An evaluation of the efficacy of a supplemental computer-based tutorial to enhance the informed consent process for cataract surgery: an exploratory randomized clinical study.

BACKGROUND: To assess whether informing patients with a computer-based tutorial in addition to standard informed consent influences the patient's attitude towards surgery and increases patient's knowledge. METHODS: In this prospective, exploratory, randomized clinical study, patients scheduled for their first eye cataract surgery were randomly allocated to two groups, receiving standard face-to-face informed consent (control group) or additionally using an interactive computer-based tool (CatInfo) containing an audiovisual presentation about cataract and its treatment (study group). Cataract-related knowledge and decisional confidence (decisional conflict scale (DCS)) were assessed as well as one-month postoperatively decisional regret (decision regret scale (DRS)) and willingness to exchange face-to-face discussion time for the use of such a tool. RESULTS: The study comprised 134 patients, 64 patients in the study group and 70 in the control group. Patients in the study group answered more questions correctly, 16.3 ± 2.0 (median 16.5, 11.0-19.0) versus 15.5 ± 1.9 (median 16.0, 8.0-19.0; p = 0.01). Patients showed a high decisional confidence with a study group mean DCS score of 92.4 ± 9.8 (median 96.9, 65.6-100) and control group score of 91.6 ± 10.9 (median 95.3, 43.3-100; p = 0.52). Mean DRS score in the study group was 2.5 ± 8.0 (median 0, 0-40) and 4.3 ± 12.5 (median 0, 0-75) in the control group (p = 0.14). Of study group patients 23 (67.6%) were willing to trade time, on average 158 ± 180 s (median 120 s, 45-900). Satisfaction with the tool was high with a mean of 9.1 ± 1.3 out of 10 (median 9.7, 5.0-10). CONCLUSIONS: Cataract-related knowledge was generally good, with slightly higher scores in the study group. In both groups, decisional confidence was high and regret after surgery was low. A tendency towards slightly higher decisional confidence and lower regret was found in the study group, although these differences were not statistically significant. Additional use of an interactive computer-based tool may prove useful in the informed consent process in a high-volume cataract outpatient setting. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04975126. Retrospectively registered - July 23, 2021.

Structure-Function Analysis of MP-3 Microperimetry versus Octopus Perimetry in Central Glaucomatous Visual Field Defects.

INTRODUCTION: The aim of this study was to compare the structure-function relationship with microperimetry and Octopus perimetry in primary open-angle glaucoma (POAG) patients with central visual field (VF) defects. METHODS: Forty eyes of 24 patients with POAG were enrolled. Circumpapillary retinal nerve fiber layer (cpRNFL) analysis measured by spectral-domain optical coherence tomography (SD-OCT) of the superotemporal, temporal, and inferotemporal optic-nerve head sectors were related to corresponding microperimetric and Octopus VF clusters using the G2 grid-pattern with dynamic strategy, respectively. The structure-function relationships of both devices were assessed via a segmented regression, as well as linear regression across overall SD-OCT cpRNFL values and outside normative (<1%) SD-OCT cpRNFL values. RESULTS: Linear and segmented regression fits were similar with both devices. Across overall cpRNFL sectorial values, structure-function relations for the superotemporal, temporal, and inferotemporal sectors were R2 = 0.176 (p = <0.001), R2 = 0.008 (p = 0.069), and R2 = 0.294 (p = <0.001) for microperimetry and R2 = 0.189 (p = <0.001), R2 = 0.020 (p = 0.002), and R2 = 0.326 (p = <0.001) for Octopus perimetry. For corresponding values outside normative limits (<1%), the relationships were R2 = 0.113 (p = <0.001), R2 = 0.001 (p = 0.836), and R2 = 0.420 (p = <0.001) for microperimetry and R2 = 0.192 (p = <0.001), R2 = 0.002, (p = 0.336), and R2 = 0.366 (p = <0.001) for Octopus perimetry. DISCUSSION/CONCLUSION: Structure-function analysis was similar for both devices. Fundus-tracking should be further evaluated in a longitudinal setting in patients affected by glaucoma.

Influence of Biometric Data on Planning Strabismus Surgery. / Einfluss von biometrischen Daten auf die Planung der Augenmuskeloperation.

PURPOSE: To evaluate the influence of optical biometry data (axial eye length, anterior chamber depth) on planning strabismus surgery using a simulation software and partial least squares regression. METHODS: This retrospective study included patients who had undergone strabismus surgery in one eye involving only the horizontal eye muscles. Furthermore, optical biometry had been performed and the extent of strabismus had been measured pre- and postoperatively. In the next step the strabismus surgery was simulated (See++, RISC, Austria) with and without axial eye length data. In the last step, anatomical data of the eye were used and their influence on the postoperative extent of strabismus was evaluated using partial least squares regression and boot strapping. RESULTS: Of 97 patients, 92 were included in the analysis. In all cases the extent of strabismus was reduced by at least 25% and in 60% of the cases the reduction was at least 75%. Taking the axial eye length into account improved the simulation slightly (change of surgical planning: 0.30 mm, standard deviation 1.65 mm). DISCUSSION: The simulation model used showed that including the axial eye length is useful for strabismus surgery planning. However, the anterior chamber depth/axial eye length was found to have a significantly greater impact.

Effect of Phacoemulsification on Outcomes after Vitrectomy with Membrane Peeling regarding New Intraretinal Cystoid Changes and Transient Macular Edema.

PURPOSE: The aim of the present study was to analyze the effect of phacoemulsification on outcomes among patients undergoing vitrectomy with membrane peeling for idiopathic epiretinal membranes, with respect to new postoperative intraretinal cystoid changes and early transient macular edema. PROCEDURES: This retrospective analysis included patients from 6 prospective studies, examining outcomes of 23G pars plana vitrectomy with membrane peeling due to idiopathic epiretinal membranes. Phacovitrectomy with membrane peeling was performed only in the case of coexisting vision affecting cataract. Optical coherence tomography was performed prior to surgery, in the first week, and 3 months after surgery. RESULTS: In total, 183 patients were included. The occurrence of new postoperative intraretinal cystoid changes and early transient macular edema showed a trend toward being higher among patients undergoing phacovitrectomy with membrane peeling, compared to vitrectomy with membrane peeling alone, but it did not reach statistical significance (p = 0.5 and p = 0.186). The final best corrected distance visual acuity (BCVA) 3 months after surgery was significantly lower among patients with new postoperative intraretinal cystoid changes compared to patients without (with a median difference of 1 line between groups; p = 0.016). CONCLUSIONS: New postoperative intraretinal cystoid changes and early transient macular edema are more frequent among patients undergoing phacovitrectomy with membrane peeling compared to patients with vitrectomy with membrane peeling alone.

Effect of Cataract Extraction on Retinal Sensitivity Measurements.

INTRODUCTION: Central and paracentral retinal function is often compromised in various retinal diseases. In these conditions, microperimetry is an important tool for assessing retinal sensitivity values. As retinal diseases are prevalent among the elderly, cataract often coexists. This study investigates the effect of cataract surgery on retinal sensitivity in patients with cataract without retinal disease. MATERIAL AND METHODS: A total of 30 patients already scheduled for cataract surgery were enrolled and microperimetry and visual acuity evaluation was performed before and after cataract extraction. The patients were allocated to 1 of 3 study groups in accordance with the main cataract subtype: nuclear, cortical, or posterior subcapsular (PSC) cataract. RESULTS: Visual acuity increased significantly after cataract surgery (from 0.34 to 0.00 logMar, p < 0.001, paired t test). Similarly, median retinal sensitivity increased significantly from 23 dB (IQR 21-25 dB) to 27 dB (IQR 25.75-28 dB) (p < 0.001, Wilcoxon test). The increase of retinal sensitivity after cataract surgery was highest in the PSC cataract group. CONCLUSION: This study showed an increase in retinal sensitivity values after cataract removal, especially in the PSC group. Therefore, coexisting cataract should be considered when interpreting microperimetry results.

Computer-Based Tutorial to Enhance the Informed Consent Process for Cataract Surgery in Serbian- or Turkish-Speaking Patients.

INTRODUCTION: This study analyses if a translated version of the CatInfo tool increases the knowledge of Serbian- and Turkish-speaking patients about cataract surgery. METHODS: In total, 61 cataract patients, literate in Serbian or Turkish, were randomly allocated into two groups. Via an interactive computer-based tool ("CatInfo"), patients either saw a detailed audio-visual presentation about cataract surgery (study group) or a "placebo" video (control group). Afterwards, all participants had a face-to-face discussion with an ophthalmologist. Immediately after the interview and on the day of surgery, all patients had to fill out a questionnaire including knowledge and demographic questions. Patients in the study group were further asked about their satisfaction with the CatInfo tool and the usefulness of such a device before other interventions. RESULTS: Patients in the study group answered significantly more questions correctly compared to the control group, and this information gain remained stable over a 1-week period. There was a significant low negative correlation between educational level and the test results, whereas age and computer habits of the participants did not have an influence on correct answers. Satisfaction with the CatInfo tool was high in the Serbian and the Turkish group (96% and 84%, respectively), and 92% of Serbian patients as well as 62% of the Turkish patients rated that they could imagine to use such a device before any other surgery. DISCUSSION/CONCLUSION: The translated version of the CatInfo tool improved patients' knowledge, and this information gain remained stable until the day of the surgery.

Reproducibility of Microperimeter 3 (MP-3) Microperimetry in Open-Angle Glaucoma Patients.

PURPOSE: Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy, leading to degeneration of retinal ganglion cells and characteristic morphological changes at the optic disc. In advanced stages of the disease, functional tests, such as standard automated perimetry (SAP), are the main diagnostic tools to detect progression. Compared to SAP, microperimetry offers fundus imaging with motion tracking to ensure precise stimulation of certain locations of the retina. Aim of the study was to assess reproducibility of microperimetry compared to SAP in patients with POAG. METHODS: This prospective monocenter study included patients suffering from POAG with visual field defects in the central 20° zone. After inclusion into the study, 3 consecutive study visits were scheduled within 1 month, assessing microperimetry and SAP at each visit. RESULTS: From 19 patients recruited, data from 18 patients could be analyzed. No significant difference between study visits could be detected in mean retinal sensitivity in microperimetry and SAP (microperimetry p = 0.401; SAP p = 0.644; Friedman's 2-way analysis of variance). The intraclass-correlation coefficient was 0.981 (95% CI 0.978-0.984) for microperimetry and 0.948 (95% CI 0.941-0.955) for SAP. Absolute agreement between deep scotoma points was found in 81 test locations (79%) in microperimetry and in 35 test locations (20%) in SAP (p = 0.003, chi-square test). CONCLUSIONS: Microperimetry and conventional perimetry showed high reproducibility, with slightly better performance of microperimetry. However, the reduced angle of visual field in microperimetry limits its application to central glaucomatous field damage.

Effect of Subfoveal and Extrafoveal Hyporeflective Zones due to Iatrogenic Traction during Membrane Peeling for Epiretinal Membranes on Postoperative Outcomes.

PURPOSE: The aim of our study using an intraoperative optical coherence tomography (iOCT) device was to assess the rate of neurosensory elevation with resulting subfoveal and extrafoveal hyporeflective zones during membrane peeling and to evaluate a possible influence on postoperative outcomes. PROCEDURES: This study included patients scheduled for pars plana vitrectomy with membrane peeling due to idiopathic epiretinal membrane. All patients underwent 23-G pars plana vitrectomy with iOCT-guided membrane peeling and were scheduled for follow-up examinations at 1 day, 5 days, and 3 months after surgery. RESULTS: Among the 171 patients included, subfoveal and extrafoveal hyporeflective zones could be detected in 12 patients (7%). Follow-up at 3 months after surgery was available for 149 patients with a median improvement in best corrected visual acuity of +2 lines (IQR: +1 to +4 lines). There were no significant differences in outcomes between patients with and those without subfoveal/extrafoveal hyporeflective zones concerning visual acuity, macular thickness, occurrence of intraretinal cystoid changes, and postoperative hyporeflective zones. CONCLUSIONS: No significant differences in postoperative outcomes were observed between patients with and those without subfoveal/extrafoveal hyporeflective zones.

Effect of Air Tamponade on Postoperative Visual Acuity and Intraretinal Cystoid Changes after Peeling of Idiopathic Epiretinal Membranes in Pseudophakic Patients.

PURPOSE: Epiretinal membrane is a macular disorder leading to metamorphopsia and decreased visual acuity. The aim of the present study was to assess the possible effects of air tamponade, balanced salt solution (BSS), and combined phacoemulsification on functional and anatomical outcomes. PROCEDURES: This prospective exploratory analysis included 72 eyes with idiopathic epiretinal membranes, scheduled to undergo 23-G pars plana vitrectomy with membrane peeling. Air tamponade or BSS was used in all cases. Optical coherence tomography (OCT) imaging was performed intraoperatively, and follow-up including visual acuity testing and OCT measurements was conducted until 3 months postoperatively. RESULTS: Mean best-corrected visual acuity improved between +2.1 and +3.1 letters, and mean central subfield thickness of the macula decreased between -29.6 and -76 µm in the examined groups, without significant differences between the air tamponade and BSS groups. There was no significant difference in the presence of intraretinal cystoid changes between the groups. CONCLUSIONS: The use of air tamponade did not show any significant differences in the anatomical and functional postoperative results compared to BSS. Furthermore, phacovitrectomy did not result in significantly more intraretinal cystoid changes 3 months after surgery.

[Reduced Caliber of the Ophthalmic Artery in Magnetic Resonance Angiography in Patients after Retinal Artery Occlusion]. / Kaliberreduktion der A. ophthalmica in der Magnetresonanzangiografie bei Patienten nach retinalen arteriellen Verschlüssen.

BACKGROUND: Retinal artery occlusion (RAO) is caused by embolic occlusion of retinal arteries. Previous strokes in the medical history were reported in up to 20% of patients. According to data from a computational blood flow analysis based on magnetic resonance imaging of a patient with RAO, about 90% of ascending emboli are washed into the brain, leaving speculations about further embolic sources for RAO, such as plaques or stenosis of the ophthalmic artery. The aim of this study was to examine the reduced caliber of the ophthalmic artery in magnetic resonance angiography (MRA). PATIENTS AND METHODS: An analysis of a prospective case series of 9 patients with newly diagnosed RAO, presenting at the outpatient department. Magnetic resonance angiography of the brain, including the ophthalmic artery and carotid siphon was performed in all patients and evaluated by an experienced radiologist also specialised in neuroradiology. Outcomes were compared to an age-matched control group of 9 patients without RAO. RESULTS: Four of 9 patients (44.4%) had a reduced caliber of the ophthalmic artery, two only at the side of RAO and another two bilateral. One of these cases also had a severe steno-occlusive disease of the internal carotid artery in the MRA, being in accordance with the results from duplex-sonography of the internal carotid artery. None of the patients in the control group had any signs of stenosis of the ophthalmic artery. CONCLUSIONS: Reduced caliber of the ophthalmic artery in MRA is present in almost half of patients with RAO and indicates that steno-occlusive disease of the ophthalmic artery could be a possible source of emboli, causing RAO.

Descemet's stripping without endothelial keratoplasty.

PURPOSE OF REVIEW: To summarize the recent literature regarding descemetorhexis stripping without endothelial keratoplasty (DWEK), increasingly referred to as Descemet's stripping only (DSO). To report the characteristic clinical, confocal and histologic findings associated with this procedure. RECENT FINDINGS: Reported clearance rates following DSO range from 63 to 100% in recent series, with variation between surgical techniques. Topical Rho-kinase inhibitor has been reported as successfully salvaging failing cases. Its use as an adjuvant to the surgery is gaining widespread adoption with the results of early series now arriving. Apart from a phenotype of central guttata with clear periphery, patient characteristics which determine success remain elusive. Surgical factors affecting success are increasingly well understood, with stromal injury felt to be a retardant to healing. Characteristic clinical signs have been observed and are described herein. Clinical, confocal and light microscopic images are obtained from patients in clinical trials of DSO with ripasudil. SUMMARY: DSO is gaining acceptance as a surgical option for a subset of patients with Fuchs' Dystrophy. The addition of Rho-associated kinase inhibitor appears to improve predictability but further results to this effect must be published and scrutinized.

Automated qualitative and quantitative assessment of posterior capsule opacification by Automated Quantification of After-Cataract II (AQUA II) system.

BACKGROUND: The present study aims to investigate an automated qualitative and quantitative assessment system (Automated Quantification of After-Cataract [AQUA II]) of posterior capsule opacification (PCO) in high-resolution digital retroillumination images and consequently reduce observer bias and increase accuracy of PCO grading. METHODS: A data set of 100 eyes with no to severe PCO was analysed. Ten eyes were consecutively photographed twice and ten images were rotated to give a total of 120 images for PCO assessment. Validity was determined by including subjective grading and repeatability was determined by evaluating the 20 additional images. Evaluation of posterior capsular opacification (EPCO), posterior capsule opacity (POCO) and AQUA I methods were included for comparative analysis of the data. RESULTS: The system developed proved to classify six types of PCO. Validity was confirmed by a Pearson correlation coefficient of r = 0.95 (EPCO r = 0.93; POCO r = 0.72 and AQUA I r = 0.94). Repeatability was better in AQUA II (95% confidence interval [CI] for mean difference: 0.5 ± 1.2) than in subjective grading (95% CI for mean difference: 0.6 ± 1.7), in EPCO grading (95% CI for mean difference: - 0.2 ± 1.5), in POCO grading (95% CI for mean difference: 1.6 ± 2.7) and in AQUA I (95% CI for mean difference: - 1.1 ± 1.9). CONCLUSIONS: AQUA II is a system that for the first time not only objectively quantifies PCO, but also qualitatively assesses PCO in an automated manner with texture classification. AQUA II showed an excellent validity and repeatability.

Effect of Air Tamponade on Tilt of the Intraocular Lens after Phacovitrectomy.

PURPOSE: The aim of the study was to examine whether air tamponade has a significant effect on postoperative tilt of the intraocular lens (IOL) in combined phacoemulsification with implantation of an IOL and vitrectomy compared to balanced salt solution. PROCEDURES: This randomized, controlled, monocentre study included patients scheduled for combined phacoemulsification with IOL implantation and pars plana vitrectomy. Patients were randomized for balanced salt solution or air tamponade. Postoperative tilt and decentration of the IOL were measured 2 months after surgery with a Purkinje meter. RESULTS: Thirty-four patients were included into the analysis. Tilt of the IOL was on average 4.1 ± 1.9°, without significant differences between balanced salt solution and air tamponade (p = 0.462). Decentration of the IOL was on average 0.31 ± 0.14 mm, without significant differences between balanced salt solution and air tamponade (p = 0.42). CONCLUSIONS: Air tamponade does not induce significantly more tilt or decentration of the IOL in combined phacoemulsification and vitrectomy compared to balanced salt solution. Potentially, this may not hold true for cases with a capsulorhexis that does not overlap the IOL optic.

Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: Advantages and Limitations.

PURPOSE: Epiretinal membranes (ERMs) are a disorder leading to progressive vision loss and metamorphopsia. The gold standard in therapy is vitrectomy with membrane peeling. The aim of this study was to assess whether the use of intraoperative optical coherence tomography (iOCT), which allows tomographic visualization of the membrane during peeling, enables peeling without staining. METHODS: This prospective study included 30 eyes of 30 patients with idiopathic ERMs scheduled for surgery. Pars plana vitrectomy with iOCT was performed in all cases, whereas staining of ERMs was only performed if needed. Internal limiting membrane (ILM) peeling was performed in case of wrinkled retinal surface after peeling of ERMs. RESULTS: In 63% (n = 19) eyes the ERM could be peeled successfully without use of staining. Nevertheless, in 89% (n = 17) of patients having had ERM peeling without dye, staining of the ILM was performed afterwards for peeling the ILM. Best corrected visual acuity improved in 80% (n = 24) and remained unchanged in 7% (n = 2) 3 months after surgery. There were no significant differences in postoperative results between patients with and without staining for ERM peeling. CONCLUSIONS: Use of iOCT helps to complete ERM peeling in a majority of cases without use of a chromovitrectomy dye, but as iOCT fails to visualize the ILM, chromovitrectomy still facilitates macular surgery in a majority of cases.

One-Year Results after Internal Limiting Membrane Flap Transposition for Surgical Repair of Macular Holes with Respect to Microperimetry.

PURPOSE: Internal limiting membrane (ILM) flap transposition in surgical repair of macular holes represents a new technique offering good anatomical success rates with large macular holes. The aim of the study was to examine microperimetric outcomes 1 year after ILM flap transposition for surgical repair of macular holes. METHODS: Patients with idi-opathic macular holes scheduled for 23-G pars plana vitrectomy with ILM peeling, ILM flap transposition, and SF6 tamponade were examined in a prospective case series. Distance corrected visual acuity (DCVA), optical coherence tomography, and microperimetry were measured before and 1 year after surgery. RESULTS: In all eyes, closure of the macular hole could be achieved. While foveal sensitivity improved in 71%, perifoveal sensitivity improved in 86% of the cases. DCVA improved in 83% and was unchanged in 17% of the cases. CONCLUSIONS: Beside visual acuity, foveal and perifoveal macular sensitivity improved, underlining the functional success of surgery after ILM peeling with ILM flap transposition.

Influence of the overall intraocular lens diameter on rotational stability.

PURPOSE: To evaluate the rotational stability of two intraocular lenses (IOLs) of similar design and material but with a difference of 1 mm in overall length. METHODS: In this prospective study patients with age-related cataract were included. An IOL with an overall diameter of 12 mm (ACR6 = small-diameter IOL) was compared to an IOL with an overall diameter of 13 mm (IDEA 613 XC = large-diameter IOL). RESULTS: In total, 60 patients were included in this study. Absolute rotation in the small- and large-diameter groups was 4.4° (SD: 4.0; range: 0.3-17.8) and 3.0° (SD: 2.4; range: 0.1-7.8), respectively. The differences between the two IOLs were not found to be statistically significant. CONCLUSION: The effect of the overall length of an IOL appears to have little impact on early rotation after cataract surgery.

Evaluation of factors influencing the remaining astigmatism after toric intraocular lens implantation.

PURPOSE: To evaluate the influencing factors on remaining astigmatism after implanting a toric intraocular lens during cataract surgery. METHODS: In this observational study, consecutive patients with cataract from three different centers who received toric intraocular lenses were included. Keratometry was performed with an optical biometry device preoperatively. The IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany) was used in Vienna, Lenstar (Haag-Streit, Köniz, Switzerland) in Castrop-Rauxel, and IOLMaster (Carl Zeiss Meditec AG) in London. Partial least squares regression was used to detect the influence of different parameters on remaining astigmatism. RESULTS: In total, 235 eyes of 200 patients were included. Mean corneal astigmatism measured preoperatively with the optical biometry device was -2.24 ± 0.87 diopters (D) (range: -5.75 to -1.00 D). Mean absolute and vector difference between the aimed for and the postoperatively measured astigmatism were 0.48 ± 0.37 D (range: 0.00 to 2.05 D) and 0.73 ± 0.46 D (range: 0.031 to -2.20 D), respectively (P = .576). Partial least squares regression showed a significant effect of preoperatively measured corneal astigmatism and deviation between preoperative measurements of the cornea on the postoperative (unintended) remaining astigmatism. CONCLUSIONS: The main source of error when using toric intraocular lenses is the preoperative measurement of corneal astigmatism, especially in eyes with low astigmatism. The influence of the postoperative anterior chamber depth on the cylindrical power of toric intraocular lenses and the effect of misalignment on the reduction of the astigmatism-reducing effect can be easily calculated.

Misalignment of a novel single-piece acrylic intraocular lens in the first three months after surgery.

PURPOSE: To evaluate the misalignment of a new single-piece microincisional hydrophobic acrylic intraocular lens (IOL) in emmetropic, myopic and hyperopic eyes within the first 3 months after surgery. SETTING: Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Department of Ophthalmology, Vienna, Austria. METHODS: Patients with age-related cataract were included in this prospective study. Each patient received a single-piece microincisional hydrophobic acrylic IOL (AF-1 NY-60, Hoya) in the study eye. Subgroups of emmetropic, myopic and hyperopic eyes were defined according to IOL power calculation. Anterior chamber depth (ACD) measurements were performed with an AC-Master. Tilt and decentration of the IOL were measured with a Purkinje meter. Follow-up assessments were performed 1 h, 3 weeks and 3 months after surgery. RESULTS: Forty-two eyes of 42 patients (21 emmetropic, 10 myopic and 11 hyperopic eyes) were included. The mean ACD 1 h, 3 weeks and 3 months after surgery was 4.597 ± 0.533, 4.483 ± 0.347 and 4.438 ± 0.398 mm, respectively. Differences in ACD between follow-ups and between subgroups were not statistically significant (both p > 0.05). On average, 3 months after surgery IOLs were tilted 0.81 ± 2.86° nasally and 0.70 ± 3.13° inferiorly and decentered 0.06 ± 0.24 mm nasally and 0.15 ± 0.29 mm superiorly. Differences in tilt and decentration were not statistically significant (both p > 0.05). We observed 1 case of severe capsular fibrosis. CONCLUSIONS: The single-piece microincisional hydrophobic acrylic IOL showed good axial stability and only little, clinically not relevant tilt and decentration in the first 3 months after surgery.

Repeatability of biometry in patients with meibomian gland dysfunction before and after vectored thermal pulsation therapy: A randomized, controlled trial.

PURPOSE: To evaluate the effect of vectored thermal pulsation therapy (VTPT) on the repeatability of biometry readings of two different optical biometers in patients with meibomian gland dysfunction (MGD). METHODS: Patients affected by MGD were included in this prospective, randomized, controlled, investigator-masked study. One eye was randomized to VTPT (LipiFlow®, Johnson & Johnson), and the contralateral eye served as a control. Three visits were scheduled at baseline, 2 weeks and 3 months after the treatment. The main outcome parameter of the study was the repeatability of three calculations of emmetropic intraocular lens power (EIOLP) at the 3 months visit as compared to baseline using an optical biometer (IOLMaster® 700, Carl Zeiss Meditec AG). Repeatability of different keratometry values obtained by the optical biometer and a Placido-disc topographer (MS-39®, CSO) served as secondary outcome parameters. RESULTS: Twenty-nine patients were included in the final analysis. While tear film parameters improved in the study eyes, there were no significant differences regarding the repeatability of three EIOLP measurements between baseline and 3-months-visit in both eyes (p > 0.05) and keratometry measurements in both the optical biometer and the Placido-disc topographer. Remarkably, throughout all study visits, there were some outliers regarding the repeatability of measurements. CONCLUSION: While both devices showed high repeatability regarding EIOLP and keratometry, future studies are needed to detect high-risk patients for poor repeatability.

Rotational stability and capsular bag performance of a hydrophobic acrylic open-loop single-piece intraocular lens.

PURPOSE: To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months. METHODS: In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1 h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration. RESULTS: In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1 h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17 mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0. CONCLUSIONS: This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values.