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To evaluate the correlation between preoperative, postoperative, and change in angle kappa and alpha to visual outcomes following implantation of three multifocal intraocular lenses. This is a retrospective study which included 122 eyes of 61 patients. There were 38 eyes in the Synergy (Johnson & Johnson, USA) group and 42 eyes each from both the Panoptix (Alcon Laboratories, USA) and FineVision (Physiol BVI, Belgium) groups. Visual outcome parameters (uncorrected distance, intermediate, near vision, halo and starburst) and angle kappa and alpha were recorded preoperatively and at three months postoperatively. The preoperative, postoperative and the amount of change in angle kappa and alpha were correlated to visual outcomes and photic phenomena among the three different diffractive trifocal IOLs. There were no significant differences in the preoperative and postoperative magnitude of angle kappa and alpha among the Synergy, Panoptix, and FineVision groups. There was no significant correlation between the preoperative and postoperative magnitude, and change in angle kappa and alpha with the postoperative uncorrected distance, intermediate and near visual acuity, and halo and starburst scores of the three different diffractive IOLs. The frequency of eyes with greater than 0.5 mm angle kappa and alpha values were low. Visual outcomes can be good even in eyes in which the angle kappa and alpha were greater than 0.5 mm. The newer diffractive multifocal IOLs were observed to be more tolerant to low and intermediate levels of angle kappa and alpha. [ABSTRACT FROM AUTHOR]

This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover's all-pairs post-hoc, Cochran's Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy. [ABSTRACT FROM AUTHOR]

This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (P < 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (P < 0.001). The ZMB group provided better MTF than the MF15 group (P < 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (P < 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (P < 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function. [ABSTRACT FROM AUTHOR]

Glistening is the condensation of water that forms within the intraocular lens (IOL) materials. In this study, a new approach was attempted to reduce the glistening of IOL materials by introducing hydrophobic acrylic monomers with different alkyl side chain lengths into the IOL materials. Various hydrophobic acrylic monomers such as butyl acrylate (BA), 2‐ethylhexyl acrylate (EHA), and dodecyl acrylate (DA) were copolymerized with a hydrophobic acrylic monomer, 2‐phenoxyethyl acrylate, respectively. In this process, we investigated the effect of the alkyl side chain lengths of hydrophobic acrylic monomers on the glistening of hydrophobic acrylic IOL materials. As the content of hydrophobic acrylic monomers (BA, EHA, and DA) increased, the glistening of IOL materials decreased significantly for all hydrophobic acrylic monomers. At the same content of hydrophobic acrylic monomers, the IOL material showed the least content of glistening when copolymerized with DA. However, the IOL material obtained using BA exhibited the largest content of glistening, indicating that the glistening reduction effect was large in the order of DA>EHA>BA. These findings show that the glistening of IOL materials decreases with increasing alkyl side chain lengths of hydrophobic acrylic monomers. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the safety and efficacy of the Yamane technique (flanged intrascleral haptic fixation with double-needle technique /FIHFT) for three-piece intraocular lens (IOL) implantation in Egyptian patients diagnosed with Marfan syndrome (MFS) presented with subluxated lenses (ectopia lentis, EL). Methods: This was a retrospective evaluation of thirty-three patients who were diagnosed with MFS and had subluxated lenses in a total of forty eyes. Seven of these patients had bilateral subluxation. Lensectomy or phacoemulsification was performed with limited anterior vitrectomy, followed by IOL implantation using the FIHFT method. Data was collected from medical records, including preoperative and postoperative corrected distant visual acuity (CDVA) using logarithm of the minimal angle of resolution (log MAR), preoperative and postoperative refractions, intraoperative and postoperative complications, and follow-up periods. Results: The mean age of patients in the study was 30.79 years, with a mean follow-up of 23.9 months. Post-surgery, the refractive sphere decreased significantly from -9.1 ± 1.4 diopter (D) to -1.4 ± 0.7 D, and cylinder measurements dropped from -4.5 ± 0.8 D to -1.4 ± 0.6 D. The spherical equivalent (SEQ) also declined from -11.4 ± 1.5 D to -2.1 ± 0.8 D. The CDVA improved from 0.80 ± 0.32 to 0.18 ± 0.10 log MAR (P < 0.001). No intraoperative complications were identified. Postoperative complications included IOL decentration (12.5%), vitreous hemorrhage (7.5%), IOL slippage (5%), IOL tilt (5%), and retinal detachment (RD) (5%). Further surgical procedures were necessary for only four cases (10%), all of which had positive outcomes. IOL tilting and slippage occurring at average ages of 18 and 19 years, respectively. No other complications, such as hypotony, elevated intraocular pressure (IOP), corneal edema, iritis, IOL dislocation, cystoid macular edema (CME) or endophthalmitis, were reported. Conclusions: The Yamane technique has proven effective and safe for treating subluxated lenses in Egyptian patients with Marfan Syndrome, resulting in improved visual acuity with minimal complications, mostly minor and manageable. Comprehensive fundus examinations before and after surgery are essential for promptly identifying retinal breaks and reducing the risk of retinal detachment. IOL tilting and slippage are more common in younger patients. [ABSTRACT FROM AUTHOR]

The article discusses the use of iris-sutured intraocular lenses in cases where capsular and zonular integrity are compromised. A retrospective study of 194 eyes showed improved visual outcomes with low long-term complication rates. The study highlighted the relevance and safety of iris-sutured intraocular lenses, especially in specific conditions, but cautioned about potential risks such as ocular hypertension and cystoid macular edema. The research emphasized the importance of multiple fixation techniques to address complex patient needs. [Extracted from the article]

Background: To assess changes in ocular biometry of the phakic eye after pars‐plana‐vitrectomy (PPV) and silicone oil (SO) endotamponade in eyes with a retinal detachment. Methods: This retrospective, consecutive case series included 72 eyes of 72 patients who underwent PPV with 5000‐centistokes SO endotamponade between July 2018 and June 2023. Pseudophakic eyes and eyes with a combined phacovitrectomy were excluded. Primary endpoints were keratometry values, anterior chamber depth (ACD), lens thickness (LT), horizontal corneal diameter (HCD), and axial length (AL) measured by swept‐source optical coherence tomography‐based biometry (IOLMaster 700) preoperatively and six weeks postoperatively. A recently described formula was used to adjust the AL (aAL) in eyes with SO endotamponade and a theoretical intraocular lens (IOL) calculation was performed. Results: The mean age was 62.1 ± 8.3 years (range: 37–85). After PPV with SO fill, there was an increase in Kmean (0.19 ± 0.51D), while ACD (0.05 ± 0.13 mm), LT (0.03 ± 0.14 mm), and HCD (0.02 ± 0.24 mm) decreased. Preoperatively, the mean AL was 25.22 ± 1.78 mm, while postoperatively the AL was overestimated by 0.12 ± 0.42 mm on average (p = 0.04). By adjusting the AL, the mean difference could be reduced to −0.002 ± 0.41 mm. The aAL resulted in a difference in the refractive outcome in eyes with an AL > 25 mm of 0.34 ± 0.10D in the IOL calculation. Conclusions: While changes in biometry after PPV with SO endotamponade in the anterior segment are clinically less relevant, a considerable overestimation of AL with IOLMaster 700 was found. We recommend the use of a recently introduced formula for adjusting AL in eyes with SO, allowing overestimation to be minimised considerably. [ABSTRACT FROM AUTHOR]

Background: We report a case of brainstem anesthesia (BSA) and subsequent cardiac arrest following a routinary peribulbar block (PB) in a patient scheduled for cataract extraction and intraocular lens (IOL) implantation, thus providing a reference for further analysis of this potentially catastrophic life-threatening complication and to evaluate the current knowledge in terms of incidence, physiopathology management, and treatment of the BSA following PB. Methods: Three databases (PubMed, Embase, and Scopus) were checked to perform a systematic review of all available studies in the English Language following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate relevant studies that clearly described BSA following BSA. Results: Our literature search identified 15 cases. All the patients experienced BSA-related symptoms, including respiratory arrest, seizure, heart rate, and blood pressure abnormalities. All the patients with respiratory arrest required assisted ventilation with intubation, whereas patients with seizures were administered intravenous midazolam. Only one patient experienced cardiac arrest and underwent cardiac resuscitation. Surgery was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15 underwent surgery after extubation. Conclusions: Despite the BSA incidence after the PB being very low, this possible life-threatening rare event should be considered in patients losing their consciousness and becoming apneic after the block. Therefore, prompt recognition and immediate treatment are paramount to cope with this potentially catastrophic scenario and save the patient's life. [ABSTRACT FROM AUTHOR]

Background/Objectives: To compare the clinical outcome of suture and sutureless iris fixation techniques for dislocated intraocular lenses (IOLs). Methods: Retrospective cohort study including patients who underwent surgery for late IOL dislocation over a 10-year period. IOL repositioning was achieved either by suturing the original IOL to the iris using the Siepser slipknot technique or by replacing it with a retropupillary sutureless iris claw IOL. Data collected during surgery included the type of dislocation, the need for anterior or posterior vitrectomy, duration of surgery, and intraoperative complications. Six months after surgery we assessed the eye and iris anatomy; refraction, astigmatism, and visual acuity; endothelial cell damage; and rate of postoperative complications. Results: Included in the study were 60 patients: 32 underwent IOL relocation and 28 underwent IOL exchange. Pseudoexfoliation (43.7% and 39.3%) and retinal surgery (34.4% and 28.6%) were identified as the main possible causes for IOL dislocation. The mean duration of the surgery was 62.9 ± 14.9 min for the Relocation group, and was 42.7 ± 11.4 min for the Exchange group (p < 0.001), with similar low intraoperative complication rates (6.25% and 7.14%, respectively). The studied parameters showed no differences between the two groups postoperatively, except for corneal astigmatism which was 1.31 ± 0.45 D in the Relocation group and was 1.89 ± 0.86 D in the Exchange group (p < 0.001). Conclusions: Both suture and sutureless iris fixation techniques for dislocated IOLs yielded similarly favorable outcomes in this study. IOL relocation resulted in less postoperative astigmatism, while IOL exchange offered the advantage of shorter surgical time. [ABSTRACT FROM AUTHOR]

Multiple iterations required to design ocular implants, which will last for the desired operational period of months or even years, necessitate the use of in-silico models for ocular drug delivery. In this study, we developed an in-silico model to simulate the flow of Aqueous Humor (AH) and drug delivery from an implant to the Trabecular Meshwork (TM). The implant, attached to the side of the intraocular lens (IOL), and the TM are treated as porous media, with their effects on AH flow accounted for using the Darcy equation. This model accurately predicts the physiological values of Intraocular Pressure (IOP) for both healthy individuals and glaucoma patients, as reported in the literature. Results reveal that the effective diffusivity of the drug within the implant is the critical parameter that can alter the bioavailability time period (BTP) from a few days to months. Intuitively, BTP should increase as effective diffusivity decreases. However, we discovered that with lower levels of initial drug loading, BTP declines when effective diffusivity falls below a specific threshold. Our findings further reveal that, while AH flow has a minimal effect on the drug release profile at the implant site, it significantly impacts drug availability at the TM. [Display omitted] • Developed an in-silico model that can simulate drug delivery from ocular implants. • Validated the predicted intra-ocular pressure values with the values reported in the literature. • For lower levels of loaded drug in the implant, bioavailability time period starts reducing as effective diffusivity is reduced below a certain threshold level. • Neglecting Aqueous Humor (AH) flow effects can result in substantially wrong predictions of drug availability at the Trabecular Meshwork. [ABSTRACT FROM AUTHOR]

Purpose: Investigations into the correction of presbyopia have considered lens design, clinical implications and the development of objective metrics such as the visual Strehl ratio. This study investigated the Jacobi–Fourier phase mask as an ophthalmic element in the correction of presbyopia. The goal was to develop a contact or intraocular lens whose performance was largely insensitive to changes in pupil diameter. Methods: Numerical simulations based on Fourier optics were performed to evaluate three different Jacobi–Fourier polynomials, with the aim of providing a range of clear vision (1 Dioptre (D)). Performance was evaluated for three pupil sizes (6, 4 and 2 mm), while polychromatic images were simulated using three different wavelengths (656.3, 587.6 and 486.1 nm). The Neural Transfer function was included in the simulation. To validate the method and results, we used the Visual Strehl combined objective metric (VSCombined) currently used in visual optics. This metric gives more weight to the phase transfer function and is more suitable for non‐symmetrical phase functions. Results: Numerical validation showed the suitability of the Jacobi–Fourier phase masks for extending the range of clear vision of presbyopic eyes, providing a visual acuity of at least 0.10 logMAR (6/7.5 Snellen) at all distances between 1 and 6 m. The results show a range of clear vision of 1D was not affected by changes in pupil size, an increase in retinal image contrast accompanied by image artefact reduction by increasing the radial order of the Jacobi–Fourier phase mask and a reduction of wavelength dependence of the retinal images. These results are supported by simulated images and the objective criterion VSCombined. Conclusions: The use of Jacobi–Fourier phase masks as ophthalmic elements for presbyopic correction show promising results, with a good range of clear vision and reduced dependence on pupil size and chromatic aberration. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare early changes in classified higher-order aberrations (HOAs) pre- and postsurgery in patients who received nontoric versus toric implantable collamer lenses (ICL; ICL Model V4c; STAAR Surgical, Monrovia, CA, USA). Methods: This prospective study included 124 eyes of 64 patients: 49 eyes were treated using a nontoric implantable collamer lens (ICL), and 75 eyes were treated using a toric implantable collamer lenses (TICL). Refractive parameters and ocular aberrations were examined before and 1 month after surgery. Results: At one month, the safety indices were 1.24 ± 0.17 in the ICL group and 1.20 ± 0.25 in the TICL group (p = 0.39). The efficacy indices were 1.07 ± 0.17 in the ICL group and 1.15 ± 0.26 in the TICL group (p = 0.02). The root mean square (RMS) values of whole-eye total HOAs, trefoil, corneal total HOAs, spherical aberration, and intraocular spherical aberration significantly increased postoperatively in both groups. The RMS of intraocular total HOAs in the TICL group significantly increased 1 month postoperatively. No statistically significant differences were observed in HOA changes between the ICL and TICL groups. Conclusions: The dominant increases in short-term aberrations after ICL and TICL V4c implantation were in corneal trefoil and intraocular spherical aberrations, which were related to the corneal incision and implanted lens. The HOA changes post-surgery were not statistically different between the two lens types. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to evaluate the visual and refractive outcomes of iris-fixated phakic toric intraocular lenses (IOLs) for visual rehabilitation in eyes with stable corneal ectasia. Methods: We conducted a study looking at the clinical outcomes of iris-fixated toric IOLs (Artisan) in 33 eyes of 27 patients diagnosed with mild-to-moderate corneal ectasia at a single center (Queen Victoria Hospital, East Grinstead, UK). The main outcome measures were functional improvement [accuracy of post-operative spherical equivalent (SE), astigmatic correction, topographic parameters, uncorrected and corrected distance visual acuity (UCVA, CDVA)] and safety of the procedure: endothelial cell count and intra- and post-operative complications. Results: Eighteen males and nine females of mean age 38.85 were included in the study with a mean follow-up of 18 months. All patients had ectasia due to keratoconus except one with post-refractive laser ectasia. Twelve patients had crosslinking, eight had intracorneal rings, and eight had previous keratoplasties. Mean pre-operative logMAR UCVA was 0.75 ± 0.35 improving to 0.02 ± 0.17 (p = 0.000). Mean pre-operative logMAR CDVA was 0.16 ± 0.17 improving to 0.02 ± 0.17 (p = 0.000). Mean pre-operative (SE) was − 3.5 ± 3.9 improving to − 2.75 ± 1.39 (p = 0.000) with up to 36–42 months of follow-up. The mean value of endothelial cell density in the overall sample was 2252.54 ± 473.24 cells/mm2 pre-operatively and 2126.75 ± 365.21 cells/mm2 at 24–36 months of follow-up visit. Two patients have intra-operative hyphemia secondary to iris prolapse. Conclusions: Implantation of iris-fixated phakic toric IOLs has shown high efficacy and safety in patients with mild-to-moderate astigmatism in corneal ectasia. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this prospective and comparative study was to investigate the association of perimetry parameters on visual acuity and contrast sensitivity in primary open-angle glaucoma (POAG) eyes with diffractive extended depth-of-focus (EDoF) and monofocal intraocular lenses (IOLs). Methods: In cataract eyes with medicinally controlled POAG with no defects in the central visual field and mean deviation (MD) values of − 10 dB or better, EDoF and monofocal IOLs with the same platform except for echelette optics for EDoF were implanted in 22 and 24 eyes, respectively. Corrected distance visual acuity (CDVA), contrast sensitivity at 3 to 18 cycles per degree (cpd), and automated perimetry using 30-2 and 10-2 Swedish Interactive Threshold Algorithm programs were examined 3 months postoperatively. The influences of perimetry parameters including MD, foveal sensitivity (FS), and the means of the central four points (central MD and central FS) on CDVA and contrast sensitivity were evaluated using linear and multiple regression analyses. Results: In POAG eyes with EDoF IOLs, contrast sensitivities at 12 and 18 cpd were associated with 30-2 and 10-2 perimetry parameters. In POAG eyes with monofocal IOLs, associations of 30-2 parameters were found in CDVA and 3-cpd contrast sensitivity. Conclusions: The visual function of POAG eyes with EDoF IOLs was associated with perimetry parameters in high spatial frequency contrast sensitivity, which was different from that of POAG eyes with monofocal IOL. Trial Registration: Japan Registry for Clinical Research: jRCTs032200218. [ABSTRACT FROM AUTHOR]

Purpose: To manage patient dissatisfaction following multifocal intraocular lens (MF‐IOL) implantation by IOL exchange with either a monofocal or an alternative MF‐IOL, and to compare outcomes in these two groups. Methods: MF‐IOL exchange was performed in 32 patients (64 eyes) with neuroadaptation failure. The MF‐to‐MF group involved patients who had a MF‐IOL exchanged with another MF‐IOL of a different optical profile and the MF‐to‐MO group involved patients who had a MF‐IOL exchanged to a monofocal IOL. Visual outcomes and complications were analysed. The Quality of Vision (QoV) questionnaire, Visual Function Index (VF‐14) and its Rasch‐revised version (VF‐8R) were also used to assess outcomes. Results: There were no significant differences (p > 0.05) in the QoV scores between the two groups, both preoperatively and postoperatively. Preoperatively, there were no significant differences in VF‐14 scores between both groups (p > 0.05). Postoperatively, there were statistically significant differences in VF‐14 (total score, intermediate vision and near vision) in favour of the MF‐to‐MF group (p < 0.05). The postoperative VF‐8R score in the MF‐to‐MF group was significantly better than the MF‐to‐MO group (p ≤ 0.001). Uncorrected and corrected near as well as corrected distance visual acuities were significantly better (p < 0.05) in the MF‐to‐MF group compared to the MF‐to‐MO group at 3 months. Conclusion: Patient dissatisfaction and neuroadaptation failure following MF‐IOL implantation can be managed by an IOL exchange with an alternative optical design of MF‐IOL or a monofocal IOL. Although, in the current study, the MF‐to‐MF group showed some better postoperative results, both options are feasible solutions. [ABSTRACT FROM AUTHOR]

Purpose: To assess visual outcomes and stability of lens alignment more than 3 years after implanting either the AT Lisa Tri Toric (Carl Zeiss Meditec) or the Acrysof IQ Restor Toric (Alcon Laboratories, Inc) intraocular lens (IOL). Methods: Patients who had received either the AT Lisa Tri Toric or the Acrysof IQ Restor Toric IOL were included in the study. The average follow-up period was 5.4 years for the AT Lisa Tri Toric group and 7.9 years for the Acrysof IQ Restor group. The examinations covered included: subjective refraction, monocular and binocular corrected and uncorrected visual acuity at far (4 m), intermediate (75 cm), and near (40 cm) distances, binocular best-corrected defocus curve analysis (4 m), contrast sensitivity evaluation, assessment of IOL axial position, and presence of positive dysphotopsia. Results: A total of 42 eyes were evaluated. Both groups exhibited good long-term lens axial stability. The AT Lisa Tri Toric group had a mean misalignment of 4.8 ± 3.2° from the preoperatively determined axis, whereas the Acrysof IQ Restor Toric group had an average misalignment of 5.4 ± 4.5° (no statistically significant difference, P =.578). Mean achieved spherical equivalent was −0.19 ± 0.36 diopters (D) for the AT Lisa Tri Toric group and 0.15 ± 0.39 D for the Acrysof IQ Restor Toric group. In the AT Lisa Tri Toric group, 18 eyes (72%) achieved an uncorrected distance visual acuity of 0.10 logarithm of the minimum angle of resolution (20/25 Snellen) or better, compared to 15 eyes (88%) in the Acrysof IQ Restor Toric group. Overall, 21 eyes (84%) in the AT Lisa Tri Toric group and 14 eyes (83%) in the Acrysof IQ Restor Toric group achieved a postoperative spherical equivalent refraction between −0.50 and +0.50 D. Conclusions: Both the AT Lisa Tri Toric and the Acrysof IQ Restor Toric IOLs showed good long-term stability and functional outcomes. They proved to be effective options for restoring vision at far, intermediate, and near distances, providing a viable solution for presbyopia correction even several years after implantation. [J Refract Surg. 2024;40(11):e845–e853.] [ABSTRACT FROM AUTHOR]

Purpose: To compare and assess the visual, refractive, and tomographic results of patients with corneal ectasia treated with either corneal allogenic intrastromal ring segments (CAIRS) or synthetic intrastromal corneal ring segments (ICRS) without concomitant corneal cross-linking. Methods: In this retrospective cohort study, 34 eyes with CAIRS were matched to 34 eyes with ICRS using the propensity score matching technique. Each group was matched on a oneto-one basis using multiple parameters such as central corneal thickness, vertical and horizontal coma, maximum anterior keratometry, steepest keratometry, and age. Visual, refractive, topographic, and aberrometric data were measured at baseline, 1 week, 1 month, 3 months, and 1 year postoperatively. Results: Initial preoperative parameters were similar between the two groups. Both groups showed significant improvement at last follow-up time in corrected distance visual acuity (CDVA) (0.52 ± 0.23 to 0.16 ± 0.18 logarithm of the minimum angle of resolution [logMAR], P <.001; 0.44 ± 0.27 to 0.17 ± 0.21 logMAR, P <.001), topographic astigmatism (4.45 ± 2.75 to 3.14 ± 1.93 diopters [D], P =.001; 3.66 ± 2.22 to 2.36 ± 1.46 D, P =.007), maximum anterior keratometry (55.85 ± 7.53 to 50.69 ± 6.38 D, P <.001; 54.59 ± 6.95 to 50.71 ± 4.51 D, P =.003), and vertical coma (1.49 ± 1.02 to 0.38 ± 0.65 D, P <.001; 1.22 ± 0.75 to 0.52 ± 0.57 D, P <.001) for CAIRS and ICRS, respectively. The improvements observed in both groups at the last follow-up visit were comparable; however, the CAIRS group demonstrated a higher percentage of eyes gaining two or more Snellen lines of CDVA (60% vs 31.58%, P =.04), and a greater magnitude of reduction in vertical coma compared to the ICRS group, although this difference did not reach statistical significance. No major complications were observed with both groups, and one eye lost one CDVA line in the ICRS group. The mean thickness of the CAIRS segments at the last follow-up visit was 401.06 ± 100.12 µm, compared to 435.29 ± 26.19 µm for ICRS. Both CAIRS and ICRS demonstrated significant compression of stromal thickness above the segment (36.19% and 32.00%, respectively). Conclusions: When adequately matched for preoperative disease type and severity, eyes with CAIRS had a similar and notable clinical improvement compared to ICRS, with possibly better improvement in vertical coma and CDVA. [J Refract Surg. 2024;40(11):e863–e876.] [ABSTRACT FROM AUTHOR]

Purpose: To assess the visual quality, patient satisfaction, and photic phenomena 3 and 12 months after the implantation of two similar diffractive intraocular lenses (IOLs) manufactured with different materials. Methods: This retrospective observational study included patients with the AcrySof PanOptix IOL or the Clareon Pan-Optix IOL (both Alcon Laboratories, Inc). Three and 12 months after the surgery, binocular contrast sensitivity under photopic conditions was measured. The presence of dysphotopsias and difficulties when driving in dim light conditions was also reported. Patient satisfaction was assessed through the Catquest 9-SF questionnaire and patients also reported the need for additional spectacles at different distances. Twelve months after the surgery, the presence of posterior capsule opacification and glistening was reported. Results: The study included 59 patients. Contrast sensitivity was stable in both groups 12 months after the surgery, the proportion of patients that always perceived halos decreased approximately 15%, and difficulties when driving at night were minimized. Both groups showed high and similar rates of satisfaction with their vision and achieved spectacle independence rates greater than 85% at the two visits. The presence of posterior capsule opacification was similar for both groups, whereas 64% and 90% of the eyes were free of glistening in the AcrySof and Clareon groups, respectively. Conclusions: Both diffractive IOLs offer consistent visual outcomes and high rates of patient satisfaction during the initial 12 months after surgery. The results also suggest that the novel material may better preserve the transparency of the IOL in the long term. [J Refract Surg. 2024;40(11):e877–e883.] [ABSTRACT FROM AUTHOR]

Purpose: To investigate the reasons for the removal and/or exchange of posterior chamber phakic intraocular lenses (PCPIOLs) and the outcomes of these procedures. Methods: In this retrospective study, PCPIOL implantations performed between January 2015 and June 2023 in a single center were reviewed. The study group consisted of the files of eyes with removed and/or exchanged PCPIOL. Visual acuities, refraction errors, endothelial cell counts, and measurements of the vault before and after exchanges were recorded. Reasons for removal and/or exchange were evaluated. The tuck-and-pull technique was used in all explantations. Results: Twenty-three of 1,490 eyes with PCPIOL implantation required removal and/or exchange. Of the explanted eyes, 17 were implanted with PCPIOLs for myopia (1.21% of all myopic corrections) and 6 were implanted with PCPIOLs for hyperopia (6.59% of all hyperopic corrections). The most common reason for removal and/or exchanges after implantation was inappropriate vault (10 of the 23 total removals and/or exchanges), followed by cataract development (7 of the 23 total removals and/or exchanges). A comparison of the biometric characteristics of eyes with PCPIOL removal and/or exchange due to inappropriate vault with other PCPIOL implantations showed that anterior chamber depth, PCPIOL length, and white-to-white distance were significantly higher in the group of explanted eyes (P <.05). All eyes with high vault in myopic patients had a 13.2- or 13.7-mm length PCPIOL. Conclusions: The main reason for PCPIOL removal and/or exchange is vault values outside the ideal limits and cataract development. Before ordering 13.2- and 13.7-mm long PCPIOLs, biometric data of both eyes and recommended PCPIOL sizes should be carefully reviewed. [J Refract Surg. 2024;40(11):e797–e803.] [ABSTRACT FROM AUTHOR]

Purpose: To assess objective reading performance at intermediate and near distances using the Salzberg Reading Desk (SRD) (SRD Vision) in patients with cataract who underwent the implantation of a diffractive extended depth of focus intraocular lens (EDOF IOL) in the dominant eye and a hybrid multifocal EDOF IOL in the non-dominant eye. Methods: This prospective, non-comparative, interventional study included 46 eyes of 23 patients with cataract who underwent bilateral cataract surgery with implantation of the DFR00V Tecnis Synergy IOL (Johnson & Johnson Surgical Vision) in the non-dominant eye and the DXR00V Tecnis Symfony OptiBlue IOL (Johnson & Johnson Surgical Vision) in the dominant eye. At postoperative 6 months, the Salzburg Reading Desk was used to assess distance-corrected reading performance at near and intermediate distances. Results: Although the monocular reading acuity at the preferred intermediate distance was statistically significantly better in the eyes implanted with the DXR00V IOL, it was better with the DFR00V IOL at preferred near distances. The mean binocular distance-corrected preferred intermediate and near reading acuity was 0.07 ± 0.09 (20/23) and 0.13 ± 0.09 (20/27) logarithm of the minimum angle of resolution, respectively. Other parameters of reading performance, such as reading speed, reading distance, reading time, and smallest scale log print size, were similar between the two IOL groups when assessed monocularly. Conclusions: Implanting a DFR00V IOL in the non-dominant eye and a diffractive DXR00V IOL in the dominant eye resulted in excellent binocular reading acuity and speed at intermediate and near distances. [J Refract Surg. 2024;40(11):e778–e782.] [ABSTRACT FROM AUTHOR]

Purpose: To evaluate range of visual acuity, visual quality, and safety of the IC-8 small-aperture (SA) intraocular lens (IOL) (Apthera; Bausch & Lomb, Inc) in patients with cataract. Methods: This was a prospective, multicenter, open-label, parallel-group, non-randomized, examiner-masked, 12-month clinical study conducted at 21 sites in the United States. Included patients (N = 453) received either the SA IOL (targeted to −0.75 diopters) in one eye and a monofocal or monofocal toric IOL (targeted to plano) in the fellow eye (SA IOL group, n = 343) or bilateral monofocal/monofocal toric IOLs (control group, n = 110). Results: At 6 months, the SA IOL group achieved superior binocular uncorrected intermediate and near visual acuity (P <.0001) and equivalent binocular uncorrected distance visual acuity versus the control group. In SA IOL eyes, 99.1% achieved monocular corrected distance visual acuity of 0.3 logarithm of the minimum angle of resolution or better. The SA IOL and control groups had comparable binocular photopic and mesopic contrast sensitivities at 6 months both with and without glare. The SA IOL group reported few visual symptoms overall, although at higher rates than in the control group. Conclusions: The SA IOL group exhibited improved intermediate and near vision, comparable distance vision and binocular contrast sensitivities, and few visual symptoms or adverse events versus the bilateral monofocal/monofocal toric IOL group, suggesting that the SA IOL is an effective option for presbyopia correction at the time of cataract surgery. [J Refract Surg. 2024;40(11):e824–e835.] [ABSTRACT FROM AUTHOR]

Background: To prospectively evaluate binocular visual outcomes after implantation of trifocal intraocular lenses (IOLs) with high-water-content hydrophobic acrylic material in Japanese patients. Methods: In 59 patients (mean age 65.1 ± 7.9 years), Clareon PanOptix (CNWTT0: Alcon) with a high-water-content hydrophobic acrylic material was implanted bilaterally. Three months postoperatively, binocular uncorrected visual acuity (BUCVA) and distance-corrected visual acuity (BDCVA) at distances of 5 m, 80, 60, and 40 cm, binocular defocus curves, and binocular photopic contrast sensitivity were examined. Subjective symptoms (night vision disturbance, glare, halos, haze, or blurry vision) were also assessed. Results: The mean postoperative BUCVA/BDCVA at 5 m, 80 cm, 60 cm, and 40 cm were − 0.115/-0.163, -0.052/-0.047, -0.054/-0.075, and − 0.043/-0.067 logMAR, respectively. A smooth defocus curve, contrast sensitivity within the normal range, and acceptable subjective symptom rates were obtained. Conclusions: The trifocal IOL, composed of a high-water-content hydrophobic acrylic material, provides good continuous binocular vision from distance to near. Trial registration: This investigator-initiated study was registered in the Japan Registry for Clinical Trials (identifier: jRCTs032220042) on April 26, 2022. [ABSTRACT FROM AUTHOR]

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

Background: Posterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole. Case presentation: A 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole. Conclusions: This case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a holography based vision simulator for the demonstration of expected postoperative vision corresponding to monofocal and multifocal intraocular lenses (IOL) to cataract patients before surgery. Methods: An artificial eye model is used to measure the optical performance of different IOL types. The resultant aberrations and degradations are then modeled using phase holograms and shown to subjects on a holographic display. We measure the contrast and resolution loss, halos around the light sources, and point spread function (PSF) corresponding to three different IOLs. We tested the holography based vision simulator on 13 healthy subjects and 6 cataract patients. Results: Monofocal, bifocal, and trifocal IOLs exhibited a contrast decrease of 5%, 42%, and 45% and a resolution limit of 4.49, 4.00, and 4.00 lp/mm (using 0.05 MTF criteria), respectively. Monofocal IOLs have the best resolution and contrast at the optimal focus distance, and multifocal lenses offer extended depth-of-field but exhibit prominent halos and reduced contrast/resolution. Conclusion: We confirmed that the visual functions of IOLs could be successfully modeled using phase holograms and simulated using a holographic display without using a physical IOL. Patients can experience the effects of different IOL options prior to surgery, which helps with IOL selection, expectation management, and patient satisfaction. [ABSTRACT FROM AUTHOR]

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

Purpose: To compare long-term intraocular lens (IOL) decentration and tilt following femtosecond laser-assisted cataract surgery (FLACS) and conventional surgery using swept-source anterior segment ocular coherence tomography (SS-ASOCT). Methods: In this retrospective cross-sectional study, all patients underwent FLACS or conventional cataract surgery. Those with a minimum of 12-months follow-up since surgery were included. Patients with surgical complications were excluded. Demographics, preoperative ocular measurements (axial length, anterior chamber depth), and postoperative measurements [corrected distance visual acuity (CDVA), autorefraction, keratometry, IOL type] were collected. Postoperative IOL tilt and decentration were compared using SS-ASOCT between patients with FLACS and conventional cataract surgery. Subgroup analysis was conducted to analyze tilt and decentration by haptic type (single-piece vs. three-piece). Results: A total of 188 eyes were included [110 (58.5%) in the FLACS group and 78 (41.5%) in the conventional group]. No differences were observed between the FLACS and conventional groups regarding preoperative parameters. FLACS resulted in less IOL decentration compared to conventional cataract surgery (170 μm vs. 240 μm, p = 0.002). No statistically significant differences were observed between the FLACS and conventional groups in the magnitude and axis of IOL tilt. Both groups had a trend of IOL tilt toward the inferotemporal aspects. Moreover, no difference regarding postoperative CDVA, spherical equivalent, and keratometric astigmatism was observed. Conclusions: FLACS resulted in significantly better long-term IOL centration than conventional surgery with manual capsulotomy. No significant difference in IOL tilt or postoperative CDVA was observed between FLACS and conventional cataract surgery. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the visual outcomes and quality of an enhanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL in patients with epiretinal membrane (ERM). This retrospective comparative study reviewed medical records of 110 eyes of 110 patients with photoreceptor-preserving ERM (55 patients in each group) who underwent phacovitrectomy and received either a conventional monofocal IOL (Tecnis PCB00) or an enhanced monofocal IOL (Tecnis Eyhance ICB00) from March 2021 to October 2021. Baseline examination included corrected (CDVA) and uncorrected (UDVA) distance visual acuity, and measurement of pupil size. Postoperative evaluation included uncorrected intermediate (UIVA) and near (UNVA) visual acuity, and defocus curve. Contrast sensitivity was assessed using CGT-2000 (Takagi, Seiko, Japan). The baseline parameters showed no difference between PCB00 and ICB00 groups. At 3 months, there was no difference of UDVA and CDVA, but UIVA (0.27 vs. 0.39 LogMAR; p = 0.001) and UNVA (0.35 vs. 0.45 LogMAR; p = 0.014) were better in ICB00 group. On the defocus curve, the ICB00 group demonstrated a slower slope decrease, with higher visual acuity from − 1.5 to -3.0 diopters when compared to the PCB00 group. The distant contrast sensitivity showed no significant difference between two groups. In conclusion, the enhanced monofocal IOL improved intermediate visual outcomes, achieving equivalent distance visual acuity and similar contrast sensitivity to the conventional monofocal IOL. It could be an alternative option to conventional monofocal IOL when planning combined phacovitrectomy for patients with photoreceptor-preserving ERM. [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]

Background: To introduce a new flange technique (called the Z.S. fixation technique) for 8 − 0 polypropylene suture in scleral fixation of a one-piece intraocular lens (IOL) and evaluate its effectiveness and safety. Methods: All surgeries were performed using two strategies. First, the Z.S. fixation technique was used to fix 8 − 0 polypropylene sutures to the sclera and the two haptics of a one-piece IOL, respectively. The one-piece IOL previously implanted in the anterior chamber was then relocated to the posterior chamber. Finally, the suture ends outside the sclera were cauterized into flanges and buried in the sclera. All effectiveness and safety data related to the Z.S. technique were recorded and compared. Results: The Z.S. fixation technique was employed in 16 eyes of 13 patients, with a follow-up duration of at least 6 months. Postoperative uncorrected distance visual acuity (UDVA) was greatly improved in most of the operated eyes (11/16). The mean log MAR UDVA after surgery was significantly improved compared with that before surgery (0.93 ± 0.72 vs. 1.53 ± 0.73, P = 0.002). IOLs in the vast majority of operated eyes (15/16) remained stable during half-year follow-up. No severe intra-/post-operative complications were observed in any of the operated eyes. Conclusion: The Z.S. fixation technique for 8 − 0 polypropylene suture in scleral fixation of one-piece IOL reduced surgical injuries and had ideal surgical effectiveness and safety. Significance: What was known: To date, most 10 − 0 polypropylene suture scleral fixation techniques required knot fixation outside the sclera, which inevitably leads to long-term complications related to 10 − 0 sutures, such as suture erosion, knot exposure, and late suture breakage. Therefore, some scholars began to use 8 − 0 polypropylene suture to perform scleral fixation for one-piece intraocular lens with specific structures, but the scope of application was very narrow. What this paper adds: We introduced a compound technique of electrocoagulation fixation and scleral flapless knotless interlaminar anchoring for 8 − 0 polypropylene suture, which can be applied to most one-piece intraocular lenses. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma. Methods: We used the Kaplan–Meier method to analyze 29 eyes of 29 patients with exfoliation glaucoma (mean age: 80.7 ± 8.3 years; 16 males; 24 eyes with intraocular lens implants; preoperative intraocular pressure [IOP]: 32.5 ± 9.3 mmHg; preoperative antiglaucoma medications: 3.4 ± 1.0; Asian ethnicity: 100%) who underwent PreserFlo MicroShunt surgery alone at Saneikai Tsukazaki Hospital from November 2022 to November 2023. The criteria for survival were a reduction in IOP of ≥20%, no additional glaucoma surgery, and IOP of 5–21 mmHg (condition 1), 5–18 mmHg (condition 2), and 5–15 mmHg (condition 3). Needling and glaucoma eye drops were considered qualified successes. Results: The mean follow-up period was 27.9 weeks, with a reoperation rate of 31% (9 cases). The complete and qualified success survival rates at 24 weeks were 56%, 52%, and 49%, and 67%, 59%, and 53% for conditions 1–3, respectively. The complete and qualified success survival rates at 48 weeks were 47%, 43%, and 45%, and 52%, 46%, and 48% for conditions 1–3, respectively. Conclusions: The postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma demonstrated an approximate 50% success rate at both 24 and 48 weeks, with a reoperation rate of approximately 30%. Caution is warranted when performing PreserFlo MicroShunt in patients with exfoliation glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to present our experience with Hoffman's SFIOL using double‐armed Gore‐Tex sutures (polytetrafluoroethylene) instead of 9.0 polypropylene suture method in four cases. Observation: In this case series article, we present our experience with Hoffman's SFIOL using double‐armed Gore‐Tex sutures (polytetrafluoroethylene) instead of 9.0 polypropylene sutures; the postoperative evaluation revealed well‐centered IOL which did not exhibit any signs of instability in all four eyes, demonstrating a successful surgical outcome without observed complications. Conclusions and Importance: Hoffman's SFIOL using double‐armed Gore‐Tex could be safe and effective methods for cases with no adequate capsular support for the IOL implantation. Compared to prolene suture, Gore‐Tex gives more tensile strength and requires less manipulation during surgery minimizing postoperative inflammation which could be a valuable option in the nearby future for similar cases. [ABSTRACT FROM AUTHOR]

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance‐corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p = 0.003 and p < 0.001, respectively). The TIOL group achieved a better‐than‐0.15‐logMAR VA from +0.5 D to −2.5 D (40 cm). VAs of the TIOL group from −1 D (100 cm) to −4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near‐vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p = 0.039). Conclusion: Compared with EDF, TIOL leads to better near‐vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The purpose of this study was to simulate the impact of biometric measure uncertainties, lens equivalent and toric power labelling tolerances and axis alignment errors on the refractive outcome after cataract surgery with toric lens implantation.In this retrospective non‐randomised cross sectional Monte‐Carlo simulation study we evaluated a dataset containing 7458 LenStar 900 preoperative biometric measurements. The biometric uncertainties from literature, lens power labelling according to ISO 11979, and axis alignment tolerances of a modern toric lens (Hoya Vivinex) were taken to be normally distributed and used in a Monte‐Carlo simulation with 100 000 samples per eye. The target variable was the defocus equivalent (DEQ) derived using the Castrop (DEQC) and the Haigis (DEQH) formulae.Mean/median / 90% quantile DEQC was 0.22/0.21/0.36 D and DEQH was 0.20/0.19/0.32 D. Ignoring the variation in lens power labelling and toric axis alignment the respective DEQC was 0.20/0.19/0.32 D and DEQH was 0.18/0.17/0.29 D. DEQC and DEQH increased with shorter eyes, steeper corneas, equivalent lens power and highly with toric lens power.According to our simulation results, uncertainties in biometric measures, lens power labelling tolerances, and axis alignment errors are responsible for a significant part of the refraction prediction error after cataract surgery with toric lens implantation. Additional labelling of the exact equivalent and toric power on the lens package could be a step to improve postoperative results. [ABSTRACT FROM AUTHOR]

Background: Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management. Case presentation: A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0. Conclusions: Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully. [ABSTRACT FROM AUTHOR]

Purpose: To assess the power profile and optical performance of 2 extended range-of-vision (ERV) intraocular lenses (IOLs), TECNIS Eyhance (ICB00) and LuxSmart, and compare them with their monofocal counterpart lenses with similar platforms and materials: TECNIS 1-piece (ZCB00) and LuxGood, respectively. Setting: Optics and Optometry Faculties of Complutense University (Madrid) and Universitat Politècnica de Catalunya Barcelona-Tech (Terrassa) in Spain. Design: Laboratory investigation on optical bench. Methods: For each design, the power distribution and (fourth and sixth-order) spherical aberration (SA) across the lens aperture were measured as well as the optical performance using modulation transfer function-based metrics with through-focus evaluation. 3 nominal powers (+10.00 diopters [D], +20.00 D, and +30.00 D) and 3 pupil sizes (2.0 mm, 3.0 mm, and 4.5 mm) were considered to assess whether the base power of the lens and pupillary dynamics have an influence on the depth-of-focus extension. Results: TECNIS Eyhance and LuxSmart IOLs had different power and SA profiles, but both designs shared a positive add power in their central region in comparison with their monofocal counterparts. LuxSmart had a greater add power while TECNIS Eyhance showed higher peak optical quality but smaller depth of focus. Conclusions: Differences of focus extension between the 2 ERV IOL designs are related to differences of power and SA profile. The nominal base power of the IOLs has little effect on their optical quality. However, pupil dynamics plays a key role since it determines the effective add power and optical performance of the ERV IOLs. [ABSTRACT FROM AUTHOR]

Purpose: To develop and assess the utility of an ophthalmic viscosurgical device (OVD) manufactured with fluoresceinconjugated hyaluronic acid (conjHA). Setting: Department of Biomedical Engineering and the Wilmer Eye Institute, Johns Hopkins University and School of Medicine, Baltimore, Maryland. Design: Laboratory study. Methods: ConjHA and unconjugated HA (unconjHA) at varied ratios were used to produce OVD (conjOVD) with varied fluorescence intensity. The conjHA:unconjHA ratio was optimized to maximize clarity under white light and fluorescence intensity under cobalt blue light (CBL), allowing for conditional visualization. The effect of conjugation on conjOVD viscosity was assessed by rotational rheometry. Intraocular lenses (IOLs) were immersed in conjOVD for 4 hours to assess staining of IOLs. A proof-of-concept study was performed in ex vivo porcine eyes. After injection and visualization, the OVDs were removed from the eyes by irrigation/aspiration (I/A). Results: 0.5 mg/mL of conjHA (degree of substitution = 0.005) enabled robust fluorescence of conjOVD under CBL. Fluorescein conjugation did not significantly affect conjOVD viscosity (P > .05 for mean difference in viscosity at all shear rates tested). No staining of IOLs was appreciated. ConjOVD was visualized under CBL when injected ex vivo and maintained clarity of the anterior chamber under white light. Importantly, conjHA enabled delineation of retained OVD after I/A. Conclusions: Use of OVD composed of fluorescein-conjugated HA is a feasible method to enable conditional visualization of OVD intraoperatively without nonspecific staining of ocular structures. Further development of this technology may enable accelerated OVD removal in ocular surgery or decreased OVD retention postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the changing patterns of corneal endothelial cells and the associated factors in children with congenital ectopia lentis (CEL) after scleral-fixated intraocular lens (SF IOL) surgery. Setting: Zhongshan Ophthalmic Center, Guangzhou, China. Design: Retrospective study. Methods: Patients were divided into the surgery group and the control group. Central endothelial cell density (ECD), coefficient of variation in cell size, the percentage of hexagonal cells (hexagonality), average cell size (AVG), and central corneal thickness were analyzed for both groups at baseline and each follow-up visit. Clinic characteristic, ocular parameters, IOL decentration, and IOL tilt of patients in the surgery group were collected. Multiple linear regression was performed to assess the potential associated factors for the postoperative changes in corneal endothelial cells in the surgery group. Results: After 2-year follow-up, the decline of ECD was 17.8% (95% CI, -21.8 to -13.9) in the surgery group and -3.1% (95% CI, -5.2 to -1.0) in the control group (P < .001), while the increase of AVG was 24.3% (17.1-31.6) in the surgery group and 2.7% (1.0 to 4.5) in the control group (P < .001). Multivariate analysis showed that axial length (AL) =24 mm and white-to-white (WTW) <12.2 mm were significantly associated with greater loss of ECD (b = -241.41, 95% CI, -457.91 to -24.91, P = .030 and b = 251.63, 95% CI, 42.10-461.17, P = .020, respectively) and AL =24 mm was significantly positively associated with the increase of AVG (b = 34.81, 95% CI, 0.90-68.71, P = .044). Conclusions: The SF IOL had a significant impact on corneal endothelium in children with CEL. More attention should be paid to monitor postoperative corneal endothelium change during longterm follow-up in CEL children, especially for those with longer AL and smaller WTW. [ABSTRACT FROM AUTHOR]

Purpose: To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation after secondary scleral-fixated IOL (SF IOL) surgery. Setting: 2 tertiary referral hospitals. Design: Retrospective case series. Methods: Patients undergoing SF IOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SF IOL surgery between June 2014 and December 2019 at 2 tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. Results: 237 eyes of 225 patients (169 [75.1%] men) were included. The redislocation group was more likely to have a younger mean age at the initial SF IOL surgery (redislocation vs noredislocation, 55.4 vs 62.0 years, respectively; P = .008), have a prior history of a previous suture break (23 eyes, 52.3% vs 1 eye, 0.5%; P < .001), and have undergone the initial SF IOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P = .002) than was the no-redislocation group. In addition, the redislocation group had a higher occurrence of complications (P < .001). Multivariate regression revealed that younger age, left eye involvement, aphakic status before the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P < .05) associated with redislocation. Conclusions: Younger age, left eye involvement, postoperative complications such as ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes. Setting: Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China. Design: Prospective cohort study. Methods: Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively. Results: A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm² vs 21.85 ± 2.30 mm², P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higherorder aberrations did not differ between the 2 groups (all P > .05). Conclusions: In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To describe the Shammas-Cooke formula, an updated no-history (NH) formula for IOL calculation in eyes with prior myopic laser vision correction (M-LVC), and to compare the results with the Shammas PL, Haigis-L, and Barrett True-K NH formulas. Setting: Bascom Palmer Eye Institute (BPEI), The Lennar Foundation Medical Center, University of Miami, Miami, Florida; Dean A. McGee Eye Institute (DMEI), University of Oklahoma, Oklahoma City, Oklahoma; and private practice, Lynwood, California, and St Joseph, Michigan. Design: Retrospective observational study. Methods: We analyzed 2 large series of cataractous eyes with prior M-LVC. The training set (BPEI series of 330 eyes) was used to derive the new corneal power conversion equation to be used in the new Shammas-Cooke formula and the testing set (165 eyes of 165 patients in the DMEI series) to compare the updated formula with 3 other M-LVC NH formulas on the ASCRS calculator: Shammas PL, Haigis-L, and Barrett True-K NH. Results: Mean prediction error was 0.09 ± 0.56 diopters (D), -0.44 ± 0.61 D, -0.47 ± 0.59 D, and -0.18 ± 0.56 D and the mean absolute error was 0.43 D, 0.60 D, 0.61 D, and 0.45 D for the Shammas-Cooke, Shammas PL, Haigis-L, and Barrett True-K NH, respectively. The percentage of eyes within ±0.50 D was 66.7% vs 47.9%, 48.5%, and 65.5%, respectively. Conclusions: The Shammas-Cooke formula performed better than the Shammas PL and Haigis-L (P < .001 for both) and as well as the Barrett True-K NH formula (P = .923). [ABSTRACT FROM AUTHOR]

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

Purpose: To investigate the factors affecting footplate position and its influence on vault characteristics after implantable collamer lens (ICL) implantation. Setting: Hunan Provincial People's Hospital, Changsha, China. Design: Retrospective case series. Methods: This study included 124 patients (124 eyes). Ultrasound biomicroscopy (UBM) was performed to assess the iris and ciliary body morphologies and observe the footplate position. Using multiple linear regression, the relationship between various ocular and ICL parameters and the vault as well as the factors affecting the footplate distance (FD) were analyzed. Based on the FD, 3 groups were formed: group 1 (<500 mm), group 2 (500 to 1000 mm), and group 3 (>1000 mm). The distribution of the vault range postoperatively was observed for the 3 groups. Results: Ciliary sulcus angle and FD significantly affected the vault (adjusted R² = 0.190, F = 6.763, P < .001), with FD being the most important factor influencing the vault (b = -0.383, P < .001). Postoperative UBM revealed that the footplate was located at different positions in the posterior chamber, with the majority (52%) being located on the ciliary body. The mean size of the 4 footplate orientations was 0.88 ± 0.24 mm. Multiple linear regression analysis revealed that ciliary body thickness (CBT), iris curvature (IC), and ICL iris contact length (IRCL) significantly influenced the FD (adjusted R² = 0.373, F = 11.432, P < .001). The vault range differed significantly among the 3 groups (X² = 32.33, P < .001). Conclusions: Different postoperative ICL footplate positions significantly affect the vault. CBT, IC, and IRCL can alter the position of the footplate from the expected position. This study provides reference for ICL size selection and vault prediction. [ABSTRACT FROM AUTHOR]

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

Purpose: This study aimed to assess the optical quality of myopic and presbyopic IPCLs with different additional powers, and to investigate the effects of pupil size on the optical quality of these IPCLs using an in-vitro modulation transfer function (MTF) measurement system. Methods: Linear scatter functions (LSFs) were recorded using the OPAL Vector system and an eye phantom consisting of wet cells filled with a balanced salt solution. A myopic IPCL or a presbyopic IPCL was placed in the posterior chamber of this model. The MTF was calculated from the LSF using the fast Fourier transform techniques. The effective apertures were set at 2.0 to 5.0 mm in 1.0 mm steps. Results: The in-focus MTF values of the myopic IPCL and presbyopic IPCL with additional powers of + 2.0 and + 4.0 diopters at 100 cycles/mm for an effective aperture of 3.0 mm were 43%, 27%, and 24%, respectively. The in-focus MTF value of both myopic and presbyopic IPCLs was the highest when the effective aperture was set at 3.0 mm, and it gradually worsened when the effective aperture became larger than 3.0 mm at 20, 60, and 100 cycles/mm. Conclusions: Both myopic and presbyopic IPCLs provided excellent MTF values, but the additional power profile can deteriorate optical performance in presbyopic IPCL-implanted eyes, even with a low additional power. Pupil size can influence visual quality in IPCL-implanted eyes for both myopia and presbyopia. Key Messages: What is known: • Implantable phakic contact lens (IPCL) has been reported to be effective for the treatment of both myopia and presbyopia, with a noticeable advantage in reducing the patients' cost burden. • The optical properties of IPCL have not yet been thoroughly investigated, neither for myopic IPCLs nor for presbyopic IPCLs. What is new: • The MTF of presbyopic IPCL was slightly lower than that of myopic IPCL even with a low additional power. • The MTF values of both myopic and presbyopic IPCLs were the highest for a 3.0 mm-pupil size, with gradually worsened for a larger pupil size. [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]

Purpose: To report the prevalence data for total corneal astigmatism (TCA) in cataract patients. Methods: The authors retrospectively collected and analyzed the preoperative biometric data of the patients who underwent cataract surgery in the Department of Ophthalmology, Peking University Third Hospital, from January 2019 to May 2023. Results: The mean age of the 10817 patients was 71 ± 10 years; the male/female ratio was 4653/6164. The mean TCA obtained by the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany), the Abulafia-Koch (AK) formula, and the Barrett toric calculator was 1.11 ± 0.81 diopter (D), 1.13 ± 0.75 D, and 1.12 ± 0.74 D respectively, which was significantly greater than the mean standard keratometric (K) astigmatism (0.99 ± 0.75 D) obtained by IOLMaster 700. Against-the-rule (ATR) astigmatism was dominant in all the TCA measurements, and its proportion increased with age. TCA measurements by different methods exhibit high variability, with a total of 1574 (8.9%) data sets from 1016 (9.4%) patients showing a difference larger than 0.5 D in at least one pair of TCA measurements. Conclusion: The use of TCA rather than K astigmatism significantly influenced the choice of intraocular lenses (IOLs) as more patients would be candidates for toric IOLs. It was essential to carefully compare and select TCA obtained with multiple methods for optimal postoperative visual quality. [ABSTRACT FROM AUTHOR]

Introduction: Pinhole intraocular lenses (IOLs) were developed to improve reading by compensating for loss of accommodative function. The IC-8® Apthera™ is a small-aperture presbyopia-correcting IOL that combines the proven principle of small-aperture optics with an aspheric monofocal lens to deliver a continuous range of vision for patients with cataracts from distance to near vision. Posterior capsule opacification is the most common sequela after cataract surgery. It is effectively treated by laser capsulotomy. However, if the laser beam is incorrectly focused, the IOL can be permanently damaged (pits/shots). Methods: In this experimental study, yttrium–aluminum-garnet (YAG) pits were purposefully created. Defects were analyzed and compared between the periphery of the ring in the clear area of the hydrophobic acrylic lens and at the carbon black (CB)-polyvinylidene fluoride (PVDF) filtering component (FilterRing™) of the pinhole lens. All defects were made using identical settings/energy levels (2.6 mJ). The damage induced to the IC-8® Apthera™ IOL was examined by low-magnification images, light microscopy, scanning electron microscopy, and micro-computed tomography (micro-CT). Results: YAG defects in the carbon black filter ring were much more severe than those in the clear zone due to the high absorption of the carbon black. Massive defects and destruction of the lens with tearing out of fragments and particles were observed. The missing volume calculated from the micro-CT reconstruction was 0.266 mm3, which is 1.6% of the entire IOL volume, or more than 1000 times the volume damaged in the largest shot in the periphery. Conclusion: Based on the results, we highly recommend using the lowest possible energy levels, posterior offset setting, and circular pattern for maximum safety when performing laser capsulotomy with pinhole implants. Care should be taken to avoid creating irreversible iatrogenic defects that may affect overall quality. The safest area for performing capsulotomy seems to be the periphery of the ring segment. Video available for this article. [ABSTRACT FROM AUTHOR]