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The determination of sulcus-to-sulcus measurements has been challenging due to the limitations of current approaches. Ultrasound methods are highly operator-dependent and require extensive training, while traditional optical devices cannot visualize structures posterior to the iris. However, modern optical anterior segment coherence tomography (AS-OCT) devices are changing this paradigm by identifying some anatomical landmarks posterior to the iris. This study evaluates the reproducibility of optical sulcus measurements in the context of sizing a novel accommodative intraocular lens (IOL). Preoperative OCT scans of patients scheduled for cataract surgery were analyzed regarding the dimensions of the ciliary sulcus using a custom scan method with a clinically available anterior segment optical coherence tomographer. Measurements were compared between two different readers, and various derived parameters were compared. The measurements by both readers were highly correlated (R2 > 0.96), and their agreement was excellent (mean difference 0.02 mm with 95% limits of agreement from −0.11 to 0.15 mm). In contrast, the sulcus diameter measurement did not agree well with automatically calculated values, such as the anterior chamber width or white-to-white. This leads to the conclusion that modern swept-source AS-OCT measurements of the ciliary sulcus dimensions are feasible, reproducible, and may be a clinically useful tool. [ABSTRACT FROM AUTHOR]

With an increase in the older individuals, the global incidence of Alzheimer's disease (AD) is increasing. Early diagnosis of AD necessitates long‐term monitoring; however, conventional diagnostic methods such as positron emission tomography (PET) and magnetic resonance imaging (MRI) are unsuitable for frequent use because of infrastructure limitations. The eye, connected to the brain via the optic nerve, offers a potential window for monitoring neurodegenerative diseases. This study presents a novel system for continuous intraocular monitoring using a fluorescent aptamer‐conjugated intraocular lens (FAIOL). FAIOL emits fluorescent signals in the presence of beta‐secretase‐1 (BACE1), an enzyme associated with amyloid beta 1–42 production. These signals can be analyzed using mobile phone applications. In vitro, experiments demonstrates that FAIOL responded to BACE1 by detecting low concentrations of the target molecule over extended periods. Ex vivo tests using porcine eyeballs shows an increase in the fluorescence signal intensity by more than 8% within 5 h in the presence of BACE1. The integrated image analysis program reduces sensor noise and provides numerical signal values, facilitating a straightforward interpretation. FAIOL holds significant potential as an innovative platform for the early diagnosis and long‐term monitoring of AD and promises improved patient outcomes through timely intervention and ongoing surveillance. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the effect of decentration and tilt on the optical quality of monofocal and trifocal intraocular lenses (IOL). Methods: Optical quality of a monofocal IOL (AcrySof IQ SN60WF; Alcon Laboratories, Inc., USA) and a trifocal IOL (AcrySof IQ PanOptix; Alcon Laboratories, Inc., USA) was assessed using an in vitro optical bench (OptiSpheric IOL R&D; Trioptics GmbH, Germany). At apertures of 3.0 mm and 4.5 mm, modulation transfer function (MTF) at spatial frequency of 50 lp/mm, MTF curve and the United States Air Force (USAF) resolution test chart of the two IOLs were measured and compared at their focus with different degrees of decentration and tilt. Optical quality at infinity, 60 cm and 40 cm and the through-focus MTF curves were compared when the two IOLs were centered at apertures of 3.0 mm and 4.5 mm. Spectral transmittance of the two IOLs was measured by the UV–visible spectrophotometer (UV 3300 PC; MAPADA, China). Results: The SN60WF and the PanOptix filtered blue light from 400 to 500 nm. Both IOLs at the far focus and the PanOptix at the intermediate focus showed a decrease in optical quality with increasing decentration and tilt. The PanOptix demonstrated enhanced optical quality compared to the previous gradient at the near focus at a decentration range of 0.3–0.7 mm with a 3.0 mm aperture, and 0.5 mm with a 4.5 mm aperture, whereas other conditions exhibited diminished optical quality with increasing decentration and tilt at the focus of both IOLs. When the two IOLs were centered, the SN60WF had better optical quality at infinity, while the PanOptix had better optical quality at 60 cm and 40 cm defocus. The optical quality of the SN60WF exceeded that of the PanOptix at far focus, with a 3 mm aperture decentration up to 0.7 mm and a 4.5 mm aperture decentration up to 0.3 mm; this observation held true for all tilts, irrespective of aperture size. As both decentration and tilt increased, the optical quality of the SN60WF deteriorated more rapidly than that of the PanOptix at the far focal point. Conclusions: The SN60WF showed a decrease in optical quality with increasing decentration and tilt. Optical quality of the PanOptix at the near focus increased in some decentration conditions and decreased in some conditions, while it showed a decrease at the other focuses with increasing decentration. While tilt only had a negative effect on optical quality. When both IOLs were centered, the PanOptix provided a wider range of vision, while the SN60WF provided better far distance vision. At the far focus, the SN60WF has better resistance to tilt than the PanOptix, but the optical quality degrades more quickly when decentered and tilted. [ABSTRACT FROM AUTHOR]

Background: Extended depth of focus (EDOF) and multifocal (Multi) intraocular lenses (IOL) can provide a fixed distance of near vision, which may result in some discomfort for patients who prefer different near distances. The aim of this study was to compare the vision, comfortable near distance (CND) and visual comfort in patients who underwent implantation of EDOF, Multi, and monofocal (Mono) IOLs. Methods: A total of 100 eyes were implanted with Tecnis ZXR00, ZMB00 or ZCB00 IOLs. Uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), corrected distance visual acuity (CDVA), the fluctuations of CND, the ability to see at comfortable or standard near distance and visual comfort were evaluated at 3-month postoperative. Results: At 3 months postoperative, the EDOF and Multi groups showed non-inferiority compared to the Mono group in the UDVA (P > 0.05) and CDVA (P > 0.05) but superiority in the UNVA (P < 0.001). The UIVA was better in the EDOF group, with comparable results for the Multi and Mono groups. There was no difference in preoperative and postoperative CND in the three groups. The CND visual acuity (CNDVA) was lower than the UNVA in the three groups, especially in the EDOF and Multi groups (P < 0.05). The CND effectively improved patients' near visual comfort and visual clarity, except for one patient in the Multi group who complained of severe fatigue and was unable to tolerate the experience at month 3. Conclusion: The EDOF and Multi IOLs achieved excellent visual quality and superior UNVA compared to the Mono IOL, but the CNDVA was significantly inferior to the UNVA. Patients' near visual experience can be effectively improved at their CND. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to identify the most accurate regression model for predicting total corneal astigmatism (TCA) from anterior corneal astigmatism (ACA) and to fine-tune the best model's architecture to further optimize predictive accuracy. Methods: A retrospective review of 19,468 eyes screened for refractive surgery was conducted using electronic medical records. Corneal topography data were acquired using the Pentacam HR. Various types (7) and subtypes (21) of regression learners were tested, with a deep neural network (DNN) emerging as the most suitable. The DNN was further refined, experimenting with 23 different architectures. Model performance was evaluated using root mean squared error (RMSE), R2, average residual error, and circular error. The final model only used age, ACA magnitude, and ACA axis to predict TCA magnitude and axis. Results were compared to predictions from one of the leading TCA prediction formulas. Results: Our model achieved higher performance for TCA magnitude prediction (R2 = 0.9740, RMSE = 0.0963 D, and average residual error = 0.0733 D) compared to the leading formula (R2 = 0.8590, RMSE = 0.2257 D, and average residual error = 0.1928 D). Axis prediction error also improved by an average of 8.1° (average axis prediction error = 4.74° versus 12.8°). The deep learning approach consistently demonstrated smaller errors and tighter clustering around actual values compared to the traditional formula. Conclusion: Deep learning techniques significantly outperformed traditional methods for TCA prediction accuracy using the Pentacam HR. This approach may lead to more precise TCA calculations and better IOL selection, potentially enhancing surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate changes in cataract and refractive surgery practice patterns among members of the Japanese Society of Cataract and Refractive Surgery (JSCRS) over the past 20 years. Study design: Questionnaire survey study. Subjects and methods: Clinical surveys were conducted annually between February and April from 2004 to 2023. Survey questions covered various areas, including cataract surgical techniques, anesthesia, endophthalmitis prophylaxis, toric and presbyopia-correcting intraocular lenses (IOLs), complications, and refractive surgery. Results: The highest (n=554 [36.8%]) and lowest (n=316 [19.1%]) numbers of responses were collected in 2012 and 2016, respectively. In perioperative management, the intraoperative use of polyvinyl alcohol-iodine solution and topical antibiotic prescription 3 days before surgery has increased. The use of intracameral injection at the end of surgery has also significantly increased, although it has not been established as common practice. In anesthesia, there is a clear polarization between the use of topical drops and tenon injection. The use of toric IOLs and presbyopia-correcting IOLs has significantly increased from 2010 to 2023. In the latter, the use of trifocal IOLs has particularly increased. Regarding IOL power calculations, the Barrett True K and the Barrett Universal II formulas are rapidly gaining popularity for application with and without post-laser vision correction, respectively. In refractive surgery, phakic IOLs and corneal refractive therapy have attracted considerable interest, followed by laser in situ keratomileusis. Conclusions: Evaluation of annual clinical survey data over the past two decades provided valuable insights into the shifting practice patterns and clinical opinions among JSCRS members. [ABSTRACT FROM AUTHOR]

This study used an optimal implant diffractive bifocal intraocular lens (IOL) made of a foldable hydrophobic acrylic polymer. The distinctive optical properties (refractive index of 1.55, abbe number of 41.91) of this polymer, the high refractive index of the polymer helps to focus light and increase the ray bending to form a good image, while the low water content of the polymer helps to prevent infections. ZEMAX-EE optical software, which produces results that are closer to the human eye, and a common metrics were used in this evaluation to assess the effectiveness of this IOL, such as the modulation transfer function (MTF), spot diagram and the behaviour of MTF field of view. These measurements were taken within the entrance pupil diameters of 1.5, 3 and 4 mm over a field of view of 20°, 30° and 40°. The results showed that the selected design and lens shape significantly improved and enhanced optical performance. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prediction error (PE) in pediatric traumatic cataract surgery involving primary or secondary intraocular lens implantation (IOL) and the factors affecting it. Methods: Retrospective data of unilateral traumatic cataract eyes of children aged ≤16 years were collected between February 2019 and March 2022 at a tertiary eye care hospital. Absolute PE was calculated by deducting the target refraction from the observed refraction at 6 weeks postsurgery following suture removal. Simulated PE was calculated in eyes with corneal scar replacing the affected eye keratometry (K) with the K of the fellow eye and standard K (44D) and was then compared with absolute PE. Results: Fifty children with a mean age of 9.5 years (2–16 years) were included. Mean absolute PE was 1.63 ± 1.8D (0 to 9D). Absolute PE was not affected by the age at surgery, method of biometry, duration of injury, type of cataract surgery, position of IOL, and preoperative keratometry. The absolute PE was affected by axial length (AXL) being 2D in AXL of 22.01 ± 0.74 mm (P = 0.039) in univariate analysis. In multivariate analysis, none of the factors affected the absolute PE. In 34 eyes with corneal scar, higher variability in PE was observed. The standard K resulted in greater simulated PE as compared to the affected eye average K in eyes with scar involving the visual axis. Conclusion: Absolute PE following pediatric traumatic cataract was studied. It was higher in shorter AXLs. In corneal scar involving the visual axis, using the fellow eye K yielded lesser simulated PE as compared to standard K.

Background: The occurrence of cataracts in rabbits is a common reason for consultation in veterinary ophthalmology. Case Description: A 6-year-old female Lop rabbit (Oryctolagus cuniculus) was referred with a 3-month history of bilateral cataracts. The owner noted that the rabbit was frequently bumping into obstacles. Physical examination was unremarkable. Routine hemogram and biochemistry panel were within usual values, and Encephalitozoon cuniculi was not detected by serology. A complete ophthalmological examination revealed bilateral hypermature cataracts causing total blindness. Bilateral tonometry showed normal intraocular pressures. Electroretinography under general anesthesia revealed strong photoreceptor responses for each eye, and ocular ultrasound was normal except for bilateral hypermature cataracts. Following electroretinography, during the same anesthesia session, conventional phacoemulsification followed by acrylic intraocular lens (IOL; +58D) implantation was performed uneventfully in both eyes. Follow-up examinations were carried out for one year. Except for immediate post-operative bilateral corneal ulcers that were quickly cured with medical treatment, no other post-operative complications were observed. The one-year follow-up examination revealed centered IOLs without posterior capsular opacity, enabling the observation of normal fundus in both eyes. The owner confirmed the rabbit had normal autonomy and moved with accuracy, as observed during follow-up visits and on videos provided by the owner. Conclusion: To our knowledge, this is the first described case of successful bilateral phacoemulsification and bilateral intraocular lens implantation with prior electroretinographic evaluation of the retinal function in a pet rabbit with cataracts. [Open Vet J 2024; 14(10.000): 2693-2699]

Ahmed Hassan Assaf,1,2 Hams Samy,2 Noha Fawky,2 Menna Ahmed Kamel1 1Department of Ophthalmology, Ain Shams University, Cairo, Egypt; 2Watany Eye Hospital, Cairo, EgyptCorrespondence: Ahmed Hassan Assaf, Ain Shams University, Abbassia, Cairo, Egypt, Email assaf.ahmed@gmail.comPurpose: To evaluate the effect of angles kappa and alpha on the visual outcomes after implantation of isofocal intraocular lens (IOL) during cataract surgery.Methods: This prospective study involved 66 eyes undergoing cataract surgery with Isopure IOLs. Exclusion criteria comprised irregular corneal astigmatism exceeding 1.0D, and ocular co-morbidities affecting visual outcomes post-surgery. Evaluation parameters included postoperative refraction, uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 cm. Additionally, postoperative angles alpha, kappa, and wavefront aberrations at a 3-mm pupil using ray tracing were assessed post-surgery at least 60 days later.Results: Patients had a mean age of 64.48 ± 9.92 years. Mean postoperative manifest refraction spherical equivalent (MRSE) was − 0.21 ± 0.27 D. Mean UDVA and CDVA were LogMAR 0.06 ± 0.04 and 0.02 ± 0.06, respectively. Mean UIVA LogMAR 0.32 ± 0.08 while mean DCIVA was LogMAR 0.29 ± 0.08. Postoperative angles kappa and alpha were 0.39 ± 0.14 mm and 0.45 ± 0.15 mm, respectively. Mean postoperative ocular RMS higher-order aberrations (HOAs) 0.23 ± 0.08. Spherical aberration, coma, and trefoil averaged 0.05 ± 0.07, 0.12 ± 0.03, and 0.07 ± 0.03, respectively. No significant correlations were observed between postoperative angle kappa and alpha with UDVA, CDVA, or HOAs. A non-significant weak positive correlation was noted between angle kappa and UIVA/DCIVA, while no correlation was found between angle alpha and UIVA/DCIVA.Conclusion: No substantial correlations were found between various postoperative angles kappa and alpha values and postoperative visual acuity metrics (UDVA, CDVA, UIVA, and DCIVA) or higher order ocular aberrations (including, spherical aberration, coma, and trefoil with a 3.0 mm diameter) in pseudophakic eyes implanted with isofocal intraocular lenses (IOLs).Keywords: intraocular lens, cataract, optical quality, angle alpha, angle kappa

Abstract Background Extended depth of focus (EDOF) and multifocal (Multi) intraocular lenses (IOL) can provide a fixed distance of near vision, which may result in some discomfort for patients who prefer different near distances. The aim of this study was to compare the vision, comfortable near distance (CND) and visual comfort in patients who underwent implantation of EDOF, Multi, and monofocal (Mono) IOLs. Methods A total of 100 eyes were implanted with Tecnis ZXR00, ZMB00 or ZCB00 IOLs. Uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), corrected distance visual acuity (CDVA), the fluctuations of CND, the ability to see at comfortable or standard near distance and visual comfort were evaluated at 3-month postoperative. Results At 3 months postoperative, the EDOF and Multi groups showed non-inferiority compared to the Mono group in the UDVA (P > 0.05) and CDVA (P > 0.05) but superiority in the UNVA (P

Eric Jennings,1 Brad Hall2 1Woolfson Eye Institute, Atlanta, GA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Eric Jennings, Woolfson Eye Institute 800 Mount Vernon Hwy NE Suite 130, Atlanta, GA, 30501, USA, Tel +1-404-256-1125, Email ejennings@woolfsoneye.comPurpose: To evaluate the efficacy of a cloud-based surgical planning platform with regards to refractive target accuracy.Methods: This was a retrospective chart review of consecutive cases from January 2022 through December 2023. Surgical planning was performed using the SMARTCataract platform, eyes were implanted with Clareon monofocal IOLs, and power calculations were done using the Barrett Universal II formula. Data were collected for the percentage of eyes within ± 0.5 D of target refraction, mean absolute error (MAE), and postoperative visual acuity.Results: A total of 148 eyes were identified that met the inclusion/exclusion criteria. The percentage of eyes within ± 0.5 D of the planned target was 94%. The MAE was 0.25 ± 0.17 D. In addition, 57%, 93%, 98%, and 100% of eyes had MAE ≤ 0.25 D, ≤ 0.5 D, ≤ 0.75 D, and ≤ 1.0 D, respectively.Conclusion: The results of this study suggest high refractive accuracy when using the SMARTCataract planning platform with the Barrett Universal II formula and excellent distance visual acuity.Plain Language Summary: When the natural lens inside the eye develops a cataract (becomes opaque) it can be replaced with a clear artificial intraocular lens (IOL). Good visual outcomes after surgery are heavily reliant on implanting the optimal lens power. A new cloud-based surgical planning tool (SMARTCataract) aims to automatically use patient data, surgeon preferences, favored IOL power calculation formulas, and desired IOL type to guide surgical planning. However, to date there are no data on the refractive outcomes when using the SMARTCataract platform. The purpose of this study was to evaluate the efficacy of the SMARTCataract platform with regards to refractive target accuracy. The results of this study suggest high refractive accuracy when using the SMARTCataract platform with the Barrett Universal II formula and excellent distance visual acuity.Keywords: SMARTCataract, biometry, accuracy, intraocular lens

Takayuki Akahoshi Department of Cataract and Refractive Surgery, Nihonbashi Cataract-Clinic, Tokyo, JapanCorrespondence: Takayuki Akahoshi, Department of Cataract and Refractive Surgery, Nihonbashi Cataract-Clinic, 2-4-1, Nihonbashi Muromachi, Chuoku, Tokyo, Japan, Email eye@phaco.expertPurpose: To analyze the patient-reported-outcomes obtained after trifocal intraocular lens (IOL) bilateral implantation in Japanese patients using three different validated questionnaires.Methods: Fifty-three patients implanted with the FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this prospective-study. At 3-months, refraction (spherical equivalent [SE] and cylinder), logMAR uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained. Specifically, patient-reported-outcomes were evaluated using the NEI VFQ-25, the Catquest-9SF, and the PRSIQ questionnaires.Results: The mean SE and refractive cylinder were 0.00± 0.22D and – 0.07± 0.23D, respectively. A 98.11% of eyes were within ± 0.50D and 100% were within ± 1.00D of the SE. A 93.40% of the eyes showed equal or less than 0.50D of astigmatism and 100% of eyes equal or less than 1.00D. The mean value for monocular UDVA was – 0.05± 0.07 logMAR and the mean value for monocular CDVA was − 0.07± 0.06 logMAR. 87.74% and 92.45% of the eyes showed 20/20 or better monocular UDVA and CDVA, respectively, with 97.17% and 98.11% showing 20/25 or better for UDVA and CDVA, respectively. The NEI VFQ-25 outcomes showed very high scores across all categories, with mean general vision, distance and near activities values of 86.70± 6.35, 96.23± 7.72 and 92.14± 10.74, respectively. The outcomes for the Catquest-9SF questionnaire showed that 90.57% of patients did not report difficulty in their everyday-life with their sight, and 100% of them were “very or quite satisfied” with their sight at present. The PRSIQ outcomes revealed that 100%, 98.11% and 98.11% of patients did not need glasses or contacts for far, intermediate and near vision, respectively.Conclusion: The results of the patient-reported-outcomes questionnaires indicated that patients implanted bilaterally with the FineVision HP IOL have high vision and health related quality-of-life scores, with a high spectacle independence rate and high patient satisfaction.Keywords: patient-reported outcomes, questionnaires, trifocal, intraocular lens, cataract

OBJECTIVE This study aims to describe a novel technique for implanting an intraocular lens (IOL) in the sulcus using a 10-0 nylon suture in cases of intraoperative posterior capsular rupture (PCR) with inadequate capsular support, anterior capsular extension during continuous curvilinear capsulorrhexis extending to the posterior capsule, or posttraumatic cataract. METHODS The study included 52 patients who underwent surgery at our hospital, during which an IOL was implanted with the assistance of a 10-0 nylon suture. All patients completed a 1-year follow-up period. RESULTS In 48 of the 52 patients, the IOL remained stable. However, in two patients, the IOL dropped into the vitreous cavity approximately 1-month postsurgery. These two individuals required IOL explantation, pars plana vitrectomy, and secondary IOL (SFIOL) implantation. CONCLUSION Implanting an IOL in cases involving intraoperative PCR with inadequate capsular support, anterior capsular extension to the posterior capsule during continuous curvilinear capsulorrhexis, or posttraumatic cataract can be challenging. The technique of IOL implantation with the assistance of a 10-0 nylon suture, as described in this study, offers a straightforward and safe approach. In addition, it can help alleviate the financial and psychological trauma associated with a second surgery for both the patient and the surgeon.

AIM: To establish an animal model of form deprivation amblyopia based on a simulated cataract intraocular lens (IOLs). METHODS: Poly(dimethyl siloxane)-SiO2 thin films (PSF) with different degrees of opacity as IOL materials were prepared. The light transmission of the PSF-IOL was measured, and its in vitro biosafety was determined by cell counting kit (CCK)-8 assay using the HLEC-B3 cell line and ARPE-19 cell line. Subsequently, the in vivo safety was determined by implanting the PSF-IOL with 10% wt SiO2 into the right eyes of New Zealand white rabbits (PSF-IOL group), and compared with two control groups: contralateral comparison group and normal control (NC) group (Contralateral comparison group: the fellow eye; NC group: a group of binocular normal rabbits without intervention). The flash visual-evoked potentials (F-VEPs) were measured to verify amblyopia. RESULTS: PSFs containing 0, 2%, and 10% wt SiO2 were successfully constructed. The 0 SiO2 PSF was transparent, while the 10% wt SiO2 PSF was completely opaque. It was found that PSF did not induce unwanted cytotoxicity in HLECs and ARPE19 cells in vitro. In vitro, PSF-IOL with 10% wt SiO2 was also non-toxic, and no significant inflammation or structural changes occurred after four weeks of PSF-IOL implantation. Finally, our IOL-simulated congenital cataract rabbit detected by F-VEPs suggested tentative amblyopia. CONCLUSION: A PSF-IOL that mimics cataracts is created. A novel form deprivation model is created by the IOL-simulated congenital cataract rabbit. It can be developed fast and stable and holds great potential for future study.

AIM:To observe the clinical effect of ciliary sulcus suture fixation of intraocular lens(IOL)with the scleral tunnel technique.METHODS: The clinical data of 36 patients(38 eyes)who underwent ciliary sulcus suture fixation of IOL with the scleral tunnel technique in our hospital from May 2021 to September 2023 were retrospectively analyzed. The patients were followed up for a total of 3-26 mo. The postoperative IOL position, visual acuity, refraction, intraocular pressure and complications were observed, and the results of tear film break-up time(BUT), corneal fluorescein staining(FL)and Schirmer Ⅰ test(SⅠt )were evaluated.RESULTS: The uncorrected visual acuity and best corrected visual acuity of all eyes were improved at 3 mo after surgery(all P

Background: Polypropylene is a commonly used suturing material for intraocular lens (IOL) scleral fixation, but a high breakage rate after several years of follow-up is reported. Meanwhile, Gore-Tex has been a popular artificial material in ophthalmic surgery. Aim: This pilot study investigated the safety and efficacy of a modified surgical technique for scleral fixation of a four-point, close-loop haptic IOL using Gore-Tex as the suture material for aphakic patients without adequate capsular support. Methods: A modified IOL scleral fixation technique was developed using a four-point, close-loop haptic IOL and Gore-Tex as the suture material. Patients undergoing the operation between March 2018 and May 2019 at one center were included in the study. The preoperative uncorrected distance visual acuity (UDVA) with spectacles and postoperative UDVA with an IOL were compared as the main outcome. Follow-up time was 17–43 months. Results: A total of 10 eyes of 10 patients were enrolled, including 3 with iatrogenic IOL dislocation, 3 with iatrogenic lens drop, 2 with traumatic lens dislocation, and 2 with late in-the-bag IOL dislocation. The mean age was 70.8 ± 12.11 years. The mean UDVA, evaluated by the logarithm of the minimum angle of resolution, was decreased from preoperative 1.89 ± 0.28 to postoperative 0.58 ± 0.70 (P < 0.001). No complications were reported except in one case with a postoperative corneal ulcer which healed after antibiotic treatment. Conclusion: The favorable outcome suggests Gore-Tex sutures as a safe and stable material for IOL scleral fixation. Prospective studies with a larger sample size would be necessary for more details on the safety and efficacy of the Gore-Tex suture in IOL scleral fixation.

Abstract Background Implantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane’s double-needle technique and flanged haptics. Methods Prospective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane’s technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty. Results The mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis. Conclusions The transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications.

Abstract Background The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. Methods A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. Results At 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens’s clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. Conclusion This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. Trial registration This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

Cataract surgery is most commonly performed today by utilizing the standardized phacoemulsification technique which results in successful outcomes and low complication rates. At present, most patients undergo cataract surgery in both eyes on separate days, referred to as delayed sequential cataract surgery (DSCS). Immediately sequential bilateral cataract surgery (ISBCS) has emerged as an alternative to traditional DSBCS and is, however, increasingly used in clinical practice throughout the world. The question arises: How safe is ISBCS with respect to postoperative complications?

Abstract Background The aim of this study was to analyze the causes and characteristics of IOL explantation within the first year after primary implantation. Methods In this retrospective, cross sectional database study, a database consisting of over 2500 IOL explants sent from 199 national and international doctors over the past 10 years was analyzed. All IOLs explanted within the first year after implantation were included in this analysis. Explants with insufficient information as well as phakic and Add-on IOLs were excluded. Main outcome measures were the reason for explantation, the time between implantation and explantation, as well as IOLs’ and patients’ characteristics. Additionally, the explanted IOLs were microscopically and histologically analyzed, as required. Results Of all explanted IOLs from the database, 1.9% (n = 50) were explanted within the first year after implantation. The most frequent reasons for early IOL explantation were IOL dislocation (32%), visual intolerance (26%), opacification (20%), and intraoperative complications (16%). The time between implantation and explantation was the shortest in cases with intraoperative complications (1.5 ± 3.1 days), followed by IOL dislocation (90.9 ± 103.9 days), visual intolerance (98.3 ± 86.5 days), opacifications (253.5 ± 124.0 days) and other indications (249.7 ± 124.0 days). Calcification of hydrophilic IOLs was the main type of opacification (80%). Notably, seven IOLs required immediate intraoperative exchange due to an intraoperative crack in the optic or a torn off haptic. Conclusion Indications for early IOL explantation were IOL dislocation, visual intolerance, opacification, and intraoperative complications. Especially intraoperative damages to the IOL and early calcification show a potential for improvement of affected IOLs and implantation systems.

Abstract Background This study assessed the agreement of ocular parameters of patients with myopia measured using Colombo intraocular lens (IOL) 2 and IOLMaster 700. Methods Eighty patients (male, 22; average age, 29.14 ± 7.36 years) with myopia (159 eyes) were included in this study in May 2023. The participants’ axial length (AXL), central corneal thickness (CCT), lens thickness (LT), white-to-white distance (WTW), front flat (K1), steep (K2), mean (Km) corneal keratometry, astigmatism (Astig), J0 vector, and J45 vector were measured using the IOLMaster 700 and Colombo IOL 2. The measurements from both devices were compared using the generalized estimating equation, correlation analysis, and Bland-Altman plots. Results With the Colombo IOL 2, lower values for K2 and J0 (odds ratio [OR] = 0.587, p = 0.033; OR = 0.779, p

Objective To analyze the accuracy of the new generation intraocular lens (IOL) formula and the Wang-Koch (WK) adjustment in individuals with severe myopia undergoing combined anterior-posterior surgery. Methods A total of 100 patients (100 eyes) with axial length (AL) >26 mm undergoing combined anterior and posterior segment surgery in our department from June 2015 to June 2021 were enrolled in this study. Totally 13 IOL calculation formulas, such as Barrett Universal Ⅱ (BUⅡ), Emmetropia Verifying Optical (EVO), Kane, Haigis, Hoffer Q, Holladay, and SRK/T as well as the first generation linear WK eye axis optimization formula (Haigis-WK1, SRK/T-WK1, Hoffer Q-WK1, Holladay 1-WK1) and the second generation linear WK eye axis optimization formula (SRK/T-WK2, Holladay 1-WK2), were utilized to determine IOL diopter. The mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE), and percentage of prediction error within different refractive thresholds were calculated to assess the accuracy of each formula. In order to investigate the impact of AL on accuracy of IOL calculation, the patients were categorized into group A (38 eyes, 26.00 mm < AL≤28.00 mm), group B (28 eyes, 28.00 mm < AL≤30.00 mm), and group C (34 eyes, AL >30.00 mm). Additionally, the patients were also divided into silicone oil (63 eyes) and non-silicone oil (37 eyes) groups based on preoperative intraocular filling to determine the effect of intraocular filling on IOL calculation. Results The MedAE values of the new-generation IOL formulas (BUⅡ, EVO, and Kane) were significantly lower (0.34D, 0.31D, 0.35D) than those of traditional formulas (P < 0.05). Additionally, the percentage of prediction errors within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D were significantly higher with the new formulas when compared to traditional ones (P < 0.05). Traditional formulas exhibited a hyperopic deviation (0.35D~0.65 D), which could be corrected using the WK eye axis adjustment. WK2 was effective in improving the accuracy of calculation in SRK/T and Holladay 1 formulas, and there was no statistical difference in the MedAE values of SRK/T-WK2 and Holladay 1-WK2 formulas with the new-generation IOL formulas. When comparing the formulas across different axial eye length groups in terms of MedAE, the new IOL formulas (BUⅡ, kane and EVO) and WK-corrected formulas (Haigis-WK1, SRK/T-WK1, SRK/T-WK2, Hoffer Q-WK1, Holladay 1-WK1, Holladay 1-WK2) showed no significant differences among the different AL groups. However, there were significant differences in the MedAE values of traditional formulas among the different AL groups (P < 0.01), with group C displaying the largest MedAE values (Haigis: 0.84D, SRK/T: 1.10D, Hoffer Q: 1.23D, Holladay 1: 1.20D). Comparing the MedAE values of different formulas in various preoperative intraocular filling groups, it was observed that the MedAE values of the new-generation IOL formulas (BUⅡ, kane and EVO), Haigis, and SRK/T formulas were significantly higher in the silicone oil-filled eye group than the non-silicone oil-filled eye group (P < 0.05). Conclusion In patients with high myopia undergoing combined anterior and posterior segment surgery, the precision and consistency of the new-generation IOL formulas and the second-generation linear WK axis correction formula exhibit significant improvements when compared to traditional formulas.

Abstract Background Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques. Methods Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years. Surgical technique: A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure. Results Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2–2.1) to 0.07 (0.02–0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment. Conclusions Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.

Takayuki Akahoshi Cataract and Refractive Surgery Department, Nihonbashi Cataract Clinic, Tokyo, JapanCorrespondence: Takayuki Akahoshi, Cataract and Refractive Surgery Department, Nihonbashi Cataract Clinic, 2-4-1, Nihonbashi Muromachi, Chuoku, Tokyo, Japan, Email eye@phaco.expertPurpose: To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism.Methods: A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery.Results: Sixty-five eyes (98.48%) were within ± 0.50D of spherical equivalent, and all were within ± 1.00D (mean: 0.00± 0.21D). Moreover, 63 eyes (95.45%) had ≤ 0.50D of residual astigmatism, and all had ≤ 1.00D (mean: – 0.08± 0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥ 20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥ 20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥ 20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥ 20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥ 20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥ 20/25 UNVA and DCNVA, respectively.Conclusion: Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.Keywords: astigmatism, trifocal, toric, intraocular lens, cataract

Francisco Pastor-Pascual,1 Paz Orts-Vila,2 Pedro Tañá-Sanz,2 Santiago Tañá-Sanz,2 Pedro Tañá-Rivero2 1Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, SpainCorrespondence: Pedro Tañá-Rivero, Oftalvist Alicante, Avda. Dénia 76, Alicante, 03013, Spain, Tel +34 965 14 15 00, Email rdi@oftalvist.esPurpose: To assess the refractive and visual outcomes at different distances following cataract surgery with implantation of an omnidirectional aberration-free diffractive trifocal toric intraocular lens (IOL).Methods: A total of 24 patients who underwent bilateral implantation with the TrivaT-aAY IOL were analyzed at 3– 4 months post-surgery. Refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, monocular and binocular defocus curve and rotational stability were measured. Patients also completed the Catquest-9SF questionnaire at the last postoperative visit.Results: The postoperative mean values of binocular logMAR CDVA, CDIVA and CDNVA were − 0.06± 0.06, 0.05± 0.07 and 0.07± 0.08, respectively. One hundred percent of patients showed a cumulative binocular CDVA ≥ 20/25, and 95.83% of patients showed a cumulative binocular CDIVA and CDNVA ≥ 20/32. The mean postoperative spherical equivalent was 0.07± 0.26D and 100% and 97.92% eyes were within ± 1.00D and ± 0.50D, respectively. The mean postoperative refractive cylinder was − 0.22± 0.29D and 100% and 89.58% eyes showed a value ≤ 1.00D and ≤ 0.50D, respectively. The defocus curves showed a wide range of useful vision, with visual acuity values > 0.2 logMAR. Mean absolute IOL rotation was 2.19± 2.17 degrees and all eyes had a rotation < 10 degrees. For the questionnaire, 95.83% of patients reported being quite satisfied to very satisfied with their vision and about 79.17% did not report any difficulty with their vision in their everyday life. Between 83.33% and 95.83% of patients reported no difficulty performing different tasks. No intra- and postoperative complications were reported during the follow-up.Conclusion: Our study shows that the TrivaT-aAY IOL provides good visual acuities at all distances and refractive outcomes with excellent rotational stability and with high satisfaction among our patients after its implantation.Keywords: astigmatism, toric, diffractive, trifocal, intraocular lens, cataract

James Paauw,1 Michael B Caplan,2 Mark Gallardo,3 Kristi Rushin,4 Jeffrey D Horn5 1Department of Ophthalmology, Piedmont Eye Center, Lynchburg, VA, USA; 2Berkeley Eye Center, Houston, TX, USA; 3El Paso Eye Surgeons, El Paso, TX, USA; 4Alcon Vision LLC, Fort Worth, TX, USA; 5Vision for Life, Nashville, TN, USACorrespondence: James Paauw, Piedmont Eye Center, Lynchburg, VA, USA, Tel +1-437-947-3984, Email paauwer@gmail.comPurpose: This study assessed the incidence of postsurgical intraocular inflammation after cataract extraction by phacoemulsification and implantation with AcrySof IQ ReSTOR intraocular lenses (IOLs) produced using an updated manufacturing process. Incidence rates were compared with historical rates of postsurgical intraocular inflammation.Methods: This was a prospective, multicenter, post-approval study at 34 sites. Patients aged ≥ 22 years received a study lens in at least 1 eye. Postsurgical intraocular inflammation (aqueous cell grade ≥ 3+ within 14 days after surgery, aqueous cell ≥ 2+ at 14 to ≤ 60 days after surgery, or aqueous cell ≥ 1+ at > 60 days) was assessed within a 180-day period after implantation. Rates of toxic anterior segment syndrome (TASS), acute postoperative endophthalmitis, chronic postoperative endophthalmitis, and uncategorized cases of postsurgical intraocular inflammation were assessed. Ocular adverse events (AEs) and ocular adverse device effects (ADEs) were evaluated. Historical rates of postsurgical intraocular inflammation were determined from the 2011– 2013 Medicare Limited Data Set files (a 5% sample of the Medicare data set representative of patients aged ≥ 65 years).Results: Final safety analysis set included 3357 eyes (1792 patients; mean age, 68.6 ± 7.9 years). Postsurgical intraocular inflammation (any type) rate was 5.1 per 1000 attempted IOL implants (95% CI, 2.95, 8.10). TASS, acute postoperative endophthalmitis, and uncategorized inflammation rates were 0.6 (95% CI, 0.07, 2.15), 0.3 (95% CI, 0.01, 1.66), and 4.2 (95% CI, 2.28, 6.99) per 1000 attempted IOL implants, respectively. There were no events of chronic postoperative endophthalmitis. Ocular AEs and ADEs were reported in 17% and 1.5% of eyes, respectively. Most common ADEs were halo (0.63%) and glare (0.51%). The historical postsurgical inflammation rate from 221,519 cataract procedures was 10.3/1000 cataract surgeries, and the endophthalmitis rate was 1.2/1000 surgeries.Conclusion: The updated IOL manufacturing process resulted in postoperative intraocular inflammation rates that were substantially lower than the historic rate.Keywords: endophthalmitis, intraocular lens, postoperative inflammation, toxic anterior segment syndrome

Ruediger Schmid,1 Andreas F Borkenstein2 1accuratis, Practice for Refractive Eye Surgery, Ulm, 89073, Germany; 2Borkenstein & Borkenstein, Private Practice at Privatklinik der Kreuzschwestern, Graz, 8010, AustriaCorrespondence: Ruediger Schmid, accuratis, Practice for Refractive Eye Surgery, Hirschstrasse 1, Ulm, 89073, Germany, Tel +49 731 28065680, Email dr.schmid@accuratis-ulm.dePurpose: Any new intraocular lens (IOL) on the market claims to outperform competitors. We aimed to estimate the modulation transfer function (MTF) for different defocus of a novel refractive enhanced depth of focus (EDoF) IOL and the simulated visual acuity over this range of vision. Further, we analyzed the wavefront pattern produced by this IOL to reveal the function of the IOL’s optics.Methods: For the novel TECNIS® PureSee® (ZEN00V) IOL, through frequency and through focus MTF were recorded on the optical bench (ISO-2 Cornea 0.28 μm, 546 nm). MTFa and the simulated visual acuity were calculated for different defocus. Apertures of 3 mm and 4.5 mm were applied. Higher order aberrations of the IOLs’ optics were recorded and analyzed.Results: PureSee® IOL demonstrated a considerable depth of focus of about 1.7 D at the spectacle plane and a continuous simulated visual acuity over this range of defocus. For the 4.5 mm aperture, near focus depth was reduced, yet far distance MTF was even better. Higher order aberrations revealed increased primary and secondary spherical aberrations.Conclusion: Optical bench results suggest that the new ZEN00V matches the clinical criteria of an EDoF IOL by an increased range of vision and is far distance dominant for an enlarged pupil. This behaviour seems to be due to subtle power changes in the central optics that produce a complex modification of wavefront.Keywords: modulation transfer function, optical bench, intraocular lens, EDoF, wavefront, enhanced depth of focus

Pedro Tañá-Rivero,1 José J Muñoz-Tomás,1,2 Paz Orts-Vila,1 Enrique Artiaga-Elordi,1 Francisco Pastor-Pascual,2 José María Marín-Sánchez,3 Christian García-Elskamp3 1Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 3Cataract and Refractive Surgery Department, Oftalvist Murcia, Murcia, SpainCorrespondence: Pedro Tañá-Rivero, Email rdi@oftalvist.esPurpose: To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery.Methods: The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery.Results: At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ± 0.50 D and 98.04% were within ± 1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤ 0.50D and 100% were ≤ 1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤ 5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up.Conclusion: Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.Keywords: cataract, intraocular lens, aspheric, bitoric, plate haptics

Jingyao Dai,1 Yiting Hua,1 Yijie Chen,1 Jiali Huang,1 Xiaoxian Zhang,1 Yiwen Sun,1 Chen Chen,1 Yanyan Chen,2 Kaijing Zhou2 1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Yanyan Chen; Kaijing Zhou, Email cyy@eye.ac.cn; zhoukaijing@wmu.edu.cnPurpose: To explore 1) the level of shared decision-making (SDM) participation in intraocular lens (IOL) selection in cataract patients and the factors that influence this participation and 2) the relationships between preparation for decision-making (PrepDM)and the level of SDM participation and satisfaction with the decision (SWD). Provide guidance for improving SDM in ophthalmology.Patients and Methods: 176 cataract patients were asked to complete the PrepDM scale, the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and the SWD instrument in IOL decision-making process. Multiple linear regression was used to analyze the influencing factors of the level of SDM. The Process program and bootstrap sampling method was used to test whether the level of participation in SDM was a mediating variable among the three.Results: The SDM-Q-9 median score was 77.78 (IQR 31.11– 88.89). Patients with a history of surgery in the operative eye (P=0.022) or PrepDM < 60 points (P< 0.001) had lower SDM-Q-9 scores than patients with no history of surgery in the operative eye or PrepDM ≥ 60 points. Patients with an education level lower than primary school had lower SDM-Q-9 scores than patients with other education levels (P< 0.05). The PrepDM of cataract patients was positively correlated with the level of SDM (r=0.768, P< 0.001) and with the SWD (r=0.727, P< 0.001), and the level of SDM was positively correlated with the SWD (r=0.856, P< 0.001). The level of SDM fully mediated PrepDM and SDW, with a mediating effect value of 0.128 and a mediating effect of 86.66% of the total effect.Conclusion: The SDM of cataract patients involved in IOL selection was in the upper middle range. Education, history of surgery in the operated eye, and PrepDM were factors that influenced the level of SDM. The level of participation in SDM fully mediated the relationship between PrepDM and SWD.Keywords: cataract, intraocular lens, shared decision-making, preparation, satisfaction

The aim of this study is to describe a modified technique for internal refixation of dislocated scleral-sutured polymethylmethacrylate (PMMA) intraocular lenses (IOLs) with eyelets. Three-port pars plana vitrectomy was performed. Through the scleral fixation site, a 30-gauge needle loaded with an 8-0 polypropylene suture was inserted into the vitreous cavity. The suture end was passed through the eyelet of IOL with 25-gauge forceps. Next, it was guided out of the eye through the original scleral fixation point. The end of the exterior suture was buried with a flapless intrascleral knotting technique. Six eyes of six patients were successfully treated with this technique and followed up for 6–12 months postsurgery. In all cases, there was significant improvement in uncorrected visual acuity. IOLs were stable with proper centration and no major complications. This modified technique offers an effective and minimally invasive surgical alternative for refixation of dislocated scleral-sutured PMMA IOLs with eyelets.

AIM: To investigate the effect of scleral-fixated capsular tension ring(SFCTR)combined with phacoemulsification and intraocular lens(IOL)implantation in the treatment of traumatic lens subluxation.METHODS: A total of 14 patients(14 eyes)who underwent SFCTR combined with phacoemulsification and IOL implantation for traumatic lens subluxation from December 2018 to February 2023 were selected. Visual acuity, intraocular pressure, anterior segment photography, and ultrasound biomicroscopy(UBM)were examined during postoperative follow-up. The location of IOL and postoperative complications were recorded.RESULTS: SFCTRs and IOLs were successfully implanted in all patients. The mean postoperative follow-up was 1.92±1.36 a. At the last follow-up, the uncorrected distance visual acuity(UDVA; 0.20±0.18 LogMAR)and corrected distance visual acuity(CDVA; 0.16±0.17 LogMAR)were significantly improved compared with the UDVA(1.13±0.56 LogMAR)preoperatively(P

Background: Implantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane's double-needle technique and flanged haptics. Methods: Prospective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane's technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty. Results: The mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis. Conclusions: The transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of botulinum toxin-A (BTX-A) treatment on corneal topography, ocular biometry and keratometry in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS). Methods: This study comprised 66 eyes of 33 patients with BEB and 5 eyes of 5 patients with HFS who underwent BTX-A injections consecutively. Refractive error values, tear break-up time (TBUT), corneal topography [corneal power of flat axis (K1) and steep axis (K2), mean corneal power (Km), corneal astigmatism (K2–K1)] and ocular optical biometry [axial length (AL), anterior chamber depth (ACD)] were recorded before BTX-A treatment and 1 month after BTX-A treatment. The researchers calculated the expected emmetropic intraocular lens power (emm-IOL) using the SRK-T, Holladay, Hoffer-Q and Haigis formulas at each examination. Results: K1 (43.48 ± 2.02 vs. 43.57 ± 2.08, p = 0.036), Km (43.91 ± 1.99 vs. 43.99 ± 2.06, p = 0.024) and ACD (3.22 (2.77–3.76) vs. 3.41 (2.99–4.02), p < 0.001) values were found to be significantly higher. The expected emm-IOL according to the SRK-T (21.04 ± 1.6 vs. 20.93 ± 1.6, p = 0.048), Holladay (21.05 ± 1.6 vs. 20.91 ± 1.62, p = 0.037) and Hoffer-Q (21.08 ± 1.65 vs. 20.94 ± 1.68, p = 0.038) decreased significantly. The expected emm-IOL according to the Haigis formula slightly decreased, but it was not significant (p = 0.386). Additionally, TBUT was found to be significantly lower (p < 0.001) after BTX-A injection. Other parameters were not statistically significant (p > 0.05). Conclusions: Our study is the first in the literature to compare optic biometry data and intraocular lens power calculation formulas before and after BTX-A injection in eyes with BEB and HFS. BTX-A injection could play an important role in changing the keratometric and ACD values. It should be considered that IOL power calculations that might be unpredictable due to blepharospasm, so repeated measurements and especially measurements after releasing the spasm with BTX-A injections, are necessary in BEB and HFS. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of intraocular lens (IOL) calculation formulas and the effect of anterior chamber depth (ACD), axial length (AL) and lens thickness (LT) on the prediction accuracy in shallow ACD eyes. Methods: This retrospective, consecutive case‐series study included 648 eyes of 648 patients with an ACD < 3.0 mm who underwent phacoemulsification and IOL implantation. Eleven formulas were evaluated: Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, Hill‐Radial Basis Function (RBF) 3.0, Hoffer QST, Kane, Olsen, Pearl‐DGS and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T). Subgroup analysis was performed based on ACD, AL and LT. Results: Overall, the Hoffer QST and Kane showed no systematic bias. The Kane, EVO 2.0, Hill‐RBF 3.0 and Hoffer QST had relatively lower mean absolute error and higher percentages of prediction error within ±0.5 D. For the ACD of 2.5–3.0 mm and AL < 22.0 mm subgroup, the Pearl‐DGS exhibited the lowest MAE (0.45 D) and MedAE (0.41 D). Most formulas had a significant myopic bias (−0.43 to −0.18 D, p < 0.05) in the LT < 4.3 mm subgroup and a significant hyperopic bias (0.09–0.29 D, p < 0.05) in the LT ≥ 5.1 mm subgroup. Conclusion: The Kane and Hoffer QST were recommended for shallow ACD eyes. In eyes with an ACD between 2.5 and 3.0 mm and a short AL, the Pearl‐DGS showed excellent performance. Clinicians need to fine‐tune the target refraction according to LT in shallow ACD eyes. [ABSTRACT FROM AUTHOR]

Purpose: A cataract is a cloudy area in the crystalline lens. Cataracts are the leading cause of blindness and the second cause of severe vision impairment worldwide. During cataract surgery, the clouded lens is extracted and replaced with an artificial intraocular lens, which restores the optical power. The fabrication of intraocular lenses using existing molding and lathing techniques is a complex and time-consuming process that limits the development of novel materials and designs. To overcome these limitations, we have developed a stereolithography-based process for producing models of clear lens designs without refractive function, serving as a proof of concept. This process has the potential to contribute toward new lens development, allowing for unlimited design iterations and an expanded range of materials for scientists to explore. Methods: Lens-like 3D objects without refractive function were fabricated by using stereolithography. A photopolymerizable resin containing 2-phenoxyethyl acrylate, poly (ethylene glycol) dimethacrylate, and a suitable photoinitiator was developed for the production of lens-like 3D object prototypes. The morphology of the printed devices was characterized by scanning electron microscopy. The transparency and thermal properties were analyzed using spectrophotometry and differential scanning calorimetry, respectively. The biocompatibility of the devices was investigated in a cultured human lens cell line (FHL-124), using a standard lactate dehydrogenase assay, and the lenses were folded and implanted in the human capsular bag model. Results: One-piece lens-like 3D objects without refractive function and with loop-haptic design were successfully fabricated using Stereolithography (SLA) technique. The resulting 3D objects were transparent, as determined by UV spectroscopy. The lactate dehydrogenase test demonstrated the tolerance of lens cells to the prototyping material, and apparent foldability and shape recovery was observed during direct injection into a human capsular bag model in vitro. Conclusions: This proof-of-principle study demonstrated the potential and significance of the rapid prototyping process for research and development of lens-like 3D object prototypes, such as intraocular lenses. [ABSTRACT FROM AUTHOR]

(1) Background: This study compares the effective lens position (ELP) and intraocular lens power (IOLP) derived from SRK/T, Hoffer Q, Holladay I, and Haigis formulas with the actual lens position (ALP) and the implanted IOLP after cataract surgery. Additionally, it aims to optimize ALP using a ray-tracing-based simulated optical model to achieve emmetropia. (2) Methods: A retrospective observational study was conducted on 43 eyes implanted with the same monofocal intraocular lens (IOL). Preoperative and postoperative biometric data were collected using the Lenstar LS900. Postoperative measurements included ALP, subjective refraction, and refraction error (RE). Optical simulations (OSLO EDU 6.6.0) were utilized to optimize ALP for emmetropia (ALPIDEAL). (3) Results: Paired t-test results between REOSLO-REOBJ (p-value = 0.660) and REOSLO-RESUB (p-value = 0.789) indicated no significant statistical differences. However, statistically significant differences were found between ALP and ALPIDEAL (p < 0.05), with a difference of −0.04 ± 0.45 mm [ranging from −1.00 to 1.20 mm]. A significant correlation was observed between ΔALP (ΔALP = ALP − ALPIDEAL) and RESUBJ. (4) Conclusions: This customized ray-tracing eye model effectively achieves refractive outcomes similar to those obtained both subjectively and objectively post-surgery. Additionally, it has enabled optical simulations to optimize the IOL position and achieve emmetropia. [ABSTRACT FROM AUTHOR]

Background: The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. Methods: A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. Results: At 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens's clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. Conclusion: This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. Trial registration: This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20. [ABSTRACT FROM AUTHOR]

Intraocular Lens (IOL) dislocation is a serious complication following cataract surgery, leading to substantial impacts on patients' vision and quality of life. According to the timing of occurrence, IOL dislocation can be categorized into early and late in-the-bag dislocation, which are significantly different in clinical presentations, etiology, and treatment approaches. Early IOL dislocation is primarily due to intraoperative mishandling, while late in-the-bag IOL dislocation is mainly caused by progressive zonular laxity and rupture, as well as capsular contraction. Risk factors for late in-the-bag dislocation include pseudoexfoliation syndrome and high myopia. Mild IOL subluxation may be treated conservatively, while severe cases require surgical interventions. This review discusses the etiopathogenesis of IOL dislocation, with a focus on the pathogenesis and risk factors of late in-the-bag IOL dislocation, and summarizes the most common surgical techniques for IOL dislocation. [ABSTRACT FROM AUTHOR]

Objective To compare the accuracy of various intraocular lens (IOL) power calculation formulas for microspherophakia (MSP) patients, including Haigis, HofferQ, Holladay I, SRK/T, Barrett Universal II, Hill-RBF3.0, Kane, EVO, and Pearl-DGS. Methods Preoperative biological measurements were performed in 48 patients (77 eyes) with MSP had undergone phacoemulsification combined with IOL implantation. Postoperative comprehensive refraction was conducted simultaneously with the calculation of prediction error (PE) and absolute error (AE) for the 9 formulas. The refractive error of various formulas based on different groupings according to axial length (AL), anterior chamber depth (ACD), corneal curvature (K), and lens thickness (LT) were compared. Results The overall differences in prediction errors (PE) and absolute errors (AE) among the 9 intraocular lens (IOL) formulas were not statistically significant (P-values of 0.47 and 0.76, respectively). However, post hoc tests revealed a significant difference in PE between the SRK/ T and Hill-RBF3.0 formula (P<0.05), with PE values of (0.62 ± 1.38) D and (0.18 ± 1.24) D, respectively. The Hill-RBF3.0 formula had the highest percentage of eyes with PE ≤ 0.5 D and PE ≤ 1.0 D, at 44.12% and 66.18%, respectively, and showed lower PE in both shallow ACD and non-shallow ACD groups, at 0.08 and 0.24, respectively. The Kane formula was most accurate in short AL and long AL groups, with PE values of 0.02 and 0.1, respectively. The impact of K and LT on the formula calculation was similar in all groups. Conclusions The accuracy of IOL prediction in patients with microspherophakia is similar among the 9 formulas evaluated. Hill-RBF3.0 formula demonstrates the lowest prediction error among different ACD groups, while the Kane formula exhibits a higher tolerance to AL variations, with K and LT having minimal impact on the formula calculation [ABSTRACT FROM AUTHOR]

Anterior dislocation of posterior intraocular lens (IOL) is one of the complications after cataract surgery, mainly caused by poor fixation of the IOL or insufficient support from the capsular bag. Although the incidence of this complication is not high, the dislocated IOL can lead to serious problems such as corneal endothelial damage, pupil deformation, and visual impairment. Therefore, it still deserves the attention of ophthalmologists, who should promptly conduct comprehensive evaluations and proper management when encountering relevant situations. This commentary analyzes the incidence, risk factors, and clinical manifestations of anterior dislocation of IOL through a review of previous studies. It elaborates on the key points of preoperative assessment, selection of surgical timing, and specific surgical treatment strategies. Various surgical options are proposed for different dislocation scenarios, including IOL repositioning with or without sutures, repositioning of IOL-capsular bag complex, and IOL replacement when necessary. Recommendations are also provided for the intraoperative management of other intraocular tissues such as the pupil, vitreous, and retina. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Design: Prospective interventional case series. Methods: Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66 cm) and near (UNVA at 40 cm) acuities at 3 months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. Results: 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were − 0.07D ± 0.27 and − 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Conclusion: Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the causes and characteristics of IOL explantation within the first year after primary implantation. Methods: In this retrospective, cross sectional database study, a database consisting of over 2500 IOL explants sent from 199 national and international doctors over the past 10 years was analyzed. All IOLs explanted within the first year after implantation were included in this analysis. Explants with insufficient information as well as phakic and Add-on IOLs were excluded. Main outcome measures were the reason for explantation, the time between implantation and explantation, as well as IOLs' and patients' characteristics. Additionally, the explanted IOLs were microscopically and histologically analyzed, as required. Results: Of all explanted IOLs from the database, 1.9% (n = 50) were explanted within the first year after implantation. The most frequent reasons for early IOL explantation were IOL dislocation (32%), visual intolerance (26%), opacification (20%), and intraoperative complications (16%). The time between implantation and explantation was the shortest in cases with intraoperative complications (1.5 ± 3.1 days), followed by IOL dislocation (90.9 ± 103.9 days), visual intolerance (98.3 ± 86.5 days), opacifications (253.5 ± 124.0 days) and other indications (249.7 ± 124.0 days). Calcification of hydrophilic IOLs was the main type of opacification (80%). Notably, seven IOLs required immediate intraoperative exchange due to an intraoperative crack in the optic or a torn off haptic. Conclusion: Indications for early IOL explantation were IOL dislocation, visual intolerance, opacification, and intraoperative complications. Especially intraoperative damages to the IOL and early calcification show a potential for improvement of affected IOLs and implantation systems. [ABSTRACT FROM AUTHOR]

Polymeric Intraocular lenses (IOLs) are vital for restoring vision following cataract surgery and for correcting refractive errors. Despite technological and medical advancements, challenges persist in achieving optimal vision and preventing complications. Surface modifications aim to mitigate the risk of posterior capsule opacification (PCO), while pre-operative measurements aid in selecting suitable IOLs. However, individualized solutions are lacking and there is a clear demand for the development of fully customized IOL surfaces. We employ laser micromachining technology for precise modifications via ablation on PMMA and acrylic IOLs, using femtosecond (fs), nanosecond (ns), and diode continuous wave (CW) lasers, at wavelengths ranging from near-ultraviolet to infrared. Characterization reveals controlled ablation patterning, achieving feature sizes from as small as 400 nm to several micrometers. Regular and confocal micro-Raman spectroscopy revealed alterations of the IOL materials' structural integrity for some patterning cases, thus affecting the optical properties, while these can be minimized by the proper selection of micromachining conditions. The results suggest the feasibility of accurate IOL patterning, which could offer personalized vision correction solutions, based on relevant corneal wavefront data, thus surpassing standard lenses, marking a significant advancement in cataract surgery outcomes. [ABSTRACT FROM AUTHOR]

Background: This study assessed the agreement of ocular parameters of patients with myopia measured using Colombo intraocular lens (IOL) 2 and IOLMaster 700. Methods: Eighty patients (male, 22; average age, 29.14 ± 7.36 years) with myopia (159 eyes) were included in this study in May 2023. The participants' axial length (AXL), central corneal thickness (CCT), lens thickness (LT), white-to-white distance (WTW), front flat (K1), steep (K2), mean (Km) corneal keratometry, astigmatism (Astig), J0 vector, and J45 vector were measured using the IOLMaster 700 and Colombo IOL 2. The measurements from both devices were compared using the generalized estimating equation, correlation analysis, and Bland-Altman plots. Results: With the Colombo IOL 2, lower values for K2 and J0 (odds ratio [OR] = 0.587, p = 0.033; OR = 0.779, p < 0.0001, respectively), and larger values for WTW, Astig, and J45 (OR = 1.277, OR = 1.482, OR = 1.1, all p < 0.0001) were obtained. All ocular measurements by both instruments showed positive correlations, with AXL demonstrating the strongest correlation (r = 0.9996, p < 0.0001). The intraclass correlation coefficients for AXL and CCT measured by both instruments was 0.999 and 0.988 (both p < 0.0001), and Bland-Altman plot showed 95% limits of agreement (LoA) of -0.078 to 0.11 mm and − 9.989 to 13.486 μm, respectively. The maximum absolute 95% LoA for LT, WTW, K1, K2, and J0 were relatively high, achieving 0.829 mm, 0.717 mm, 0.983 D, 0.948 D, and 0.632 D, respectively. Conclusions: In young patients with myopia, CCT and AXL measurements obtained with the Colombo IOL 2 and IOLMaster 700 were comparable. However, WTW, LT, corneal refractive power, and astigmatism values could not be used interchangeably in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Dislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques. Methods: Retrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years. Surgical technique: A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure. Results: Seven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2–2.1) to 0.07 (0.02–0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment. Conclusions: Transscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs. [ABSTRACT FROM AUTHOR]

Key Clinical Message: If an intraocular lens (IOL) is incorrectly labeled, problems can arise for surgeons and patients. Precise biometry is important to accurately determine the IOL power and prevent the implantation of the wrong IOL. Labeling and verifying IOLs with accuracy is crucial to ensuring the best possible results of cataract surgery. Mislabeling of IOLs can cause unpredictable problems for surgeons. However, we can prevent incorrect IOLs by using precise biometry to determine accurate IOL power and safely implant the correct IOL. A 50‐year‐old female with no medical or ocular history came to our clinic complaining of decreased vision in both eyes that had been ongoing for several months. After being diagnosed with cataracts, primary angle closure suspect, and high hyperopia, the patient underwent phacoemulsification surgery. A posterior chamber IOL was implanted, and visco‐goniosynechialysis was performed. During follow‐up appointments, it was discovered that the patient had an uncorrected visual acuity of 20/50 in her right eye, which was corrected to 20/20 with a + 7.00 D lens. Upon further evaluation, it was determined that the source of the error was due to a manufacturing mislabeling of the IOL power. The patient then underwent successful IOL exchange surgery, and her best‐corrected visual acuity became 20/20 with no significant refraction. This case highlights an uncommon source of refractive surprise after phacoemulsification surgery, successfully managed with IOL exchange surgery using the same IOL power from a different brand. [ABSTRACT FROM AUTHOR]

Purpose: To determine change in biometric values of eye after fasting and to elucidate whether this change is significant enough to delay the refractive and cataract surgeries during fasting. Study Design: Cross sectional observational. Place and Duration of Study: Eye department, DHQ-UTH, Gujranwala, from April 2021 to May 2021. Methods: Thirty subjects of either gender between 20-40 years of age who participated in both phases were enrolled in this study. Phase 1 was conducted one week before Ramadan and 2nd phase in the last week of Ramadan. After routine ophthalmic examination, keratometric(K) values were obtained with Auto Ref-Keratometer (Canon), while Axial length (AL), Anterior chamber depth (ACD), and Intraocular lens power (IOLp)were obtained from Master-Vu A-scan (Sonomed, Model # MV4500). Data was analyzed using SPSS version 25. Results: Out of 30 participants, 66.6% were female and 33.3%were male with mean age of 29.8 years. Mean K1 increased to 43.03 D during fasting from non-fasting reading of 42.24 D, while Mean K2 increased to 43.87 D during fasting from non-fasting reading of 43.28 D with significant p-value (<0.05). Mean ACD was 3.15mm in non-fasting that also increased to 3.21D in fasting state. Mean AL in non-fasting state was 23.41mm that remains the same in fasting state as well. Mean IOLp in non-fasting state was 21.18D that reduced to 20.42D in fasting state with significant p-value. Conclusion: Fasting increased the keratometry and ACD values with no effect on AL but that reduced overall intraocular lens power [ABSTRACT FROM AUTHOR]

Introduction: This study is a retrospective case series to compare the accuracy of the Barrett toric calculator using predicted posterior corneal astigmatism (PCA) and PCA measurements using swept-source optical coherence tomography (SS-OCT) and a Scheimpflug camera. This evaluation was conducted across different types of anterior and posterior astigmatism. Methods: A total of 146 eyes from 146 patients implanted with toric intraocular lenses were included. Mean absolute prediction error, standard deviation of prediction error, and the percentage of eyes with prediction errors within ±0.50 diopters (D) were calculated using vector analysis. Biometric measurements were conducted using the IOLMaster 700 and Pentacam HR. A subgroup analysis was conducted based on the orientation of both anterior and posterior corneal astigmatism. Results: The Barrett toric calculator with predicted PCA yielded the best results, with 78.1% having a prediction error ≤ 0.50 D, which was a significantly higher percentage than the Barrett formula with the two versions of measured PCA (P < 0.05). In the subgroup with a horizontally steep meridian PCA using the IOLMaster 700, the Barrett formula with predicted PCA yielded the best results, with 78.3% of cases having a prediction error of less than 0.5 D. This percentage was significantly higher than the other two measured PCA subgroups (P < 0.05). Conclusion: The Barrett toric formula with predicted PCA demonstrated a statistically significantly higher proportion of cases with a prediction error ≤ 0.5 D compared to the two measured PCA formulas (from the IOLMaster 700 or Pentacam). This trend persisted even when the posterior corneal astigmatism was horizontally steep. [ABSTRACT FROM AUTHOR]