Predictability of combined cataract surgery and trabeculectomy using Barrett Universal â ¡ formula.

PURPOSE: To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and trabeculectomy. METHODS: We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas. RESULTS: The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula. CONCLUSIONS: The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.

Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure.

Purpose: To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). Methods: We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. Results: The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann-Whitney U test, p=0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm2 (p=0.735) in the LI and lensectomy groups, respectively. Conclusions: Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.

Reply to Cione et al. Comment on "Iida et al. Development of a New Method for Calculating Intraocular Lens Power after Myopic Laser In Situ Keratomileusis by Combining the Anterior-Posterior Ratio of the Corneal Radius of the Curvature with the Double-K Method. J. Clin. Med. 2022, 11, 522".

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Development of a New Method for Calculating Intraocular Lens Power after Myopic Laser In Situ Keratomileusis by Combining the Anterior-Posterior Ratio of the Corneal Radius of the Curvature with the Double-K Method.

BACKGROUND: A new method, the Iida-Shimizu-Shoji (ISS) method, is proposed for calculating intraocular lens (IOL) power that combines the anterior-posterior ratio of the corneal radius of the curvature after laser in situ keratomileusis (LASIK) and to compare the predictability of the method with that of other IOL formulas after LASIK. METHODS: The estimated corneal power before LASIK (Kpre) in the double-K method was 43.86 D according to the American Society of Cataract and Refractive Surgery calculator, and the K readings of the IOL master were used as the K values after LASIK (Kpost). The factor for correcting the target refractive value (correcting factor [C-factor]) was calculated from the correlation between the anterior-posterior ratio of the corneal radius of the curvature and the refractive error obtained using this method for 30 eyes of 30 patients. RESULTS: Fifty-nine eyes of 59 patients were included. The mean values of the numerical and absolute prediction errors obtained using the ISS method were -0.02 ± 0.45 diopter (D) and 0.35 ± 0.27 D, respectively. The prediction errors using the ISS method were within ±0.25, ±0.50, and ±1.00 D in 49.2%, 76.3%, and 96.6% of the eyes, respectively. The predictability of the ISS method was comparable to or better than some of the other formulas. CONCLUSIONS: The ISS method is useful for calculating the IOL power in eyes treated with cataract surgery after LASIK.

Factors Influencing Contrast Sensitivity Function in Eyes with Mild Cataract.

This study was aimed to evaluate the relationship between the area under the log contrast sensitivity function (AULCSF) and several optical factors in eyes suffering mild cataract. We enrolled 71 eyes of 71 patients (mean age, 71.4 ± 10.7 (standard deviation) years) with cataract formation who were under surgical consultation. We determined the area under the log contrast sensitivity function (AULCSF) using a contrast sensitivity unit (VCTS-6500, Vistech). We utilized single and multiple regression analyses to investigate the relevant factors in such eyes. The mean AULSCF was 1.06 ± 0.16 (0.62 to 1.38). Explanatory variables relevant to the AULCSF were, in order of influence, logMAR best spectacle-corrected visual acuity (BSCVA) (p < 0.001, partial regression coefficient B = -0.372), and log(s) (p = 0.023, B = -0.032) (adjusted R2 = 0.402). We found no significant association with other variables such as age, gender, uncorrected visual acuity, nuclear sclerosis grade, or ocular HOAs. Eyes with better BSCVA and lower log(s) are more susceptible to show higher AULCSF, even in mild cataract subjects. It is indicated that both visual acuity and intraocular forward scattering play a role in the CS function in such eyes.

Comparison of Predictability Using Barrett Universal II and SRK/T Formulas according to Keratometry.

PURPOSE: To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas, according to the keratometry. METHODS: We retrospectively reviewed the clinical charts of 335 consecutive eyes undergoing standard cataract surgery. IOL power calculations were performed using the Barrett Universal II and the SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ±0.25, ±0.5, and ±1.0 D of the targeted refraction, 1 month postoperatively, and also investigated the relationship of these outcomes with the keratometric readings, using the two formulas. RESULTS: The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (the paired t-test, p < 0.001). The absolute error using the SRK/T formula was significantly larger than that using the Barrett Universal II formula (p=0.006). We found a significant correlation between the prediction error and the keratometric readings using the SRK/T formula (Pearson correlation coefficient, r = -0.522, p < 0.001), but there was no significant correlation between them using the Barrett Universal II formula (r = -0.031, p=0.576). CONCLUSIONS: The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the corneal shape, than the SRK/T formula. The Barrett Universal formula, instead of the SRK/T formula, may be clinically helpful for improving the refractive accuracy, especially in eyes with steep or flat corneas.

Quantitative Analysis of Objective Forward Scattering and Its Relevant Factors in Eyes with Cataract.

This study was aimed to quantitatively assess objective forward scattering and its relevant factors in eyes having cataract. Our study comprised 192 eyes of 192 patients (mean age, 71.3 ± 9.2 (standard deviation) years) who have cataract formation for surgical consultation. We determined uncorrected and corrected distance visual acuities (UDVA and CDVA), manifest refraction, the grade of nuclear sclerosis, objective scattering index (OSI) with the OQAS II (Visiometrics, Spain), log(s) with the C-Quant (Oculus, Germany), and ocular higher-order aberrations (HOAs) using the wavefront sensor (KR-1W, Topcon, Japan). The mean OSI was 5.11 ± 3.19 (0.90 to 20.90). We found explanatory variables relevant to the OSI to be, logMAR CDVA (p < 0.0001, partial regression coefficient B = 5.917) and log(s) (p = 0.0006, B = 0.911) (adjusted R2 = 0.333), in order of influence. No significant correlation was found with other clinical factors such as gender, age, manifest refraction, UDVA, ocular HOAs, or nuclear sclerosis. Eyes with worse CDVA and higher log(s) are more predisposed to show higher OSI in cataractous eyes. It is suggested that objective forward scattering was associated, not only with CDVA, but also with subjective forward scattering, in cataractous subjects.

Cataract surgery in a patient with an angle gamma due to macular heterotopia.

PURPOSE: We report a case of cataract surgery in a patient with a detectable angle gamma due to macular heterotopia. OBSERVATION: A 48-year-old man had angle gamma due to macular heterotopia secondary to retinopathy of prematurity. The preoperative corrected distance visual acuity was 20/32 in the right eye and 20/200 in the left eye. Ocular deviation was esotropic at an angle of 70-80prism diopter. Only the right eye was capable of fixating due to the amblyopia in the left eye. The preoperative root mean square was measured (cornea: 1.32 µm, total: 1.64 µm in ordinary fixation position, cornea: 0.36 µm, total: 3.40 µm in pupil center position). The total aberration was lower in the ordinary fixation position than in the pupil center position. Corneal refractive power was 41.75 D in the ordinary fixation position and 43.05 D in the pupil center position. The axial lengths were 22.25 and 22.54 mm, respectively. We selected the VA60BBR intraocular lens (IOL) at +28.00 D based on the targeted fixation state. Target refraction was -1.32 D. The postoperative course was favorable, and the resulting visual acuity was 20/40. CONCLUSION: We report a case of cataract surgery on a patient with an angle gamma due to macular heterotopia. The postoperative course was favorable, and the patient's satisfaction was good considering that we selected the IOL's postoperative fixation state to meet the patient's occupational demands.

Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism.

PURPOSE: To evaluate the long-term clinical outcomes and rotational stability of toric intraocular lenses (IOLs) to correct preexisting astigmatism in cataract patients. SETTING: Kitasato University Hospital, Kanagawa, Japan. DESIGN: Prospective observational study. METHODS: Phacoemulsification with implantation of a toric IOL (Acrysof IQ toric SN6AT) was performed in cataract patients with corneal astigmatism. The postoperative follow-up was up to 2 years. RESULTS: This study enrolled 378 eyes of 302 patients with a mean age of 63.4 years ± 16.9 (SD). The corrected distance visual acuity 3 months postoperatively was 20/25 or better in 94.7% of eyes. The mean refractive cylinder was -1.92 ± 1.45 diopters (D) preoperatively, -0.59 ± 0.62 D 3 months postoperatively (322 eyes), and -0.67 ± 0.90 D at 2 years (73 eyes). There were statistically significant differences between the preoperative and 3-month postoperative measurements (P<.001, Wilcoxon signed-rank test). The mean IOL misalignment was 4.1 ± 3.0 degrees 2 years postoperatively. The mean IOL rotation was 4.5 ± 4.9 degrees within 1 day postoperatively. The rotation was more than 20 degrees in 6 eyes, all of which had an axial length (AL) of more than 25.0 mm. All rotations occurred within 10 days postoperatively. CONCLUSIONS: Toric IOLs were effective in reducing preexisting corneal astigmatism and had overall good rotational stability. A large degree of IOL rotation might occur in eyes with a relatively long AL, especially during the early postoperative period. The 6 rotated IOLs were implanted to correct with-the-rule astigmatism. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Five-year clinical study of patients with pseudophakic monovision.

PURPOSE: To assess the long-term clinical outcomes and acceptability of pseudophakic monovision. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Case series. METHODS: Patients who had surgery using the monovision method with monofocal intraocular lenses had routine postoperative examinations. Assessed were visual acuity, near stereopsis, ocular deviation, patient satisfaction, and the rate of spectacle dependence preoperatively and 1, 3, and 6 months and 1, 2, 3, 4, and 5 years postoperatively. RESULTS: The study enrolled 54 patients with a mean age of 74.7 years ± 7.9 (SD). The mean difference in the spherical equivalent refractive error between eyes of each patient was 2.13 diopters. The binocular uncorrected distance visual acuity was at least 0.10 logMAR in 98% of patients, with 76% achieving Jaeger 2 or better binocular uncorrected near visual acuity. Near stereopsis in patients who shifted from exophoria to intermittent exotropia decreased, although no serious problems were observed. The rate of spectacle dependence was 88% preoperatively, 41% at 1 year, and 22% at 5 years. Patient satisfaction improved gradually during the follow-up. CONCLUSION: Pseudophakic monovision was an effective approach for correcting presbyopia throughout the 5-year observation period; however, a longer follow-up, including further studies is necessary to allow selection of appropriate patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Pseudophakic monovision using monofocal and multifocal intraocular lenses: hybrid monovision.

PURPOSE: To evaluate the visual function after bilateral cataract surgery performed with a new technique (hybrid monovision) that uses a monofocal intraocular lens (IOL) and a diffractive multifocal IOL. SETTING: Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. DESIGN: Case series. METHODS: Hybrid monovision was achieved by implanting a monofocal IOL (AQ310Ai) in the dominant eye and a diffractive multifocal IOL (Tecnis ZM900) in the nondominant contralateral eye. The target refraction was emmetropia in both eyes. Visual acuity at various distances, contrast sensitivity, near stereopsis, reading ability, and the degree of patient satisfaction were measured. RESULTS: The study enrolled 32 patients with a mean age of 61.2 years ± 14.7 (SD). At all distances, the mean binocular visual acuity was better than 0.1 logMAR. Binocular contrast sensitivity was better than monocular vision in the eye with the diffractive multifocal IOL. Near stereopsis within normal range was maintained in 62.5% of patients. Of the patients, 18.8% reported spectacle dependence. With binocular vision, no patients reported waxy vision (ie, as though they were looking through water). CONCLUSION: Hybrid monovision may be an effective approach for managing loss of accommodation after cataract surgery and may be the method of choice in cases of waxy vision caused by bilateral multifocal IOL implantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Influence of age on ocular wavefront aberration changes with accommodation.

PURPOSE: To perform a quantitative analysis of high order wavefront aberrations of the entire optical system of the eye that accompanies accommodation demands in the healthy and emmetropic eye. METHODS: Fifty-six healthy emmetropic eyes of 30 patients were separated into three groups according to age: group 1, 20 to 29 years; group 2, 30 to 39 years; and group 3, 40 to 49 years. Using iTrace ray-tracing technology, pupil diameter, objective refraction, and wavefront aberrations at accommodation demands of 0 to 4.00 diopters (D) in five 1.00-D increments were determined. In analyzing higher order aberrations in the central 4-mm diameter zone of the pupil, Zernike polynomials were used to study the changes associated with accommodation in the magnitude of total higher order aberrations, third order aberrations (coma-like aberrations), fourth order aberrations (spherical-like aberrations), and the spherical aberration component (C4(0)) of the fourth order aberrations. RESULTS: Pupil diameter decreased significantly (P < .05) with accommodation demand in each group. Total higher order aberrations in group 1 increased significantly (P < .05). No significant change was seen in third order aberrations in any group, but fourth order aberrations increased significantly (P < .05) in group 1. Spherical aberration (C4(0)) showed phase shifts from positive to negative in all groups, but the shift in group 3 was minimal, remaining positive even for a 4.00-D accommodation demand. CONCLUSIONS: Among higher order aberrations accompanying accommodation demands, spherical aberration (C4(0)) in particular showed characteristic changes; however, these changes showed age-related disparities. The changes were probably due to the effects of reduction in accommodation resulting from age-related changes in the crystalline lens.

[Assessment of visual function and satisfaction in pseudophakic monovision].

PURPOSE: To investigate the visual function and acceptability of pseudophakic monovision in relation to age. METHODS: We examined 82 cases (age: 49-87 years) with pseudophakic monovision. All cases were undergone monovision using monofocal intraocular lens (IOLs). The cases were classified into three groups based on their age (A, less than 60 years; B, between 60 to 70 years ; and C, more than 70 years). Refractive error, visual acuity at various distances, contrast sensitivity, and near stereopsis were measured. Using a questionnaire, patient satisfaction before and after cataract surgery was evaluated. RESULT: The mean difference in spherical equivalent refractive error between both eyes was 2.27 D (A, 2.39D; B, 2.30D; and C, 2.20 D). Most cases had a binocular uncorrected visual acuity of 20/25 or better at all distances. For contrast sensitivity, binocular summation was observed at 1.5 to 6 cycles/ degree. Near stereopsis was in the normal range, which was less than or equal to 100 seconds of arc. Moreover, it was found that 82% of the patients were satisfied with the results (A, 68%; B, 86%; and C, 93%). CONCLUSION: Pseudophakic monovision may be an effective approach for managing loss of accommodation after cataract surgery especially in patients over 60 years of age. However, careful selection of patients should be carried out.

DPPH radical-scavenging effect on some constituents from the aerial parts of Lippia triphylla.

Lippia triphylla (L'HER) O. KUNTZE: (Verbenaceae; common name, Lemon Verbena) is used in Peru as a spice and herb tea for the prevention of arteriosclerosis. From the aerial parts of this plant, 25 known compounds--3 phenylpropanoid glucosides, 7 flavonoids, 5 phenylethanoid glycosides, 5 lignans, 2 sesquiterpenoids, and 3 triterpenoids--were isolated, and their chemical structures were elucidated on the basis of physical and spectral data. Among them, 19 aromatic compounds were examined for their scavenging effect on the stable free radical 1,1-diphenyl-2-picrylhydrazyl--4 phenylethanoid glycosides and 5 lignans indicated a potent scavenging effect. Of note, the EC(50) values of two phenylethanoid glycosides reached almost thrice that of alpha-tocopherol.

Three unusual 22-beta-O-23-hydroxy-(5 alpha)-spirostanol glycosides from the fruits of Solanum torvum.

Three novel 22-beta-O-spirostanol oligoglycosides, torvosides J (1), K (2) and L (3) have been isolated from the fruits of Solanum torvum SWARTZ and their chemical structures have been characterized based on the spectroscopic means. They are worth of note as rare 22-beta-O-spirostanol glycosides.