACT FROM AUTHOR]

Purpose: To examine the long‐term risk of glaucoma after cataract surgery in childhood. Methods: This study took place from January 2022 until December 2022 and included patients from a large family with hereditary childhood cataract who had cataract surgery before 18 years of age. Patients underwent an ophthalmologic examination to determine the presence of glaucoma or ocular hypertension (OHT). Patients who did not want to participate in the examination could contribute with a medical journal from their treating ophthalmologist. The risk of long‐term glaucoma was determined using survival analysis, and risk factors were assessed using a Cox proportional hazards regression model. Results: We included 68 patients (133 eyes) with a median age at cataract surgery of 7 years (IQR: 5–10). The median follow‐up time after cataract surgery to glaucoma/OHT or the latest ophthalmologic examination was 35 years (IQR: 15–48). Twelve patients (18 eyes) had glaucoma, and five patients (eight eyes) had OHT, resulting in 15 patients with glaucoma/OHT. The long‐term risk of glaucoma/OHT diagnosed in adulthood was 47.7% (CI: 21.8–70.9) at the age of 70 years of patients who were free of glaucoma before their 18th year. We could not confirm or dismiss an association between glaucoma/OHT and sex, age at surgery, number of ocular interventions before 18 years of age or glaucoma after cataract surgery in a first‐degree relative. Conclusion: Cataract surgery in childhood is associated with a high risk of late‐onset glaucoma. Regular lifelong follow‐up is important to ensure early diagnosis and prevent extensive vision loss. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the study was to explore the possible correlations between the anterior segment parameters derived from anterior segment swept-source optical coherence tomography (AS-SS-OCT) with the surgically induced corneal astigmatism (CSIA) calculated from total keratometry (TK) measured by AS-SS-OCT. Methods: Seventy-one eyes of 67 patients with age-related cataract who underwent phacoemulsification combined with intraocular lens implantation with 2.2-mm incision were included. The CSIA values were calculated from anterior keratometry (CSIAKant) and TK (CSIATK) measured by AS-SS-OCT, respectively. Hotelling's T2 test was used to evaluate the difference. The correlation of CSIA with various parameters derived from AS-SS-OCT was tested with the Spearman correlation coefficient. Results: The centroid of CSIAKant and of CSIATK were 0.31 ± 0.55 D @ 54° and 0.41 ± 0.59 D @ 51°, with no significant difference (F = 1.283, p = 0.281, Hotelling's T2). The mean absolute CSIAKant and CSIATK were 0.58 ± 0.24 D and 0.65 ± 0.28 D. Spearman test showed that the magnitude of CSIAKant was negatively correlated with preoperative peripheral corneal thickness (PCT, p = 0.045) and the magnitude of anterior keratometry (p = 0.044). The magnitude of CSIATK was negatively correlated with preoperative central corneal thickness (CCT, p = 0.003) and preoperative PCT (p = 0.015). Conclusions: The increased thickness of the peripheral cornea is correlated with the decrease in the magnitude of the CSIA. The correlation we identified between the corneal thickness and the CSIA indicated that certain preoperative parameters should be considered for the prediction of CSIA for a more precise refractive outcome. [ABSTRACT FROM AUTHOR]

Purpose: To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC). Methods: This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36 months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6 months or 1 year. Uveitis success was defined as the absence of persistent anterior uveitis at 3 months. Results: Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6 months and three of five eyes (60%) at 1 year achieved surgical success. Around 6 months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18 months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort. Conclusions: Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of a capsular tension ring (CTR) on the intraocular lens (IOL)–capsule complex after cataract surgery in patients with long axial length. Methods: This was a prospective study. Patients underwent phacoemulsification and IOL implantation, with or without CTR implantation. Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months postoperatively to determine the postoperative aqueous depth (PAD), capsular bend index (CBI), and IOL tilt and decentration. Spherical equivalent values were obtained through subjective refraction and autorefraction. Root mean square was adopted to evaluate the indices listed above. Results: Forty-three patients (56 eyes) were included in the study. Generalized estimating equation analysis of PAD showed a statistical difference between groups (P =.031). The RMS of the change in PAD was smaller in the CTR group than in the non-CTR group during the 3 months after surgery (P =.015). CBI in the CTR group increased more from 1 to 3 months after surgery than that in the non-CTR group (P =.025). The RMS of the change in vertical decentration was smaller in the CTR group than in the non-CTR group during the 3-month follow-up (P =.009). Conclusions: CTR implantation can stabilize the axial position of the IOL within the capsular bag after cataract surgery in patients with long axial length without affecting the refractive stability. The formation of capsular bend may be slightly delayed in the early stage after CTR implantation, but it accelerates from 1 to 3 months after surgery. [J Refract Surg. 2024;40(9):e654–e661.] [ABSTRACT FROM AUTHOR]

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PURPOSE: To evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure. METHODS: One hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation. RESULTS: Of the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax. CONCLUSIONS: Our model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulations utility, by screening the video for subjects before operations.

Justin Spaulding,1 Brad Hall2 1Cataract & Laser Institute, Medford, OR, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Justin Spaulding, Cataract & Laser Institute, 1408 E Barnett Road, Medford, OR, 97504, USA, Tel +1-541-779-2020, Email justinophtho@gmail.comPurpose: To evaluate the efficiency of a hybrid tip in removing cataract grade 3 and 4 in high and low intraocular pressure (IOP) settings.Methods: This was a randomized, prospective, double-arm contralateral eye study. One randomized eye of each subject had phacoemulsification with high IOP settings (50 mmHg) while the other eye had phacoemulsification with low IOP settings (20 mmHg). Operative endpoints included phaco time, aspiration time, fluid use, cumulative dissipated energy (CDE), total case time, total torsional time, and total longitudinal time. Postoperative endpoints included central corneal thickness (CCT), and IOP.Results: A total of 102 eyes (51 patients) completed the study. Phaco time in grade 3 and grade 4 cataracts were 38.4 ± 9.6 s and 44.1 ± 9.9 s in the high group, respectively, and 38.9 ± 8.6 s and 46.3 ± 11.0 s in the low group, respectively. Aspiration time in grade 3 and grade 4 cataracts were 95.3 ± 21.2 s and 111.8 ± 32.8 s in the high group, respectively, and 105.4 ± 27.0 s and 108.6 ± 23.1 s in the low group, respectively. Fluid volume used in grade 3 and grade 4 cataracts were 39.2 ± 6.8 mL and 45.2 ± 10.8 mL in the high group, respectively, and 38.3 ± 7.3 mL and 43.2 ± 8.0 mL in the low group, respectively. The CDE in grade 3 and grade 4 cataracts were 7.8 ± 2.6 and 10.2 ± 3.2 in the high group, respectively, and 7.7 ± 2.2 and 9.9 ± 4.5 in the low group, respectively.Conclusion: Results suggest that a hybrid phacoemulsification tip was efficient in removing cataracts of grade 3 and grade 4 with high and low IOP settings.Plain Language Summary: Phacoemulsification involves emulsifying the natural lens during cataract surgery with an ultrasonic handpiece and removing the lens from the eye. An important facet for safety and good postoperative outcomes is the phacoemulsification tip. Traditional tips have used a metal cutting edge. A new hybrid tip is available that utilizes a soft polymer on the metal tip. The purpose of this study was to assess the efficiency of the hybrid tip to remove different grades of cataract. The results of this study suggest that a hybrid tip was efficient in removing grade 3 and grade 4 cataracts at both low and high intraocular pressure settings.Keywords: active sentry, phacoemulsification, intrepid hybrid

AIM: To investigate the influencing factors of corneal edema after phacoemulsification combined with intraocular lens(IOL)implantation in middle-aged and elderly patients with diabetic cataract, reducing postoperative complications of cataract in such patients.METHODS: A total of 198 middle-aged and elderly patients(226 eyes)with diabetic cataract who underwent phacoemulsification combined with IOL implantation in Zhongxian People's Hospital of Chongqing from August 2021 to June 2023 were retrospectively analyzed, and they were divided into corneal edema group(n=53)and non-corneal edema group(n=173)according to their postoperative corneal edema. Baseline data were collected and compared between the two groups, and the operation-related indexes such as preoperative corneal thickness, endothelial cell density, operation time and effective phaco time were recorded and compared between the two groups. The influencing factors of corneal edema were analyzed by multivariate Logistic model, and the risk nomogram was drawn.RESULTS: The age distribution of patients ≥60 years old in the corneal edema group was significantly higher than that in the non-corneal edema group, the duration of diabetes mellitus in the corneal edema group was significantly longer than that in the non-corneal edema group, and the lens nuclear hardness grade was significantly higher than that in the non-corneal edema group(all P