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Purpose: To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulas in patients who underwent intrascleral IOL fixation using the four-flanged technique., Methods: This prospective, longitudinal, single-site, single-surgeon study's setting was the Department for Ophthalmology and Optometry, Medical University of Vienna, Austria. Patients who received IOL implantation via the four-flanged technique were followed up to 3 months after the operation. Refraction was measured using the Early Treatment of Diabetic Retinopathy Study visual acuity test at 4 m. Lens decentration, tilt, and aqueous anterior chamber depth were evaluated using anterior segment optical coherence tomography. The SRKT, Holladay 1, and Hoffer-Q formulas were used to assess prediction error (PE) and absolute error (AE). Correlations between axial length, keratometry, and white-to-white distance were subsequently evaluated., Results: A total of 28 eyes of 28 patients were examined in this study. The application of all formulas resulted in a hyperopic PE (SRKT: 0.35 ± 0.86 diopters [D], Holladay 1: 0.36 ± 0.78 D and Hoffer-Q: 0.37 ± 0.73 D). There was no variation between the PE of different formulas discovered ( P > .05). The AE was within 0.50 D in 54% to 61% and within 1.00 D in 79% of eyes, depending on the formula used. Furthermore, Cochrane's Q test detected no significant distinctions between formulas ( P > .05). The PE of each formula demonstrated a significant correlation to the axial length of the eyes ( P < .05). The correlation estimates ranged from -0.25 D/mm to -0.39 D/mm, subject to the applied formula., Conclusions: This study demonstrates that the four-flanged technique for scleral IOL fixation yields reliable outcomes. PE was closest to zero using the Hoffer-Q formula, although there was no statistically significant difference compared to the other formulas. Axial length emerged as the most pertinent factor for PE. Short eyes resulted in a more hyperopic outcome, whereas longer eyes resulted in a more myopic outcome than intended. This myopic and hyperopic shift was due to the standardized surgical technique with an externalization of the haptics 2.5 mm behind the limbus resulting in a consistent aqueous anterior chamber depth across all eye lengths, coupled with a reduction or increase in the distance from the IOL to the macula, which is dependent on the length of the eye. [ J Refract Surg . 2024;40(12):e985-e993.] ., Competing Interests: Disclosure: MS is a speaker for Oertli. VD is a speaker for Hoya. DS has received a grant from Alcon Laboratories, Inc and is a speaker for Oertli, Alcon Laboratories, Inc, and Bausch & Lomb. CA-F has received grants from Rayner and Oertli and is a speaker for Rayner. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To evaluate the surgically induced astigmatism over a 6-month follow-up period in patients who underwent scleral IOL fixation using an acrylic single-piece IOL with special haptics designed for sutureless scleral fixation., Methods: We conducted a prospective longitudinal study at a single site with a single surgeon. We included patients who received transscleral IOL implantation following the Carlevale technique and were followed up post-operatively for 24 weeks. We measured the patient's refraction at baseline, week 12 and week 24 using the best corrected visual acuity at 4 m (EDTRS chart). We performed corneal tomography at every visit using an anterior segment optical coherence tomography (AS-OCT). We evaluated surgically induced astigmatism (SIA) and refraction during each follow-up visit and compared them to baseline. We then assessed changes in SIA over time., Results: In total, 27 eyes of 27 patients consisting of 16 female and 11 male individuals were evaluated. The mean patient age was 71 ± 11.7 years, mean axial length was 24.30 ± 1.47 mm (range: 21.4-27.23) and mean white-to-white distance was 12.07 ± 0.40 mm (range: 11.4-12.7). The mean SIA decreased from 1.78 ± 0.96D at week 1 significantly to 0.80 ± 0.55D at week 12 (p < 0.001) and then stayed unchanged around 0.82 ± 0.72D at week 24 (p = 1.0)., Conclusions: The scleral fixated Carlevale IOL and its implantation procedure were found to result in a predictable SIA of <1D after 24 weeks. However, the axis orientation of the SIA appeared to be random, making it unsuitable for implementation in toric IOL calculations., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the accuracy of three distinct postoperative toric intraocular lens (TIOL) rotational stability measurement methods., Setting: Department of Ophthalmology and Optometry, Medical University of Vienna, Austria., Design: Single-center, prospective, interventional clinical trial., Methods: 128 eyes of 81 patients with age-related cataract received a hydrophobic acrylic TIOL Clareon CNW0T3-9. To evaluate rotational stability, three distinct assessment methods were used: (Rotix) comparing the TIOL axis at the end of surgery (EoS) to 1 week (1w) and 6 months (6m) postoperatively using reference vessels at the sclera, (Slit-lamp) comparing the intended axis (IA) with the axis at 1w and 6m using slit-lamp photography using the horizontal axis as a reference and (Casia) comparing the IA with the axis at 1w and 6m using the axis determination tool of a swept-source anterior segment optical coherence tomographer (Casia 2)., Results: Mean absolute rotation from EoS/IA to 6m differed significantly among Rotix (1.33± 1.99° [0.01;19.80]), Casia (2.88± 2.64° [0.00; 19.00]), and Slit-lamp (4.38± 3.38° [0.02;19.38]), as indicated by Friedman's test (X2=71.852, p<0.001). Bland-Altman coefficients (CoR) of repeatability indicated the closest agreement of results between Casia and Rotix, with a CoR of ±3.95°, followed by Slit-lamp and Casia (±6.82°), and lastly, between the Slit-lamp and Rotix (±7.19°)., Conclusion: When assessing true TIOL rotational stability, it is imperative to use fixed anatomical landmarks as reference and establish a baseline at the end of surgery. When assessing TIOL rotation along the horizontal axis, considering cyclorotation of the eye is crucial and must not be underestimated., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To compare intraindividual monocular visual performance of a monofocal extended depth-of-focus (EDOF) and a trifocal EDOF intraocular lens (IOL) following bilateral cataract surgery., Design: Single-center, prospective, fellow-eye comparison clinical trial., Methods: All patients received uneventful bilateral cataract surgery with implantation of the monofocal EDOF Isopure IOL in the dominant eye and the trifocal EDOF FineVision Triumf IOL in the nondominant eye. Intraindividual monocular comparison included visual acuity at various distances, defocus curves, internal total higher-order aberration (HOA), spherical aberration (SA) Z(4.0), IOL decentration, and tilt. Additionally, subjective outcomes were evaluated using Halo and Glare simulation and the Seven-Item Visual-Functioning Index questionnaire., Results: In total, 25 patients (50 eyes) were included. Intraindividual monocular best-corrected distance visual acuity, distance-corrected intermediate visual acuity, and best-corrected near visual acuity were comparable (P > .05). However, monocular contrast acuity (P = .019), distance-corrected near visual acuity (P < .001), and defocus curves at defocus levels of 0.0 D (P = .005) and between -1.5 and -4.0 D (P < .001) differed significantly. At 5 mm, internal HOA and SA Z(4.0) were significantly different (P < .001) and comparable at 3-mm pupil diameter, as were IOL tilt and decentration (P > .05)., Conclusion: In this combined fellow-eye comparison, near vision was significantly better with the trifocal EDOF IOL. The monofocal EDOF IOL demonstrated similar distance and intermediate visual performance as the trifocal EDOF IOL. Overall, low values of photic phenomena and visual impairment were observed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare intraindividually the incidence and intensity of posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates between two similar open-loop single-piece hydrophobic acrylic intraocular lenses (IOLs) differing slightly in their particular material, optic surface and sharp posterior edge design over a period of 3 years., Setting: Department of Opthalmology, Medical University Vienna., Design: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison., Methods: 100 patients randomly received a Vivinex XY1 IOL in one eye and a Clareon CNA0T0 IOL in the fellow eye. The amount of PCO (score: 0 - 10) was assessed subjectively and objectively with digital retroillumination picturs using automated image analysis software (AQUA). Best-corrected distance visual acuity (CDVA) as well as the presence of glistenings, subjective visual symptoms and Nd:YAG laser capsulotomy rate were noted., Results: 67 of 100 patients were available for the 3-years follow-up examination. The objective PCO score of the Vivinex XY1 IOLs was 1.0 ± 1.0 compared to the PCO score of 1.5 ± 1.2 for the Clareon CNA0T0 IOLs (p < 0.001). 7.5% of patients had a neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy in the Vivinex XY1 eye, and 9.0% had a capsulotomy in the Clareon CNA0T0 eye (p = 1.0)., Conclusion: Both hydrophobic acrylic IOLs showed low PCO and YAG rates with a small but significant favor of the Vivinex XY1 IOL compared to the Clareon CNA0T0 IOL. The interaction of various factors such as hydrophobic material, smooth optic surface and sharp posterior optic edge is the major key for PCO prevention., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)

Background: To evaluate the frequency and anterior segment optical coherence tomography parameters of patients with scleral fixated intraocular lenses (IOL) and reverse pupillary block (RPB)., Methods: Retrospective analysis at a tertiary care centre (Department for Ophthalmology and Optometry, Medical University of Vienna, Austria). We researched our records for patients who underwent scleral fixated IOL implantation from January 2018 till February 2023. Patients were included only if there was at least one adequate post-operative scan of anterior segment optical coherence tomography (AS-OCT) available. Initially, AS-OCT scans were assessed for IOL tilt and decentration employing a 3D scan and then later for anterior chamber angle (ACA), aqueous anterior chamber depth (AQD), pupil diameter and iris-IOL distance using the 2D scan at a 0° angle. Both an iris-IOL distance of 0 or less and an ACA of more than 70° were required to define an RPB., Results: A total of 110 patients met the inclusion criteria, 41 were treated using the Carlevale, 33 the four flanged, 24 the Yamane and 12 the Scharioth technique, respectively. RPB was found in 32 patients (29%). Twenty patients with RPB were treated using YAG peripheral iridotomy, mean ACA decreased from 91.91° ± 13.77 to 61.02° ± 8.52, (p < 0.001), mean AQD decreased from 4.67 mm ± 0.47 to 4.31 ± 0.36 mm (p < 0.001) and mean iris-IOL distance increased from -0.09 ± 0.04 to 0.33 ± 0.30 (p < 0.001)., Conclusions: RPB is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG peripheral iridotomy is a potent option to treat RPB, and subsequently reduce the risk of iris chafing and secondary inflammation or glaucoma., (© 2024 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To assess rotational stability and refractive outcomes of a new toric hydrophobic acrylic intraocular lens (IOL)., Design: Single-center, prospective, interventional clinical trial., Methods: A total of 130 eyes of 82 patients with age-related cataract and total corneal astigmatism of greater than 1.0 diopters (D) received a hydrophobic acrylic toric IOL Clareon CNW0T3-9. Baseline measurement for rotational stability evaluation was performed at the end of surgery (EOS), with the patient still supine on the operating table, using non-movable vessels as reference landmarks. Postoperative retroillumination pictures were taken at 1 h, 1 week, 1 month and 4-6 months postoperatively. Subjective manifest refraction was assessed at the 6 months follow-up visit., Results: Final results were obtained in 126 eyes of 80 patients. Mean absolute rotation from EOS to 6 months was 1.33 ± 2.00 [0.01, 19.80] degrees. Rotational stability values from EOS to 1 h, 1 h to 1 week, 1 week to 1 month and 1 month to 6 months were 0.86 ± 0.82 [0.00, 3.90], 1.06 ± 1.94 [0.00, 19.45], 0.47 ± 0.42 [0.00, 2.03] and 0.38 ± 0.40 [0.00, 2.56] degrees. Mean preoperative corneal astigmatism was 1.78 ± 0.83 [1.00, 4.76] D which changed to a mean postoperative refractive astigmatism of 0.33 ± 0.27 [0.00, 1.25] D at 6 months., Conclusion: The Clareon toric IOL presented very good rotational stability with a mean absolute rotation below 1.4° from EOS to 6 months. Only two IOLs rotated more than 5° with none of them requiring repositioning surgery. Refractive outcomes were satisfying with a mean residual refractive astigmatism below 0.50 D., Trial Registration: Registered at Clinicaltrials.gov NCT03803852 ; on May 17, 2022., (© 2024. The Author(s).)

Purpose: To compare intraindividual differences in visual performance of a monofocal and enhanced monofocal intraocular lens (IOL) of the same platform., Design: Prospective, interventional, fellow-eye comparison clinical study., Methods: In total, 55 patients (110 eyes) with bilateral age-related cataract were enrolled. All patients received a monofocal ZCB00 IOL in the dominant and an enhanced monofocal Eyhance ICB00 IOL in the nondominant eye. After 2 to 4 months, monocular best-corrected distant visual acuity (BCDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), contrast visual acuity, monocular defocus curves, internal higher-order aberrations (HOAs) and spherical aberrations (SA), decentration, and tilt were compared., Results: The monocular mean BCDVA, DCIVA at 80 cm and 66 cm, and DCNVA were -0.03 ± 0.07, 0.24 ± 0.12, 0.32 ± 0.13, and 0.50 ± 0.13 logarithm of the minimum angle of resolution for the enhanced ICB00 and -0.06 ± 0.06 (P = .014), 0.30 ± 0.11 (P = .005), 0.38 ± 0.12 (P = .004), and 0.55 ± 0.14 (P = .034) logarithm of the minimum angle of resolution for the ZCB00, respectively. Internal HOAs (P = .001) and negative SA (P < .001) were increased with the ICB00 at 3 mm and comparable at 5 mm (P > .05). Contrast acuity, tilt, and decentration were similar (P > .05)., Conclusions: Significantly increased monocular DCIVA at 80 cm and 66 cm and DCNVA at 40 cm were observed with the enhanced ICB00 IOL, and the ZCB00 IOL demonstrated better BCDVA. This would result in a mean gain of 2 to 3 Early Treatment of Diabetic Retinopathy Study letters at near and intermediate distance. Monocular defocus curves displayed highest differences of 5 Early Treatment of Diabetic Retinopathy Study letters at -1.25 diopters (D) and -1.50 D levels of defocus and a depth of focus of 1.23 D for the ICB00 IOL and 0.94 D for the ZCB00 IOL. Decentration, tilt, and HOAs were generally low., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL)., Design: Intraindividual, randomized, double-masked, controlled clinical trial., Participants: Patients scheduled for sequential same-day bilateral cataract surgery., Methods: All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT., Main Outcome Measures: Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months., Results: One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively., Conclusions: Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess intra-individually visual acuity (VA) and subjective outcome after mix-and-match implantation of a monofocal EDOF IOL and a diffractive trifocal IOL., Methods: The monofocal EDOF Isopure IOL was implanted in the dominant eye and the trifocal FineVision HP IOL in the non-dominant eye. Postoperative evaluation included VA at various distances, contrast acuity, monocular defocus curves, decentration and tilt, wavefront aberrometry, VF-7 questionnaire and a halo and glare simulator., Results: 50 eyes of 25 subjects were enroled. The trifocal IOL performed better at monocular DCNVA (p < 0.01) and at defocus levels of -1.5D to -4.0D (p < 0.01), the monofocal EDOF IOL was better at -0.5D (p = 0.013). No differences in monocular BCDVA, DCIVA, contrast acuity, decentration or tilt were observed (p > 0.05). Wavefront analysis revealed lower HOAs in the trifocal group at 5 mm (p < 0.01) and no difference (p = 0.107) at 3 mm pupil aperture. The monofocal EDOF IOL displayed increased negative SA at 5 mm (p < 0.01) and 3 mm (p < 0.01) pupil diameter. Low values of optical phenomena and satisfying results of the VF-7 questionnaire were obtained., Conclusion: Excellent visual performance and low rates of optical phenomena were achieved after mix-and-match implantation of the monofocal EDOF Isopure IOL and the trifocal FineVision HP IOL. Trifocal IOL implantation in the non-dominant eye may decrease optical disturbing phenomena. Similar results were observed for monocular distance, intermediate and contrast VA. The trifocal IOL provided better monocular near VA. Decentration and tilt and HOAs were low., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulae in patients who underwent intrascleral IOL fixation using two different techniques., Methods: This is a prospective, randomized, longitudinal, single-site, single-surgeon study. Patients who underwent intrascleral IOL implantation using the Yamane or the Carlevale technique were followed up for a period of six months postoperatively. Refraction was measured using the best-corrected visual acuity at 4 m (EDTRS chart). Lens decentration, tilt and effective lens position (ELP) were assessed using an anterior segment optical coherence tomography (AS-OCT). The prediction error (PE) and the absolute error (AE) were evaluated for the SRK/T, Hollayday1 and Hoffer Q formula. Subsequently, correlations between the PE and axial length, keratometry, white to white and ELP were assessed., Results: In total, 53 eyes of 53 patients were included in the study. Twenty-four eyes of 24 patients were in the Yamane group (YG) and 29 eyes of 29 patients were in the Carlevale group (CG). In the YG, the Holladay 1 and Hoffer Q formulae resulted in a hyperopic PE (0.02 ± 0.56 D, and 0.13 ± 0.64 D, respectively) while in the SRK/T formula the PE was slightly myopic (- 0.16 ± 0.56 D). In the CG, SRK/T and Holladay 1 formulae led to a myopic PE (- 0.1 ± 0.80 D and - 0.04 ± 0.74 D, respectively), Hoffer Q to a hyperopic PE (0.04 ± 0.75 D). There was no difference between the PE of the same formulae across both groups (P > 0.05). In both groups the AE differed significantly from zero in each evaluated formula. The AE error was within ± 0.50 D in 45%-71% and was within ± 1.00 D in 72%-92% of eyes depending on the formula and surgical method used. No significant differences were found between formulae within and across groups (P > 0.05). Intraocular lens tilt was lower in the CG (6.45 ± 2.03°) compared to the YG (7.67 ± 3.70°) (P < 0.001). Lens decentration was higher in the YG (0.57 ± 0.37 mm) than in the CG (0.38 ± 0.21 mm), though the difference was not statistically significant (P = 0.9996)., Conclusions: Refractive predictability was similar in both groups. IOL tilt was better in the CG, however this did not influence the refractive predictability. Though not significant, Holladay 1 formula seemed to be more probable than the SRK/T and Hoffer Q formulae. However, significant outliers were observed in all three different formulae and therefore remain a challenging task in secondary fixated IOLs., (© 2023. The Author(s).)

Purpose: To evaluate neuroretinal integrity in different subtypes of optical coherence tomography (OCT)-graded partial-thickness macular holes., Methods: Fovea-centred SD-OCT images (Cirrus, Carl Zeiss Meditec AG; Spectralis, Heidelberg Engineering GmbH) and visual acuity (VA) acquired at every visit were analysed by two retina specialists retrospectively in 71 eyes of 65 patients. Partial-thickness macular holes were classified as lamellar macular hole (LMH), epiretinal membrane foveoschisis (ERMF) or macular pseudohole (MPH)., Results: Lamellar macular hole, ERMF and MPH were diagnosed in 33 (47%), 31 (43%) and 7 (10%) eyes with a VA of 0.18 ± 0.25, 0.15 ± 0.2, and 0.06 ± 0.08 (p = 0.323), respectively. Median follow-up time was 11 (interquartile range 4-32.5), 10 (interquartile range 5-18) and 19 (interquartile range 8-24) months in LMH, ERMF and MPH. In all subgroups, VA remained stable during the follow-up (p = 0.652, p = 0.915 and p = 1.000). Epiretinal proliferations (EP) were present in 12 LMH and 3 ERMF. At baseline, eyes with EP had significantly worse VA (p < 0.001), wider foveal cavities (p = 0.007) and thinner foveal floors (p < 0.001) compared with eyes without EP. Twelve out of 15 eyes with EP showed exudative cystoid spaces. Among all 71 eyes, 51 remained morphologically and functionally stable during follow-up., Conclusion: In our study cohort, EP are associated with worse VA and advanced neuroretinal tissue loss presenting with wider foveal cavities and thinner foveal floors. During the follow-up period, VA remained stable in all entities of partial-thickness macular holes., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Aims: To provide clinical guidance on the use of intraocular lens (IOL) power calculation formulas according to the biometric parameters., Methods: 611 eyes that underwent cataract surgery were retrospectively analysed in subgroups according to the axial length (AL) and corneal power (K). The predicted residual refractive error was calculated and compared to evaluate the accuracy of the following formulas: Haigis, Hoffer Q, Holladay 1 and SRK/T. Furthermore, the percentages of eyes with ≤±0.25, ≤±0.5 and 1 dioptres (D) of the prediction error were recorded., Results: The Haigis formula showed the highest percentage of cases with ≤0.5 D in eyes with a short AL and steep K (90%), average AL and steep cornea (73.2%) but also in long eyes with a flat and average K (65% and 72.7%, respectively). The Hoffer Q formula delivered the lowest median absolute error (MedAE) in short eyes with an average K (0.30 D) and Holladay 1 in short eyes with a steep K (Holladay 1 0.24 D). SRK/T presented the highest percentage of cases with ≤0.5 D in average long eyes with a flat and average K (80.5% and 68.1%, respectively) and the lowest MedAE in long eyes with an average K (0.29 D)., Conclusion: Overall, the Haigis formula shows accurate results in most subgroups. However, attention must be paid to the axial eye length as well as the corneal power when choosing the appropriate formula to calculate an IOL power, especially in eyes with an unusual biometry., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the reliability and reproducibility of a new semiautomated evaluation method, "Rotix," for intraocular lens (IOL) rotation and to define a standardized evaluation method for future toric IOL studies., Design: Reliability and reproducibility study., Methods: Setting: Department of Ophthalmology, Medical University of Vienna., Patient Population: A dataset of 25 patients with 2 consecutive follow-up visits was created to test the intra- and interrater reliability. A data test set of 10 patients including 30 pictures taken 5 minutes apart was created to test the short-term reproducibility., Intervention: Evaluation of IOL rotational stability using nontoric implants in 25 × 2 consecutive follow-up visits. Two experienced graders performed axis evaluation 3 times in a randomized order. One experienced grader performed axis evaluation for the short-term reproducibility study. Reference landmarks at the end of operation were used to assess the IOL axis., Main Outcome Measures: Intra- and interrater reliability and short-term reproducibility of axis measurements., Results: Mean standard deviation for intrarater reliability was 0.16 degrees. The intraclass correlation coefficients were 0.97 for grader 1 and 0.96 for grader 2. A very high interrater correlation of 0.95 was found. The mean individual difference between grader 1 and grader 2 was 0.061 ± 0.28 degrees. Short-term reproducibility showed a mean standard deviation of 0.22 ± 0.14 degrees., Conclusion: The novel semiautomated evaluation method showed an accurate inter- and intrarater reliability. Short-term reproducibility was below 0.25 degrees. The method of using nonmovable reference landmarks showed reliable results and should be used as a standard in future toric IOL studies., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To assess and compare safety and effectiveness between 23-gauge and 25-gauge vitrectomy systems for the treatment of common vitreoretinal diseases in non-vitrectomized eyes., Methods: Retrospective evaluation of patients who underwent pars plana vitrectomy from April 2018 to December 2019 at the Department of Ophthalmology and Optometry at the Medical University of Vienna (MUV) for the following indications: macular epiretinal membrane, macular hole, macular lamellar hole, vitreous hemorrhage, vitreous opacities, vitreomacular traction syndrome and macular edema., Results: 201 eyes of 195 patients that underwent 23-gauge (n = 105 eyes) or 25-gauge (n = 96 eyes) vitrectomy were included in this study. The mean best-corrected visual acuity (BCVA) improved at 1-3 months postoperatively and beyond 3 months in both gauge groups. Risk of any complication within 1 month postoperatively was lower in the 25-gauge group, but the difference was statistically not significant (HR [95% CI]: 0.95 [0.53; 1.70], p = 0.85). Intraocular pressure less than 5 mmHg was observed in 2 eyes (2%) in the 23-gauge group at the first postoperative day. Intraocular pressure elevation over 25 mmHg occurred in 5 eyes (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group) at postoperative day 1, between 7 and 28 days in 5 cases (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group), and in 2 eyes (2%) of the 23-gauge group at postoperative day 145 and 61, respectively. Retinal detachment occurred in 1 eye (1%) in the 23-gauge and in 3 eyes (3%) in the 25-gauge group. We did not observe any cases of endophthalmitis., Conclusion: Results in terms of safety, surgical success and visual outcomes for the treatment of common vitreoretinal surgery indications seem to be comparable between 23-gauge and 25-gauge vitrectomy systems, indicating that the two gauge systems can be used equally in the clinical routine., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: consultant at Oertli Instruments (Andreas Pollreisz).This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: To evaluate the change in the fovea's postoperative location after successful pars plana vitrectomy with combined epiretinal and internal limiting membrane peeling in patients with idiopathic epiretinal membranes (iERMs)., Methods: In this prospective study 32 eyes of 32 patients with iERMs were followed from baseline before until 3 months after surgery. Study measures included 4-m Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, enhanced-depth imaging-optical coherence tomography, and intraoperative fundus photographs. Foveal movement was assessed by measuring the change in the papillofoveal distance (∆PFD)., Results: Mean ∆PFD in the study eye was -124 µm (±138) and -272 µm (±213) one day and 3 months after surgery, respectively. Mean ∆PFD after 3 months was greater in the study than in the fellow eye (P < 0.001). ∆PFD at Month 3 did not correlate with the internal limiting membrane area peeled (P = 0.78)., Conclusion: Foveal movement starts immediately after surgery and causes a statistically significant reduction in PFD after uneventful macular pucker surgery. ∆PFD correlates statistically significantly with baseline best-corrected visual acuity and baseline central retinal thickness. The internal limiting membrane peeling size had no significant effect on the amount of postoperative foveal dislocation.

Purpose: To assess the influence of artificial tears of different viscosity on K-readings prior to cataract surgery., Design: Prospective randomized crossover, before-and-after clinical study., Methods: Setting: Department of Ophthalmology, Medical University of Vienna., Patient Population: A total of 123 eyes of 80 patients prior to cataract surgery were assigned to 2 groups based on normal and dry eyes., Intervention: Two native baseline keratometries were followed by instillation of either high- or low-viscosity eye drops. Keratometry was repeated 30 seconds, 2 minutes, and 5 minutes after instillation., Main Outcome Measures: Influence of eye drops of different viscosity in normal and dry eyes on short time K-readings., Results: Repeatability between native baseline measurements was high (standard deviation = 0.02 mm in normal and in dry eyes). In normal and dry eyes, a statistically significant increase in measurement variability after instillation of both low-viscosity and high-viscosity eye drops was observed (P < .01). Measurement variability was most pronounced between baseline measurement and 30 seconds and diminished over time. Variability of K-readings appeared higher in dry eyes compared with normal eyes. Astigmatism changed more than 0.5 diopters in 13.2% of normal eyes and 34.4% in dry eyes using eye drops of high viscosity., Conclusion: Tear film-stabilizing eye drops prior to keratometry measurements influenced K-readings significantly, especially in dry eyes. A time period of more than 5 minutes should be allowed to pass after instillation of eye drops. The higher the viscosity of the eye drops, the stronger the influence and the longer its persistence., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: To prospectively investigate retinal vascular changes in patients undergoing epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling using swept source optical coherence tomography angiography (SSOCTA)., Methods: Consecutive patients were grouped based on ERM severity and followed using SSOCTA up to month 3 after surgical intervention. Superficial and deep foveal avascular zone (s/dFAZ) as well as foveal and parafoveal vessel density (VD) were correlated with ERM severity and visual acuity. Differences between groups were evaluated., Results: Significant correlations were found between ERM severity and baseline sFAZ, dFAZ and best corrected visual acuity (BCVA), central retinal subfield thickness (CST) and ΔCST (r = -0.52, r = -0.43, r = -0.42, r = 0.58, r = 0.39; all p<0.05). Vascular flow parameters did not correlate with age, peeling size, pseudophakia or CST, but correlated with intraretinal cysts presence. No associations of BCVA with any of the OCTA parameters across time were found. Significant differences between ERM severity groups 1 and 2 were found for sFAZ at baseline (p = 0.005) and at the 3-month follow-up (p = 0.014), and for dFAZ at baseline (p = 0.017). Superficial foveal and parafoveal VD were not significantly different between groups (all p>0.05)., Conclusions: This study clearly shows that ERM severity based on ERM staging has to be taken into account when undertaking studies in patients with idiopathic ERM using SSOCTA. Further, specific changes in the superficial and deep retinal vasculature in eyes undergoing ERM and ILM peeling were found. However, the clinical usefulness and prognostic value for post-surgical treatment BCVA of the SSOCTA-derived variables (sFAZ and dFAZ area, as well as foveal and parafoveal VD) used remains questionable., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To evaluate the long-term uveal and capsular biocompatibility of 5 intraocular lenses (IOLs) in eyes with uveitic cataract., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Design: Comparative case series., Methods: Patients with uveitis of various origin were consecutively recruited for cataract surgery (1998-2006) and received 1 of 3 hydrophilic acrylic IOLs (Hydroview, AcrySof MA60BM, or Injectacryl F3000), a silicone IOL (CeeOn 911), or a hydrophilic acrylic IOL with heparin surface modification (BioVue(3)). A 7-year follow-up was performed in the Hydroview, AcrySof, and CeeOn groups. Visual acuity, anterior chamber flare measurements, specular microscopy, biomicroscopy, and fundoscopy were performed postoperatively at 6 months and 1, 2, and 3 years., Results: The study enrolled 136 eyes of 115 patients. There were no significant differences in anterior chamber flare results between the 5 groups. The Hydroview group had the highest grade and the CeeOn IOL and AcrySof groups had the lowest grade of posterior capsule opacification. The BioVue(3) and Injectacryl IOLs had good uveal biocompatibility. Patients in all groups had better visual acuity postoperatively., Conclusions: Overall, patients with uveitis benefited from cataract surgery. The long-term results indicate that all sharp-edged hydrophilic and hydrophobic IOLs performed well in eyes with uveitis. Higher uveal biocompatibility was achieved with the modern hydrophilic acrylic IOLs than with the hydrophobic acrylic IOL. Modern hydrophilic acrylic IOLs seem to be a good option in these cases., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Background: To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non-infectious uveitis., Methods: Retrospective analysis of patients with inactive uveitis requiring/not requiring immunosuppressive therapy who received IVTA because of chronic CMO refractory to previous systemic steroids. Number of IVTA (re-)treatments, distance visual acuity, near visual acuity, mean foveal thickness, intraocular pressure, duration of CMO, type of uveitis and systemic therapy were assessed previous to and 1, 4, 12 weeks following each IVTA treatment., Results: Between March 2003 and May 2006, 24 eyes of 18 patients received between one and three IVTA injections. A resolution of chronic CMO was observed in 7/24 eyes (29.2%, 5 eyes after single injection of IVTA, 1 eye each after two and three injections of IVTA), a significant increase in distance visual acuity in 9/24 eyes (37.5%; 5 eyes with resolution of CMO, 4 eyes despite persistent CMO) and in near visual acuity in 13/24 eyes (54.6%; 6 eyes with resolution of CMO, 7 eyes despite persistent CMO)., Conclusions: IVTA might be considered as a treatment for patients with chronic CMO when persistent despite previous systemic steroid therapy. Even patients without sustained resolution of CMO after IVTA might benefit in terms of transiently increasing visual acuity, but progression of cataract and rise in intraocular pressure limit repeatability.

Purpose: To evaluate the uveal and capsular biocompatibility of 3 types of sharp-edged foldable intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome (PEX)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: Eighty-five eyes with PEX had implantation of 1 of the following sharp-edged 3-piece IOLs: hydrophilic acrylic (Injectacryl F3000, OphthalMed), hydrophobic acrylic (AcrySof MA60MB, Alcon), or silicone (CeeOn 911, AMO). Postoperative evaluation (flare, cellular reaction, and capsular reaction) was performed at 1, 3, and 7 days as well as 1, 3, 6, and 12 to 18 months., Results: One year after surgery, flare was comparable between the IOLs. In terms of uveal biocompatibility, whereas the Injectacryl had the highest deposition of debris on the IOL surface (P = .04), the CeeOn 911 had significantly more small round cells in the first 6 months (P<.03). The AcrySof had the highest number of foreign-body giant cells (P = .01). In terms of capsular biocompatibility, lens epithelial cell outgrowth was highest in the AcrySof group (P<.02). Anterior capsule opacification was comparable between the 3 groups. Posterior capsule opacification was mild in all groups but was significantly greater in the Injectacryl group (P<.05). There were no cases of clinically significant IOL decentration or capsule contraction., Conclusions: In general, inflammatory cells accumulated more easily on hydrophobic IOLs than on hydrophilic IOLs; the AcrySof IOL had the highest prevalence of foreign-body giant cells. All 3 IOLs had good biocompatibility, although the AcrySof group had increased inflammatory signs.

Purpose: To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs)., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed., Results: There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08), Conclusions: Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.

Purpose: To compare the ongrowth of lens epithelial cells (LECs) on the anterior surface of 6 different hydrophilic intraocular lenses (IOLs)., Setting: Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria., Methods: Six models of hydrophilic IOLs were compared in this prospective study: Visionflex A-100 (Distra Softcryl), Rayner Centerflex 570H (Rayner), Collamer CC4204BF-IOL (Staar), Injectacryl F 3000 (Distra), Hydroview H60M (Bausch & Lomb), and MemoryLens (ORC). Postoperative biomicroscopic examinations were performed 1, 3, 7, 30, 90, 180, and 365 days after surgery. Lens epithelial cells in each quadrant of the anterior capsule-free lens surface were graded. The product with the highest density and the number of quadrants with this density were used to measure LEC ongrowth., Results: The Hydroview and Visionflex IOLs showed significantly more LECs than the other IOLs starting on day 7 after surgery (P < .028). There was a statistically significant difference in LEC ongrowth on the Memory IOL compared with all other IOLs from day 30 onward (P < .001). The Rayner, Collamer and Injectacryl IOLs had the fewest LECs on the anterior surface compared with all other IOLs from day 7 until the final examination., Conclusions: The findings show that LEC ongrowth on the IOL surface is material dependent. The findings suggest that the material of the recently developed hydrophilic IOLs induces less LEC ongrowth than older models.

Purpose: To analyze uveal and capsular biocompatibility 1 year following implantation of a sharp-edged, hydrophilic, collagen-containing posterior chamber intraocular lens (IOL)., Setting: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria., Method: In a prospective study, a Collamer CC4204BF IOL was implanted in 30 eyes of patients with senile cataract. A standardized surgical technique and postoperative regimen were applied. To assess uveal biocompatibility, cellular inflammation on the anterior IOL surface was evaluated with a specular microscope. Capsular biocompatibility was registered semiquantitatively with a biomicroscope, based on an assessment of fibrosis on the anterior and posterior capsules. Tyndall values were measured with the Kowa FC-1000 laser flare-cell meter. Decentration of the lens was also registered., Results: One year after implantation, the values of flare and cell count in the anterior chamber were lower than preoperatively. Round and spindle-shaped, epithelioid, and foreign-body giant cells were not found on the anterior surface of the IOL. The capsulorhexis rim was moderately fibrosed in 56.6% of cases. Fibrosis of the capsule over the optic was also moderate in 36.6%. The central portion of the posterior capsule was devoid of fibrosis in 43.3% and mildly fibrosed in 50%. Three lenses revealed outgrowth of lens epithelial cells to the anterior surface of the IOL. A neodymium:YAG capsulotomy had to be performed in 1 case. All lenses were well centered in the capsular bag 1 year after implantation., Conclusions: The absence of inflammatory cells on the anterior surface of the IOL indicates the high uveal biocompatibility of the lens. In terms of capsular biocompatibility, the results were satisfactory.

Purpose: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic (Hydroview) and hydrophobic acrylic (AcrySof) intraocular lenses (IOLs) after phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) or uveitis and compare the results with those in a control group., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: This prospective nonrandomized comparative trial comprised 143 eyes recruited consecutively. Of these, 49 eyes had PEX, 43 had uveitis, and 51 served as controls. A standardized surgical protocol was used. Cell reaction, anterior (ACO) and posterior (PCO) capsule opacification, and flare were evaluated 1 year after cataract surgery., Results: Regarding uveal biocompatibility, the number of foreign-body giant cells (FBGCs) increased in proportion to associated ocular pathologies in both IOL groups. The difference between the Hydroview control and Hydroview uveitis groups was statistically significant. The number of FBGCs was greater on AcrySof IOLs than on Hydroview IOLs in all 3 groups. The difference in FBGCs between the 2 IOL types was statistically significant in the control and PEX groups. Regarding capsular biocompatibility, lens epithelial cell (LEC) outgrowth was inversely correlated with intraocular inflammation. Outgrowth was statistically significantly higher with Hydroview IOLs, occurring in 85% in the control group, 45% in the PEX group, and 28% in the uveitis group (P <.0001). With AcrySof lenses, the percentages were 0%, 8%, and 4%, respectively. The PEX and uveitis groups were more likely to develop ACO than the control group (P <.012). There was no statistically significant difference in ACO between the 2 IOL types in the 3 patient groups. The PCO was statistically significantly greater in the uveitis group than in the control group (P <.026) and statistically significantly more dense on Hydroview than on AcrySof IOLs in all 3 patient groups (P <.002). Flare was statistically significantly higher in the uveitis group than in the PEX and control groups with both IOL types (P <.012). There was no statistically significant difference in flare between the 2 IOL types., Conclusions: Uveal and capsular biocompatibility depends on the intensity of ocular inflammation. The greater the inflammation, the less the biocompatibility of hydrophilic and hydrophobic acrylic materials. AcrySof stimulated more FBGCs. The Hydroview material had better uveal but poorer capsular biocompatibility than AcrySof. The sharp optic edge effect of the AcrySof IOL and the advantages of the Hydroview lens in normal eyes are less apparent in compromised eyes.

Purpose: To compare the course of inflammation after small-incision cataract surgery with implantation of 1 of 3 types of foldable intraocular lenses (IOLs) in eyes with uveitis., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: Seventy-four eyes with uveitis and cataract and 68 control eyes with cataract were prospectively selected to receive a foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia) IOL. All surgery was performed by the same surgeon using a standardized protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag IOL implantation. Preoperative and postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 28, 90, and 180 days after surgery using the Kowa FC-1000 laser flare-cell meter. All uveitic eyes were in remission for at least 3 months before surgery., Results: In the uveitic eyes, there was no statistically significant difference in the postoperative course of flare and cell among the 3 IOL groups. Six months after surgery in uveitic eyes, flare values reached preoperative levels and the cell count was lower than preoperatively in all 3 IOL groups. Relative flare values were higher in the eyes with uveitis and a CeeOn 911 IOL; however, the difference between this group and the 2 acrylic IOL groups was not significant., Conclusions: There were no significant differences in inflammation after implantation of foldable IOLs in uveitic eyes. Although absolute flare values and cell counts in eyes with uveitis were higher than in control eyes, primarily because of a damaged blood-aqueous barrier (BAB), BAB recovery was similar between the 2 groups. The changes in the BAB indicate that foldable IOL implantation is safe in uveitic eyes.

Purpose: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses (IOLs) in eyes with uveitis., Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria., Methods: This prospective study comprised 72 eyes with uveitis and 68 control eyes having phacoemulsification and IOL implantation by 1 surgeon. Patients received 1 of the following IOLs: foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia). Postoperative evaluations were at 1, 3, and 7 days and 1, 3, and 6 months. Cell reaction was evaluated by specular microscopy of the anterior IOL surface and the anterior and posterior capsule reaction, by biomicroscopy., Results: Small round cell deposition was observed on all IOLs in the immediate postoperative period, especially in eyes with uveitis. This reaction decreased 3 to 6 months after surgery. Although the CeeOn 911 had a higher mean grade of small cells, there was no statistical difference between the 3 IOL types after 6 months in the uveitis and control groups. Foreign-body giant cells (FBGCs) increased after 1 week to 1 month. The AcrySof IOLs had the highest number of FBGCs; after 6 months, there was a statistically significant difference between the AcrySof and Hydroview uveitis groups (P =.036) and the AcrySof and CeeOn 911 uveitis groups (P =.003) but there was no difference among the 3 IOL types in the control group. Lens epithelial cell outgrowth persisted on the Hydroview IOLs in control eyes and regressed on all 3 IOL types in uveitic eyes and on the AcrySof and CeeOn 911 IOLs in control eyes (P =.0001). Anterior capsule opacification (ACO) was more severe on all IOL types in uveitic eyes and on the CeeOn 911 IOL in control eyes. Posterior capsule opacification (PCO) was more severe in uveitic eyes. The Hydroview group had more severe PCO than the AcrySof and the CeeOn 911 groups in uveitis and control eyes. Six months postoperatively, the difference was significant (P =.0001). There was no significant difference between the AcrySof and CeeOn 911 IOLs., Conclusions: Intraocular lens biocompatibility is inversely related to inflammation. Hydrophilic acrylic material had good uveal but worse capsular biocompatibility. Hydrophobic acrylic material had lower uveal but better capsular biocompatibility. Silicone showed a higher small cell count (mild) and more severe ACO but achieved PCO results comparable to FBGC results and better than those with the AcrySof lens 6 months after surgery. Despite the differences in IOL biocompatibility, all patients benefited from the surgery.

Background: The early postoperative inflammation after cataract surgery is mainly caused by surgical trauma., Patients and Methods: 450 data-sheets of patients, who were operated for senile cataract with small-incision phacoemulsification and in-the-bag implantation of a foldable intraocular lens were retrospectively analysed. Postoperative inflammation was evaluated with the Laser Flare-Cell Meter Kowa FC-1000 on day 1, 3, 7 and 28. All the operations were done with the same phacomachine model Orbit Oertli. The absolute phacotime was measured, the data classified in steps of 20 seconds. Statistical analysis was made with the student's t-test., Results: In the first postoperative week there is a statistical significant difference in the flare-values between the groups with short phacotime (up to 39 seconds) and the group with long phacotimes (over 80 seconds). One month after operation this significance was absent., Conclusions: The early postoperative inflammation is influenced by the duration of phacoemulsification. Surgical techniques and phacomachines that may reduce phacotime are helpful with respect to early postoperative inflammation.

Background: Patients with pseudoexfoliation syndrome (PEX) are known to have a greater degree of inflammation after cataract surgery when compared to patients with senile cataract in otherwise healthy eyes. We performed a randomised, prospective study to compare the influence of the intra-ocular lens (IOL) material of two different IOLs on the postoperative inflammation of the anterior chamber., Patients and Methods: 28 eyes of 27 patients with PEX and cataract and 29 eyes of 29 control patients were included in this study. The IOLs used were the hydrophilic, acrylic lens: Bausch&Lomb-Hydroview and the hydrophobic, acrylic Alcon Acrysof MA60 lens. The patients were examined preoperatively as well as on day 1, 3, 7 and 1, 3, and 6 months after surgery using the Laser flare-cell meter (LFCM) KOWA FC 1000., Results: The preoperative flare and cell values were significantly higher in PEX eyes as compared to the control group. The values decreased after about 1 month to reach values comparable to those in the control group. Over the six months period there was no significant difference between the values of both lenses in the PEX group except on the first postoperative day where the flare and cell values were higher in the Acrysof-lens group. When comparing both groups with the Hydroview-lens there was also no significant difference, except on day 7, between the PEX group and the control group up to 6 months after surgery. When comparing both groups with the Acrysof-lens, there was a significant difference between the PEX group and the control group until 1 month after surgery., Conclusion: Although PEX-eyes had higher flare and cell values up to one month after surgery, we could not determine a significant difference, except on the first postoperative day, between both IOLs. A significant difference was evident between the PEX and control group in eyes with an Acrysof-lens. Using this clinical model, the LFCM highlights only certain aspects of biocompatibility of different lens types.